How long does tendinopathy last if left untreated? Natural history of the main tendinopathies affecting the upper and lower limb: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Natural history of disease refers to the progression of a disease process in an individual over time, in the absence of treatment. Understanding natural history of tendinopathies is key for clinicians to make accurate prognostic predictions and design effective intervention studies. OBJECTIVE: To quantify the natural history of the main tendinopathies regarding pain and function and to compare outcomes between untreated individuals and those receiving treatment. METHODS: A systematic literature search was conducted until February 2023, across PubMed, Cochrane, Embase and Scopus databases. Selection criteria included randomized controlled trials (RCTs) with a "wait-and-see" group and cohort studies with ≥3 months of follow-up reporting on pain and function-related outcomes. Standardized mean differences (SMDs) of "wait-and-see" groups were pooled using a random-effects inverse-variance model. Risk of bias was assessed using Cochrane Risk-of-Bias (RoB2), and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS: Six RCTs were included, encompassing 518 subjects with tendinopathy. Pooled results demonstrated significant pain (SMD = 0.30, 95%CI: 0.19-0.41) and physical function improvement (SMD = 0.38, 95%CI: 0.28-0.48). These estimates remained consistent regardless of age or follow-up duration. In rotator cuff tendinopathy, untreated individuals improved but did not fully recover at one year, with similar outcomes to other interventions (e.g., surgery). Subjects with lateral elbow, patellar and achilles tendinopathies when untreated, did not fully resolve symptoms within 12-16 weeks. CONCLUSIONS: This review provides limited conclusions about natural history of tendinopathies. Future studies should incorporate true no-intervention groups to accurately reflect tendinopathy's natural progression.

Reducing the carbon footprint of general anaesthesia: a comparison of total intravenous anaesthesia vs. a mixed anaesthetic strategy in 47,157 adult patients.

Global warming is a major public health concern. Volatile anaesthetics are greenhouse gases that increase the carbon footprint of healthcare. Modelling studies indicate that total intravenous anaesthesia is less carbon intensive than volatile anaesthesia, with equivalent quality of care. In this observational study, we aimed to apply the findings of previous modelling studies to compare the carbon footprint per general anaesthetic of an exclusive TIVA strategy vs. a mixed TIVA-volatile strategy. This comparative retrospective study was conducted over 2 years in two French hospitals, one using total intravenous anaesthesia only and one using a mixed strategy including both intravenous and inhalation anaesthetic techniques. Based on pharmacy procurement records, the quantity of anaesthetic sedative drugs was converted to carbon dioxide equivalents. The primary outcome was the difference in carbon footprint of hypnotic drugs per intervention between the two strategies. From 1 January 2021 to 31 December 2022, 25,137 patients received general anaesthesia in the hospital using the total intravenous anaesthesia strategy and 22,020 in the hospital using the mixed strategy. The carbon dioxide equivalent footprint of hypnotic drugs per intervention in the hospital using the total intravenous anaesthesia strategy was 20 times lower than in the hospital using the mixed strategy (emissions of 2.42 kg vs. 48.85 kg carbon dioxide equivalent per intervention, respectively). The total intravenous anaesthesia strategy significantly reduces the carbon footprint of hypnotic drugs in general anaesthesia in adult patients compared with a mixed strategy. Further research is warranted to assess the risk-benefit ratio of the widespread adoption of total intravenous anaesthesia.

Should Exercises be Painful or not? Effects on Clinical and Experimental Pain in Individuals with Shoulder Pain.

