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Biomedical subjects

C Fontaine

Publications and source records attributed to C Fontaine.

At least 55 records · Page 3Linked to original sources
PubMed2000

[Rupture of the patellar ligament one month after treatment with fluoroquinolone].

Musculoskeletal disorders including arthralgia and myalgia are adverse effect common to all fluoroquinolones. We report a case of spontaneous rupture of the patellar ligament in a 37-year-old man participating in leisure sports which occurred one month after a three-week course of Ciprofloxacine(R). Several cases of tendon ruptures have been reported in the literature, including the patellar tendon. Unusual features in our case were the one-month delay before tendon rupture and the absence of inaugural signs. We reviewed the pathophysiological mechanisms leading to fluoroquinolone-related tendon rupture as well as the risk factors and discussed proper management. Care must be taken when prescribing fluoroquinolones for patients at risk. Close follow-up is most important.

Adult↗
PubMed2000

[Bankart procedure: clinical and radiological long-term outcome].

PURPOSE OF THE STUDY: There are few reports onlong-term outcome after Bankart procedure. The purpose of this study was to determine the rate of recurrent dislocation, the clinical results and the incidence of glenohumeral osteoarthritis after a minimum 10-year follow-up. MATERIAL AND METHODS: Ninety-seven Bankart procedures were performed in 97 patients between 1972 and 1986 for treatment of anterior shoulder instability with recurrent dislocations. We retrospectively reviewed 74 patients and obtained 64 complete radioclinical evaluations for an average follow-up of 16 years. Clinical evaluation was based on the G. Walch and the Duplay group score but for easier comparisons, we also calculated the Rowe et al. score. Radiographical evaluation was established on the Samilson and Prieto classification but real glenohumeral osteoarthritis with joint narrowing was noted independently as grade four. We also studied the contralateral shoulder. RESULTS: At last follow-up, 7 shoulders (9.5%) had recurrent dislocation, but two of them occurred subsequent to severe trauma over 18 months. Most patients (95 %) were satisfied or very satisfied. Six patients (8.1%) had persistent apprehension but in some it was not due to anterior apprehension. According to the Duplay score (or the Rowe score), 25 shoulders (44.6%) had an excellent result (35/61.4 %) 16 (28.6%) a good result (7/12.3%), 11 (19.7%) a fair result (11.19.3) and 4 (5.4 %) a poor result (4/7%). Operated shoulders were pain free for 75% and painful for forced movements only for 25%. External rotation at 90 degrees of abduction was reduced by 8.7 +/- 15.7 degrees. There was no limitation of internal rotation. Patients returned to preoperative sports activities at the same level for 70.9 % and at a lower level for 12.7%. According to the Samilson classification, 7 (13%) of the shoulders had grade 2 and 2 (3.7%) had grade 3 glenohumeral osteoarthritis. We found 4 cases (7.4%) of real glenohumeral osteoarthritis (grade four) and 2 of these patients had contralateral osteoarthritis of a non unstable shoulder. There was no perioperative complication. DISCUSSION: In our hands the Bankart procedure is appeared as a safe procedure with a low rate of glenohumeral osteoarthritis and a high rate of patient satisfaction.

Adolescent↗
PubMed1999

Innervation of the medial epicondylar muscles: an anatomic study in 50 cases.

The median nerve is classically distributed to the medial epicondylar muscles by two branches (superior and inferior) for the pronator teres muscle, a common trunk for the flexor carpi radialis and palmaris longus muscles, and a branch for the flexor digitorum superficialis muscle. The 50 dissections were made by two workers on 30 upper limbs of formalized cadavers and 20 limbs from fresh-frozen cadavers. The innervation of the pronator teres m. was classical in only 26% of cases, and the "normal" pattern for the flexor carpi radialis and palmaris longus mm. was found in only 40% of cases. The innervation of the flexor digitorum superficialis m. was the least subject to variations, a single branch being observed in 68% of cases. We found a solitary medio-ulnar anastomosis of Martin-Gruber to the flexor carpi ulnaris muscle. This study confirmed the great variability of the branches of the median nerve at the elbow, and the importance of identifying them in surgical procedures for transposition of the medial epicondyle.

Cadaver↗
PubMed1999

A trans STT, trans capitate perilunate dislocation of the carpus. A case report.

We report a case of carpal injury not previously described, associating three lesions of the carpus secondary to a hyperextension mechanism: fracture of the capitate, scapho-trapezio-trapezoid sprain and lunotriquetral ligament rupture. The patient was operated by percutaneous pinning after closed reduction. The capitate fracture was not fixed. At follow-up, the patient had no restriction of his everyday activities and was very satisfied.

