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Biomedical subjects

J C Dosch

Publications and source records attributed to J C Dosch.

At least 19 recordsLinked to original sources
PubMed2002

[Computed tomographic analysis of humeral retrotorsion and glenoid retroversion].

PURPOSE OF THE STUDY: Analysis of the anatomic relations of the humeral head and the glenoid cavity is particularly important for clinical study of shoulder arthroplasty and glenohumeral instability. Analysis of humeral retroversion and glenoid retroversion is quite difficult and data in the literature are scarse. We conducted a computed tomography (CT) analysis of stable shoulders to detail retroversion of the entire height of the glenoid cavity and to measure humeral retrotorsion using two comparative methods. We also compared glenoid retroversion and humeral retrotorsion observed in individual subjects. MATERIAL AND METHODS: This prospective study used a standardized CT analysis method. Both shoulders of 30 persons free of glenohumeral instability were studied. Two methods, described by Dähnert and Bernageau, were used to analyze humeral retrotorsion. The Benageau method was used to analyze glenoid retroversion. RESULTS: According to the Dähnert method, humeral retrotorsion was 10 degrees +/- 13 degrees; it was 24 degrees +/- 13 degrees with the Bernageau method; data dispersion was 60 degrees and 65 degrees respectively. According to the Dähnert method, retrotorsion was more pronounced on the dominant side compared with the non-dominant side. There was a significant correlation between retrotorsion values for the two sides. For 95% of the shoulders, glenoid retorversion decreased progressively from the superior part of the glenoid cavity (12.8 degrees +/- 6.4 degrees ) to the lower part (3.1 degrees +/- 4.4 degrees ). Glenoid retroversion was greater on the dominant side. For 21 of the 30 persons (70%), there was a significant correlation between retroversion for the two sides. Correlation coefficients between glenoid retroversion and humeral retrotorsion were negative. Greater humeral retrotorsion was thus related with less pronounced glenoid retroversion and vice versa. DISCUSSION: This study allowed quantification of glenoid retroversion and humeral retrotorsion. There is a spiral twist in the joint surface of the glenoid cavity with progressive decrease in glenoid retorversion from the upper to the lower part of the cavity for 95% of the shoulders. To our knowledge, this spiral twist in the glenoid cavity is not taken into consideration in any of the currently available implants. The correlation for both parameters between the right and left side is probably determined genetically. The influence of dominance could be explained by adaptation to more or less pronounced stress. The negative correlation between humeral retrotorsion and glenoid retroversion would improve glenohumeral stability. A comparative study with unstable shoulders would be required to verify this hypothesis. The validity of the Dähnert method for assessing humeral retorversion is, in our opinion, insufficiently established. The Bernageau method, which provides a direct measurement, appears to be preferable despite the difficulty in identifying anatomic landmarks.

Anthropometry↗
PubMed2002

[Traumatic bilateral rotatory C1-C2 dislocation in an adult: case report and review of the literature].

Trauma led to bilateral rotatory atlantoaxial dislocation in a 23-year-old woman. Clinical diagnosis of this uncommon dislocation of the cervical spin is generally difficult and often made late. Typical signs include pain in the upper cervical spine and a fixed rotated position of the head. Integrity of the transverse ligament of the atlas is a determining factor for atlantoaxial stability and allows orthopedic treatment after reduction using moderate traction on the head. As for most authors, orthopedic was successful in our patient who totally recovered cervical spine mobility without pain.

Accidents, Traffic↗
PubMed2001

Pressure overload induces heterologous expression of the atrial natriuretic factor (ANF) gene.

Several investigations have demonstrated the regional heterogeneity of myocardial phenotype, and hypertrophy may also induce regionally disparate changes. We have utilized the direct DNA injection technique to study regional variations in overload-induced ANF expression. Pressure overload was induced by stenosis of the ascending aorta in canines. ANF promoter reporters were injected into the left ventricle; in different regions including the base, the midwall region, and the apex. Injections were made at different depths to include the epicardial and endocardial layers. The animals were sacrificed 7 days following surgery and the left ventricle harvested for tissue analysis. Under normotensive conditions, ANF reporter expression was similar throughout the heart. PO increased ANF expression and the increases were greater in the endocardium than in the epicardium. PO also significantly increased expression in the midwall and base regions, but not in the apex. It is unknown from these experiments, whether the greater increases in midwall expression are a function of greater wall stress, metabolic demand, or phenotypic differences in the midwall myocytes. These findings do indicate that regional differences in overload-induced changes in gene expression are evident and may be functionally important in determining myocardial response to increased functional demand.

