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F de Peretti

Publications and source records attributed to F de Peretti.

At least 19 recordsLinked to original sources
PubMed2006

[Inaugural cutaneous metastases of an osteosarcoma: a case report].

Inaugural cutaneous metastasis is exceptional in osteosarcoma. We report a case of a woman with osteosarcoma of the right knee who presented two tumefactions of the scalp at the time of diagnosis. Magnetic resonance imaging identified a high intensity T2 signal in the femur and also a high-intensity signal in the soft tissues. The head scan confirmed the presence of two subcutaneous tumors. Biopsy of the two sites demonstrated the metastatic nature of the cutaneous lesions. The patient was given preoperative and postoperative chemotherapy. Wide resection followed by prosthesis reconstruction was performed. Pulmonary metastases developed and led to two thoracotomy procedures. The patient has remained in remission 22 months. Six cases of cutaneous metastases of osteosarcoma have been reported in the literature. The cutaneous metastases were secondary in five of six cases, occurring after other metastatic localizations had been discovered. The present case is the first published observation of synchronous cutaneous metastases. The duration of remission suggests that cutaneous localizations should be treated like other inaugural metastatic localizations with intensive chemotherapy and wide resection of the primary tumor.

Adult↗
PubMed2005

[Hydatid disease of the femoral shaft treated with surgery and hypertonic solution wash-out combined with albendazole].

We report a case of pathological fracture of the femoral shaft in a patient presenting a diaphyseal hydatid cyst. Surgical treatment consisted in wide resection followed by washout using a 20% hypertonic saline solution and nail plate fixation. Albendazole was given as adjuvant treatment. Postoperatively, the patient developed rhabdomyolysis with local superinfected necrosis which required early revision to remove the material. At twenty-two months, the local and general course was satisfactory. The pathological fracture healed and no secondary localization could be identified. Echinococcosis serology remained negative. The surgery-hypertonic solution-albendazole combination appears to be an attractive therapeutic solution for bone hydatid disease.

Adolescent↗
PubMed2004

Anatomy of the presacral venous plexus: implications for rectal surgery.

The presacral venous plexus results from anastomoses between the lateral and median sacral veins, and courses into the pelvic fascia covering the anterior aspect of the body of the sacrum. The presacral venous plexus is not directly visible during rectal surgery, and injuries to this plexus may be life-threatening. Dissection of the retrorectal plane or anchoring of the rectum to the sacral promontory as in rectal prolapse surgery exposes the patient to the risk of injury to the presacral venous plexus. The aim of this study was to identify some avascular areas in the anterior aspect of the sacrum in order to lower the occurrence of such injuries during rectal surgery. The pelvis of 10 fresh cadavers was dissected after injection of a colored resin into the inferior vena cava, and the presacral venous plexus was studied. Four avascular tetragonal areas were common to all the specimens. The corners of a square with a side of 3 cm, centered on the anterior aspect of the body of sacrum, were always contained in the avascular areas. The upper side of this square was parallel to a line passing through the sacral promontory, at a 3 cm distance from it. Staples or sutures should be placed in the avascular areas to avoid injuries to the presacral venous plexus.

Cadaver↗
PubMed2004

[Ankylosed spine fractures with spondylitis or diffuse idiopathic skeletal hyperostosis: diagnosis and complications].