Carpal Bones↗
PubMed1999

Esophageal cancer resection and right aortic arch: successful approach through left thoracotomy.

Esophagectomy is usually performed through a right thoracotomy because of the left position of the aortic arch. We report four cases of right-sided aortic arches in patients admitted for esophageal carcinoma. Two cases were included in total situs inversus syndrome and were thus diagnosed before esophageal carcinoma diagnosis. In these cases, the standard surgical technique was modified in a mirror image fashion and was thus performed through a left thoracotomy. The two other cases were of isolated right aortic arch and were discovered during preoperative evaluation of the esophageal carcinoma. Such asymptomatic anatomical variations have to be recognized by the esophageal surgeon because of the possible association of heart malformation and risk of iatrogenic aortotracheal or aortoesophageal fistula during tracheal or esophageal endoscopy, biopsy or intubation. Usually, esophageal resection and anastomosis are impossible through a right thoracotomy and left thoracotomy is required.

Adult↗
PubMed1999

Synovectomy combined with the Sauvé-Kapandji procedure for the rheumatoid wrist.

The aim of synovectomy-stabilization (synovectomy combined with the Sauvé-Kapandji procedure) of the rheumatoid wrist is to obtain a stable painless wrist, retaining enough mobility for function. Thirty-nine wrists were retrospectively examined, at a mean follow up of 64.8 months. The improvement in pain was very significant. We noticed a decrease in wrist motion affecting both flexion and radial deviation. The arthritic change in the wrist continued to increase. We noticed a mean ulnar shift of 2.2 mm and a mean increase in the radial deviation of the wrist of 7 degrees. Only transfer of the extensor carpi radialis longus tendon to the extensor carpi radialis brevis tendon was effective in correcting radial deviation of the carpus. Ninety-seven per cent of patients were very satisfied or satisfied. These encouraging results, even at advanced stages of wrist arthritis, have prompted us to lessen the indications for wrist arthrodesis.

Adult↗
PubMed1999

Epirubicin plus tamoxifen versus tamoxifen alone in node-positive postmenopausal patients with breast cancer: A randomized trial of the International Collaborative Cancer Group.

PURPOSE: To assess whether the addition of epirubicin (EPI) therapy to prolonged treatment with tamoxifen (TAM) improves relapse-free and overall survival in postmenopausal women with node-positive primary breast cancer. PATIENTS AND METHODS: Six hundred four patients entered onto a randomized clinical trial were allocated to receive TAM 20 mg/d for 4 years or TAM 20 mg/d for 4 years plus EPI 50 mg/m(2) intravenously on days 1 and 8 every 4 weeks for six cycles. Analysis was performed according to allocated treatment, with all randomized patients included (intention to treat), irrespective of eligibility status. RESULTS: After a median follow-up period of 5.7 years, an improvement in relapse-free survival (RFS) was observed for the TAM and EPI-treated patients, compared with those who received TAM alone. The unadjusted hazard ratio was 0.72 (95% confidence interval, 0.54 to 0.96), with a corresponding reduction in the odds of recurrence of 27.9% (SD, 12. 3), which was statistically significant (P =.023). Adjustment for prognostic and/or predictive factors did not materially affect the hazard ratio. No difference was observed in terms of overall survival (reduction in odds of death, 11.9% [SD, 16.3]; P =.46). Combined chemohormonal treatment was associated with a higher incidence of acute side effects but without a clear increase in long-term cardiotoxicity. Twelve nonbreast second malignancies, including five hematologic malignancies (two of which were cases of acute myelogenous leukemia), were observed. CONCLUSION: The data show that combined chemohormonal treatment reduces the risk of relapse in postmenopausal patients with node-positive breast cancer. No evidence was found, however, for an improvement in overall survival. The size of benefit observed for both outcomes was consistent with that reported in the Early Breast Cancer Trialists' Collaborative Group overview. The trial presented here, however, provides the first report of an improvement in RFS associated with the provision of a single cytotoxic drug in addition to prolonged TAM.

Adult↗
PubMed1999

[The biphalangy of the thumb. General review of the literature].

