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Biomedical subjects

C Fontaine

Publications and source records attributed to C Fontaine.

At least 73 records · Page 4Linked to original sources
PubMed1997

[Arthrodesis of the wrist in inflammatory arthropathy. Effects of fusion of intracarpal joint spaces on functional results].

We retrospectively analysed 25 wrist arthrodeses performed in 23 patients because of inflammatory joint disease (21 rheumatoid arthritis, 1 case of Still's disease, 1 case of psoriatic arthritis) to assess: 1) the functional result, the position and the fusion rate; 2) the correlation between the radiographic features and the results on pain. The results were evaluated after an average of 56 months (12-121) by an observer not involved in surgery. 8 wrists were pain-free, 12 caused occasional pain, 4 caused frequent pain and 1 wrist was responsible for continuous pain at follow-up. The position of the arthrodesis was acceptable in the sagittal plane (mean extension 4.3 degrees), but with a slight ulnar tilt (mean ulnar tilt 12.8 degrees). Fusion was achieved in all cases after a mean of 8.2 weeks (5-16). All the intracarpal joints had united in only 8 cases, while the scaphotrapezo-trapezoid joint had not united in 17 cases, but fusion was spontaneously obtained in 8 cases. We identified 5 non-unions between lunatum and triquetrum, 5 non-unions between hamatum and capitatum and 3 non-unions between triquetrum and hamatum. Pain at follow-up was related to non-union of triquetro-lunate joints (p = 0.035). Wrist arthrodesis remains appropriate for severe lesions of the rheumatoid wrist in order to restore function and relieve pain.

Adolescent↗
PubMed1997

[Complete elbow prosthesis for inflammatory and hemophiliac arthropathy. A retrospective analysis of 22 cases].

We retrospectively analysed 22 total elbow prostheses (8 GSB III, 14 Kudo) implanted because of inflammatory (19 elbows) or haemophilic (3 elbows) diseases, in order to evaluate: 1) functional result and mobility; 2) frequency of loosening. The results were evaluated after an average of 36 months [16-67] by an observer who took part neither in therapeutic decisions, nor in surgery. Twenty elbows were associated with severe pain before surgery, while 16 elbows were painless and 5 had occasional pain at follow-up. The range of flexion was 133 degrees (from 96 degrees to 50 degrees) and the average range of extension was 32 degrees (extension ranged from [-10 to -90 degrees]). Only 2 elbows had a range of pronation-supination less than 100 degrees, the average range of pronation was 75 degrees (from [30 degrees to 90 degrees]) and 75 degrees (from [20 degrees to 90 degrees]) in supination. The functional results were comparable for the two types of prostheses. We observed 2 postoperative dislocations (1 GSB III and 1 Kudo) which were stabilized after surgical revision; and one late dislocation (1 GSB III) related to friction-wear. We identified incomplete ossification between the humerus and ulna in the 8 GSB III and 10 of the 14 Kudo. A reduction of 20 degrees in all mobility sectors was identified with the Kudo when ossifications were observed. Two implants became loose : the two pieces of 1 GSB III and the ulnar piece of 1 Kudo. One humeral piece of Kudo was broken at the junction between the stem and the trochlea. Three other GSB III had severe osteolysis which could compromise fixation or subsequent prosthetic revision. For the inflammatory and haemophilic arthropathies, the elbow prosthesis gave painless and satisfactory mobility for the short and medium term. The loosening of the 22 prostheses and the frequency of osteolysis with the GSB III (3/8) justify a longer follow-up.

Adult↗
PubMed1997

Long-term survival in an adult metastatic renal peripheral primitive neuroectodermal tumor (PPNET) with multimodality treatment including high-dose chemotherapy.

We describe a 42-year-old male patient with a primitive peripheral neuroectodermal tumor (PPNET) arising from the kidney. The patient was treated sequentially with surgery, radiotherapy, experimental cytokine treatment (rhIL-6), combination chemotherapy and consolidated in complete remission with high-dose chemotherapy, supported by autologous stem cells (AST) and hematopoietic growth factors. The patient remains in complete remission at 34+ months after AST and is surviving disease-free for five years after initial presentation. The case presented here is unusual because of the renal origin and the long remission duration and survival when compared with the usual outcome of adult metastatic PPNET. High-dose chemotherapy may have favorably influenced the outcome in this patient. The case is discussed in the context of the general treatment of metastatic PPNET.

