[Validation of identification criteria for patients having surgery for rhegmatogenous retinal detachment at Toulouse University Hospital]. / Validation des critères d'identification des patients opérés d'un décollement de rétine rhegmatogène au CHU de Toulouse.

INTRODUCTION: Seasonal variations seem to modify the incidence of rhegmatogenous retinal detachment (RRD), with a summer peak, although the meteorological parameters involved have not been studied in France. In order to conduct a national study evaluating the association between the occurrence of RRD and various climatological variables (METEO-POC study), we need to establish a national cohort of patients having undergone surgery for RRD. The data of the National Health Data System (SNDS) allow the realization of epidemiological studies concerning various pathologies. However, as these databases were initially intended for medical administrative use, the identification of the pathologies coded in these databases must be validated before any use for research purposes. In order to carry out a cohort study using SNDS data, the objective of this study is to validate the identification criteria for patients having undergone RRD surgery at Toulouse University Hospital. METHODS: We compared the cohort of RRD surgery patients at Toulouse University Hospital from January to December 2017 assembled from SNDS data with the cohort of patients meeting the same selection criteria assembled from Softalmo software data. RESULTS: With a positive predictive value of 82.0%, a sensitivity of 83.8%, a specificity of 69.9%, and a negative predictive value of 72.5%, we can consider that our eligibility criteria are performing well. CONCLUSION: Since the selection of patients via SNDS data is reliable at Toulouse University Hospital, we can use it at the national level for the METEO-POC study.

[How can we determine the best cerebral perfusion pressure in pediatric traumatic brain injury?]. / Quelle pression de perfusion cérébrale après traumatisme crânien chez l'enfant?

The management of cerebral perfusion pressure (CPP) is the one of the main preoccupation for the care of paediatric traumatic brain injury (TBI). The physiology of cerebral autoregulation, CO2 vasoreactivity, cerebral metabolism changes with age as well as the brain compliance. Low CPP leads to high morbidity and mortality in pediatric TBI. The recent guidelines for the management of CPP for the paediatric TBI indicate a CPP threshold 40-50 mmHg (infants for the lower and adolescent for the upper). But we must consider the importance of age-related differences in the arterial pressure and CPP. The best CPP is the one that allows to avoid cerebral ischaemia and oedema. In this way, the adaptation of optimal CPP must be individual. To assess this objective, interesting tools are available. Transcranial Doppler can be used to determine the best level of CPP. Other indicators can predict the impairment of autoregulation like pressure reactivity index (PRx) taking into consideration the respective changes in ICP and CPP. Measurement of brain tissue oxygen partial pressure is an other tool that can be used to determine the optimal CPP.

The management of femur shaft fracture associated with severe traumatic brain injury.

The aim of this article is to describe the management of femoral shaft fractures in patients with severe traumatic brain injury (TBI). This is a major problem and two questions remain currently of interest: When and how to perform orthopedic surgery in severe TBI patients? The main point of perioperative management remains the prevention of secondary brain insults and the monitoring of intracranial pressure is essential especially in patients with intracranial lesions on the CT-scan. The "double hit" concept, suggesting that surgery by itself might increase the preexisting systemic inflammatory response, gives argument for very early or delayed surgery. Early definitive femoral osteosynthesis, if requires lengthy surgical procedure, does not seem appropriate in this context and "damage-control orthopedics" with external fixation seems to be a good alternative.

[Acetaminophene-induced hypotension in intensive care unit: a prospective study]. / Etude prospective de l'incidence des hypotensions artérielles induites par l'injection intraveineuse de paracétamol en réanimation.

OBJECTIVES: The aim of this study was to evaluate the incidence of paracetamol-induced hypotension in intensive care unit (ICU). The secondary end-point was the description of pathophysiologic phenomenon during this hypotension and risk factors. STUDY DESIGN: An observational study in three ICU of a French teaching hospital. PATIENTS AND METHODS: All consecutives patients whom benefit from intravenous paracetamol administration were included in the study. When a 20% droop in arterial blood pressure occurred, plasma samples were obtained and tryptases were measured at 6 and 48 hours. Clinical, biological characteristics and paracetamol administration duration were prospectively monitored. RESULTS: During a 2-months period, 127 ICU patients were included in the study with 1507 paracetamol administration. Twenty droops in arterial blood pressure were recorded in ICU. The incidence rate was 1.33%. Administration duration was 32+/-9 min. No respiratory nor cutaneous manifestations occurred during hypotensions. A specific treatment was administrated in half of the patients. Hypotension incidence was higher (3.9%) in patients with brain injury. Eighty percent of patients with hypotension have a severe sepsis or a septic shock. CONCLUSION: In this cohort of ICU patients, hypotension incidence was higher than reported in drug legal mentions. Immunoallergic phenomenon was excluded. Brain injury and sepsis seems to be risk factors.

The radiometric analysis of the chest and spine deformity following surgical treatment of idiopathic scoliosis by the C-D method.

