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Biomedical subjects

A Lortat-Jacob

Publications and source records attributed to A Lortat-Jacob.

At least 19 recordsLinked to original sources
PubMed2006

Pasteurella multocida infection of a total knee arthroplasty after a "dog lick".

The patient we report here underwent a total knee arthroplasty (TKA) which got infected with P. multocida after her dog had licked a small wound at the third toe of the same foot. Despite a correct treatment comprising synovectomy and cleansing, and an active antibiotic treatment for 3 months, the patient was readmitted for persistent infection of the same knee 2 weeks after the end of the antibiotic treatment. Sampling during surgery allowed for the growth of a P. multocida isolate proven by a molecular method to be identical to the previously isolated strain. This recurrent P. multocida infection was treated by a two-step change of the TKA comprising a 2-month period of antibiotic treatment between the two surgical interventions.

Aged↗
PubMed2006

[Results of reimplantation for infected total knee arthroplasty: 107 cases].

PURPOSE OF THE STUDY: The purpose of this study was to assess the results of reimplantations of total knee arthroplasties complicated by infection. Outcome was assessed in terms of eradicated infection and function. MATERIAL AND METHODS: This retrospective multicentric study included 107 cases of infected total knee arthroplasties treated by changing the implants. Seventy-seven patients had a two-stage revision and thirty had a one-stage procedure. Patients were reviewed with a minimal 2-year and an average 52-month follow-up. RESULTS: Revision arthroplasty (one- or two-stage) eradicated infection in two out of three patients. With a two-year follow-up, revision arthroplasty was successful in 77% of patients without any sepsis risk factor, in 65% of patients with one risk factor and in 33% of patients with at least two risk factors. After reimplantation for total knee arthroplasty infection, overall function outcome was good (KS knee score: 74.8 after two-stage revision and 75.5 after one-stage revision, NS). After two-stage procedures, the knee outcome was excellent in one-third of patients, good in another third and fair or poor in the final third. After one-stage reimplantation, 40% of the knees had an excellent outcome, 30% a good outcome and 30% a fair or poor outcome. Regarding functional outcome, overall results were fair (KS function score 62.5 for one-stage and two-stage revisions). Functional outcome was fair or poor in 42% of patients with a two-stage procedure and in 55% of patients with a one-stage revision (NS). DISCUSSION: Our study was unable to disclose any difference between one-stage and two-stage revision for eradicating infection. Unfavorable systemic and local conditions decreased the rate of success after revision total knee arthroplasty for infection. Length of infection before reimplantation, number of surgical procedures and bacterial virulence or resistance were not, in our series, predicting factors for failure of septic revision total knee arthroplasty. No difference was found for the clinical and functional results between one-stage and two-stage procedures. Functional outcome was fair or poor for half of the patients after septic revision total knee arthroplsty. The use of an external device between the two procedures for two-stage revision significantly decreased the functional outcome compared with the use of a spacer. Articulated spacers did not offered any advantage compared with a static spacer for functional outcome.

Adolescent↗
PubMed2006

Polymorphism of the cell wall-anchoring domain of the autolysin-adhesin AtlE and its relationship to sequence type, as revealed by multilocus sequence typing of invasive and commensal Staphylococcus epidermidis strains.

We sequenced the adhesin-cell wall-anchoring domain of the atlE gene of 49 invasive and commensal Staphylococcus epidermidis strains. We identified 22 alleles, which could be separated into two main groups: group 1 (alleles 1 and 6 to 16, 32/49 strains) and group 2 (alleles 2 to 5 and 17 to 22, 17/49 strains). Allele 1 (the type strain sequence) was by far the most prevalent (21 of 49 strains). Multilocus sequence typing showed a clear relationship between the atlE allele and the sequence type (ST), with the "nosocomial" ST27 clone and closely related STs expressing group 1 alleles.

Adhesins, Bacterial↗
PubMed2005

[Not Available].

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Journal Article↗
PubMed2005

Use of genotypic identification by sodA sequencing in a prospective study to examine the distribution of coagulase-negative Staphylococcus species among strains recovered during septic orthopedic surgery and evaluate their significance.

