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Biomedical subjects

P Vives

Publications and source records attributed to P Vives.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Hallux valgus treated by Scarf osteotomy of the first metatarsus and the first phalanx associated with an adductor plasty. Apropos of 50 cases with a 2-year follow up].

PURPOSE OF THE STUDY: Fifty hallux-valgus were treated with Scarf Osteotomy of the first metatarsal, associated to a phalangeal varisation or shortening osteotomy and an adductor plasty. Patients were evaluated with a minimum follow-up of two years. MATERIAL AND METHODS: Forty five females and two males were operated with an average age of fifty years. The pre operative metatarsus varus was of 15 degrees 8. Mean alignment of metatarsal bar was 31 degrees 4. The cuneo-metatarsal joint was twenty two times spheric and twenty eight times plane. The average metatarso-phalangeal great toe valgus was 39 degrees 8. RESULTS: They were appreciated with a minimal follow-up of two years, according to the 3 Groulier's criteria: correction of deformation, statics troubles, functional activity. The metatarsus varus improved with an average of 10 degrees 4, as well as the alignment of the metatarsal bar (25 degrees). The post operative average phalangeal valgus was 22 degrees 7. These results were statistically significant. Cuneo-metatarsal joint type did not influenced final result. Articular joint line was normal in 64% of cases. Global result was excellent or good in 70%, passable in 22%, and bad in 8% of cases. DISCUSSION: Scarf Osteotomy of the first metatarsal allows complete correction of metatarsus varus. The surgical approach can be proposed at every age. There are no vascular trouble or arthrosis worsening. It must be completed with a phalangeal varisation or shortening osteotomy and adductor plasty.

Adolescent↗
PubMed1999

[Long-term outcome following surgical repair of ruptures of the fibular collateral ligament of the ankle. A report of 50 cases].

The authors report their findings in a series of 49 patients with 50 acute ankle sprains, who underwent surgical repair of their ruptured fibular collateral ligaments. All patients were selected for surgical treatment based upon the findings on stress-films taken under anesthesia, showing a laxity at least superior by 10 degrees to the value found on the contralateral ankle. All patients were reviewed 2 to 12 years after operation. Clinical evaluation was based upon Duquennoy's criteria, and dynamic x-rays were performed in all patients to evaluate residual laxity. The clinical results were good or excellent in 78% of patients, fair in 14% and poor in 8%. Seven patients (14%) complained of subjective instability. Stress films showed residual laxity from 5 to 10 degrees in 10 patients (20%). The authors conclude that their findings do not support the alleged superiority of surgical repair over conservative management of severe ankle sprains.

Adolescent↗
PubMed1999

[Uretero-acetabular fistula after removal of a septic total hip prosthesis].

The authors report a case of an uretero-acetabular fistula after a Girdlestone procedure. The reason of ablation was an infected hip prosthesis. The urinary fistula was treated with an uretero-ileoplasty and hip infection with a two stages procedure. There was no recurrence of infection at two years follow-up. Different causes of this urinary complication are discussed.

Acetabulum↗
PubMed1999

[Gauthier's subcapital osteotomy in the treatment of metatarsophalangeal luxation of the 2nd ray. Apropos of 44 cases with 5 year followup].

The authors report on a series of 44 metatarsophalangeal dislocations of the second ray which were treated surgically using Gauthier's technique. The patients were 44 middle-aged women. The surgical indication was a dislocation of the 2nd metatarsophalangeal joint with hallux valgus. There was excess length of the second metatarsal ray or acquired shortness of the first metatarsal. The treatment always included an osteotomy of the neck maintained by a transosseous pin. The average follow-up was 8 years and 3 months (minimum 5 years). Postoperative results were evaluated using clinical and radiological criteria. Surgical treatment gave 68.2% very good and good results and 4 recurrences of dislocation. The results in this series are identical with those in other series reported, but the backward displacement of the head of second metatarsal was found to be limited. Weil's osteotomy seems to provide better results because it better restores the relative lengths of the metatarsals and often makes interphalangeal arthroplasty unnecessary. Gauthier's metatarsal osteotomy is an easy procedure which effectively improves static metatarsalgia, but it provides limited metatarsal shortening. Weil's osteotomy is preferable in cases with long lateral metatarsals.

Adult↗
PubMed1998

Seizures and neuronal damage induced in the rat by activation of group I metabotropic glutamate receptors with their selective agonist 3,5-dihydroxyphenylglycine.