PURPOSE OF THE STUDY: Spinal fractures in patients with ankylosing spondylitis or idiopathic skeletal hyperostosis can raise difficult diagnostic and therapeutic problems. Spinal fracture is well known in ankylosing spondylitis but exceptional in diffuse idiopathic skeletal hyperostosis. The purpose of the present work was to identify clinical and radiological features in patients with ankylosing spondylitis, to determine whether similar risks and clinical expression are observed in patients with diffuse idiopathic skeletal hyperostosis, and to present a radiological classification of these fractures. We did not assess therapeutic methods in the present study. MATERIAL AND METHODS: Forty-eight fractures in 48 patients were observed over a period of 17 years. Twenty patients (mean age 62 years) had ankylosing spondylitis and 28 patients (mean age 81 years) had diffuse idiopathic skeletal hyperostosis. A fall was the immediate cause of the fracture in more than half of the patients. No notion of trauma could be identified in six patients. The radiological classification was established as follows; type I open-wedge anterior fracture, type II "sawtooth" fracture, type III occult or radiologically invisible fracture, type IV non-specific fractures comparable to other spinal fractures. A computed tomography was obtained in all patients seen after 1992 and magnetic resonance imaging was performed in case of suspected extradural hematoma. The ASIA classification (as modified by Frankel) was used for cord injuries. Clinical course and complications were noted. RESULTS: Diagnosis was established the day of fracture in 32 patients (12 spondylitis and 20 hyperostosis) and between day 2 and 30 for 16 (8 spondylitis and 8 diffuse idiopathic skeletal hyperostosis). The radiological classification was: type I n=30, type II n=4, type III n=8, type IV n=6 (one odontoid fracture, five compression fractures). Three patients had extradural hematomas (2 spondylitis and 1 hyperostosis). Thirty-four patients (11 spondylitis and 23 hyperostosis) had cord injuries, including 16 with a symptom-free interval. The ASIA classification was: type A n=4, type B n=6, type C n=20, type D n=4. Thirty-two patients died within the first three months after spinal fracture (10 spondylitis and 22 hyperostosis), due to bed rest related complications in 30. One patient died after rupture of an aortic aneurysm. DISCUSSION: Spinal fractures in patients with ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis generally occur spontaneously or after low-energy trauma. Subsequent complications have serious consequences. Late diagnosis either results from missing a radiologically visible fracture or from the presence of an occult "paper thin" fracture. We do not have experience with diagnostic scintigraphy or magnetic resonance imaging. In our opinion, repeating standard x-rays the second and third weeks and use of a spiral scan or multiple spiral scan could provide early diagnosis. CONCLUSION: The possible diagnosis of spinal fracture should be explored very extensively in patients with a symptomatic ankylosed spine who present symptoms compatible with spinal fracture, with or without trauma.

Adult↗
PubMed2004

[Delayed diagnosis of inferior cervical spine injury].

PURPOSE OF THE STUDY: According to data in the literature, traumatic injury of the inferior cervical spine is not recognized in 4.5 to 33% of victims. The purpose of our study was to evaluate the rate of delayed diagnosis, search for causes, and propose a diagnostic approach. MATERIAL AND METHODS: This prospective study included 284 patients recruited by eleven referral centers between November 1999 and March 2001. Each participating center completed a data chart and classified lesions. Exclusion criteria were whiplash without neurological disorder and without imaging anomaly, spinal ankylosis, and trauma more than three weeks before the first examination. RESULTS: Among the 284 patients included, 240 had a unique lesion of the inferior cervical spine, 44 had multiple injuries. In all, 338 spinal lesions were recorded. There were 35 patients with multiple trauma injuries and 95 patients with spinal cord injuries. Time to diagnosis was less than 24 hours for 211 patients (74%), one day to one week for 38 patients (14%), and more than one week for 35 patients (12%). Defective management was noted in 13% of the cases. Late diagnosis was considered to have had a prejudicial effect in nine patients (3%). There was no correlation between time to diagnosis and type of lesion, level of lesion, or presence of multiple injuries. DISCUSSION: Late diagnosis of inferior cervical spine injury can be an inevitable result of the context. This is particularly true for patients with multiple injuries or patients with purely discal or ligament injuries whose first manifestations occur late after the trauma. Beyond these specific situations, there is no logical explanation for late diagnosis other than insufficient diagnostic management. Spinal injury should always be suspected in trauma victims and the initial neurological status must be noted. If the subject is conscious, plain x-rays should be obtained in the event of pain in the cervical spine. A computed tomography is the exploration of choice. Dynamic views should be performed in all cases to search for pure ligament injury. The correct time for such explorations can only be determined on an individual basis. If the patient is unconscious, standard procedure includes x-ray of the cervical spine, and computed tomography of the skull-spine junction and the cervico-thoracic spine. Widespread systematic use of spiral and multiple array computed tomography should limit the number of late diagnoses. CONCLUSION: Late diagnosis of inferior cervical spine injury is probably not uncommon. Improved management can be achieved through better medical awareness, better knowledge of cervical spine injuries, and routine imaging in application of the rule of prudence.

