[Validation of the dialectal Arabic version of Barratt's impulsivity scale, the BIS-11]. / Validation de la version en arabe dialectal de l'échelle d'impulsivité de Barratt, la BIS-11.

INTRODUCTION: Impulsivity is a symptom of several disorders such as personality disorder, bipolar disorder, suicidal behaviour, substance use disorders, schizophrenia...Forensic psychiatry is particularly concerned with impulsivity. It increases the risk of violence among clinical populations and figures in various instruments such as the HCR-20, the VRAG and the PCL-R to assess violence risk. It is one of many dimensions that can lead to aggressive behaviour among psychiatric patients. The Barratt Impulsiveness Scale (BIS), in its 11th version, is a 30-item self-report instrument that helps assessing impulsivity trait among normal and clinical populations. The BIS is the most commonly administered self-assessment of impulsiveness. As of March 2009, there have been 551 citations of the BIS-11 among many publications. The purpose of the present study is to examine the psychometric properties of the Arabic translation of the BIS-11th version in a sample of the general population and to identify an eventual correlation between impulsivity and socio-demographic characteristics. PATIENTS AND METHODS: This is a prospective study conducted over a five-month period, from June to October 2010, and including 134 persons from the general population having provided their informed consent. The dialectal Arabic version was carried out by translation from English to dialectal Arabic followed by a back translation to English. Some questions were modified to be understood by a population with low education. After giving their verbal informed consent, the participants filled in the Arabic version of the BIS-11. For the illiterate, responses and quotations were performed by the interviewer. The persons were also asked to fill in socio-demographic data. Cronbach's coefficient was calculated, and then we assessed impulsivity prevalence and a correlation between demographic features and impulsivity scores. For the analyses, the statistical software SPSS 11 was used. RESULTS: The sex ratio is 1.02. Most of the interviewed persons were 20 to 49 years old. Around 25.4% of the sample were analphabets, 32.1% had primary education, 29.1% had secondary education and 13.4% were undergraduates. The Cronbach's alpha was respectively 0.66 for attention, 0.72 for motor impulsivity, 0.61 for lack of planning and 0.78 for total impulsivity. Factor analysis identified three factors explaining the total variance of 32.6%. Impulsivity prevalence was 9%. We did not find significant correlation between demographic features and impulsivity scores. DISCUSSION: Limits of the study: scale stability over time was not verified. This was due to the difficulty in re-inviting the same persons to fulfil the scale a second time. Because no instrument for assessing exists in Arabic, comparison was not possible between the translated Barratt's scale and the reference. Our sample represents the general population. This choice was justified in order to study an eventual correlation between impulsiveness and socio-demographic characteristics. We must mention difficulties when asking persons with low education to complete the scale, what may have caused a poorer performance of the scale due to difficulties in understanding some questions. Moreover, we had chosen a non-clinical sample. The validation of the scale could be performed in a clinical population. The measure of internal consistency (Cronbach's alpha) fell within an acceptable range (0.61-0.78), suggesting that the Arabic version of the BIS-11 is reliable. Exploratory factor analysis of the current version identified three factors, but these factors differed from those of other translated versions. CONCLUSION: There is growing interest in the impulsivity concept. Forensic psychiatry is particularly concerned by impulsivity. In fact, it is related to psychiatric patients' violence. Impulsivity also reveals the problem of responsibility assessment in psychiatric expertise and the dangerousness of psychiatric patients. The Arabic version of the BIS-11 has a good apparent and internal consistency. This version could be useful in assessing psychiatric patient's dangerousness.

Vertebral hydatidosis and paraplegia.

We report the management of two children and 11 adults with paraplegia secondary to vertebral hydatidosis. Destruction of pedicles, posterior vertebral elements and discs as well as the vertebral bodies was common and all six patients with thoracic disease had involvement of adjacent ribs. The 13 patients had a total of 42 major surgical procedures; two patients died from postoperative complications and four from complications of the disease and paraplegia. All eight patients initially treated by laminectomy or anterior decompression alone relapsed within two years and seven required further surgery. Circumferential decompression and grafting gave the best results, six of nine patients being in remission an average of three years and six months later. The prognosis for such patients is poor; remission is the aim, rather than cure. Anthelminthic drugs may improve the prognosis, but radical surgery is likely to remain the keystone of treatment in the foreseeable future.

[Proximal femoral epiphysis growth after closed reduction for congenital hip dislocation]. / Croissance de la tête fémorale après réduction de la luxation congénitale de la hanche.

