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Biomedical subjects

G Bollini

Publications and source records attributed to G Bollini.

At least 37 records · Page 2Linked to original sources
PubMed2000

Treatment approaches for congenital pseudarthrosis of tibia: results of the EPOS multicenter study. European Paediatric Orthopaedic Society (EPOS).

This study was designed to analyze the different therapeutic methods used by European Paediatric Orthopaedic Society members from 13 countries for congenital pseudarthrosis of tibia. The treatment data of 340 patients who underwent 1287 procedures for this condition were analyzed. The essential findings were that the method of choice needed to approach the biological problem with the aims of: (1) resecting the pseudarthrosis to provide stability, the basic requirement for bony consolidation; (2) correcting length discrepancy and axial deformity; (3) achieving fusion; and (4) solving the additional problems around the main deformity such as alignment, leg length discrepancy and ankle valgus. The Ilizarov technique emerged as being the optimal method, having the highest rate of fusion (75.5%) of pseudarthrosis and rate of success in correction of the additional deformities. There was also consensus that surgery should be avoided before the third year of life.

Adolescent↗
PubMed2000

Free vascular fibular transfer in congenital pseudoarthrosis of the tibia: results of the EPOS multicenter study. European Paediatric Orthopaedic Society (EPOS).

This paper presents a review of the literature, describes the principal author's (B.R.) personal experience and provides the results of the European Paediatric Orthopaedic Society (EPOS) multicenter study. The objective is to evaluate the present status and future role of free vascular fibular transfer in treating congenital pseudoarthrosis of the tibia. Variables such as the selection of cases, age at operation, technical surgical details and postoperative results will be considered. The data on the EPOS study were incomplete at the time of writing, but the considerable amount of information already amassed is a valuable contribution to this updated report.

Child↗
PubMed2000

Functional results at the end of skeletal growth in 30 patients affected by congenital pseudoarthrosis of the tibia.

From a multicentric study on Congenital Pseudoarthrosis of the tibia (CPT) conducted on 340 patients, we evaluated the functional results on a group of thirty patients who were at the end of skeletal growth (age < or = 16 years). The prognosis of CPT is very much related to the radiologic classification. Crawford type 2 and Crawford type 4 pseudoarthrosis have a worse prognosis, with a lower percentage of fusion at the site of pseudoarthrosis. Crawford 4 patients have the worst functional results. Most of them showed a severe leg length discrepancy, needed a permanent brace, with an ankle joint function fair or poor. The presence of fibula pseudoarthrosis seems to be responsible for most of the worst functional results. The level of deformity caused by either the natural course of the disease or its treatment, is decisive in the evaluation of the functional results.

Adolescent↗
PubMed2000

[Sagittal equilibrium of the pelvis: analysis of the inclination of the ischio-pubic ramus from the horizontal].

PURPOSE OF THE STUDY: The sagittal equilibrium of the spine and pelvis has been examined in numerous studies looking for the origin of certain posture disorders of the spine and the cause of lower back pain. Sagittal x-rays of the pelvis provide an analysis of the degree of inclination of the pelvis from the horizontal and the bi-coxo-femoral axis and information on the form of the sacrum. There is no radiographic parameter however which analyzes the transition between the pelvis-sacrum component and the femoral component, i.e. the periacetabular region. In the sagittal plane, a line tangent to the ischio-pubic ramus would appear to best reflect the orientation of the periacetabular region and the muscular forces applied to this region. The purpose of this work was to analyze the inclination of the ischio-pubic ramus from the horizontal and its relations with other sagittal radiographic parameters in a population of growing children with spinal disorders. MATERIALS AND METHOD: The study population included 100 children with spinal disorders who underwent a teleradiographic series with lateral view in the upright position. Most of the children had scoliosis (80 cases), 7 had kyphoscoliosis, 4 isthmic spondylolysis with spondylolisthesis, 1 spondylodiscitis and 4 lower back pain. Mean age was 13 years (range 2.5-22 years). We measured 7 radiographic parameters: lumbo-sacral angle, slope of the sacrum, pelvic version, incidence, thickness, overhang, and inclination of the ischio-pubic ramus from the horizontal. Data were analyzed to search for correlations between radiographic parameters and between radiographic parameters and clinical features. RESULTS: Mean inclination of the ischio-pubic ramus from the horizontal was 33.9 degrees (SD =5.9 degrees ). The only positive statistical correlation between the inclination of the ischio-pubic ramus and the clinical data was a relationship with the position of the arms compared with the horizontal (p =0.04). There was no correlation with age, sex, ethnic background, etiology. There was no correlation between the inclination of the ischio-pubic ramus and the other radiographic parameters (coefficient r ranging from 0.06 to 0.43). DISCUSSION: The interdependence of sagittal radiographic parameters of the pelvis and the spine have been largely demonstrated. Certain pathological situations (isthmic spondylolysis with spondylolisthesis, lower back pain, etc.) can be explained by the value of these parameters, particularly incidence. The inclination of the ischio-pubic ramus from the horizontal reflects the periacetabular region. When analyzed in the sagittal plane, it was found to be a more stable parameter, independent of most clinical criteria (particularly age, and etiology) and of the other radiographic parameters studied. The only determining factor appears to be acquisition of the upright position. The consistency of this parameter constrasts with the variability of the other radiographic parameters of the pelvis and the spine, particularly incidence, although the inclination of the ischio-pubis ramus is an expression of a region different than the pelvis. This study suggests that the periacetabular region plays a key role in acquisition of the upright position in humans. The periacetabular region would be a fixed point around which the lower limbs and spine describe varying orientations.