Cervical Vertebrae↗
PubMed2002

Anatomical study of the blood supply of the coxal bone: radiological and clinical application.

The aim of this work was to study the arterial blood supply of the coxal bone in order to optimize radiological embolization and to minimize the risk of postoperative osteonecrosis. Ten fresh cadavers were dissected after intra-arterial injection of colored resin. All the collateral vessels running to this bone were described and counted. On 25 dry bones, the vascular foramina were measured with the aid of a millimetric gauge and a vascular map was created. The posterior part of the ilium appears to be twice as well vascularized as the anterior part. Fractures of the posterior arch of the pelvis are theoretically more hemorrhagic. The presence of the iliolumbar artery in contact with the sacroiliac joint increases the risk with open book or shearing fractures. The artery of the ischium, a collateral of the pudendal artery, supplies the posterior and lateral parts of the acetabulum and the artery of the roof of the acetabulum, its superior and lateral parts. The branches of the anterior and posterior divisions of the obturator artery supply the superior part of the surroundings of the obturator foramen and the antero-inferior and postero-inferior parts of the acetabulum. The Kocher approach may injure the artery of the ischium. Letournel's extended lateral approach and Mears' triradiate approach may injure the artery of the ischium and the artery of the roof of the acetabulum. The risk of osteonecrosis appears to be theoretically increased if one adds an endopelvic approach. The anterior approach to the acetabulum appears to be that which theoretically leads to the least devascularization. The French version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer Link server located at http://dx.doi.org/10.1007/s00276-002-0029-2.

Arteries↗
PubMed2001

[Videoscopic retropleural and retroperitoneal approach to the thoracolumbar junction of the spine].

PURPOSE OF THE STUDY: A minimally invasive anterior approach has been developed for the thoracolumbar junction of the spine. The aim of this study was to evaluate the possibilities of videoscopic treatment of fractures and malunions of the thoracolumbar junction and to report the first results obtained with this technique. MATERIAL AND METHODS: Video-assisted surgery was performed in eleven patients using costal resection and a retropleural and retroperitoneal approach. Anterior arthrodesis was performed in all cases, four with anterior instrumentation. The indications were trauma for six patients and malunion for five. RESULTS: Mean follow-up was 17.4 months. For malunion patients, the mean angular gain was 22.4 degrees. Radiological anterior fusion was achieved in all cases except one. The mean angular loss was 5.7 degrees. DISCUSSION: The surgeon can control the procedures by direct vision, while the assistant follows the operation on the video display screen. The upper par of L1 can be reached via a supradiaphragmatic retropleural approach, while a larger exposure is possible if the insertions of the diaphragm are released and the retroperitoneal space is opened. The crus does not have to be sectioned to expose the lateral part of the thoracolumbar vertebrae. Possible complications are similar to those which can be observed with open procedures. CONCLUSION: The videoscopic approach enables the exposure of throacolumbar junction with a smaller parietal lesion than with open procedures. It enables arthrodesis procedures with corporectomay, angular correction and anterior osteosynthesis.

Adolescent↗
PubMed2000

Five years' experience of the retroperitoneal lumbar and thoracolumbar surgery.

Retroperitoneal videoscopic spine surgery has been developed in our department since 1994. It has been used not only at the lumbar, but also at the thoracolumbar and lumbosacral level. Thirty-eight patients have been operated on. We have performed 12 thoracolumbar approaches, 23 lumbar approaches, and 3 retroperitoneal lumbosacral approaches. In every case, a video-assisted technique has been employed. These techniques have been used for anterior grafting in 18 cases of fracture, for corporectomy and grafting with or without anterior osteosynthesis in 6 cases of malunion, for cage implantation or isolated grafting in 10 cases of degenerative disc disease, and for the treatment of 4 cases of spondylodiscitis. Results were satisfactory for every type of pathology. The complications related to the approach were the same as those seen with open surgery; however, the videoscopic approach seems to us less invasive, with cosmetic benefit, less blood loss, and more rapid recovery. A video-assisted technique appears to be a good compromise between videoscopic technique and open surgery. With the development of these techniques, few indications remain for open anterior surgery on the lumbar spine in our opinion.