Adult↗
PubMed1997

Selective induction of the secretion of cathepsins B and L by cytokines in synovial fibroblast-like cells.

We have investigated the potent influence of some cytokines, tumour necrosis factor-alpha (TNF-alpha), platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF) and interferon-gamma (IFN-gamma), on the secretion of cysteine proteinases (cathepsins B and L) by cultured synovial fibroblast-like cells from patients with rheumatoid arthritis (RA). After treatment of synovial fibroblast-like cells with cytokines, culture media were evaluated for cathepsins B and L by enzyme immunoassays, and for cathepsin B and L activities using the enzymatic substrates. Z-Phe-Arg-AMC and Z-Arg-Arg-AMC, and specific inhibitors. Treatment of synovial fibroblast-like cells with TNF-alpha or PDGF resulted in a marked increase in cathepsin B secretion. Moreover, after prolonged PDGF treatment, the amount of secreted cathepsin B returned to the low control level. In contrast, bFGF led to increased cathepsin L secretion. IFN-gamma induced both cathepsin B and L secretion. Our results show that cytokines induce a selective secretion of cathepsins B and L by synovial fibroblast-like cells. This selective effect of cytokines on the secretion of cysteine proteinases suggests that synovial fibroblast-like cell-mediated articular degradation is a highly regulated process.

Arthritis, Rheumatoid↗
PubMed1997

[Value of a synthetic osseous model obtained by stereo-lithography for preoperative planning. Correction of a complex femoral deformity caused by fibrous dysplasia].

PURPOSE OF THE STUDY: The authors investigated the application of life-sized bone models obtained by stereolithography in orthopaedics. MATERIALS: The method was applied to planify correction of a severe femoral bone deformity secondary to fibrous dysplasia in a 27 years old man. This deformity was responsible for abnormal hip range of motion 70 degrees/-10 degrees (flexion-extension), -20 degrees/60 degrees (abduction-adduction), -30 degrees/60 degrees (external-internal rotation), and restricted walking ability because of lack of abduction and external rotation. A "shepherd-cross" deformity was identified on X-rays. A correction osteotomy was considered but we were unable to planify the angle of osteotomy on plain X-rays. CT scan identified 100 degrees of varus cervical deformity and 90 degrees of cervical antetorsion, but CT scan was helpless to choose the position for the osteosynthesis device. METHODS: 2D pictures obtained by CT scan were introduced and treated on a Silicon Graphics Indigo2 hardware. Mimics software authorized 2D and 3D views of bone which were separated of soft tissue by color separation process. CTM software authorized the 3D bone surface reconstruction (3D files). The 3D files were used to obtain life-sized bone model in 6 hours by stereolithographic process (scale 1/1). RESULTS: We planified a 70 degrees valgus and 40 degrees derotation and chose the best location for osteosynthesis device considering the fibrous dysplasia (best location was the posterior and superior aspect of the femoral neck). The planified osteotomy was performed and we obtained the stability of a nail-plate in the femoral neck. During surgery, we observed the bone model and the deformed femur had the same shape. Likewise, the model strongly indicated the inside bone structure (ie distribution of fibrous dysplasia tissue). Bone healing was obtained after 5 months with improvement of range of motion [(70/0) (20/30) (30/20)]. Histologic examination diagnosed fibrous dysplasia without malignancy features. CONCLUSION: Computer-generated life-sized bone models are available from computer tomographic data by means of stereolithographic process. This technic was helpful to improve planification of this complex proximal femoral osteotomy. Obtaining life-sized bone models could improve preoperative planning in case of multidirectional deformity, unusual site for osteotomy, or severe deformity impairing the choice for fixation device or its position into bone extremities. The indications for this method should be restricted to unusual and severe bone deformities, with inadequate preoperative assessment by standard X-rays or CT scans. Likewise, this method could be indicated for preoperative planning of technically demanding osteotomies such as oblique plane.