The thumb has only two phalanges whereas the other fingers present three. For two millennia, many anatomists tried to solve this riddle. Four different theories can be found in the review of literature, to explain what element misses in the radial column. In the first theory (Galen), the first metacarpal should be the proximal phalanx of the thumb. The particular ossification of the first metacarpal advocates for this theory. In the second theory (Sappey), the first metacarpal should result from the fusion between the true first metacarpal and the proximal phalanx of the thumb, and the proximal epiphysis should be constituted from both metacarpal and phalangeal parts. In the third theory (Paturet), the middle phalanx is thought to be missing. Apart morphological considerations, the main argument refers to symbrachydactyly, which consists in decreasing digital ray length (by reducing the middle phalanx), and usually affects digits excluding the thumb. In case the thumb is affected (in complex symbrachydactylies), the reduction concerns thus the first metacarpal, suggesting that the thumb middle phalanx has already disappeared. In the fourth theory (Pfitzner), the distal phalanx of the thumb should result from the fusion between the second and third phalanges of the thumb. This mechanism, named symphalangy, is well known in the foot, especially in the fifth toe, but also for the other toes, and even in the two ulnar fingers.

Humans↗
PubMed1999

[Right aortic arches: anatomic and embryologic classification].

Right aortic arches are rare but non exceptional abnormalities of embryonic aortic system. Sometimes responsible for tracheal or esophageal compression, they may be totally asymptomatic and fortuitously discovered. They have to be preoperatively identified in order to modify the procedure of an eventual mediastinal surgery. In this review, we describe the embryonic events which lead to these anatomical variations and the anatomosurgical classification used to precisely define their type. This anatomical definition is indispensable to adjust the surgical procedure to the consequent modification of anatomical relationships.

Aorta, Thoracic↗
PubMed1999

[Retrospective study of 23 arthrolyses of the elbow for post-traumatic stiffness: result predicting factors].

INTRODUCTION: The goal of the study was to determine the results of elbow arthrolysis for post-traumatic stiffness, and to identify factors governing the result of that procedure. PATIENTS AND METHODS: Between 1984 and 1997, 26 elbow arthrolysis were performed. Twenty-three patients were retrospectively assessed by an independent examiner, 3 patients were lost for follow-up. The mean age at surgery was 41 years. The traumatisms responsible for stiffness were: 5 elbow dislocations, 7 radial head fractures, 3 olecranon fractures, 8 humeral palette fractures. The surgical approach was 2 times posterior, 9 times lateral, 12 times combined (posterior and lateral). The surgical approach was chosen according to the preoperative analysis of the stiffness factors and the scars in case of previous surgery. RESULTS: At follow-up (85 months (12-144)), 5 patients were very satisfied, 17 patients were satisfied and one patient was not satisfied. Six patients had discomfort in daily gesture. Ten patients had no pain, 6 had pain while effort and 7 had climatic pain. Two ulnar palsies existing at arthrolysis did not improve after neurolysis and anterior ulnar nerve transposition. Range of motion increased in every sector of mobility, and at follow-up mean ROM was: 121 degrees flexion, -31 degrees extension, 69 degrees pronation and 65 degrees supination. The average absolute benefit in flexion-extension was about 38 degrees. The average relative (flexion-extension) benefit according to Merle d'Aubigné was about 44%. At follow-up, the average pronation-supination was higher than 100 degrees. The range of motion was not correlated to the type of injury, to the surgical management, nor to the type of rehabilitation program. Likewise, the delay between traumatism and arthrolysis had no influence on the result. On the other hand, the range of motion was directly correlated to the preoperative mobility and mobility obtained just after surgery (p = 0.001). However, the range of motion at follow-up was slightly decreased (5 degrees to 15 degrees) compared to the mobility obtained just after surgery. DISCUSSION: The final range of motion was mainly related to the severity of the preoperative stiffness. We noticed that few patients were bothered in daily gestures, in spite of a relative stiffness. The type of injury did not seem to influence the final result. Elbow arthrolysis remains a mobilizing technique giving reliable long-lasting results. CONCLUSION: The range of motion obtained after arthrolysis performed because of elbow post-traumatic contracture is mainly related to preoperative stiffness. By comparing with postoperative range of motion, a loss of 5 degrees to 10 degrees can be predicted.

Adult↗
PubMed1999

Whole blood capcellia CD4/CD8 immunoassay for enumeration of CD4+ and CD8+ peripheral T lymphocytes.

We evaluated the Whole Blood Capcellia(R) CD4/CD8, an immunoenzymatic method that provides absolute counts of CD4+ and CD8+ T cells in peripheral blood. The assay is based on the separation of T cells by use of an anti-CD2 magnetic bead suspension, followed by reaction of the CD4 or CD8 molecules with the corresponding monoclonal antibody coupled to peroxidase. CD4-positive monocytes were excluded from the assay. Freeze-dried magnetic bead-T-cell complexes were used as calibrators. Capcellia counts from HIV-1-infected patients were compared with those obtained by flow cytometry as the comparison method. The results by Capcellia correlated well with those by flow cytometric analysis: r2 = 0.95; P <0.001; (y = 0.96x - 22.1); Sy|x = 64 for CD4; r2 = 0.81; P <0.001; (y = 1.26x - 76.4); Sy|x = 139 for CD8; n = 76. The correlation between CD4+ T-cell counts determined by two trained experimenters was significant (r2 = 0.96). Our results indicate that this new ELISA technique for lymphocyte immunophenotyping is an efficient alternative to flow cytometry.

