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Biomedical subjects

J F Kouvalchouk

Publications and source records attributed to J F Kouvalchouk.

At least 19 recordsLinked to original sources
PubMed1990

[Osteochondral lesions of the dome of the talus with partial necrosis. Surgical treatment by curettage and filling].

There are several types of lesions of the talus, including non united fractures and true osteochondritis in adolescents. This article focuses on lesions of the dome of the talus having a large subchondral necrotic zone. The etiology of these lesions is unclear. Even when they result from trauma, this may not be the sole cause. Thirty-three similar cases were studied, allowing analysis of the radiological appearance and the value of arthro scanner data. All the cases were treated by surgery (and were subsequently classified histologically). The necrosis was treated by curettage and filling with cancellous bone grafts taken from the lower tibial epiphysis. Twenty-seven patients were followed up at least one year (average 3 years 3 months). The outcome was functionally good or very good in twenty-two cases. The anatomical reconstruction was scored by radiology as very good in nineteen patients and satisfactory in five, who had irregularities and non-homogenous appearance of the talar dome. These results justify the use of curettage and filling. Arthroscopic techniques, although appropriate for simple ablations of osteochondral fragments, do not appear to be satisfactory for treating lesions including subchondral necrosis. Filling can only be performed surgically.

Adolescent↗
PubMed1986

[Irradiation of bone homografts. Their use following tumor resection. Apropos of 4 cases].

Since 1978 gamma irradiation has been used for sterilization of bone allografts. The radiation source used was Co 60 (2.5 to 3 megarads). Which was applied at the Atomic Centre of Saclay. The technique of sterilization is absolutely reliable at relatively low cost. It allows pieces of bone from cadavers to be harvested several hours after death, without special aseptic precautions. It appears to diminish antigenicity of the graft very little and incorporation is perhaps slowed down. The grafts did not become radioactive. The graft is carefully packed and frozen as soon as it is taken from the cadaver. Freezing is continued during the irradiation process and the graft may then be stored for several months. This technique was used for reconstruction after tumor resection twice in the knee, once in the pelvis and once in the fibula. There was no postoperative infection. Scintigraphy showed satisfactory incorporation. In one case of replacement of the femoral condyle the cartilage of the graft was replaced by the intact articular cartilage of the patient. Later, this articular cartilage was shown to be necrotic and a total prosthesis was inserted. The fibular graft was secondarily complicated by a fracture. Sterilization using irradiation makes bone harvesting in cadavers easier and allows bone banks to be established. It should lead to more extensive use of allograft bone.

Adolescent↗
PubMed1984

[Ruptures of the Achilles tendon. Comparison of the results of surgical and nonsurgical treatment].

The authors have compared the results obtained in 76 cases of rupture of the tendo Achillis treated conservatively with a previously published series of cases treated surgically. The same assessment of the results was used. The main complication of surgical treatment was skin necrosis; the main complication of conservative treatment was recurrent rupture. To objective assessment, the loss of strength in the triceps surae was about 20 p. 100 in both series. Subjectively, the conservatively-treated patients seemed more satisfied. These findings support the conclusions of other published comparative studies that conservative treatment is worthwhile since it avoids general anaesthesia and hospital treatment. It is indicated when the conditions are favourable. Surgical treatment should be used in young athletes because healing is quicker in cases of recurrent rupture or old ruptures.

Achilles Tendon↗
PubMed1982

[First human case of Drechslera longirostrata mycosis. Spondylodiscitis complicating prosthesis endocarditis. Treatment with combined ketoconazole and amphotericin B].

In a patient with spondylodiscitis secondary to cardiac valve prosthesis infection with endocarditis the fungus Drechslera longirostrata, which had not yet been known to cause mycoses, was isolated from cultures of prosthetic material and an intervertebral disc. The cardiac prosthesis had to be replaced and the vertebral lesion, which extended along 3 lumbar segments and was destructive enough to produce neurological disorders, required surgical immobilization of the spine. The disc infection was cured after combined administration of amphotericin B and ketoconazole, both drugs having proved unsuccessful when given alone. Infections caused by rare opportunistic fungi are becoming increasingly common and are difficult to diagnose since immunological methods are inapplicable. In some resistant or extremely severe fungal infections antifungal agents can be used in combinations for their synergistic effects, with subsequent reduction of dosage and potential side-effects. Combinations must be based on in vitro sensitivity tests.

Adult↗
PubMed1979

[Valgisation osteotomy in the treatment of osteoarthrosis of the hip: 21 cases (author's transl)].

Study of 21 cases of femoral valgisation osteotomy, with a minimum follow-up of 5 years, confirms the value of this operation in the treatment of certain types of osteoarthrosis of the hip, and above all those types in which there is an inferior capital osteophyte. The indications depend upon: --clinical features: as in the case of all osteotomies, mobility must be at least equal to 70 degrees flexion. --radiological findings: reposition films in adduction should show widening of the joint space and above all improved congruence. The presence of geodes and lack of cover of the femoral head are not, in themselves, contraindications. The operation involves, in addition to valgisation inter-trochanteric osteotomy, relaxation of the peri-articular muscles (psoas, adductors, gluteus medius) in order that the relative lengthening of the upper end of the femur related to ventricalisation of the neck should not be in contradiction with the usual principles of surgery for osteoarthrosis. Valgisation osteotomy results in an increase in weight-bearing surfaces and thus a decrease in unit pressure. Indicated and performed in this way, this operation gives highly satisfactory and durable results, as shown by the follow-up period of our own cases.

Adolescent↗
PubMed1976

[Results of surgical treatment for rupture of the achilles tendon].

The authors analyse the results obtained on 53 cases of rupture of the Achillis tendon. Early minor complications were numerous (26 p. 100) the average follow-up, in 38 cases, was about 6 years. A number of ankle limitations, triceps weakness were noted. All patient had a calf atrophy. Final results were not related to the surgical technique (suture or grafting using plantaris). The authors conclude that the results obtained after surgical treatment are not as good as generally thought.

Achilles Tendon↗