Animals↗
PubMed2001

[Role of standard radiography and computed tomography in the assessment of shoulder instability: decision-making value in surgical planning. (Radio-anatomic study of 51 unstable shoulders)].

The therapeutic algorythm for shoulder instability, either arthroscopically, either surgically, should focus on clinical data as well as imaging ones. The latter involve standard X-rays and arthrotomodensitometry (AOTDM). Both of these are crucial for the surgical approach. This paper emphasizes their limits and places. We analysed anatomical and imaging data of 51 unstable shoulders operated on between January 1998 and February 2000. Our purpose was to determine the sensitivity and specificity of imaging techniques for each anatomical structure playing a role in the management. Standard X-rays include comparative AP and Bernageau's views. Based on our results, their efficiency is confirmed for the therapeutic approach of bony lesions. Their sensitivity was respectively 96% and 93% for the reconnaissance of Hill-Sachs lesions and lesions of the anterior glenoïd rim. The sensitivity of AOTDM in identifying labral desinsertions was 91% but their extent was not precisely documented likewise for the labral degeneration and absence. The sensitivity was respectively 69% and 71%. Results were poor for the evaluation of the anterior ligament complex. TDM could not accurately document 90% soft tissues lesions which carry a poor prognosis for arthroscopic reconstructive procedures. There is a good correlation between the aspect of anterior capsular attachment and the sprain lesions (P = 0.003). We could conclude that the AOTDM is not determinant factor for choice of the reconstructive procedure, either arthroscopically, either surgically.

Adolescent↗
PubMed2000

[Head and brain injuries. Place of imaging].

This article considers the various mechanisms of brain injury and specifies the most efficient radiologic technique for assessing patients, depending on clinical presentation. The brain injuries include either extracerebral and intracerebral lesions. The former require rapid diagnosis and therapy and the latter determine management in an intensive therapy, unit and outcome. Standard X-rays are obsolete. The CT, rapidly performed, is the most relevant imaging procedure for surgical lesions. Cortical contusions and diffuse axonal injuries are underestimated by CT and best depicted by MRI. Only late MRI has a strong correlation with neuropsychological outcome. In terms of prognosis, MRI needs to be evaluated. The indications include: a) unstable neurological status: CT; b) moderate head injury: CT may help to decide hospital admission; c) severe head injury: initial CT may be followed by MRI; d) long-term consequences: MRI. Special Indications: a) angio-MRI: suspicion of vascular lesion; b) CT with thin slices and bone window: depressed skull fracture; c) teleradiology (image transfer): to decide a patient transport from a peripheral hospital to a neurosurgical centre. In conclusion, CT remains the first-line examination to detect immediately life-threatening lesions. MRI is the examination of choice for full assessment of brain lesions.

Brain Injuries↗
PubMed2000

[Diagnostic imaging of the brachial plexus and the cericothoracobrachial outlet].

Imaging of the brachial plexus and of the thoracic outlet syndrome is difficult due to the complex path of the brachial plexus and the morphological variations during the movements. This imaging includes simple radiographs, computed tomographies (CT) and myelo CT scan, magnetic resonance imaging and echo-Doppler. Pathologies of this area include congenital deformities (dysplasia of the upper RIB or of the clavicle), non-malignant or malignant tumors, muscular pathologies, and pathologies of the nerve roots or trunks.

Brachial Plexus↗
PubMed1999

[A case of a aggressive giant-cell tumor with multiple bone metastases].

PURPOSE OF THE STUDY: Giant-cell tumor are known for local recurrence. Metastases are rare (2 p. 100), and generally located in the lung. We present a case with multiple bone metastases and rapid course. MATERIAL, METHODS AND RESULTS: A 45-year-old man presented a 5 cm giant-cell tumor of his right distal tibia and two other localisation in the fifth and sixth cervical vertebral bodies. He underwent a resection of the distal tibia and reconstruction with a controlateral free vascularized fibula. The bodies of the fifth and sixth cervical vertebral were resected and replaced by an iliac crest graft. Other localisations appeared in iliac right crest, in the posterior wall of the cotyle and in the second, third and fourth cervical vertebral bodies. Chemotherapy was administered and clinical signs regressed but eight months later the patient presented a recurrence of his tumor in the distal tibia with new localisation in the left fifth rib, in the right clavicle, in the frontal bone, in right ischio-pubal branch and in the right proximal femur. A new chemotherapy was performed but had little effect and probably hasved dubic death 13 month after the first symptom. DISCUSSION: The present observation is characterised by the large number of localisations (13; the highest number found in the literature was 11 localisations) and by the rapidity of the clinical course. Low grade giant-cell tumors generally give benign metastase with a course lasting several years. The chemotherapy helpt us to slow the progression of the lesions but was unable to prevent the development of new localisation and the recurrence in the distal tibia. More over, its toxicity could have caused the death of the patient. CONCLUSION: We present the case of one patient who presented a giant-cell tumor with unusual presentation: multiple bony metastases with rapidly fatal outcome.

