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Biomedical subjects

J M Clavert

Publications and source records attributed to J M Clavert.

At least 19 recordsLinked to original sources
PubMed2005

[Discoid menisci in children: clinical patterns and treatment in eighteen knees].

PURPOSE OF THE STUDY: Surgery is indicated when discoid menisci become symptomatic. The purpose of the surgical procedure is to resect any damaged tissue and restore the physiological shape of the meniscus. As a rule, as much meniscal tissue as possible must be spared because of the long-term deleterious effects on the cartilage of total meniscectomy. We analyzed a consecutive series of 18 cases of discoid menisci in children to search for secondary lesions and factors favoring their development in order to determine the optimal surgical procedure. MATERIAL AND METHODS: This retrospective series included 17 children (18 menisci) aged 7.5 years on average at diagnosis between 1985 and 2003. We noted the clinical manifestations, the imaging findings, time to treatment, and operative observations. The Watanabe classification was used to describe the discoid menisci. We also noted meniscal and cartilage damage and their consequences, as well as the consequences of late surgery on the type of procedure used. RESULTS: The main complaint was pain. Physical examination usually revealed a positive pivot test. Signs of osteochondral lesions of the lateral condyle were also observed in three children, and the MRI revealed degenerative menisci in four. Mean time from diagnosis to surgical treatment was 20 +/- 17 months. The Watanabe classification was type I (n=9), type II (n=5), type III (n=4). Arthroscopy revealed nine meniscal lesions and three cartilage lesions, one associated with osteochondritis. Meniscectomy was performed in eleven cases, meniscoplasty in seven. Meniscectomy was significantly more frequent (p<0.05) when there was a meniscal lesion (9/11 of the meniscectomies) and when the time from diagnosis to treatment was long (28 months versus 8 months for meniscoplasty, p<0.01). Time to surgery was associated significantly (p<0.05) with the proportion of meniscal, chondral, or osteochondral lesions. Inversely, the type of meniscus did not affect age at diagnosis, initial manifestations, or presence of a positive pivot test. DISCUSSION: While therapeutic abstention is warranted for asymptomatic menisci, surgical treatment should be undertaken if symptoms develop, irrespective of the type. If possible, surgery should be performed less than six months after diagnosis. The risk of secondary meniscal or cartilage injury increases with longer delay before surgery. Similarly, the chances of performing meniscoplasty are reduced with longer time from diagnosis to surgery. It must be recalled that the objective of conservative mensical surgery is to prevent secondary cartilage lesions after extensive meniscectomy and consequently the risk of osteoarthritis.

Child↗
PubMed2000

[Treatment of neglected Monteggia's fracture by ulnar lengthening using the Ilizarov technique].

We present an original method for the treatment of neglected Monteggia fractures using the Ilizarov technique. This method allows reduction without accessing the radial head by progressive ulnar lengthening after proximal subperiosteal osteotomy of the ulnar bone. We used this method in a six and a half year old girl and achieved excellent radiographical and functional results with normal joint amplitudes. In our opinion, the quality of the outcome is related to the progressiveness of the bone lengthening enabled by this technique which allows restoration of the ulnar length, preservation of the axes of both forearm bones, and controlled reduction of the radial head.

Bone Lengthening↗
PubMed1998

[Treatment of osteoid osteoma using laser photocoagulation. Apropos of 28 cases].

UNLABELLED: THE PURPOSE OF THE STUDY was to evaluate interstitial laser photocoagulation for local destruction of osteoid osteoma, with computed tomographic (CT) guidance. MATERIAL AND METHODS: 28 patients (age range from 5 to 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 microns optical fiber was used. The fiber was introduced into the nidus through a 18-gauge needle. Around the fiber tip, well-defined coagulative necroses from 5 to 9 mm (energy delivery, 400-1000J) were obtained. RESULTS: 27 patients had complete pain relief, which was effective within 24 hours in 18 patients. One patient had pain recurrence after 6 weeks. The remaining nidus was treated secondarily with complete relief. Treatment was unsuccessful in one patient, and surgical excision was performed. 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 6-12 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.

Adolescent↗
PubMed1997

Treatment of Madelung's deformity by lengthening and reaxation of the distal extremity of the radius by Ilizarov's technique.

Madelung's deformity was first described in 1878. It is characterised by a typical deformity of the carpus and not only causes pain but also impedes mobility and aesthetic appearance. Surgical correction can be effected during adolescence, the most frequently employed technique being conical osteotomy. We present a novel technique of lengthening and aligning the distal radial extremity using Ilizarov's technique. Five carpal joints were operated on in three 13-year old girls. An aesthetic effect was obvious in all the cases. Mobility improved by 30 degrees in the direction of the extension and pain always subsided directly after surgery.