Adaptation, Biological↗
PubMed2000

[Conservative surgical treatment of osteogenic sarcoma of the limb in children and adolescents].

PURPOSE OF THE STUDY: Advances in chemotherapy protocols over the last 20 years have considerably improved the prognosis and functional outcome in patients with osteogenic sarcoma. We report here the results of a cooperative study conducted under the auspices of the French Society of Pediatric Oncology (SFOP). Twenty-nine oncology centers participated in this retrospective national multicentric study. MATERIALS AND METHODS: The study included 153 patients with osteogenic sarcoma of the limb who were treated by the OS87 protocol with conservative surgery between 1987 and 1994. The OS87 protocol consisted in conservative or non-conservative surgery combined with pre- and postoperative chemotherapy. The following inclusion criteria were used: age under 20 years, tumor localization in a limb (pelvis and spine excluded), no metastasis at diagnosis, biopsy proven osteogenic sarcoma. RESULTS: Mean age at diagnosis was 13 years. The knee localization predominated (80 p. 100). 82.5 p. 100 of the patients had grade IIB disease (Enneking classification). For the 187 patients included in the protocol surgery was non-conservative in 20 p. 100 of the cases and conservative in 80 p. 100. The choice of the surgical technique (arthroplasty, allograft, autograft, resection without reconstruction) depended on the patient's age and school situation. Data analyzed here concerned only those patients who had conservative treatment. Mean follow-up was 64 months. The actuarial survival curve plateaued at 71 p. 100 at more than 6 years. Early and late complications were numerous and variable (mechanical, infectious, local recurrence). Secondary amputation was required in 10 p. 100 of the patients. The overall functional outcome of the preserved limbs was nevertheless good with rapid restoration of self-sufficiency despite major surgery and a high number of reoperations (about 65 p. 100 of cases). DISCUSSION: In light of the frequency and the seriousness of the complications, these results are modest. Patients and family should be advised of the risk, particularly the risk of secondary amputation which may be required early due to contaminated excision or at mid term due to major non-cancerological complications. As survival has been improved, functional capacity must be preserved for several years. This orients surgery towards more "biological" reconstruction which can provide greater longevity than arthroplasty.

Adolescent↗
PubMed1999

[Pseudo-paralysis of the brachial biceps in obstetrical brachial plexus lesions (OBPL):concerning the "overly optimistic" EMG in OBPL].

In birth palsy of the brachial plexus, the mixed interference pattern recorded for the brachial biceps on the electromyogram often conflicts with the muscle's inability to flex the elbow. We report our observations of a six-month-old infant who presented paralysis of the upper and medial elements of the brachial plexus, in whom we demonstrated early biceps-triceps co-contractions, which may explain this discrepancy and 'pseudo-paralysis' of the biceps. We analyse and discuss the practical consequences of these findings, and notably the possible therapeutic use of triceps-to-biceps surgical transposition.

Brachial Plexus↗
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↗