A semi-automated quantitative CT method for measuring rotator cuff muscle degeneration in shoulders with primary osteoarthritis.

BACKGROUND: Rotator cuff muscle degeneration is an important parameter to consider when planning shoulder arthroplasty. HYPOTHESIS: We hypothesized that rotator cuff muscle degeneration is correlated with scapulohumeral subluxation in patients planned for anatomical total shoulder arthroplasty (TSA). MATERIALS AND METHODS: We developed a semi-automated quantitative CT method to measure rotator cuff muscle degeneration, and retrospectively analyzed 107 preoperative shoulder CT scans of patients with primary osteoarthritis. On a standardized sagittal-oblique CT slice perpendicular to the scapular axis, two observers measured the cross-sectional areas of residual rotator cuff muscle tissues, normalized by the estimated area of healthy muscles. Muscle degeneration was quantified in a semi-automated manner, and divided into atrophy and fatty infiltration. Scapulohumeral subluxation was determined in 3D as the distance between the humeral head center and the glenoid surface center, projected on the same CT slice, and normalized by the humeral head radius. We tested all potential correlations between muscle degeneration and scapulohumeral subluxation. RESULTS: Muscle degeneration, primarily due to atrophy, predominated in the supraspinatus; it varied from 0.8% to 88.8%. Scapulohumeral subluxation varied from 2.5% to 72.9%, and was mainly in a posterior and postero-superior orientation. There was a significant but weak correlation between the amount of subluxation and both supraspinatus (R=0.207, P=0.032) and infraspinatus (R=0.225, P=0.020) degeneration. Inter- and intra-observer reproducibility of muscle degeneration measurements were both excellent (ICCs range=0.955-0.987 and 0.971-0.988, respectively). CONCLUSION: This new semi-automated CT method allows to quantitatively and reproducibly measure rotator cuff muscle degeneration in shoulders with primary osteoarthritis. Muscle degeneration is weakly correlated with scapulohumeral subluxation in patients planned for anatomical TSA. LEVEL OF EVIDENCE: Level IV. TYPE OF STUDY: Diagnostic retrospective study.

[Cerebral venous thrombosis after lumbar puncture and intravenous steroids in two patients with multiple sclerosis]. / Thrombose veineuse cérébrale après ponction lombaire et stéroïdes intraveineux chez deux patients souffrant d'une sclérose en plaques.

Two patients affected with a multiple sclerosis developed cerebral venous thrombosis after lumbar puncture and treatment with intravenous methylprednisolone. In one case, the course was favorable. The second patient died in spite of intracerebral thrombolysis. The autopsy confirmed the diagnosis of cerebral venous thrombosis and multiple sclerosis. We discuss the relationship between lumbar puncture, steroid treatment and cerebral venous thrombosis.

[Antithrombotic agents and prevention of cerebrovascular accidents]. / Antithrombotiques et prévention des accidents vasculaires cérébraux.

Prevention remains a major therapeutic approach of stroke. Inhibitors of platelet aggregation are the treatment of choice in the secondary prevention of an arterial embolism stroke. Aspirin (200-300 mg/d) is the most commonly used drug, ticlopidine (500 mg/d) is advised if aspirin is contraindicated or if a recurrent stroke of arterial embolism origin occurs in spite of treatment with aspirin. We are waiting with interest for the results of the clinical trial of clopidogrel, a derivative of ticlopidine. Till now, no studies have proved the benefit of antiplatelet treatment in the primary prevention of stroke. In non rheumatic atrial fibrillation, the unanimous results of recent studies confirmed the benefit of oral anticoagulation in the primary and secondary prevention of stroke. Although coumadin is superior to aspirin in non rheumatic atrial fibrillation, aspirin is an efficient alternative when anticoagulation is contraindicated.

[Recurrent Miller Fisher syndrome. Significance of anti-GQ1B antibodies]. / Syndrome de Miller Fisher recurrent. Signification des anticorps anti-GQ1B.

In the present report, an unusual case of recurrent Miller Fisher syndrome is described. The patient presented within ten years three similar episodes of ophthalmoplegia, ataxia and areflexia associated with oropharyngeal weakness and signs of mild distal sensory neuropathy. An elevated titer of anti-GQ1b ganglioside antibodies correlated well with the clinical symptoms and signs. The pathogenic role of these antibodies in Miller Fisher syndrome is discussed.

[Muscle cramps: mechanism , etiology and current treatment]. / Les crampes musculaires: mécanismes, étiologies et traitements récents.

Spasms of skeletal muscles occur in healthy individuals or in the course of functional disorders of the peripheral motor neuron or its axons. Like fasciculations, they are a motor manifestation, but a painful one. Cramps evoke the notion of ephapsis and of immature terminal axons. There are, however, also other responsible regulatory systems, mostly the sensible and spinal ones. Three personal observations are used to illustrate the various triggering mechanisms. A review of the literature on this subject is added. Symptomatic treatment has not changed over past decades: Quinidine remains the treatment of choice. Other stabilizers of cell membranes are actually available, whose usefulness varies as a function of the cause of cramps.