[Use of rapidly degrading bone implants with a Dextran base].
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Biomedical subjects
Publications and source records attributed to R Durroux.
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17 cases of subacute or at once chronic osteomyelitis are shown. At this occasion, an analysis of epidemiological, topographical, clinical and bacteriological data is given. An immunological study has been made in 5 cases: diagnosis is difficult at all stages. A reflexion is proposed concerning the treatment to be performed.
The Salter and Harris classification concerning the epiphyseal cartilage traumas is gradually showing its limits. The type V according to Salter, the prognosis of which being severe, should be due to the traumatic compression of the growth cartilage. But no experimental research could up to this time demonstrate this fact. Among 24 rabbits seen during growth, we tried to create a type V on the distal end of the femur. But, even when the impacts had been very strong, we never could create a single V-type injury. During discussion, and in order to give an explanation of late epiphysiodesis, one could call up the role of the periosteum, of the pre-cartilaginous collar, of the metaphyseal lack of blood vessels. This role should be important in forming a so-called "V-type".
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The authors report a series of fourteen patients with a glomus tumor in the hand. The major symptoms were excruciating spontaneous pain upon mechanical and thermal stimulation of the tumor. In subungual tumors, a blue discoloration is suggestive of diagnosis; but this was found in only 50 percent of cases. The difficult in correct diagnosis and therefore for complete removal is due to in the location of the tumor. Recurrence may occur in cases of incompletely removed tumor. In three cases, the tumor was submitted to electron microscopic examination which led to a better comprehension of the histogenesis of these tumors.
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The authors have made a systematic study of specimens of synovium and capsule removed during total hip replacement for slowly and rapidly progressive arthritis, rheumatoid coxarthritis and necrosis. Out of 1 120 cases, there were 328 tissue samples suitable for satisfactory morphological interpretation. A number of conclusions are drawn from the detailed analysis of the different types of lesion. The vast majority of cases of common arthritis consist of hyperplastic and degenerative metamorphic lesions often associated with signs of inflammation. The dominant feature at this stage of coxarthritis is the histiocytic macrophage response to foreign bodies of bone and joint cartilage; it is frequent in rapidly progressive arthritis and necrosis. Several cases of synoviocytic and pseudo-tumour histiocytic hyperplasia are identified, as well as myxoid and amyloid degenerative disease of connective tissue and microcrystal formation.
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The authors have conducted stapling experiments in 25 rabbits which have shown that, after four weeks, growth was stopped because of lesions of the germinal layer of the growth plate and the formation of bony bridges. They have reviewed the results obtained in 105 children with satisfactory results in 80 p. 100. The cause of some complications have been analysed. The best indication was idiopathic genu valgum of adolescence.
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While getting synovial sclerosis and articular drying, the synoviorthesis breaks the circulus vicious which comes from iterative hemarthrosis to articular destruction. With 25 cases and a follow up of 6 years, we have got 39% of good results, 35% of medium and 26% of bad ones. The therapeutic efficiency requires a certain latent time (0 to 15 days for isotopical synoviorthesis, 2 to 3 months for those ones with osmical acid.) A new synoviorthesis can be made if needed. Neither age nor radiological stage are of any influence. The radiological worsening uses to go on unchanged. The synoviorthesis should be performed at an early stage, previous to the cartilage and bone destructions.
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Infection of the joint with pyogenic organisms usually causes purulent arthritis the prognosis of which is linked to the severity of the bone, cartilage and ligamentous destruction. The tissue response to infection is moreover influenced by a certain number of factors such as the nature of the bacteria and, above all, the circumstances of onset of the infections. Considering the difficulties in diagnosis, special mention should be made of bone and joint infections with a torpid course.
The authors present 11 cases of pubic or ischio-pubic osteitis of which ten had undergone bone biopsy by aspiration, needle biopsy, or surgery. In 7 cases, a germ was isolated by culture of the bone sample. In 2 cases, there were purulent and necrotic lesions on pathological examination of the fragment. In 6 cases, the bony lesions were mainly of the marrow with fibrosis and lymphocyte-plasma cell infiltration. In 5 of these 6 biopsies, the bacterial culture was positive. This subacute mononuclear osteitis may thus be a variety of bacterial osteitis. All the patients were treated with antibiotics which seemed necessary.
In 16 cases of reflex sympathetic dystrophy of the knee, the authors obtained by drill biopsy 29 bone samples from the epiphyseal and metaphyseal regions of the femur and tibia and 8 cartilagenous samples (including 6 by arthrotomy and 2 after patellectomy). They noted thinning of the cortical bone, lacunae of cortical reabsorption, rarefaction of the trabeculae, of which some were dead, stasis and fibrosis of the bone marrow. The 8 cartilage samples were pathological, with, in particular, fibrosis of the surface cartilage (vascular pannus formation). The association of chondromalacia of the patella with an S.R.D. syndrome of the knee is frequent.