Adolescent↗
PubMed2000

Traumatic rotatory displacement of the lower cervical spine.

The authors describe the classification for traumatic rotary injuries of the cervical spine. The classification is based on a review of 306 severe lower cervical spine injuries observed in 255 patients between 1980 and 1994. Traumatic rotatory displacements (TRD) represented 39% of the 306 severe injuries. Three different lesions were observed: unilateral facet fractures, fracture-separation of the articular pillars, and unilateral facet dislocations.

Cervical Vertebrae↗
PubMed1996

Short device fixation and early mobilization for burst fractures of the thoracolumbar junction.

The authors present a retrospective study based on a homogeneous series of 34 patients with burst fractures of the thoracolumbar junction, fixed using Cotrel-Dubousset instrumentation. These patients underwent instrumentation using a short construct of hooks and screws gripping the two vertebrae above the lesion (2HS) and screws and hooks gripping the first vertebra below the lesion (1SH). This construct was therefore called "2HS-1SH". In order to evaluate just the material resistance after getting up, only the patients who were upright on the 4th day without a body cast and with no secondary anterior osteosynthesis were included in this study. Four patients showed some neurological symptoms on admission but recovery was so quick that they could be included in this study. Mean follow-up was 4 years 1 month (range 3 years 1 month and 6 years 2 months). Vertebral and regional kyphosis angles were measured preoperative, postoperatively and at the final follow-up. Functional recovery and complications were analyzed. Mean vertebral kyphosis was 21.2 degrees preoperatively, 3.8 degrees postoperatively and 5.3 degrees at the final follow-up. Regional kyphosis angles were respectively 19.2, 0.2, and 2.7 degrees. We had two cases of deep suppuration, one early and the other late. None of the patients required analgesics for more than 6 months after the operation. Patients returned to work after 5 months on average. The authors concluded that fixation by screw-and-hook constructs is an effective way to stabilize thoracolumbar junction burst fractures.

Adolescent↗
PubMed1996

New possibilities in L2-L5 lumbar arthrodesis using a lateral retroperitoneal approach assisted by laparoscopy: preliminary results.

Four patients underwent lumbar interbody fusion, performed via a video-assisted retroperitoneal laparoscopic approach, complementary to posterior osteosynthesis at the L2-L3, L3-L4 and/or L4-L5 level. In three cases the interventions were for lumbar fractures, and in one case for microcristalline arthritis. After surgical training on human cadavers and several porcine operative sessions, retroperitoneal lateral approaches on the left side were performed by the authors without CO2 insufflation, assisted by videoscopy. The fusion process was monitored by fluoroscopy. It is possible to perform this technique cranially above L2 or caudally below L5. Minimal blood loss was observed. Average time for these interventions was 127 min. Interbody fusion was achieved in the first, second and fourth cases; the outcome in the third case at the final check-up, 6 months after operation, was uncertain. The first patient had a complication of ureteral wound, which was certainly caused by insufficient experience with the new technique. The authors hope to extend the application of this technique to other procedures as they become more experienced.

Adult↗
PubMed1996

[Coral as support of traumatic articular compression. A prospective study of 23 cases involving the lower limb].