Material and methods. A group of 61 consecutive patients with AIS treated operatively by C-D method was evaluated in order to assess the immediate postoperative changes of spinal and rib cage deformity and to determine relationships between spinal and rib hump correction. Postoperative spinal and thoracic shape changes were measured on radiograms and CTscans at apex of the curve.
Results and Discussion. Statisticaly significant corrections of lateral curvature (60%), axial rotation (RAsag - 9% , RAml-18%), and rib cage deformity (RHindex- 24%) were recorded. Kyphosis changes were not significant. Axial rotation as well as rib hump increase was observed in some cases. Thoracic deformity correction in C-D method appeared to be related with translation of the apex of the curve, but in the horizontal plane this effect was negative probably due to the rigidity of the structural changes. Postoperative derotation of the curve apex seemed to influence the rib hump size reduction.

Radiometric analysis of deformity of the thorax and spine following surgical treatment of idiopathic scoliosis using the C-D method.

A group of 61 consecutive patients with AIS were treated surgically using the C-D method. Based on selected radiological markers measured on A-P and lateral radiograms and CT scans at the apex of the curve, and evaluation was made of postoperative changes in the shape of the spine and thorax, and the mutual effects of correcting particular elements of spinal and thoracic deformity were analyzed statistically. Following the C-D operation, statistically significant reductions were recorded in the Cobb angle (60%), axial rotation (RAsag - 9%, RAml - 18%), and thoracic malformation (RHi - 24%). The changes in the shape of the spine on the sagittal plane were not statistically significant. In some cases post-operative increases were observed in the angle of axial rotation and the index of thoracic malformation. The correction of thoracic deformity proved to be associated with shifting the apex of the curve towards the medial line of the body, but on the horizontal plane this effect was negatively correlated, probably due to permanent structural changes. Reduction in the dimension of the costal prominence was associated with changes in axial rotation at the apex of the curvature.

The cadmium contents in the femoral head in inhabitants of Upper Silesia.

The cadmium content was analyzed in tissue samples from the femoral head, obtained perioperatively from 45 patients undergoing hip arthroplasty at the Voivodeship Hospital No. 5 in Sosnowiec. The average cadmium concentration was 0,06 ug/g in the cancellous and cortical bone, and 0,09 ug/g onm the articular surface. No differences were found in the cadmium content between males and females, nor were age a differentiating factor. Increased cadmium content was observed, however, in the cancellous and cortical bone from patients smoking more than 20 cigarettes per day. Increased cadmium content in the femoral head was found to exert a negative impact on the concentrations of calcium and magnesium.

The value of computerized tomography in the treatment of acetabular fractures.

The purpose of this study was to evaluate the suitability of various techniques for imaging acetabular fractures and to analyze our own material from the period 1988-2000. early and late outcomes were evaluated in 42 patients treated for acetabular fractures, of whom 24 were treated surgically. Standard X-rays and special projections of the pelvis were compared to CT scans performed once just after the trauma, and again an average of 5 years after trauma. Particular attention was given to how the diagnosis of these kinds is both accelerated and broadened by CT examination, and to the role computerized tomography plays in planning the type of treatment, the surgical approach to be used, and prognosis for late outcomes in acetabular fractures.

[Database for assessment of treatment results in patients with multiple trauma]. / Baza danych do oceny wyników leczenia chorych z obrazeniami wielonarzadowymi.

Data base for assessment of results of treatment of politrauma patients is presented. It was created on the basis of Abbreviated Injury Scale, Injury Severity Score and Revised Trauma Score. Examination was supplemented with TRISS method inclusive of graphic assessment PRE-CHART and statistic Z and M. The software was created on the basis of Excel 7.0 and Windows 95.

[Comparison of three different methods of axial rotation assessment in idiopathic scoliosis]. / Porównanie trzech róznych metod oceny kata rotacji osiowej w idiopatycznych bocznych skrzywieniach kregoslupa.

In a group of 20 children with idiopathic scoliosis the degree of axial rotation was measured with the use of radiography (Drerup's method), ultrasonography and computer tomography. The measurements obtained by Drerup's radiographic method and by ultrasonography were compared with the results of the CT measurements, the latter being considered as the most precise. According to the statistical analysis of the results the spinal axial rotation measurements according to the Drerup's radiographic method appeared to be more precise than the ultrasonographic method. An equation was presented permitting to calculate the tomographic rotation angle RAsag on the basis of the results of the Drerup's radiographic measurement.

[A trial of ultrasonographic use for evaluating leg lengthening]. / Próba zastosowania ultrasonografii do oceny wydluzania konczyn.

Modified de Bastiani method of callotasis with Wagner apparatus was used as a lengthening procedure of 4 femurs and 1 tibia. The ultrasonography was applied to measure the degree of distraction, to determine the eventual axial deviation of the bone ends and to follow up the callus formation in the gap. The obtained results were compared with radiography.

Urinary MHPG is not a good predictor of antidepressive drug response.

The final results of treatment with 4 antidepressants (amitriptyline, imipramine, chlorimipramine and mianserine) in 80 patients with endogenous depression were analyzed with respect to their pre-treatment levels of urinary MHPG. The analysis revealed that MHPG measurements were of no practical value in predicting individual response to antidepressants.

Failure to correlate urinary MHPG with clinical response to amitriptyline.

On the basis of studies carried out in a group of 44 patients with endogenous depressive illness, the authors conclude that MHPG in urine is not a good predictor of response to amitriptyline treatment. There are no correlations between MHPG level and clinical improvement after 2 weeks' treatment and with final results of the therapy.