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Biomedical subjects

R Kohler

Publications and source records attributed to R Kohler.

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

Diffuse brain stem tumor in an adolescent with multiple enchondromatosis (Ollier's disease).

Among patients with enchondromatosis, those with Ollier's disease are usually considered to be at a lower risk for extra-osseous malignancy than those with Maffucci's disease. However, several reports suggest that Ollier's disease may also be associated with gliomas. We report here the youngest patient in the literature (16 years) to be detected with a brain tumor and Ollier's disease. This is also the first case with diffuse brain stem involvement. Thus, counselling of patients with Ollier's disease may become more difficult than initially thought.

Adolescent↗
PubMed1999

[Nicolas Andry (1658-1742) inventor of the term "orthopedics"].

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.

France↗
PubMed1999

Blount's disease: classification and treatment.

Forty-three tibia vara in 27 patients were analyzed retrospectively in two centers. The criteria for diagnosis of the child form are discussed. A simple classification is suggested to facilitate the choice of treatment. In stage 0 (possible Blount's disease), the patient is younger than 2 1/2 years, and an observation period is indicated for gathering data. In stage 1 (confirmed Blount's disease and absence of medial metaphyseal bony bridge), known as physis+, a valgization osteotomy is proposed. In stage 2 (evidence of a medial metaphysoepiphyseal bony bridge) known as physis-, valgization osteotomy with lateral epiphysiodesis and treatment of the lower limb discrepancy is proposed. For stages 1 and 2, there are two possibilities: normal medial tibial plateau or sloping of the medial tibial plateau, indicating a transphyseal elevation osteotomy. When one-step correction is proposed for stage 2 disorder, external fixators such as Orthofix or Ilizarov devices are useful.

Adolescent↗
PubMed1998

Physical exercise increases survival after an experimental myocardial infarction in rats.

To directly evaluate the effect of physical exercise on survival, 80 rats were randomly assigned to either sedentary life (n = 40) or physical exercise 7 days/week during 6 weeks (n = 40), starting 2 weeks after coronary ligation. All animals were followed daily for 183 days. Size of myocardial infarction was determined by planimetry of serial histologic sections of the left ventricle. Physical exercise had no effect on survival in the total treatment group. However, rats with large myocardial infarctions, randomized to physical exercise, had significantly (p = 0.03) better survival (50%) after 6 months than control rats (17%) with large infarctions.

Animals↗
PubMed1998

[Surgical management of malignant bone tumors in the child. Saint-Etienne Hospital experience, apropos of 17 cases].

From 1980 to 1997, seventeen children were treated for malignant bone tumors in the Department of Paediatric Surgery of the Saint-Etienne Hospital, with an average follow-up of 6 years and 3 months (2M-17Y). The histologic diagnoses were osteosarcomas (12 cases) and Ewing's sarcomas (5 cases). All children were treated surgically. For the 12 lower limb tumors, the techniques used were prosthetic replacement in 7 cases (associated with bone allograft in 3 cases), amputation in 3 cases and isolated bone allograft in 2 cases. The two ilium tumors were treated by resection and reconstruction with autologous bone graft. A single resection was performed for the shoulder-blade Ewing's tumors and a prosthesis for the 2 proximal humerus tumors. Six children died during follow-up. The authors stress that carcinologic resection is a priority before functional results. They insist on the mechanical failures of implants and on the difficulties of reoperations.

Adolescent↗
PubMed1998

[Percutaneous epiphysiodesis. Analysis of a series of 60 full-grown patients].