While it is well documented that the overactivation of ionotropic glutamate receptors leads to seizures and excitotoxic injury, little is known about the role of metabotropic glutamate receptors (mGluRs) in epileptogenesis and neuronal injury. Intracerebroventricular (i.c.v.) infusion of the group I mGluR specific agonist (R,S)-3,5-dihydroxyphenylglycine (3,5-DHPG) (1.5 micromol) to conscious rats produced severe and delayed seizures (onset at 4 hr) in 70% of the animals. The i.c.v. infusion of the group I mGluR non-selective agonist 1S,3R-1-aminocyclopentane-1,3-dicarboxylic acid (1S,3R-ACPD) (2 micromol) produced a similar rate of severe seizures, but with an early onset (0.6 hr). The analysis of motor activity showed that 3,5-DHPG elicited higher central stimulatory action than did 1S,3R-ACPD. Histopathological analysis of the hippocampus showed that 3,5-DHPG produced severe neuronal damage mainly in the CA1 pyramidal neurons and, to a lesser extent, in the CA3. Although 1S,3R-ACPD infusion also induced a slight injury of the CA1 and CA3 pyramidal neurons, damage was greater in the CA4 and dentate gyrus cells. In conclusion, the in vivo activation of group I mGluRs with the selective agonist 3,5-DHPG produces hyperexcitatory effects that lead to seizures and neuronal damage, these effects being more severe than those observed after infusion of the non-selective agonist 1S,3R-ACPD.

Analysis of Variance↗
PubMed1998

[Importance of arthrodesis of the big toe combined with a metatarsal alignment according to Lelièvre in the surgery of the rheumatoid forefoot. Apropos of 70 observations].

PURPOSE OF THE STUDY: The authors reviewed 70 cases of rheumatoid forefoot treated by Lelièvre, lateral metatarsal resection alignment, associated to first metatarsophalangeal joint arthrodesis. MATERIAL: Rheumatoid arthritis evolution was 20 years an average. It involved cortico-dependent polyarthritis in 48 per cent cases. Metatarsalgia were always present. METHODS: Mean follow up was 44 months (minimum 24 months) Results were analyzed according to Gainor. RESULTS: Foot pain disappeared in thirty two cases. Shoe wearing was normal 50 times. Arthrodesis fused 55 times. Lateral toes metatarsophalangeal joint space was satisfactory 28 times. Metatarsal divergence improved, 80 per cent of patients were satisfied in a subjective estimation and 85 per cent using Gainor's criteria. DISCUSSION: First-Metatarsophalangeal joint arthrodesis ensures permanent stability of the first ray and therefore an harmonious support distribution. The dorsal surgical approach allows an early weight bearing in cortico or immuno dependent patients. CONCLUSION: This technique keeps a low morbidity and ensures stable mid term results.

Adult↗
PubMed1997

[Mri and surgical indications in perforating ulcer in diabetic patients].

The authors report a series of thirty-six perforating ulcers of the foot in diabetic patients, evaluated using M.R.I. M.R.I. showed osteomyelitis in 16 cases, cellulitis in 15 cases, osteoarthropathies in 21 cases, tenosynovitis of flexor tendons in 2 cases, oedema in 2 cases and abscess in one case. In 19 cases, M.R.I. was used to improve diagnostic accuracy. The medical treatment made use of thermo-moulded soles allowing for the recovery of walking, with a hole facing the perforating ulcer of the foot. The application of insulin-soaked sponges in the event of clean perforating ulcer of the foot and iodized solution in the event of infected perforating ulcer of the foot promoted healing. The treatment was only conservative, when the lesions were limited to the soft tissues. Surgical treatment was performed in 19 cases due to a global involvement of soft and osteoarticular tissues. In fourteen cases the surgical treatment was limited and was performed through the perforating ulcer. Resection of metatarsal heads or metatarso-phalangeal joints was performed in 10 cases, with resection of surrounding pathologic tissue. The surgical treatment was limited to the soft tissues in 6 cases. In 4 cases, M.R.I. findings resulted into a transmetatarsal amputation because the vascular plexus was of poor quality and infection spread from the perforating ulcer to the dorsal aspect of the foot. In our opinion, dorsal infectious involvement in a perforating ulcer of the foot, is a factor of poor prognosis. A below-knee amputation has been performed in one patient.

Abscess↗
PubMed1997

[Complications and failures of total ankle prosthesis. Apropos of 21 cases].

PURPOSE OF THE STUDY: The authors relate a heterogeneous series of twenty one total ankle prosthesis performed by the same surgeon with an average follow up of 37 months. MATERIAL AND METHODS: Four types of prosthesis were implanted: 4 Ramses, 8 New Jersey, 5 Star, 4 Freeman. The etiology was seven times a rheumatoid polyarthritis, ten times post-traumatic, two idiopathic arthrosis, an hemochromatosis and a late clubfoot sequelae. RESULTS: Results were appreciated according to Bousquet's criteria: 4 excellent results, 5 good, 3 fair, 9 bad. The ankle mobility was not improved by arthroplasty. We noticed 7 loosening whose 2 septic occurring between 18 and 38 months after implantation of prosthesis. DISCUSSION: This series indicates that prosthesis should be only suggested for patients over sixty years old. No difference was found between post-traumatic and rhumatoîd. The pre-operative subtalar arthrosis promoted in significant way an unexpected failure occurrence. CONCLUSION: Indications for total ankle arthroplasty must remain selected. Arthrodesis remains in the immediate future, the best solution for young patients with post-traumatic arthrosis.

