Rotation sequence is an important factor in shoulder kinematics. Application to the elite players' flat serves.

The aim of this study was to test three different rotation sequences (YXY, ZXY, and XZY) on the shoulder kinematics (rotations of the humerus relative to the thorax) during an original movement such as the tennis flat serve (FS). Nine elite male and female players performed a minimum of five flat serves. An optoelectronic motion analysis system was used to record the movements. Segment kinematics during each FS was reconstructed from the spatial trajectories of the markers according to ISB recommendations. For each rotation sequence, three angles were reported for the shoulder joint, each corresponding to a rotation component around a defined axis. The occurrence of gimbal lock (GL) and angle amplitude coherences were examined. From these three rotation sequences tested, it appears that the XZY sequence was the only decomposition not to suffer from GL. Moreover, the rotation sequence XZY was found to be coherent for all rotation components. Thus, these results show that the best rotation sequence, from both GL and amplitude coherence points of view, is XZY to describe the shoulder kinematics during the tennis serve.

Segment-interaction in sprint start: Analysis of 3D angular velocity and kinetic energy in elite sprinters.

The aim of the present study was to measure during a sprint start the joint angular velocity and the kinetic energy of the different segments in elite sprinters. This was performed using a 3D kinematic analysis of the whole body. Eight elite sprinters (10.30+/-0.14s 100 m time), equipped with 63 passive reflective markers, realised four maximal 10 m sprints start on an indoor track. An opto-electronic Motion Analysis system consisting of 12 digital cameras (250 Hz) was used to collect the 3D marker trajectories. During the pushing phase on the blocks, the 3D angular velocity vector and its norm were calculated for each joint. The kinetic energy of 16 segments of the lower and upper limbs and of the total body was calculated. The 3D kinematic analysis of the whole body demonstrated that joints such as shoulders, thoracic or hips did not reach their maximal angular velocity with a movement of flexion-extension, but with a combination of flexion-extension, abduction-adduction and internal-external rotation. The maximal kinetic energy of the total body was reached before clearing block (respectively, 537+/-59.3 J vs. 514.9+/-66.0 J; p< or =0.01). These results suggested that a better synchronization between the upper and lower limbs could increase the efficiency of pushing phase on the blocks. Besides, to understand low interindividual variances in the sprint start performance in elite athletes, a 3D complete body kinematic analysis shall be used.

Pacing strategy and VO2 kinetics during a 1500-m race.

We investigated the oxygen uptake response (V.O (2)) to a 1500-m test conducted using a competition race strategy. On an outdoor track, eleven middle-distance runners performed a test to determine V.O (2max), velocity associated with V.O (2max) (v-V.O (2max)) and a supramaximal 1500-m running test (each test at least two days apart). V.O (2max) response was measured with the use of a miniaturised telemetric gas exchange system (Cosmed, K4, Roma, Italy). The 1500-m running test was performed at a mean velocity of 107. 6 + 2 % v-V.O (2max). The maximal value of oxygen uptake recorded during the 1500-m test (V.O (2peak)) was reached by subjects at 75.9 + 7.5 s (mean + SD) (i.e., 459 +/- 59 m). The time to reach V.O (2max) (TV.O (2peak)) and the start velocity (200- to 400-m after the onset of the 1500 m) expressed in % v-V.O (2max) were negatively and significantly correlated (p < 0.05), but our results indicate that a fast start does not necessarily induce a good performance. These results suggest that V.O (2max) is reached by all the subjects at the onset of a simulated 1500-m running event and are therefore in contrast with previous results obtained during treadmill running.

Relation between preferred and optimal cadences during two hours of cycling in triathletes.

