[Transperitoneal laparoscopic approach to the L5-S1 disk. Value of computed x-ray tomography]. / Abords du disque L5-S1 par coelioscopie trans-péritonéale, Intérêt d'une étude tomodensitométrique préalable.

PURPOSE OF THE STUDY: The aim of this study was to determine the laparoscopic approach of L5-S1 disk, by preoperative C.T. evaluation. MATERIAL AND METHODS: 30 patients justified tomodensitometry for low back pain or sciatalogy. We added two scan views and a lateral radiologic mode including pubis. We defined several parameters in order to evaluate the "useful" triangle limited by iliac veins and anterior edge of S1 plateau. This surface was divided in discal and vertebral surfaces. We studied also cutaneous projections of axis and usefull zones for discal or transcorporeal approach. RESULTS: The "usefull" surface was about 6 cm2 (from 0 to 13.12 cm2). The average vertebral surface was 2.58 cm2 and 3.42 cm2 for discal surface. The best cutaneous point for introduction was 3.3 cm from ombilic in transcorporeal approach and 11.3 cm in discal approach. DISCUSSION: Peroperative C.T. evaluation seems to be more usefull than radiological for preoperative planning. Peroperative radiographical control is not always efficient to prevent foraminal radicular risk.

[Early management of language disorders]. / Interventions précoces dans les troubles du langage.

The audio-language consultations of the Centre d'Audiophonologie of Lyon, France, allow the diagnosis of language delay to be documented in very young children. Based on a five-year clinical study, the authors propose a method of regular follow-up for the child and the parents.

[Early treatment. An overview]. / Interventions précoces: un tour d'horizon.

"Early training" for deaf children was introduced some twenty years ago. The idea rapidly gained ground for using the same principles to help as early as possible all children suffering from a handicap the diagnosis of which could be made at birth or very early in life, as well as those children who are retarded or language-risk children. Such interventions take account of the parents, the child, and are aimed at encouraging or furthering everything in the field of arousal, communication and language. In many respects speech therapists are the best trained to meet the needs of multidirectional help for the very small child, and especially to provide help orienting the relationship towards language.

[Lesions of the hip in congenital myxedema in children]. / Les lésions de la hanche au cours du myxoedème congénital chez l'enfant.

A series of 51 cases of congenital myxoedemia in children was analyzed to determine incidence of associated hip lesions. Mechanisms of epiphysial and articular cartilage growth are reviewed and events summarized that occur normally in the "growing hip": the upper femoral nucleus, and orientations of femoral neck and their physiologic variations. The role of thyroid hormones in bone growth is also discussed. Reviewed in greater detail are the myxedematous hips in children, or epiphysial dysgenesis, the causes of delay in bone maturation, the effect of substitutive therapy and mineralization disorders. In contrast to the richness of radiographic data, often very disturbing, restriction or even absence of functional signs is almost a constant feature, enabling a diagnosis of Legg-Perthes-Calvet's disease to be rejected, certain radiologic images being considered wrongly as comparable. Radiography provides images varying from delayed ossification of a sometimes very long upper femoral nucleus, termed "joint emptiness", to "pseudo-fragmentations" that are frequently encountered and are actually progressive ossifications. These sometimes progress towards deformity of femoral head in coxa plana but are usually well adapted to the acetabulum, reducing initial fears. Different parameters studied in the 51 patients are analyzed and an optimistic conclusion given, since neonatal screening for congenital myxedema and subsequent therapy should eliminate skeletal complications, particularly in the hip.