PURPOSE OF THE STUDY: Percutaneous epiphysiodesis is the actual treatment for mild leg length discrepancy. The authors discuss complications and efficiency of this technique and its accuracy for the prevision of leg length discrepancy. MATERIAL AND METHOD: We reviewed 60 skeletally mature patients (35 boys, 25 girls). Limb length was defined by clinical and teleradiographic evaluation. Bone age was recorded using Sempé's and Pavia's atlas, using the hand, and Sauvegrain's method, using the elbow. Anticipated discrepancies and timing of epiphysiodesis were calculated using Héchard and Carlioz's graph. The percutaneous curetage was employed in all cases. RESULTS: The treatment was successful for all cases. Complications occurred postoperatively in 2 children who developed an hematoma. 10 children required a surgical revision: 2 cases had an inverted discrepancy, 4 patients were found to have limb deviation, and in four children this treatment was not adequate. The outcome was excellent in 48.3 per cent of cases, satisfactory in 31.7 per cent, acceptable in 6.7 per cent and bad for 13.3 per cent of cases. DISCUSSION: Percutaneous epiphysiodesis is well tolerated in childhood with similar results to other techniques (stapling and Phemister's technique). Our experience suggest that:--complications are rare--this treatment is a satisfactory surgical solution--effective previsions for the best time for surgery have not yet been defined.

Adolescent↗
PubMed1997

[Orthopedic treatment of scoliosis: new technique using impression by optic procedure].

The authors present a new procedure for acquiring the whole external trunk shape. The construction of braces starts with corrected a positive mold using computer-assisted design software connected to a digital tooling machine. The computer-assisted design and construction of braces enable the determination, measurement, and modification of a three-dimensional image of the trunk, which allows the positive to be corrected. The outer-trunk can be re-balanced, derotated or rectified in the sagittal or frontal plane and the inner modeling of the spine and chest can be rectified. Moreover, in the case of scoliosis or kyphosis, the software produces automatic correction. This rapid (acquisition time < 2 seconds), non invasive, safe and painless procedure can also be used to detect and follow mild spinal deformities.

Adolescent↗
PubMed1997

A multicenter, randomized study comparing the efficacy and safety of intravenous and/or oral levofloxacin versus ceftriaxone and/or cefuroxime axetil in treatment of adults with community-acquired pneumonia.

Five hundred ninety patients were enrolled in a prospective, multicenter, randomized trial comparing the efficacy and safety of 7 to 14 days of levofloxacin treatment with that of ceftriaxone and/or cefuroxime axetil in the management of community-acquired pneumonia in adults. Patients received either intravenous and/or oral levofloxacin (500 mg once daily) or the comparative agents, parenteral ceftriaxone (1 to 2 g once to twice daily) and/or oral cefuroxime axetil (500 mg twice daily). Erythromycin or doxycycline could be added to the comparator arm at the investigator's discretion. The decision to use an intravenous or oral antimicrobial agent for initial therapy was made by the investigator. Clinical and microbiological evaluations were completed at the baseline, during treatment, 5 to 7 days posttherapy, and 3 to 4 weeks posttherapy. Four hundred fifty-six patients (226 given levofloxacin and 230 administered ceftriaxone and/or cefuroxime axetil) were evaluable for clinical efficacy. Streptococcus pneumoniae and Haemophilus influenzae were isolated in 15 and 12%, respectively, of clinically evaluable patients. One hundred fifty atypical pathogens were identified: 101 were Chlamydia pneumoniae, 41 were Mycoplasma pneumoniae, and 8 were Legionella pneumophila. Clinical success at 5 to 7 days posttherapy was superior for the levofloxacin group (96%) compared with the ceftriaxone and/or cefuroxime axetil group (90%) (95% confidence interval [CI] of -10.7 to -1.3). Among patients with typical respiratory pathogens who were evaluable for microbiological efficacy, the overall bacteriologic eradication rates were superior for levofloxacin (98%) compared with the ceftriaxone and/or cefuroxime axetil group (85%) (95% CI of -21.6 to -4.8). Levofloxacin eradicated 100% of the most frequently reported respiratory pathogens (i.e., H. influenzae and S. pneumoniae) and provided a >98% clinical success rate in patients with atypical pathogens. Both levofloxacin and ceftriaxone-cefuroxime axetil eradicated 100% of the S. pneumoniae cells detected in blood culture. Drug-related adverse events were reported in 5.8% of patients receiving levofloxacin and in 8.5% of patients administered ceftriaxone and/or cefuroxime axetil. Gastrointestinal and central and peripheral nervous system adverse events were the most common events reported in each treatment group. In conclusion, these results demonstrate that treatment with levofloxacin is superior to ceftriaxone and/or cefuroxime axetil therapy in the management of community-acquired pneumonia in adults.

