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J Letenneur

Publications and source records attributed to J Letenneur.

At least 19 recordsLinked to original sources
PubMed2001

[Rehabilitation after anterior cruciate ligament reconstruction: inpatient or outpatient rehabilitation? A series of 103 patients].

PURPOSE OF THE STUDY: The goal of this work was to evaluate outpatient rehabilitation after anterior curciate ligament reconstruction using the bone-tendon technique. MATERIAL AND METHODS: This was a prospective non-randomized study of 103 consecutive patients participating in the same rehabilitation program, excepting for the first month. During the first postoperative month, 55 patients (group A) attended a physical therapy outpatient clinic near their home and 48 patients (group B) followed the same rehabilitation protocol at an inpatient facility of their choice. We recorded preoperative data for age, sex, weight, height and function (sports, occupational activities). Surgery data concerned delay between severe sprain and surgery, and the exact surgical procedure used (meniscal tear, associated procedure). Clinical assessment (mobility, effusion, clinical and radiological laxity) and functional scores (Tegner, Lysholm, Arpege, IKDC) as well as delay to recovery of gait and to renewed physical activity were recorded at 3 and 6 weeks and 4, 6 and 12 months postoperatively. Two isokinetic tests were done 4 and 6 months postoperatively. RESULTS: There was no statistical difference for the pre and peroperative data between the two groups, with the exception of meniscal tears that were more frequent in group A (p<0.05). Postoperative outcome and complications were not significantly different between the 2 groups except for greater flexion at 3 weeks in group B (related to difference in measurement date). Fifteen complications were observed in each group: 4 reflex dystrophies and 2 cyclope syndromes in each group, 5 patellar syndromes in group A and 1 in group B; 3 painful surgical wound sites in group A and 8 in group B (including one requiring revision). In group A there was one early failure due to a surgical error requiring revision. At 1 year, there were 2 cases of persistent femoropatellar syndromes, one of which occurred after reflex dystrophy. A high percentage of the patients were lost to follow-up (45% in group A and 50% in group B) and lack of randomization should also be considered when interpreting the results. DISCUSSION: This is the first report comparing inpatient and outpatient rehabilitation protocols after anterior cruciate ligament reconstruction. The only reports in the literature have compared different ambulatory rehabilitation programs that appear to be internationally accepted as the routine procedure. The current trend towards short hospital stays for surgery is compatible with outpatient rehabilitation programs if dependent patients receive proper support from an ambulatory medical unit, a physical therapist or a home assistant. Our study demonstrated that the bone-tendon technique for anterior cruciate ligament reconstruction is compatible with an outpatient rehabilitation program if quality medical and surgical follow-up is ensured. This type of rehabilitation program gives results comparable with those obtained after inpatient programs conducted in a rehabilitation facility during the first postoperative month.

Activities of Daily Living↗
PubMed2000

[Tumoral calcinosis of the foot in patient on hemodialysis].

We report a new case of tumoral calcinosis in a renal failure patient. In this patient the pseudotumoral formation was found in an unusual localization on the medial border of the foot. The condition progressed with successive development of bilateral tumors and septic contamination. Pathology confirmed the diagnosis. The patient was successfully treated with tumor resection and renal graft. The origin of these pseudotumors remains a question of debate. Several pathogenc mechanisms have been put forward. Pronosis is always favorable. Several authors have suggested a phosphorus calcium work-up can be useful for classifying these tumors, guiding surgical treatment if required and managing the underlying cause.

Adult↗
PubMed1999

Multiple rheumatoid bursitis with migrating chylous cysts. Report of a case in a European woman and review of the literature.

We report a case of recurrent multiple bursitis (19 episodes at nine sites) requiring seven surgical procedures in a European women with a 38-year history of severe, nodular, destructive seropositive rheumatoid arthritis unresponsive to second-line drugs. The episodes of bursitis were not correlated with activity of the joint disease. Some cysts migrated over a considerable distance. At least two cysts contained chylous fluid. The histologic study of one cyst demonstrated a cholesterol crystal granuloma. Potential relationships linking cholesterol crystals, chylous cysts, and migrating multiple bursitis are discussed. The relevant literature is reviewed.

