[Sports-related concussions in youths]. / Commotions cérébrales chez le jeune sportif.

Mild head trauma can be associated with concussion, defined as transient brain function impairment without radiological findings. Sports-related concussion is also reported in pediatrics (rugby, ice hockey, football, boxing, etc.). Misdiagnosis can lead to persistent neurocognitive signs with athletic and academic problems. Consensual tools are available, but they are not well-known by first-line doctors, coaches, and patients or parents. Concussed players should not be allowed to return to the field on the same day. Return to play should be gradual over 3weeks or more. School activities may need to be modified to favor cognitive rest. Prevention is based on risk information and knowledge transfer, rule changes, and protective helmets, whose effectiveness is not always proven.

Proximal migration of fibular malleolus during tibial lengthening despite syndesmotic screw fixation: a series of 22 cases.

INTRODUCTION: During tibial lengthening procedures, it is recommended to prevent fibular malleolus proximal migration using a distal tibiofibular syndesmotic screw, which is removed at 6 months. We have observed proximal migrations of the fibular malleolus despite placement of this syndesmotic screw. OBJECTIVE: The objective of this study was to demonstrate this migration and to study the influence of two factors that may favor its occurrence: positioning of the syndesmotic screw and union of the fibula at the time of removal. HYPOTHESIS: An unhealed fibula at the time the distal tibiofibular syndesmotic screw is removed and its tricortical position promote the proximal migration of the fibular malleolus. MATERIAL AND METHODS: This was a retrospective, single-center, analytical study that included 22 lengthening procedures in 18 patients from 5 to 17 years of age who had undergone tibial lengthening and presented a preoperative continuous fibula. The position of the fibular malleolus, union of the fibula, and the tri- or quadricortical position of the screw were assessed based on four successive x-rays. RESULTS: Tricortical positioning of the syndesmotic screw was significantly associated with proximal migration of the fibular malleolus during lengthening (P=0.0248<0.05). However, there was no significant relation between an unhealed fibula and proximal migration of the fibular malleolus when the screw was removed (P=0.164>0.05). DISCUSSION: Proximal migration of the fibular malleolus during lengthening is promoted by placing a non-quadricortical syndesmotic screw. Quadricortical positioning of the screw should be recommended. Migration of the fibular malleolus after ablation of the syndesmotic screw seems to be related to absence of fibular union but this series was too small to demonstrate this clearly. LEVEL OF EVIDENCE: Level IV: Retrospective study.

Increase in male reproductive success and female reproductive investment in invasive populations of the harlequin ladybird Harmonia axyridis.

Reproductive strategy affects population dynamics and genetic parameters that can, in turn, affect evolutionary processes during the course of biological invasion. Life-history traits associated with reproductive strategy are therefore potentially good candidates for rapid evolutionary shifts during invasions. In a series of mating trials, we examined mixed groups of four males from invasive and native populations of the harlequin ladybird Harmonia axyridis mating freely during 48 hours with one female of either type. We recorded the identity of the first male to copulate and after the 48 h-period, we examined female fecundity and share of paternity, using molecular markers. We found that invasive populations have a different profile of male and female reproductive output. Males from invasive populations are more likely to mate first and gain a higher proportion of offspring with both invasive and native females. Females from invasive populations reproduce sooner, lay more eggs, and have offspring sired by a larger number of fathers than females from native populations. We found no evidence of direct inbreeding avoidance behaviour in both invasive and native females. This study highlights the importance of investigating evolutionary changes in reproductive strategy and associated traits during biological invasions.

[Salter and Harris type-II distal femoral physeal fracture-separations at adolescent age: a new therapeutic approach (preliminary study)]. / Fractures-décollements épiphysaires de type SalterII de l'extrémité distale du fémur chez l'adolescent : nouvelle proposition thérapeutique (étude préliminaire).