Antibodies, Monoclonal↗
PubMed1998

Inter- and intraobserver reproducibility in radiographic diagnosis and classification of femoral trochlear dysplasia.

Dejour's radiographic criteria are commonly used to diagnose and assess femoral trochlear dysplasia in case of patello-femoral instability. The aim of this study was to establish the intra- and interobserver reliability of these radiographic criteria. Sixty-eight lateral knee radiographs were examined independently by 7 observers (2 juniors, 5 seniors) to assess interobserver agreement, and the 2 juniors repeated the observations to test intraobserver agreement. These 68 true lateral views were harvested from clinical records of 64 patients who underwent a trochleoplasty because of patellofemoral instability. To evaluate the agreement on analytic data (morphologic type of trochlea) we used the kappa statistical method, and to evaluate the agreement on numerical data (depth and prominence of the trochlear groove) we used interclass correlation analysis. The "crossing sign" (between the trochlear groove and the anterior aspect of both condyles) was reliable since the probability of rating as normal a pathologic trochlea was only 3.1% (0 to 8.8%). In classifying trochlear morphology interobserver agreement was slight (kappa = 0.17) and intraobserver agreement was fair (kappa = 0.3). On the other hand, the measurements of the depth and prominence of the trochlear groove were more reliable since the interclass coefficients between observers were 0.62 and 0.38 respectively. The most frequent interobserver error was related to misdiagnosis of type II. To clarify Dejour's criteria we propose a diagnosis of type II only when 5 mm or more are measured between the intersections with the medial and lateral femoral condyles. We recommend the use of the prominence of the trochlear groove to evaluate the grade of bony trochlear dysplasia.

Adult↗
PubMed1998

[In vivo study of kinematics of the elbow using electromagnetic goniometer].

We used an electromagnetic goniometer to study the angular and translations displacements between the humerus and the 2 bones of the forearm. The electromagnetic gionometer allows acquisition of the coordinates and analysis of the 6 degrees of motion. To validate our external fixation apparatus, we used a fresh body upper limb. At first, a series of measurements was conducted with the apparatus. We then performed a series of measurements, by fixing the transmitter and receiver with external fixation pins directly inserted into the bones of the arm and forearm. To assess the reproducibility of our method, we chose a healthy subject. We performed 20 measurements over his right and left elbows. In order to study normal elbow kinematics, we performed measurements on 10 healthy subjects. The study of rotation showed that the apparatus was adapted to measure flexion-extension. It limited pronation-supination movement to about 26.7 degrees. Abduction was increased by 19.7 degrees by our apparatus during flexion-extension, but abduction was reliable within a 2 degrees range for pronation-supination. The sliding movements recorded during flexion-extension were reliable within approximately 3 mm for frontal translations, 6 mm for fitting, and 1 mm for external translations. For the sliding movements recorded in pronation-supination, frontal translations were reliable within about 7 mm, fitting was reliable within 1.9 mm and external translations were reliable within about 2.9 mm. During flexion-extension of the elbow, flexion-extension, frontal translations and external translations were reproducible. The reproducibility test showed that only 6 measurements were reproducible. The kinematic elbow study of a healthy subject showed that the average amplitude of flexion-extension was close to the measurement observed with the manual goniometer. The results in the healthy subject showed that the elbow is more stable during pronation-supination than during flexion-extension. This preliminary study should allow us, in the near future, to study elbow prosthesis kinematics.

Cadaver↗
PubMed1998

[Treatment of humeral fractures by Marchetti nailing. Apropos of 45 cases].

Between 1995 and 1997 we implanted 45 Marchetti nails. These nails were implanted for traumatic fractures in 39 patients, but also for pathologic fractures in 5 patients. Among these 39 patients, 7 were lost of view, the average age was 60 years. Among these 39 patients, 4 have got an other treatment before which failed. 10 fractures were placed D1, 8 fractures placed D2, 5 fractures placed D3, 16 fractures placed D4 according to the classification of Hackethal modified by De la Caffinière. The fracture type was classified according to A. O. classification: 7 A1, 11 A2, 7 A3, 2 B1, 6 B2, 1 B3, 4 C1, 1 C2. Among the 32 patients reviewed with an average of follow-up of 11 months, we have observed 5 very good results, 14 good results, 6 passable results and 3 bad results (classification of Stewart and Hundley). The average length of consolidation was 3 months. At follow-up the average elbow mobility was 129 degrees. Among the 3 bad results, there were 2 pseudarthrosis, in D4 zone. We have got 3 supracondylar fractures during the removal of the nail and 2 impactions of the metaphysis fracture. 5 patients had a nailing for pathologic fractures, one of them bilateral (4 women and one man, average age 65 years). Only two patients were reviewed, the fracture healed without any difference with the traumatic group. Contrary to other nailing, this materiel respects the rotator cuff. The global functional result was good.