Exercise can reduce pain, however the effect of painful versus non-painful exercises is uncertain. The primary aim of this randomized crossover study was to compare the effect of painful versus nonpainful isometric shoulder exercises on pain intensity after exercise in individuals with rotator cuff-related shoulder pain. Secondary exploratory aims were to describe the effects on pressure pain thresholds (PPTs), conditioned pain modulation (CPM) and muscle strength. On separate days, 35 individuals performed painful isometric shoulder exercises (external rotation; 20% above pain threshold), nonpainful isometric shoulder exercises (external rotation; 20% below pain threshold), and a rest condition, in randomised order. Shoulder pain intensity, PPTs, CPM, and external rotation strength were assessed before, immediately after and 45 minutes after conditions. No significant differences were observed between painful and nonpainful exercises. Visual analogue scale scores increased immediately after both painful and non-painful exercises compared with rest (P = .047, partial ƞ2 = .07), but were similar to preexercise levels after 45 minutes. No changes in PPTs, CPM, or muscle strength after exercises compared with rest were observed. Painful and non-painful isometric exercises caused a moderate but short-lasting increase in shoulder pain in individuals with RCRSP. Isometric exercises had no effect on pain sensitivity and shoulder muscle strength or CPM. PERSPECTIVE: This study evaluated for the first time in individuals with rotator cuff-related shoulder pain the effects of painful versus non-painful isometric exercises on different pain-related outcome measures. Both painful and non-painful isometric exercises caused a moderate but relatively short-lasting increase in shoulder pain in individuals with rotator cuff-related shoulder pain. Trial registration number: (ClinicalTrials.gov) NCT03675399.

Influence of age, gender and obesity on pressure discomfort threshold of the foot: A cross-sectional study.

BACKGROUND: Foot pain is a highly prevalent health problem for which measures such as a pattern of Pressure Discomfort Threshold of the foot plantar surface can provide valuable information for orthosis design. This study aimed to describe such pattern as a tool for the assessment of painful conditions of the feet and to analyse how it modifies according to age, gender and obesity. METHODS: A cross-sectional study was performed with participants allocated in: Group 1 people aged 20 to 35 years, Group 2 aged 50 to 65 years and Group 3 aged over 65. Pressure Discomfort Threshold on twelve points of the foot plantar surface was measured with an adapted manual dynamometer. Inferential analyses of the data were performed using one-way analysis of variance (ANOVA) considering foot areas, age group, gender and obesity. FINDINGS: 36 participants were analysed. The pattern of Pressure Discomfort Threshold for all individuals showed a significantly higher threshold on the heel and external foot (P < 0.001, η2 = 0.124) and was statistical significantly influenced by age (P < 0.001, η2 = 0.17), especially in participants aged over 65; by gender, with women having higher values (P < 0.001, η2 = 0.13), and by obesity (P < 0.001, η2 = 0.19). INTERPRETATION: A Pressure Discomfort Threshold pattern exists in the foot plantar surface. The characteristics of the discomfort pattern of the foot and its association with aging, gender and obesity may have considerable implications for orthosis and footwear design.

The effect of vibration therapy on neck myofascial trigger points: A randomized controlled pilot study.

BACKGROUND: The purpose of this study was to evaluate the effect of low-frequency self-administered vibration therapy into myofascial trigger points in the upper trapezius and levator scapulae on patients with chronic non-specific neck pain. METHODS: Twenty-eight patients with chronic non-specific neck pain were randomly assigned into a vibration group, receiving 10 self-applied sessions of vibration therapy in the upper trapezius and levator scapulae trigger points; or a control group, receiving no intervention. Self-reported neck pain and disability (Neck Disability Index) and pressure pain threshold were assessed at baseline and after the first, fifth and 10th treatment sessions. FINDINGS: Significant differences were found in the vibration group when compared to the control group after the treatment period: the vibration group reached lower Neck Disability Index scores (F = 4.74, P = .033, η2 = 0.07) and greater pressure pain threshold values (F = 7.56, P = .01, η2 = 0.10) than the control group. The vibration group reported a significant reduction in Neck Disability Index scores (χ2 = 19,35, P = .00, Kendall's W = 0.28) and an increase in pressure pain threshold (χ2 = 87,10, P = .00, Kendall's W = 0.73) between the assessment times over the course of the treatment. The mean increase in pressure pain threshold in the vibration group after the 10 sessions was 8.54 N/cm2, while the mean reduction in Neck Disability Index scores was 4.53 points. INTERPRETATION: Vibration therapy may be an effective intervention for reducing self-reported neck pain and disability and pressure pain sensitivity in patients with chronic non-specific neck pain. This tool could be recommended for people with non-specific neck pain.

Laterality judgement and tactile acuity in patients with frozen shoulder: A cross-sectional study.