OBJECTIVES: To determine whether the integrated electromyographic signal of two lower limb muscles indicates preferred cadence during a two hour cycling task. METHODS: Eight male triathletes performed right isometric maximum voluntary contraction (MVC) knee extension and plantar flexion before (P1) and after (P2) a two hour laboratory cycle at 65% of maximal aerobic power. Freely chosen cadence (FCC) was also determined, also at 65% of maximal aerobic power, from five randomised three minute sessions at 50, 65, 80, 95, and 110 rpm. The integrated electromyographic signal of the vastus lateralis and gastrocnemius lateralis muscles was recorded during MVC and the cycle task. RESULTS: The FCC decreased significantly (p<0.01) from P1 (87.4 rpm) to P2 (68.6 rpm), towards the energetically optimal cadence. The latter did not vary significantly during the cycle task. MVC of the vastus lateralis and gastrocnemius lateralis decreased significantly (p<0.01) between P1 and P2 (by 13.5% and 9.6% respectively). The results indicate that muscle activation at constant power was not minimised at specific cadences. Only the gastrocnemius lateralis muscle was affected by a two hour cycling task (especially at 95 and 110 rpm), whereas vastus lateralis remained stable. CONCLUSION: The decrease in FCC observed at the end of the cycle task may be due to changes in the muscle fibre recruitment pattern with increasing exercise duration and cadence.

[Neurological features after consumption of a variety of neo-caledonian shellfish]. / Manifestations neurologiques consécutives à la consommation d'un coquillage du lagon calédonien.

A few days after a seafood meal a patient suffered ataxia and stupor. His examination revealed a confused patient with cerebellar signs and ocular disturbances (hypotropia). Blood results, cerebrospinal fluid and brain CT scan were unremarkable. The patient developed a septic shock and died 4 weeks after admission. No necropsy was performed. Questioning his family confirmed that he had eaten a shellfish meal a few hours before onset of the digestive signs. Trocas (Tectus pyramis) were definitely identified. The clinical picture strongly suggested a seafood poisoning, namely ciguatera. However, no toxicologic assay was performed. To our knowledge, this poisoning has never been reported with trocas. Nevertheless, the feeding habits of trocas would suggest similarity with ciguatera poisoning.

[Venous access in oncology]. / Accès veineux en cancérologie.

INDICATIONS: Many treatments administered to cancer patients require venous access either via a peripheral vein or a larger central vein at the risk of local or systemic infection, thrombus formation or venous occlusion and dysfunction. PRECAUTIONS: Insertion of a central catheter is an invasive procedure which must be conducted under conditions of rigorous asepsia. Strict rules based on well-defined protocols must be applied throughout its use. INFECTIOUS COMPLICATIONS: Local or systemic infectious complications account for 18 to 25% of all nosocomial infections and are often related to colonisation of the puncture site by a Gram positive germ. In case of infection, ablation of the central catheter is not mandatory for diagnosis or antibiotic treatment. THROMBUS FORMATION: Reported at varying frequencies in the literature from 4 to 42%, thrombus formation is unpredictable and often difficult to diagnose. Anticoagulants or fibrolytic agents are indicated but it may also be necessary to withdraw the catheter. MECHANICAL COMPLICATIONS: Displacement, rupture, obstruction and extravasation are frequent complications. Back flow must be checked in all venous accesses and free flow carefully verified. The access must remain patent throughout the period of use, guaranteed by a standard heparinization and rinsing protocol. UNDENIABLE PROGRESS: This complications must not mask the important progress achieved with the use of central venous access for specific and symptomatic treatment in cancer patients.

[Analysis of medical catalog terms using the MAOUSSC model: application to Gyncecology-Obstetrics]. / Analyse des libellés des actes du catalogue des actes médicaux à l'aide du modèle MAOUSSC: application à la Gynècologie-Obstétrique.

BACKGROUND: The Model of Assistance and Orientation of a User within a System of Coding (MAOUSSC) used to describe activity in human medicine was used to analyse French medical nomenclature in Gynecology and Obstetrics. METHODS: French medical nomenclature for gynecology and obstetrics was translated with the multiaxial model (MAOUSSC) to allow critical analysis. RESULTS: All the 119 medical acts in the French nomenclature involving the female genital tract and obstetrics could be translated with the model. 24% of the acts were imprecise, ambiguous or implicit: the nature of the procedure was not explicit in 7 cases, the surgical route was not given in 86 and the surgical instrumentation not named in 75. Activities involving numerous medical specialties and ambulatory activity can be described with the MOUSSC model. CONCLUSION: The MAOUSSC model is still in the experimental stage. It is however easy to implement, has a high potential for describing various medical acts and is suitable for the description of gynecological and obstetrical activity both in terms of economical and medical efficacy.