Adult↗
PubMed1997

[Femoral reconstruction with endosteal bone allografts protected by a metallic mesh in reoperation of total hip prosthesis. 19 cases with an average follow-up of 83 months].

PURPOSE OF THE STUDY: To assess after 83 months of follow-up, the results of 19 femoral revisions carried out according to an original method combining a cemented stem and bone reconstruction by means of impacted-morcelized bone allograft protected by a titanium mesh. MATERIALS: Twenty hips (18 patients mean aged 58 at surgery) were included between 1986 and 1991. Five hips had a least one previous prosthetic revision, one hip was revised because of septic loosening. No patient was lost for follow-up, but two had died during the follow-up period: one patient died one month after surgery was excluded, one other died 7 years after the index procedure and was included with his last hip rating. Loss of femoral bone stock was severe according to the SOFCOT four stage rating system: 2 femurs were grade II, 14 grade III, and 3 grade IV. Femoral stem migration was assessed with landmarks recommended by Walker. All the measurements were performed with a digitizer (OrthoGraphics). METHODS: All the procedures were carried out through a posterolateral approach, augmented by 4 trochanteric osteotomies and 5 distal femoral windows. After prosthesis and cement removal, a bone plug was placed into the medullary canal. Then, cancelous bone morcelized allografts were impacted in the femoral defects through the medullary canal. A titanium mesh cylinder was placed into the femur to separate the graft from the cement introduced later to obtain fixation of the revision stem. The stem was extended about 5 centimeters over the distal edge of the grafts in order to bridge the femoral defects. The mesh was extended only in front of the grafts and was used to protect them from excessive cement penetration. RESULTS: Functional improvement was noticeable since the Merle d'Aubigné Hip score improved from 9.8 to 16.3 at follow-up. The pain score improved from 2.1 to 5.5 and walking score from 2.3 to 5. Adverse effects occurred during the first cases and were related to cement removal: 3 greater trochanter fractures, 5 distal femoral perforations and 2 non displaced femoral shaft fractures. The septic revision had recurrence of infection associated with radiolucent lines > 2 millimeters and the only one graft resorption. One trochanteric non-union was observed but no prosthetic dislocation. Only one femoral stem migration (4.4 millimeters) was detected without any other radiographic features of loosening after 9 years of follow-up. This stem was considered as loosed, but was not revised because of few clinical symptoms. Only 2 radiolucent lines less than 2 millimeters at the bone cement interface in Gruen's zones 3 to 5. Likewise, no radiographic feature of stress-shielding was observed. On follow-up X-rays, 3 hips had corticalisation of the grafts, and 12 hips demonstrated normal cancelous trabeculations in the grafts. CONCLUSION: Satisfactory functional and radiographic results were obtained with this method after 5 to 10 years of follow-up instead of severe preoperative femoral bone stock impairement. Likewise, we observed only one recurrence of loosening diagnosed with the help of digitized X-ray examination. Only one significant (> 3.5 mm) femoral stem migration was detected. Radiographic features of femoral reconstruction were observed but without histologic proof of graft integration. This method uses a longer stem than the "Exeter", but avoids a high rate of femoral stem migration and appears compatible with femoral bone reconstruction.

Adult↗
PubMed1996

[Articular fractures of the base of the first metacarpal. Comparative study of direct osteosynthesis and closed pinning].

The authors retrospectively studied 35 articular fractures of the base of the first metacarpal, with an average follow-up of 3 years. Treatment consisted of closed reduction and pinning in 19 cases, open reduction and rigid fixation in 16 cases. Results were estimated in terms of pain, range of movement (flexion-adduction arc and abduction-extension arc), strength and X-rays. There was no significant difference between the two groups, for age, sex, occupation, side and postoperative care. Only one significant difference between both procedures was found: flexion-adduction was better after osteosynthesis than after closed pinning (p = 0.03). The authors observed a better range of flexion-adduction and pinch strength after treatment of Bennett's fracture. Radiographic features were not different at follow-up between open and closed osteosynthesis.