BACKGROUND: Disrupted tactile acuity and poor laterality judgement have been shown in several chronic musculoskeletal pain conditions. Whether they are impaired in people with frozen shoulder (FS) remains unknown. OBJECTIVES: To determine whether there is impairment in tactile acuity and laterality judgement in subjects with FS. METHODS: Thirty-eight subjects with idiopathic FS and 38 sex and age-matched healthy controls were enrolled. The two-point discrimination threshold (TPDT) over the affected and unaffected shoulder of patients with FS and shoulder of healthy controls was evaluated. In addition, all participants performed a left/right judgment task (LRJT). Independent and dependent t-tests were used to compare group means. Pearson-product moment coefficient correlations between pain intensity and duration and LRJT and TPDT were calculated for the FS group. RESULTS: The TPDT over the affected shoulder was significantly increased compared to the unaffected shoulder (mean difference, 3.82 mm; 95% confidence interval [CI]:0.53, 7.10; p = .02) and controls (mean difference, 5.80 mm; 95% CI: 1.09, 10.52; p = .02). Patients with FS were less accurate (mean difference, 5.90%; 95% CI: 0.36, 11.43; p = .03) and slower (mean difference, -0.26 s; 95% CI: 0.06, 0.45; p = .01) responding to images of their affected shoulder compared to their unaffected shoulder. No associations were found between pain intensity and duration and either TPDT or laterality judgement. CONCLUSIONS: Participants with FS demonstrated reduced tactile acuity and impaired laterality judgement over their affected shoulder compared to their unaffected shoulder. When compared to controls, subjects with FS showed reduced tactile acuity. TRIAL REGISTRATION CLINICALTRIALS. GOV IDENTIFIER: NCT03320200.

Efficacy of environmental friendly disinfectants against the major postharvest pathogens of stone fruits on plastic and wood surfaces.

Disinfection of surface facilities during postharvest handling operation is an important practice to avoid secondary fruit infections at stone fruit packinghouses. The aim of this work was to evaluate the effect of six environmental friendly disinfectants against Monilinia fructicola, Penicillium expansum, Rhizopus spp., and Alternaria spp. on plastic and wood surfaces. Hydrogen peroxide, peracetic acid, sodium hypochlorite, Mico-E-pro®, Proallium FRD-N®, and DMC Clean-CNS® were used as the disinfectants. Untreated and surfaces treated with water were used as controls. Plastic and wood surfaces were sampled with Rodac plates at 2 and 24 h after treatments and the number of colonies were counted. In general, all disinfectants reduce the number of viable conidia from all studied surfaces. Hydrogen peroxide used in a concentration of 150 mg L-1 was the less effective disinfectant in all studied pathogens. The commercial product Mico-E-pro® composed of oregano, onion, and orange extract at a dose of 10 mg L-1 was the most effective disinfectant. Rhizopus spp. was the pathogen more resistant to the disinfectants followed by P. expansum, M. fructicola, and Alternaria spp. Water decreased the number of conidia adhered to the surface. In addition, the untreated control showed substantial conidia reduction after 24 h of artificial inoculation.

[Disability after stroke: a longitudinal study in moderate and severe stroke patients included in a multidisciplinary rehabilitation program]. / Ictus y discapacidad: estudio longitudinal en pacientes con discapacidad moderada-grave tras un ictus incluidos en un programa de rehabilitacion multidisciplinar.

INTRODUCTION: Stroke is a recognized cause of disability among adults. However the impact that the deficits that occur after a moderate/severe stroke have on long-term disability, as well as the response of the resultant deficits to rehabilitation, are not completely understood. PATIENTS AND METHODS: A total of 396 patients with a modified Rankin score >= 3 after an ischemic (n = 221) or hemorrhagic (n = 175) stroke were included in this study. All patients were assessed with cognitive, behavior, emotional, motor and functional domains. All patients were assessed at baseline and six months after inclusion in a multidisciplinary rehabilitation program. RESULTS: Risk of falling (Berg Balance Scale < 45 in 83.1% of the sample at baseline and 49.5% at follow-up) and functional problems (82.8% with a Barthel Index < 75 at baseline and 53% at follow-up) were the most prevalent deficits. Emotional disturbances were those that most improved while behavioral problems were those that did less. Although global disability improved during treatment among most patients, only 11% of our patients, especially those with preserved cognitive function at baseline, could be classified as patients with mild disability at follow-up. CONCLUSIONS: Stroke consequences are multidimensional. The symptoms that the stroke can cause in multiple domains, as well as the pattern of recovery are widely diverse, with prevalence of behavioral long-term disturbances.

