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Biomedical subjects

C Court

Publications and source records attributed to C Court.

At least 19 recordsLinked to original sources
PubMed2002

[Contribution of systematic culture of drainage fluids in Altemeier class 1 and 2 procedures].

PURPOSE OF THE STUDY: We conducted a prospective study to determine the therapeutic impact of systematic culture of suction drainage collections in Altemeier class I and II procedures. MATERIALS AND METHODS: We examined the following questions: how many microbiologically positive samples and infections of the operative site were present in the included patients? for positive cases, what was the antibiotic prescription (excluding antibiotic prophylaxy protocols planned before surgery for cleaning)? if the sample was positive in a patient with no clinical infection, what antibiotics were prescribed? RESULTS: A total of 1039 samples were collected in 470 patients undergoing Altemeier class I and II procedures. One hundred five cultures were positive in 34 patients who had undergone major surgery. There were 11 postoperative infections during the study period. Mean delay to diagnosis of infection was 19.5 days. Only one infected patient with positive drainage samples developed an infection on the 7(th) day; the causal germ was different from that identified in the drainage collection. Only one of the patients with a positive drainage sample was given antibiotics, but this treatment was initiated at peroperative reception of the laboratory results. DISCUSSION: Our findings demonstrate that systematic samples of drainage collections make no contribution to therapeutic decision making in patients undergoing class I and II surgery.

Bacteria↗
PubMed2001

[Revision arthroplasty of the shoulder for painful glenoid loosening: a series of 14 cases with acromial prostheses reviewed at four year follow up].

PURPOSE OF THE STUDY: We present the results of a continuous series of 14 patients who underwent revision arthroplasty of the shoulder for painful major loosening of the glenoid component. MATERIAL AND METHODS: Mean follow-up was four years after revision. Loosening was diagnosed seven and a half years after the primary arthroplasty. The diagnosis of loosening was based on the association of a painful impairment of the shoulder with increasing radiolucency or migration of the component. The degree of pain alone guided the surgical decision. The posterior approach provided wide exposure. A glenoid component with an acromial fixation was used in all cases. RESULTS: The loosening was confirmed in all cases at surgery. Two were early failures of the fixation. The glenoid required a bone graft in all cases. The acromion was a useful landmark for proper positioning of the prosthesis. Fixation with cement and screws provided a strong fixation allowing immediate rehabilitation exercises. Good fixation of the glenoid component was achieved in all cases. After seven years follow-up there has been evidence of iterative loosening in one patient. In another case, one screw broke, suggesting forthcoming loosening. Twelve cases had no or very little pain. Two painful cases were associated with anterior migration of the humeral head. DISCUSSION: Even when the local conditions are unfavorable, good implant fixation can be achieved by grafting the glenoid bone loss. Functional improvement is essentially due to pain relief. CONCLUSION: This series, the largest published to date on revision surgery of painful loosening of total shoulder arthroplasty, demonstrated that iterative fixation is technically possible and can provide highly significant pain relief.

Adult↗
PubMed2001

[Pelvic and spinal giant metastases from thyroid carcinomas: report of 8 cases].

PURPOSE OF THE STUDY: We report 8 cases of giant metastases in 7 patients with a pelvis or spinal localization in patients with differentiated carcinoma of the thyroid gland. MATERIAL AND METHOD: Surgery was indicated for major functional disorders: pathological fracture, neurological complications. All patients were treated by embolization, tumor resection and reconstruction. All patients were given suppressive doses of thyroid hormones and 6 received complementary radiotherapy. Radioactive iodine, 100 mCu was also given in 5 cases. Outcome was analyzed retrospectively. RESULTS: Two postoperative infections were successfully treated by surgical cleaning in one operation. There were no surgery-related neurological complications. One patient died in the immediate postoperative period due to the cancer. Mean follow-up in the other patients was 4 years. Functional outcome was excellent without local recurrence or mechanical complications. DISCUSSION: These results suggest that surgical resection of giant bone metastases from thyroid carcinomas can provide favorable functional outcome similar to that achieved for small-sized metastases.

Adenocarcinoma, Follicular↗
PubMed2001

[Complex fractures of the proximal end of the radius and ulna in adults: a new classification].

Unlike injuries involving only one of the forearm bones, complex lesions of the proximal end of the radius and the ulna are particularly unstable. Various situations-Monteggia fracture, transolecraneal dislocation, or fracture-dislocation-are encountered. The classification systems proposed to date and recalled here are insufficient, making it difficult to provide optimal therapy and also hindering comparison between published series. We propose a descriptive classification including all the anatomic varieties of complex fractures of the proximal end of the radius and the ulna. This classification is based on our experience with 38 cases and takes into account 4 basic elements: the height of the ulnar fracture line, the direction of the displacement of the proximal radius, the association of a fracture of the proximal radius and/or of the coronoid process.

Adult↗
PubMed2001

[Complex fractures of the proximal end of the radius and ulna in adults: a retrospective study of 38 cases].