A total of 212 coagulase-negative Staphylococcus strains recovered prospectively during 119 surgeries for proven or suspected bone and joint infection (BJI) were identified by sodA sequencing. These strains were identified as 151 Staphylococcus epidermidis isolates, 15 S. warneri isolates, 14 S. capitis isolates, 9 S. hominis isolates, 6 S. lugdunensis isolates, 5 S. haemolyticus isolates, 4 S. caprae isolates, 4 S. pasteuri isolates, 3 S. simulans isolates, and 1 S. cohnii isolate. Only S. epidermidis, S. lugdunensis, S. capitis, and S. caprae were found to be infecting organisms and were involved, respectively, in 35 (81.4%), 3 (7.0%), 3 (7.0%), and 2 (4.6%) cases of BJI.

Adult↗
PubMed2004

Drop foot after high tibial osteotomy: a prospective study of aetiological factors.

Drop foot is not uncommon after high tibial osteotomy for genu varum. The authors report their results of a prospective study of 16 patients operated on between May 1990 and May 1991. All patients had medial femoro-tibial osteoarthritis with a constitutional genu varum. They all had a subtraction valgus high tibial osteotomy fixed by a blade plate. The experimental protocol included clinical review, antero-lateral compartment pressure measurements, intra- and post-operative electromyography, assessment of the post-operative drainage, serum estimation of muscle enzymes and post-operative arteriography. From their own results and a literature review, the authors consider successively the different aetiological factors for post-operative drop foot. Certain deficits occur due to direct trauma on the nerve during high osteotomy of the fibula, by local high pressure due to poor haemostasis or ineffective drainage. In addition, there are several related phenomena. The pneumatic tourniquet sensitises the nerve to trauma, and stretching of the nerve during correction of the deformation depends on the local anatomical factors and their marked variation. In order to diminish the frequency of these post-operative complications, the authors suggest limiting the surgical approach, and limiting as far as possible the traumatic manoeuvres on the nerve by using a tibial resection jig, which allows correction without forced manoeuvres. Finally, the authors discuss the benefits of using a pneumatic tourniquet.

Action Potentials↗
PubMed2004

Bacteriological investigation of infected pressure ulcers in spinal cord-injured patients and impact on antibiotic therapy.

STUDY DESIGN: Retrospective. OBJECTIVES: To improve the use of bacteriological results for treating spinal cord-injured patients with infected pressure ulcers. SETTING: Microbiology and Orthopaedics Department, Ambroise Paré University Hospital, Boulogne-Billancourt, France. METHODS: Tissue specimens, sampled at the end of the surgical intervention from unbridled and cleaned ulcers were analysed. Drainage liquids were cultured at day 1 (D1) and day 5 (D5) postsurgery. For part of the patients, a presurgery superficial sample was analysed and compared with the surgical and postsurgical samples. RESULTS: In all, 168 surgical samples from 101 patients, 183 D1 and 104 D5 wound drainage liquids were included in this study. Out of the 168 surgical samples 17 (10%) had a negative culture, whereas 151 (90%) had a positive culture. For drainage liquids, the culture was negative in 48% and 56% of the samples at D1 and D5, respectively. The most frequently isolated species were enterobacteria, followed by staphylococci and streptococci. CONCLUSION: Culturing deep tissue specimens sampled from the surgically cleaned and unbridled ulcers allows for the isolation of the bacterial species that are really involved in the ulcer infection. As the identification of these bacteria and their antibiotic susceptibility are available, when the culture results of the D1 postsurgical drainage liquid is also available, it is easier to choose targeted antibiotic treatment.

Anti-Bacterial Agents↗
PubMed2004

Traumatic lumbosacral dislocation: four cases and review of literature.

Diagnosis, physiopathology, and treatments of four patients with traumatic lumbosacral dislocations are described. This is a rare but severe lesion of the lumbosacral junction that usually occurs in patients with multiple trauma. It often is not thought of and the diagnosis may be missed. Evidence of lumbosacral dislocation should be examined and confirmed by computed tomography scans in patients with multiple fractures of transverse lumbar processes, asymmetric lumbosacral joints on frontal images, or slipping of L5 over S1 on lateral images. Treatment consists of reduction of the dislocated and fractured parts, lumbosacral arthrodesis, a posterolateral graft, and posterior instrumentation. Instrumentation may be short, extending from L5 to S1, or long, from L4 to S1, depending on the extension of the lesion. In some cases, reduction can be done intraoperatively, when the L4-S1 instrumentation is inserted, provided L5 transpedicle screws are pulled posteriorly. It usually is preferable to explore the vertebral canal to ensure that there is no disc lesion compressing the dura before proceeding with reduction. Compression of the dura could be avoided with a preoperative magnetic resonance imaging scan on which a lesion of the L5-S1 disc is sought. Additional interbody vertebral arthrodesis should be considered when the L5-S1 disc is affected severely. This lesion should be looked for preoperatively with a magnetic resonance imaging scan and intraoperatively by exploring the canal. This can be done at the time of the posterior surgery or during a second anterior surgical procedure.

