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Biomedical subjects

C Vielpeau

Publications and source records attributed to C Vielpeau.

At least 37 records · Page 2Linked to original sources
PubMed1999

Naproxen in the prevention of heterotopic ossification after total hip replacement.

The effectiveness of naproxen, indomethacin, and a placebo were compared for the prevention of heterotopic ossification after total hip arthroplasty. Eighty-four men at high risk of experiencing heterotopic ossification received randomly either naproxen 750 mg per day, indomethacin 75 mg per day, or a placebo for 6 consecutive weeks after surgery. Efficacy analysis showed that in 70% of patients treated with naproxen, in 34.8% of those treated with indomethacin, and in 15% of those treated with a placebo, no heterotopic ossification appeared on radiographs taken at 6 months. Naproxen was significantly more effective than the placebo or indomethacin in preventing the development of heterotopic ossification. Stratification into five categories, according to Brooker's classification at 6 months, showed that both drugs were equally superior to the placebo. Class III heterotopic ossification occurred only in patients who were given the placebo. The improvement in clinical criteria was comparable in the three groups, although at 6 months there was an improvement in abduction in patients treated with indomethacin compared with those treated with naproxen and the placebo. The overall tolerance was rated good by 87% of patients and 86% of physicians, with no difference between the groups. The results show that naproxen, given daily for 6 weeks, is an effective and safe medication for the prevention of heterotopic ossification after total hip replacement.

Aged↗
PubMed1998

[Incidence of arthrosis in the results of the treatment of coxarthrosis in the young adult with Chiari's osteotomy. Retrospective study of 52 hips with 10.5 years of follow-up].

PURPOSE OF THE STUDY: Fifty two of 53 Chiari pelvic osteotomies performed between 1974 and 1991 were reviewed clinically and radiographically with an average follow-up of 10.5 years. MATERIAL AND METHODS: In more than 46 per cent of cases, the osteotomy was performed on a dysplastic painful hip with severe osteoarthritis. Major complications were rare. The Chiari's osteotomy fixation screw was removed in 16 cases. Technically, the average displacement was 22 mm. A ascending osteotomy, related to the level of the osteotomy (p = 0.001), provided good displacement. RESULTS: The functional results were very good or good in 65 per cent of the patients and lasted more than 10 years. Seventy five per cent of the hips were pain free. Radiographically, the center edge angle and the femoral head covering were corrected by the procedure. Degenerative changes of the hip joint were improved or stabilized in 63.5 per cent of the cases. Fifteen hips had undergone secondary total hip replacement, seven during the first five years and 8 after 13 years. DISCUSSION: Factors associated with a positive outcome included: age under 30 at the time of surgery (80 per cent of survivorship up to 15 years of follow up), low stage (I or II) of osteoarthritis, and a technically perfect Chiari osteotomy. The outcome of initial stage III or IV initial osteoarthritis were not as long lasting. Chiari osteotomy functional results were good for the initial 10 years, after this time they deteriorated quickly. CONCLUSION: Chiari pelvic osteotomy is an alternative procedure to early total hip replacement for severe painful dysplastic hips with low stage of osteoarthritis in young patients.

Adolescent↗
PubMed1998

[Lateral meniscal cyst. Retrospective study of 105 cysts treated with arthroscopy with 5 year follow-up].

UNLABELLED: A retrospective study was performed on 122 patients with 124 lateral meniscal cysts, selected from a series of 8100 knee arthroscopies (1.5 per cent). Eight of the patients were lost for follow up, 11 patients had chronic anterior cruciate ligament deficiency or previous medial meniscectomy. Therefore 105 of 124 patients were included in this study. Average follow-up was 5 years (range of 1 to 12.5 years). MATERIAL AND METHODS: Mean age was 33 years (range of 12 to 69 years). All patients had pain over the joint line with a palpable mass. All were noted to have a meniscal tear at the time of surgery and 60 (57 per cent) had a horizontal cleavage component. They were all arthroscopically treated. RESULTS: Meniscal tears were treated by arthroscopic partial meniscectomy in 104 cases and meniscal repair in one case. Cysts were treated by intra-articular debridement in 91 cases and open cystremoval in 14 cases. Eleven cysts recurred and a second arthroscopy was required. The clinical results, including cysts recurrence, were excellent or good in 87 per cent of cases. Osteoarthritis following treatment of these meniscal cysts occurred in 9 per cent of cases. CONCLUSION: When there is a cyst and no other intra-articular damage, the prognosis was excellent at 5 year follow-up. For lateral meniscal cysts; arthroscopic partial meniscectomy with intra-articular debridement yields predictable results.

Adolescent↗
PubMed1998

[Villonodular synovitis of the knee. Analysis of a series of 17 cases and review of the literature].