A collaborative approach to building a terminology for medical procedures using a Web-based application: from specifications to daily use.

The MAOUSSC (Model for Assistance in the Orientation of a User within Coding Systems) Web server supports a collaborative work on the description of medical procedures. The specifications for the MAOUSSC application are conceptual modeling, definition of semantically fully described procedures, re-use of an existing vocabulary, the UMLS, and sharability. This paper reports on some difficulties in applying those principles in a networked building and updating of the terminology. The users are physicians who have to represent procedure terms in the MAOUSSC formalism. They must apply the constraints of the underlying model, and re-use the representation of the UMLS knowledge base. In our experience, we found that the implementation of syntactic and semantic constraints was not sufficient. Guidelines for pragmatical aspects in representation are required to make a collaborative approach in terminology building more operational.

A Web terminology server using UMLS for the description of medical procedures.

The Model for Assistance in the Orientation of a User within Coding Systems (MAOUSSC) project has been designed to provide a representation for medical and surgical procedures that allows several applications to be developed from several viewpoints. It is based on a conceptual model, a controlled set of terms, and Web server development. The design includes the UMLS knowledge sources associated with additional knowledge about medico-surgical procedures. The model was implemented using a relational database. The authors developed a complete interface for the Web presentation, with the intermediary layer being written in PERL. The server has been used for the representation of medico-surgical procedures that occur in the discharge summaries of the national survey of hospital activities that is performed by the French Health Statistics Agency in order to produce inpatient profiles. The authors describe the current status of the MAOUSSC server and discuss their interest in using such a server to assist in the coordination of terminology tasks and in the sharing of controlled terminologies.

Methodology for using the UMLS as a background knowledge for the description of surgical procedures.

The Unified Medical Language System (UMLS) contains and organizes a large number of terms from a variety of biomedical terminology systems. This study examines the relevance of the UMLS content and structures to the specific purpose of the conceptual representation of medical procedures. The MAOUSSC modelling is a compositional formalism with a description of elementary procedures in terms of elementary concept entities and combinations of such descriptions into more complex ones. The UMLS knowledge base is expected to provide semantically categorized medical concepts and interconcept relations. A method to reuse the UMLS has been developed. Quantitative and qualitative results are presented. Some difficulties in reusing the UMLS as a background knowledge are related to the preeminence of some terminology sources and to the instanciation of interconcept links. Other ones suggest that purpose-independence in categorization cannot be achieved.

[Percutaneous surgery for lithiasis: results and perspectives. Apropos of 390 operations]. / La chirurgie percutanée pour lithiase: résultats et perspectives. A propos de 390 interventions.

Percutaneous nephrolithotomy (PCNL) has radically changed the treatment of renal stones. The indications for this technique have been modified by the development and refinement of extracorporeal lithotripsy (ECL). The authors present their experience of 390 PCNL performed between 1984 and 1991, for solitary stones in 75% of cases. There were only 11 cases of failed puncture (3.8%). The overall morbidity was 18% with only 4.4% of major complications, i.e. life threatening or requiring reoperation. There were two deaths (0.5%). Stones were completely eliminated in 80.25% of patients, after a second operation (PCNL or other technique) in 32 cases (11%). 45 staghorn calculi were treated with 11% of complications and a 51% complete cure rate. The mean hospital stay was 6 days (2 to 30). PCNL is a safe and reliable technique. Its indications have decreased (6.5% of our patients treated for renal stones), but it still retains a place in the therapeutic approach to patients with renal stones.

[Precancerous conditions of the prostate]. / Les états pré-cancéreux de la prostate.

Carcinoma in situ, dysplasia, prostatic intra-epithelial neoplasia, duct-acinar dysplasia and large-acinar hyperplasia are various terms describing more or less identical forms of prostatic epithelial atypia. The precancerous nature of these lesions can be demonstrated by: morphological and functional similarities with carcinoma, a younger age than that of carcinoma, a higher incidence in cancerous prostates, an identical zonal distribution and a significant progression of high-grade lesions towards carcinoma. These hypoechoic lesions can be detected or monitored by transrectal ultrasonography. They also secrete PSA at levels intermediate between those of benign prostate and adenocarcinoma. Because of the occasional risk of malignant transformation and a frequent association with carcinoma, these lesions should be regularly monitored by digital rectal examination, PSA assays and possibly by ultrasound-guided biopsies.

