The role of physiotherapy after total knee arthroplasty in patients with haemophilia.

With the availability of clotting factor concentrates, advances in surgical techniques, better implant design, and improvements in postoperative management, total knee arthroplasty has become the treatment of choice for haemophilia patients suffering from end-stage haemophilic knee arthropathy. The success of this surgery is also dependent on close collaborations among the orthopaedic surgeon, the haematologist and the physiotherapist. Although haemophilic patients undergoing this surgery would likely benefit from a targeted rehabilitation programme, its specificities, modalities and limitations have thus far not been extensively studied. Employing the published data of rehabilitation after knee prosthesis in patients with osteoarthritis and haemophilic arthropathy along with clinical experience, the authors present a comprehensive and original review of the role of physiotherapy for patients with haemophilia undergoing knee arthroplasty.

[Followup of pregnant women in the context of malaria: two case reports]. / Suivi de la grossesse dans le cadre du Paludisme: à propos de deux observations.

Whether or not a pregnant women should travel to regions where malaria is highly endemic will always be open to question as no prophlaxis can guarantee complete protection in every case. No chemoprophylaxis is 100% effective or entirely without side-effects, particularly for pregnant women whose immune status provides a favourable environment for the emergence of this parasitosis. The advice given will depend on the country and the region, a possible resistance of the parasite to treatment, the season, the length and circumstances of the stay and individual factors. The choice of treatment is very limited as many therapies are contra-indicated in pregnancy; in addition it is extremely important to give a sufficiently clear explanation concerning precautions and prophylaxis as well as of how a possible bout of malaria should be treated, particularly in case of extended stay.

Effects of immunosuppressive agents and particularly of cyclophosphamide on lymphocytes subsets in treated multiple sclerosis patients.

Immune treatments have been used in multiple sclerosis (MS) since 20 years, but it is still difficult to estimate their clinical efficacy as well as their precise immunological effects. The development of the monoclonal antibodies techniques makes it possible to appreciate certain immune effects of these treatments in MS patients and to correlate them with clinical results. It appears that Cyclophosphamide is able to correct the CD4/CD8 ratio imbalance observed in most MS patients and that this correction is generally associated with a beneficial effect on the disease. Other immunosuppressive agents appear less effective both on the CD4/CD8 ratio and on the progression of MS.