Aged↗
PubMed1996

[Anterior instability of the shoulder in athletes: apropos of 51 cases of stabilization using the Latarjet-Patte intervention].

We report the 45-month results of the Bristow Latarjet procedure in 48 patients (51 shoulders), all sportsmen. At review, 87% were satisfied, 71% practiced the same sport at the same level, and 74% had good or excellent objective results. Five patients reported recurrence of dislocation, external rotation was restricted more than 10 degrees in 36%, and 31% of the shoulders had radiological evidence of degenerative arthropathy. We compare the results with the literature, particularly concerning recurrent dislocation and osteoarthritis.

Adolescent↗
PubMed1994

Treatment of delayed and nonunions of the humeral shaft using the Seidel locking nail: a preliminary report of five cases.

We report the treatment of five cases of delayed/or nonunions of the humerous using the Seidel locking nail. Union occurred in all cases despite two distal unscrewings. Shoulder motion was pain free, with slightly restricted abduction. No subacromial impingement occurred. Elbow motion was slightly limited in extension in two elderly patients, most likely because of previous immobilization. This method of treatment therefore seems to be of value because it avoids iatrogenic risk to the radial nerve and the possible need for bone grafting.

Adult↗
PubMed1994

[Proximal tibial epiphyseal separation in adolescents. Apropos of 13 cases with 10 reviewed after 5 years].

INTRODUCTION: The goal of this study was to evaluate the mid-term follow-up of fractures of the proximal tibial epiphysis. MATERIAL AND METHODS: From January 1981 to May 1987, 12 male teenagers sustaining 13 fractures of the proximal tibial epiphysis were treated in our institution. 9 patients totalizing 10 fractures were reviewed with a minimal 5 years follow-up. RESULTS: All knees were painless with a symmetric range of motion except in one case with a 15 degree flexion lag. One case of PCL deficiency was observed. Differences in femoro-tibial angles between both limbs was under 5 degrees in 7 of the 9 patients. In 2 cases, an evolving deformity was noted. Differences in posterior epiphyseal tibial tilt between both knees was over 5 degrees in 2 of the 8 unilateral cases. In 1 surgically treated patient an evolving deformity was noted. Mean tibial length discrepancy (T.L.D.) was over 10 millimeters in 1 case with evolving discrepancy. 3 cases of asymptomatic minimal post traumatic arthritis were noticed. DISCUSSION: In our series, as opposed to most others, Salter-Harris type IV fracture was the most often encountered due to the advanced age of our patients. Unusual cases, such as 2 triplane fractures and Salter-Harris type II avulsion fracture, were present. Lateral ligament insufficiency was noted in case of varus malalignement of the fractured limb. Due to the advanced age of our patients, no major T.L.D. was noted, but frontal or sagittal malalignement occurred in half of the unilateral cases, 50 per cent of which were proved to be evolutive. Arthritic remodeling was noticed only in cases of Salter-Harris type IV when aggravated by limb malalignement. CONCLUSION: Fractures of the proximal tibial epiphysis are mainly encountered in late adolescence with an unusual proportion of Salter-Harris type III and IV fractures. In spite of their advanced age, these patients are at high risk for limb malalignement which can increase. We have noted the incidence of arthritic remodeling in Salter-Harris type IV fracture. A longer follow-up is needed to determine if these changes will have clinical relevance.

Adolescent↗
PubMed1994

[Search of papillomavirus genome in synovial membranes and rheumatoid nodules].