Adult↗
PubMed1997

[Haglund disease treated by simple resection of calcaneus tuberosity. An angular and therapeutic study. Apropos of 74 cases with 2 years follow-up].

PURPOSE OF THE STUDY: The authors report the treatment of Haglund's disease, using a simple os calcis tuberosity resection. They reviewed long term results and the value of radiological criteria for pre-operative evaluation. MATERIAL: The series included 54 patients (74 feet) mostly female and young. The simple resection of os calcis tuberosity was performed without further operation or post-operative splint. METHODS: Post-operative results were appreciated according to 3 criteria: pain, functional activity and shoe wearing. Radiological criteria used Fowler and Philip angle, angle of calcaneal inclinaison, total angle, CL angle, Denis and Huber-Levernieux test and Heneghan and Pavlov parallel lines. Correlation tests with simple regression were used for statistical analysis. RESULTS: Results were graded as excellent and good in 73 per cent fair in 16.2 per cent and poor in 10.8 per cent cases. DISCUSSION: Results were compared to other series. Neither radiological criteria, angular or not, can rule out simple tuberosity resection, because results showed no relation between test and angle measurements. There is no correlation between post-operative radiographs and final result. The only efficient criteria of resection is the difference between Fowler and Philip, and CL angles. This technique may be recommended after few months of medical treatment, without using calcaneal osteotomies of Zadek type. CONCLUSION: The simple resection of os calcis tuberosity showed good results in 73 per cent cases at an average follow up of 6 years 9 months.

Achilles Tendon↗
PubMed1997

[Femoropatellar osteoarthritis treated by prosthesis. Retrospective study of 50 implants].

MATERIAL AND METHODS: 51 prosthesis were performed in 47 patients and were studied in order to assess long term results. One patient was lost for follow up. The diagnosis was: primitive arthritis in 48 knees and post traumatic arthritis in 3 knees. 25 knees had patellofemoral subluxation, 16 patients had been previously operated on patellofemoral joint. The average age at the time of surgery was 60.5 years and follow up time averaged 3 years. 22 prosthesis had more than 4 years follow-up. The operations were performed using a lateral approach with tibial tubercle osteotomy and lateral patellar retinaculum release. The trochlear component was asymetric and made of chrome cobalt alloy; the patellar component was shaped in polyethylene. Both components were cemented. RESULTS: Using the Guepar scoring system, 41 (82 per cent) PFA were rated excellent or good and 9 poor. Post operative roentgenograms demonstrated patellofemoral alignment in all knees, even in cases of preoperative patellar subluxation, without tilting of the patella. Follow up roentgenograms demonstrated progressive but moderate deterioration of the tibio femoral joint in 9 cases. In 3 cases, more severe tibio femoral arthritis were treated by T.K.R one to three years after P.F.A. In one of these knees, we discovered an asymptomatic loosening of trochlear component. The last 6 poor results were always due to persistent pain. DISCUSSION: The purpose of this study was to assess the results of P.F.A. and to clarify the indications. It appears that the 82 per cent success rate of this study may be compared with the results of literature. All the authors have found P.F.A. to be a viable solution, preferable to patellectomy (even in older patients) or isolated patellofemoral realignment. The clinical and radiological results did not deteriorate with time. Persistent patellofemoral malalignment was not observed in this study thanks to the use of a lateral approach. The presence of tibio femoral arthritis adversely affected the outcome, but accelerated changes on the tibio femoral joint after P.F.A. were not observed.

Adult↗
PubMed1996

[Fractures of the tarsal scaphoid].