PURPOSE OF THE STUDY: The prognosis of distal femoral physeal fracture-separation is poor in children. In adolescents, more than half of the cases are classified as Salter and Harris type-II. The gold-standard treatment for a displaced fracture combines anatomic reduction with internal fixation with a pin or screw, preserving the growth cartilage. Despite this treatment, the rate of mid- and long-term complications has been high in the literature, most problems being related to leg length discrepancy and misalignments (genu valgum and genu varum). In order to avoid these problems, for adolescents, we propose and osteosynthesis system which bridges the entire growth cartilage with a blade-plate. Depending on the bone age, puberty and thus potential for further growth, we combine this osteosynthesis with a contralateral distal femoral epiphysiodesis to prevent invalidating leg length discrepancy. MATERIAL AND METHODS: We reviewed retrospectively the cases of 21 patients aged 11 to 15 years treated between 1990 and 2005 for Salter and Harris type-II distal femoral physeal fracture- separation. Clinical and radiographic outcome was compared between the 16 patients treated with the classical internal fixation system or cast immobilization and the five patients treated with a blade-plate. A complete physical examination was available for the follow-up in all cases. A full stance view was used for the radiographic analysis. The mean follow-up was 6.7 years (range 2-17), minimal two years. RESULTS: In patients treated with the classical fixation system or a plaster cast, four of 16 (25 %) developed frontal misalignment of more than 5 degrees and five of 16 (32 %) leg length discrepancy of more than 2cm. No misalignment or leg length discrepancy (>2cm) was observed among the five patients treated with a blade-plate. DISCUSSION: The results observed in our patients treated with the classical fixation systems are comparable with those reported by others. Our patients treated with the blade-plate system constitute the only series with no cases of frontal misalignment or invalidating leg length discrepancy after this type of fracture. We used contralateral distal femoral epiphysiodesis in all patients whose predictable leg length discrepancy at the end of growth was greater than 2cm, that is 11-3.5 years (bone age) in girls and 13-14.5 years in boys. CONCLUSION: Internal fixation techniques bridging the growth cartilage are the only techniques used for Salter and Harris type-II distal femoral physeal fracture-separation in adolescents which have been able to prevent posttraumatic knee misalignment (genu valgum or genu varum). Leg length discrepancy can be prevented by a contalateral distal femoral epiphysiodesis when the fracture occurs in a child or early puberty.

[Fracture of the intercondylar eminence of the tibia type II in children: 20 surgically-treated cases]. / Fracture de l'éminence intercondylienne du tibia de type II chez l'enfant: à propos de 20 cas traités chirurgicalement.

PURPOSE OF THE STUDY: The purpose of this study was to detail therapeutic indications for fractures of the intercondylar eminence of the tibia with little displacement and preservation of the posterior hinge (type II fracture in the Zarincznyj classification). MATERIAL AND METHODS: We reviewed retrospectively a multicentric serie of type II fractures of the intercondylar eminence observed in children treated surgically. There were twenty patients, ten girls and ten boys, mean age 11.9 years (range 6-16). Imaging included plain x-rays of the knee (anteroposterior and lateral views) in all patients as well as computed tomography (5 patients) and magnetic resonance imaging (1 patient). Surgical treatment was performed in all cases, on average six days after trauma (range 0-25). A medial parapatellar arthrotomy was used in all cases. A non-resorbable thread was used for fixation associated with an anchor in the last four cases. Clinical and radiological assessment was reviewed at mean 3.7 years follow-up. RESULTS: All children had resumed their sports activities at the same level as before the accident within 4.8 months on average. None of the children suffered from an unstable knee or functional impairment at last follow-up. The Lysholm score was 88.9 on average (range 70-100) at three months postoperative and 99.2 (range 89-100) at last follow-up. DISCUSSION: There is currently agreement that non-displaced fractures of the anterior intercondylar eminence of the tibia should be treated orthopedically and that forms with displacement require surgery. Conversely, the type II fractures with an anterior gap but a preserved posterior hinge, the appropriate treatment remains a subject of debate. In our experience, surgery would appear to be preferable to orthopedic management. Surgery enables putting correct tension on the anterior crucicate ligament and limits the risk of residual laxity which, even though rarely associated with instability, could in the long-term lead to osteoathritic degradation or meniscal damage. CONCLUSION: Surgical treatment of fractures of the intercondylar eminence of the tibia with little displacement and preservation of the posterior hinge provides satisfactory results and the best guarantee of long-term stability.

