[Failure in the screening and diagnosis of developmental dysplasia of the hip].
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Diagnostic Errors↗
Biomedical subjects
D Moulies
Publications and source records attributed to D Moulies.
[Effects of isoflurane and halothane on motor evoked potentials in the rabbit].
The effects of isoflurane or halothane on motor evoked potentials (MEPs) were assessed and compared in the rabbit, in order to contribute to devise a rigorous human anaesthetic protocol to be used for monitoring of MEPs in corrective spinal surgery. Ten black adult New Zealand rabbits were anaesthetised twice at a month interval, once with isoflurane and once with halothane. Once a control cortical stimulation had been carried out after the animal had breathed pure oxygen for three minutes, the following concentrations of anaesthetic agent were given for 3 min each: respectively 0.3 vol %, 0.5 vol % and 1 vol % of isoflurane, and 0.5 vol % and 1 vol % of halothane. Cortical stimulation was carried out every minute. The signs of anaesthesia (diameter decrease of the pupil, eye covered by the nictating membrane), muscle relaxation (ears drop) and breathing rate were recorded. MEPs were recorded 1, 2, 3 and 5 minutes after the end of anaesthesia. Isoflurane had a stronger effect on MEPs than halothane. The effect was more pronounced on amplitude than on latency. MEPs remained present whatever the concentration of halothane. In 70% of cases, MEPs, discontinued with isoflurane, more rapidly, more deeply, and for a longer time. Mean latency was more constantly increased in the isoflurane than in the halothane group. The effect of volatile halogenated anaesthetics on mean latency of MEPs seemed to be more delayed than that on amplitude. One should also take into account an individual sensitivity, it is concluded that the interpretation of MEPs during anaesthesia with volatile halogenated agents should be carried out with caution.
Anesthesia, Inhalation↗
Monitoring of the motor pathway during spinal surgery.
Paraplegia caused by irreversible lesions of the spinal cord is one of the major possible complications after scoliosis surgery. Several monitoring methods have been proposed but none are completely satisfactory. Since 1986 the authors assessed motor pathways during scoliosis surgery, using electrical stimulation of the motor cortex and lower limb muscle recordings (tibialis anterior muscle). Twenty-seven patients were included in this study: 25 with idiopathic scoliosis and 2 with dorsal kyphosis. Recordings in anesthetized patients with hypothermia were performed before and after spinal derotation during the surgical procedure. Magnetic cortical stimulation was carried out in ten awake patients before and after surgery. Reproducible responses were obtained in 22 patients under anesthesia. In eight patients no difference of the latency of the muscle response was detected before and after the correction of the spinal angulation. In 14 patients the increase of latency ranged from 0.4 ms to 5.2 ms. No correlation was found between the slowing of motor conduction and the magnitude of spine correction. No central neurologic complications were seen after surgery. The authors concluded that their study demonstrated that motor pathway assessment in anesthetized patients can be performed at different times during the surgical procedure. This technique should help in the future monitoring spinal function during scoliosis surgery.
Adolescent↗
[Flat feet in children].
Flat feet are common in children. Loss of the medial arch may be due to intrinsic or extrinsic abnormalities of the foot. Physical evaluation usually suffices to identify the various growth stages which modify alignment and joint mobility, thus affecting foot function. Flat feet not caused by intrinsic structural abnormalities are right considered benign since they only exceptionally cause discomfort in adulthood. Shoe inserts provide only improved comfort during walking. Surgery is used in the extremely small proportion of patients with severe arch loss or deformities secondary to another condition.
Adolescent↗
[Pyloric stenosis in infants. Contribution of ultrasonography and video-surgery].
Hypertrophic pyloric stenosis is the commonest condition requiring abdominal surgery in infancy. The Fredet-Ramstedt pyloromyotomy gives a very rare morbidity rate as shown by a review of 300 personal cases. The diagnostic value of sonography is gaining significance over contrast roentgenography, a pyloric diameter of more than 14 mm and a muscular thickness of more than 4 mm being required for the diagnosis. Over the last 18 months, we performed extramucosal pyloromyotomies using laparoscopy in 19 infants. This new surgical technique using laparoscopy with precautionary measures for the pneumoperitoneum appears to be very promising and should become a widespread technique in the future.
Gastroesophageal Reflux↗
[Pyloric stenosis in infants. New surgical approaches].
Pyloromyotomy as described by Fredet and Ramstedt is still widely used for the treatment of infantile hypertrophic pyloric stenosis, with a very low mortality rate. Three hundred case-records of patients treated using this technique were reviewed. Pyloromyotomy can benefit from the use of videosurgical methods. The creation of a pneumoperitoneum requires special precautions in infants. Nineteen infants were treated using laparoscopic Fredet-Ramstedt pyloromyotomy, a technique which can be expected to gain widespread acceptance during the next few years.
Female↗
[An unusual germ causing a limp: Eikenella corrodens].