PURPOSE OF THE STUDY: Pigmented villonodular synovitis is a rare pathology found predominantly in the knee. We report management and treatment of 17 cases of pigmented villonodular synovitis of the knee. MATERIAL AND METHODS: The mean follow-up was 9 years (maximum: 17 years). The diagnosis was always confirmed at histopathology. There were 12 women and 5 men. The average age at the initial symptoms was 28 years. Six cases were diffuse, 7 localized and 4 cases were mixed. RESULTS: First treatment was only arthroscopic in 8 cases, and open synovectomy in 6 cases and mixed in 2 cases. Six patients had a recurrence, one had more than one recurrence. The mean delay for recurrence was 2 years and 5 months. Loss of range of motion was noted in 6 cases. For these 6 cases, flexion was always greater than 90 degrees and flessum always inferior to 10 degrees. DISCUSSION: Ethiopathogeny of this disease is unclear and no etiopathogenic theory is defined. Magnetic resonance imaging is useful for diagnosis, and absolutely necessary for preoperative tumor localization, and also for survey. In localized types, arthroscopic synovectomy can be performed with success but in diffuse or mixed form an open synovectomy must be performed according to the high rate or recurrence observed after incomplete synovectomy. Synoviorthesis with Yttrium 90 seems to be a good adjuvant for the treatment of recurrent pigmented villonodular synovitis. CONCLUSION: Arthroscopy is the treatment of choice for localized forms. We propose a mixed concept with an anterior and parameniscal arthroscopic synovectomy (without meniscectomy), an open synovectomy for the posterior localization, and an open anterior synovectomy when the tumor mass is too voluminous.

Adolescent↗
PubMed1994

[Detection of deep vein thrombosis of the limbs by ultrasound in orthopedic and traumatologic surgery. Results of 1647 studied patients].

INTRODUCTION: This study was undertaken to estimate the efficiency of duplex ultrasound scanning and its utility to detect deep vein thrombosis in orthopedic patients and to describe their features. MATERIAL AND METHODS: A total of 1647 in-patients, all receiving low-molecular-weight heparin, were investigated from 1989 to 1993, either for screening because of a high risk of thrombosis (asymptomatic group: 930 patients, mean age + SD: 63 + 17 years) or for clinical suspicion of deep vein thrombosis (symptomatic group: 717 patients, mean age + SD: 57 + 21 years). Difference between the two groups mean ages was significant (p < 10(-8)). An Hitachi EUB 450 duplex and an Acuson colour duplex 128 XP, with 3.5 MHz and 7.5 MHz linear probes were used. Veins were tested for compressibility in the transverse view from caval site to both ankles. Retrospective analysis of patients' database results was done. RESULTS: There was no significant difference in deep vein thrombosis rate between screening asymptomatic group (356/930: 38 per cent) and symptomatic group (2531717: 35 per cent). There was a linear relation, in the 2 groups, between age and deep vein thrombosis rate, from 10 per cent before twenty to 45 per cent after eighty years old. For a relative risk to have thrombosis detected before twenty definite at 1, it was 2.1 for 20-29, 4.9 for 40-49, 6.2 for 60-69 and 8.6 later than 80 years old. Proximal deep vein thrombosis was detected in only 5 per cent (87/1647) of patients. Distal muscular soleal veins were the most usual involved sites of thrombosis. Isolated soleal thrombosis were detected in 16 per cent (270/1647) of patients. There was no significant difference between the deep vein thrombosis rate after total knee or hip arthroplasty among selected patients for duplex scanning from 1989, and the true prevalence assessed among all the patients who have undergone total hip or knee arthroplasty during the last 6 months. DISCUSSION: Pessimistic results previously reported for duplex screening among asymptomatic patients are not confirmed. Calf vein thrombosis rate assessed with duplex exceeds by 15 to 20 per cent the rates assessed by contrast venography, among patients receiving low molecular weight heparins. That difference could be attributed to the isolated muscular soleal thrombosis usually missed at contrast venography. CONCLUSION: Deep vein thrombosis rate among orthopedic surgical patients, is much higher when detected with Duplex ultrasound scanning than detected with contrast venography, and is related to patient age. Soleal vein thrombosis is the most prevalent. Duplex ultrasound scanning is an efficient and useful screening method for deep vein thrombosis in orthopedic surgery. Mechanical calf venous pump stimulation in association with low molecular weight heparin, has to be evaluated in attempting to reduce those muscular soleal veins thrombosis.

Adult↗
PubMed1993

[Bone regeneration in the distal third of the fibula after resection of an aneurysmal bone cyst using an original technique].

