[Occult spinal dysrhaphia. Anatomoclinical study and therapeutic indications. Apropos of 20 cases].
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Biomedical subjects
Publications and source records attributed to F Pichon.
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Proximal disinsertion of the subscapularis is an effective operation in the correction of an abnormal position in internal rotation of the shoulder. Such a decision should be taken only if the head of the humerus is still well rounded. Restoration of movement by muscular transfer of active external rotation is performed in subsequent months only if the teres minor and infraspinatus muscles do not recover spontaneously.
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A wide exposure of the hip joint is often necessary in the treatment of congenital dislocation of the hip: Salter's or Olliers's approach, and in that of epiphysiolysis: Dunn's approach. This description of these approaches completes a review of the surgical approaches which are used in the child.
It exist multiple approaches to the hip in the child. This first section is devoted to a description of those approaches which offer only limited exposure of the joint. Alongside the medial approach used for joint puncture and the obturator approach, scarcely of any use, three important approaches respecting the integrity of the gluteal muscles may be used: those of Hueter and of Watson-Jones, to the anterior aspect of the neck of the femur and that of Moore, approaching its posterior aspect.
Twenty-three dogs underwent a complete transection of the spinal cord at L 1 level. Section was followed in eighteen animals by reconstruction effected through suture of the arachnoide with the aid of monofilament 10 X 0 thread. The operation was in all cases concluded by an osteosynthesis with metallic material in order to prevent any movements in the operated site, and a tight dural closure was achieved in order to prevent propagation of any epidural hematoma or secondary granuloma. This technique did not prevent an unfavorable evolution of the suture, which demonstrated three different morphological features:--necrosis of the spinal cord cut ends with secondary formation of a transverse cyst;--secondary infiltration of the operated focus by a fibrous scar growing from the inner aspect of the dura;--failure of axon regeneration through this fibrous block in spite of noteworthy proliferation of axons coming from the dorsal roots. A critical analysis of those results led to a comparaison with various previous works on the same subject. The most recent of these works have led to promising prospects which need confirmation.
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The authors have reviewed the results of 30 surgical procedures of progressive bone lengthening using the Wagner's technique. In 28 cases, internal fixation was applied at the end of the lengthening period. There were 17 femora and 13 tibae operated on. In 6 cases, lengthening was associated with a correction of the alignment of the femur, and in 2 cases was associated with the treatment of a non-union of the tibia. Complications are described; they were found to be relatively rare.