TITLE: Ictus y discapacidad: estudio longitudinal en pacientes con discapacidad moderada-grave tras un ictus incluidos en un programa de rehabilitacion multidisciplinar.Introduccion. Los ictus son causa frecuente de discapacidad en el adulto; sin embargo, la repercusion que los deficits que acontecen tras un ictus moderado-grave tiene sobre el grado de discapacidad final, asi como la respuesta de estos a programas de rehabilitacion, no se ha estudiado por completo. Pacientes y metodos. Se incluyeron 396 pacientes con Rankin modificado >= 3 despues de un ictus isquemico (n = 221) o hemorragico (n = 175). En todos los pacientes se evaluo su situacion cognitiva, conductual, emocional, motora y funcional. Todos los pacientes fueron incluidos en un programa de rehabilitacion multidisciplinar y reevaluados tras seis meses de tratamiento. Resultados. El riesgo de caida (escala de equilibrio de Berg < 45 en el 83,1% de la muestra) y los deficits funcionales (indice de Barthel < 75 en el 82,8% de la muestra) fueron los problemas mas prevalentes en el momento del ingreso, mientras que los conductuales lo fueron en el del alta (55,1% de la muestra). Los problemas emocionales fueron los que mas mejoraron, mientras que los conductuales fueron los que menos lo hicieron. El nivel de discapacidad global mejoro tras el tratamiento, aunque solo un 11% de los pacientes, especialmente los que tenian buena situacion cognitiva en el ingreso, lograron alcanzar una discapacidad leve. Conclusiones. Las consecuencias del ictus son multidimensionales. La afectacion de las distintas esferas y el patron de recuperacion son diferenciales, con predominio a largo plazo de los problemas conductuales.

Influence of temperature on decay, mycelium development and sporodochia production caused by Monilinia fructicola and M. laxa on stone fruits.

Brown rot on peaches and nectarines caused by Monilinia spp. results in significant economic losses in Europe. Experiments were conducted to study the effects of temperature (0-33 °C) on the temporal dynamics of decay and mycelium development and the subsequent sporulation on peaches and nectarine fruit infected by M. laxa and M. fructicola. The rates of decay and mycelium development increased with temperature from 0 °C to 25 °C for both Monilinia species. At 0 °C, decay was faster for M. laxa (0.20 cm2 days-1) than for M. fructicola (0.07 cm2 days-1); indeed, M. laxa was able to develop mycelia and sporodochia, but M. fructicola was not. At 4 and 20 °C, there were no differences in decay and mycelia development between the two Monilinia species. When temperature increased from 25 to 33 °C, the rates of fungal decay and mycelium development decreased. At 30 and 33 °C, M. fructicola decayed faster (0.94 and 1.2 cm2 days-1, respectively) than M. laxa (0.78 and 0.74 cm2 days-1, respectively) and could develop mycelia and produce sporodochia, whereas M. laxa failed at 33 °C. These results indicated that M. fructicola is better adapted to high temperatures, whereas M. laxa is better adapted to low temperatures. These results can be used to predict the relative importance of the two species during the season at a given site and to improve management strategies for brown rot in areas where both species are present.

Efectos de un programa de rehabilitación cardíaca fase III sobre los factores de riesgo hipertensión arterial y obesidad en personas mayores de 60 años con enfermedad cardiovascular / Effects of a phase III cardiac rehabilitation program on the risk factors of arterial

