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Biomedical subjects

J Cottalorda

Publications and source records attributed to J Cottalorda.

At least 19 recordsLinked to original sources
PubMed2000

Toe-walking in children younger than six years with cerebral palsy. The contribution of serial corrective casts.

Our aim in this retrospective study was to analyse the value of serial corrective casts in the management of toe-walking in children aged less than six years with cerebral palsy. A total of 20 children (10 hemiplegic and 10 diplegic) had elongation of the triceps surae by serial casting at a mean age of four years and one month. The mean passive dorsiflexion of the foot with the knee in extension was 3 degrees (-10 to +5) and 12 degrees (0 to +15) with the knee in flexion. After removal of the cast passive dorsiflexion was 20 degrees (+10 to +30) with the knee in extension, and 28 (+10 to +35) with the knee in flexion. At a mean follow-up of 3.08 years (2.08 to 4.92), passive dorsiflexion was 9 degrees (-10 to +20) with the knee in extension and 18 degrees (0 to +30) with the knee in flexion. Serial corrective casts are useful for the treatment of equinus in young children as the procedure is simple and the results are at least equal to those of other non-operative techniques. It is a safe alternative to surgical procedures especially in young children. If the equinus recurs operation can be undertaken on a tendon which is not scarred.

Ankle Joint↗
PubMed2000

[Pseudotumoral subacute osteomyelitis: a series of 41 children].

PURPOSE OF THE STUDY: To confirm that subacute osteomyelitis in children is a real entity, and give the main characteristics of this disease MATERIAL AND METHODS: We reviewed 41 cases as well as the litterature. RESULTS: Pain without fever was the only constant symptom. The erythrocyte sedimentation rate was increased slightly. XRays were the most important investigation, showing a geode in the metaphysis or more rarely in the epiphysis evoking a benign bone tumor in a child. DISCUSSION: The treatment was most often surgical: scraping permits the isolation of the microbe in 50 per cent of cases (staphylococcus most often) and usualy leady to recovery. CONCLUSION: This form of osteomyelitis is relatively frequent and must be discussed in front of a cystic tumoral image of the child's long bone.

Adolescent↗
PubMed1999

Effect of indinavir and higher CD4+ T-cell count on viral load response after 6 months of highly active antiretroviral therapy.

This retrospective, unmasked chart review was undertaken to determine which HIV-infected patients receiving protease inhibitors (PIs) for the first time were most likely to experience a decrease in plasma viral load (PVL) and which factors were associated with a PVL < 500 copies/mL below the detectable limits after 6 months. A total of 308 patients aged > 15 years with a PVL > 500 copies/mL received therapy that included a PI in addition to other antiretroviral therapies (128 patients, saquinavir hard-gel capsule 600 mg TID; 107 patients, indinavir 800 mg TID; and 73 patients, ritonavir 600 mg BID). The choice of drug was at individual clinicians' discretion. Patients were followed for a median of 10 (range, 6 to 21) months. Of the 128 patients who received saquinavir, 45% were switched to another PI (33%, indinavir; 12%, ritonavir). Seventy percent of the 73 patients initially given ritonavir were switched (45%, indinavir; 25%, saquinavir), as were 23% of the 107 patients initially given indinavir (15%, saquinavir; 8%, ritonavir). A total of 34.1% (n = 105) of patients achieved a PVL < 500 copies/mL; in 51.6%, PVL decreased > 0.5 log copies/mL. In this subgroup, both treatment-naive patients and those who were receiving a new combination of antiretroviral therapy when they started PI treatment had a more pronounced decline in PVL (P < 0.001). After adjustment by logistic regression analysis for age, sex, mode of transmission, and duration of highly active antiretroviral therapy (HAART), CD4+ cell count and initial type of PI received were independently associated with PVL < 500 copies/mL. In the present study, the treatment success rate was low (34.1%) compared with rates observed in randomized, controlled trials. A higher CD4+ cell count and use of indinavir at the initiation of HAART are associated with a better viral load response.

Adult↗
PubMed1999

[Gait analysis of 57 healthy children by measurement of ground reaction forces on an Adal treadmill].

PURPOSE OF THE STUDY: The purpose of this study was to present a new treadmill proposed for evaluating gait in children. We analysed differences in ground reaction forces between boys and girls, and we calculated the symmetry index in healthy children. MATERIAL AND METHOD: Time and ground reaction forces of about 30 steps were measured using a new treadmill. The apparatus consists of 2 walking belts which function as two independent treadmills placed side by side, separated by 4 mm. The 2 treadmills were mechanically separated in order to allow independent measurement of the ground reaction forces induced by each lower limb during stance phase. The children (28 boys and 29 girls), all clinically healthy, were divided into three groups according to their height (between 105 and 150 cm). They walked at three different velocities (2.7 km/h, 3.6 km/h and 4.5 km/h according to their height). The graphs representing the subject's measurements were composed of fore-aft, medial-lateral, and vertical parameters. The analysis of these graphs considered stride, stance, double stance and nine specific points. We also calculated the symmetry index of each child. RESULTS: We determined the values of the symmetry index in healthy children. We did not find any significant difference in gait between girls and boys, except for Fz3 at 2.7 kg/h, where Fz3 was higher in girls than in boys. DISCUSSION: We compared our results with those reported in the literature and found that ADAL has a very important advantage in gait analysis in children because it is simple and easily accepted by children.

