Day surgery for anterior cruciate ligament reconstruction in children: a prospective study on feasibility and satisfaction.

PURPOSE: To evaluate the feasibility of day surgery anterior cruciate ligament reconstruction (ACLR) in children. Our hypothesis was that proper patient selection, adequate information and a streamlined clinical pathway would allow for a safe and satisfactory procedure. METHODS: A total of 20 patients, seven girls and 13 boys, who underwent outpatient ACLR at mean age of 14 years (8 to 16) were included in this single institution prospective case series. Surgery took place under simple general anesthesia while analgesia protocol combined local anesthesia, oral analgesics for the postoperative period and compressive cryotherapy. The main failure criterion was the inability to return home the day of surgery or the need for rehospitalization during the first week after discharge. Secondary evaluation parameters were the rate of postoperative complications, postoperative pain, quality of life (QOL) and patients' satisfaction outcome questionnaire (PSOQ) at postoperative day 1, 7 and 31. RESULTS: Of the 20 patients included, only one failed the ambulatory mode. The mean PSOQ score was, respectively for children and parents, 91.4% and 90.7% at day 7 and 94.6% and 95.7% at one month. Postoperative QOL at day 7 was very satisfying for all patients. Two minor early complications were reported. Both of the late complications, which included one partial wound dehiscence and one persistent knee swelling, resolved spontaneously. CONCLUSION: This study indicates that, in a targeted and well-informed population, day surgery for children ACLR yields high level of patient and family satisfaction in a safely manner. LEVEL OF EVIDENCE: IV, prospective case series.

[Can we overcome schistosomiasis? A Senegalese example]. / Peut-on vaincre les bilharzioses ? Un exemple sénégalais.

The authors report the results of controlling schistosomiasis in 53 villages from Ninefecha area-(Kedougou District, East Senegal) within Schistosomiasis National Control Program partnership. The four aims were: i) praziquantel treatment of 3324 children 6-14 years old, ii) installation of a laboratory for children prevalence annual monitoring (random draw one in three), iii) health education of the concerned people ("sensitization"), iiii) construction of latrines. 900 latrines are required and 649 have been built. The initial prevalence (2006) of 44% for S. mansoni and 4% for S. haematobium are now respectively 1.9% and 1.4% (2013). The program must be continuous as shown in the Assoni village: a prevalence study in children 0-5 years old, for which praziquantel is not recommended, reveals an infestation rate for S. mansoni of 78% in 2008 and of 47% in 2012. This age group is an important parasite reservoir and health education of parents is absolutely necessary. A permanent and effective center like Ninefescha hospital for distribution of praziquantel, sensitization meetings and latrines control is essential for the success of the program.

Experimental study of progressive tibial lengthening in dogs using the Ilizarov technique. Comparison with and without associated intramedullary K-wires.

UNLABELLED: A delay in the union of bone regenerate in surgical lengthening procedures and the healing index (HI) are major factors in the quality of the results in progressive bone lengthening. Early removal of the external fixator (EF) is associated with a low rate of postoperative complications, including pin track infection, and with better muscle and joint function recovery. Addition of intramedullary wires (IMWs) to the EF led to a 9-49% decrease in the HI depending on the clinical series. We hypothesized that IMWs may accelerate the ossification process of bone regenerate and tested it in this experimental study. METHODS: Progressive tibial lengthening of 28 mm was obtained in 12 dogs operated with the classical Ilizarov technique (group I) and in 12 dogs operated with the same technique and addition of two IMWs 1.5 mm in diameter (group II). The following criteria were assessed: HI, X-ray measurements, and histological aspect of the bone regenerate and postoperative complications. RESULTS: The mean HI was 32.3% lower in group II than in group I. The radiological bone union criteria were observed on day 15 of the fixation period in group II versus day 30 in group I. Histology showed that maturation occurred earlier and bone cortices were thicker in group II than group I. Intramedullary ossification was present along the IMW in group II, whereas it was absent in group I. No clinical complications were observed in either group. DISCUSSION: The presence of the IMWs clearly contributes to stimulation of the ossification processes of the bone regenerate and to acceleration of bone union. IMWs allowed an earlier removal of the external fixator for a 32% time reduction compared to cases without IMWs. In addition, new intramedullary bone formation and presence of IMWs are expected to increase the mechanical resistance of the bone regenerate. CONCLUSION: Improvement of quantitative and qualitative criteria of bone regenerate in progressive bone lengthening with an EF combined with IMWs was demonstrated in this experimental study. SIGNIFICANCE: Favorable results encourage the authors to continue using IMWs in addition to the EF in patients treated with long-bone progressive lengthening. LEVEL OF EVIDENCE: II.

Filling a cervical spine cage with local autograft: change of bone density and assessment of bony fusion.

