[Stress fractures in disabled athletes' preparation for the paralympic games in Athens, 2004: an assessment]. / Fractures de fatigue en handisport lors de la pratique de l'athlétisme : bilan de la préparation aux jeux paralympiques d'Athènes 2004.

OBJECTIVES: To identify stress fracture frequency and the associated risk factors in disabled female athletes preparing the Paralympic Games in Athens in 2004. MATERIAL AND METHOD: The study is focused on four athletes (including one with a vision impairment) among the 31 women selected to participate in the Paralympic Games. The medical records of selected athletes not having been able to participate in the Games due to a stress fracture were analyzed. RESULTS: One case of stress fracture to the first metatarsal was reported of one below-knee amputee and an additional case to the second metatarsal of one hemiplegic athlete. Two of three athletes with physical disability were unable to participate in the Games because of stress fracture occurring during the preparatory phase. DISCUSSION - CONCLUSION: Among four athletes selected to take part in the Paralympic Games. If morphological predispositions are inherent to the sportswomen, the main favouring factor to be retained is their running asymmetry. Training programmes must therefore take this characteristic into account and must not offer heavy-load repetitive exercise (such as endurance or jogging) at the expense of technique. Over-intense training exposes the disabled athlete to this type of pathology and is likely to affect his chances of competing.

[A baropodometric parameter to analyze the gait of hemiparetic patients: the path of center of pressure]. / Un paramètre baropodométrique pour l'analyse de la marche du patient hémiplégique: le trajet du centre de pression.

PURPOSE: Hemiparetic gait has been previously evaluated by several biomechanical methods, but plantar pressure distribution has been much less studied. Our purpose was to analyze the changes in the path of the center of pressure (COP) following the occurrence of hemiparesis using an F-Scan in-shoe transducer. MATERIALS AND METHODS: Twenty patients, mean age 50 years [26-67] with hemiparesis due to vascular causes underwent gait analysis (by the F-Scan system). All patients had steady neurological status and were self-sufficient for gait. Podo-orthoses were removed during the test. Five to six cycles of gait, about 8 m, were recorded. Comparison of the COP path was performed between hemiparetic and healthy foot. The group control consisted of 9 healthy volunteer subjects. RESULTS: Differences in the COP path were found in the hemiparetic foot of patients: a significant decrease for the anteroposterior displacement (P=0.002) and the lateral displacement (P=0.04) and a significant anterior displacement of the more posterior contact COP (P=0.005). The "gait line" was irregular, with slowing down going forward and, for some, going back. These results are likely consistent with the equine of the foot. No change was observed in the control group. CONCLUSION: The use of an F-Scan in the shoe transducer allows for revealing the importance of the COP path in analyzing hemiparetic gait; this noninvasive investigation would be helpful for evaluating the best therapy to propose to and to follow-up patients with hemiparesis.

[Incidence of constipation after recent vascular hemiplegia: a prospective cohort of 152 patients]. / Incidence de la constipation dans une population de patients atteints d'hémiplégie vasculaire récente: étude prospective de 152 cas.

Constipation is a major problem for institutionalized patients. This prospective study was performed on a population of 152 in-patients of a stroke rehabilitation center. Constipation was defined as less than three stools weekly or the use of laxative medication. Constipation occurred in sixty percent of the patients. The incidence of constipation was not related to age or sex but was strongly related to functional status of patients assessed by Barthel Index (p<0.003). The influence of both brain lesion or reduce activity is evaluated.

[Paraplegia and bilharziasis. A propos of 4 cases (including 2 confirmed cases of bilharzial myelitis]. / Paraplégie et bilharziose. A propos de quatre observations (dont deux de myélite bilharzienne certaine).

Four observations of paraplegia of bilharzians are presented. In two of them the anatomical proof of medullar localization of parasitosis was obtained, once in vivo, only once after a post-mortem. Medical study enables us to spot 55 cases of bilharzian paraplegia, of which 25 sufficiently explicit on the clinical point of view, indicated medullar parasitosis. A parasitosis diagnosis must especially therefore be sought out with the greatest care so that the specific and remarkably active treatment may be started as soon as possible.

The mobile arm support.

The Mobile Arm Support, conceived and researched by Dr. Radulovic, is intended for the use of patients whose arm is afflicted. The support consists of a supporting harness, an articulated splint on which the arm is fixed and a pneumatic system of elevation that counterbalances the weight of the arm. Its originality lies in the use of a splint as a simple lever, supported by a spherical articulation, located as close as possible to the centre of the scapulohumeral joint and linking shoulder and arm movements. A clinical study involving 18 patients has shown that the support reduces pain, increases ranges of movement of the shoulder and elbow, and increases functional possibilities.

[Evolution in prostheses for sprinters with lower-limb amputation]. / Evolution des prothèses des sprinters amputés de membre inférieur.

