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B Chaminade

Publications and source records attributed to B Chaminade.

10 recordsLinked to original sources
PubMed2005

Bacillus cereus infections in Traumatology-Orthopaedics Department: retrospective investigation and improvement of healthcare practices.

OBJECTIVE: To investigate 41 open fractures infected with Bacillus cereus in a Traumatology-Orthopaedy ward and propose a care protocol at admission. METHODS: All B. cereus strains isolated from patients hospitalized in the Traumatology-Orthopaedy ward between March 1997 and August 2001 were submitted to molecular analysis (RAPD and PFGE) in order to investigate a putative outbreak. Susceptibility to the main antibiotics and antiseptics used in this kind of surgery was also evaluated. RESULTS: The B. cereus clinical isolates were mainly isolated from patients who had initially open fractures and were not clonally related. Furthermore, analysis of the clinical data was in favour of a telluric contamination of the wound (wound contamination with terrestrial environments) before admission. Finally, betalactam antibiotics used for prophylactic chemotherapy were not effective against the strains tested as well as the antiseptics who displayed poor effect. CONCLUSION: B. cereus could be termed an emerging pathogen and people need to be aware of its potential importance in orthopaedic trauma cases. In this purpose, a systematic screening for B. cereus at admission should be necessary in front of patients with open fractures associated with telluric contamination. Furthermore, if this bacterium can be isolated, chemotherapy should be based upon ciprofloxacin that would prevent the development of B. cereus infection responsible for deleterious complications.

Adolescent↗
PubMed2004

[Percutaneous fluoroscopic and arthroscopic controlled screw fixation of posterior facet fractures of the calcaneus].

We describe a new technique for reduction and percutaneous osteosynthesis of displaced posterior facet fractures of the calcaneus which appears to overcome the problems encountered with other percutaneous methods described for this type of surgery. The method relies on the use of traction which allows automatic reduction of the greater tubersosity. The patient is installed on an orthopedic traction table. Pin traction provides anatomic reduction of the posterior articular surface and restitution of Böhler's angle under fluoroscopic and arthroscopic control. We used this technique in thirteen patients with fifteen displaced posterior facet fractures of the calcaneum. Mean patient age was 50.4 Years. Mean follow-up was twenty Months. We did not have any cutaneous or infectious complications in this short series. In the majority of the cases, the overall functional and physical results were excellent or good. The mean Böhler's angle was 27 degrees, corresponding to 83% correction compared with the healthy side. These preliminary results are encouraging. We were able to restitute calcaneum anatomy, shorten hospital stay, and avoid all skin complications. Indications for this percutaneous technique could be widened. It is a valid alternative to open treatment of posterior facet fractures of the calcaneum.

Adult↗
PubMed2002

[Importance of a cefpirome-vancomycin combination on bactericidal kinetics in severe MRSA infections in intensive care].

UNLABELLED: Vancomycin is always the drug of choice for treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in spite of his bactericidal kinetic. BACKGROUND: The aim of this study was to evaluate in vivo the improvement of bactericidal kinetic of vancomycin associated with cefpirome against MRSA infection in critically ill patients. METHODS: The prospective cross-over study was carried out in 20 patients with severe pneumonia or bacteremia. There were randomized to receive vancomycin 2 g per day (Group 1, n = 10) or vancomycin with cefpirome 2 g x 2 (Group 2, n = 10). Clinical recovery, bacteriologic parameters (bactericidal kinetic and bactericidal power in vivo at the peak and the valley), duration of ventilation and stay in ICU were comparatively explored in both groups. RESULTS: Clinical outcome did not significantly differ between Group 1 and 2. Bactericidal kinetics were better in the Group 2 (40% vs 60% after 6 hours to the dilution for 1/8e) but the difference was not significant. However, bactericidal power in sera was also better in the Group 2 with more bactericidal dilution at 1/16e (68% vs 88.8%: NS) and overall at 1/32e (10.5% vs 50%: p < 0.05) and CRP, an inflammatory marker, was significantly lower in the Group 2 than in the Group 1 (119.5 +/- 24 mg/l vs 198.6 +/- 78 mg/l: p < 0.05) on the third day.

Adult↗
PubMed2001

[Double measurement of the Böhler angle: prognostic value of radiological angles in posterior facet fractures of the calcaneus].