Adolescent↗
PubMed1996

[Kapandji enlargement plasty of A1 pulley. Results in 15 primary trigger fingers with a 5 year (2-8 years) follow-up].

We retrospectively studied 15 enlargement plasties of the A1 pulley performed in a university orthopaedic department for trigger finger. The study objectives where: 1)to evaluate whether closure of the enlarged A1 pulley led to recurrent trigger finger; 2) to determine whether the complexity of the procedure was responsible for complications. Fifteen trigger fingers operated by enlargement of the A1 pulley according to Kapandji, instead of opening of the A1 pulley, were reviewed after 5 years of follow-up (2-8 years) by an observer who did not participate in surgery. These 15 fingers (6 thumbs, 7 ringer finger, 1 long finger and 1 index finger) were operated in 14 patients (11 females, 3 males) with a mean age of 55 years at surgery. All trigger fingers were primary (no patients had pathological conditions predisposing to trigger finger). After surgery, all symptoms resolved. No recurrence was observed during the follow-up period. No loss of range of motion or loss of sensation were observed. Reflex sympathetic dystrophy was observed in one case after surgery and resolved before the sixth postoperative month. The authors recommend this procedure, which doesn not lead to recurrence despite closure of the enlarged A1 pulley. Technically more demanding than simple A1 pulley opening, this procedure was safely performed in our department despite participation of junior surgeons.

Adult↗
PubMed1996

CD4 masking during human immunodeficiency virus type 1 infection, quantified on peripheral blood lymphocytes, is a potential marker of disease progression.

In human immunodeficiency virus type 1 (HIV-1)-infected adults, the proportion of gp120-free CD4 molecules on the surface of T lymphocytes was measured by double-epitope EIA and expressed as a CD epitope concentration ratio. In 51% of these patients (n=81), CD4 T cells showed a significant decrease (up to 100%) in the accessibility of the CD4 epitope in the D1 domain remained accessible. Of interest, a significant increase in the CD4 gp120 binding site concentration, without a change in T cell counts, was observed within 10 days after initiation of zidovudine treatment. Furthermore, CD4 masking by gp120 was associated with a poor clinical patient status. The assessment of the CD4 epitope concentration ratio is proposed as a surrogate marker of disease progression in HIV-1-infected patients.

Adult↗
PubMed1996

[Evaluation of methods for radiographic measurement of the tibial slope. A study of 83 healthy knees].

PURPOSE OF THE STUDY: We compared on lateral X-rays of 83 healthy knees, 6 methods measuring the tibial sagittal slope. Each method determined the tibial slope according to an independent anatomical axis. The goals of the study were to: 1) detect the differences between the 6 methods; 2) determine if any mathematical relation could be observed between the 6 methods; 3) compare accuracy of proximal anatomical axis versus long anatomical axis to evaluate the tibial slope. MATERIAL: 50 healthy patients (83 knees) knees were included in the study. The patients (26 male and 24 females) were 39.3 +/- 15.8 years old. METHODS: We obtained true lateral X-rays orientated with an image intensifier in order to obtain the exact superposition of the femoral condyles. The measurements were carried out by an observer according to two procedures: 1) by manual goniometric measurements twice; the mean value between both lectures was recorded; 2) with a digitizer (Orthographics TM, Salt Lake City, Ut). We measured the angle between the tangent to the medial tibial plateau and the perpendicular direction to each of the studied anatomical axis: tibial proximal anatomical axis (TPAA); tibial shaft anatomical axis (TSAA); posterior tibial cortex (PTC); fibular proximal anatomical axis (FPAA); fibular shaft axis (FSA); anterior tibial cortex (ATC). The values obtained with the digitizer were used to compare the six methods. The values obtained with the TSAA were considered as reference. RESULTS: Tibial slope values were different with the 6 methods. ATC gave the higher values and PTC the smaller. The difference could be 5 degrees between two methods measuring the same posterior tibial slope. However different, the values obtained with the 6 methods were strongly correlated (R > 0.85; p = 0.0001). We determined mathematical relationships between the values obtained with the 6 methods according to the regression analysis. The correlation with the values obtained with TSAA (reference values) was stronger for TPAA and TPC (respectively R = 0.92 and R = 0.9). The mean error between manual and digitized measurements was 1.28 degrees, but for the same knee the error could exceed 4 degrees. The highest error was 4.64 degrees with the TSAA, likewise the error frequency was higher with the TSAA (12 knees with an error > 3 degrees versus 7 knees for the other methods (p = 0.01)). In our 33 bilateral knees, after one side measurement, the forecast of the contralateral tibial slope showed an error of 5 degrees or more in 5 patients (15.1 per cent) and an error of 3 degrees or more in 13 patients (39.3 per cent). Among the proximal anatomical axis, only the TPAA and the TPC were not influenced by age, sex, patient height or weight. CONCLUSION: Values of posterior tibial slope observed with the 6 methods were different but correlated. Among the proximal axis, the TPAA and PTC gave higher reliability. The values obtained with these two methods: 1) were not influenced by morphometric variables, 2) were strongly correlated with the references values obtained with the TSAA, 3) gave low error with manual measurements by comparing with digitized measurements. Forecast of the contralateral tibial slope after one side measurement is unreliable. Satisfactory accuracy could be obtained with a two times manual goniometric measurement, but using a digitizer improves measurement accuracy and is less time consuming.