PURPOSE OF THE STUDY: Complex lesions of the proximal end of the radius and ulna are uncommon and generally associate a fracture of the proximal ulna and a dislocation of the radial head, which also may be fractured. We assessed the effect of the type of fracture and treatment on functional outcome and complications. MATERIAL AND METHODS: Thirty-eight adults (25 men and 13 women) were treated for complex fractures of the proximal end of the radius and ulna. For 25 of them, mean follow-up was 2.4 years. For the ulna, there was an epiphyseal fracture in 10 cases, a metaphyseal-epiphyseal fracture in 16 and a diaphyseal fracture in 12. The coronoid process was fractured in 20 cases and the proximal radius in 19. There was an anterior displacement in 24 cases. There were 9 open fractures and 13 patients had another injury of the upper limb. Functional outcome was assessed with a 100 point scale using subjective (pain) and objective (active motion, muscle force, stability) criteria. RESULTS: For the 25 fractures with more than 1 year follow-up, outcome was very good in 8, good in 6, fair in 8 and poor in 3. The pain and muscle force scores followed a similar pattern. Motion appeared as the determining factor for good outcome. Seven early revisions (2 for deep infections, 2 for disassembly of the fixation system, 3 for insufficient fixation) were required among the 38 patients. Among the late complications, there were 3 nonunions, 5 misalignments, and 4 proximal radio-ulnar synostoses. Six elbows required revision to restore motion. DISCUSSION: Certain characteristics of the fractures were predictive of poor outcome: skin opening, association with a lesion of the homolateral upper limb, mirror lesion of the lateral condyle, metaphyseal-epiphyseal fractures, communitive fractures, presence of a fracture of the radial head or the coronoid process. CONCLUSION: Complex proximal fractures of both bones of the forearm threaten the functional prognosis of the upper limb due to the risk of stiffness. Successful treatment depends on three factors: stable anatomic reconstruction of the ulnar articulation, and reconstruction of the lateral column and the coronoid process, necessary for a stable elbow. In addition, early mobilization, possible with a stable osteosynthesis, is indispensable for recovering useful joint movement.

Adolescent↗
PubMed2000

Loss of sagittal plane correction after removal of spinal implants.

STUDY DESIGN: A retrospective review of a clinical series was performed. OBJECTIVES: To evaluate the incidence of adult patients who experienced spinal collapse after spinal implant removal after a long spinal arthrodesis, and to assess the various factors that may influence the likelihood of collapse after implant removal. SUMMARY OF BACKGROUND DATA: Published reports describing the benefits or complications of spinal implant removal do not exist. Spinal implant removal, often considered a benign procedure, is even required by the Food and Drug Administration (FDA) for certain implants. METHODS: The medical records and radiographs of 116 consecutive adult patients with long posterior instrumented fusions (>5 segments) were reviewed. The information obtained included original diagnosis, patient age, number of previous surgeries before implant removal, levels of anterior and posterior fusion, time from fusion to implant removal, time from implant removal to failure, and reason for hardware removal. Radiographs also were assessed including scoliosis, lordosis, and kyphosis measurements before implant removal, after hardware removal, after failure, and after revision surgery. RESULTS: Of 116 patients, 14 underwent spinal implant removal. Most of these patients reported prominent implants either proximally in the thoracic spine or distally in the ilium (Galveston technique). Of these 14 patients, 4 experienced increased pain and collapse after implant removal despite thorough intraoperative explorations demonstrating solid fusion. CONCLUSIONS: Spinal implant removal after long posterior fusion in adults may lead to spinal collapse and further surgery. Removal of instrumentation should be avoided or should involve partial removal of the prominent implant.

Adolescent↗
PubMed2000

[Surgical treatment of metastases from thyroid cancer in the axial skeleton. A retrospective study of 18 cases].

Between 1990 and 1997, 18 patients with a mean age of 55.5 years (11 females, 7 males) underwent surgical treatment for a metastasis from thyroid cancer involving the axial skeleton. At the time of surgery all patients had a poor prognosis: 7 metastases revealed the thyroid cancer, all 18 patients had a neurological or mechanical complication, 9 had multiple metastases, all were over 40 years of age. After arteriography with embolization, the surgical procedure consisted of curettage of the tumor and reconstruction, followed by treatment with iodine 131. The survival rate 3 years after surgery was 50%. At the last review, the functional outcome was good and 17 patients had total neurological recovery. Four complications occurred: 1 operative hemorrhage, 3 postoperative infections. Four patients had local recurrence of the metastasis with a one-year survival rate of 20%. When the thyroid cancer was revealed by the axial metastasis, the 3-year-survival rate was 42%. In cases with huge metastases, the 3-year-survival rate was 71%. It appears from these data that surgical treatment of metastases from thyroid cancer in the axial skeleton still achieves a good functional outcome even in cases where neurological or mechanical complications had occurred before surgery.

Adult↗
PubMed1999

[Technical aspects of arthroscopic arthrolysis after total knee replacement].

