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Biomedical subjects

J L Husson

Publications and source records attributed to J L Husson.

14 recordsLinked to original sources

[Iliac eventration after posterior iliac bone removal. An original technique of reconstruction].

A tricortical bone graft removal from the iliac crest causes a parietal defect that may be complicated by iliac or iliolumbar eventration, according to the extent of the bone loss. On the basis of their experience with a particularly characteristic clinical case, the authors describe an original reconstruction technique. The surgical techniques aimed at parietal restoration described in the literature include either the use of foreign materials or of those provided by the patient (skin, fascia lata, etc.), or the use of the surrounding anatomical elements to reconstruct a solid wall. Most of these procedures may be difficult to implement if the loss of substance is extensive, or in a posterior site. Thus, in order to prevent possible recurrence in case of major bone defects, we propose to combine the cure of the eventration with a restoration of bone continuity with a cold-conserved allograft and the reconstruction of the musculoaponeurotic curtain by the translation of the lumbosacral fascia. This procedure allowed obtaining a very satisfactory result, which was stable after 18 months both as regards parietal reconstruction and as regards pain, owing to the restoration of balance in the paraspinal muscular support.

Adult

Symptomatic spinal epidural lipomatosis induced by a long-term steroid treatment. Review of the literature and report of two additional cases.

Spinal epidural lipomatosis associated with Cushing's syndrome is an uncommon complication (11 reported cases). Two additional symptomatic cases with neurologic deficit are described. Steroid treatment was systemic in the first case and local with epidural injections in the second. The second case is unique because no similar observations have yet been reported. In most cases, a preoperative computed tomographic scan establishes the diagnosis by demonstrating dural compression by an adipose mass. Myelography is far less specific. In some cases, the exact diagnosis is made at the time of surgery. The treatment is primarily surgical, with laminectomy over the length of the compression and the removal of the compressing fat. Neurologic recovery is dependent on two factors: the level of the compression and the adequacy of decompression.

Epidural Neoplasms

[Recurrent postoperative sciatica. Prospective evaluation of magnetic resonance imaging and x-ray computed tomography with iodine injection].

The respective performance of MRI and CT were studied prospectively in 80 cases. Surgery was indicated in 56 patients after MRI examination and 21 patients after CT; the 21 patients were included in the 56. Among these patients, 45 were reoperated and 11 preferred the medical treatment. Surgery confirmed the diagnosis for 44 patients (from the 45), and the only discordance was the presence of ligament calcification, associated to a disc protrusion not seen on MRI. Surgery confirmed also the diagnosis for the 21 cases diagnosed by CT after iodine injection. However, among the 24 cases of fibrosis diagnosed by CT after i.v. injection were found: 19 recurrent disc protrusions, 4 disc protrusions with fibrosis, and 1 disc protrusion at a level above the operated disc.

Adult

Recurrent postoperative sciatica: evaluation with MR imaging and enhanced CT.

Magnetic resonance (MR) imaging and computed tomography enhanced with intravenous iodine injection (ECT) were prospectively compared in 80 patients in the diagnosis of recurrent postoperative sciatica. Diagnostic accuracy was determined with surgical verification. Isolated fibrosis was considered a contraindication to surgery. A decision to operate was made in 56 of the 80 patients on the basis of MR imaging findings; in 21 of the 56, the decision was also made on the basis of ECT findings. Of the 80 patients, 45 underwent surgery, In all but one of these patients, the diagnosis made on the basis of MR imaging findings was confirmed with surgical analysis. The only surgical finding that did not agree with MR imaging findings was a calcification of the common posterior ligament. The 21 diagnoses of disk herniation based on ECT findings were confirmed surgically, but among the 24 diagnoses of fibrosis made with the help of ECT, there were actually 19 recurrent herniations, four herniations with fibrosis, and one herniation at the level above the previously resected disk. MR imaging seems to be the investigation of choice in diagnosing the cause of recurrent postoperative sciatica.

Adult

[Syndrome of compression of the external saphenous nerve (or the sural nerve)].

