[Diplopia after peridural and intradural infiltrations of prednisolone. 2 cases].
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Biomedical subjects
Publications and source records attributed to P Flory.
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Reactive arthritis induced by Strongyloides is exceedingly rare. A case in a 53-year-old man from the Guadeloupe (French Antilles) is reported. The outcome was rapidly favorable under thiabendazole therapy. The cycle of Strongyloides is reviewed, and the contribution of parasites to reactive arthritis in patients with genetic risk factors is discussed. Establishing the correct diagnosis is sometimes difficult but is essential in order to avoid inappropriate administration of corticosteroids that can lead to fatal, multivisceral dissemination of the parasite, particularly in patients with strongyloidiasis.
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Two experiments are reported which investigated the effects of data-driven generation of study items on direct and indirect measures of memory. Previous research in the field of implicit memory has traditionally employed generation procedures at encoding which focused on conceptually driven processing. The present study undertook to device data-driven generation procedures that were predicted to lead to a generation effect on word-stem completion. In Experiment 1 subjects had to generate target items from anagrams and newly developed "assemblograms", requiring mainly data-driven processing, as well as from semantic cues and definitions, involving mainly conceptually driven processing. Effects of these generate conditions were compared to the usual name condition on a direct word-stem cued recall test, and on an indirect word-stem completion test. Differences between data-driven generation on the stem completion task and the name condition failed to reach significant differences in retention. In Experiment 2 subjects generated targets from assemblograms and from semantic cues. The data revealed the predicted occurrence of a generation effect on an indirect memory test following data-driven generation. The finding of a generation effect in an indirect as opposed to a direct memory test was seen as support for the view that generating a study item may enhance data-driven as well as conceptually driven processing, depending on the processing demands made by generation procedures. The results were interpreted within the transfer-appropriate processing framework, with additional reference to Glisky and Rabinowitz's two-component account of generation effects (Glisky & Rabinowitz, 1985).
We have evaluated the level of state and trait anxiety, neuroticism, extroversion and coping style as predictors of the effectiveness of patient-controlled analgesia (PCA) in 110 patients undergoing total abdominal hysterectomy. After operation patients were allocated to receive pain control with either PCA or i.m. injections (IMI). Pain was assessed using the short form McGill pain questionnaire at 6, 18 and 24 h after operation, and by recording the amount of analgesic consumed in the first 24 h after surgery. Both state anxiety and coping style were significant predictors of postoperative pain, irrespective of the method of analgesia used. Patients using PCA experienced significantly better pain control than those receiving IMI. However, it was those with high levels of state anxiety who experienced the greatest reduction in pain with PCA. In addition to achieving better pain control, patients who received PCA used significantly less analgesia and were discharged earlier than patients who received IMI.
We describe an uncommon case of cervical pyomyositis in a 60-year-old woman without predisposing factors, admitted for cervicobrachial neuralgia with fever and paravertebral contracture. Ultrasonography and computed tomography (CT) showed a collection in the left longissimus capitis. Ultrasonography guided needle aspiration yielded thick pus, which cultured Staphylococcus aureus. Our patient completely recovered after antibiotherapy. Pyomyositis is rare and most commonly affects rhizomelic muscles (cervical localization is extremely rare) and occurs in patients with predisposing factors. Staphylococcus aureus is responsible for over 85% of cases; ultrasonography and CT scan are useful for abscess localization and aspiration.
A case of multicentric reticulohistiocytosis is presented with extensive immunohistochemical study of the infiltrate in both paraffin and cryostat sections. Factor XIIIa dermal dendrocyte marker was demonstrated in the cytoplasm of histiocytes, which has not been reported previously in this disease. In addition, the S100 protein stained positive. This immunophenotyping study suggests a dermal dendrocyte lineage with an unusual expression of S100 protein.
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Fourteen autogenous vascularized fibular bone grafts have been performed. The indications for surgery were segmental bone defects 17 cm in length on average, seven times because of radical tumor resection (three malignant, two locally aggressive tumors) and seven times because of primary or secondary bone loss in trauma patients. Two free vascularized fibular grafts were done in the upper extremity, four in the femur and eight in the tibia. The results with a follow-up from one half to seven years show that all extremities could be saved with no recurrence of tumor or infection. All vascularized fibular grafts healed with a good functional result. With stable osteosynthesis (AO-plates and external fixateur) partial weightbearing was possible after three weeks, full weightbearing after 8 to 12 months. For the femur a plate or interlocking nail should be used and for the tibia an external fixateur. Additional cancellous bone grafting should be done in two stages.
Indications for occipital-cervical fusion are destruction by tumor, pathological instability and certain fracture dislocations of this region. For palliative surgery we prefer a combined fusion with tension band wire and bone cement; in curative procedures a well fitting cortical bone graft fixed by a circumferential tension band wiring is used. For occipital anchoring we suggest an epidural course of wires through 2 bore holes, in order to cervically fix a circumferential wire around the posterior arch of the vertebra.
Progress in micro- or macroreplantation has resulted in higher survival rates of formerly amputated parts. Progress has been made as a result of intensive laboratory training and considerable experience due to the popular application of microsurgical techniques. More amputated digits or limbs may survive because the time of ischemia can be exceeded in using cold storage or perfusion. Homo- or heterodigital vessel transposition, expanded indications for vein graft interposition, as well as heterotopic transplantation allow for extremity preservation even in crush injuries, and in disastrous multiple amputations combined with contusion or avulsion. Nowadays, microvascular digital replantation with vessel anastomosis distal to the distal interphalangeal joint in adults is technically feasible. Finger amputations in children are a prime indication for replantation. Maintenance of extremity length is possible in applying external fixation. Emergency free flaps or compound tissue transfer under the "Urgence differée" condition may provide reliable soft tissue coverage. Secondary reconstruction with regard to bone defects, tendon repair, and eventual nerve grafting have to be aspired, finally leading to an improvement of functional results in daily and leisure activities as well as in early professional readaptation.