[The interest of electroneuromyography in peripheral facial palsy]. / Apport de l'électroneuromyographie dans les paralysies faciales périphériques.

In case of peripheral facial palsy, electroneuromyogram of the facial nerve provides an indication of the nature (myelinic and/or axonal) and severity of nerve damage, thereby facilitating establishment of a prognosis, which is favorable for myelin damage, and guarded for severe axonal damage. The initial examination must be carried out during the second week. In case of severe axonal damage, examination results can be monitored at the third, and more particularly the sixth and the twelfth months. Stable neurophysiological data between the sixth and the twelfth months signal damage stability and open the way to possible palliative surgery. In the event of trigeminal damage, neurophysiological exploration furthers analysis of temporal muscle innervation. ENMG can confirm and precisely indicate peripheral hemifacial spasm.

[Low circulating anti-Müllerian hormone and normal follicle stimulating hormone levels: which prognosis in an IVF program?]. / Pronostic en fécondation in vitro des patientes ayant une AMH basse et une FSH normale.

OBJECTIVE: To evaluate the results of controlled ovarian hyperstimulation (COH) for IVF in patients with low anti-Müllerian hormone (AMH) and normal basal follicle stimulating hormone (FSH) and Estradiol levels (≤50 pg/mL). PATIENTS AND METHODS: A retrospective cohort study including 704 patients for whom AMH and FSH levels (measured between days 3 and 5 of the menstrual cycle) were available, is performed in the IVF center at the Sèvres Hospital (France). Three groups are designed and analyzed: group 1 with AMH less or equal to 2 ng/mL and FSH less or equal to 10 mUI/mL (study group), Group 2 with AMH greater than 2 ng/mL and FSH less or equal to 10 mUI/mL (control group) and Group 3 with AMH less or equal to 2 ng/mL and FSH greater than 10 mUI/mL (group with decreased ovarian reserve). RESULTS: IVF outcome for patients from the study group is significantly worse than that of the second but not than that of the third group. In the first group, the number of retrieved oocytes, the number of total obtained embryos, the clinical pregnancy rate and the live birth rate are significantly lower than in the second group; moreover, there are more cancelled cycles because of poor response in the first group. There is no difference with the third group. DISCUSSION AND CONCLUSIONS: This study shows that women with a low baseline AMH have a similar response to COH to the poor responders patients with a decreased ovarian reserve revealed by an elevated FSH level. Thus, when a woman undergoing IVF cycle presents a low AMH, she might be considered as a poor responder patient regardless of the FSH level and, although the clinical pregnancy rate is not so disappointing (18%), the couple should be informed of a higher risk of cycle cancellation.

[Results of nerve sutures in the wrist in children]. / Résultats des sutures nerveuses au poignet chez l'enfant.

INTRODUCTION: Wounds involving the peripheral nerves cause serious damage in the upper limb. The prognosis for recovery remains uncertain despite microsurgery. It is commonly accepted that the results are far better in children than in adults. We sought to confirm this idea on the basis of objective recovery criteria, discriminating between peripheral axonal regeneration and the child's own capacity to adapt. In other words, do nerves regenerate better in children? MATERIALS AND METHODS: The clinical results of 25 nerve sutures of the wrist, in children under 15, were analysed with a minimum follow-up of 12 months. The subjects were reviewed clinically and had an electromyogram. The resulting data was compared to that for adults found in the literature. RESULTS: Clinically, the overall function of the hand was always satisfactory. The sensory results were often excellent (S4 or S3+ in 23 cases/25). The mean value muscular testing was between M2 and M3. With respect to the EMG results, the values we recorded were rarely representative of the functional results. The motor recordings were mostly poor, demonstrating that the nerve supply was compensated by a phenomenon involving collateral innervation. DISCUSSION: The poor results of peripheral nerve surgery are only due to the quality of the restored innervation. Dellon and Mackinnon demonstrated that they were also due to the incapacity of the nerve centres to integrate a change in the profile of sensory information. It would therefore seem that not only the quantity of nerve tissue repair is insufficient, but also the quality. Children have a superior cerebral capacity to adapt than adults and probably benefit from better cortical acquisition processes and are thus capable of putting the changes in the nerve messages to better use. The analysis of the clinical and EMG results also reveals a trend demonstrated partial nerve repair in children. We think that the functional results suggest that children have a better central capacity to adapt.

[Pseudo-paralysis of the brachial biceps in obstetrical brachial plexus lesions (OBPL):concerning the "overly optimistic" EMG in OBPL]. / Pseudo-paralysie du biceps brachial dans les paralysies obstétricales du plexus brachial (POPB)--à propos de l'"optimisme" de l'EMG.

In birth palsy of the brachial plexus, the mixed interference pattern recorded for the brachial biceps on the electromyogram often conflicts with the muscle's inability to flex the elbow. We report our observations of a six-month-old infant who presented paralysis of the upper and medial elements of the brachial plexus, in whom we demonstrated early biceps-triceps co-contractions, which may explain this discrepancy and 'pseudo-paralysis' of the biceps. We analyse and discuss the practical consequences of these findings, and notably the possible therapeutic use of triceps-to-biceps surgical transposition.

[A case of compression of the posterior tibial nerve by a synovial cyst with impact on the superior tibiofibular joint]. / Un cas de compression du nerf tibial postérieur par un kyste synovial développé aux dépens de l'articulation péronéo-tibiale supérieure.

The authors report a case of compression of the posterior tibial nerve by a cyst originating from the superior tibio-fibular joint. The clinical signs were dysesthesia of the sole of the foot and paresis of the toe flexors. The diagnosis was obtained by electromyographic studies. The patient recovered completely after surgical excision of the cyst, which had developed beneath the tendinous arch of origin of the soleus muscle.