To date, it remains debatable whether cervical spine fusion cages should be filled with any kind of bone or bone substitute. Using a bone substitute would produce additional costs, using an autologous bone graft from the iliac crest would make the use of the cage at least questionable. As an alternative, cortical and subcortical bone from the anterior osteophytes of the segment in which the disc has been removed could be used to fill the cage: higher costs and complications at the iliac crest could both be avoided and the cage could be filled. However, the fate of these bone chips made from the anterior osteophytes is unclear as well as whether fusion will occur using this technique. The objective of the current study was to investigate possible changes in the bone density of this local autograft in the cage within the first 12 months after surgery by means of computed tomography. A second objective was to assess segmental bony fusion using this technique. 21 patients, suffering from degenerative disc disease of the cervical spine, were included into this prospective study. They all underwent anterior decompression, cage insertion and plate stabilisation. The cage (Rabea, Signus Medizintechnik, Alzenau, Germany), was filled with bone chips made from the anterior osteophytes of the segment that underwent discectomy. On the third day after surgery as well as three, six and 12 months after surgery, an axial computed tomography scan through the cage was taken and density within the apertures of the cage was measured in a standardised manner. Flexion-extension lateral radiographs were taken to investigate segmental fusion. Statistical significance was assumed to be at a 95 % level of significance. 23 cages were implanted. The mean value of the bone density obtained by computed tomography was 505 (+/- 119) HU on day three, 635 (+/- 156) HU after three months, 769 (+/- 162) HU after six months, and 814 (+/- 198) after 12 months. There was a significant difference when the values after 12 months were compared to those obtained after three days (p < 0.001) and after three months (p = 0.004). Bony fusion was seen in 21 out of 23 segments (91.3 %) after 12 months. It may be concluded that this technique could be an alternative to the current treatment options.

Gas permeability of porous silicon nanostructures.

The gas (air and hydrogen) flow through porous silicon ( PS ) nanostructures is studied. Being well described by Darcy's law, the gas flow measurements allow us to deduce PS permeability values, which are measured to be 10(-16) - 10(-15) m(2), corresponding to the 50-70% porosity range. A strong porosity dependence of the PS intrinsic permeability is found to be in good agreement with Kozeny's model. The influence of nanoscale morphology on the porous layer permeability is shown and discussed, taking into account the fractal-like specific surface of the PS nanostructures. In particular, the liquid permeability of the PS nanostructure is estimated to be 6.4x 10(-18) m(2) from the observed Klinkenberg effect for gas flow.

Factors affecting the interface of cervical spine facet screws placed in the technique by Roy-Camille et al.

The objective of the study was to investigate the influence of bone cement, length of burr hole and bone density on pullout force and insertional screw torque of cervical spine facet screws. Both facets of 24 human cervical vertebrae were scanned for bone mineral density (BMD) and assigned to two groups for measuring of insertional screw torque and pullout strength. Maximal insertional screw torque was measured and removal of the screws was performed in displacement control (0.25 mm/s) without bone cement (PMMA), with 0.1 ml of PMMA and with the burr hole completely filled with PMMA. Screw torque was 59.1 N cm (+/-25.7 N cm), pullout force was 382.8 N (+/-140.5 N) without PMMA. Injection of 0.1 ml PMMA did not change significantly both screw torque (p=0.73) and pullout (p=0.129). Filling of the burr holes with PMMA increased significantly both screw torque (p<0.0001) and pullout force (p=0.028) when compared with injection of 0.1 ml of PMMA. A positive, moderate correlation was seen between BMD and screw torque before (r=0.501; p=0.097) and after filling with PMMA (r=0.514; p=0.088), BMD and pullout force before (r=0.441; p=0.152) and after complete filling with PMMA (r=0.673; p=0.047). The PMMA does increase both screw torque (p<0.0001) and pullout force (p=0.028) of facet screws significantly if the burr hole is filled with PMMA completely when compared with injection of 0.1 ml PMMA. Bone mineral density of the cervical facets moderately correlates with peak insertional torque and pullout force. This is true for a facet without PMMA and for a facet filled with PMMA. The length of the burr hole seems to be less important.

Polysyndactyly and asymptomatic hypothalamic hamartoma in mother and son: a variant of Pallister-Hall syndrome.

We report on a 53-year-old woman and her 20-year-old son who both presented with polysndactyly, without other external malformations or mental retardation. MRI imaging revealed, as an incidental finding, asymptomatic hypothalamic hamartomas in both patients. The siblings of both mother and son are unaffected. This family may represent an autosomal dominant variant of Pallister-Hall syndrome.

Tumor necrosis factor-alpha levels and weight loss in chronic obstructive pulmonary disease.