[Necrotizing cellulitis complicating varicella in two children given nonsteroidal anti-inflammatory drugs]. / Dermo-hypodermite nécrosante compliquant la varicelle chez l'enfant sous anti-inflammatoires non stéroïdiens: à propos de 2 cas.

We report two cases of fasciitis with necrotizing hypodermitis of the foot and arm which complicated varicella in immunocompetent children given nonsteroidal anti-inflammatory drugs. The skin barrier and immune function are weakened by the varicella zoster virus. Exposure to nonsteroidal anti-inflammatory drugs further favors necrotizing cutaneous infections caused by group A beta hemolytic streptococci. MRI can confirm the presence of superficial aponevrosis necrosis defining necrotizing fasciitis but should not retard surgical management which is always indicated for necrotizing fasciitis and sometimes for necrotizing dermo-hypodermitis.

[Total hip arthroplasty without cement in children and adolescents: 17 cases]. / Arthroplastie totale de hanche sur mesure et sans ciment chez l'enfant et l'adolescent: à propos de 17 cas.

PURPOSE OF THE STUDY: Hip disease can produce major pain and functional disorders in children who should benefit from total hip arthroplasty. We report our experience with total hip prostheses implanted without cement in children. MATERIAL AND METHODS: We performed 17 total hip arthroplasties in 13 children who had various conditions, mainly chronic juvenile osteoarthritis and aseptic osteonecrosis secondary to sickle cell anemia. The acetabular inserts were not cemented. All the femoral stems were custom-made using computer-assisted preoperative planning based on standard x-rays and computed tomography findings. Outcome was assessed on the basis of patient satisfaction, pain, and function. Radiographically, we assessed stem implantation, stability and integration. Results were classed with the Harris score and also with the Steinbrocker classification in order to take into account the child's overall functional handicap. RESULTS: Mean follow-up was 36.4 months. There were three cases of superficial hematoma, one case of superficial sepsis and one acetabular loosening. All patients were satisfied. Unsatisfactory function, observed in 80% of the children preoperatively, was found in only 17% postoperatively. The Harris score improved from 23.8 preoperatively to 87.7 at last follow-up. There were no cases of stem loosening and integration was achieved in 85.3% of the cases proximally in the area with hydroxyapatite surfacing. DISCUSSION: The problem with these children is to determine when total hip arthroplasty should be proposed. We retain three important indications: uncontrollable chronic pain, normal school attendance impossible, no other possibility for conservative surgery. Several studies have reported only mediocre results with cemented stems. We opted for custom-made stems without cement for three reasons: preservation of bone stock, better adaptation to bone whose quality and morphology had been remodeled by the underlying condition and repeated osteotomies which also affect the gluteus medius, and finally, better chance of success for future revisions in these active young patients. CONCLUSION: The question on whether or not total hip arthroplasty should be performed early in these children to avoid osteotomies which could alter the longevity of a future prosthesis remains open. Custom-made stems inserted without cement have provided satisfactory results in our experience. To date, follow-up is too short to compare our results with those obtained by others using cemented stems.

[Progressive forearm lengthening in children: 14 cases]. / Les allongements progressifs de l'avant-bras chez l'enfant.

