Biomedical subjects
Publications and source records attributed to L P Fischer.
We report four cases of sciatica caused by gas in the epidural space with no other abnormality. Only 21 similar cases have been reported. Clinical features are identical to those of common sciatica, and plain radiographs are often uninformative. Computed tomography shows a low-density epidural collection displacing the nerve root.
In prosthetic surgery of the hip joint it is essential to recenter the hip to recreate the leverage of the gluteus medius muscle. Determination of the center of rotation of the hip is difficult if both hip joints have been destroyed. On the basis of 70 frontal radiographs of the hip in the standing position, the authors measured the position of the center of the femoral head in relation to Köhler's line and the TD line joining the two radiological Us ("tear-drops"). On the same radiograph they defined the horizontal and vertical indices. The descriptive analysis of these parameters stresses the influence of sex on the coordinates of the center of rotation of the hip. The authors demonstrated the statistical correlations between the coordinates of this center of rotation of the joint and certain horizontal and vertical indices. It emerged that knowledge of these indices suffices to define the theoretic position of the center of rotation. The method is compared with other principles set out in the literature. The procedure has a clinical application in the context of preoperative planning of prosthetic reconstruction of the acetabulum, whenever it is destroyed bilaterally (after trauma, in congenital dislocation or acetabular loosening, etc).
Vascular injuries during orthopaedic hip surgery are rare. However, they must always be feared because they threaten life and limb. We present 11 vascular injuries observed over a 12-year period. Seven women and 4 men, treated by elective surgery, presented 14 vascular injuries (6 arterial, 5 venous and 3 prosthetic vascular graft). Four injuries occurred during revision procedures. They were all operated as an emergency for ischaemic syndrome (6 cases) and/or haemorrhage (7 cases). Four patients (37%) died and 4 developed sequelae, various directly attributable to the vascular injury. In the light of these cases, we tried to determine the various mechanisms of the injury and the orthopedic and vascular risk factors. Preoperative detection and well defined therapeutic rules are very important for the prevention of these severe vascular accidents.
Nicolas Andry was born in 1658 in Lyons, France, and had a long Parisian career. He wrote a book entitled "L'orthopédie ou l'art de prévenir et de corriger dans les enfants les difformités du corps" just before his death, which was the first to use the term orthopedics.
Throughout the XIXth century and until 1945, bone surgery focused primarily on correcting deformities in children. The treatment of injury-related bone lesions in adults (compound fractures and dislocations) remained within the province of general surgeons until circa 1970. Lyons played a unique role in the XVIIIth and XIXth centuries, for three reasons. 1) The term "orthopedics" (which means "straight children", or "children to be made straight") was coined in 1743 by an 80-year-old inhabitant of the Saint Nizier parish in Lyons, Nicolas Andry or André, a former dean of the Paris School of Medicine. The term was adopted throughout the world. 2) The first French orthopedic surgeon was Gabriel Pravaz, who was from the Pont-de-Beauvoisin neighborhood of Lyons. He treated "children to be made upright" in his orthopedic and pneumatic institute located quai des Etroits, and was the first to successfully reduce congenitally dislocated hips (before 1850). 3) In 1987, the most famous bone surgeon was Ollier, who brilliantly applied the method developed by Claude Bernard to the experimental study of the role of the periosteum. He observed that new bone was laid down after "subperiosteal resection" of infected bone or joint tissue. His technique allowed to reduce dramatically the number of limb amputations for infection. In 1897, in addition to Ollier (who died in 1900), many other outstanding surgeons from Lyons demonstrated an interest in bone surgery. Around 1897. Jaboulay (known as a vascular and transplantation surgeon) successfully performed amputations through the middle of the pelvis. Also during this period, Gangolphe used osteotomies to correct limb deformities, and also performed bone grafts. Between 1897 and 1910, the radiologist E. Destot, who worked at the Hôtel-Dieu hospital in Lyons, published two books on the classification of fractures, "The wrist" and "The foot", both of which were promptly translated in English. The Lyons School at the Hôtel-Dieu that demonstrated its excellence in the XIXth century gave birth in the XXth century to a school of infantile bone surgery, headed by G. Nové-Josserand from 1894 to 1937 then by L Tavernier from 1937 to 1947. Tavernier was a sports enthusiast, and was proficient not only in pediatric surgery but also in the areas of meniscal lesions and bone tumors. He was succeeded by Guilleminet (1947-1962), then by Joseph Marion. Two teaching hospital departments of adult orthopedic surgery were created, one headed by Albert Trillat, who, together with H. Dejour and A. Mounier-Khun, was known throughout Europe as an outstanding sports injury surgeon, and the other by Jean Creyssel, who worked with G. de Mourgues and played a significant role in France in bringing trauma-related injuries (traditionally treated by general surgeons) into the field of orthopedic surgery. The first successful total hip arthroplasty procedures were done around 1966. Orthopedics and traumatology became a separate specialty in 1969, and in the wake of this change many departments focusing only or preferentially on one part of the body (e.g., the hand and upper limb, knee, or hip) were created. Over the last century, the Lyons Society for Surgery has played a key role in publishing discoveries in bone surgery and in disseminating knowledge in this field. Although societies for surgery of the hip, knee, spine, hand, foot, and so on now exist, meetings of the Lyons Society for Bone Surgery remain useful since new ideas and techniques sometimes stem from experience acquired in other fields. It is worthy of note that in other European countries traumatology is a specialty in itself, which includes visceral and bone traumatology. It can be anticipated that harmonizing the traumatology specialty in Germay and the orthopedic surgery and traumatology specialty in France may raise a number of problems.