[The diagnostic value of erythrocyte polyamines (EPA) in prostatic adenocarcinoma (PA): apropos of 100 patients]. / Intérêt diagnostique des polyamines érythrocytaires (PAE) dans l'adénocarcinome prostatique (AP): à propos de 100 patients.

Spermidine and spermine are ubiquitous polyamines which are intensely metabolised in the prostate. Polyamines are involved in the processes of proliferation and differentiation of normal and neoplastic cells. As the erythrocyte levels of these polyamines are correlated with the intratumoral levels, we assayed EPA in 45 controls, 66 patients with benign prostatic hypertrophy and 100 patients with prostatic cancer. Erythrocytic polyamines are markers of proliferation and prostatic metastases and can be used to distinguish between hormone-sensitive and hormone-resistant patients. Although non-specific, polyamines constitute circulating markers of the state of tumour proliferation of a given patient and definitely have a prognostic value which needs to be evaluated by further studies.

[Bladder replacement and continent diversion: what about metabolic complications?]. / Remplacement de vessie et dérivation continente: qu'en est-il des complications métaboliques?

During the past several years there has been increasing interest in refunctionalizing patients who have undergone radical extirpative surgery for pelvic malignancies and patients with dysfunctional bladders. To accomplish this, intestinal segments have been successfully employed in a variety of configurations. Independent of their optimal urosurgical implementation these procedures are not without potential complications, a significant portion of which involve metabolic derangements. Besides first follow-up results of patients with bladder substitution or continent urinary diversion, analysis of experimental investigations and functionally comparable clinical conditions enables an insight into potential following physiopathological interrelationships. These concern, besides the problem of chronic metabolic acidosis, disorders of bile acid and vitamin B12 metabolism as well as the potential induction of a secondary hyperoxaluria with subsequent oxalate concrement diathesis. Furthermore, there may be a malabsorption of calcium and vitamin D with development of intestinal osteopathy due to the reduction of absorptive surface. Apart from these problems of enteral loss and deficiency manifestations, several case reports and investigations suggest that bone demineralization can occur as a consequence of chronic metabolic acidosis and patients are at risk of skeletal demineralization. The pathogenesis of this association has yet to be clarified. These physiopathological interrelationships must be considered in medical attendance of patients with intestinal substitute bladders and continent supravesical pouch systems over many years. As these procedures become more popular, it becomes important to identify any metabolic changes that may occur as their consequence.

[Percutaneous treatment of simple kidney cysts]. / Traitement per-cutané des kystes simples du rein.

Percutaneous treatment of renal cysts is an effective and minimally invasive alternative to surgery for the treatment of simple, symptomatic renal cysts or cysts complicated by renal stones or hydronephrosis. Moderately large cysts and parapelvic cysts should be treated by sclerotherapy, while very large and peripheral cysts should be resected percutaneously. A series of 29 cysts was treated: 6 percutaneous resections, 22 scleroses, 1 simple puncture-aspiration. Pain relief was obtained in 96% of cases. Resolution of hydronephrosis and renal stones was obtained in 100% of cases. The morbidity (infection, haematoma) was low (10%), but 9 patients (32%) presented with a small residual cavity which, in 1 case, evolved towards a true recurrence of the cyst. The long-term outcome of these asymptomatic residual cavities is unknown.

Early endoscopic realignment of complete traumatic rupture of the posterior urethra.

Early primary endoscopic realignment of complete traumatic rupture of the posterior urethra is a simple, rapid and non-traumatic technique. We have recently treated 5 patients in this manner. All are continent and 4 are potent. Four patients were followed up for 1 year. One patient required no further management and had excellent urinary flow rates. The other 3 developed short secondary strictures which were managed successfully by 1 or 2 internal urethrotomies.

[Radical prostatectomy and biologic glue]. / Prostatectomie radicale et colle biologique.

