[Functional and anatomical results after surgical treatment of ruptures of the rotator cuff. 2: postoperative functional and anatomical evaluation of ruptures of the rotator cuff]. / Résultats fonctionnels et anatomiques après traitement chirurgical des ruptures de la coiffe des rotateurs. 2ème partie: évaluation fonctionnelle et anatomique postopératoire des ruptures de la coiffe des rotateurs.

PURPOSE OF THE STUDY: The authors examined the anatomic condition and the function of the rotator cuff obtained after an average period of four years following surgical repair in a series of 100 full thickness rotator cuff tears. The aim was to assess the validity of Constant's scoring method and to analyse risk factors and the frequency of recurrent tears. MATERIAL AND METHODS: The series comprised 98 patients, 62 men and 36 women whose average age was 56 years. It included 69 tears of less than 2 cm in size (39 cases) or between 2 to 4 cm (3 cases) of the supra-spinatus, 22 tears of the supra- and infraspinatus measuring between 2 to 4 cm, and 9 massive tears. The tendon of the long head of the biceps was pathological in 1/3 of cases. All 98 patients were operated on by the same surgeon using the same repair technique, and all followed ambulatory rehabilitation along the same principles of self-rehabilitation applied pre operatively. In each patient function was assessed using Constant's scoring method, and the condition of the repaired cuff was determined by ultrasonography at the time of clinical follow-up. The average follow-up period was 4 years (2 to 6 years). RESULTS: Ultrasonography revealed intact cuffs in 65 per cent, thinned cuffs in 11 per cent and recurrent full thickness tears in 24 per cent of cases. The risk of recurrent tear increased with the extent of the tear to be repaired (57 per cent), in older patient (25 per cent) and with a higher level of post-surgical occupational use (18 per cent). A drop in the post-operative Constant score had a predictive value for a full thickness recurrent defect. DISCUSSION: Constant's scoring method appears to be a reliable, reproducible method for analysing functional results following surgical repair of full thickness cuff tears and to reflect the anatomic condition of the repaired cuff. At clinical follow-up, the anatomic condition of the cuff is more determinant of final functional results than initial tear size. CONCLUSIONS: Assessment of functional results must be complemented by anatomic examination using ultrasonography in order to specify the size of any possible recurrent defect and to detect thinning of the cuff which cannot be identified by Constant's score. Analysis of the risk factors for recurrent tear led the authors to question the necessity of repairing massive tears in older patients and pointed to the valuable advantages of reinforcing fragile cuffs during initial repair especially in very active patients.

[Functional and anatomical results after surgical treatment of ruptures of the rotator cuff. 1: Preoperative functional and anatomical evaluation of ruptures of the rotator cuff]. / Résultats fonctionnels et anatomiques après traitement chirurgical des ruptures de la coiffe des rotateurs. 1ère partie: évaluation fonctionnelle et anatomique préopératoire des ruptures de la coiffe des rotateurs.

PURPOSE OF THE STUDY: In a consecutive series of 98 patients presenting 100 full thickness cuff tears and managed by the same medico-surgical team, the authors studied the correlation between preoperative shoulder function values and the anatomic lesions found at surgery. Predictive factors of tear size were evaluated and any elements that were likely to improve preoperative function were determined so that patients could be best prepared for surgery. The validity of preoperative radiographic assessment of lesions was examined. MATERIAL AND METHODS: Prior to surgery, each patient was given the same rehabilitation program, the same arthrotomographic assessment of lesions and each was rated functionally using Constant's scoring method. Preoperative radiographic assessment of lesions showed supra-spinatus tears in 69 per cent, combined supraspinatus and infraspinatus tears in 22 per cent, and tears involving the supraspinatus, infraspinatus and subscapularis in 9 per cent. RESULTS: The preoperative Constant score averaged 46/100 points. The score was higher when patients had been prepared by preoperative rehabilitation to overcome stiffness. The optimum duration of rehabilitation was found to be 3 months (p < 0.05). Active range of motion was 90 per cent of normal in 84 per cent of cases. The patients in this series therefore underwent surgery more for continuing severe pain (25 per cent) and muscle weakness (86 per cent) than for reduced active motion. DISCUSSION: Examination of the correlations existing between an anatomic lesion and the preoperative rating of shoulder function shows that the Constant preoperative score provides a good prediction of the size of the tear to be repaired (p = 0.0063). The greater the tear size, the lower the preoperative Constant sore is. Active range of motion (especially in abduction and external rotation) and muscular strength are factors with the most predictive value contrary to pain and discomfort which are influenced by tear size. CONCLUSION: Preparing patients suffering full thickness cuff defects through preoperative rehabilitation to overcome stiffness provides the best conditions for surgery. Constant's functional scoring method gives a reproducible and reliable reflection of the anatomic rotator cuff lesion to be repaired. Its use for preoperative rating is useful for determining a reference value for function prior to surgery.

Bacterial pyomyositis in a patient with a multiple myeloma.

Pyomyositis is relatively rare in regions with a temperate climate. The most common aetiologic agent is staphylococcus aureus. Most patients with pyomyositis from temperate regions involve immunocompromised states. Because of the rarity, it is often initially misdiagnosed. Computed tomography scan is considered the most helpful tool for the diagnosis of pyomyositis. We present a case in a patient with multiple myeloma.

