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Biomedical subjects

J L Jouve

Publications and source records attributed to J L Jouve.

At least 19 recordsLinked to original sources
PubMed1999

[Monitoring colorectal cancer after surgical resection].

POSTOPERATIVE FOLLOW-UP: Despite adjuvant therapy, approximately 50% of all patients undergoing curative surgery for Dukes C colorectal cancer will develop a recurrence within 3-5 years and 95% of these will die from their cancer shortly thereafter. ENDOSCOPY: Generally performed every 3 years after checking that all cancerous foci have been removed, colonoscopy is required to detect adenomes and metachronic cancers. Its contribution to screening for local recurrence is however rather limited since most recurrences develop in an extraluminal localization. CEA: Assayed at 8 months, repeated carcinoembryonic antigen assay can detect asymptomatic recurrence in 50 to 60% of the cases, usually 4 to 8 months prior to other explorations. Specificity is high (85% to 95% depending on the series), allowing exploratory laparotomy if CEA alone is elevated. However, the only randomized study evaluating CEA was unable to demonstrate any prolongation of survival with monthly tests. OPTIMAL FOLLOW-UP: There is some debate about the usefulness of intensive clinical and radiographic follow-up as the 4 randomized studies available were unable to demonstrate any beneficial effect. It must be noted however that the number of patients included in these studies was too low to evidence a small improvement in survival rates. In France, a 6% improvement at 5 years would result in 200 fewer deaths due to Duke C colorectal cancer annually. A large multicentric randomized study will be initiated shortly in France to evaluate the impact of intensive CEA monitoring versus no monitoring and intensive versus periodical radiological follow-up.

Carcinoembryonic Antigen↗
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

[Incidence of treatment modalities for cancer of the small intestine in Burgundy (France)].

AIMS: To determine the epidemiological characteristics and management of cancers of the small bowel, on a population-based survey. METHODS: The registry of digestive tumors of Burgundy recorded all new cases of cancers of the small intestine in the departments of Côte d'Or and Saône et Loire (1,052,000 inhabitants). RESULTS: Two hundred and ten new cases of malignant tumors of the small intestine were recorded between 1976 and 1995 including 4 main histological types: adenocarcinomas (39.5%), carcinoids (26.2%), lymphomas (18.6%) and sarcomas (10.5%). Age-standardized incidence rates for males and females were respectively 8.8 and 5.6 per 1,000,000 inhabitants. There was evidence of lymph node invasion in 29.5% and visceral metastasis in 31.4%. Treatment was primarily surgical (90.5%), with a post-operative death rate of 17.1%. The rate of curative surgery remained constant over time, averaging 58.6%, 20% of the patients underwent chemotherapy, with a high proportion of lymphomas, often in association with surgery. The relative survival rates at 1, 3 and 5 years were 51.2, 38.3 and 32.7%, respectively. The multivariate analysis showed that survival was linked to age, and strongly to histological type and stage of diagnosis. CONCLUSION: Cancers of the small intestine are an heterogeneous group of rare tumors, often diagnosed at advanced stage. No significant improvement has been achieved in their management over the past 20 years.

Adolescent↗
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↗
PubMed1998

[Eosinophilic ascites and urticaria].

INTRODUCTION: The finding of eosinophilic ascites is unusual. It requires the search for the main etiology, i.e., parasitic or malignant disease, vasculitis or hypereosinophilic syndrome. The diagnosis of exclusion is either mucosal, muscular or serous eosinophilic gastroenteritis. This last type, the most unusual--as less than 50 cases have been documented until now--is associated with eosinophilic ascites. EXEGESIS: We report a new case of serous eosinophilic gastroenteritis that occurred in a 23-year-old woman. This case was unusual because of its clinical history, as abdominal pain fits (along with the occurrence of ascites) were associated with urticaria fits. The lack of eosinophils in both the blood counts and the various digestive biopsies were unusual too. The disease evolution was favorable with corticosteroid therapy; however, a minimal dose of 8 mg/day was necessary to control the disease symptoms. CONCLUSION: Because of its association with urticaria fits, this case emphasizes the need for differential diagnosis in patients with hypereosinophilic syndrome and food allergy.

Abdominal Pain↗
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↗
PubMed1998

[Adjuvant chemotherapy for colon adenocarcinoma in the county of Côte-d'Or].

OBJECTIVES: The aim of this study was to assess the use of adjuvant chemotherapy in colon adenocarcinomas on a population basis and determine which factors could modulate its prescription. METHODS: The influence of time of diagnosis, age, sex, place of residence, health care pattern, tumor location and number of metastatic lymph nodes was investigated from the 1988 to 1995 data from the Registry of Digestive Cancers in Côte-d'Or (France). Each independent variable was given an odds-ratio (OR). RESULTS: An adjuvant chemotherapy was performed for 0.9% of 231 Dukes'A cancers, 3.8% of 367 Dukes'B and 16.7% of 264 Dukes'C. For the latter, the prescription of adjuvant chemotherapy was influenced by time of diagnosis (from 1.3% in 1988-89 to 35.8% in 1994-95; OR = 228 for period 1994-95 compared with the first period), age (the proportion of treated patients under 75 years of age has increased from 2.2% in 1988-89 to 57.9% in 1994-95; OR = 30.1 for patients younger than 75 years compared with older ones) and health care pattern (OR = 0.21 for treatment in non university hospitals and 0.06 in the private sector compared with university hospitals. CONCLUSION: In spite of an increasing proportion of patients treated by adjuvant chemotherapy for Dukes'C colon cancers, this treatment of proved effectiveness has not yet reached its full development.