Antineoplastic Agents↗
PubMed1998

[Massive gas embolism following lung inflation for thoracic tomodensitometry in a multiple trauma patient with lung contusions].

We report a case of gas embolism into both right and left circulation in a polytrauma patient with lung contusions, revealed by thoracic CT scan showing the heart and aorta filled with gas. It followed a lung inflation with a O2/N2O mixture for about 30 seconds at a pressure of at least 40 cmH2O in order to obtain apnoea for CT scan and to recruit atelectatic territories. The presumed mechanism was the passage of the O2/N2O mixture during the lung inflation manoeuvre out of disrupted airways into torn pulmonary blood vessels and pushed back into the heart chambers. The patient recovered fully. Lung inflation manoeuvre to obtain a prolonged apnoea during CT scan examinations of thorax is contraindicated in case of thorax trauma, as it carries a risk of gas embolism.

Accidents, Traffic↗
PubMed1997

Interstitial laser photocoagulation of osteoid osteomas with use of CT guidance.

PURPOSE: To evaluate interstitial laser photocoagulation (a minimally invasive percutaneous technique of thermal destruction of deep-seated tumors, with low-power laser energy) in local destruction of osteoid osteoma, with computed tomographic (CT) guidance. MATERIALS AND METHODS: Fifteen patients (age range, 8-48 years) with presumed osteoid osteoma were treated with CT-guided interstitial laser photocoagulation of the nidus. A high-power semiconductor diode laser (805 nm) with a 400-microm optical fiber was used. The fiber was introduced into the nidus through an 18-gauge needle. Around the fiber tip, well-defined coagulative necroses from 5 to 9 mm (energy delivery, 400-1,000 J) were obtained. RESULTS: Fourteen patients had complete pain relief, which was apparent within 24 hours in eight patients. One patient had recurrence of pain after 6 weeks. The remaining nidus was treated a second time, with complete relief. Treatment was unsuccessful in one patient, and surgical excision was performed. Daily activities were not restricted after the intervention. All patients were followed up for more than 1 year, with no sign of recurrence. The only notable complication was a mild reflex sympathetic dystrophy of the wrist in one patient. Sclerosis of the nidus was observed 4-6 months after the procedure. CONCLUSION: Percutaneous interstitial laser photocoagulation of osteoid osteoma seems to be a promising, simple, precise, and minimally invasive alternative to traditional surgical and percutaneous ablations.

Activities of Daily Living↗
PubMed1996

[High grade osteosarcoma of the lower limb. Complications and results of the treatment of 20 patients].

UNLABELLED: Over 11 years we treated 30 osteosarcomas: 20 of them were high grade non metastatic osteosarcomas of the lower limb, which were treated by neoadjuvant chemotherapy (Rosen T10, or OS 87 protocol of the French Society for Pediatric Oncology). MATERIAL AND METHODS: There were 12 males and 8 females; the mean age was 19 years (range 12-51). The site of the tumor was the femoral neck (1 case), femoral diaphysis (2 cases), distal femur (12 cases), proximal tibia (4 cases), distal tibia (1 case), 3 were IIA and 17 IIB according to Enneking system. Conservative treatment was performed in 17 cases: there were 12 knee prostheses, 4 allografts and 1 knee arthrodesis with allograft. RESULTS: a) Surgical complications: Mechanical complications occurred in 10 patients. The function was preserved 8 times. In 2 patients the knee became stiff. An infection occurred in 3 patients: a conservative treatment was possible in 2 of them with a fair result. In the third case, an above-the-knee amputation had to be done. b) Functional results were studied according to Enneking rating. 14 arthroplasties (12 done as first surgical treatment and 2 after mechanical complication) had a 68, 19 score. c) Oncologic results: 8 patients were good respondents and 12 patients were bad respondents to chemotherapy according to Huvos grading. One local relapse was observed which could be treated by mean of a second chemotherapy and a prosthetic reconstruction. The patient is still alive and disease-free at 7 years (9 years after the diagnosis of the osteosarcoma). 5 patients had distant metastasis (lung, bones, and brain). One out of 5 was good respondent and 4 out of 5 are presently dead. Using Kaplan Meier statistical analysis, the overall survival wzs 76.8 per cent and the event-free survival was 67.4 per cent at 80 months. CONCLUSION: We preferred a simple prosthetic reconstruction without osseous sleeve or an intercalary allograft if possible: these procedures allow the patient very rapid autonomy to have despite a prolonged chemotherapy.