Adolescent↗
PubMed1995

Outcome of Chiari pelvic osteotomy in adults. 90 hips with 2-15 years' follow-up.

We studied retrospectively 90 Chiari osteotomies in 83 adults with pain, hip dysplasia and arthrosis. At follow-up after 6 (2-15) years, 35 hips were pain-free, 38 had rare or slight pain, and 17 had moderate or severe pain. The dysplastic acetabulum was corrected in all but 5 cases. There was diminution of arthrosis in 36 hips, no change in 38, and worsening in 16 hips. Functional outcome was best when surgery was performed before the age of 40, and in hips with the greatest degree of dysplasia. However, two thirds of the patients aged over 40 years at surgery had a good result.

Adolescent↗
PubMed1995

[Outcome of hip shelf arthroplasty in adults after a minimum of 15 years of follow-up. Long term results and analysis of failures of 56 dysplastic hips].

PURPOSE OF THE STUDY: The goal of this study was to evaluate late results of hip shelf arthroplasty in adults after a minimum of 15 years follow-up. MATERIAL: 65 hip shelf arthroplasty performed for painful hip dysplasia between 1964 and 1977 were studied retrospectively in 1992. These 65 procedures were performed in 57 patients mean aged 32 +/- 14 years [17-56]. Nine patients (9 hips) were excluded (2 deceaded, 5 lost for follow-up, and two reoperated because of severe infection). Consequently, the functional results were evaluated for 56 hips (48 patients). Before surgery, according to Merle d'Aubigné's hip rating system, all the hips were painfull (mean pain score was 2.6 +/- 1.7 [0-5]). On radiography, all the hips had a dysplastic acetabulum and arthritic changes. Arthritic changes were severe in 32 hips (57.1 per cent). METHODS: The hip shelf arthroplasty was carried out according to Roy-Camille. 10 hips had additional varus femoral osteotomy. The 48 patients (56 hips) included were evaluated by means of Merle d'Aubigné's hip rating system and AP and false lateral weight-bearing Xrays. In 1992, 24 procedures were changed for total hip replacement (THR) (17 before 15 years (early failure) and 7 after 15 years of follow-up (late failure)). These 24 hips were included with their last hip rating observed just before THR. Survival analysis was performed according to Kaplan-Meier using date of revision for THR as end-point. RESULTS: After 16.1 +/- 5.6 years of follow-up the functional score for 56 hips was: excellent in 4 hips, very good in 7 hips, good in 10, satisfactory in 14, poor in 17, and bad in 4. The survival rate established for 65 hips was 60 per cent at 15 years and 40 per cent at 21 years. Only 39 hips shelf arthroplasties were still functional after 15 years (mean follow-up 19.1 +/- 3 years [16-28], but 18 hips (46.1 per cent) were painfree or slightly painful (pain score to 5 or 6). Among these 39 hips, the results were excellent in 4 hips, very good in 7 hips, good in 10, satisfactory in 10, poor in 6, and bad in 2. Arthritic change was the main reason for failures: the Kaplan-Meier survival rate at 21 years was 87 per cent when arthrosis was slight and only 15 per cent and 42 per cent when arthrosis was moderate to severe (p = 0.0001). The adverse effect of arthrosis was promoted by lack of congruency for early failures, and by severity of dysplasia and hip subluxation for late failures. The additional femoral varus osteotomies had no influence on functional or radiographic outcome. DISCUSSION: Our study indicated that hip shelf arthroplasty performed for painful acetabular dysplasia in adult has a 40 per cent probability survival rate at 21 years. The high rate of revision (42.8 per cent) could be related to the prevalence of severe pre-operative arthrosis. The low rate of lost for follow-up (8.7 per cent) and the long follow-up period (16.1 years) made our conclusion reliable. CONCLUSION: In spite of a high revision rate we recommend shelf athroplasty to treat acetabular dysplasia in adults. This procedure, very reliable in cases of moderate arthrosis, could be performed in cases of severe arthrosis to delay and make easier THR, but a low survival rate could be expected unless dysplasia, lack of congruency and subluxation were mild.

