Biomedical subjects

G Bollini

Publications and source records attributed to G Bollini.

At least 19 recordsLinked to original sources

PubMed1999

[Iterative fractures in type I primary hyperoxaluria. Report of 2 cases].

PURPOSE OF THE STUDY: Type I primary hyperoxaluria is a rare autosomal recessive disease linked to a deficit in an hepatic enzyme. The purpose of this study was to analyze orthopedics problems caused by type I primary hyperoxaluria before and after liver and kidney transplantation. MATERIAL AND METHODS: Two cases of children carrying this type I primary hyperoxaluria followed up after liver kidney transplantation are presented and compared to last publications. RESULTS: Combined transplantation progressively corrected osseous lesions and aspect of the stroma. However it did not provide protection against fractures particularly for femoral neck fractures. DISCUSSION: In type I hyperoxaluria overproduction of calcium oxalate causes its accumulation in the whole organism and particularly in bone. Osseous fragility favors pathological fractures. Only combined liverkidney transplantation can save and cure these children. Frequency of this fracture after transplantation indicates preventive plating at first pain, possibly at the same time as transplantation. Kidney transplant failure puts the patient in a "congealed" clinical state where the bone is very rich in oxalate and where the hemodialysis does not eliminate oxalate salts. CONCLUSION: Type I primary hyperoxaluria is a very rare disease. Fractures are very common even after liver and kidney transplantation and especialy femoral neck fractures. We think that preventive plating must be done at first pain. We do not have any explanation for bony weakness after liver-kidney transplantation.

Child↗

PubMed1999

[Idiopathic scoliosis: evaluation of the results].

Natural history studies in idiopathic scoliosis must be known to assess the effectiveness of treatment. Natural history is better known to day for mild angulations but as far as scoliosis are operated on for greater angulations natural history of scoliotic population with Cobb angle greater than fifty degrees is less and less available. Effectiveness of school screening is debated because of over-referral of either non scoliotic children or patient with mild non evolutive scoliosis. Attempt to find any criteria for evolutive scoliosis was disappointing. Only scoliosis with Cobb angle greater than thirty five degrees during growth spurt is defined as an evolutive scoliosis with a 95% confidence interval. Scoliotic curves show a tendency to progress even during adult life especially if the Cobb angle is over thirty degrees at skeletal maturity. Effectiveness of bracing is established for Cobb angle over thirty degrees. Comparing natural history and the results of bracing for mild idiopathic scoliosis controversies remain according to the effectiveness of bracing. Scoliotic population is more at risk for back pain than a population based control group. In severe idiopathic scoliosis non operated patients ar more at risk for back pain than operated one. Multi-hooks systems used for surgical correction of scoliosis are helpful in term of coronal plan correction but no system effectively derotates the spine. Scoliotic population experiences significatively more back pain than control group. There is a higher prevalence of negative perception of health but a more positive perception of self in the scoliotic population compared to a control group.

Adolescent↗

PubMed1999

[Osteopetrosis: diagnostic and therapeutic management. Apropos of 5 cases].

PURPOSE OF THE STUDY: The purpose of this study was to analyse 5 cases of osteopetrosis: 2 dominant and 3 recessive forms. MATERIAL AND METHODS: Among five cases of children suffering from osteopetrosis. There were three malignant and two benign forms. Three children affected by malignant form, received a bone marrow transplantation. RESULTS: Only one child who received a bone marrow transplantation was still alive and cured (one died due to transplantation complications, the other child died accidentally). The two children presenting a benign form were periodically followed for iterative fractures and did not present serious complications. DISCUSSION: Our analysis compared to literature review allows us to insist on bone marrow transplantation. This is the only possibility for these children who were condemned in the past. The frequency of iterative fractures on children presenting a dominant form necessitates medical and orthopedic follow-up. Narrowness of the medullary canal, bone fragility contra indicates intramedullary nailing when fixation is indicated. CONCLUSION: Osteopetrosis is an autosomal metabolic bone disease caused by an anomaly of osteoclasts action. Two main forms exist: the dominant form which is benign, and the recessive form which is malignant. Actually recessive forms can be treated and cured by bone marrow transplantation and the children who were in the past condemned are saved. Children with dominant form must be followed up by an orthopaedic surgeon because of bone weakness. The increase in number of cases detected in immigrant populations with a high rate of consanguineous marriages led us to present this study.