Fibrin glue (reconstituted fibrin glue-Tissu-col-Immuno-France) was used in 24 patients following radical prostatectomy with ilio-obturator lymphadenectomy (Group II) to improve haemostasis of the operative field, to decrease or eliminate lymphatic oozing and to promote healing of the urethrovesical anastomosis. The results in terms of duration of drainage, quantity of fluid evacuated by these drains, operative complications and length of hospital stay were compared to those obtained in 24 clinically identical patients operated previously without the use of fibrin glue (Group I). Although fibrin glue is easy to use, ensures a particularly dry operative field at the end of the operation and does not induce any infectious complications (abscess, hepatitis), it increases the cost of the operation (5 ml vial = 2,500 FF) and the use of this product does not reduce the drainage time (Group I: 7 +/- 4.6 days; Group II: 8.5 +/- 5.4 days) the volume of blood or lymphatic discharge (Group I: 500 +/- 570 ml; Group II: 660 +/- 825 ml) or the length of hospital stay (Group I: 16.5 +/- 4.8 days; Group II: 17.4 +/- 5.5 days). These results argue against the routine use of fibrin glue in radical prostatectomy.

Percutaneous treatment of benign renal cysts.

The percutaneous treatment of benign renal cysts has been proposed in alternative to conventional surgery. It minimizes the complication rate and assures good clinical results. In our Department, 15 patients with 16 symptomatic benign renal cysts underwent either percutaneous cyst aspiration + sclerosis (10 cases) or percutaneous resection of the cyst wall (6 cases). In the first group, all patients were relieved from symptoms, and 70% had no residual cavity. Two patients presented a secondary infection of the cyst, treated with systemic antibiotics and percutaneous drainage (1 case). In the second group, we did not observe any complication, all patients were relieved from symptoms, and only 1 cyst recurred, probably due to incomplete resection.

[Detection of a prostatic adenocarcinoma in the cysto-prostatectomy specimens of an invasive tumor of the bladder]. / Découverte d'un adénocarcinome prostatique sur les pièces de cystoprostatectomie pour tumeur infiltrante de vessie.

Among one hundred consecutive patients submitted to radical cysto-prostatectomy for invasive transitional cell carcinoma of the bladder, 26 also exhibited adenocarcinoma of the prostate on histological specimens: 17 microscopic foci and 9 larger prostate carcinomas. In 3 cases, the tumor was found in the apex of the prostate gland. Pelvic lymphadenectomy was positive in 4 cases but always corresponded to a urothelial metastasis. Follow-up was never marked by a metastatic development of this adenocarcinoma. This frequency of latent prostatic adenocarcinoma is not different from its observed incidence in the general population on autopsy studies. The high incidence of this association makes removal of the whole prostatic tissue during total cystectomy necessary.

[Vascular injuries of the limbs. Evaluation of 106 lesions in 76 patients]. / Traumatismes vasculaires des membres. Bilan de 106 lésions chez 76 blessés.

A total of 106 lesions due to vascular injuries (noniatrogenic) to limbs were treated in 81 patients at the CHR, Rennes (Cardiovascular and Thoracic Unit) between 1970 and 1983. Analysis of data allowed a profile of arterial lesions (type and location) to be retraced, and demonstrated the high frequency of associated lesions, these varying in distribution according to whether the upper limbs (major seriousness of neurologic sequelae) or lower limbs (very high incidence of osteoarticular lesions) were involved. Among the "immutable" severity factors (related to the injury) emphasis has to be placed on "contending or crush injuries", widely displaced lesions, extensive arterial dilacerations (middle segments of limbs) and multiple vascular lesions. This study focused attention mainly on the tactical and technical factors allowing improvement in the always reserved prognosis of these lesions. Firstly, by maximum reduction in the duration of ischemia by early diagnosis (to avoid referral to a "second hand") and by judicious indication for angiography (conducted preferably in the operation room and if necessary repeated after vascular repair surgery). Secondly, by repair of lesions in conformity with well established rules and principles: bone stabilization initially, formal venous repair surgery for large venous trunks, preferably "conservative" surgery of arterial vessels to ensure a perfect result initially (any recovery operation results in a very high incidence of failures).