Administration, Oral↗
PubMed1997

The expression of the C. elegans labial-like Hox gene ceh-13 during early embryogenesis relies on cell fate and on anteroposterior cell polarity.

Clusters of homeobox-containing HOM-C/hox genes determine the morphology of animal body plans and body parts and are thought to mediate positional information. Here, we describe the onset of embryonic expression of ceh-13, the Caenorhabditis elegans orthologue of the Drosophila labial gene, which is the earliest gene of the C. elegans Hox gene cluster to be activated in C. elegans development. At the beginning of gastrulation, ceh-13 is asymmetrically expressed in posterior daughters of anteroposterior divisions, first in the posterior daughter of the intestinal precursor cell E and then in all posterior daughters of the AB descendants ABxxx. In this paper, we present evidence that supports position-independent activation of ceh-13 during early C. elegans embryogenesis, which integrates cell fate determinants and cell polarity cues. Our findings imply that mechanisms other than cell-extrinsic anteroposterior positional signals play an important role in the activation and regulation of the C. elegans Hox gene ceh-13.

Animals↗
PubMed1996

[Rôle of growth hormone therapy in the genesis of slipped capital femoral epiphysis].

The authors report two cases of children treated with growth hormone who had a secondary slipped capital femoral epiphysis. Endocrine disease, radiotherapy are some well-known etiological factors reported in literature, but growth hormone influence is still discussed. This hormone could have an indirect incidence on this pathology because of its effects on growth cartilage. The increased number of treatment with growth hormone is certainly a risk factor for slipped capital femoral epiphysis. Regular checking from "France Hypophyse" allows an early diagnosis of epiphysis and surgical fixation can be made immediately. Systematic controlateral side fixation it still discussed but allowed to continue the treatment with the same posology.

Adolescent↗
PubMed1995

[Treatment of osteoid osteoma by CT-controlled percutaneous drill resection. Apropos of 27 cases].

PURPOSE OF THE STUDY: Osteoid osteoma is a benign tumor requiring excision due to pain, usually severe and invalidating. Surgical "en bloc" resection is not always easy. Complete resection of the nidus is required to prevent recurrence while at the same time a limited resection should also be used to avoid a pathological fracture or a growth plate injury in children. In order to achieve these 2 goals, we have developed an alternative method: CT guided drill resection. This method is reported with special reference to its technical aspects. MATERIAL AND METHODS: Twenty seven patients (16 children and 11 young adults) were treated during a seven year period (June 87 through June 94) and observed clinically and radiologically with an average two-year follow-up (range one to three years). Osteoid osteoma was localized mainly in the lower limb: Femoral neck (or head): 10 cases, 3 in the acetabulum; Femoral shaft: 6 cases; Tibial shaft: 4 cases. Diagnosis was based on clinical features and imaging: radioisotope bone scan and computed tomography in all cases--angiography in 3 patients to assess the diagnosis more accurately. The procedure was performed under general anesthesia (a short hospitalization is needed). The nidus was first localized by Computed Tomography, then approached and resected through a small percutaneous incision. A special device has been manufactured in order to remove a bone cylinder containing the nidus. It was thus possible to perform histological studies of the specimen and confirm the diagnosis. Histological confirmation was possible in 50 per cent of the cases. No complication (except a case of transient extensor hallucis palsy) was observed in this series, 24 patients healed completely; pain disappeared immediately, and the control CT scan returned to normal after a one-year follow-up. In 3 patients, because of a technical error, the nidus was not totally removed. These patients underwent a second procedure, which was effective. DISCUSSION: This method is a good alternative to the direct surgical approach because of its technical advantages: precision in nidus localization and minimal bone resection; consequently, one should underline the practical benefits for the patient: short hospitalization, immediate full weight bearing, quick return to socio-economic activities. Furthermore, some localizations of the nidus which are difficult to reach (for instance the acetabulum) represent a good indication for the method. Accurate pre-operative diagnosis has now become possible with recent advances in imaging techniques but still remains "uncertain". The resection of the specimen allows confirmation of the diagnosis is most of cases. This procedure should ideally be performed by a team (orthopedic surgeon and a radiologist): collaboration instead of competition is in fact the best way to progress in this field of "interventionnal radiology".