In 1931, Böhler proposed that measuring the radiological angle of the tuberosity could be useful in posterior facet fractures of the calcaneus to evaluate initial damage as well as reduction quality. In opposition to the 1998 SOFCOT symposium, certain authors considered that the Böhler angle has no prognostic value. Progress in pathological anatomy has helped to better understand posterior facet fractures, justifying the use of a "double measurement". The fundamental fracture line separates the posterior facet into a lowered medial fragment and a pivoted lateral fragment. The double contour of the posterior facet visualized radiographically allows measurement of a medial Böhler angle and a lateral Böhler angle. It is demonstrated that is the smaller the medial Böhler angle, the greater the subtalar degeneration. Surgical restoration of a satisfactory Böhler angle is a necessary prerequisite for a good outcome. "Double measurement" of the Böhler angle on the lateral view contributes to the prognostic value of this historical angle.

Calcaneus↗
PubMed2000

[Management of acute respiratory distress syndrome in Midi-Pyrnees].

OBJECTIVE: To assess management of acute respiratory distress syndrome (ARDS) in Midi-Pyrénées, France. METHODS: A prospective study using a questionnaire divided into 10 parts, definition, etiology, radiography, computed tomography, management, was conducted in 26 intensive care units in the Midi-Pyrénées. Management of ARDS in Midi-Pyrénées was comparted with management elsewhere as described in the literature. RESULTS: Overall participation rate was 73%. Disparities were found concerning the definition. Four etiologies accounted for 75% of all ARDS cases. Chest x-rays were used for positive diagnosis and thoracic scans for complications. Ventilatory and hemodynamic optimizations were the first line therapy used. Twenty-nine percent and 41% of the intensive care unites used nitric oxide and prone position respectively. CONCLUSIONS: There are differences between ARDS management in Midi-Pyrénées and that described in the current literature. Epidemiologic studies such as this one are necessary before publishing guidelines for the management of ARDS.

Diagnosis, Differential↗
PubMed2000

Experimental study of the subtalar joint axis: preliminary investigation.

An experimental study of the subtalar joint has been conducted with the aim of establishing its axis of movement as well as analysing the associated movement. For description of the axis, CT data for five positions of a single foot were reconstructed using a 3D programme, the 3D data was processed by Patran software. Measures of angular displacements were made from three amputated feet placed in a specially constructed foot frame. Four instantaneous axes of movement could be defined. Calculation of displacements showed an important rolling of the calcaneus (45 degrees). Tacking was evident in inversion, with an opposite displacement between the front and rear part of the calcaneus, whereas during eversion tacking affected only the rear part of the bone: these results were confirmed by 3D reconstructions. Henke's axis was described as that for the talonavicular joint, but acceptable for the subtalar joint. Several authors investigating the coordinates of this axis have reported large differences and described screw-like movements, the latter being incompatible with a fixed axis: instantaneous axes, however are compatible with a screw-like movement. The subtalar joint appears to work as a pivot joint during inversion and as a plane joint during eversion. Although Henke's axis has pedagogical value the subtalar joint has a series of instantaneous axes.

Adult↗
PubMed2000

[Simple screw fixation for calcaneal fractures: 60 cases with preoperative computed tomography analysis].

PURPOSE OF THE STUDY: In accordance with the conclusions established at the SOFCOT symposium in 1988, we propose surgical treatment of displaced fractures of the calcaneus with screw fixation after reduction. We developed an original classification system of 3D computed tomography images which allows a precise description of the fractures and guides joint and calcaneal body reconstructions. The purpose of this work was to provide a precise analysis of operated fractures in order to identify prognostic factors and validate use of exclusive screw fixation for calcaneal fractures. MATERIALS AND METHODS: This series included 60 operated articular fractures of the calcaneus. The Uthéza classification was: 12 vertical, 7 horizontal with 1 fracture line, 3 horizontal with 2 fracture lines, 23 mixed with 1 fracture line and 15 mixed with 2 fracture lines. 3D computed tomography evidenced the fundamental fracture lines and their anterior extension. Fixation was achieved with one screw inserted in a transverse position under the posterior facet and one oblique screw from the greater tuberosity to the sustentaculum tali. The medial and lateral Böhler angles were measured on plain x-rays. The analysis included search for a double line on the posterior talocalcaneal facet, secondary body displacement, the position of the oblique screw and the degree of posttraumatic subtalar wear. The clinical criteria established in the 1988 SOFCOT guidelines were recorded. Analysis of variance, Pearson and Spearman coefficients, and RIDITS analysis (the most powerful method available for evidencing a relationship between two qualitative variables one of which is ordinal) were used to search for prognostic elements and correlations. RESULTS: No severe complications were encountered with the wide lateral access. A negative medial Böhler angle was significantly correlated with an additional posterior facet line. A mean 80 p. 100 reduction in the lowering of the medial part of the posterior facet and an 87 p. 100 reduction in lateral pivoting were achieved irrespective of the type of fracture. Minimal secondary body displacements were significantly related to anchorage of the oblique screw outside the sustentaculum tali. Functional outcome was satisfactory (very good + good + average) in 75 p. 100 of the cases and physical outcome in 50 p. 100 (very good + good) irrespective of the type of fracture. Outcome was significantly correlated with reduction in the Böhler angle, double lines on the posterior facet, secondary displacement and osteoarthritis. DISCUSSION: The 3D analysis of posterior facet fractures using our classification was useful in guiding reconstruction with correction of the medial lowering and the lateral pivoting. A negative medial Böhler angle was a factor of poor prognosis: more posterior facet lines, joint wear and deterioration of the functional and physical outcome. Good outcome required good reduction of the Böhler angle and good anchorage of the oblique screw in the sustentaculum tali. Good subtalar mobility was associated with pain relief. Uniform anatomic and pathologic classifications and precise analysis criteria are needed for pertinent comparison between series and proper definition for indications for first-line reconstruction-arthrodesis. CONCLUSION: Measurement of the medial Böhler angle improves the sensitivity of revision criteria for articular fractures of the calcaneus. Screw fixation has proven its reliability.