IgG antibodies to rat esophagus stratum corneum are highly specific for rheumatoid arthritis and have been recently shown to be directed against human (pro)filaggrin. Although the mechanisms underlying the loss of tolerance of B lymphocytes for filaggrin remain unelucidated, a role of infection with the human papillomavirus has been suggested on the basis of the following facts: 1) the protein exhibiting the greatest molecular homology with filaggrin is papillomavirus-encoded; 2) human papillomavirus proteins bind to cytoskeletal proteins; 3) human papillomavirus replication is enhanced by friction and rheumatoid lesions predominantly develop in areas subjected to friction, as shown by the distribution of rheumatoid nodules; 4) the rheumatoid pannus resembles a benign tumor. The objectives of this study were to look for the human papillomavirus genome in six synovial membrane specimens and two rheumatoid nodule specimens from rheumatoid arthritis patients with disease durations of more than ten years and in 20 synovial membrane specimens collected during surgical procedures in osteoarthritis patients. The methods used were polymerase chain reaction with papillomavirus-specific primers. The papillomavirus genome was not detected in any of the 28 specimens. A role for the human papillomavirus in the pathogenesis of rheumatoid arthritis cannot be ruled out on the basis of these findings because filaggrin is expressed in other tissues, including the thymic medulla epithelium. In addition, the primers used in this study may have been inappropriate.

Arthritis, Rheumatoid↗
PubMed1994

[Severe anterior sprains of the knee. Ligamentoplasty using the patellar tendon and reinforcement].

One hundred four severe knee sprains, treated by ligamentoplasty, according to Marshall-MacIntosh, with a Kennedy polypropylene ligament augmentation device, were reviewed with an average follow-up of 31 months. The functional result was evaluated as good or excellent in 3 out of the 4 cases; 87% of the sportsmen were satisfied. The result was unsatisfactory in 26% of the cases, with rupture or an elongation of the transplant in 9 cases (8.6%), due for some patients to premature resumption of sports; in 4 cases reoperation was necessary. A failure is always possible, even with an augmentation; however, with a ligament augmentation device, early rehabilitation and sports are possible (after an average of 6 months). There was no intolerance: 2 cases of synovitis, with a rupture, were observed. The authors underscore the ill effects of a delay between the accident and the stabilization, which causes numerous lesions of the menisci and the cartilage. This is generally admitted in the literature. The ligament augmentation device has been used for 3 years; the operation is performed after the acute phase of the first lesions and at the latest during the first year after the injury, before secondary lesions of the menisci occur.

Adolescent↗
PubMed1994

[The Seidel humeral nail in limited indications: pathological fractures, delayed union, pseudarthrosis and reconstruction].

The authors report 10 cases of Seidel locked intramedullary nailing of the humeral shaft for borderline indications (5 delayed unions, 2 complex nonunions, 2 reconstructions for tumor and a panmetastatic humerus). All delayed unions went to union in spite of unscrewing of the expanding screw in 2 cases. In cases of segmental reconstruction, union never occurred due to unlocking of the distal bolt by bone incompetence. Diaphyseal straightening was obtained, but not rotational stability. These elderly patients, in whom the osteoporotic bone is inadequate for plate osteosynthesis, were pleased with the result in comparison with their preoperative status. For pathological fracture, a painfree status is obtained. No subacromial impingement was observed.

Adult↗
PubMed1993

[Bone infections due to Aeromonas hydrophila--apropos of 2 case reports].

The authors report on two cases of bone infection due to Aeromonas hydrophila: one case in a compound fracture and the other a late infection in an implant. They confirm the rapid onset of systemic infectious disease but not the magnitude of local manifestations. The use of modern antibiotics sensitive to Aeromonas proved effective in lowering the risk of dramatic local evolution which has been described.

Adult↗
PubMed1992

[Complex injuries of the proximal humerus treated with humeral head prosthesis. Apropos of 21 cases reviewed after a median 4-year follow-up].

Of a total of 35 complex fractures of the upper humeral epiphysis treated by Neer arthroplasty, 21 were evaluated at a mean of 4 years after operation. The shoulder function according to Constant was 70% of the contralateral one. The internal and external rotations were rarely symmetric. Clinical improvement was possible during the first 2 years. Late breakage and migration of wires used to fix the tuberosities caused failure of this method of fixation. Dynamic radiographs revealed significant gleno-arthroplastic movement and a constant medialization of the prosthetic humerus.

Adult↗
PubMed1991

Deliberate hypotension with nicardipine or nitroprusside during total hip arthroplasty.