A case of retroperitoneal appendicular abscess due to Eikenella corrodens is reported. This facultative anaerobe is normally found on the respiratory and intestinal mucosa and may be responsible for opportunistic infections. Culture is difficult and growth is slow. There have been few previous reports of the localization reported herein. A limp was the first manifestation of the infection. The differential diagnosis and pathophysiology of this symptom are discussed.
Abscess↗
[Single preoperative intravenous dose of metronidazole for appendectomy in children].
One hundred children were prophylactically treated with 15 mg/kg-1 of metronidazole immediately before appendicectomy and retrospectively compared with 100 other patients without any antibioprophylaxis. No statistically significant difference was found between the two groups as regards age, weight, sex and macroscopic appearance of the appendix. The overall incidence of complications was 1% in the antibioprophylactic group and 9% in the control group. Furthermore, a single pre-operative intravenous dose of metronidazole was as effective as conventional antibioprophylaxis.
Appendectomy↗
[Antibiotic prevention with a single dose of metronidazole in appendectomy in children].
One hundred children were prophylactically treated with 15 mg/kg-1 of metronidazole immediately before appendicectomy and retrospectively compared with 100 other patients without any antibioprophylaxis. No statistically significant difference was found between the two groups as regards age, weight, sex and macroscopic appearance of the appendix. The overall incidence of complications was 1% in the antibioprophylactic group and 9% in the control group. Furthermore, a single pre-operative intravenous dose of metronidazole was as effective as conventional antibioprophylaxis.
Appendectomy↗
[Traumatic epiphyseal separation of the lower end of the femur].
Forty-one children suffering from displacement of the distal femoral epiphysis were reviewed with a five year follow-up. This is a rare lesion, caused by severe trauma. It is seen at all ages, four of the cases being neonatal, but principally in adolescence, in 22 cases. The Ogden classification is preferable to the Salter-Harris classification for these fractures, which are usually in type II (39 cases). The prognosis is related to the severity of the initial displacement and to the quality of the reduction and its maintenance. Epiphysoidesis developed frequently and early, in 15 cases. It seemed to be due to an initial vascular injury rather than to mechanical compression. The results were not very satisfactory with 23 good, 11 fair and 7 bad results. It is recommended that an anatomical reduction should be maintained by percutaneous crossed pins. In adolescents aged 15 years or over, primary surgical epiphysiodesis of the whole growth cartilage seems to be a reasonable possibility.
Adolescent↗
Congenital hypo- and hypermyelination neuropathy. Two cases.
Two young patients were referred recently to the authors for investigation of a peroneal atrophy syndrome. Since the first symptoms were observed in infancy, a congenital hypomyelination neuropathy was suspected, and superficial peroneal nerve biopsies were taken. Signs of severe and widespread demyelination/remyelination were observed. These features appeared morphologically similar to those observed in the globular or tomaculous neuropathies. The mechanism of the hypermyelination is discussed.
Child↗
[Osteochondral fractures of the knee in child athletes].
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Adolescent↗
[Fractures of the upper part of the radius in children].
The authors analyse the results of forty five cases of fractures of proximal radius in children with average follow up 7 years. The average age of the children was 9 years. Detailed radiological examination warrants classification under four degrees of displacement (four cases displaced, 17 cases lower 30 degrees, 15 cases between 30 degrees and 60 degrees, 9 cases upper 60 degrees). Associated lesions was present in 15 cases. For treatment, 21 immobilisations, 10 closes reductions, 6 percutaneous reduction by means of a kirshner nail, 8 open reduction were done. Pronostic is good for degrees I and II (20 excellent, 1 good result), pronostic is incertain for degrees III and IV (13 excellent, 2 good, 3 fair and poor results). Correlation is straight between procedure of management and result. The authors suggest their indications, who are depending from age and displacement.
Adolescent↗
[Osteochondral fractures of the knee in athletic children].
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Adolescent↗
[Traumatic dislocation of the hip in children].
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Acetabulum↗
[Isolated fractures of the tibial diaphysis in children].
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Adolescent↗
[Fractures of the medial epicondyle in children].
The authors have analysed retrospectively the results of 53 fractures of medial epicondyle in children. For the review of the radiographies, they describe four degrees of displacement. The average age of the children was 12,5 years (range 7 to 16 years). Posterior dislocation of the elbow was present in 50% of the cases. The fracture of the medial epicondyle was treated surgically in thirty-five cases. Results were: 42 excellent, 8 fair, and 3 poor. Non union explains these three poor results. Neurologic complications were few and transient in all cases.
Adolescent↗
[Sacroiliac osteochondritis].
Reporting a clinical observation, the authors emphasize upon the scarceness of sacroiliac osteochondritis. Sacroiliac osteochondritis is difficult to recognize, it is rather frequently a case of diagnosis by elimination, which can be only confirmed by the course. Its prognosis is excellent. The best management is strict rest.
Adolescent↗