[An unknown after surgical lengthening of the femur in children: spontaneous postoperative parasitic lengthening]. / Une inconnue après allongement chirurgical du fémur chez l'enfant: l'allongement parasite spontané post-opératoire.

The authors have studied overgrowth or diminished growth seen in 54 femora lengthened surgically by a one-stage procedure between 1963 and 1979. Thirty six cases were of poliomyelitis. An overgrowth was regularly seen of the order of 2.5 p. 100- that is 11 mm on average. This stimulation of growth by lengthening was not related to age. It was more marked where there was severe involvement. In contrast, in 13 cases of congenital femoral abnormalities and 5 cases of miscellaneous diseases (Ollier's disease, neurofibromatosis, sequelae of septic arthritis) overgrowth or diminished growth have been observed. This phenomenon was not constant and could not be predicted.

Treatment of lumbar disc herniation by chymopapain chemonucleolysis. A report on 120 patients.

Ninety of 120 patients with herniated lumbar discs who received an intradiscal injection of chymopapain achieved successful recovery. Sixteen of the 21 patients who underwent subsequent surgery had a good result. Study of the unsuccessful cases showed that disc sequestration and lateral stenosis were the major organic causes of failure. Certain radiologic criteria suggestive of sequestration and of important segmental stenosis are described. They appear to be a contraindication to chemonucleolysis. Psychogenic pain components and the failure of the enzyme to hydrolyse the nuclear proteoglycans in a few cases were the other two causes of poor results. A survey of postchemonucleolysis computed tomographic scans suggested that, although capable of digesting nuclear material in most cases, chymopapain may also work through an "anti-inflammatory" mechanism.

[Treatment of disk sciatica by chemonucleolysis. 120 cases]. / Traitement des sciatiques discales par chimionucléolyse. 120 observations.

One hundred and twenty patients suffering some sciatica due to disc herniation have been treated by chemonucleolysis. All the patients had received conservative treatment for at least four months. The minimum followup after nucleolysis was six months. In 114 patients, radiculography was positive and in 6, radiculography was negative but phlebography was positive. Patients with symptoms of spinal stenosis, or with signs of sequestrated disc or who had been previously operated on by laminectomy were excluded from the study. By a lateral extradural approach, 4000 units of chymopapain were injected into the disc under general anaesthesia after discography. All patients except 3 had only disc injected. Results were good in 92 patients. 21 of the 28 failures were operated on. In 18 cases, a mechanical cause was found at operation with 16 good results. Complications were rare and benign. No neurological complication was noted. It is concluded that chemonucleolysis should be the last step in the conservative management of sciatica.

[Treatment of intervertebral disk sciatica by chemonucleolysis. Analysis of 56 cases]. / Traitement des sciatiques discales par chimionucléolyse. Analyse de 56 observations.

The authors report 56 cases of sciatica treated by chemonucleolysis with follow-up ranging from six months to two years. All patients presented with manifest clinical symptomes of intervertebral disc herniation, and the diagnostic was verified by myelography. In all cases myelographic findings corresponded to clinical topography when the topography was precisely defined. This group of patients, therefore, was highly selected, and the authors attempted to eliminate excluded herniations when the myelographic anomaly appeared at a distance from the intervertebral space. Cases of sciatica caused by stenosis, paralytic sciatica, and pure lumbar pain were not treated in this study. At the end of the second month, 70 percent of patients obtained good results; the authors, believe, therefore, that failure of treatment can be ascertained by the eighth week. Thirteen of the fifteen treatment failures in this study were operated. Results of this surgery performed after chemonucleolysis were similar to results obtained from surgery performed as initial treatment. No serious complications were observed. Chemonucleolysis, therefore, appears to be an effective means of treatment for sciatica caused by intervertebral disc herniation. Based on their own experience and reports in the literature, the authors believe that chemonucleolysis is the ultimate stage of conservative treatment when classical measures have failed. In addition, the authors' experience and careful review of the literature has shown that serious iatrogenic accidents are exceptionally rare and can be avoided by the use of rigorous technique.

[Avascular necrosis of the femoral head following fracture of the neck. Early diagnosis using radioactive tracers]. / Nécrose avasculaire de la tête fémorale après fracture du col. Diagnostic précoce par traceur radioactif

The authors have injected Sr85 intravenously and studied its fixation in samples taken from the femoral head with a trephine in the course of reduction and fixation of fractures of the femoral neck. Thirty-eight cases were studied, of which ten developed secondary avascular necrosis of the femoral head. All the patients were followed up for more than three years. The standard technique is described in detail. The authors consider that this technique was valid. All the necroses were able to be predicted. The examination of the samples took about 15 minutes during the operation. The method makes it possible to choose between internal fixation and prosthetic replacement.