Adenocarcinoma↗
PubMed1998

[Treatment of substance loss of the bones of the leg in traumatology by transfer of the free vascularized iliac crest. Apropos of 13 cases].

PURPOSE OF THE STUDY: Free iliac crest transfer as described by Taylor is an option for tibial bone reconstruction in traumatology. Our purpose was to evaluate results, bone reconstruction quality and delay for bone healing using microsurgical technique. MATERIAL: 13 men were operated on between December 1986 and January 1994, mean aged 31 years (extreme 18-58) Bone lesion was localized at the middle third in 5 cases and at the lower third in 8 cases. The bone defect was directly related to traumatism in 2 cases, and secondary to resection of infected or necrotic bone in 11 cases. Limb neurologic and vascular problems have always been evaluated before reconstruction and amputation always been discussed. Preoperative limb arteriography showed only one major vessel of the limb in 6 cases. Delay between injury and bone reconstruction averaged 11 months. METHODS: Bone debridement and bone stabilization by external fixator was performed on a first step. Resection of the fibula was performed to allow secondary compression at the reconstruction site. All necrotic and infected bone was "en bloc" resected using an oscillating saw. Bone reconstruction was performed in a second step when the wound was clean. Surgical team included a plastic surgeon for the micro surgical procedure and an orthopedic surgeon for bone fixation. Osteo-musculo-cutaneous flap and osteo-muscular flap were used according to the size of the skin defect. Bone osteosynthesis was achieved by direct fitting after distraction applied by the external fixator. Vessel anastomosis was performed under microscope. RESULTS: One patient had to be amputated due to a lesion of a single vessel by an llizarov wire. In the remaining 12 cases, bone healing has been achieved after 10 months on average. Bone reconstruction averaged 8 centimeters. A secondary procedure has had to be performed in 9 cases. Two stress fractures have been observed. DISCUSSION: "Carcinologic" resection of infected bone is one of the key of this procedure, as described by Weiland. Many techniques had been described to treat traumatic bone defects. Papineau's technique is a long procedure and leads to instable scars on the leg. Use of cancellous bone covered with a free or a pedicled muscular flap gives good results, but it may appear logical to treat a composite defect with a composite graft. Progressive bone lengthening using Ilizarov technique is not an easy procedure among adults. Use of vascularized bone graft is known to be a good procedure for treatment of osteomyelitis, but this type of technique is technically demanding. Fibula transfers are useful especially when defect are more than 10 cm. long, but this bone is fragile and stress fractures are frequent. Iliac crest is closer to the tibia and appears to be a good donor site when bone defect is 5 to 10 cm. long. CONCLUSION: Free iliac crest transfer appears to be a reliable procedure for traumatic tibial loss ranging from 5 to 10 cm long although amputation must always be discussed in such difficult traumatic cases, especially if there is a posterior tibial nerve lesion.

Adolescent↗
PubMed1997

Imaging of vascularized fibular grafts in large bone reconstruction in skeletally immature patients.

OBJECTIVE: To describe the imaging findings of vascularized fibular grafts (VFG) in large bone reconstruction in children and teenagers. DESIGN AND PATIENTS: Fifteen patients aged from 4 to 19 years underwent VFG for bone reconstruction for primary tumors involving bone in 13 cases and for chronic osteomyelitis in 2 cases. Lesions were located in the femur (6 cases), the tibia (6 cases), the humerus, the distal fibula and the ilium. Radiographic follow-up was performed in all patients, radionuclide studies in 12 patients and MRI in 8. RESULTS: Plain films showed a lamellated periosteal reaction on the VFG within 3 weeks following the procedure in all cases. Fusion of VFG and host bone occurred during the first 3 months. Radionuclide uptake of the VFG was seen in all cases but one. MRI showed cortical thickening and conservation of the high signal intensity of fatty marrow on T1-weighted sequences, and periosteal enhancement on dynamic post-contrast studies in all but one of the patients. CONCLUSION: Radionuclide studies and MRI show the periosteal enhancement and assess the viability of the VFG satisfactorily. However, we feel that plain films may be sufficient to ascertain this viability.

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

Food products and consumer protection: a conceptual approach and a glossary of terms.

There is greatly increased activity in measures being taken to ensure the production of safe food. Several concepts, increasingly based on quantitative risk analysis, are being introduced and new terminology and definitions are being proposed. This article presents a general approach to the production of microbiologically safe food and a glossary of appropriate terms. Where possible, an attempt is made to provide a more adequate terminology, based on that used in risk analysis; background information is also presented.

Consumer Product Safety↗
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↗