[Study of names and folklore associated with Mycobacterium ulcerans infection in various endemic countries in Africa]. / Etude des appellations et des représentations attachées à l'infection à Mycobacterium ulcerans dans différents pays endémiques d'Afrique.

The purpose of this article is to present names used for Mycobacterium ulcerans infection (Buruli ulcer) and explain their meanings in various African languages. Representations associated with the disease were also studied. The study approach involved qualitative analysis of information from interviews and literature. Interviews were conducted with the directors of various programs and management centers. Findings from 9 African countries where Buruli ulcer is known to be endemic, i.e., Benin, Cameroon, Congo-Brazzaville, Côte d'Ivoire, Ghana, Uganda, Democratic Republic of Congo, Southern Sudan and Togo, showed that the names used for the disease could be classified into three categories based on the geographical origin of infection, the features of the observed lesions, and aspects of ost often associated with belief in witch-craft, i.e., bad luck, fetishes, and curses. Representation of the disease in different African languages were similar and appear to demonstrate a good understanding of the disease in the countries where Buruli ulcer is prevalent. The impact of the representations of the disease on therapeutic choices and itineraries is also discussed.

Bone density and local growth factors in generalized osteoarthritis.

Osteoarthritis is usually considered to be a primary disorder of chondrocyte function with secondary changes in bones. However, a defect in the subchondral bone resulting in loss of its shock absorbing capacity could transfer the stress of loading directly to the articular cartilage with secondary changes in the cartilage. Review of histomorphometric and bone densitometric studies at sites of osteoarthritis at the hip or knee revealed that cartilage fibrillation could not be dissociated from bony changes even in the earliest stages of osteoarthritis and that subchondral trabeculae are thickened and more spaced in osteoarthritis. Microfractures of subchondral trabecular bone were less frequently seen in osteoarthritis compared to controls. Changes of the tidemark were found to be multiform and metabolically active in the osteoarthritic process. Endochondral ossification depletes the calcified cartilage at the cartilage/bone interface and the tidemark has been thought of as a calcification front advancing in the direction of non-calcified cartilage. Duplication of the tidemark is cited as evidence of this advancement. In the few experimental animal studies of subchondral bone in osteoarthritis, thicker trabeculae which were closer together were found in guinea pigs already when only mild cartilage changes were present. In the dog, with cruciate ligament transection, changes in bone were later than in the cartilage, but the changes in bone could still contribute to the progression of osteoarthritis. To study if bone changes may precede injury to the cartilage and if metabolic and systemic influences can also alter the subchondral bone, rendering it less able to withstand normal mechanical stresses, bone at different sites in the body has been studied extensively by the authors. Epidemiological and case control studies have revealed that osteoarthritis cases have more bone at all sites than expected and that bone in cases with generalized osteoarthritis shows both quantitative and qualitative differences, including increased contents of growth factors and hypermineralization. These findings suggest that a more generalized bone alteration may be the basis of the pathogenesis of osteoarthritis.

Biochemical and density assessment of the new bone in late remodeling after callus distraction.

Biochemical changes in a canine bone-lengthening model were characterized 5 months after surgery. The mineral content and the total amount of EDTA-extractable noncollagenous proteins, insulin-like growth factor-I, and osteocalcin were determined for the lengthened callus, and a gradient density fractionation analysis of bone powder particles was performed. The results were compared with two other areas of the lengthened tibia and one region of the contralateral tibia. The mineral and osteocalcin contents showed significant decreases, whereas the hydroxyproline concentration was significantly increased. Neither the insulin-like growth factor-I content nor the concentration of EDTA-extractable proteins was significantly different in any of the examined regions.

[Arthrodesis of the elbow using Ilizarov's external fixator]. / Arthrodèse du coude par fixateur externe d'Ilizarov.

Arthrodesis of the elbow was achieved without major surgery on the joint itself, while maintaining satisfactory pronation, supination, and function of the arm. To this end, the external fixator of Ilizarov was used in a compression set-up which interfered only moderately with daily life activities. Solid fusion was achieved after 4 1/2 months. To our knowledge this is the first time that this technique has been used for such an indication. The operative technique is described and its advantages emphasized.

[Tibial fractures following Maquet's tuberosity advancement. Apropos of 2 clinical case reports]. / Fractures du tibia après avancement tubérositaire selon Maquet. A propos de deux observations cliniques.

Although accustomed to using the Maquet tibial tuberosity advancement, the authors had two similar and rare complications in which a fracture of the tibial shaft occurred at the end of the vertical osteotomy. Both incidents arose from a mechanical incision effect. This can be prevented by making a larger circular hole in the distal portion of the osteotomy.

Bone density and osteoarthritis.

Osteoarthritis (OA) is a physiologic imbalance, a "joint failure" similar to "heart failure" in which mechanical as well as constitutional factors play a role. The initiation and progression of cartilage damage are distinct phenomena. One of the mechanisms of initiation of OA is subchondral bone stiffness, often a part of generalized inherited increased bone density. Evidence is accumulating that primary OA might initially be a bone disease rather than a cartilage disease. OA cases have a better preserved bone mass, even independent of body weight. Studies on iliac crest bone, a site far from load bearing forces, have shown differences in bone mass, biomechanical characteristics, biochemical composition, and mineralization profile according to the presence of OA in the hands. Women with OA had significantly more bone and the bone was significantly stiffer, they had higher compressive strength, higher osteocalcin, higher insulin-like growth factor I and II and transforming growth factor beta content, and a mineralization profile shifting to higher densities. These quantitative and qualitative differences in bone may produce disease by increasing subchondral bone stiffness and by making subchondral bone less deformable to impact leads. This stiff bone transmits more force to overlying cartilage, making it more vulnerable.

[Indications for scintigraphy with gallium 67 and with indium 111 labelled leukocytes in the diagnosis of postoperative infections in osteo-articular surgery]. / Indications des scintigraphies au Gallium 67 et aux leucocytes marqués à l'Indium 111 dans la mise au point des infections postopératoires en chirurgie osteo-articulaire.

A prospective scintigraphic study using Gallium 67 and granulocytes labelled with Indium 111 was carried out in 60 patients who were thought to have infection following orthopaedic operations. Both investigations gave positive results in 11 of the 16 infections observed. The Indium 111 labelled leucocyte scan was more accurate than the Gallium 67 studies in delineating patients who did not have an infection, and appears to be more reliable in the diagnosis of post-operative sepsis.