[Role of the surgeon in the diagnosis and management of rheumatic diseases].
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Child↗
Biomedical subjects
P Touzet
Publications and source records attributed to P Touzet.
The male sterile G cytoplasm of wild beet displays modified mitochondrial respiratory complexes.
Cytoplasmic male sterility (CMS) in higher plants has been mainly studied in cultivated species. In most cases, pollen abortion is linked to the presence of an additional mitochondrial polypeptide leading to organelle dysfunction in reproductive tissues. In wild beet, both CMS and hermaphrodite plants coexist in natural populations. The G cytoplasm is widely distributed along the Western European coast, and previous genetic studies have demonstrated that this cytoplasm confers male sterility in beet. In the present study, we have identified two mutations of G mitochondrial genes, each of which results in the production of a respiratory chain complex subunit with an altered molecular weight; the NAD9 subunit has a C-terminal extension while the COX2 subunit has a truncated C-terminus. NADH dehydrogenase activity was unchanged in leaves, but cytochrome c oxidase activity was reduced by 50%. Moreover, Western blot analyses revealed that alternative oxidase was more abundant in male sterile G plants than in a fertile control (Nv), suggesting that this alternative pathway might compensate for the cytochrome c oxidase deficiency. Implications of respiratory chain changes and a putative link with CMS are discussed.
Amino Acid Sequence↗
[Pott's disease paraplegia in children. Mechanics and therapeutic strategies. Six cases].
PURPOSE: We report a series of 6 Pott's disease paraplegias treated between 1982 and 1996. MATERIALS AND METHOD: Out of 15 children suffering from Pott's disease, 6 had paraplegia. Treatment consisted of anterior medullar decompression and anterior spine fusion with bone grafting. Two or three weeks later, posterior spine fusion was achieved systematically using a CD fixation device in 3 cases. RESULTS: Neurological signs completely disappeared in 5 children. Vertebral fusion was correct in all patients and kyphosis was less than 50 degrees. DISCUSSION: The posterior approach to the spine must be proscribed as a first step, except for spine dislocation. The anterior approach allowed us to drain the abscess, to correct the kyphosis, and to perform an anterior spine fusion. The posterior spine fusion was performed a few weeks later in order to avoid kyphosis aggravation. CONCLUSION: Prognosis of Pott's disease is good but at the present time, paraplegia remains too frequent. Adapted treatment must be performed without delay.
Age Factors↗
[Pyogenic sacroiliitis in children. Apropos of 11 cases].
PURPOSE OF THE STUDY: Sacroiliitis in children is a rare disease. Since 1878, only 100 cases have been reported in the international literature. MATERIALS AND METHODS: We reviewed a series of 11 cases (mean age of 7.75 years) with a delay of 45 months. All the patients had limp, and hip pain. RESULTS: The clinical examination found each time F.A.B.E.R.E. and Glaensen signs. The hip mobility was limited most of time. There was a non specific inflammatory syndrome. Roentgenogram signs were delayed, and associated widening of the joint, geodes, condensation, and at an ultimate stage, fusion of the joint. Tc 99m scintigraphy always showed the localisation. DISCUSSION: This examination shortened the diagnosis delay, C-T scan was performed twice. It allowed visualize the local extension and complication such as abscess. It facilitated the indication of the surgical approach, and results can be appreciated through follow up CT scan studies. The germ was rarely determined as it has been reported in the literature. Therefore an articular ponction must be performed each time a sacroiliitis is suspected, under general anesthesia and associated to an arthrography or under CT scan control. Surgical drains were placed five times only. The authors limited their indication to an important collection, an abscess, or an intra-articular sequestra. CONCLUSION: At the maximum follow up (mean 45 months) all patients had a normal clinical exam. Each time there were joint modification on the roentgenogramm but without any functional correlation.
Adolescent↗
[A method of cost evaluation of orthopedic treatment of femoral diaphyseal fractures in school-age children].