INTRODUCTION: Infection risk makes the management of a bone bank more and more difficult. On the other hand, realizing an autologous graft is not always without consequences. That is why we estimated the mechanical quality, the osteo-integration and the biocompatability of a coral graft. MATERIAL AND METHODS: Between 1988 and 1992, two of us systematically used coral graft as "support" after lifting of some articular depression in fractures of inferior limb. Osteosynthesis was systematically associated. In this way, we operated 13 fractures of the lateral tibial plateau, 8 thalamic fractures of the calcaneus and 2 fractures of the inferior extremity of the tibia. Average follow-up is 20 months, with extremes of 68 and 12 months. Material ablation was realized 13 times and coral graft biopsy 4 times. Bone integration was estimated radiologically in 3 stages: stage 1: non union = "margin" around the coral, stage 2: possible integration = the coral is perfectly visible, but its borders grow indistinct, stage 3: certain integration = peripheral disparition of the coral weft, radiological interpenetration between coral and bone framework. We systematically searched for secondary displacements and complications. RESULTS: Mechanical conditions were respected, there was no secondary displacement. "Possible integration" (stage 2) was found in 8 cases at an average follow-up of 20 months. In 9 cases, we found "certain integration" (stage 3), at an average follow-up of 28 months. It is possible that a more important follow-up time would allow to find more integration cases. Biocompatibility is debatable under the operating conditions of the authors. We counted 5 aseptic serous flows which continued to be aseptic (1 tibial plateau, 1 inferior extremity of the tibia, 3 calcaneum). Three coral grafts were removed to obtain healing. DISCUSSION: When biocompatibility is satisfactory the integration is certain. The longer the follow-up time, the more stage 3 cases can be observed. Nevertheless, this integration runs out with time. We did not find any explication to aseptic serous flows. It may result from some impurities. On the other hand, use of the coralin hydroxyapatite does not seem to drive to allergic complications. CONCLUSION: In accordance with this study, we use the coral graft only in case of tibial plateau fracture. Our experience with coral graft in the other fields of bone surgery is not sufficient to express an opinion.

Adult↗
PubMed1994

Motorcycle petrol tanks and their role in severe pelvic injuries.

Between 1985 and 1992, nine patients who sustained severe pelvic lesions as a result of motorcycle accidents were admitted to and treated in the authors' department. In six of these nine cases the petrol tank of the motorcycle was one of the wounding agents, and all six patients had the same kind of motorcycle with an oversized petrol tank. All six patients had unstable pelvic lesions. In addition, four had subperitoneal haematomas which required multiple transfusions; five had perineal and/or genital lesions, and one had a ruptured membranous urethra. Severe pelvic injuries are rare, but can have after-effects which jeopardize the social and family life of the patients. A national epidemiological study would be useful to evaluate the frequency of such injuries and to draw conclusions leading to improved safety for motorcyclists.

Accidents, Traffic↗
PubMed1994

[Letournel's ilio-femoral way in acetabular fractures of the two columns. A prospective study].

PURPOSE OF THE STUDY: The authors present the anatomical and functional results of the systematic use of Letournel's extensive lateral approach for internal fixation of the fractures of the acetabulum involving the two columns. MATERIAL: This prospective study concerns 25 patients. Mean age was 38 years. Mean follow-up was 4 years and 6 months (with extremes of 1 year and 9 years 9 months). 13 cases had a minimum of 4 years of follow-up. There were 1 transversal fracture, 9 transversal fractures associated with a posterior wall fracture, 2 anterior column fractures associated with a hemitransversal posterior fracture, 6 "T" shaped fractures, 7 fractures of the two columns. During the procedure, a trochanterotomy was carried out. Not any of the patients was irradiated postoperatively and they did not take any indomethacin. The patients were operated on 10 days after the accident, on average (with the extremes of 2 and 60 days). The average time of the procedure was 4 H 20 and 1080 cc of globular sediment were used during the intervention on average. The same surgeons participated in each operation. METHODS: The anatomical results were analysed according to Matta's criteria and the congruence study head-roof and head-acetabulum of the SOFCOT symposium in 1981. The functional results were analysed using the quotation of Merle d'Aubigné. Complications were searched systematically. The appearance of heterotopic ossifications was analysed according to Brooker. RESULTS: 23 patients had a satisfactory anatomical reduction and 11 patients out of 13 did not present any arthrosis after a minimum of 4 years follow-up. 12 patients had very good or good functional results. 3 patients had no heterotopic ossifications, 7 were grade I, 5 grade II, 8 grade III, and 2 grade IV. The gluteus medius was quoted 4 in 18 patients and 5 in 5 patients. There were 2 cases of deep suppuration, one of them was a patient who died 6 months later of a pancreas cancer unrecognized at the time of the accident. There were 5 aseptic osteonecroses and 3 cases of regressive paralysis of the sciatic nerve. 4 total hip prosthesis were inserted secondarily. DISCUSSION: The Letournel extensive lateral approach was efficient to obtain an anatomical reduction but, functionally, it was only efficient in one case out of two. For the moment, the authors associate systematically a postoperative irradiation to reduce the ossifications (10 to 12 gray in 5 sessions). On the other hand, they try to obtain a more efficient reinsertion of the glutei muscles, thank to a bone fragment of the iliac crest. CONCLUSION: The authors limit their indications of the Letournel's extensive lateral approach to the fractures of the two columns, not older than 10 days or to the comminuted ones.