Bone Marrow Transplantation↗

PubMed1998

Five cases of Kingella kingae skeletal infection in a French hospital.

Five cases of Kingella kingae skeletal infections were diagnosed in children admitted to La Timone Hospital between 1992 and 1997. Patients were between 6 and 31 months old and presented with septic spondylodiskitis, calcaneus osteomyelitis, and hip-joint arthritis. All displayed either an upper respiratory tract infection or eczema during the month prior to their admission. Laboratory findings included an elevated leukocyte count and an elevated erythrocyte sedimentation rate. Standard radiography was unrevealing, but 99mTc bone scans and magnetic resonance imaging showed significant abnormalities. Isolation of Kingella kingae was achieved in all cases by culture of fluid aspirates using the Bactec blood culture system. This bacterium was sensitive to the most common antibiotics tested, and the outcome was favourable in all cases.

Arthritis↗

PubMed1998

Reimplantation of growth plate chondrocyte cultures in central growth plate defects: Part I. Characterization of cultures.

Growth plate lesions or resections may cause severe growth arrest because of the bony bridge between the epiphysis and metaphysis. Actual treatments for epiphysiodesis include resecting the bone bar and setting an interpositional material. Growth plate cultures may provide the appropriate cartilage necessary to restore growth potential when implanted in a growth plate defect. The aim of this work was to determine certain cell culture parameters in order to optimize in vitro cultures to obtain abundantly mature and functional chondrocytes. We studied the manner in which enzymatic digestion, carried out by various enzymes, obtained chondrocytes. Treatment with trypsin (0.2%) during 30 minutes at 37 degrees C and then collagenase (200 U/mL) during 6 hours was chosen. Under these conditions, 40 +/- 16 10(6) chondrocytes per gram of growth plate were obtained, and cellular viability was 79 +/- 12%. The density of the cellular seeding, the nature of the culture substrate, and the culture medium composition were determined to optimize the growth of differentiated cells. Seeding at 20,000 or 30,000/cm2 on a type I substrate and Ham F-12 medium not supplemented with either glucose or growth factors was demonstrated to be the best choice for this purpose.

Animals↗

PubMed1998

Reimplantation of growth plate chondrocyte cultures in central growth plate defects: Part II. Surgical experimentation in rabbits.

An original and reliable technique to culture growth plate chondrocytes was developed to obtain an abundant amount of mature and functional chondrocytes. Growth plates were provided from the epiphysis of 3-week-old rabbits. Isolation of the chondrocytes was optimized by the use of trypsin and collagenase. The culture was realized according to the following conditions: seeding at 20,000 or 30,000/cm2 on type I collagen substrate and in Ham F-12 medium without a supplementation of glucose or growth factors. After 7 days of culture, the implantation was to be carried out. Different implantation substrates were evaluated in vivo. Agar turned out to be the only substrate to provide strong and healthy chondrocytes 21 days after the grafting. Then implantation was tested on large iliac resections in rabbits to check whether an enchondral ossification occurred with the culture. Poor results were obtained because of an early disappearance of the cultured chondrocytes. In an other experimentation, the culture was implanted into surgically created defects in the growth plate area. In this case, the culture did produce an epiphysiodesis. However, the 6-week postoperative histological examination showed that the implant remained viable, continued to maintain a proteoglycanrich matrix, and began to organize in ordered columns of mature chondrocytes.

Animals↗

PubMed1998

Aneurysmal bone cyst in children: analysis of twenty-seven patients.