[Acute interstitial nephritis with uveitis. A case report]. / Néphrite interstitielle aiguë avec uvéite. A propos d'un cas.

Dobrin et al described in 1975 the first case report with acute renal failure due to tubulo-interstitial nephritis accompanied by uveitis and an inflammatory syndrome. The young adults are frequently involved and the complete resolution is usually obtained after corticosteroid treatment; this contrasts with the tendency towards relapse of the uveitis. The etiology and the pathogenesis of this syndrome remain unknown. We report the case of a woman which the renal function was incompletely reversible with corticosteroids.

Contributions of chronological age, age at menarche and menopause and of anthropometric parameters to axial and peripheral bone densities.

Bone mineral density (BMD) was measured in 128 normal postmenopausal women at different skeletal sites: lumbar spine and proximal femur, using dual-energy X-ray absorptiometry (DXA), and the cancellous and cortical envelopes of the distal third of radius and tibia, using precise low-dose quantitative computed tomography (QCT). Multivariate analysis included chronological age, ages related to menstrual history (menopause and menarche) and anthropometric factors, e.g. height and weight, as independent predictive variables. Weight is a much-studied predictor of bone density. At sites of high bone turnover, i.e. cancellous envelope, the effect of weight appeared overshadowed by estrogen-related parameters: age-past-menopause was the first predictor of BMD in the cancellous compartment of radius and in Ward's triangle, and the number of reproductive years was the strongest predictor of BMD in the cancellous compartment of tibia and in the spine (L2-4). This suggests that in addition to menopause, the length of menstrual life should be considered as an explanation for the variations in current bone mass in postmenopausal women. At the cortical level of radius, the effect of chronological age was predominant. At the cortical level of tibia, height and weight were the best predictors of BMD. We conclude that the influence of parameters related to menstrual history is predominant in sites with mainly cancellous tissue and that anthropometric factors constitute the best predictors of BMD in the cortical sites of weight-bearing bones.

Identification of a functional mononuclear precursor of the osteoclast in chicken medullary bone marrow cultures.

Mononuclear cells were isolated from the peritrabecular bone marrow from the medullary bone of laying hens maintained on a calcium-deficient diet for 1 week. These cells were cultured for up to 7 days on devitalized bovine bone slices after removing the nonadherent fraction. The mononuclear precursors of the osteoclast that are present in such cultures adhere to bone matrix. These cells are TRAP+, express the vitronectin receptor at high levels, and also express high levels of sodium pumps and of carbonic anhydrase, enzymes that are characteristically enriched in the mature osteoclast. Finally, the most mature mononuclear precursors were found to be capable of resorbing the extracellular bone matrix before forming multinucleated osteoclasts.

[Bone histomorphometric study in involuted fractured osteoporosis treated with 1-ethane-1-hydroxybiphosphonate (etidronate) during one year]. / Etude histomorphométrique osseuse dans l'ostéoporose fracturaire d'involution traitée par l'éthane-1, hydroxy-1, 1 bisphosphonate (étidronate) pendant un an.

The efficacy of the biphosphonate etidronate has recently been demonstrated versus the vertebral fracture rate in fractured involuted osteoporosis in the literature. However, it would appear that the increase in bone mass (measured from the calcium density) may alone account for these results. The authors undertook a histomorphometrie study in 20 patients with a group mean age of 55 years presenting recent vertebral fracture in the context of osteoporosis, in order to assess the cell changes which may affect bone quality. This factor remains the only one which can account for the reduced number of fractures. The patients received treatment with phosphorus (1,500 mg/d) for 3 days followed by etidronate (400 mg/d) for 14 days every 90 days. A permanent daily intake of 50 mg of calcium and 400 IU of vitamin D was also administered. Each patient underwent bone biopsy of the iliac wing before and after one year of treatment (4 cycles). No change in the bone mass or architectural parameters was observed. However, general slowing of the bone remodeling was found, affecting the natality and activity of the osteoforming and osteoresorbing cells. However, this remodeling which is traditionally uncoupled in osteoporosis was once more coupled. This results in a slowing of bone loss, ageing of the bone present and no change in the architecture. Thus, the diphosphonates appear to have a beneficial effect on the quality of bone rather than on its quantity. This represents a novel approach to the treatment of osteoporosis.

[In vitro identification of a mononuclear precursor of osteoclast]. / Identification, in vitro, d'un précurseur mononucléé de l'ostéoclaste.

Osteoclast is derived from mononuclear hematopoietic stem cells, most likely within the granulocyte-macrophage lineage. The exact differentiation process of osteoclasts precurssors has only been partially uncovered. The authors isolated in vitro, from the medullary bone of hens a mononuclear precursor of the osteoclast. This cell expressed several characteristics of mature and multinucleated osteoclast including the capacity to resorb the extracellular bone matrix.

Brachial plexus compression by an iatrogenic arteriovenous fistula.

A case of left brachial plexus compression by an iatrogenic arteriovenous fistula was treated by detachable balloon technique with immediate relief of pain. Good results on paresia were obtained in a few weeks.