Age Factors↗
PubMed1998

Do viral load and CD8 cell count at initiation of tritherapy influence the increase of CD4 T-cell count?

BACKGROUND: Tritherapies including protease inhibitors improve clinical status and usually increase CD4 T cell count. However, the dissociation between the marked decreases in viral load and the incomplete restoration of CD4 cell counts with a three-drug combination has been reported. We assessed this potential difference among our patients. METHODS: Patients were enrolled when a protease inhibitor was prescribed to them for the first time. Using a computerized medical record (ADDIS), we retrospectively assessed a potential relationship between the increase in CD4 T cells (deltaCD4) at M3, M6 and variables including sex, age, CDC staging, protease inhibitor, prior antiviral therapy, CD8 and viral load at baseline. We used Epi-Info 6.4 and BMDP software. RESULTS: Data were analyzed on 154 patients. The median CD4 T cell count was 157 at baseline, 215 at month 3 and 202 at month 6. The median viral load was 52000 copies at baseline, 530 at month 3 and 500 at month 6. In a univariate analysis, a significant relationship was found between deltaCD4 and CD8 at baseline. A statistically significant negative correlation appeared between the CD8 cell count at baseline and deltaCD4 at M6 (r=-0.28, Pearson). Moreover, we found that there also was a relationship between deltaCD4 and viral load at baseline. There was a correlation between deltaCD4 at M6 and the viral load at M0 (r=0.37, Pearson). In a multiple regression model, after CD8 count at baseline had been accounted for, we found a significant correlation between deltaCD4 and viral load at baseline (multiple r=0.33 at M3, and 0.40 at M6). CONCLUSIONS: Patients with a low viral load do not benefit from as great an increase in CD4 T cell count as others when they receive a tritherapy including protease inhibitors. These results suggest that another mechanism rather than direct viral pathogenicity leads to CD4 T cell destruction. This mechanism may not be efficiently stopped by antiviral therapy, especially protease inhibitors.

Adult↗
PubMed1998

Predicting the outcome of adductor tenotomy.

This study reviewed 57 hips in 30 children (18 girls and 12 boys) with cerebral palsy who had undergone an adductor tenotomy alone or in combination with an anterior obturator neurectomy (23 hips). Results were evaluated by the Reimers migration percentage (MP). The hips were split into three groups: group A (12 hips) a preoperative MP of less than 20%, group B (25 hips) between 20 and 40%, and group C (20 hips) more than 40%. The mean age at the time of surgery was 6 years and 1 month (range: 2.5-13 years). The mean period of review was 6 years and 3 months (2-20 years). The results were considered as "good" when radiographs at the longest follow-up showed a decrease of > 10% of the MP, as "bad" when they showed an increase of > 10%, and as "stable" when the MPs varied less than 10%. At the latest review of group A, 11 were stable (92%) and 1 was bad. In group B, 12 were stable (48%), 7 were good (28%), and 6 were bad (24%). In group C, 7 were stable (35%), and 13 were bad (65%). The preoperative migration percentage provided to be the only predictor of outcome. Age at the time of surgery had no constant significant effect on the outcome, neither had the addition of an anterior neurectomy.

Age Factors↗
PubMed1998

Reimplantation of growth plate chondrocyte cultures in central growth plate defects: Part I. Characterization of cultures.

Growth plate lesions or resections may cause severe growth arrest because of the bony bridge between the epiphysis and metaphysis. Actual treatments for epiphysiodesis include resecting the bone bar and setting an interpositional material. Growth plate cultures may provide the appropriate cartilage necessary to restore growth potential when implanted in a growth plate defect. The aim of this work was to determine certain cell culture parameters in order to optimize in vitro cultures to obtain abundantly mature and functional chondrocytes. We studied the manner in which enzymatic digestion, carried out by various enzymes, obtained chondrocytes. Treatment with trypsin (0.2%) during 30 minutes at 37 degrees C and then collagenase (200 U/mL) during 6 hours was chosen. Under these conditions, 40 +/- 16 10(6) chondrocytes per gram of growth plate were obtained, and cellular viability was 79 +/- 12%. The density of the cellular seeding, the nature of the culture substrate, and the culture medium composition were determined to optimize the growth of differentiated cells. Seeding at 20,000 or 30,000/cm2 on a type I substrate and Ham F-12 medium not supplemented with either glucose or growth factors was demonstrated to be the best choice for this purpose.

