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Biomedical subjects

C R Michel

Publications and source records attributed to C R Michel.

At least 19 recordsLinked to original sources
PubMed1993

Early and semi-early surgery for scoliosis caused by hemivertebrae--indications and results.

We report a series of 50 congenital scolioses due to hemivertebrae. This malformation was responsible for progressive deformity, largely predominant on the frontal plane. The average follow-up was 5 years and 3 months. Seven patients had mature bones. The series comprised 31 girls and 19 boys. Three types of operations were performed: (a) hemivertebrae resection (5 cases); (b) early, most posterior convexity fusion carried out before the age of 6 years (26 cases), and (c) semi-early convexity fusion performed between the ages of 6 and 12 years (19 cases). The results obtained in children with a more than 2 years' follow-up were: (a) early convexity fusion (18 cases): 7 epiphyseodesis effects, 6 graft effects and 4 failures; (b) semi-early convexity fusion (16 cases): 6 epiphyseodesis effects, 8 graft effects and 2 failures; (c) hemivertebrae resection (5 cases): moderate gain that remained stable in 4/5 cases.

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↗
PubMed1990

The Dwyer procedure in the treatment of idiopathic scoliosis. A 10-year follow-up review of 21 patients.

Despite the well-known Dwyer procedure, developed in 1969, comprehensive reports on its use, with long-term follow-up, are relatively scarce. The purposes of this study were to detect eventual late complications and to compare late results with postoperative angular curve correction. This article reports on 21 children operated on between October 1972 and October 1975 and reviewed with a minimum follow-up of 10 years (10 other patients were lost to follow-up after 5 years). Patients had idiopathic lumbar or thoracolumbar curves (average curve, 56 degrees). Results are discussed with a special reference to longitudinal observation. There is a great correction of the instrumented curve (postoperative, 5 degrees), but a loss of correction of 10 degrees is generally observed, prevented by a complete immediate correction or even hypercorrection. The upper curve, noninstrumented, also shows improvement (mean preoperative, 38 degrees; postoperative, 22 degrees; 10 years, 22 degrees) but re-equilibration cannot be predicted. Pseudarthrosis of one intervertebral space occurs frequently, and may cause failure of the cable with a loss of correction of 10-20 degrees. Kyphosis (or simple loss of lumbar lordosis) is commonly observed but should be balanced with correction of rotation. The following conclusions were made: morbidity is not severe, despite the advanced surgical technique. The technique is difficult and has a direct consequence on the quality of results; pseudarthrosis is a frequent complication, followed by important loss of correction; indications should be discussed carefully in idiopathic lumbar and thoracolumbar curves. It is still too early to advocate either anterior instrumentation of Zielke (VDS) or segmental posterior instrumentation (C. D. Luque) because of short-term follow-up.

Adolescent↗
PubMed1990

[Idiopathic high patella in adolescents. Apropos of 61 surgical cases].

The patellar height was measured according to the index of Caton and Deschamps. The normal index equals 1, the patella considered as being high with an index of 1.2 or greater. The authors reviewed 50 patients presenting with such an anomaly in patellar height to verify whether this patella alta said to be idiopathic was simply a radiographic sign or represented a true anatomic and clinical entity. 61 knees were hence operated on between 1963 and 1988, 50% of which had a lowering of the tibial tuberosity. In 8 cases, the lowering was performed secondarily, after a failure of the first operation to correct the anomaly. The mean pre-operative index of patellar height was 1.34 and the trochlea appeared indisputably dysplastic in 50 of the 61 cases. The mean age at the time of surgery was 17 years. Medial translation of the tibial tuberosity averaged 9.5 mm and the lowering 7 mm allowing a normalization of the patellar index. 76.8% of patients had a perfect post-operative stability, evaluated as a score of 8 or 9 on the ARPEGE scale. At the completion of this study it appeared that patella alta is rarely an isolated finding and is most often part of a regional patello-femoral dysplasia. Its existence, when responsible for a functional problem, must absolutely be taken into account and treated to obtain a satisfactory result.

Adolescent↗
PubMed1989

[Caudal anesthesia in pediatric surgery. Pharmacokinetic study and clinical significance].