The authors have analyzed a retrospective series of 27 aneurysmal bone cysts (ABCs) in children and adolescents. The average age at diagnosis was 10 years (range: 3 years 7 months to 16 years), with a mean follow-up of 5 years (range: 1 month to 13 years 9 months). Pathologic fractures (8 cases) and pain (8 cases) were the main reasons for consultation. Of five spinal ABC patients, four presented with neurologic involvement. Although conventional radiology is useful for diagnosing ABCs, magnetic resonance imaging (MRI) is nevertheless the most important technique for checking the extent of the lesions. However, the diagnosis still must be based on the pathologic laboratory findings, even though this is sometimes difficult because of associated lesions. In lesions of the long bones, recurrence was observed after curettage in 5 of 12 cases. For this reason, simple resection or resection with reconstruction is recommended rather than curettage whenever possible. When an ABC is in contact with the growth plate in young children, blunt curettage should be performed to preserve the child's growth potential. Subsequent recurrence usually is easier to treat than an epiphysiodesis bridge and its consequences. The surgical procedures used to preserve the growth plate are described, along with methods of bone construction after surgery.

Adolescent↗

PubMed1997

Myositis ossificans: report of seven cases in children.

The clinical features of seven children with myositis ossificans (circumscripta and progressiva) and radiographic signs of the disease are described. We recommend systematic radiological examination to seek other skeletal malformations for congenital hallux valgus in young children, for it may be the first sign of a myositis ossificans progressiva. The "zone phenomenon" observed on histology, along with differential diagnosis and evolution, is documented. The necessity of a biopsy and different forms of treatment are discussed.

Adolescent↗

PubMed1997

[Focal fibrocartilaginous dysplasia and tibia vara. Apropos of 2 cases. Review of the literature].

Focal cartilaginous dysplasia is a rare condition associated with unilateral tibia vara in young children. The authors report 2 cases. In one patient spontaneous correction occurred at the age of 18 months. In the other case the patient's deformity persisted, and an osteotomy was performed at the age of 36 months. Through these 2 cases and 26 cases of the literature, the authors discuss the healing process and etiology. The most likely exploration is an abnormal development at the insertion of the pes anserinus inducing epiphysiodese like effect. In most cases, the growth plate of the proximal tibial appears to correct the deformity. Surgical correction is necessary after the age of 36 months, if the angular deformation is up to 30 degrees of varus.

Bone Diseases, Developmental↗

PubMed1997

[Lower limb morphotypes. A clinical study in 1401 children].

PURPOSE OF THE STUDY: The purpose of this study was to analyse the repartition between femoral anteversion and tibial torsion from birth to ten years of age in children. MATERIAL: One thousand four hundred and one children ranging from 2 to 13 years age were examined in public schools by the same clinician. METHODS: Qualitative data (foot progression angle, hindfoot aspect, knee position during gait) and quantitative data (femoral anteversion, tibial torsion) were clinically quantified. RESULTS: Repartition of femoral and tibial torsion showed four lower limb morphotypes in normal children. CONCLUSION: Four femoral anteversion and tibial torsion associations are encountered in normal children. Age variation of the lower limb orientation leed to have repetitive examinations in children with in or out-toeing gait in order to make distinction between normal and pathologic gait pattern.

Adolescent↗

PubMed1996

Acute fracture of the distal tibial physis: role of gradient-echo MR imaging versus plain film examination.

