[Microtraumatic pathology of the lumbar isthmus: isthmic lysis or spondylolysis]. / La pathologie micro-traumatique des isthmes lombaires: lyse isthmique ou spondylolyse.

The authors report the study of a series of 23 partial isthmic lyses which occurred in a young population (15 cases) and in an adult one (8 cases) between 1983 and 1988, in the form of persistent lumbosacral pains. The initial radiological signs, the key to an early diagnosis, are defined: cortical notches more often regarding the lower cortex than the upper one, incomplete fissures reaching the two cortical poles, gradual narrowing of the isthmus. The value of standard radiography is underlined, with the oblique incidences close to the profile regularly ensuring the diagnosis, with the exception of 4 cases out of 23 for which tomography was required. As regards the evolution, the value of the diagnosis of the initial lesions is recalled, giving the hope of a restoration of the posterior inter-articular fractures by a rigid setting (4 months on average). This ability to reconstruct the lumbar isthmus is observed in the young subjects (10 out of 13 immobilizations) but also in the adult subjects (3 reconstructions for 5 immobilizations carried out). These results enable the early detection of prelytic states, in order to administer an suitable treatment resting on the rigid setting of the lumbosacral region, re-education and the control of the risk factors.

[Breast reduction and abdominoplasty: preventive and therapeutic effect on back pain in women]. / Réduction mammaire et abdominoplastie: effet préventif et thérapeutique sur la douleur rachidienne chez la femme.

In two out of three women breast reduction and reconstructive abdominoplasty relieve back pain and even sciatica. The biomechanical action of these techniques is analyzed. Further research consists of comparative measurements of intra-disc and spinal intra-muscular pressures between the pre- and post-operative periods.

[Spinal biomechanics and the sitting position]. / Biomécanique rachidienne et station assise.

Our study was conducted in two stages. In a first stage, elaboration of a reliable biomechanical model for the lumbar spine, permitting to calculate for each lumbar level, for a definite posture and a given patient, the normal and tangential forces as well as the overall stresses applied to the disc, and represented by the intradiscal pressure of the nucleus pulposus and the overall stresses in the annulus fibers. This biomechanical model was constructed with the help of radiographs and formulas of forces and moments balance in comparison with a reference axis system. This biomechanical model was then used to compare stresses on the disc in various sitting positions, in order to determine an ergonomic adaptation of the sitting position at work.

[Bone histomorphometry in monoclonal dysglobinemia. Diagnostic and prognostic value]. / L'histomorphométrie osseuse dans les dysglobulinémies monoclonales. Intérêt diagnostique et pronostique.

Data of bony histomorphometry by transiliac biopsy were studied in 35 cases of multiple myeloma and 26 cases of benign monoclonal dysglobulinemia. In a first stage, the comparison between the two groups showed an osteoclastic resorption which was significantly higher in myeloma patients in osteolytic forms as well as asymptomatic forms, showing the diagnostic advantage of this measurement in these forms of the disease. Also, the association of a preservation of the bony trabecular volume with an osteoclastic hyper-resorption was only observed in myeloma patients. In a second stage, study of the evolution of myeloma patients permitted to demonstrate the pejorative prognostic value of an intense hyper-resorption (STRO greater than or equal to 6) from a vital point of view as well as the future of the bone; patients with an initial hyper-resorption develop an osteolysis during the first year and/or a hypercalcemia during the first 24 months; the search for a correlation between these parameters of bony resorption and known prognostic factors, has proven negative except for calcemia and the level of beta 2 serum microglobulins. This fact emphasizes the advantage of a treatment toward osteoclasts associated with the classic chemotherapy of multiple myeloma.

[Periungual capillaroscopy in rheumatoid arthritis. Prospective study of 80 cases]. / La capillaroscopie périunguéale dans la polyarthrite rhumatoïde. Etude prospective de 80 cas.