Acetabulum↗
PubMed1995

The effect of five prosthetic feet on the gait and loading of the sound limb in dysvascular below-knee amputees.

The purpose of this study was to determine the effects of prosthetic foot design on the vertical ground reaction forces experienced by the sound and amputated limbs in a group of persons with dysvascular below-knee amputations. Stride characteristics, joint motion, and ground reaction forces were recorded simultaneously during a self-selected free walking velocity in seven subjects wearing five different prosthetic feet (SACH, Flex-Foot, Carbon Copy II, Seattle, Quantum). Subjects used each foot for one month prior to testing. Results indicated that the sound limb was exposed to higher vertical ground reaction forces than normal despite a reduced walking velocity. Use of the Flex-Foot resulted in the lowest sound limb vertical forces, which appears to be related to its large arc of dorsiflexion motion. In addition, there was increased loading response knee flexion of the sound limb indicating an attempt by these subjects to modulate floor impact. These results suggest that the intact lower extremity is susceptible to excessive floor impact, and that prosthetic foot design can have an effect on the magnitude of the vertical forces experienced by the limb.

Aged↗
PubMed1994

Vascular effects of loop diuretics: an in vivo and in vitro study in the rat.

The vascular effects of loop diuretics were studied in two models designed to eliminate hemodynamic repercussions linked to sodium and water depletion: in vivo, in unilaterally nephrectomized rats with a contralateral uretero-venous shunt, and in vitro, in the isolated perfused rat kidney. In anesthetized rats, local vascular resistance was calculated from the simultaneous recording of blood pressure and renal, iliac and carotid blood flows (electromagnetic flowmeter, Skalar). Furosemide and piretanide (10 to 80 mg/kg i.v.) induced a comparable dose-dependent decrease in renal vascular resistance, which was not modified by reserpine and indomethacin pre-treatment. The iliac relaxing response was blunted by vasoconstriction, which disappeared after combined treatment with reserpine and indomethacin. The relaxation induced in the iliac and carotid vasculature persisted after bilateral nephrectomy. In vitro, the vasorelaxing effect of diuretics in isolated rat kidneys perfused in an open circuit was studied after vascular tone had been re-established by a continuous perfusion of PGF2 alpha. Furosemide, piretanide and ozolinone induced a concentration-dependent decrease in renal tone (EC50 = 0.47 x 10(-4) mol/l, 1.03 x 10(-4) mol/l and 2.07 x 10(-4) mol/l respectively) in Wistar rats. A similar response to piretanide was found in spontaneously hypertensive stroke-prone rats (EC50 = 0.32 x 10(-4) mol/l) and in their normotensive controls (EC50 = 0.74 x 10(-4) mol/l). Our results show that loop diuretics induce a direct relaxation in the renal, iliac and carotid vasculature. This vascular effect, which appears at relatively high concentrations of the drugs, is prostaglandin independent and persists after bilateral nephrectomy.