Actuarial Analysis↗
PubMed1992

CT and MRI of suprasellar lesions.

The authors report their experience of CT and MRI imaging in the study of suprasellar pathologies. The problems concerning the differential diagnosis between meningioma developed in the suprasellar region and pituitary tumour with suprasellar extension are discussed and illustrated; the demonstration of bone abnormalities (blistering, hyperostosis) is particularly useful for the diagnosis of presellar meningioma. The CT and MRI features of craniopharyngioma are compared; CT, of course, is more reliable than MRI in detecting calcifications; with both methods it may be difficult to visualize the cystic components. Glioma of the chiasma is readily diagnosed by MRI, provided the tumour is not too large. Non-thrombosed suprasellar aneurysms have typical features at CT and MRI. Cystic lesions are easily identified by MRI. The CT and MRI images of inflammatory lesions are not very typical.

Brain Diseases↗
PubMed1991

[MR tomography of aneurysmal bone cyst].

The preoperative findings of magnetic resonance imaging (MRI) in six histology-proven aneurysmal bone cysts (ABC) are examined and compared with previous publications concerning MRI of ABC. The signal intensities differ considerably, and not all of our cases conform with the literature data. They can be summarised in three different subheadings: one form that is very inhomogeneous in T1- and T2-weighting, with fluid-fluid levels in the cystic spaces; one intermediate form without fluid-fluid levels, which is inhomogeneous only in T2-weighted images; and finally, an unusual form of ABC that has homogeneous low signal both in T1- and T2-weighting, and which has not been described in literature so far.

Adolescent↗
PubMed1991

[Screw fixation of fractures of the odontoid process].

In the year 1981, J. Böhler completed for the first time a screw fixation for unstable fractures of the odontoid process of the axis. This surgical technique preserves the anatomy and the physiology of the articulation between the atlas and the axis, as a guarantee for a good functional recovery. It is not a very difficult technique when performed by a trained surgeon with a very good X-ray image intensification for the per-operative control. We have treated 32 unstable fractures of the odontoid process without any neurological complication per- or post-operatively. We had a follow-up on only 29 cases. In 19 cases the fracture healed in leading to a good bone union, complete mobility and no residual pain. Seven patients complained of residual pain or a limitation in cervical movement, because of the association with other cervical fractures, an age superior of 70 years, or a major initial instability. In 2 cases the authors noted a non-union and a secondary displacement because of technical faults at the beginning of their experience. These good results determined the authors to prefer the direct screw fixation for the unstable fractures of the odontoid process, to the posterior arthrodesis which leads to functional limitations.

Adolescent↗
PubMed1988

Radiology of posterior lumbar apophyseal ring fractures: report of 13 cases.

The authors report radiological findings in 13 cases of avulsion of the posterior lumbar apophyseal ring. The lesion affected young adults in 10 cases and adolescents in 3 cases. The lesion involved the inferior endplate of L4 in 11, and of L5 in 1 patient, and of L3 in 1 patient. 6 patients presented with unilateral sciatica, 3 with bilateral sciatica, and 4 with low back pain. Acute spinal trauma was evident only in 2 adolescents. Radiological recognition of the lesion was possible on plain films in 9 cases. CT demonstrates association of avulsion of the posterior vertebral apophyseal ring and herniated disc in all cases. Avulsion of the posterior apophyseal ring has to be differentiated from posterior longitudinal ligament, annulus, or herniated disc calcifications, as well as from posterior degenerative ridge osteophytes. Controversy about physiopathology of the lesion remains: weakness of the apophyseal ring during childhood and in patients with Scheuermann's disease may explain avulsion of the apophyseal ring in association with median disc herniation.

Adolescent↗
PubMed1988

A dysplasic origin of the "fat C2 body".

The authors recall the traumatic etiology of the so-called "fat C2" and describe a non traumatic origin of this radiological sign in a case of unusual ossification of the C2 body.

Cervical Vertebrae↗
PubMed1987

[Roentgen diagnosis of traumatic instability of the middle and lower cervical spine (C3-C7)].

The problems are discussed that are encountered in diagnosing instability of the middle and lower cervical spine on the basis of conventional radiographs. Two aspects are considered: 11 elementary radiological signs are presented; the corresponding radiological syndromes, their clinical presentations, and the roentgenographic signs are discussed. Both aspects are illustrated by means of appropriate radiographs.

Cervical Vertebrae↗