Unexplained weight loss is common in chronic obstructive pulmonary disease (COPD). Blood levels of tumor necrosis factor-alpha (TNF-alpha), a cytokine causing cachexia in laboratory animals, are elevated in various human diseases associated with weight loss. We therefore prospectively measured TNF-alpha serum levels (immunoradiometric assay) in patients with clinically stable COPD (n = 30; all male; mean age, 65 yr) whose weight was less (Group I; n = 16) or more (Group II; n = 14) than the lower limit of normal taken from Metropolitan Life Insurance Company tables. The patients had no cause known to elevate TNF-alpha serum levels; notably, they were not infected. Group I patients had unintentionally lost weight during the previous year, whereas the weight of Group II patients had not changed during the same period. The two groups had similar chronic airflow obstruction and arterial blood gas impairment; hyperinflation and reduction in diffusing capacity were more pronounced in Group I, but differences were not significant. TNF-alpha serum levels (pg/ml; mean [SD]) were significantly higher in Group I than in Group II (70.2 [100.0] versus 6.7 [6.4]; p < 0.001). Group II TNF-alpha serum levels did not differ significantly from those of healthy subjects (7.8 [3.9]), whereas those of Group I were significantly higher (p < 0.001). Because renal function was in the normal range, we conclude that increased TNF-alpha production--and not decreased TNF-alpha clearance--is a likely cause of weight loss in patients with COPD.

Left lung asthma.

The chest radiograph of a woman with acute asthma showed signs of obstructive emphysema of the left lung. Fiberoptic bronchoscopy excluded obstruction of a large bronchus. The signs disappeared after antiasthmatic treatment, suggesting that they were caused by airway closure. In usual asthma, airway closure affects both lungs; the reason for the unilateral predominance we observed is unknown.

Anterior cervical fusion and Caspar plate stabilization for cervical trauma.

A technique for anterior cervical iliac graft fusion with standardized, commercially available screw and plate fixation (Caspar plating) has been developed. The step-by-step procedure, as well as the instruments designed to facilitate the procedure, are described in this report. Sixty cases of cervical trauma (fractures, subluxations, ligamentous instability, or a combination of these problems) were treated with Caspar plating. All patients obtained fusion, and stability was achieved immediately after surgery without external stabilization. No unusual surgical complications occurred, and the most dreaded complication of dural penetration by drilling or screw placement was not observed. This report details the neurological presentation, anatomical lesions, surgical therapy, and outcome of these patients. Caspar plating combines the advantage of an anterior surgical approach with immediate postoperative stabilization without external stabilization. This advantage persists even in the presence of posterior ligamentous instability. The technique is an important addition to the surgical treatment of cervical trauma.

[Absence of clinical and biological manifestations after massive absorption of nitulamide]. / Absence de manifestation clinique et biologique après absorption massive de nitulamide.

Nitulamide (ANANDRON (R] is an antiandrogen used as an adjuvant therapy in the treatment of advanced prostatic cancer. The effects of ingestion of high doses of nitulamide has not been so far reported. A 79 years old man was admitted 2 hours after the ingestion of 13 g of nitulamide (170 mg/kg or 43 times the therapeutic dose), in a suicide attempt. He was receiving nitulamide 300 mg/day for two weeks. On admission, he underwent immediately gastric lavage, followed by administration of oral activated charcoal and received an intravenous infusion of glucose in balanced salt solution. During the first 12 hours, the patient presented with moderate vomiting and diarrhoea. There was no change in the following parameters: blood cell count, plasma electrolytes, serum transaminases and serum bilirubin, arterial blood gases, plasma cortisol value, as compared to the pre-treatment values. Chest X ray was unchanged. Plasma concentrations were measured 2 hours, 3 hours, 12 hours, 24 hours, 48 hours and 72 hours after ingestion. The initial level reached 6 times the normal therapeutic range, then fell to 3.5 times at the 72th hour. The patient recovered rapidly and was discharged on the 4th day. Biologic parameters were controlled on 4th, 9th, 30th day and remained unchanged. Treatment was started again on the 30th day with nitulamide 150 mg/day. We did not notice any side effect previously described in daily administration of nitulamide: anemia, rise in serum transaminases, interstitial pneumopathy.

[Comparative in vitro activity of chlorine and bromine on the cysts of free-living amoebae]. / Activité comparée in vitro du chlore et du brome sur les kystes d'amibes libres.

A continuous flow type apparatus is used for investigation of the chlorine and bromide activity in vitro on the cysts of two free-living amoeba strains : Naegleria gruberi and Acanthamoeba polyphaga. The Naegleria cysts are sensitive more to chlorine than to bromine ; those of Acanthamoeba are perfectly resistant to these disinfectants in the limit of the available concentrations in swimming-pools. The sensibility to these disinfectants stays the same at 25 degrees C and 35 degrees C.