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P Scemama

Publications and source records attributed to P Scemama.

7 recordsLinked to original sources
PubMed2001

[Epiphyseal distal torsion of the femur in osteoarthritic knees. A computed tomography study of 75 knees with medial arthrosis].

PURPOSE OF THE STUDY: We used computed tomography (CT) to measure external torsion of the distal femur preoperatively in patients with osteoarthritic knees presenting genu varum in order to assess the correlation between femoral distal external torsion (FDET) and radiological or epidemiological data obtained during the general preoperative work-up. MATERIAL AND METHODS: Seventy-five knees were studied in 38 patients. Mean age was 70.4 years; there were 13 men and 25 women. The degree of external torsion of the distal femur was defined as the angle measured on the CT-scan between a line drawn tangent to the most posterior part of the condyles and the epidondylar line drawn from the lateral epicondyle to the most prominent point of the medial epicondyle. This angle was compared with the angle of the epiphyseal tibial varum measured on the anteroposterior radiograph and the overall deviation of the lower limb (HKA), and with the angle between the mechanical axis and the femoral shaft axis (HKS). We assessed the effect of gender and sex and looked for correlations between the FDET angle and measurements made on standard radiographs. Student's t test was used compare the FDET angle by sex and side. The alpha risk was set at 5%. RESULTS: The FDET angle measured a mean 5.36 +/- 1.87 degrees (0-9 degrees ). We did not find any correlation between the FDET angle and tibial epiphyseal varum or HKS angles. A weak statistical correlation between the FDET and the HKA angles had no clinical value. Finally, the FDET angle was not correlated with sex or side. DISCUSSION: Computed tomography provides reliable and reproducible measurements. Our work clearly demonstrated the wide interindividual variability of the FDET angle. We were unable to identify any measurement on standard radiographs allowing an indirect prediction of the FDET angle. CONCLUSION: Our findings suggest that measuring the FDET angle on preoperative CT-scans in candidates for total hip arthroplasty can be useful for adapting the angle of rotation for the femoral component to each patient.

Adult↗
PubMed1999

[Ipsilateral hip and femoral shaft fractures: components of therapeutic choice].

PURPOSE OF STUDY: Ten cases of ipsilateral hip and femoral shaft fractures were reviewed. MATERIAL AND METHODS: All patients were treated operatively for both fractures between 1988 and 1997 in Pitié Hospital. Five were treated with antegrade reamed intramedullary nails and cancellous screw fixation of the femoral neck, and 5 by long Gamma nail. The shaft fractures were fixed prior to definitive neck stabilization. RESULTS: Ipsilateral hip and femoral shaft fractures accounts for 5.6 p. 100 of the whole femoral shaft fractures registered in the same period. All cases occurred in young adults and resulted from high-energy impaction injuries. There were numerous associated injuries and all patients were polytrauma. The hip fracture was initially overlooked in 1 case without subsequent nonunion or avascular necrosis. At a mean follow-up examination of 22 months, two-thirds had a good result and one-third a fair or a poor result. Nonunion of the femoral neck occurred in one patient as a result of initial displacement and subsequent malreduction, while all shaft fractures united. DISCUSSION: X-ray films of the hip should be done in all cases of femoral shaft fracture in order to decrease the high incidence of missed femoral neck fractures in ipsilateral injuries of the femur. The results indicate that patients with ipsilateral fractures of the femoral neck and shaft can obtain good results when rigid anatomic stabilization of the femoral neck is performed. The femoral shaft fracture is given first priority and is reduced and immobilized with antegrade closed intramedullary nailing. The femoral neck fracture is then treated with cancellous screw fixation or compression screw with long Gamma nail. CONCLUSION: The authors recommend the use of a long Gamma nail to fix this dual fracture whenever possible.

Adolescent↗
PubMed1987

[Prognostic value of hemodynamic results in the acute phase of myocardial infarction].

The prognostic value of right cardiac catheterization in the acute phase of myocardial infarction is presently well established. The objective of this study is to determine the best discriminating threshold of the pulmonary capillary pressure (PCP) on the one hand and the cardiac index on the other hand. 96 patients presenting an acute myocardial infarction were entered in the study. Six thresholds for each parameter were studied. The following results were obtained: there are important clinical and hemodynamic discrepancies, especially for severe cases. The cardiac index (CI) has a better prognostic value than the pulmonary capillary pressure. The threshold greater than 18 mmHg for PCP and less than 2.2 l/min for the cardiac index, proves to be the most discriminating (better sensitivity with better specificity: sensitivity 60 p. cent with specificity at 81 p. cent for PCP; sensitivity at 73 p. cent with specificity at 78 p. cent for CI). A combined analysis of the two parameters, associated to their best discriminating threshold enables to identify a class of high-risk patients presenting approximately an 80 p. cent mortality in a hospital environment. In spite of the development of non-invasive methods to evaluate the prognosis in the acute phase of myocardial infarction, the hemodynamic exploration remains the leading method for its evaluation.

Aged↗
PubMed1984

Abnormal properties of skin fibroblasts from patients with breast cancer.

The growth properties of fibroblasts from the thoracic skin of patients with mammary cancers were compared to those of fibroblastic cultures from patients with benign lesions or having undergone surgery for non-neoplastic diseases. As expected, an inverse correlation was found between the doubling potential of fibroblasts in vitro and the donor's age for cells from patients with benign lesions; however no correlation, was found with cultures from cancer patients. Moreover, the latter group responded in an abnormal way to three biological parameters: anchorage dependence, colony formation on monolayers of normal human epithelial cells and saturation densities in overcrowded culture conditions. Skin fibroblasts from one patient with a benign lesion, whose mother had developed a breast cancer, displayed all the abnormal growth properties. Periodic controls of this patient resulted in the early detection of a carcinoma 3 years after the first operation for a benign microcystic lesion. Finally, we found that multiple subcultivations in overcrowded culture conditions cause the selection of a fibroblastic cell subset with greater growth potential which, in the cell strain tested, could invade foreign tissue in vitro.

Adult↗