In 1987, 758 caudal anaesthesia allowed the execution of 41% of all our department's operations. Urological, genital, inguinal and lower limbs surgery were the most frequent. The injection into the extradural space through the hiatus sacralis always included the mixture of lidocaine with bupivacaine to speed up the beginning of the operation. The patients were split up into 2 equal groups and were given 1.25 ou 2.50 mg.kg-1 of bupivacaine (i.e. 0.50 ml.kg-1 of a 2.50 or 0.50% solution). Bupivacaine plasma levels were determined by high performance liquid chromatography in 40 patients from the first group and in 42 patients from the second. They reached their maximum about 500 or 1,000 ng.ml-1 respectively, 30 mn after the injection and always fell back 4 hours after the administration. These concentrations were compared with the levels obtained by infusion to the dog, which cause serious cardiac disorders with 6,000 to 8,000 ng.ml-1 levels, and elicit ventricular fibrillation with 8,000 to 10,000 ng.ml-1. So the safety margin appears greater when overdose and/or intravascular injection are avoided. Caudal anaesthesia is easy, fast acting and allows to relieve post-operative pain. It is suitable for all surgery below the umbilicus and can be used on an outpatient basis.

Anesthesia, Caudal↗
PubMed1988

[Results of Salter's innominate osteotomy in residual hip dysplasia in children. Apropos of 60 cases].

Sixty Salter innominate osteotomies were analysed retrospectively with a mean post-operative follow-up of five years. The 53 children, suffering from congenital dislocation of the hip discovered at walking age, had initially been treated by Somerville-Petit conservative management. The results were assessed using the Severin classification and showed 80 per cent of good results (Severin groups Ia, Ib and IIa). The bad results were all due to errors of operative indications (failure to respect the Salter pre-requisites) or technical faults. Complications were uncommon. There were 11 pin extrusions, which led to the use of threaded pins to so as to gain sounder fixation of the osteotomy. An analysis of the characteristics of each hip allowed an assessment to be made of the effects of Salter osteotomy using several angular parameters, including Hilgenreiner's and Wiberg's angles. The description of a new parameter, the angle between the acetabulum and the epiphyseal line (acetabulo-epiphyseal line) and its normal values provides a new approach to the lower limit for the indications for operation on dysplastic hips. This parameter seems to be more discriminatory than Wiberg's angle in relation to dysplasia and makes it possible to determine a threshold of uncovering of the head that justifies surgical correction.

Adolescent↗
PubMed1988

[Spontaneous epiphyseal separation in children with spina bifida. Apropos of a series of 12 cases].

Unknown complication but nevertheless frequent, the spontaneous slipped epiphyseal injury in child with spina bifida states the problem for its diagnosis and its treatment. The authors give their experience about 12 cases in 10 children, insisting on the problem of the pseudo-infected and the pseudo-tumoral cases with an early diagnosis. A review of the literature is made about this subject. The treatment is generally orthopaedic excepted at the hip where it is surgical. A physiopathogenic study is made; explaining the mechanism, the frequency of this pathology and its complications.

Bone Neoplasms↗
PubMed1987

[Brachymetapodies: diagnostic and therapeutic aspects. Apropos of 3 cases].

The authors present 3 cases of brachymetapody (or "hereditary type E brachydactyly"). These conditions are defined by an abnormal shortness of some metacarpals and metatarsals, sometimes associated with other malformations and short stature. The feet may require a surgical correction with different alternatives, adapted to the type of malformations: lengthening of the short rays if they are the least numerous, shortening of one single "long" ray. Surgical indications depend upon pain, more than upon aesthetic considerations. In one of the reported cases, bilateral shortening osteotomy of the first metatarsal and proximal phalanx was performed.

Adolescent↗
PubMed1986

[Congenital superior radioulnar synostoses. A study of 43 cases].

Superior radioulnar synostosis is a rare abnormality which frequently gives rise to functional disability. Its pattern of inheritance is uncertain. We have studied 29 children, 18 boys and 11 girls, who had a total of 43 such synostoses. Twenty children had significant functional disability. Fourteen required operation, 10 undergoing a Judet's osteotomy and 4 osteotomy of the lower end of the radius. The dominant hand was placed in the position of function, and the other in 30-40 degrees of supination. The osteotomies were secured by pins and supported in a plaster splint. Use of the forearm and hand was improved in all cases. Operation is best carried out between the ages of 4 and 10, and a useful functional improvement can be expected.

Age Factors↗
PubMed1986

[Measurement of femoral anteversion in children by ultrasonics].

After reviewing the anatomy of the frontal geometry of femur and values for femoral anteversion during growth, an ultrasound method is described for measurement of femoral anteversion. The principle underlying the technique is the use of a spirit level fixed to a bar probe and an effective contention in rotation of lower limbs, this ensuring validity of results even in infants. Analysis of findings in a preliminary series of 10 infants (20 hips), age range 2 to 16 years, with torsion anomalies of lower limbs, showed values obtained to be totally superimposable on those provided by a CT scan.

Adolescent↗