UNLABELLED: Arthroscopic arthrolysis is a reliable technique for the treatment of knee stiffness due to arthrofibrosis following ligament replacement or following the treatment of knee fracture. However, its use is uncommon for this indication in total knee arthroplasty (TKA). In this study, we questioned whether or not arthroscopy is a reliable technique for treatment of knee stiffness following TKA, due to arthrofibrosis. MATERIALS AND METHODS: Four men mean aged 54 (38-70) underwent knee arthroscopy for a history of arthrofibrosis following TKA. In two cases the arthrofibrosis had appeared after a primary TKA done for limited range of motion and in two other cases had followed a revision arthroplasty. The mean knee flexion before the TKA was 80 degrees (40-110) and it was 105 degrees (100-120) after performing the TKA. The knees were not mobilized under anesthesia though the mean flexion was 75 degrees (60-80) 15 days after the TKA. The indication for arthroscopy was a painless limited range of motion of the knee. The arthroscopy was performed 6 months (2.5-12) after the TKA and at this time the flexion was limited to 65 degrees (60-80). The extension was limited in 2 cases to 10 degrees and 30 degrees. Patients were evaluated an average of 20 months (8-36) after the arthroscopy. With 2 peripatellar portals we sectioned the adhesions in the suprapatellar pouch, the 2 retinaculars and the adhesive bands in the 2 gutters. Two anterior additional portals were used in case of extension lag. A suction drain was placed and the portals were sutured. A continuous passive motion machine was started in the recovery room. RESULTS: The mean operating time for arthroscopic arthrolysis was 38 minutes (30-60). The mean knee flexion was 116 degrees (100-130) at the end of arthroscopy and was 93 degrees (75-110) at the last review. The mean flexion improved by 31 degrees (15-50). The mean flexion improved by 45% (25-83). The 2 extension lags decreased respectively from 30 degrees to 10 degrees and from 10 degrees to 0 degree. For these 2 patients the increase in range of motion was 70 degrees and 40 degrees respectively. The average amount of bleeding was 200 ml (86-520). There were no complications. DISCUSSION: Few surgeons are experienced in arthroscopy for knee stiffness after TKA. Our results are similar to those reported by most authors. Regarding the technique, the section of the two retinaculars is necessary for the mobility of the patellar and most of the mobility is gained after the release of the gutters. The use of only two portals avoids damaging the TKA component and decreases the theoretical risk of infection. The major loss of motion after arthrolysis occurred during the first days following the arthroscopy. This is why we recommend using a regional anesthesia for the arthroscopy and during the following days to allow intensive mobilization of the knee. The arthrolysis should be done from 3 to 6 months after the TKA for better results. CONCLUSION: Arthroscopy for the treatment of knee stiffness, due to arthrofibrosis, following TKA is a useful, reliable and safe technique.

Adult↗
PubMed1998

[Knee fractures in the adult].

In the adult, fractures of the knee are joint fractures. The knee is a weight-bearing joint, and its mobility and stability must be recovered quickly for good functional recuperation. Aside from X-ray investigations, the initial examinations seek vascular, nerve and cutaneous lesions. The existence of a bruise or a cutaneous break decides the therapeutic choice and timing. Fractures of the lower extremity of the femur (sub-, inter-, supra- or unicondyle) most often require open surgery for better restitution of the joint surfaces; for fractures of the tibial plate, whether uni-, spino- or bituberous, a graft must be associated in case of crushing fracture. Fractures of the patella require surgery in case of rupture of the extensor.

Adult↗
PubMed1998

Cytokine release from marrow mononuclear cells is negatively correlated to cortical elasticity in non-osteoporotic postmenopausal women.

Activation of bone remodeling is likely to be under the control of mechanical factors acting, in part, through soluble local factors. We therefore investigated a relationship between cytokine production by marrow cells and bone elasticity. We studied 36 non-osteoporotic postmenopausal women undergoing hip arthroplasty for hip arthrosis (mean age: 68 +/- 8 years; lumbar BMD Z-score: +0.54 +/- 0.33 SD). Adherent marrow mononuclear cells were cultured for 48 hours with autologous plasma, and supernatants were harvested for PGE2, IL-1, TNF-alpha, and IL-6 measurements. Femoral neck cortical bones were removed during surgery for cortical histomorphometric evaluation and determination of elasticity indices (C33) using ultrasonic transmission method. In this nonosteoporotic population, femoral neck longitudinal elasticity indices were inversely correlated to both cortical thickness (r = -0.58, P < 0.01) and cortical porosity (r = -0.33, P < 0.01). The longitudinal elasticity indices were also negatively correlated to basal IL-1 and TNF-alpha release by adherent mononuclear marrow cells (r = -0.59, P < 0.01; r = -0.60, P < 0.01, respectively). However, no relationship was found between the three cytokines tested and either cortical thickness or porosity. These data show a link between cortical biomechanical properties and local factors involved in bone remodeling. We suggest that increased bone elasticity decreases transmission of strain, which in turn decreases cytokine release from marrow cells. However, whether cytokines influence bone elasticity or vice versa remains to be demonstrated.

Aged↗