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Biomedical subjects

D Goutallier

Publications and source records attributed to D Goutallier.

At least 91 records · Page 5Linked to original sources
PubMed1990

[Chordoma of the mobile spine. Report of 9 cases. Review of the literature].

The authors reported 9 cases of chordomas of the mobile spine: 6 lumbars and 3 cervicals. There are 5 men and 4 women. Mean age at diagnosis is 60 years old. Mean delay between the first clinical manifestations and the diagnosis is 22 months. Clinical findings are not specific. Roentgenologic findings show 2 typicals aspects: a lytic lesion on the lateral side of the vertebrae frequently involving more than one cervical vertebrae, a mixed lesion (lytic and sclerotic) or only sclerotic was detected only at the lumbar spine. Magnetic resonance imaging and computed tomography are the most useful investigations to determine the local extension of the tumor. Certitude of the diagnosis is always microscopic. Evolution is difficult to precise in this kind of embryological tumor. Radical surgery at the earliest time is the best guarantee of a better prognosis which still remain severe.

Adult↗
PubMed1989

Methotrexate diffusion from acrylic cement. Local chemotherapy for bone tumours.

We investigated the possible use of acrylic cement containing chemotherapeutic drugs in the treatment of malignant lesions in bone. The diffusion of methotrexate (MTX) from methylpolymethacrylate implants was studied in vitro: polymerisation of the cement did not destroy the drug; liberation began immediately and about 10% was released by 18 hours. Some release continued for as long as six months. In vivo experiments on rats with induced osteosarcoma showed that MTX in cement had both local and general effects which were dependent on the dosage. A series of 17 large dogs with spontaneous osteosarcoma were then treated by local resection and cement containing MTX. General chemotherapeutic effects were detectable from 2 hours to 5 days, survival was increased and local recurrence was reduced, but there were four cases of delayed wound healing. Preliminary studies in human patients confirm the possibility that this method of local chemotherapy could be a useful addition to the treatment of malignant tumours of bone.

Animals↗
PubMed1989

[Superior radio-cubital congenital synostosis. Computed tomographic scanning studies and value of osteotomy fixation using an external fixator].

The purpose of this case report was to describe the radiological features by computed tomography and a modification in the fixation of the rotation after the usual transverse osteotomy: an external fixation was used; it allows post-operative vascular assessment with the possibility to derotate the correction in case of circulatory or neural impairment.

Adolescent↗
PubMed1989

[Comparison of nuclear magnetic resonance and histology in necrosis of the femoral head].

The histological aspect of the femoral head in patients operated for osteonecrosis (stages III and IV) and undergoing a total hip prosthesis, was correlated with nuclear magnetic resonance, pre- and postoperatively. The decreased signal of the NMR image is particularly clear in the area of sub-chondral bone plate, the fibrous and vascular area bordering the lower portion of the sequestrum. On the contrary, the aspect of the signal is heterogeneous in the sequestrum itself. This may be explained by a different condition of the adipocytes in the sequestrum.

Femur Head Necrosis↗
PubMed1989

[Natural history of hip necrosis in sickle cell disease. Apropos of 104 necroses].

The authors have followed 140 patients with sickle cell disease anemia (101 cases) or related hemoglobinopathies (39 cases). Among them hip involvement was noted in 55 (104 hips). Forty three times the hip involvement occurred in childhood and twelve times in adult life. When the necrosis appeared in childhood (84 hips) the average age was twelve. The deformity involved the femoral head (coxa plana, coxa magna) as well as the neck (short neck, coxa vara). After an average follow-up of nineteen years, clinical and radiological examinations evidenced 64 functional impairments and 25 arthrosis, 10 of which have already been operated on. The necrosis appearing during adult life (20 hips) had the same outcome as idiopathic necroses, leading rapidly to arthrosis after collapse of the sequestrum. It seems that the etiology of the necroses is linked to rheologic disorders, the deformity of the red cells causing arteriolar thromboses. In this series the hip disease was correlated with sickle cell retinopathy as defined after angiography. On the contrary there was no correlation with the severity of anemia, its treatment, the ethnical origin of the patient.

Adolescent↗
PubMed1989

[Results between 5 and 10 years of Chiari pelvic osteotomy in advanced hip arthrosis].