Cuantificar la evolución temporal de la hipertensión arterial (HTA) y la obesidad a lo largo del Programa de Rehabilitación Cardíaca (PRhbC) Fase III, y estimar la posible influencia de las características del paciente sobre la efectividad del programa.Diseño de estudioObservacional retrospectivo.Pacientes y métodosSe aplicó un PRhbC Fase III de un año de duración sobre 18 pacientes mayores de 60 años con enfermedad cardiovascular (ECV). Se midió la tensión arterial (TA) sistólica (TAS) y diastólica (TAD) así como la circunferencia abdominal (CA) en el momento inicial, a los 6 meses y a los 12 meses.ResultadosLa disminución de la TA resulta significativa tanto para la TAS (p-valor=0,00) como para la TAD (p-valor=0,02). La mejoría de la CA no es significativa (p-valor=0,14). En la evolución temporal de la mejora de la TAS y la TAD no resulta significativa la componente cuadrática (p-valores=0,28 y 0,27, respectivamente). Ninguna de las características del paciente influye significativamente sobre el cambio de la TAS, TAD y CA, con p-valores de 0,23, 0,82 y 0,34 para la edad; 0,81, 0,79 y 0,37 para el tiempo tardado en iniciar el programa; y 0,56, 0,57 y 0,98 para la capacidad funcional.ConclusionesEl PRhbC Fase III consigue controlar la HTA, con una mejoría constante a lo largo del programa. Éste resulta más efectivo para el control de la HTA sistólica que de la HTA diastólica. Sin embargo, no consigue controlar la obesidad. La efectividad del programa sobre la HTA y la obesidad no depende de la edad, del tiempo transcurrido desde el episodio cardiovascular hasta el inicio del programa ni de la capacidad funcional (AU)

To quantify time of evolution of arterial hypertension (AHT) and obesity during Phase III of the Cardiac Rehabilitation Program (CRhbP) and to assess the possible influence of the patient's characteristics on the effectiveness of the program.Study designAn observational retrospective study.Patients and methodsA Phase III CRhbP was applied for one year on 18 patients over 60years of age with cardiovascular disease (CVD). Both systolic (SBP) as well as diastolic (DBP) blood pressure (BP) and abdominal circumference (AC) were measured at the start of the program, at 6 months and at 12 months.ResultsThe decrease in BP was significant for both SBP (p-value=0.00) and DBP (p-value=0.02). Improvement in AC was not significant (p-value=0.14). Considering the time course for the improvement of SBP and DBP, the quadratic component (p-values=0.28 and 0.27, respectively) was not significant. None of the patient's characteristics had a significant influence on SBP, DBP and AC changes, with p-values of 0.23, 0.82 and 0.34 for age; 0.81, 0.79 and 0.37 for the time delay in initiating the program; and 0.56, 0.57 and 0.98 for functional capacity.ConclusionsThe use of Phase III CRhbP can control AHT, with constant improvement during the program. This is more effective in controlling systolic BP than diastolic BP. However, it was not able to control obesity. The program's effectiveness regarding BP and obesity does not depend on age, or on time from the onset of the cardiovascular episode until the onset of the program or on functional capacity (AU)

Neonatal outcome following pregnancy exposure to antidepressants: a prospective controlled cohort study.

OBJECTIVE: To determine the incidence of early adverse effects associated with antidepressant drug use during pregnancy. DESIGN: Prospective, controlled cohort study. SETTING: A Drug and Health Information Centre in Milan, Italy. POPULATION: A total of 200 neonates exposed to antidepressants in utero and 1200 controls. METHODS: Women who took antidepressants during pregnancy and delivered liveborn children between 1995 and 2003 were selected. Each case was matched for maternal age and gravidity to six randomly selected controls (not exposed to teratogenic drugs or drugs known to cause neonatal side effects). Odds ratio was estimated for attributable risks. MAIN OUTCOME MEASURES: Neonatal adverse events and Special Care Unit admission rate, assessed through an interview with the mothers. RESULTS: Of the 200 neonates exposed to antidepressants in utero, 14 had adverse events and 3 required Special Care Unit admission. Jaundice (n = 5), agitation (n = 3) and respiratory distress (n = 2) were the most common symptoms. In the control group, 50 newborns had side effects and no statistically significant differences in the prevalence rate compared to the exposed group were found, even after stratification for drugs and pregnancy period of exposure. Only the prematurity rate was significantly higher in exposed compared to non-exposed newborns (OR = 2.31; 95% CI 1.14-4.63). CONCLUSIONS: These results do not support an association between antidepressant exposure and unsafe fetal and neonatal outcomes in newborns. However, a collaborative international multicentre epidemiological monitoring of the use of psychotropic drugs during pregnancy is needed in order to guarantee pregnant women and their children safe and effective treatments, both at brief and long time from exposure.

Distribution of uranium and radium isotopes in an aquifer of a semi-arid region (Manouba-Essijoumi, Northern Tunisia).