Accidents, Traffic↗
PubMed2003

[Re-infection with a different strain after prosthesis revision for bacterial infection: 13 cases].

PURPOSE OF THE STUDY: Treatment of an infected arthroplasty is always a delicate task. Multidisciplinary management involving surgeons, clinicians, bacteriologists, and the patient may be long and not always successful. Rare re-infections caused by a bacterial strain different from the initial strain may be a cause of failure. We analyzed cases of re-infection with a different strain in search of an explanation. MATERIAL AND METHODS: We reviewed 13 cases of re-infection in 12 patients with 7 hip and 5 knee arthroplasties. The causal germ had been clearly identified by the bacteriology laboratory during the first infection. The antibiotic regimens were confirmed by the medical team. All patients underwent surgery in our unit. At the time of the second infection, the implant had been removed, had been left in place, or had been changed. We recorded the new strains isolated and studied their antibiotic susceptibility profile. Treatment protocols and biological and functional results were analyzed. RESULTS: A mean 27 months after the re-infection, clinical and biological success had been achieved in 7 cases. The failures more frequently corresponded to cases where the first infection was caused by an aggressive germ and where the second germ was found during reimplantation. DISCUSSION: Theoretically a change in the causal germ could be explained by an insufficient initial biological analysis with an unrecognized or masked germ, by peroperative contamination subsequent to the difficulties observed in these hospitalized patients, and finally by secondary contamination. We recall the criteria of secondary infection (free interval, distant infectious focus, time sequence), measures taken to prevent peroperative infections, and conditions for optimal bacteriological sampling. If no resistance emerges after the first antibiotic treatment, there could nevertheless be a selection of conditions enabling growth of germs infrequently encountered. We stress that re-infection should not be considered necessarily as a failure of initial management but can, in certain cases, be considered as a de novo infection, and treated as such.

Adult↗
PubMed2003

[Dynamic radiographic evaluation of the antero-inferior gleno-humeral ligament].

PURPOSE OF THE STUDY: The purpose of this work was to propose an objective radiographic evaluation of the antero-inferior gleno-humeral ligament for comparison with the clinical assessment proposed by Gagey. MATERIAL AND METHODS: A test radiogram was obtained from 32 healthy volunteers (15 men, 17 women, mean age, 29 years, age range 21-54 years) free of shoulder disease. The dynamic test image consisted in a strictly AP view of the shoulder in forced abduction in neutral rotation. The subjects were awake and in dorsal decubitus. Displacements of the scapulo-thoracic articulation were limited by a counter-force applied to the acromion, in accordance with the method described by Gagey. Bilateral images were obtained for comparison. Several angles were measured between the humeral shaft and the scapula to search for the most reliable and reproducible measurement. RESULTS: Three series of angles were measured between the axis of the humeral shaft and the scapula. The mean angle between the axis of the humeral shaft and line drawn from the lower rim of the glenoid cavity to the lateral border of the scapular tubercle was 130.3 degrees (range 110-148 degrees) on the dominant side and 131.5 degrees (108-148 degrees) on the non-dominant side; giving 38 degrees variability on the dominant side and 40 degrees variation on the non-dominant side and a standard deviation of 10.4 degrees on the dominant side and 11.5 degrees on the non-dominant side. The mean difference in gleno-humeral abduction was 3.8 degrees (range 0-14 degrees) between the dominant and non-dominant side. DISCUSSION: Among the different angles measured between the scapula and the humerus, the angle between the axis of the humeral shaft and the line drawn from the lower rim of the glenoid cavity to the lateral border of the scapular tubercle was the most reliable and reproducible. Inter-observer measurements were well correlated. We observed that the variability in the radiographic values of the scapulo-humeral angle was much greater than the clinical values described by Gagey who, finding very constant values during forced abduction, described "invariable" scapulo-humeral abduction of the shoulder. Our study demonstrates that scapulo-humeral abduction is not an invariable parameter. More interestingly, the difference in amplitude between the dominant and non-dominant sides showed very strong interindividual correlation. Interobserver variability was low and reproducibility was good. CONCLUSION: This dynamic radiographic test enables a precise quantified assessment of pure gleno-humeral abduction which depends on the antero-inferior gleno-humeral ligament. This test is reliable and reproducible. Variations in the length of the antero-inferior gleno-humeral ligament evaluated radiographically were greater than described clinically. We did not find any difference in pure gleno-humeral abduction greater than 14 degrees between the dominant and non-dominant sides in healthy subjects.