Adolescent↗
PubMed1996

Prenatal diagnosis of unilateral tibial hemimelia.

We describe a case of unilateral tibial agenesis which was initially observed at 21 weeks' gestation. Unlike bilateral tibial hemimelia syndrome, a rare autosomal dominant condition, unilateral tibial agenesis, which accounts for about three-quarters of all newborns with this condition, has not previously been described. This case could have been a sporadic abnormality but, in view of the association with other observations (distal bifurcation of the femur, club foot), could be considered as an autosomal recessive inherited condition with variable penetrance. Ultrasonographic features and the genetic prognosis are discussed.

Adult↗
PubMed1993

[Superior femoral epiphysiolysis. Long term results].

Analysis of the long-term outcome of slipped capital femoral epiphysis convincingly demonstrates that early diagnosis is essential. Chronic slipping with significant displacement are associated with a high rate of adverse outcomes including necrosis, chondrolysis, and early osteoarthritis. Orthopedic reduction increases the risk of complications. Inadequate reduction is associated with poor hip function and a high risk of early osteoarthritis. Improvements in overall long-term outcome could be achieved only by reducing the number of chronic forms with major displacement, since prognosis is generally favorable in acute forms and chronic forms with minor displacement.

Adolescent↗
PubMed1993

[Clinical experience with totally implantable venous access systems in pediatric hematology and oncology].

Forty-three children with malignant diseases who received 48 totally implanted venous accesses (TIVA) were retrospectively analyzed. More than half the patients had acute leukemia. Mean age was 6 years 10 months. Mean duration of use of the TIVA was 473 +/- 50 days (range 28 to 1,285 da; median 424 days). Removal of the TIVA was required because of an adverse event in 33% of cases. Main reasons for removal included infection (22.9%), thrombosis (6.25%), and catheter dysfunction (4.16%). Catheter-related infections were most often due to staphylococci (90%), especially S. epidermidis (63%). Infection rate was 0.48 per 1,000 patient-days. Flushing with a vancomycin-heparin solution can be expected to decrease this rate. Selection of the implantation site is discussed. In children under 6 years of age, the cephalic vein and external jugular vein are often frail or absent and are therefore less appropriate than the internal jugular vein or subclavian vein.

Adolescent↗
PubMed1992

[Fibromatosis and fibrodysplasia ossificans progressiva. An avoidable diagnostic error].

BACKGROUND: Myositis ossificans progressiva is a rare progressive disease of connective tissue and muscle whose early diagnosis, before the lesions become ossified, can be difficult. The congenital malformations that accompany the disease may help in this diagnosis. CASE REPORT: A 12 year-old boy developed a localized swelling in the right trapezius muscle. Muscle biopsy showed fibromatosis lesions. Surgical excision was incomplete and despite chemotherapy, new lesions appeared periodically in the cervical and dorsal regions where they became ossified. Bilateral hallux valgus was noticed at that time and used to rectify the diagnosis as myositis ossificans progressiva. CONCLUSION: Many children suffering from myositis ossificans progressiva have congenital malformations, most commonly of big toes and thumbs. These anomalies are important for distinguishing myositis ossificans progressiva from other inflammatory diseases of muscle.

Child↗
PubMed1991

[Costal exostoses, complicated in the neonatal period, by brachial plexus paralysis. A distinct entity of exostoses?].

Two highly unusual cases of brachial plexus palsy due to compression by exostosis of the first rib in the neonatal period are reported. Etiologic diagnosis in these patients required elimination of other tumors of the first rib, including multiple exostoses. The contradictions found lead the authors to suggest individualization of a form of multiple exostoses different from classical multiple exostoses by a number of features including growth, complications, and inheritance. At present, it is not known whether this new entity carries the same risk of malignant transformation as classical multiple exostoses.

Bone Neoplasms↗
PubMed1991

[A retrospective study of 54 children hospitalized in the Department of Pediatric Surgery for suspicion of child abuse].

Forty-five children admitted to the department of pediatric surgery at Strasbourg (France) from 1980 through 1989 were reported as being possible victims of abuse. The conditions of the hospital admission and nature of the injuries found are analyzed. On the basis of the data in the reports established by social workers and judicial authorities and in psychiatric expert evaluations, the social and familial characteristics of child abuse are defined. Although based on the demonstration of many elements pointing in the same direction, the diagnosis of child abuse remains fraught with difficulty.

Age Factors↗
PubMed1990

[Hemorrhagic cyst of the kidney in the neonatal period. Apropos of 2 cases].