Adolescent↗
PubMed1995

[Cervical spondylolysis in children. Apropos of 4 cases. Review of the literature].

PURPOSE OF THE STUDY: A clinical and radiological study of four cases of spondylolysis in children. Literature review shows the congenital origin of the disorder and how it is to be treated. MATERIAL AND METHODS: We report on four children with cervical spondylolysis. One of the children presented a two-level spondylolysis C5C6. One case was totally asymptomatic and was hazardly discovered. Standard radiographs were used for diagnosis. Conservative treatment was administered in all cases and all patients were immobilized for a few days. DISCUSSION: It has been clearly established that cervical spondylolysis is a congenital disorder often associated with other anomalies: spina bifida, dysplasia of the posterior articular processes. In the child, cervical spondylolysis is only discovered in fifty per cent of Post traumatic cases. The most frequent finding is at C6. A diagnosis can be made based on the radiographs and the CT scan. MRI will only be indicated in spondylolisthesis in order to analyze the disc statement and the degree of canal narrowing. When possible conservative treatment should be adopted. Arthrodesis is reserved for unstable and painful lesions. CONCLUSION: Cervical spondylolysis in the child is a rare congenital disorder. It must be distinguished from the congenital absence of a pedicle and from a pedicle or isthmic fracture. It is a lesion which is normally discovered once the patient has turned adult and is very well long term tolerated.

Adolescent↗
PubMed1993

[Osteosarcoma].

Osteosarcoma is the most frequent bone tumor in children and young adults. It represents 8% of all tumors in children. Pain and bone tumefaction are the clinical signs. Bone X ray, scintiscan, CT scan and MRN must be done before the biopsy which signs the diagnosis. The best treatment is chemotherapy with high dose methotrexate + leucovorin rescue, adriamycin, cisplatinum and ifosfamide, in different associations followed by surgery either conservative in 80% of the patients or radical. Histologic response to chemotherapy, good or bad responders, is the best prognostic. Postoperative chemotherapy varies with the histologic response; 60 to 70% of patients are living recurrence free at 5 years but metastases could be later.

Adolescent↗
PubMed1992

[Neurological complications of surgery for spinal deformities].

The aim of this study was to precisely analyse the physio-pathogenic mechanisms, bring to light the risk factors, and find a more practical way of proceeding in spinal surgery. Out of 667 spinal instrumentation surgical operations carried out between 1980-1989, we found 33 (4.8 per cent) neurological complications and have divided them into 2 groups: 7 peripheral complications, 26 cord and central complications. After further analysis, especially of the cord complications (2.5 per cent), we were able to pick out the factors which influence the rate of neurological complications and their evolution: secondary aetiology and the kyphotic composition of spinal deformation, and above all the notion of cord at risk. The delay of cord complications and especially the relation between the severity of the neurological syndrome and its evolution is extremely important. Somesthesic evoked potential monitoring confirmed that per operative diagnosis of a cord injury is possible. The steps to take when confronted with neurological complications, depend on the results of many examinations: pre and post-operative neurological evaluations electrophysiological exploration of the cord and neuro radiological explorations (myelography, scanner and IRM). This helps to complete aetiology and eliminate mechanical causes, which are the only positive indications of iterative surgery. The problems of instrumentation removal in emergency and the legal-medical aspect brought on by this type of complication are discussed.

Humans↗