Bone Screws↗
PubMed1999

New developments in phospholipase A2.

Some of the most recent data concerning various phospholipases A2, with special emphasis on secretory, cytosolic, and calcium-independent phospholipases A2 are summarized. Besides their contribution to the production of proinflammatory lipid mediators, the involvement of these enzymes in key cell responses such as apoptosis or tumor cell metastatic potential is also discussed, taking advantage of transgenic models based on gene invalidation by homologous recombination. The possible role of secretory and cytosolic platelet-activating factor acetyl hydrolases is also briefly mentioned. Finally, the ectopic expression in epididymis of an intestinal phospholipase B opens some novel issues as to the possible function of phospholipases in reproduction.

Animals↗
PubMed1998

[3-dimensional imaging of thalamic fractures of the calcaneum. Validation of classifying fractures into 3 forms].

UNLABELLED: Three dimensional CT scans enables to visualize the calcaneum and to follow the fracture pattern without any risk of errors. PURPOSE OF THE STUDY: This technique has been used to validate our previous classification (using three forms: vertical, horizontal, and mixed) which resulted from a two dimensional tomodensitometric study. MATERIAL: The study was based on a series of 74 fractures, all of them studied with 3D CT and 71 of which were operated. METHOD: The previous classification relied on correlation between lateral radiographs and position on coronal CT plane of the Palmer's fracture line. This we called the Fundamental Line (FL); so the vertical form had medial fundamental line, with thalamic verticalization; and so that the horizontal form with thalamic horizontalization had a lateral FL; the mixed form had a medio thalamic FL with double contoured image. RESULTS: In vertical fractures (16 cases, i.e. 20 per cent), the FL was seen denting the thalamus inwards, continuing forward and damaging the forward facet in about two thirds of cases. The thalamic fragment tilted on its axes frequently, with a great rotation movement; in about half cases, it extended backwards (propagated variation). This lateral fragment, called "cortico thalamic" (CT) explained the vertical thalamic x-ray image. In the horizontal fractures (15 cases, i.e. 20 per cent), the FL dents the thalamus outwards, the medial fragment, pushed downwards, explaining the horizontal image. In the mixed cases (40 cases i.e. 55 per cent) the FL was medio thalamic; the two fragments, downed medially and tilted laterally, are of equivalent importance, hence the double contoured image. In half cases, an accessory line separates the sustentaculum tali, creating the two lined mixed form (14 cases i.e. 35 per cent of the mixed). In those cases, the medial thalamic fragment is unsoldered, when in 50 per cent of cases (i.e. 7 out of 14), the pre-thalamic line, following the sinus tarsi, separates it from the forward part and completely isolates it. Therefore, the initial classification in three forms was in fact confirmed. Moreover, the fundamental line appears in all three forms, being the boundary between the lateral thalamic fragment (always tilted) and the medial fragment (always pushed downside). The anterior of cuboidian joint facets are frequently damaged by the forward prolongation of the Fundamental Line according to studied cases. DISCUSSION: This three form classification emphasizes the role of the Fundamental Line, which in effect acts as a boundary between the two typical displacements of this fracture: downward or rotation movement of the thalamic fragments (since it is there that the main displacements occur). A comparison with the Eastwood and Sanders classifications has been carried out. CONCLUSION: This three dimensional CT approach validates, visualizes and completes the three form classification. This will help us to understand fracture displacements in different forms, and therefore, the particular fracture reduction and osteosynthesis best suited for each case.

Calcaneus↗