PURPOSE OF THE STUDY: There are few indications for forearm lengthening in children. Several techniques have been proposed. We report our experience with progressive lengthening of the forearm in children using a unilateral axial external fixator and an improved technique consisting in initial insertion of an intramedullary guide wire. MATERIAL AND METHODS: Since 1990, we performed 14 forearm lengthenings in 9 children. Radial agenesia (5 forearms in 4 children), and hereditary multiple exostosis (3 forearms in 2 children) were the predominant causes. The ulna was involved in 9 cases and the radius in 5. Age at initiation of the lengthening procedure ranged from 4.5 to 14.8 years (mean 9.9). The lengthening technique consisted in a transverse subperiosteal osteotomy of the bone shaft then progressive distraction with a unilateral axial external fixator. When axial deviation had to be corrected, we used a subtraction osteotomy. In our last 10 cases, we inserted an intramedullary guide wire in the lengthened bone. The external fixation was left in place throughout the lengthening procedure and until complete bone healing. Serial radiographs were used to assess bone healing, the degree of lengthening achieved and any axial deviation at the end of lengthening. RESULTS: All 14 forearms were reviewed at a mean 50.6 months. Mean lengthening was 26.4 mm (range 10 - 52 mm). There were no nerve or vessel complications. In one case, reducible claw finger completely regressed after temporary interruption of the lengthening. There were 6 cases of late healing requiring a secondary bone graft. The healing index was 61.9 days per cm gained length. There were 3 cases with an axial deviation at the end of lengthening. DISCUSSION: Insertion of a guide wire in the bone being lengthened reduced the risk of late healing compared with lengthening procedures without a guide wire, avoiding axial deviation. In addition, this technique led to more rapid bone healing so the fixator could be removed earlier. We have found this method to be easier to perform on a normally axed segment. This would require an initial subtraction osteotomy for prior alignment. CONCLUSION: Forearm lengthening is a difficult procedure. Use of an intramedullary guide wire associated with an external fixation and an initial osteotomy for axial correction when needed and possibly stabilization of the wrist is an important contribution, particularly for malformed forearms.

Long-term gene delivery into the livers of immunocompetent mice with E1/E4-defective adenoviruses.

We have compared the in vitro and in vivo behaviors of a set of isogenic E1- and E1/E4-defective adenoviruses expressing the lacZ gene of Escherichia coli from the Rous sarcoma virus long terminal repeat. Infection of tumor-derived established cell lines of human origin with the doubly defective adenoviruses resulted in (i) a lower replication of the viral backbone that correlated with reduced levels of E2A-specific RNA and protein, (ii) a significant shutoff of late gene and protein expression, and (iii) no apparent virus-induced cytotoxicity. Independently of the extent of the deletion, the additional inactivation of E4 from the viral backbone therefore drastically disabled the virus in vitro, with no apparent effect on transgene expression. A lacZ-transgenic model was used to compare the different recombinant adenoviruses in the livers of C57BL/6 mice. The immune response to the virally encoded beta-galactosidase was minimal in this model, as infusion of the E1-defective adenovirus resulted in a time course of transgene expression that mimicked that in immunodeficient (nu/nu) mice, with very little inflammation and necrosis in the liver. Administration of a doubly defective adenovirus to the transgenic animals led to long-term extrachromosomal persistence of viral DNA in the liver, with no detectable methylation of CpG dinucleotides. However, transient transgene expression was observed independently of the extent of the E4 deletion, suggesting that the choice of the promoter may be critical to maintain transgene expression from these attenuated adenovirus vectors.

[Focal fibrocartilaginous dysplasia and tibia vara. Apropos of 2 cases. Review of the literature]. / Dysplasie fibrocartilagineuse focale et tibia vara. A propos de 2 cas. Revue de la littérature.

Focal cartilaginous dysplasia is a rare condition associated with unilateral tibia vara in young children. The authors report 2 cases. In one patient spontaneous correction occurred at the age of 18 months. In the other case the patient's deformity persisted, and an osteotomy was performed at the age of 36 months. Through these 2 cases and 26 cases of the literature, the authors discuss the healing process and etiology. The most likely exploration is an abnormal development at the insertion of the pes anserinus inducing epiphysiodese like effect. In most cases, the growth plate of the proximal tibial appears to correct the deformity. Surgical correction is necessary after the age of 36 months, if the angular deformation is up to 30 degrees of varus.

Baculovirus-infected cells do not produce the amyloid peptide of Alzheimer's disease from its precursor.