Animals↗
PubMed1994

[Pigmented villonodular synovitis of the hip. Results of a national survey apropos of 58 cases].

Pigmented villonodular synovitis is an uncommon synovial disease which only rarely involves the hip. In a multicenter retrospective study, we identified 58 histologically-proven cases. There were 33 females and 25 males. Mean age at diagnosis was 38 years. In all but two cases, only one hip was involved; the right hip was affected somewhat more often (33 cases) than the left. Two patients probably had bilateral hip disease. Mean delay to diagnosis was four years. Pain was the presenting symptom in most cases. A palpable mass in the groin was found in six patients. Plain roentgenograms were considered normal in only three patients. Bony cysts were seen in 39 patients and kissing cysts in 19. Joint space narrowing was found in 40 patients and was diffuse in half the cases. Roentgenograms suggested pigmented villonodular synovitis in 63% of cases, osteoarthritis of the hip in 16%, and inflammatory hip disease in 14%. Additional imaging studies included opaque arthrography in 21 subjects, computed tomography in 23, magnetic resonance imaging in 11, and arthroscopy in 9. Initial treatment was osmic acid synoviorthesis in 14 patients, partial synovectomy in 9, and total synovectomy in 21; in addition, eight patients had insertion of a cup prosthesis and 13 had total arthroplasty of the hip. Treatment was successful in 65% of cases after a mean follow-up of three years; among the 35% of failures, there were seven recurrences (14%). Total hip arthroplasty was performed secondarily in nine patients. This study illustrates the diversity of roentgenological changes in pigmented villonodular synovitis of the hip and the high frequency of osteoarticular lesions precluding conservative treatment. Magnetic resonance imaging and/or arthroscopy should be used to establish the diagnosis at an early stage when conservative treatment with total synovectomy and synoviorthesis is most likely to be successful.

Adolescent↗
PubMed1994

[Reconstruction of the acetabulum using femoral head autograft in total hip arthroplasties].

We have reviewed, at a mean follow-up of 63.7 months, 36 total hip replacements performed with bulk acetabular autograft. Before surgery all the hips had acetabular insufficiency. Improvement of acetabular coverage was achieved in all cases with the patient's femoral head screwed to the ilium. Only one massive graft resorption was observed, simultaneous to loosening of the socket. Partial graft resorption was observed in 6 cases, and was not correlated with loosening of the socket. In all cases we observed radiographic features consistent with graft incorporation. Periprosthetic ossifications were noted in 13 cases. At follow-up, four sockets were loose, among which were included three Weill threaded rings. The mean functional improvement scores evaluated with the Merle d'Aubigné hip rating were: 4 points for pain, 2.7 points for mobility, and 2.4 points for walking. The authors concluded that femoral head, used as a massive autograft during total hip replacement, was a safe procedure for bone stock reconstruction in case of severe acetabular insufficiency.

Acetabulum↗
PubMed1994

Two-site enzyme immunoassay of CD4 and CD8 molecules on the surface of T lymphocytes from healthy subjects and HIV-1-infected patients.

A highly sensitive two-site enzyme immunoassay (Capcellia) was developed to determine the concentration of CD4 and CD8 molecules expressed on the surface of human T lymphocytes. This assay, performed in one step (20 min), involves the specific immunocapture of T lymphocytes and reaction of the CD4 or CD8 molecules with an enzyme-labeled monoclonal antibody (mAb). The results were expressed as molar concentrations of the T-cell markers on the basis of results obtained with calibrated CD4 and CD8 standards. The assay was sensitive enough to detect 0.4 pmol/L CD4 or 0.8 pmol/L CD8, which corresponded to approximately 20 x 10(6) CD4+ or CD8+ T cells per liter of blood. Mean concentrations in healthy adults were 17.2 pmol/L for CD4 and 22.1 pmol/L for CD8. The CD4 concentration was < 8 pmol/L in 50% of HIV-1-infected patients and in 95% of AIDS patients. Given the epitopic specificity of the mAb to CD4 we used, these values correspond to the concentration of CD4 molecules free of envelope glycoprotein (gp)120.

AIDS-Related Complex↗