Bovine collagen induced systemic symptoms: antibody formation against bovine and human collagen.

We describe the first case of systemic symptoms after injection of bovine collagen and silicone polymers associated with antibodies to both native type I and II bovine and human collagen that varied with clinical features. Joint inflammation, edema at the injection site of bovine collagen implant and fever appeared 6 months after injection. Our patients history raises the question of whether the injection of animal derived collagen, particularly combined with silicone, induces or exacerbates autoimmune disease.

[Congenital convexity of the feet. Anatomical study and practical conclusions]. / Le pied convexe congénital. Etude anatomique et déductions pratiques.

The authors have studied the pathological anatomy of two congenital pes convex, (C.P.C) coming from an 8 days boy suffering of arthrogryposis. One of the feet has been dissected by stage whilst the other one has been operated on according to a procedure of correction of the deformities. The two feet combined an irreducible dislocation of the os naviculare on the neck of the talus, a calcaneo cuboïdeum subluxation, a moderate equinus of the hind foot, an important contracture of the extensor tendons and an elongation of the structural soft tissues of the sole. The main abnormalities of the talus and of the calcaneus involved the upper direction of the anterior articular facet, in relation to the dorsal dislocation of the os naviculare and the dorsal subluxation of the cuboïdeum. The subtalaris joint was little altered. The study of dissections and the clinical reports published connected with the observations of the authors confirm the pre-eminence of the transversal dislocation of the tarsus and of its irreducibility. On the other hand the abnormalities of the subtalar joint have been, probably over estimated. The sometimes important increase of talo calcaneal angle on A.P. radiographies may be explained by the incidence itself. The verticality of the talus is not a reliable feature of C.P.C. and the deformities of the fore foot are variable (pronation, supination). This study leads to a new definition of the C.P.C.: Congenital deformity of the foot with tarsi-transversa dislocation or subluxation involving mainly the talo-navicular joint. The criterious of diagnosis are debated and a logical surgical procedure of correction is suggested.

Antepartum fetal heart rate monitoring. A semi-quantitative evaluation of the 'non-stressed' fetal heart rate.

1964 recordings (from 246 patients were analysed on the basis of a semi-quantitative evaluation of base-line heart rate variability. All the tracings were obtained in the antepartum period, between the 20th wk of pregnancy and prior to the onset of labour. None of the recordings were made during labour or after induction of uterine activity so that a 'non-stressed' fetal heart rate test was obtained in every case. The percentage of flat tracing in each recording and the presence of sinusoidal patterns were compared with the neonatal outcome. When the tracings included a more than 50% flat pattern, 81.8% of the babies were distressed at birth. When a less than 50% flat recording was present only 11.4% of the neonates were distressed. Sinusoidal patterns were more frequently associated with abnormal tracings including those with more than 50% flat recordings. The presence of sinusoidal features did not significantly influence the neonatal outcome for tracings with a less than 50% anomaly: conversely sinusoidal patterns superimposed on a more than 50% flat tracing were predictive of fetal compromise and neonatal distress in 100% of the cases. These results allow to advocate the use of 'non-stressed' antepartum fetal heart rate monitoring, as a reliable test in the management of high risk pregnancies.

Antepartum fetal heart rate monitoring. II. Deceleration patterns.

Fetal heart rate was studied during the antepartum period in 246 patients, yielding a total of 1964 recordings. The following parameters were evaluated and correlated: --the semi-quantitative assessment of fetal heart rate instability (as expressed by the percentage of duration of flat traces); --the presence of decelerations and their relationship to the presence or absence of uterine contractions; --the neonatal condition. Overall, 50% of the patients exhibited uterine contractions while 30% contained decelerations patterns either occurring spontaneously or in association with uterine contractions. A definite relationship was observed between the presence of severe decelerations (irrespective of the time relationship with any uterine contraction) and poor neonatal outcome. A relationship does exist between the presence of severe decelerations and flattening in the recording, which, as demonstrated in the previous part of the paper also exhibited a strong positive relationship with the neonatal outcome. When one considers the different degrees of flattening, it appears that a further correlation between decelerations and neonatal state is demonstrable only in the case of a 10--50% flat recording. Here the probability of a distressed baby is 20% in the absence of decelerations, but 43.4% in the presence of decelerations. In other cases (i.e., less than a 10% or more than a 50% flat recording) the pronostic significance of the instability of the record is not significantly modified by he presence or absence of decelerations. These results indicate that consideration of decelerations is only advisable in these cases where instability is moderately affected (flattening in 10-50% of the record) and that the use of the oxytocin challenge test OCT may be reserved for such cases, when these are neither spontaneous contractions nor decelerations and not contraindications present.

Antepartum fetal heart rate monitoring. III. Fetal movements and accelerations in fetal heart rate.

This third part of the paper deals with the study of the relationships between fetal movements, fetal heart rate accelerations associated with such movements, fetal heart rate instability and neonatal outcome. No correlations has been found between absence of fetal movements and neonatal distress. A correlation has been found between the lack of fetal heart rate accelerations, the flatness of the record and poor neonatal outcome. In extreme situations (i.e. flatness in less than 10% of the record or in more than 80%) the presence or absence of accelerations does not add further useful information. Such information, however, is gained in the intermediary situations (the 'combined' recordings) and particularly when the record is between 51 and 80% flat where there appears to be an 85.6% risk to the fetus. Consequently, when trying to analyse an antenatal record it seems advisable to take primarily into account the percentage of flat recordings (providing the records are numerous enough and of sufficient length). Then, in records between 10 and 50% flat, the presence or the lack of spontaneous decelerations requires consideration whereas, when the record is between 51 and 80% flat, it is the presence or absence of fetal heart rate accelerations which is important.