Resection of the distal-third of the fibula for tumor may improve important static troubles of the ankle. The authors report an original technique which permits to benefit to osteogenic ability of periosteum to produce new bone in children and teenagers. This technique avoids to take out autograft and permits a complete regeneration of the fibula, using a "lift" procedure. It can be also used when a large bone graft has to be taken in the medial-third of the fibula and when the periosteum is separable enough to be completely preserved.

Adolescent↗
PubMed1993

[An unusual cause of fracture of the femoral neck: bone sarcoidosis].

A case of pathological fracture of the femoral neck in a 84-year old female is presented. The histological examination of the femoral head showed sarcoidosis. This diagnosis was not known before the trauma. Other localisations of bone sarcoidosis were found in the tarsus and the fingers after a systematic X-ray check-up.

Aged↗
PubMed1992

[Fatigue fracture below the internal tibial plateau after locked intramedullary nailing].

The authors present a case of stress fracture of the medial condyle of the tibia following intramedullary nailing with distal locking. This complication, which appeared two years after the surgical procedure and one year after the removal of the nail, has not yet been described in the literature. The patient was a young man without any excessive physical load. The presence of the intramedullary nail was accompanied by a bone clearness in the medial part of the superior epiphyseo-metaphyseal level of the tibia.

Adult↗
PubMed1991

[Epiphysiolysis of the upper extremities of the femur in idiopathic panhypopituitarism. Apropos of a case with review of the literature].

A case of a 39 year old male patient with slipped capital femoral epiphysis and idiopathic panhypopituitarism is reported. A review of the literature shows that a slipped epiphysis with hypothalamo-hypophyseal dysfunction, may be observed either in a proportional pituitary dwarfism or in a skeletal disproportion of the eunuchoidal or even of the acromegalic type. This association leads to examine the causal role of the hormonal status.

Adult↗
PubMed1989

Pigmented villonodular synovitis of the knee: results from 13 cases.

Arthroscopy is an indispensable tool in the diagnosis, treatment, and postoperative follow-up of pigmented villonodular synovitis (PVNS) and enables classification of PVNS into three forms: diffuse, localized, and mixed. A series of 13 cases of PVNS of the knee is presented; 12 patients underwent surgery. According to the anatomic type of PVNS found, the authors used extensive classic surgery or endoscopy. Follow-up averaged 4.2 years (range, 1-10 years). The best results were obtained in cases of localized PVNS. Overall, nine patients were totally asymptomatic at follow-up. Four patients experienced some pain when fatigued or with changes in the weather. There was no recurrence of symptoms.

Adolescent↗
PubMed1989

Allografts of the hemipelvis after tumour resection. Technical aspects of four cases.

Four en-bloc resections for malignant tumours of the hip, the peri-acetabular region and the iliac wing were reconstructed using an irradiated hemipelvic allograft together with a total hip prosthesis. Technical aspects include the use of an anterior Enneking approach which excises the previous biopsy site, division and re-attachment of the iliac crest and fixation of the prosthesis using a modified acetabular cup and three polypropylene artificial ligaments to increase the stability of the joint. Weight-bearing was allowed at three months. The oncological and clinical results were satisfactory after a mean follow-up of 19 months, with walking distances of 500 metres to two kilometres without pain.

Adult↗
PubMed1986

[Reconstruction prosthesis of the upper part of the femur. Intermediate results in 20 resections for tumor. Current trends].

Twenty total hip prostheses inserted after massive resection of the upper part of the femur for tumour have been reviewed after a 3 year mean follow-up. Fifteen cases were of primary malignant tumour. The mean resection of the femur measured 175 mm in length and was reconstructed using Cochin prostheses. From the oncological standpoint, the results were comparable with those obtained after disarticulation of the hip, but the functional results were, of course, much better. Five patients were able to resume their previous professional work; 13 were able to have a normal type of life and only 2 were severely crippled. Nineteen hips were painless. Nine patients could walk without a stick, 9 used one stick for walking outside and 2 used sticks permanently. Two cases were complicated by dislocation. Despite an extensive resection of the greater trochanter, one third of the hips were stable on standing on one leg, thanks to the design of the prostheses. No prostheses broke. Two loosenings of the acetabular cup had to be revised. No loosening of the femoral stem was found, despite the frequency of osteolysis of the diaphysis to 4-5 cms below the level of resection. The authors intend now to improve the design of the prostheses and to aid the reinsertion of the muscles, which can be improved by using homografts surrounding the femoral prostheses.

Femoral Neoplasms↗
PubMed1977

[Superselective arteriography of the hip. Technic, normal appearance and 1st results in primary osteonecrosis of the femoral head].

The arteries vascularising the femoral head were selectively catheterised via the axillary, or left humeral route. Injection into the posterio circumflex artery revealed an interruption of the superior capsular branches in necroses of the femoral head at their onset. In the more develped lesions either a persistence of the obstruction of the capsular branches or a revascularisation was found.

Angiography↗