Thirty-two evolved coxarthritis in adults were operated on by Chiari pelvic osteotomy. Seventeen osteotomies were only pelvic. They concerned fourteen dysplastic hips and three primary coxarthritis. In ten cases, an additional intertrochanteric osteotomy of valgisation was performed in the same procedure. The intertrochanteric valgisation aimed to put in load bearing the medial part of a flattened head (nine out ten cases) and the Chiari to stabilize the hip. At last in five cases the Chiari can be considered as a salvage procedure aiming to delay a degradation of a previous intertrochanteric osteotomy. After a mean of follow-up of 6.4 years (from five to ten years), the results were good: twenty five hips has no clinical degradation. Among them twenty two has excellent to good result, according to the Merle d'Aubigné scale. Twenty four out those twenty five hips showed either widening of the joint space or no modification and twenty showed better congruity. In case of subluxated hip with flattened head, intertrochanteric valgisation osteotomy combined to the Chiari in the same procedure seemed to improve the quality of the results. That explains, perhaps, the lack of correlation found between the stage of arthritis and the results. Complications were very few (one transitory paresia of the peroneal nerve). All osteotomies healed, with a simple lying in bed of forty five days without fixation of the shaft nor plaster. Out of fast hip destructions, no formal contraindication could be found. But indications must be prudent over fifty years, in cases of necrosis and in cases of total joint space narrowing.

Acetabulum↗
PubMed1988

[Long-term results of interbody anterior arthrodesis in the treatment of common low back pain. Importance of preoperative discography findings].

The results of 50 anterior interbody arthrodeses performed for incapacitating chronic low back pain with disc degeneration were assessed with a mean follow-up of seven years and a rate of examination of 74.5 per cent. Systematic pre-operative discography was made of the levels above and below the fused region. The overall functional results were assessed using a new scale of evaluation which showed that only half of the patients were definitely improved at the latest follow-up examination. The outcome in relation to pain radiating to the lower limbs seemed to be the same as in low back pain and there was therefore no need for any posterior procedure. The factors that improved the success rate were an effective fusion, which was obtained in 80 per cent of cases at the first attempt and a healthy disc at the new effective lumbosacral level. The factors that diminished the success rate were mainly those relating to social and working activity, mainly the effects of accidents at work. Even though the results were less than perfect, interbody fusion, which the authors continue to practise, cannot be excluded from the therapeutic methods used to manage low back pain.

Adult↗
PubMed1988

[Idiopathic osteonecrosis of the medial femoral condyle. Treatment with tibial osteotomy or unicompartmental arthroplasty].

Thirty-three patients, with a mean age of 72 years, were treated for idiopathic osteonecrosis of the medial femoral condyle by a valgus upper tibial osteotomy in 18 cases and by a unicompartmental arthroplasty in 15 cases. The site of the osteonecrosis was in the medial femoral condyle alone in 27 knees and in the medial femoral condyle and the medial tibial plateau in six knees. Pre-operatively, the two groups were comparable with involvement localised to the medial compartment and with no changes in the lateral compartment or the patello-femoral joint. The mean age of the unicompartmental arthroplasties was higher. At follow-up at the present time, which was nine years for the osteotomies and five years for the prostheses, no knee has had to have a further operation. All the knees were improved by the operation. The functional results were the same in both groups. The necrotic nature of the medial femoral condyle did not affect the cementing of the femoral component in the arthroplasties and no loosening occurred. After osteotomy, no further depression of the osteochondral fragment developed. When the knee did not show osteoarthritic change before operation, the valgus tibial osteotomy was not able to prevent narrowing of the medial compartment in this series unless the correction obtained exceeded two degrees of valgus.

Aged↗
PubMed1988

[Debeyre's unicondylar osteotomy. Results in the treatment of lax arthritic genu valgum].

64 unicondylar varus osteotomies carried out on lax knees with advanced degenerative arthritis were reviewed with a mean follow-up of 9 years (5 to 18 years). 9 knees had to be reoperated early (during the 1st and 2nd post-operative year) because of complications occurring when this type of osteotomy was first performed. Among the 55 others, 44 knees are still markedly improved by the osteotomy: the knees are painless or almost painless, and restoration of the tension of the lateral ligaments at the time of osteotomy makes the laxity disappear quite lastingly. Modification of the articular relationships in the lateral femoro-tibial compartment reduces the sub-luxation and, post-operatively a lateral femoro-tibial interspace, which has not deteriorated in time, reappear. Femoro-tibial degenerations occurred after the 5th year and are related in 7 cases to a degeneration of the lateral femoro-tibial compartment and in 4 cases to a degeneration of the medial femoro-tibial compartment. In these 11 knees, the functional discomfort caused by the degeneration imposed, in the current follow-up, a re-operation for 5 of them (2 valgus tibial osteotomies in 2 medial femoro-tibial degenerations and 3 total knee prostheses in lateral femoro-tibial degenerations. Persistence of a valgus exceeding 4 degrees results in recurrence of the deformity; a definite hyper-correction resulted only exceptionally (2 cases) in a degeneration of the medial femoro-tibial compartment. Thus, unicondylar osteotomy seems able to improve lateral knee arthritis at an already quite advanced stage; but it requires a precise technique in order to avoid the early failures observed at the beginning of our experiment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