This study involved the screening for dermal microcirculatory abnormalities using periungueal capillaroscopy in a group of 80 cases of rheumatoid arthritis, so-defined in terms of ARA criteria. Excessive erythrocyte aggregation and/or pericapillary edema were detected in 74% of cases and were statistically correlated with ESR, reflecting an inflammatory syndrome. Capillary neogenesis, probably in reaction to subclinical cutaneous vascularity, was detected in 59% of cases (86% of subjects presenting extra-articular rheumatism). In 28% of cases this was accompanied by spontaneous hemorrhage, suggesting a progressive condition. Stigmata of cutaneous atrophy were present in 54% of subjects. These findings demonstrate the frequency of subclinical cutaneous damage in rheumatoid disease and suggest the possibility of the clinical usefulness of capillaroscopy, a non-invasive technic, in the follow-up of this disease.

[Peroneal nerve entrapment syndrome of the front of the foot. Treatment by neurolysis. Apropos of a bilateral case]. / Le syndrome du nerf musculo-cutané au dos du pied. Guérison par neurolyse. A propos d'un cas bilatéral.

A case of bilateral entrapment of the superficial peroneal nerve at the anterior aspect of the ankle was seen in a 51 year old patient. After failure of the conservative treatment, surgical neurolysis resulted in complete relief.

[The back in everyday life]. / Le dos au quotidien.

The adaptation of man to an erect posture is the result of phylogenetic as well as ontogenetic evolution of the spinal structures and is largely responsible for the development of back pain. Apart from the specific conditions of overwork, a large number of physical activities and certain postures maintained over long periods of time can favour the development of back pain. The prevention of benign back pain therefore depends on a re-education of the correct use of the back. This can be performed in the form of individual prevention or in small groups of subjects suffering from back pain in whom a high risk activity can be isolated in order to direct the re-education. Primary prevention can also be considered in subjects not presenting back pain, consisting of a better knowledge of the back and its correct use.

[Muscular ultrasonic diagnosis. Etiological approach to various backaches]. / Echotomographie musculaire. Approche étiologique de certaines lombalgies.

Certain cases of mechanical back pain present unusual clinical and ultrasonographic features involving the posterior lumbar muscle groups, which can be used to distinguish various types. The clinical examination may isolate a juxta-vertebral territory in which pressure triggers or exacerbates the back pain; anaesthesia of this territory is accompanied by pain relief. Ultrasonography may reveal a hypoechogenic area in this muscle territory in which histomorphometric and ultrastructural studies, performed in three cases, revealed endomysial and perimysial adiposis associated with atrophy probably due to peripheral neuropathy.

[Misleading pains in the lower limbs of rheumatologic origin]. / Les douleurs trompeuses des membres inférieurs d'origine rhumatologique.

Pain in the lower limbs related to rheumatic disease may be the source of diagnostic difficulties when it presents in the guise of pseudo-vascular manifestations. A narrow spinal canal and atypical neuralgia may present a very misleading clinical picture. Similarly, traumatic muscular pathology and bone trauma and tumours may also be misleading. A popliteal cyst and reflex sympathetic dystrophy may simulate venous disorders. Iatrogenic disease, particularly complications of anticoagulant treatment also need to be recognized.

[Femoral paralysis caused by hematoma of the internal iliac fossa during anticoagulant treatment. Value of early surgical treatment]. / Les paralysies crurales par hématome de la fosse iliaque interne, au cours des traitements anticoagulants. Intérêt du traitement chirurgical précoce.

The authors report two personal cases and review published cases of femoral paralysis due to hematoma of the internal iliac fossa complicating anticoagulant treatment. The interest of pelvic body scanning is emphasised both in diagnosis and for the assessment of the course of various hematomas of the internal iliac fossa. A plan for treatment is proposed in which surgery is of great importance. The latter is always effective both for the pain and the motor deficiency, a precise topographical localisation of the hematoma may be a decisive argument in favour of an early operation.