Groundwaters from the Sebkhet Essijoumi drainage basin, situated in northern Tunisia, West of the city of Tunis, were sampled and analyzed for uranium and radium isotopes. Low (234)U/(238)U activity ratios coupled with relatively high (228)Ra and (238)U concentrations were found in the Manouba plain phreatic aquifer, at the northern part of the basin, where remote sensing has indicated that this plain corresponds to the main humid zone of the area. Low (234)U/(238)U ratios probably reflected short residence time for waters in the Manouba plain, and high ratios longer residence time in the south, where water reaching the phreatic aquifer seems to have previously circulated in rocks constituting the southern hills. Assuming that, in the Manouba plain aquifer, the groundwater flows downstream from the Oued Lill pass area to the South-West of the Sebkha, the difference in the (228)Ra/(226)Ra activity ratio suggests that the residence time of water has been 2.8 years longer near the Sebkha than upstream.

Rapid identification of single nucleotide polymorphisms by fluorescence-based capillary electrophoresis

We describe the application of two different fluorescence-based techniques (ddNTP primer extension and single-strand conformation polymorphism (SSCP)) to the detection of single nucleotide polymorphisms (SNPs) by capillary electrophoresis. The ddNTP primer extension technique is based on the extension, in the presence of fluorescence-labeled dideoxy nucleotides (ddNTP, terminators), of an unlabeled oligonucleotide primer that binds to the complementary template immediately adjacent to the mutant nucleotide position. Given that there are no unlabeled dNTPs, a single ddNTP is added to its 3' end, resulting in a fluorescence-labeled primer extension product which is readily separated by capillary electrophoresis. On the other hand, the non-radioisotopic version of SSCP established in this study uses fluorescent dye to label the PCR products, which are also analyzed by capillary electrophoresis. These procedures were used to identify a well-defined SNP in exon 7 of the human p53 gene in DNA samples isolated from two human cell lines (CEM and THP-1 cells). The results revealed a heterozygous single-base transition (G to A) at nucleotide position 14071 in CEM cells, proving that both fluorescence-based ddNTP primer extension and SSCP are rapid, simple, robust, specific and with no ambiguity in interpretation for the detection of well-defined SNPs

[Protrusion of Acetabular Cup in THR.]. / Protruze umelé jamky kycelního kloubu.

The authors report on a case of a complete protrusion of the cup of the hip joint into pelvis. Angiographic examination documents a considerable displacement of iliac vessels caused by the pressure of the displaced acetabular cup which poses a great risk of the injury of vessels during the revision surgery. As a solution of this complication the authors used a separate extraperitoneal approach described in literature as an approach to iliac vessels after Leitz allowing a safe removal of the acetabular cup and the ball of the prosthesis. For the removal of the stem the transgluteal approach was used. Key words: Pelvic protrusion of the acetabular cup, angiography, extraperitoneal release of iliac vessels.

[Circadian rhythm of cortisol in patients after reconstruction surgery of the esophagus using various intestinal segments for transplantation]. / Dobowy rytm kortyzolemii u chorych po operacjach wytwórczych przelyku wykonanych z uszypulowanych przeszczepów jelitowych.

The authors determined the circadian rhythm of cortisol expressed as blood 11-hydroxycorticosteroid level (11 OHCS) in group of healthy subjects and in 3 groups of patients after the formation of an artificial oesophagus from the jejunum, large intestine and ileum and caecum. In all examined patients the normal circadian rhythm of 11 OHCS was maintained. In patients with oesophagus made up of jejunum and large intestine mean level 11 OHCS in blood was insignificantly higher in comparison with a group healthy subjects. In group patients with the oesophagus made up of ileum and caecum the 11 OHCS level in blood was significantly lower in comparison to the group of healthy subjects and to patients with oesophagus made up of jejunum and large intestine.

[Multiorgan trauma complicated by purulent processes and occlusion of the digestive tract]. / Uraz wielonarzadowy powiklany procesami ropnymi i niedroznoscia przewodu pokarmowego.

Authors presented a case of multiorgan trauma complicated, during a treatment by purulent course and occlusion of digestive tract. They punctuate an important rate of intensive care and postoperative care, which enabled a diagnose of early dangerous complications and effective treatment.

[Secondary internal osteosynthesis after external fixation for recent or old open fracture of the lower limb]. / Ostéosynthèse interne secondaire après fixation externe pour fracture ouverte, récente ou ancienne, du membre inférieur.