Acetabulum↗
PubMed1994

[Triple and quadruple images in scan of fractures of the articular processes of the lower cervical spine].

The authors describe the triple and quadruple image aspects of the articular pillar, which are encountered respectively in one-sided uni- and biarticular fractures of the lower cervical spine, and they have analysed these images' specificity from a retrospective study. This study concerned 52 cases out of a group of 220 patients hospitalised between 1979 and 1992, with an injury of the lower cervical spine and who underwent a CT-scan examination in addition to the conventional radiographic check-up. Among a total of 70 lesions, 14 uniarticular and 4 biarticular one-sided fractures were recorded. All presented these characteristic aspects, formed by the separated fragment of the articular process; the unseparated component of the process and, concerning the triple image the intact process, or concerning the quadruple image the fragments of the second fractured process. An only case of a transisthmian fracture associated with a fracture of the lower articular process showed a similar aspect, which underlines the high specificity of these images.

Cervical Vertebrae↗
PubMed1994

[Modular construction (2 HS-1 SH), using Cotrel-Dubousset's universal instrumentation for comminuted fractures of the thoracolumbar junction. Comparison with various other constructions].

INTRODUCTION: The authors' objective was to study the anatomical and functional results of an original construct using the Cotrel-Dubousset instrumentation. MATERIAL AND METHODS: This construct is called "Modular construct" or "2 H.S.-1 S.H." fits up two vertebrae above the fracture and a single below. So if the fracture is situated on the L1 level, a supra-laminar hook is set up on each side of T11, and two pedicular screws in T12 (2 H.S.). In the same way, a pedicular screw and an infra-laminar hook are set up on each side of L2 (1.S.H.). Two transverse bars connect together the right and the left rod. This retrospective work is based on the study of 24 patients who had a Thoraco-lumbar burst fracture according to Denis'classification, who were operated on in our Department, and started again to walk without external contention. All the patients had a postero-lateral bone graft. There were no [corrected] anterior arthrodesis performed. The average follow up was 4 years. This series was compared with a concomitant series of miscellaneous constructs realized by the same operators with the C.D. instrumentation. RESULTS: The average regional kyphosis angles went from 16.9 degrees in pre-operative to 3.9 degrees in post-operative, and 8 degrees at the maximum follow up. The average vertebral kyphosis angles went from 18 degrees in pre-operative to 3.8 degrees in post-operative, and 6.3 degrees at the maximum follow up. The miscellaneous constructs had poorer results. There were two severe infections, one early the other late. DISCUSSION: These results compared with the literature show that the 2 H.S.-1 S.H. construct is a competitive one. We think that its mechanical qualities arise from adding systematically hooks at the ends of the construct. These hooks protect the screws during flexion and from pull out constraints.

Female↗
PubMed1993

[Fuel tanks of motorcycles. Role in severe trauma of the pelvis].

Between 1985 and June 1992, 8 subjects who sustained severe pelvic lesions as a result of motor cycle accidents were admitted and treated in our department. In 5 of these 8 patients the fuel tank of the motor cycle was one of the wounding agents. All 5 patients had unstable pelvic lesions. In addition, 4 had a subperitoneal haematoma which required multiple transfusions; 4 had perineal and/or genital lesions, and 1 had a ruptured membranous urethra. A national epidemiological study would be useful to evaluate the frequency of these particular injuries and draw lessons that would lead to better safety of motor cyclists.

Accidents, Traffic↗