Adolescent↗
PubMed1998

[Radiographic course of 39 rheumatoid wrists after synovectomy and stabilization].

Between 1984 and 1995, 39 patients underwent wrist synovectomy-stabilisation. Among these patients, 5 had died and 2 could not rectum for review. These 7 patients were excluded from the study. 32 patients were therefore included in the study. These patients had an average age of 50 years, with an average follow-up of 65 months. We used the Larsen classification to assess wrist osteo-articular involvement. To evaluate carpal instability, we measured: the carpal height with the Mac Murtry index, Shapiro's angle and the modified Shapiro's angle (the angle between the radial diaphysis and the second metacarpal diaphysis), the angle of finger ulnar deviation, the carpal ulnar deviation with the ulnar deviation index of the carpus, the radial deviation with the radial deviation index of the carpus, the carpal frontal dislocation. Carpitis continued to develop and Larsen's grade deteriorated in 50% wrists despite surgery. The average value of the radial sliding index of the carpus increased from 0.11 to 0.15: this showed an average ulnar sliding of 2.2 mm. The average Shapiro's angle increased from 118.2 degrees to 125 degrees. At follow-up, we observed anterior translation of the carpal bones and an increased distance between the proximal and distal carpal rows. The distance between the proximal and distal rows of the carpus appeared to be corrected by extensive synovectomy. Radio-carpal and mid-carpal synovectomy increased the carpal ulnar sliding. The modified Shapiro's angle was corrected by transfer of the extensor carpi radialis longus onto the extensor carpi radialis brevis. In contrast with other operations without stabilisation, the Sauvé-Kapandji procedure limited ulnar sliding and radial tilting of the carpus. Stabilisation of the carpus therefore participates in control of ulnar deviation of the long fingers. Transfer of the extensor carpi radialis longus onto the extensor carpi radialis brevis seems effective on wrist relaxation, by medialization of the traction force of the extensor carpi radialis longus. Our results with of Larsen stage IV were encouraging. The indication for wrist arthrodesis could be limited to stage IV with radio-carpal dislocation or stage V.

Adult↗
PubMed1998

[Fracture of the scaphoid carpal bone secondary to an intraosseous cyst. Apropos of a case].

The authors report a cases of scaphoid fracture secondary to an intraosseous cyst in a young patient performing a high-risk sport. Intraosseous synovial cyst is a frequent and usually asymptomatic disease. Its aetiology remains controversial. No cases of fracture have been previously described. Our patient may have presented several risk factors for scaphoid fracture secondary to a synovial cyst.

Adult↗
PubMed1998

The blood supply of the deltoid muscle. Application to the deltoid flap technique.

The major ruptures of the rotators cuff point out the problem of their surgical repair. Various techniques are described in the literature, among them the deltoid flap technique, described by Apoil and Augereau. This technique points out the problem of a few cases of flap early necrosis (Saragaglia). We studied the deltoid arterial blood supply on 40 cadaveric shoulder, after coloured injection into the subclavian artery. Our study included 40 macroscopic and 15 radiographic observations. The thoracoacromial artery gave off two collaterals to the anterior part of the deltoid muscle. The first one, called the deltoid artery, ran into the anterior part of the deltoid, near the deltopectoral line. In 53%, it gave off a first superior collateral branch, which ran at 3 cm under the clavicle. The second one, called the acromial artery, ran deep to the anterior part of the deltoid muscle, near the clavicle and the acromion. The posterior circumflex humeral artery was the most important artery. It supplied the posterior and middle parts of the deltoid muscle. The anterior circumflex humeral artery supplied the anterior part of the deltoid muscle in 63%. In ten cases, we dissected a deltoid flap. In all the cases, the acromial artery was cut near the acromion. When the deltoid artery gives off its superior collateral branch, it was always cut. Then, this flap was only vascularized by its inferior aspect. These results show that the flap is located in a poorly supplied area. Thus, the flap necrosis could be explained by an insufficient anastomotic network. An operative technique modification could avoid this complication.

Acromion↗