The amyloid peptide (Abeta) of Alzheimer's disease (AD) is produced by proteolytic cleavage of a larger precursor, the amyloid peptide precursor or APP. The discovery of pathogenic mutations in the APP gene provides strong evidence for the hypothesis that APP metabolism is involved in the etiology of AD. To study the metabolism of the protein, human APP has been expressed in several mammalian cell types. Insect cells, infected by a recombinant baculovirus carrying the human APP sequence, also provide an interesting expression system because these cells do not produce endogenous APP. Baculovirus-infected cells synthesize very high amounts of extracellular soluble APP, after cleavage of the transmembrane protein, as described for mammalian cells. However, we demonstrate here that insect cells do not produce Abeta from APP. These results suggest that while the enzymatic activity needed for the production of soluble APP is conserved between insect and mammalian cells, the enzymes required for the production of Abeta from APP are only expressed in mammalian cells.

Is there a place for patellofemoral arthroplasty?

Indications for patellofemoral arthroplasty were studied based on a 2- to 10-year followup review. Of 183 patellofemoral prostheses implanted between 1980 and 1990, 104 were associated with unicompartmental arthroplasty, and 79 were implanted alone. Thirteen patients were lost to followup. The results of 66 patellofemoral arthroplasties are reported at an average followup of 66 months. The mean age of the patients at surgery was 57 years. Underlying causes of the osteoarthritis included patellar dislocation or dysplasia (22), patellar fracture (20), and primary osteoarthritis (24). A metallic femoral groove was associated with a polyethylene patella with no metal backing. Two (9%) prostheses were revised in the dysplasia group, 1 (5%) in the posttraumatic group, and 7 (29%) in the primary osteoarthritis group. In this latter group, the indications of patellofemoral arthroplasty must be restricted to lesions of the patellofemoral joint in a knee in neutral axis evaluated preoperatively on full standing and stress radiographs. The best results of patellofemoral arthroplasty were obtained in osteoarthritis after patellar dislocation or patellar fracture.

[Health education and AIDS. A randomized controlled trial]. / Education pour la Santé et SIDA. Un essai comparatif avec tirage au sort.

In 1987 a small health education research team in Montpellier became interested in AIDS prevention among high school students (15-19 years old). Studies at that time indicated that the majority of the youth were relatively well informed about AIDS, for example 99% of those questioned knew that the disease was transmitted by sexual intercourse or by the exchange of contaminated needles. Further studies indicated, however, that the young people did not feel that the subject concerned them personally--it was considered a problem like many others. The team decided therefore to design a programme which would involve the young people, and thus motivate them not only to question, but to look for answers and implicate themselves in the search for information. The programme design consisted in creating video workshops in selected high schools. Adults with different backgrounds were trained in video production and communication skills in order to develop sufficient staff for workshop supervision. A network of available specialists was recruited for consulting purposes and a specialized library which included audiovisual materials was created so that the young people would have sufficient resources available for their research. In order to incite the students to contemplate the subject of AIDS and all that it involves, a contest was held. The theme was simply, "AIDS" and the duration was the length of the 1988-89 school year. Eight workshops were created in eight different schools. The teams were created quite spontaneously and the dynamic of interrogation anticipated was realized. With the help of trained adult supervisors, each team started their project by designing a five minute video.(ABSTRACT TRUNCATED AT 250 WORDS)

[Oncocytic tumors of the kidney apropos of 2 cases. Actualities in the preoperative diagnosis and therapeutic attitude]. / Tumeurs oncocytaires du rein à propos de 2 cas. Actualités dans le diagnostic pré-opératoire et attitude thérapeutique.

The authors report two cases of renal oncocytoma treated by radical nephrectomy. There is still a controversy because the term oncocytoma is used for all tumors containing oncocytes, either true oncocytoma or adenocarcinoma with oncocytoma cells. The main problem is to distinguish, prior to surgery, between renal oncocytoma, a tumor with benign evolution, and renal adenocarcinoma with oncocytes, to offer conservative surgery for renal oncocytoma.