OBJECTIVE: Recent reports indicate that, compared with MR imaging, plain film radiography often underestimates the extent of injury in children with physeal fracture-separation. Such underestimation may have significant therapeutic and prognostic outcomes. We performed this study to assess the benefit of MR imaging compared with plain film radiography in the diagnosis and immediate treatment of acute fractures of the distal tibial physis. SUBJECTS AND METHODS: Twenty-nine patients with acute fractures, including 15 Salter-Harris II, four Salter-Harris III, four Salter-Harris IV, and six triplane fractures, were prospectively examined by MR imaging with gradient-echo sequences. The MR images were compared with plain film radiographs. All cases were reviewed in a blind fashion by two experienced radiologists to determine the Salter-Harris classification on the basis of first plain film radiographs and then MR images. Two experienced pediatric surgeons were asked to propose treatment on the basis of first plain film radiographs and then MR images. Both the radiologists and the surgeons were asked to rate the two techniques in terms of degree of confidence and overall diagnostic effectiveness. RESULTS: Only 1 or 29 fractures (3%) was misclassified by plain film radiography. MR imaging never caused the treatment plan to be modified. However, the position of fracture fragments in Salter-Harris IV and triplane fractures was always better appreciated on MR images, facilitating more accurate surgical treatment. Except for those in the misclassified fracture, all other fracture lines were seen on both plain film radiographs and MR images but were more easily seen on MR images. CONCLUSION: Gradient-echo MR imaging allowed easier assessment of fracture lines than did plain film radiography, but the latter technique remains the primary means of evaluating epiphyseal injuries. For acute fractures of the lower extremity of the tibia, gradient-echo MR imaging should be limited to complex fractures and to cases in which the classification of a fracture on the basis of plain film evaluation is uncertain.

Acute Disease↗

PubMed1995

Osteoarticular infection due to Coxiella burnetii in children.

We report three cases of chronic osteoarticular infections associated with Q fever in children. In two of them, serologic diagnosis was confirmed by direct immunofluorescence of Coxiella burnetii in the synovial and bone biopsy specimen. We suspect that bone infections due to Coxiella burnetii could be underdiagnosed because this etiology is not frequently seen.

Abscess↗

PubMed1995

[Munchmeyer's disease in children].

The clinical features of two children with myositis ossificans progressiva are described. Skeletal malformations can be observed in many sites: hand, femur, tibia and spine. Phalangeal abnormalities (shortened hallux, hallux valgus) are essential to the diagnosis. We recommend systematic roentgenographic examination to search for other skeletal malformations for congenital hallux valgus in young children because it can be the first sign of myositis ossificans progressiva. Progression of disability does not seem to be influenced by any form of medical treatment. Surgical removal of ectopic bone is thought to be followed inevitably by rapid recalcification at the original site.

Abnormalities, Multiple↗

PubMed1995

[Acetabular anteversion in congenital luxation of the hip].

MATERIAL AND METHOD: Acetabular anteversion angle (AAA) and orientation angle of the iliac bone (AOOI) determined by use of a CT scan were studied in CDH. 55 children with CDH were selected on hip arthrography for this study. Subluxated hips were excluded (i.e. opposite hip of a unilateral CDH is normal). 10 boys and 45 girls with a mean of age of 2 years 1 month (extremes from 1 to 4 years 3 months) were studied. CT scan was performed before any orthopaedic treatment in 3 cases of bilateral luxation and 14 cases of unilateral. In the other cases, time between the end of orthopaedic treatment and CT scan varied between 4 and 18 months. A group of 23 normal children, 10 boys and 13 girls, (mean age of 2 years 10 months) served as reference group. On the selected CT slide we measured AAA, AOOI, IAA and IAP (anterior acetabular index and posterior acetabular index as proposed by Guggenheim). RESULTS: We noted that the orientation of the iliac bone was variable in the two groups. This orientation angle could have higher or lower values. AAA: in bilateral luxation, this angle was higher (16 degrees +/- 5 degrees) than in reference group (13 degrees +/- 4 degrees), p < 0.005. In unilateral luxation there was no statistical difference (14 degrees +/- 4 degrees) with reference group, between normal and pathological side and when CT scan was performed before or after orthopaedic reduction. AOOI: there was no significant difference between bilateral, unilateral or reference group. Correlation analysis showed that AAA and AOOI moved in the same direction. IAA: in bilateral luxation this index was higher (p < 0.001); in unilateral luxation only right luxation showed an higher index (p = 0.002). IAP: no significant difference between the different groups. DISCUSSION: This study shows that there is any typical CT scan aspects of morphologic abnormality in CDH. The lesions of the anterior or posterior acetabular wedge are variable. The orientation of the iliac bone is also variable; we concluded that acetabular anteversion must be analysed depending on the morphologic aspects of the anterior and posterior extremities of the acetabulum and iliac bone orientation.