PURPOSE OF THE STUDY: The authors relate a series of 47 cases of tarsal scaphoid fractures, between 1976 and 1992. MATERIAL AND METHODS: These fractures occurred 11 times after a high level fall, 28 times after a motor vehicle accident and 8 times after a direct traumatism. The fracture line was vertical 35 times; horizontal 27 times. An impaction was often associated (32 cases). In 17 observations, a true enucleation occurred as a part of the fracture dislocation. Many periscaphoidal lesional associations were found. 39 fractures were fixed. Radiographs showed 30 consolidations with an anatomical reduction. 37 patients were reviewed with an average follow up of 7 years and 6 months. RESULTS: Results were assessed using Mestagh's scoring system: 7 very good, 15 good, 6 fair and 9 bad. The very good and good results represent 59 per cent. In 37 patients reviewed, the clinical investigation showed 8 deformities of valgus flat foot, a varus foot, requiring 11 times orthopedic soles wearing. 11 patients had a lameness. Radiological results showed 11 times a peri-scaphoidal arthrosis, a necrosis and 2 non union. A narrowing of the astragalo-cuneate joint line was found 8 times. DISCUSSION: Various anatomical types don't have the same prognosis. Vertical and horizontal fractures gave 18 times a very good and good result when in 11 reviewed patients with a fracture dislocation, we noticed 7 poor or bad result. An osteosynthesis by screw gives goods results when fragments are large. For compound fracture when a surgical procedure will be insufficient, the conservative treatment, if keeps a sufficient breadth of medial arch, can give a satisfactory result. An immediate astragalo-scaphoïdal arthrodesis can be suggested in front of a multi-fragmentary dislocation fracture. CONCLUSION: The scaphoïdal tarsal fracture is unusual and its diagnosis remains sometimes difficult. The treatment is often surgical by direct approach. In consideration of the pejorative post-operative outcome of fracture dislocations, some authors suggest an immediate astragalo-scapho-cuneate arthrodesis.

Adolescent↗
PubMed1996

[Subtalar dislocations. Apropos of 35 cases].

PURPOSE OF THE STUDY: The subtalar dislocation is a rare injury. The authors appreciate the difference of frequency between medial and lateral displacement, the factors likely to increase a classical favorable prognosis and the therapeutic attitude to suggest. MATERIAL AND METHODS: 35 observations were included of which two bilateral, 26 had a medial displacement, 9 a lateral displacement. Treatment was conservative in 21 cases and surgical in 14 cases. The results were analysed using Gay and Evrard's clinical scoring system at which we added radiological results. RESULTS: The average follow-up was 7 years and 7 months. The global results are 11 excellent, 13 good, 9 fair, 2 poor. DISCUSSION: The high frequency of medial displacement is explained by the fact that the subtalar joint is only really unstable in inversion. The lateral displacement is rare. The prognosis is good in pure dislocation. It is only good enough every time a fragmentary talar fracture is associated as a factor of stiffness. The 11 arthrosis cases are secondary to a dislocation associated with a talar dislocation, a scaphoid dislocation or a vascular injury. In the series, there is no syndrome of tarsal sinus, and no post traumatic instability. Talar necrosis are rare: 3 cases in this series. They occur following large dislocations at the limit of enucleation. The reduction is urgent. The treatment is more often conservative. It must be surgical in case of associated injury requiring a surgical procedure or in front of widely open dislocation. CONCLUSION: Subtalar dislocation is a rare injury. In the majority of cases, the displacement is medial. The prognosis is good in pure cases. It's only good enough every time a fragmentary talar fracture is associated as a factor of joint stiffness.

Accidental Falls↗
PubMed1996

Mycobacterium kansasii infection limited to the skin in a patient with AIDS.

We describe a case of cutaneous Mycobacterium kansasii infection in a 56-year-old man with acquired immunodeficiency syndrome, who received treatment with trimethoprim-sulphamethoxazole for Pneumocystis carinii pneumonia. Resolution of the cutaneous lesion was observed without specific treatment.

HIV Infections↗
PubMed1996

["Chevron" basal osteotomy of the middle metatarsal bones for static metatarsalgia. Apropos of 69 cases].

PURPOSE OF THE STUDY: Round or flat forefoot metatarsalgia are frequent and surgical techniques are various. The authors relate a series with chevron basi-metatarsal osteotomy. MATERIAL: 69 operated metatarsalgia were reviewed at a mean follow up of 5 years. METHODS: The surgical approach was dorsal, aligned on metatarsal diaphysis. The basi metatarsal "chevron shape" osteotomy was performed using an oscillatory saw, on 1, 2 or 3 metatarsi inducing lowering and shortening. This osteotomy wasn't fixed. Weight bearing was allowed at the third post-operative day. RESULTS: In 68 per cent of cases, the global result was good or very good, but it persisted 32 per cent of post-operative pain either climatic or continuous, including 29 per cent metatarsalgia. The plantar corns only disappeared one out of twice, but the shoe wearing was improved in 82.6 per cent of cases. DISCUSSION: This study showed that the results improved when 3 median metatarsal osteotomy were performed simultaneously. The forefoot morphology didn't influenced the final result. In fact, this technique includes a good result one out of twice in hollow feet. It seems that three metatarsal osteotomies induce a metatarsal elevation and shortening, once out of twice. CONCLUSION: The advantage of this technique are : a dorsal medio plantar surgical approach, an osteotomy realized in cancellous bone and no need for fixation allowing a more accurate adjustment of the metatarsal height.

Adult↗