Adult↗
PubMed2002

[Secondary infection of joint implants: diagnostic criteria, treatment and prevention].

Peroperative contamination is the most frequent cause of infection after arthroplasty. For other cases of infection subsequent to bacteremia or a neighboring focus, it would be more appropriate to use the term "secondary" infections rather than hematogeneous infections. Arguments favoring secondary infection include long symptom-free interval between prosthesis implantation and the infectious episode, a causal germ not generally responsible for peroperative infection, presence of a distant infectious focus, positive blood culture, and a positive bacteriological sample from the prosthesis level showing the same strain as grown from the distant focus or blood samples. Both acute and chronic infections are observed, leading to prosthesis dysfunction. History taking generally identifies a neglected acute but transient episode. Search for a bacteriological diagnosis must be completed before initiating an antibiotic regimen. If detected very early, washing with open synovectomy and resection of suspicious tissue should be attempted in order to maintain the implant if possible. Local antibiotics have proven efficacy. Beyond a certain delay, treatment for chronic infection usually requires removing the prosthesis, cleaning the bone interface, and new arthroplasty delayed or not. Search for the portal must be undertaken early in order to initiate appropriate local treatment. The causal event may be any invasive procedure, with or without material implantation. The risk-benefit ratio for antibiotic prophylaxis remains to be determined.

Acute Disease↗
PubMed2002

[Total hip arthroplasty and femoral head osteonecrosis in renal transplant recipients].

PURPOSE OF THE STUDY: Osteonecrosis of the femoral head is reported in a very variable proportion of renal transplant recipients. When these patients require total hip arthroplasty (THA), immunosuppression and poor bone quality increase the risk of aseptic loosening and infection. In the literature, functional outcome has been satisfactory although rates of early and late complications have varied greatly. The purpose of our work was to determine the long-term outcome in a series of renal graft recipients who underwent THA for osteonecrosis of the femoral head. MATERIAL AND METHODS: Forty-eight THA were implanted for aseptic osteonecrosis of the femoral head (Ficat grade III and IV) in 32 renal transplant recipients between 1974 and 1995 (21 men and 11 women). Mean age was 30 years at transplantation and 39 years at THA surgery. Thirty patients had been on hemodialysis for a mean 1 year prior to transplantation. Joint disease concerned 2 or more joints in 23 of the 32 patients. Fifteen hips had a surgical history: 8 drillings and 3 head arthroplasties. The THA was implanted under general anesthesia via the posterolateral approach. All implants were fixed with a gentamycin cement. A cephalosporin was used for the antibiotic prophylaxis in 20 cases and a cephalosporin/vancomycin combination in 24. Functional outcome was assessed with the Postel-Merle-d'Aubigné (PMA) score. Functional gain was [(PMAreview-PMApreop)/PMApreop]. General or local complications were recorded at last follow-up. The complete or incomplete nature of lucent lines seen on the last follow-up x-rays and their evolution were also recorded. Reasons for second procedures were noted. RESULTS: Early complications were: phlebitis (n=1), hematoma (n=7), dislocation (n=1), deep infection (n=2). At last follow-up (mean=5 years 7 months), four patients (6 THA) had died and six (7 THA) were lost to follow-up. Preoperatively, function was scored fair or poor in 91% of the patients. At last follow-up function was scored good, very good, or excellent in 75%. Mean functional gain was 38%. A second operation was necessary for seven THA due to aseptic loosening (mean delay 9 years 10 months), for five others for septic loosening (mean delay 6 years 8 months), and finally for two for instability (one early and the other after more than 2 years). In all, 29% of the THA were reoperated. Two deaths were related to late THA infection. Active lucent lines were observed in 11% of the THA (excepting patients reperated for loosening). DISCUSSION: The functional gain provided by THA in renal transplant recipients with aseptic osteonecrosis of the femoral head is clearly established. Implant survival remains a problem. The rate of early local complications was high in our series, mainly related to hematoma formation and infection. The infections observed were particularly severe requiring early comprehensive management at onset of clinical signs. For patients with suspected deep infection, we propose an aspiration biopsy of the joint to obtain a bacteriological sample. CONCLUSION: THA enables good functional outcome for renal transplant recipients suffering from osteonecrosis of the femoral head, but at the cost of a high risk of early and long-term complications not always reported in the literature.