Two cases of haemorrhagic renal cysts in neonate are reported. Both cases were premature newborns with obstetrical difficulties and delayed tumoral syndrome. The first case was considered a solitary renal cyst. The surgical procedure was a prominent domme resection. Four years later a contralateral Wilm's tumor appeared which became bilateral in 12 months, terminating in death 3 months later. The second case is clinically and radiologically similar in the neonate period. The surgical procedure was a nephrectomy. Compared histological reading of both resection materials, allowed us to establish diagnosis of congenital cystic nephroma. Cystic wall cells were normal elements of Bolande's tumor, of which microcystic forms have been soon reported. Hypothesis in our two cases would be mesoblastic nephroma in a pure cystic form, which would allow to widen morphologic spectrum of Bolande's tumor.

Female↗
PubMed1990

[Angioma of the umbilical cord. Apropos of a case].

We report a case of umbilical cord angioma in a female newborn. Ultrasonographic antenatal diagnosis had suspected either an omphalocele or a tumor of the umbilical cord. A caesarean had been decided at term. Surgery was necessary to ligate the umbilical vessels. The cord was 37 cm long and 7 cm large in several places. It weighed 495 g. The interest of this case resides in its rarity. First description of this kind of tumor was made by Gerdes in 1864 and since, only 20 cases have been reported. Antenatal diagnosis difficulties in umbilical cord tumors are reviewed. Vitelin cyst, angioma, and teratoma represent the most common diagnosis which are histologically and clinically discussed. Associated malformations and complications of umbilical cord angioma are reviewed in the literature.

Diagnosis, Differential↗
PubMed1989

[Malignant peritoneal mesothelioma in a child. Diagnostic difficulties in a locally "non tumoral" form, revealed by cervical lymph node metastasis].

We report the unusual case-history of a ten-year-old girl who presented with enlarged cervical and supraclavicular lymph nodes apparently due to sinus histiocytosis upon initial histological evaluation. However, they were shown to be nodal metastases from an epithelial form of malignant mesothelioma coexpressing keratin, vimentin, and desmin. Exploratory laparotomy disclosed a diffuse "non tumoral" peritoneal mesothelioma. The neoplastic cells were so highly differentiated that analysis of peritoneal fluid pointed to reactive mesothelial hyperplasia. Intensive combination chemotherapy failed to achieve complete remission, but the child's condition was satisfactory after two and a half years follow-up. On the basis of data from the literature, we review the course, immunohistochemical features, and differential diagnosis of malignant peritoneal mesothelioma.

Child↗
PubMed1988

[Isolated tracheoesophageal fistulas. Apropos of 3 cases revealed in the newborn].

We report here on 3 cases of isolated tracheoesophageal fistula. This corresponds to approx. 2.7% of esophageal congenital abnormalities treated in our service. In all 3 cases, diagnosis could be evoked in the neonate in front of respiratory symptoms appearing with feeding. Esophageal contrast radiological studies confirmed in all cases the fistula and its level C7-T1. No other invasive investigation was necessary to the diagnosis. We did not observe associated malformations. Surgical approach was made by a right cervical incision to obtain in good conditions divisions of the fistula and suture of the esophageal and tracheal ends; in one case, a muscular flap was interposed. Followup and longterm results (up to 17 years) were excellent, with one case of regressive recurrent laryngeal nerve paresthesia.

Age Factors↗
PubMed1984

[Retention in flexion of supracondylar fracture of the humerus in children. Comments apropos of the treatment of 120 displaced fractures].

The authors analyse the results obtained in 120 cases of supracondylar fracture of the humerus in children by reduction under general anaesthesia followed by fixation of the elbow in flexion, the wrist being placed close to the neck. The biomechanical basis of this technique is reviewed. It is essential that the posterior periosteum should be intact. Technical details are given together with indications. Seventy out of 120 fractures were reviewed after 2 years. There were 82 p. 100 of good results in grade II fractures. Six out of 24 grade IV fractures showed secondary displacement.

Biomechanical Phenomena↗
PubMed1983

[Diffuse superficial nephroblastomatosis. Chemotherapy. 1 case].

A case of superficial diffuse nephroblastomatosis involving both kidneys in a 14-months old child is reported. Urographic and arteriographic results as well as the still little-known ultrasonographic images made it possible to determine pre-operatively the nature of the tumour and to exclude the initial diagnosis of Wilm's tumour. A relatively non-aggressive chemotherapy resulted in complete involution of the subcapsular tumoral envelope. The close embryogenic and oncogenic relationship between nephroblastoma and nephroblastomatosis is recalled.

Dactinomycin↗
PubMed1983

Cardiac tumors in infancy. Recent aspects.

Intracardiac tumor is rare in the newborn but often responsible for severe cardiorespiratory distress and neonatal death. Diagnosis is made very late and most of them are only recognized after death. We observed 5 cases of intracardiac tumors in newborn, of various etiology and, in the last patients, diagnosis was made very early after birth and even during pregnancy. Echography and especially fetal echocardiography seems to be of great importance in managing this kind of pathology.

Echocardiography↗