For about 15 years, technical advances in prosthetic treatment have been the main factor in the increased performance of athletes with lower-limb amputation. For trans-tibial amputation, the prosthesis for sprinting is composed of a gel liner and a socket joined by a locking or virtual vacuum liner. Because of these dynamic properties, the carbon prosthetic foot equipped with tacks ensures outstanding performance. For trans-femoral amputation, a hydraulic swing and a stance control unit are added to the same prosthesis. In comparison with the able-bodied runner, athletes with amputation have smaller loading times in the prosthetic limb and larger ones in the sound limb. The length of the energy-storing prosthetic foot is determined by the "up-on-the-toes" running gait. The sprinting gait with trans-tibial amputation is almost symmetrical. The hip extensor effort is the main compensation of propulsion reduction with lower-limb amputation. With trans-femoral amputation, the lack of knee increases the asymmetry. The total prosthetic knee extension (early in late-swing phase and lasting during total stance phase) compensates with extension of both hips, especially the opposite one. The amputation and sound limb load transfer with lumbar hyperlordosis concern the pelvis, trunk and shoulders. Because of athletes with amputation, research in prosthetic treatment has progressed. The development of orthotics and prostheses for such athletes has benefited non-athletes with amputation.

[The phlebologist confronted with the neurologic foot. Phlebologic aspects of the neurologic foot]. / Le phlébologue devant un pied neurologique. Aspects phlébologiques du pied neurologique.

Vascular complications are frequent in paralyzing neurologic disorders, particularly in peripheral neurologic diseases: edema of the declive, cold feet, acrocyanosis, increased sudation. An enlarged leg in a paralyzed subject presenting frequently reduced sensitivity may indicate phlebitis, but also hematoma of an undetected fracture, or osteoarthropathy. Trophic disorders, such as edema, ulcerative hyperkeratosis and subcutaneous hematoma, are sometimes indicative of an unrecognized peripheral neuropathy, notably diabetic. Sclerous complications of venous impairment, or trophic disorders in algesic dystrophy, may result in incorrect diagnosis of a neurologic disorder. In practical therapeutic terms, it is necessary to emphasize the value of elastic retention, attentive pedicure and flexible and shock-absorbing footwear.

[Urethral calibration in menopausal women examined for vesico-sphincter disorders]. / Calibrage urétral chez la femme ménopausée consultant pour troubles vésico-sphinctériens.

In order to appreciate the consequences of aging on the urethra, two prospective studies assessed its caliber in postmenopausal women. The population included aged women who came to consultation for disorders of the bladder and sphinecters. The clinical checkup, assessing the patient's age, morphology, time elapsed since menopause, local consequences of hormonal deficiency and urinary functional signs, was completed by an urodynamic examination. In the first study (76 patients), the urethra was calibrated using two Peters dilating bougies ranging from Charrière 10 to Charrière 26. In the second study (50 patients), measurements were made with OTIS-type ball dilators ranging from Charrière 9 to Charrière 30. This exploration was made in 126 patients. Urethral caliber was greater than or equal to Charrière 24 in 78% of patients. Only 2.3% of women had urethral "stenosis" with a Charrière score under 18. Contrary to what we were expecting, the urethral caliber does not seem to decrease with age. This unexpected statement and the difficulties of statistical analysis we have encountered lead us to complement our study.

[10 cases of giant lumbo-sacral neurinoma]. / Dix cas de neurinomes géants lombo-sacrés

Among giant tumours of the cauda equina, apart from ependymomas, neurinomas merit a special place. Depending on their site, they give rise to severe lumbar pain or root pain, with, almost constantly, aggravation during the night. X ray suggests the diagnosis when one finds displacement of the bone without inflammation, a regular bony defect, well-limited and asymmetric, and when the tumour is frequently prolonges in several directions across the bony orifices, sometimes giving a very large paravertebral mass which requires a double approach during surgery. The prognosis of isolated neurinomas is excellent, with disappearance of the pain immediately after operation, regression of the neurological signs or, at any rate, stabilisation when the latter are important. As far as the problem of spinal stability is concerned, this has been solved by sufficient spontaneous bony reconstruction.

[Para- and tetraplegia caused by decompression accident (deep sea diving). Study of 9 cases with more or less severe sequelae]. / Para et tétraplégies par accident de décompression (plongée sous-marine). Etude de 9 observations avec séquelles plus ou moins graves

The authors report 9 cases of para and tetraplegia due to decompression sickness following deep sea diving. Poor technique was the cause of 8 of these cases, but one remained totally unexplained. The sequelae were serious; 3 dorsal paraplegias, which were functionally complete, 4 incomplete tetraplegias giving rise to permanent disability. In 2 cases there remained some spasticity of the lower limbs, in some cases associated with genito-urinary disorders. The authors review recent physiopathological theories. -- Blood disturbances may be due to the presence of gas bubbles which aggress the organism and give rise to coagulation disorders. -- The formation of the bubbles may be the cause of the spinal lesions, e.g. liberation in situ, gas embolism; the bubbles may form in various parts of the circulation and may cross the pulmonary barrage. Bubbles probably form in the lung itself, in the pulmonary veins and in the aorta, including the spinal capillaries. There is some slowing of the circulation, secondary to increased pressure, and pulmonary stasis may also play a harmful role. Finally, the dorsal spinal segments, which are the most poorly vascularised, are particularly exposed. This corresponds to the clinical findings. As far as treatment is concerned, the authors emphasize that recompression with hyperbaric equipment, should be carried out as an emergency, especially in unconsciuos subjects, together with other appropriate treatment. Such facts are important now that deep sea diving is becoming more and more commonly practised.