Activities of Daily Living↗
PubMed2001

[Subcutaneous infection and necrotizing fasciitis of the limbs in adults. Surgical treatment].

We report the clinical aspect of subcutaneous cellular tissue streptococcal necrosis. These dramatic infections have 2 clinical aspects: superficial and deep. The hypodermic tissue necrosis is limited and does not affect the fascia. It is caused by the thrombosis of local vessels and is followed by skin necrosis. Necrotizing fasciitis is more dramatic and much less frequent. Anatomic pathophysiology concerns the soft tissue surrounding the fascia. A Streptococcus is involved in most of the cases for both diseases, even if this is difficult to demonstrate. Surgery is suggested after a short therapeutic test, if erythema does not regress after a few hours of penicillin-therapy. Surgery consists in excision of all the necrotic tissue. Deep necrotizing fasciitis calls for a really dramatic surgery with a high level of mortality and heavy functional sequels.

Adult↗
PubMed2001

[Femorotomy and cleaning for infected hip prostheses: report of 30 cases].

PURPOSE: We report infected hip prostheses treated by an original technique: frontal femorotomy after trochanterotomy. MATERIAL AND METHODS: This extensive technique enables perfect cleaning of the femur and truly effective freshening of the endomedullar canal. We report 30 cases operated since 1991 use of femorotomy has been systematic from 1995. RESULTS: We were able to reimplant 25 of these 30 hips. Our results after infection were rather good with 4 recurrent infections in difficult cases (multi-operated patients and multiresistant germs in half of the cases). Fusion of femorotomy was obtained in all cases. The mechanical outcome was not improved by femorotomy. The main problem was trochanter nonunion with 5 cases, all of them having had a trochanteromy during the first procedure. DISCUSSION: We use femorotomy as our routine technique for femoral cleaning in case of hip prosthesis infection. In less complicated cases, we do not remove the trochanter from the femoral valve, limiting trochanteric complications, the main problem with this technique.

Adult↗
PubMed2000

Arthroscopic treatment of bilateral humeral head osteonecrosis.

A 37-year-old woman with a renal transplant was treated by arthroscopic debridement for bilateral steroid-induced humeral head osteonecrosis. Radiologically, the right shoulder had been categorized as stage III and the left as stage IV according to Arlet and Ficat. Relief of pain and improved range of motion were obtained especially on the right shoulder. Arthroscopy is an efficient procedure for treatment of humeral head osteonecrosis in the renal transplant recipient including radiological stages III with episodes of locking.

Adrenal Cortex Hormones↗
PubMed2000

[Comparative study of 2 surgical techniques in the treatment of ischial pressure ulcers in paraplegic patients. Retrospective study of 90 cases].

This is a retrospective study concerning 90 paraplegic or tetraplegic patients with ischial pressure sores. Sixty-two patients were treated by gluteus maximus musculocutaneous island flap and 28 by VY hamstring myocutaneous flap. The authors describe the surgical technique of the two flaps. It is a one time surgery (excision and flap). There were 25% immediate complications for the patients who had VY hamstring myocutaneous flap and 27% for those who had gluteus maximus musculocutaneous island flap. There were 35% mid- and long-term recurrences with VY hamstring myocutaneous flap and 50% with gluteus maximus musculocutaneous island flap. The authors now use the gluteus maximus island flap for the small pressure scores and the VY bomstring flap for the big one which are near the anus.

Adult↗
PubMed1999

Wrist arthroscopy and dislocation of the radiocarpal joint without fracture.

The authors report a rare case of dorsal dislocation of the radiocarpal joint without any bony lesion associated. The traumatic cause was a high energy motorbike accident. Fractures of the other limbs were associated. The authors report the clinical, radiological, and arthroscopic features. Wrist arthroscopy showed a complete tear of all the extrinsic ligaments, a radial avulsion of the triangular fibrocartilage complex, and the integrity of the intracarpal ligaments, which guided the treatment. The dislocation was treated by closed reduction and radiocarpal pinning. The authors propose wrist arthroscopy in radiocarpal dislocation for diagnosis of soft tissue and cartilaginous lesions to guide the treatment (close or open).

Accidents, Traffic↗