PURPOSE OF THE STUDY: This cohort illustrates growth of the center of ossification of the femoral head during and after orthopedic reduction of congenital hip dislocation. MATERIAL AND METHODS: Thirty files of pediatric patients with congenital hip dysplasia were studied retrospectively. Mean age of the children was 24.5 Months. All had unilateral dysplasia, allowing a comparison of femoral head growth by calculating the centers of ossification on the AP views. RESULTS: Mean ratio between the radiological surface of the center of ossification of the femoral head on the dysplastic side and the normal side was about 1: 2. This ratio progressed rapidly during the first Months after reduction and became 1: 1 at a mean 43 Months after reduction. Beyond this time, growth of the femoral heads followed a similar pattern. DISCUSSION: Growth of the center of ossification of the femoral head is related to biomechanical stress forces. Reduction is the only event in the natural history of the disease, but renewed growth of the femoral head cannot provoke in itself normal acetabular growth. Complementary pelvic osteotomy was required for 13 hips. CONCLUSION: Accelerated growth of the femoral head ossification center continues to be a good indicator of femoral head vitality. Early and rapid growth observed after reduction, without osteochondritis, can lead to a normal femoral head at the end of growth.

[Supracondylar femoral extension osteotomy for knee flexion contracture correction in poliomyelitic conditions]. / Ostéotomie fémorale supra-condylienne d'extension dans la correction des flexums post-poliomyélitiques du genou.

PURPOSE OF THE STUDY: Knee flexion contracture due to quadriceps paralysis is a major handicap in poliomyelitis patients. The patient has to stabilize the knee with the ipsilateral hand to achieve weight bearing and the deformed knee precludes use of orthopedic devices. Extension can be achieved with supracondylar femoral osteotomy if the knee flexion contracture is less than 30 degrees. We assessed functional and anatomic outcome. MATERIAL AND METHODS: We reviewed the files of 87 patients who had undergone 93 supracondylar femoral osteotomies for knee flexion contracture (6 bilateral cases); mean age was 18 years and mean flexion was 25 degrees. The surgical correction was achieved by diaphyseal metaphyseal impaction with resection of an anterior wedge and preservation of the posterior component of the articulation. If some gluteus maximus activity was retained and the tibiotarsal joint was in a slightly equine position, weight bearing in a stable locked position became an automatic postural event even in case of total paralysis of the quadriceps. Osteotomy was not possible if the contracture flexion was greater than 30 degrees due to excessive tension on the vaculonervous bundles. The procedure was equally impossible in children under 12 years of age due to the risk of recurrence subsequent to migration and callus remodeling with bone growth. RESULTS: Complete extension of the knee was achieved peroperatively in all cases. The most serious complications were three cases of septic arthritis that led to an irreducible stiff knee. In addition, we had two cases of transient paralysis of the common fibular nerve that recovered spontaneously. Bone fusion was achieved in all cases within 30 days. Recurrent flexion contracture was observed in 5 cases and required a revision using the same procedure in 3 or them. Postoperatively, the amplitude gained in knee extension corresponded to the amplitude lost for flexion. Sixty-three patients were able to walk independently without manual stabilization and a knee extension orthesis could be installed for 19 others. Three patients were still unable to walk despite the correction of the knee flexion contracture due to failure of poorly accepted orthopedic devices. DISCUSSION: Several conservative methods (physiotherapy, manipulations, successive corrective casts) and surgical procedures (release of posterior soft tissues, Ilizarov technique) have been proposed for the correction of paralytic knee flexion contracture. Supracondylar femoral osteotomy for extension can be useful after the end of growth if the flexion contracture remains below 30 degrees. The procedure is simple and morbidity is relatively low compared with the regularly successful results. When the flexion contracture exceeds 30 degrees, the supracondylar osteotomy cannot be employed due to the risk of stretching the vasculonervous bundles and due to the instability and disorganization of the lower femur. Progressive correction can be proposed for these patients: regular monitoring of the neurological and vascular situation is required. Functional improvement is considerable after correction of knee flexion contracture. The patients can walk more easily, no longer need to stabilize their knee with their hand, and can benefit from orthopedic devises due to the more favorable biomechanical conditions.

[Use of Ilizarov fixator in the treatment of post-osteomyelitis pseudoarthroses in children]. / Utilisation du fixateur d'Ilizarov dans le traitement des pseudarthroses post-ostéomyélitiques de l'enfant.

PURPOSE OF THE STUDY: The aim of this study was to emphasize the importance of the distraction osteogenesis technique in the treatment of post-osteomyelitis nonunion. We report 12 cases. PATIENTS AND METHODS: Mean patient age was 9.5 years. There were 7 cases of nonunion of the femur and 5 involving the tibia. Nonunion was associated with 5.9 cm shortening in 10 cases, 8.4 cm circumferential bone defect in 1 case, shortening and bone defects in 6 cases, and shortening and joint deformities in 2 cases. RESULTS: Consolidation was obtained in 11 cases with an average delay of 11.6 months. Infection was eradicated in 75 per cent of the cases. Average residual shortening was 0.4 cm. Joint deformities and axial deviations were corrected at the same time in all cases. DISCUSSION: The advantages of the Ilizarov technique are well known for the treatment of such deformities and musculoskeletal system disorders subsequent to osteomyelitis: nonunion, infection, shortening, joint deformities and malunion.