[ aftermaths of the extensor system after reconstruction of the auterior cruciate ligament by the patellar tendon]

A few articles in the literature studied the sequelle of the withdrawal of the extensor system after reconstruction of the anterior cruciate ligament by Kenneth JONES methods. The goal of this work was to value these aftermaths clinics, radiological and isokinetics. It is a retrospective study of 113 patients operated in the institute of orthopedics MT KASSAB with a reconstruction of the anterior cruciate ligament by Kenneth JONES technique under arthroscopy. These patients were seen in order to appreciate the functional results, arthrometric [by Telos], isokinetic [by an isokinetic dynamometer [BIODEX]] and radiological [patellar height, calcifications, femoro-patellar osteoarthritis and the positioning of femoral and tibial tunnels by Aglietti's and Locker-Vielpeau's index]. At a middle review of 32 months: 36 patients [32%] had some pains, 33 patients had dysaesthesia to the external face of the knee or one gene to the level of the withdrawal site. The variation of the patellar height was not meaningful [p = 0.052 a limit value] and it was not correlated to the occurence of anterior pain [p = 0.38]. Eleven calcifications of the patellar tendon were noted, six to the level of his patellar insertion and five in full tendon. None of these calcifications did require a surgery. Three patients had a pinch of the femoro-patellar spacing with osteophytes. The postoperative amyotrophy of quadriceps was 0.83 cm. The muscular deficit of quadriceps was lower to 7% compared to the controlateral side. Thirteen sportsmen had accidents of isokinetic curves accompanied by pains. The withdrawal of the extensor system is delicate dragging a fragilisation of this system with a risk of fracture. The essential opposition point between the withdrawal of a patellar tendon and the one of the ischiojambier rest the post-operative morbidity. It is classic to say that the patellar withdrawal is source of problems that they are about previous pains, aftermaths dysaesthesia, cartilaginous lesion, patellar lowering or muscular deficit of quadriceps. The aftermaths on the site of withdrawal of the patellar tendon are radiologically frequent but the most often asymptomatic

Cocci gram positive infection: regain registry

The Gram positive coccus infections were always preoccupying. In Tunisia, the epidemiological, clinics, therapeutic data concerning these infections remain insufficient. The main objective of this national epidemiological investigation achieved in 13 hospital units in Tunisia is to identify the criteria of choice of antibiotherapy and the profile of patients hospitalized for an infection to Gram positive cocci. This study included 450 patients with an average of 45.35 +/- 21.23 years of which 299 [66.4%] of men and 316 [70.2%] hospitalized in care unit. Two hundred fifty eight patients [62.2%] had one or several medical antecedents, and 145 [32.2%] one or several surgical antecedents. The diabetes [18%] and the chronic renal insufficiency [13.2%] were the two most frequent comorbidities. Signs of gravity to the admission were noted at least 14% of the patients and about 20% of the patients had presented a severe sepsis or a septic shock. The staphylococci [65.4%] were the most frequently the Gram positive cocci isolated follow-up by the streptococci [24.7%]. The resistance of the Gram positive cocci to glycopeptides concerned only one stump cf negative coagulase staphylococcus. Staphylococcus aureus is more frequently responsible for infections of skin and the soft cloths, bone and joint infections and severe sepsis. The rate of success clinic is more elevated in the infectious illness services [84.2% vs 55.3% p<0.0001], whereas mortality is more elevated the services of resuscitation [19.3% vs 3% p<0.0001]. The factors of bad prognosis are age>60 years, in the septic shock, the arterial hypotension to the admission, a score of Glasgow<8 to the admission and an infection to Staphylococcus aureus

[Prognostic factors of pneumococcal meningitis. Retrospective study of 31 cases]

Our aim was to study the susceptibility of Streptococcus pneumoniae to antibiotics in patients with pneumococcal meningitis and to search for the prognosis factors in those patients. We have studied retrospectively 31 cases of pneumococcal meningitis. Comparisons were performed with univariate analysis. The mean age was 36,7 +/- 20,5 years [ranged: 9 and 78 years]. The sex ratio was 3,4. The susceptibility of Streptococcus pneumoniae to penicillin G was affected in 10 cases [33% of isolated pneumococcus. The MIC to penicillin G was >/= 2 in only one case. The hospital mortality was 26% [8/31]. With univariate analysis, factors associated with death were: age >/= 55 years [Ss p= 0,006, OR: 17.2; IC[95%]: 2.3-134], albuminorachie >/= 7g/l [p= 0,002, OR: 22; IC[95%]: 1,9-251], shock [p= 0,031, OR: 6.7; IC[95%],: 1.05-42] and Glasgow Coma Score [GCS] /= 7g/l shock and Glasgow Coma Score

Liaisons proprioceptives proximodistales entre muscles quadriceps et soleaire chez l'homme

Electrical stimulation of femoral nerve modulates vonluntary tonic activity of ipsilateral soleus muscle. Stimulus time-locked inhibitory and facilitatory phases can be distinguished. EMG temporal analysis suggests that early perturbations are correlated with spinal effects of centripetal electrical activity. The inhibitory effects which momentarily abolish voluntary soleus activity are thought to result from quadriceps lb fibres recruitment. While no heteronymous activity is induced at rest, femoral nerve Ia fibres activation can produce soleus muscle reflex when soleus motor nucleus excitability is increased by voluntary command. Recurrent discharge resulting from soleus reflex response enhances inhibition initially due to quadriceps lb volley. Secondary effects of isometric quadriceps contraction [and soleus contraction when the femoral stimulus elicits a reflex in this muscle] have their own effects later. These findings suggest that proprioceptive relationships of the two muscular groups are efficient during tonic isometric voluntary command