The total knee arthroplasty (TKA) favours deep venous thrombosis (DVT), more often sural thrombosis. In this case, pulmonary embolism is exceptional but sural thrombosis can give a poor functional prognostic by trophic disorders. The purpose of this work is to verify the predictive value of D-Dimer by Elisa technic in the detection of DVT after TKA. We have studied 42 TKA at the Edouard HERRIOT Hospital(Lyon) between April 2, 1992 and October 20, 1994. Patients were divided in two groups: with DVT (n = 5) and without DVT (n = 37). Prophylactic heparinotherapy was systematic. The biologic follow-up by ELISA technic(Fibrinostika FbDP, Organon Teknika) of the D-Dimer were realized at D0 (Day 0) preoperative period and D1, D4, and D6 postoperative period. An echo-Doppler exam were effected at D8 postoperative. The analysis of mean rate of the D-Dimer didn't show significative difference between the two groups at D0, D1, D4 and D6. But, we observed that the rate of D-Dimer increased after TKA significantly in both groups. We can't evaluate predictive interest of the D-Dimer after TKA but the little number of DVT authorizes to pursue this study and to moderate our conclusion.
Just after he died, in 1858, at forty nine and honoured through an awe-inspiring burial, an eight feet Florentine bronze of him was raised in the middle of Lyon's hospital. He was devoted to osteo-articular surgery and fights against unexpected limb positions after joint infection. To drain matter out of a joint, he opened or punctured it with the new hollowed needle recently devised by Pravaz, Lyon's doctor. He too invented a wire netting system to maintain limbs in accurate position. As infection went out, he purposed different other wiring devices (using bronze fitted with a Lyon's goldsmith) to move joints and make it useful despite former infection. Close to rich surgical achievements and top level teaching, he wrote: "Treatise of tendon and muscular cuttings" (Traité des sections des tendons et des muscles) and "Treatise of joint diseases" (Traité des maladies des articulations). He also indulged about literature, as Lamartine: a romantic at heart, he expressed his feelings to his Bugey birth country, its beautiful hills and attractive rivers, every time through gloomy mood. He sets against Prince Napoléon, further Napoléon III, to avoid turning medical studies to much scientific and to keep in sight literature in view of human relations with any patients.
Based on a prospective study of 30 right or left femurs removed in a continuous series in the anatomy department, a study was made of the dimensions of the endosteal canal of the upper end of the femur. The femora were analysed by means of 12 CT scans below the lesser trochanter. The sections were numbered and the dimensional parameters calculated by computer, using an original plan. The results were subjected to descriptive and correlative analysis. From these dimensional findings it appeared that the anatomy of the upper end of the femur is not random; morphotypic models exist and the laws of a normal model are regulated by a mathematical equation.
The retrovirus S.I.A.D. grown in marrow bone and iatrogenic infections may be possible after bone graft in following total hip arthroplasties. Previous investigators proposed several methods to kill the virus, but without bacteriological safety. They found 20 to 55% of loss on mechanical properties. The present study reports the response of autoclaved femoral heads compression testing on material machine Model 1026 Instron. The stress response of marrow bone to stains showed a classic peak and with linear regression study we saw a relationship between autoclaved bone and cold bone. The cortical bone resists to strains highly 12% of load.
In 1901 Albert Gayet raked up from Antinoe three mummies exhibited to day at the Anatomy Museum of Lyon. The study of the three mummies was made in detail as to their dress, anthropometric and scannographic findings. The clothes were characteristic of coptic civilization. The radiographic date gave a life span of around 40 years. The X-ray imagery shows the remains of cerebral and visceral organs. The sexual criteria are thought to be those of two women and undetermined for the child. Later, several investigations like endoscopic autopsy, tooth microscopy and chromosomic map will be necessary.
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The mechanical properties of 20 frozen (-30 degrees C) femoral heads are determined. 10 were treated by gamma radiations. It is noted that the rate of weakness of cancellous bone is 20%.
124 patients undergoing total hip replacement were randomly allocated to receive Kabi 2165, 2,500 anti-Xa units twice a day (group A); Kabi 2165, 2,500 anti-Xa units twice a day during the first 48 h postoperatively and then 5,000 anti-Xa units once a day (group B), or adjusted-dose standard heparin, monitored by activated partial thromboplastin time (group C). The first dose was given 2 h before surgery in the three groups. Deep-vein thrombosis (DVT) was detected by radiolabelled fibrinogen uptake and bilateral venography was performed in patients who had a positive scan. In patients who had a negative scan, bilateral venography was performed routinely the day before discharge from hospital. The frequency of DVT demonstrated by venography was 4.9% in group A, 7.3% in group B and 10% in group C. The difference between the three groups was not statistically significant. The incidence of proximal DVT was 2.4, 2.4 and 7.5%, respectively, for the three groups. There was no significant difference between the three groups with respect to mean estimated blood loss, the number of blood units transfused, wound hematoma formation, or hemoglobin and hematocrit levels.
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The dissection of 18 knees taken from fresh cadavers has led to a detailed description of the semimembranosus muscle (musculus semimembranosus). It is exclusively tibial with its three tendons rendering the muscle functional, whatever the position of the knee may be. There are other attachments, sometimes described are merely expansions extending to the menisco-tibial and menisco-femoral formations, from which this distal termination must be distinguished. Electromyography performed on 17 specimens confirms that this muscle serves more as a brake on outer rotation than an inner rotator muscle, especially when the hip is flexed and the knee stretched.
By means of dynamic roentgenographic study (5 to 7 X-rays) of the cervical spine in sagittal plane, the authors were able to define: amplitudes of each intervertebral joints. C4, C5 and C6 are the more mobile levels, position of instant centers of rotation for each intervertebral joint in healthy and pathologic individuals. This method allows a kinematic diagnosis of discopathies.