To induce deliberate hypotension during anesthesia, nicardipine was administered to patients undergoing total hip arthroplasty and was randomly compared with nitroprusside. Hemodynamic measurements were performed before and 10, 20, 30, and 60 min after starting to administer either nicardipine (n = 12) or nitroprusside (n = 12) (B, T1, T2, T3, and T4, respectively); at the end of drug infusion (T5); and 10, 20, and 60 min later (T6, T7, and T8, respectively). Plasma renin activity and catecholamine levels were measured at B, T1, T5, T6, and T7. In addition, plasma nicardipine concentration was measured in five patients at T1, T2, T5, T7, and T8. As with nitroprusside, nicardipine administration (1-3 micrograms.kg-1.min-1, after a titration dose of 4.7 +/- 1.5 mg) resulted in hypotension (up to -34% +/- 3%), a decrease in systemic vascular resistances (up to -49% +/- 4%), and increases in heart rate (up to +17% +/- 6%), cardiac index (up to +37% +/- 8%), plasma norepinephrine (up to +63% +/- 17%) and epinephrine (up to +232% +/- 68%) levels, and plasma renin activity (up to +336% +/- 207%). Ten and 20 minutes after discontinuation of the hypotensive drug, nicardipine led to persistent vasodilation and hypotension, which differed significantly from the hypertensive rebound observed after nitroprusside discontinuation, despite a similar increase in plasma renin activity and catecholamine levels. Our results indicate that after the infusion was terminated, the nicardipine-induced vasodilation was opposed to the vasoconstrictive effects of angiotensin II and catecholamines, thus avoiding hypertensive rebound.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

[Triplane fractures of the upper head of tibia. Apropos of 2 cases].

The authors reported 2 cases of Salter-Harris type IV fracture of the proximal tibial epiphysis in which the fracture line mimicked that of triplane fractures of the distal tibia. X rays and CT aspects were detailed. A surgical management is proposed according to the risk of evolving varus deformity.

Adolescent↗
PubMed1987

Systemic haemodynamic and metabolic effects of deliberate hypotension with isoflurane anaesthesia or sodium nitroprusside during total hip arthroplasty.

Isoflurane (ISO) was examined as an alternative hypotensive agent to nitroprusside (SNP) in 16 patients (mean age: 60 years) anaesthetized for total hip arthroplasty. MAP was decreased to 50 per cent of the awake level by infusion of SNP in Group I (n = 8) and with ISO in Group II (n = 8). Fentanyl (10-16 micrograms X kg-1) was administered to both groups. Haemodynamic measurements were repeated in the lateral position before, during and after hypotension. Polygeline and fresh frozen plasma were infused throughout the study period in volumes sufficient to maintain pulmonary capillary wedge pressure in the 7-9 mmHg range. The MAP decrease was the same in both groups, as were perioperative blood replacement (mean 500 ml), and postoperative haematocrits. Total perioperative fluid replacement was higher (p less than 0.01) in Group I (mean 2500 ml) than in Group II (mean 1300 ml). Venous tone was more affected by SNP than by ISO. ISO decreased the systemic vascular resistance index and oxygen consumption (VO2) without any change in CI or in Qs/Qt, in contrast to SNP which increased CI, VO2 and Qs/Qt.

Adult↗
PubMed1986

[Gritti's amputation. Surgical technic, apparatus and indications].

The amputation proposed by R. Gritti in 1857 involves a supracondylar operation with repair surgery to the patella, which is attached to the femur, allowing a long stump to be maintained. Principal criticisms were related to the apparatus used, until be availability of a prosthetic knee occupying minimal spaces and allowing alignment with the healthy knee. Weight bearing is terminal with a light prosthesis that locks in without difficulty. It can therefore be substituted for conventional lower third of thigh amputations in certain cases.

Amputation, Surgical↗
PubMed1985

[Trauma to the axillary artery in shoulder dislocations. Apropos of a case].

The authors have observed one case of injury to the axillary artery complicating anterior dislocation of the shoulder. It produced a marked haematoma of the axilla and ischaemia of the upper limb. At operation, avulsion of a posterior branch was associated with thrombosis of the trunk of the axillary artery. The result was good after saphenous vein grafting. This complication is very rare. Similar complications could arise from an excessively forceful reduction.

Adult↗