PURPOSE: The purpose of our study is to analyse the indications, results and limits of secondary internal fixation after external fixation for open fracture of the lower limb. MATERIAL: Our series covered 21 patients treated between 1991 and 1994. There were 17 men and 4 women. Tibia was affected 17 times and femur 5 times (one bifocal fracture). In Gustilo's classification, we had 1 case of type 1, 12 of type II and 8 of type III. METHODS: We used 15 times the FESSA External Fixator and 6 times a monotube external fixator in emergency. We have done secondary 11 intra medullary nailing and 11 patients were treated by plating (one patient had both) 13 patients had a bone graft (cortico-cancellous graft). In the first group of patients (10 cases), the initial treatment gave us good results for both skin and bone healing. The external fixation was replaced by an internal one in order to accelerate bone consolidation and to allow an early weight-bearing. Removal of the external fixation was made at an average of 4 months postoperative. In the Second group (11 cases) the internal fixation was proposed because of an insufficiency of the external fixation leading to complications as: non union, mal union and bone defects. External fixation was removed in a mean time of 8 months. Internal fixation was completed by local bone autograft. RESULTS: 17 patients have been reviewed. Consolidation occurred with an average of 6 months after internal fixation 1 to 24 months. We had no deep infection but only 2 superficial ones. DISCUSSION: We chose 2 types of indication, and we called them programmed and for necessity. The first group of 10 patients whose stain was moderate and whose initial setting up had permitted a perfect anatomic reduction with a rapid wound healing. Internal fixation was performed after a short duration of external fixator. An early weight bearing was allowed so that the functional recovery could be obtained quickly. The second group is represented by patients whose internal fixation was done for non union, malunion or bone defect. In such a case autogenous cancellous graft was used to fill the defect.

[Massive reconstruction of acetabulum and proximal femur]. / Reconstructions massives du cotyle et du fémur proximal.

In revision hip surgery, allografts are useful for restoring the bone stock and allow the muscle fixation avoiding the use of massive metallic prothesis. MATERIAL AND METHODS: We have reviewed 51 hip reconstructions with a follow up of 4 years and half (1982 - 1991). Indications were: - revision arthroplasties with destroyed acetabulum, - bone tumors (mainly chondrosarcoma). RESULTS: The results are good for pain, articular movement and the consolidation of the allograft host bone junction. Some complications were encountered: - Post-operative death (early or late for tumoral extension) in case of major surgery for tumor (4 cases). - Deep infections (2 cases). - Weakness of the gluteus medius with hip dislocation needing anti-dislocation device. - Aseptic serous fluid leak meaning immunobiologic reaction of bone grafts (3 cases). DISCUSSION: This surgery has to be compared to massive reconstruction prostheses, arthrodesis with limb shortening, femoral head and neck resection and in some cases inter ilio-abdominal amputation which gives also major post-operative complication.

[Difficulties in diagnosis of esophageal achalasia]. / Trudnosci diagnostyczne Kurczu wpustu.

The authors present the case of 36 years old patient with dysphagia. This symptom appeared three years ago and became more severe for six month. The endoscopic and radiologic examinations revealed achalasia of the cardia. The surgical treatment was performed. Two weeks after surgery all symptoms disappeared. We present this case because achalasia of the cardia is comparatively rare disease which diagnostic is not easy.

[Massive reconstruction of the acetabulum and proximal femur]. / Reconstructions massives du cotyle et du fémur proximal.

Bone allografts are used in situations of repeated hip surgery to repair bone loss and allow muscle fixation without excessive use of massive metallic prostheses. We examined 51 cases of hip reconstruction after a mean follow-up of 3 and a half years. Indications were: reoperations on arthroplasties, usually after the weight carrying areas of the acetabulum had been destroyed; repeated operations on the upper extremity pellucid femurs; bone tumours (especially chondrosarcomas). Results have been good based on patient satisfaction, mobility and consolidation of the allograft-bone junction. Complications included: post-operative death after major surgery for invasive tumours (n = 4); sepsis (n = 2); hip luxation requiring an anti-luxation crescent (n = 3); and aseptic serous effusion suggestive of possible immunologic reactions against the bone grafts (n = 3). These operations were compared with massive reconstruction prostheses, with arthrodeses with limb shortening and with hanging limbs, and in certain cases with interilioabdominal amputations.