Animals↗
PubMed1998

Reimplantation of growth plate chondrocyte cultures in central growth plate defects: Part II. Surgical experimentation in rabbits.

An original and reliable technique to culture growth plate chondrocytes was developed to obtain an abundant amount of mature and functional chondrocytes. Growth plates were provided from the epiphysis of 3-week-old rabbits. Isolation of the chondrocytes was optimized by the use of trypsin and collagenase. The culture was realized according to the following conditions: seeding at 20,000 or 30,000/cm2 on type I collagen substrate and in Ham F-12 medium without a supplementation of glucose or growth factors. After 7 days of culture, the implantation was to be carried out. Different implantation substrates were evaluated in vivo. Agar turned out to be the only substrate to provide strong and healthy chondrocytes 21 days after the grafting. Then implantation was tested on large iliac resections in rabbits to check whether an enchondral ossification occurred with the culture. Poor results were obtained because of an early disappearance of the cultured chondrocytes. In an other experimentation, the culture was implanted into surgically created defects in the growth plate area. In this case, the culture did produce an epiphysiodesis. However, the 6-week postoperative histological examination showed that the implant remained viable, continued to maintain a proteoglycanrich matrix, and began to organize in ordered columns of mature chondrocytes.

Animals↗
PubMed1998

Aneurysmal bone cyst in children: analysis of twenty-seven patients.

The authors have analyzed a retrospective series of 27 aneurysmal bone cysts (ABCs) in children and adolescents. The average age at diagnosis was 10 years (range: 3 years 7 months to 16 years), with a mean follow-up of 5 years (range: 1 month to 13 years 9 months). Pathologic fractures (8 cases) and pain (8 cases) were the main reasons for consultation. Of five spinal ABC patients, four presented with neurologic involvement. Although conventional radiology is useful for diagnosing ABCs, magnetic resonance imaging (MRI) is nevertheless the most important technique for checking the extent of the lesions. However, the diagnosis still must be based on the pathologic laboratory findings, even though this is sometimes difficult because of associated lesions. In lesions of the long bones, recurrence was observed after curettage in 5 of 12 cases. For this reason, simple resection or resection with reconstruction is recommended rather than curettage whenever possible. When an ABC is in contact with the growth plate in young children, blunt curettage should be performed to preserve the child's growth potential. Subsequent recurrence usually is easier to treat than an epiphysiodesis bridge and its consequences. The surgical procedures used to preserve the growth plate are described, along with methods of bone construction after surgery.

Adolescent↗
PubMed1998

[Surgical management of malignant bone tumors in the child. Saint-Etienne Hospital experience, apropos of 17 cases].

From 1980 to 1997, seventeen children were treated for malignant bone tumors in the Department of Paediatric Surgery of the Saint-Etienne Hospital, with an average follow-up of 6 years and 3 months (2M-17Y). The histologic diagnoses were osteosarcomas (12 cases) and Ewing's sarcomas (5 cases). All children were treated surgically. For the 12 lower limb tumors, the techniques used were prosthetic replacement in 7 cases (associated with bone allograft in 3 cases), amputation in 3 cases and isolated bone allograft in 2 cases. The two ilium tumors were treated by resection and reconstruction with autologous bone graft. A single resection was performed for the shoulder-blade Ewing's tumors and a prosthesis for the 2 proximal humerus tumors. Six children died during follow-up. The authors stress that carcinologic resection is a priority before functional results. They insist on the mechanical failures of implants and on the difficulties of reoperations.

Adolescent↗
PubMed1998

[Intra-thoracic costal sites of osteogenic exostoses in the child].

PURPOSE OF THE STUDY: The authors report 2 cases of internal costal exostosis in children. OBSERVATIONS: Case 1: A 15-year-old boy with hereditary multiple exostosis presented for chest pain. Radiograph and CT scan showed an internal rib exostosis. It was removed by thoracotomy. Eighteen months later, the child was painfree. Case 2: An-11-year old boy presented with fever and a headache. A chest radiograph showed an image of pulmonary opacity interpreted as a pneumonia. The child was admitted for antibiotic therapy. Two months later, X-ray lesion persisted and a CT-scan was obtained. It showed a solitary costal internal exostosis which was removed by thoracotomy. At 12 months follow-up, he was asymptomatic. DISCUSSION: Internal costal exostosis can induce some complications such as hemothorax, diaphragmatic or pericardic wounds. In case of symptomatic exostosis, the authors recommend a surgical removal to avoid severe complications. If the exostosis is asymptomatic, abstention can be recommend. As a matter of fact, hemothorax, for instance, can occur even due to a round and smooth exostosis without any history of trauma.

Adolescent↗
PubMed1998

[Treatment of blunt splenic trauma in children].