The authors describe a new canal syndrome, which they call the "superficial sural aponeurosis canal syndrome" or "sural nerve tunnel syndrome". Mostly seen in sportsmen, it was observed in this case in the context of a myositis ossificans circumscripta of the tendo-muscular junction of the heel. The clinical signs are caused by compression of the sural nerve where it passes through a nonextensible tunnel formed by the fold of the posterior sural aponeurosis. This is distinguished from a loge syndrome; the most typical clinical sign is increased pain in the territory of the sural nerve during plantar flexion of the ankle; in this position reduced sensory conduction velocity is measured. The treatment consists in a section of the fibro-aponeurotic arch.

Female

[Role of MRI in the study of the Achilles tendon and patellar tendon].

The possibilities of MRI and radiography with mammogram to diagnose mechanical tendinitis have been prospectively evaluated in thirty sportsmen. Sixteen had Achilles tendon lesion, fourteen had patellar ligament lesion. Each patient included in the study was programmed for radiography with mammogram and MRI of the pathologic tendon and the controlateral tendon. These examinations were separately interpreted by two reviewers who had no knowledge of pain location. The number of tendinitis diagnosis based on X-ray and MRI was approximatively the same. But the microtearings were more often diagnosed on MRI data than on X-ray data (10/1). Eight patients underwent an operation. The surgery findings always confirmed the MRI diagnoses. MRI seems to be the examination of choice to evaluate the tendon injuries and particularly microtearings before surgery.

Achilles Tendon

[Entrapment syndrome of the superficial posterior sural aponeurosis].

The development of a large circumscribed area of myositis ossificans at the junction of the aponeurosis of the tendo Achilles and the calf muscles may cause compression of the lateral saphenous nerve beneath the tight aponeurotic arch. The condition is usually encountered in athletes. Plantar flexion of the ankle will produce pain and diminution of sensation in the area served by the nerve. Treatment is by section of the tight band.

Achilles Tendon

[Initial degeneration of the articular cartilage in the rat].

The authors have investigated the process of degeneration of articular cartilage in its early stages using an experimental model which has made it possible to show, for the first time, the effects of a mechanical parameter other than excessive pressure--that is excessive friction. The two healthy hips in twenty anaesthetised young rats were used for the study. One hip was kept immobile and served as a control. The other was subjected to physiological movements of flexion and extension continuously and without rest for periods varying from twelve hours to seven days. The articular cartilage of the two femoral heads was examined by light microscopy, transmission electron microscopy and scanning electron microscopy. A new fact was demonstrated. Cartilage wear is also associated with the simple movement of two joint surfaces over one another without any muscle contraction being involved. In the genesis of cartilage wear, excessive friction alone seems to be as important as excessive pressure.

Aging

[Medial and lateral discoid menisci in the same knee. Apropos of a case].

To our knowledge, the case of association of discoid lateral and medial menisci in the same knee has not yet been reported. There are several factors which may contribute in the development of discoid meniscus: usually congenital, the types described by SMILLIE and WRISBERG must be distinguished and have not the same prognosis; thus, the discoid meniscus only acquired after birth seems rare.

Adolescent

[Treatment of chronic pain of the musculoskeletal system by epidural stimulation].

In order to reduce refractory chronic pain of the musculoskeletal system, the orthopedic surgeon can stimulate electrically the peripheral nerves or the posterior funiculi of the spinal cord (epidural neurostimulation). The authors specify their current indications for epidural stimulation in the treatment of such painful diseases: radicular pain caused by arachnoepidurites, sequelae of trauma inflicted to the spine and medulla; postoperative lomboradicular pain of mixed source, and distal lesions of the plexus brachialis. The indication for an implant stems from a rigorous strategy which requires more particularly that pain regress by more than 50% under transcutaneous neurostimulation applied for a period of least one month and that the psychological and spinal-cerebral integrity be verified. The surgical procedure comprises two stages: first, positioning of an epidural electrode and, then, insertion of a totally implantable multiprogrammable radiostimulator. Judging from a prospective assessment of 20 cases of postoperative lumbar arachnoepiduritis treated in this way, the results are considered quite encouraging.

Analgesia, Epidural