[Camptocormia: From diagnosis to treatment]. / La camptocormie: Du diagnostic au traitement.

Camptocormia or Bent Spine Syndrome (BSS) is a symptom, often unknown, affecting elderly patients. Camptocormia is a dynamic anteflexion of the trunk occurring during physical exercises or in standing position and reducible in decubitus. It is caused by an impairment of the extensor muscles of the spinal column, either idiopathic or secondary to a muscular or a neurological disease. Its diagnosis is primarily anamnestic and clinical. The use of imaging could highlight a paraver tebral muscular fatty infi l tration with preserved volume in the case of idiopathic disorder and allows exclusion of osteoarticular pathologies. The treatment must be proposed as early as possible, before advanced adipose muscle evolution and significant anteflexion of the trunck. Symptomatic measures apply to primary and secondary forms and include physiotherapy, technical assistances to the walk and equipment by lordosis supporting corsets.

La camptocormie ou Bent Spine Syndrome (BSS) est un symptôme, souvent méconnu, touchant le patient âgé. La camptocormie est une antéflexion dynamique du tronc survenant à l'effort ou en position debout et est réductible en décubitus. Elle est causée par une atteinte des muscles extenseurs du rachis soit d'origine musculaire idiopathique ou secondai re, soit d'origine neurologique. Son diagnostic est essentiellement anamnestique et clinique. Le bilan par imagerie permet d'étudier la musculature paravertébrale et permet d'exclure les pathologies ostéoarticulaires. Le traitement étiologique ou symptomatique doit se faire précocement, avant que l'évolution adipeuse des muscles extenseurs et l'antéflexion soient trop importantes. Dans le traitement de la camptocormie, les mesures symptomatiques s'appl iquant aux formes primaires et secondaires associent de la kinésithérapie, des aides techniques à la marche et l'appareillage par des corsets lordosants.

Idiopathic scoliosis and breast asymmetry.

The aim of this study is to describe the semiology for the assessment of breast asymmetry in the presence of scoliosis. Twenty-four women with right idiopathic scoliosis treated with bracing alone (23 out of 24) or with bracing and spine surgery (1 out of 24) were evaluated by physical and morphological examinations and three-dimensional (3D) surface scan. Physical examination revealed a smaller right breast in 20 women. A left costal protrusion was observed in 18 patients. Anthropomorphic analysis revealed that the right breast was higher in 19 cases, and smaller in 18 cases. The calculations from 3D scan showed the right breast to be smaller in 19 women. A strong correlation is found between clinical parameters, anthropomorphic measurements and 3D scan analysis, suggesting that a meticulous clinical examination is sufficient to evaluate breast asymmetry in patients with idiopathic scoliosis. A patient who is properly diagnosed and informed of her skeletal deformity and breast asymmetry is more likely to have realistic expectations from breast surgery.

Postoperative outcome of Crohn's disease in 30 children.

BACKGROUND: Thirty children operated on for Crohn's disease (CD) were reviewed (1975-1994). The aim of the study was to assess their postoperative outcome. PATIENTS: 19 boys and 11 girls, aged 15.3 (2) years (range 11.3-20) at surgery were studied. RESULTS: Surgical indications were acute complications of CD and chronic intestinal illness. Six months after surgery, 11 of 12 patients had been weaned off steroids, and 22 of 23 patients were weaned off nutritional support; 17 patients without recurrence had a mean (SD) weight gain of 2.1 (8) kg and a height gain of 3.36 (3) cm. During 3.1 (2.7) years follow up, 12 patients (40%) had a recurrence of the disease after 19.4 (14) months (means (SD)): supra-anastomotic recurrence (six), severe perianal disease (two), and chronic illness (four). Six of 14 patients who were treated with mesalazine (13) or azathioprine (one) had recurrences. The postoperative recurrence rate was 50% at two years. CONCLUSION: Surgical treatment modifies the immediate outcome of severe or complicated CD, but does not prevent recurrence, despite localised resection or prophylactic postoperative treatment. Extension of the disease before surgery seems to be a major risk factor for postoperative recurrence in children.