Acetabulum↗

PubMed1993

Physeal and epiphyseal extent of primary malignant bone tumors in childhood. Correlation of preoperative MRI and the pathologic examination.

Twenty-two patients with metaphyseal primary malignant bone tumors (17 osteosarcomas, 5 Ewing's tumors) occurring before closure of the growth plate were examined with plain radiographs and MRI in order to determine the physeal or epiphyseal extent of the tumor. Results were correlated with the pathologic examination. Transphyseal spread was pathologically proven in 13 cases (59%): 12 cases of osteosarcoma and 1 case of Ewing's tumor (70% and 20%, respectively). There was no significant relation between epiphyseal invasion, age of patient, length of tumor or, in the cases of osteosarcoma, response to chemotherapy. Plain radiographs showed epiphyseal involvement in 4 cases and there were 10 false negatives. MRI revealed epiphyseal involvement in all cases; there were no false positives or false negatives. T1-weighted images in coronal or sagittal planes appeared to be sufficient. These findings are very useful in planning surgical limb salvage procedures and stress the ineffectiveness of the "barrier effect" of the growth plate against tumor spread.

Adolescent↗

PubMed1993

[Fibrous dysplasia in children].

The authors report a series of 19 children (ten boys and nine girls) presenting fibrous dysplasia with an average follow-up of 7 years 10 months. Twenty five bones were involved. The average age at diagnosis was 9 years (range 3 years to 14 years). Fatigue fractures and pains were the main reasons for consultation. The most frequent anatomic sites were the femur, the tibia and the humerus. In six cases it was decided to simply watch the children without any treatment. The clinical results were good for 18 children. In two cases the initial radiological lytic aspect remained at the longest follow-up. Nine complications (among which two iterative fractures and three recurrences) occurred. None of the cases developed malignant transformation. The authors discuss the different possibilities of treatment with a review of the literature.

Adolescent↗

PubMed1993

[Aneurysmal cyst of the bones in children].

The authors have analysed a series of aneurysmal bone cysts (A.B.C.) in children and adolescents which were reviewed at an average follow-up of 4 years 2 months (6 months-15 years). The average age at diagnosis was 8 years (3-19 years). Pathological fractures were the main reason for consultation, probably due to the predominance of central lesions. If conventional radiology remains indispensable to diagnosis, magnetic resonance imaging is nevertheless the most important examination in determining the extent of the affection. The diagnosis remains anatomopathological, even if this may be difficult due to associated lesions (A.B.C. illness and A.B.C. symptoms). In long bones lesions, we observed recurrence after curettage in 3 out of 7 cases. For this reason the recommend simple resection or reconstructive resection rather than curettage whenever possible. 5 lesions in contact with growth plate were observed. In such cases we recommend its conservation by careful curettage, especially in young children. We feel that subsequent recurrence is easier to treat than an epiphysiodesis bridge. The surgical techniques employed to conserve the plate are described along with methods of bone reconstruction after surgery.

Age Factors↗

PubMed1993

[Closed spinal dysraphism].

This retrospective review included 133 patients with one or several of the following defects: diastematomyelia, neurenteric cyst, dermal sinus or cyst, meningeal malformation, sacral agenesis, tethering of the spinal cord, and lumbosacral lipoma. Physical evaluation readily identified most lumbosacral lipomas, as well as most cases of diastematomyelia since hypertrichosis over the defect was common. Some patients developed life-threatening clinical manifestations, e.g., meningitis due to a dermal sinus. On the basis of this retrospective review and a review of the literature, the clinical and therapeutic aspects of each defect are discussed.

Adolescent↗