[Ischemic bilateral lumbosacral plexopathy and walking disability following surgical treatment of secondary aortoenteric fistulas: a case report and review of literature]. / Ischémie bilatérale des plexus lombosacrés avec atteinte de la marche suite à une réparation de fistule aortodigestive secondaire: à propos d'un cas Revue de la littérature.

OBJECTIVE: Aortoenteric fistula is a rare and serious pathology with a high mortality rate (around 50%). The surgery's neurological complications are also rare (around 0.25% of reconstructive interventions); two-thirds are spinal cord infarcts, with the remaining one-third corresponding to cases of ischemic polyradiculopathy. The latter condition is rarely described and appears to have a better functional prognosis. METHODOLOGY: We report a patient case with aortoduodenal fistula complicated, first by acute haemorrhage and then, by polyradicular damage and a sensorimotor impairment in both legs. RESULTS: EMG revealed bilateral damage to the lumbosacral plexus but NMR did not detect any abnormalities. The motor impairment in the legs was linked to sensory damage. We monitored the patient for two years. The initial functional disability score was 68 but it worsened steadily to a maximum value of 126 two years later. CONCLUSION: The paraclinical data (EMG, NMR) and the functional worsening strengthened our diagnosis of bilateral lumbosacral plexus ischemia, which is rarely described. However, the prognosis appears to be better than for infarction of the conus medullaris, the principal differential diagnosis.

[Study of bone mass with dual energy x-ray absorptiometry in a population of 99 lower limb amputees]. / Etude de la masse osseuse par ostéodensitométrie dans une population de 99 amputés de membre inférieur.

OBJECTIVES: Osteopenia in lower extremity amputation is described with an increased risk of fracture and it seems to be interesting to study bone mass in a population of 99 amputees of limb. MATERIAL AND METHOD: We studied the bone mass with Dual Energy Xray Absorptiometry in patients with limb amputation, above and under knee and who have been treated in the rehabilitation department of Mulhouse's hospital and more specifically the percentage of the difference of the mesure between amputed and non amputed side and the influence on this mesure of several factors like sexe; age; diabetes mellitus; delay of amputation; aetiology and use of prosthesis. RESULTS: For all the population, we find lower values of BMD (Bone mineral density) for femoral neck -10.4% +/- 12.2 (P < 0,001) and trochanter -14.9% +/- 14.5 (P < 0,001) between amputated and non amputated side, and also comparing with normal population -19.9% +/- 18.8 (P < 0,001) for femoral neck and -8.8% +/- 22 (P < 0,001) for trochanter.There is no influence of sexe, age, and time since amputation on BMD. The study of sub-groupes shows that the loss of bone mass is depending on traumatic amputation, the level of amputation (above knee) and when prothetis doesn't fit. Arteritis or diabetis are not pejoratif factors. CONCLUSION: This work confirms the mechanical factors as an important parameter of bone loss in the limb amputation.