UNLABELLED: The conservative management of blunt splenic trauma in children has been generally accepted for about twenty years, in order to avoid serious post-splenectomy infectious complications. The objective of this study was to evaluate the results of conservative management. PATIENTS AND METHODS: 21 cases of blunt splenic trauma were treated between 1 January 1991 and 31 December 1995. Eleven cases were isolated and 10 were associated with other visceral, musculoskeletal or head injuries. The lesion consisted of subcapsular or intraparenchymal haematoma in 8 cases and ruptured spleen in 13 cases. All children were initially managed conservatively, except in the case of unstable haemodynamic parameters after resuscitation, perforated viscus or secondary complication. RESULTS: Emergency surgery for blunt splenic trauma was never required over this 5-year period. Four children required secondary surgery, 2 for left renal lesion, 1 for pancreatic pseudocyst and 1 for epidermoid cyst of the spleen discovered incidentally at the time of the trauma (partial splenectomy). No associated bowel perforations were observed. Four children were transfused, 3 for an associated visceral lesion and only once because of ruptured spleen. The mean length of hospital stay was 18.2 days in the case of isolated rupture and 28.7 days for a ruptured spleen associated with other lesions. No immediate or long-term complications were observed with a mean follow-up of 6 months. CONCLUSION: Conservative management of blunt splenic trauma is possible under good conditions of security and total splenectomy was never required. The blood transfusion rate was very low.

Adolescent↗
PubMed1997

[Orthopedic treatment of scoliosis: new technique using impression by optic procedure].

The authors present a new procedure for acquiring the whole external trunk shape. The construction of braces starts with corrected a positive mold using computer-assisted design software connected to a digital tooling machine. The computer-assisted design and construction of braces enable the determination, measurement, and modification of a three-dimensional image of the trunk, which allows the positive to be corrected. The outer-trunk can be re-balanced, derotated or rectified in the sagittal or frontal plane and the inner modeling of the spine and chest can be rectified. Moreover, in the case of scoliosis or kyphosis, the software produces automatic correction. This rapid (acquisition time < 2 seconds), non invasive, safe and painless procedure can also be used to detect and follow mild spinal deformities.

Adolescent↗
PubMed1997

Salmonella spondylitis.

We report a case of salmonella spondylitis in an adolescent without sickle cell disease or any history of salmonella gastroenteritis. The infecting organism (cultured from material aspirated from the bone lesion) was Salmonella enterica serovar Newport. With nonoperative treatment, evolution was favorable.

Adolescent↗
PubMed1997

Myositis ossificans: report of seven cases in children.

The clinical features of seven children with myositis ossificans (circumscripta and progressiva) and radiographic signs of the disease are described. We recommend systematic radiological examination to seek other skeletal malformations for congenital hallux valgus in young children, for it may be the first sign of a myositis ossificans progressiva. The "zone phenomenon" observed on histology, along with differential diagnosis and evolution, is documented. The necessity of a biopsy and different forms of treatment are discussed.

Adolescent↗
PubMed1997

[Muscular lengthening of the triceps by successive casts in children with cerebral palsy].

PURPOSE OF THE STUDY: Twenty children with cerebral palsy who underwent elongation of the triceps surae using successive plaster-casts (28 short triceps) were reviewed. This study was retrospective. MATERIAL AND METHODS: Among the eighteen children, 10 were hemiplegic, 8 were diplegic and 2 were spastic quadriparetic. All of them except one were ambulatory children. The authors describe their elongation technique by plaster-casts and the treatment they lead. The mean age at time of elongation was 4 years and 6 months (range 2 years 4 months to 8 years). The passive dorsiflexion of the foot before elongation was of 0 degree (range -20 degrees to +10 degrees) knee in extension, and of 5 degrees (range -15 degrees to +15 degrees) knee in flexion. RESULTS: The passive dorsiflexion of the foot after elongation was of 23 degrees (range +10 degrees to +30 degrees) knee in extension, and of 27 degrees (range +10 degrees to +35 degrees) knee in flexion. One major complication was noted: the persistence of a varus foot in child after elongation. 24 elongations were reviewed with a mean follow-up of 21 months (range 12 months to 30 months). The passive dorsiflexion of the foot was of 10 degrees (range 0 degree to +20 degrees) knee in extension and of 17 degrees (range -5 degrees to +25 degrees) knee in flexion. DISCUSSION: Compared to different procedures (surgical lengthening, botulinum-A toxin) elongation by successive plaster-casts is a quick, safe, complication-free, and simple technique, whose results are equivalent. Even if recurrence of equinus is probable, a surgical procedure of lengthening could be made on an operative-free tendon. CONCLUSION: Elongation of the triceps surae muscle by successive plaster-casts constitutes a safe alternative technique compared to surgical procedure.

Achilles Tendon↗