Biomedical subjects
Publications and source records attributed to H Olivier.
At one time, benzodiazepines were the number one prescription drug in the United States and the world. While the use of benzodiazepines has declined since the Journal published an article about the use and misuse in 1989, benzodiazepines still have clinical efficacy and clinical misuse. This article details current epidemiology, indications, and precautions to prevent abuse.
Eighty prostheses, including 46 humeral prostheses and 34 total ones, have been laid for complex injuries of the shoulder. In 56 cases, these were recent fractures, mainly of the head and tubercle of the humerus, in subject ages 65 in average. In 34 cases, the injuries were older and comprised malunion or epiphyseal necrosis. Five cases of subluxation and six of secondary displacement of the tubercles were noted. Pain was suppressed in most cases, but mobility was less satisfactory (37% exceeding 90 degrees active elevation). The humeral sealing evolved in a reassuring way, but a poorly evolutive glenoid rim was often observed. Finally, upper subluxation may occur during the evolution, which suggests the possibility of secondary ruptures in the rotator cuff.
Loosening of acetabular cups in cemented total hip arthroplasties is associated with an important bone destruction. Within all the solutions proposed, the authors relate their experience of 46 cases treated by cancellous morcelised bone grafts to reconstruct the bone stock, in order to position correctly the new socket and provide a better cemented fixation. With a mean follow-up of 32 months, the clinical and radiological results were good with 2 loosenings, 1 due to a septic recurrence. The evolution of allografts and autografts were similar. This technique is specially adapted to the cavitary bone lesions but is also suitable to treat some segmentary lesions. It was associated to a metallic support in cases of fractures or severe bone lesions. This technique seems to be superior to a new isolated cementation, to the utilisation of acetabular mobile sockets or to structural massive bone grafts.
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Post-irradiation bone lesions of the pelvis, rare but grave functionally, may appear from few months to some years after irradiation. The most severe lesions occur in the hip, with necrosis, fracture or cartilaginous lesions. Radiological appearances may be dissociated, giving a false impression of progression. Undisplaced fractures may consolidate. In other cases an arthroplasty is indicated, often total, but the bad quality of the bone receiving the prosthesis explain certain poor results caused by loosening.
Arthroplasty of the hip with a pair of locked cupolas uses a metal cupola and a polyethylene cotyloid cupola. Ancillary instrumentation and 3 sets of protheses allow an acrylic fixation using a thin layer of cement. The authors report their experience with 75 surface replacement arthroplasties. The initial complications seem related to errors made in at the outset in drilling the femur, thereby compromising the solidity of the neck and the vascularization of the head. These results can be transposed upon the case of total conventional prothesis. The indications, which principally incluse centered coxarthrosis, have been widened to comprise necrosis limited to the femoral head, to rheumatoid polyarthritis, to ankyloses of the hip in a bad position, and to re-setting of non cemented cupolas. These encouraging results should be tempered by their short follow-up period (less than 2 years), and the present uncertainty as to the future performance of the lock joints and the wear of the polyethylene.
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