PURPOSE OF THE STUDY: Femoral diaphysis fractures are very frequent in children. The objective of this study was to evaluate the cost of orthopaedic treatment for femoral diaphysis fracture in school's age children. MATERIAL AND METHODS: 50 femoral fractures were reviewed at an average of 5 years follow-up with many economic parameters. DISCUSSION: Different treatments are available for this type of fracture. Actually, there is a controversy between orthopaedic and surgical treatment and no one gives better long term results. Therefore economic reasons can help for the choice of the method when the final result is equivalent. The same study should be realized for other available fracture treatments. CONCLUSION: Future studies should use the same methodology in order to obtain the real cost of each treatment.
Adolescent↗
Amino acid analysis of proteins separated by two-dimensional electrophoresis in maize: isoform detection and function identification.
The possibility of using experimentally determined amino acid composition to assess relatedness between 75 proteins separated by two-dimensional electrophoresis (2-DE) and to identify them was tested on maize. Two independent parameters, the relative Euclidean distance and the correlation coefficient between the amino acid compositions, were evaluated and used. Previous sequence information for 31 out of the 75 proteins made it possible to evaluate the method for the detection of isoforms and for identification. However, the extension of the interrogation beyond maize to all plant sequences raised the problem of false positives that could nevertheless be limited by replications and by using additional information. The efficiency of the method to assess relatedness between proteins should make amino acid composition analysis a valuable tool in large protein characterization programs based on 2-DE, by facilitating the transfer of information from one well-documented organ/tissue or genotype to another.
Amino Acids↗
[Brucellosis of the pubic symphysis. Apropos of a case. Review of the literature].
The authors report a case of symphysis pubis osteomyelitis due to Brucella. Such localisation seems not to have been reported before. Despite an initially bad observance of antibiotic treatment, evolution has finally been favourable. At two year follow-up, no functional or radiological sequellae was observed.
Adult↗
[Total hip prosthesis for chronic juvenile arthritis. A review of a series of 34 prosthesis].
PURPOSE OF THE STUDY: The purpose of this study was to analyse the results of total hip arthroplasty for chronic juvenile arthritis in order to evaluate risks, problems and benefits of this procedure. MATERIAL AND METHODS: Between 1984 and 1992, 34 total hip prostheses were implanted for chronic juvenile arthritis in 20 patients. Most prosthesis were Zweymuller cementless prosthesis. Mean follow up was 5 years. RESULTS: Results were good. In 85 per cent of cases, patients had a normal activity recovery. Pain relief was very good since in 80 per cent cases patients had a total indolence. DISCUSSION: Beyond these good clinical results at this mean follow-up, the main interest of this study is to characterize two different periods in the surgical technique. The first period when cemented prosthesis was employed and the second one when cementless femoral implants with screwed acetabular component were used. Cementless prostheses appear to be a satisfying solution in this disease, preserving bones and showing very good radiological and functional results. CONCLUSION: Furthermore, the very low complication rate despite general discomfort may prompt us to use total hip arthroplasty for the treatment of chronic juvenile arthritis.
Adolescent↗
Characterizing allelic proteins for genome mapping in maize.
Mapping cDNA probes in order to construct genetic linkage maps is becoming a widespread strategy for genome analysis and gene isolation, particularly in cultivated plant species. Nevertheless, almost all cDNAs reveal two or more unlinked loci, making it difficult to identify the gene(s) actually expressed. In a highly polymorphic species, such as maize, two-dimensional polyacrylamide gel electrophoresis (2-D PAGE) of proteins may circumvent this limitation. With the analysis of various segregating populations, we previously showed that the apparent position shifts of proteins on the 2-D gels are monogenic and codominant. In this paper we compared allelic proteins on the basis of their high performance liquid chromatography (HPLC) profile and partial amino acid sequences. In a sample of 20 position shifts, the allelic proteins appeared to be similar in all but one case, strongly suggesting that polymorphism of structural genes is involved. Thus 2-D PAGE could prove to be a useful tool for genome mapping: when a cDNA probe detects several loci, a position shift of the encoded protein will allow the identification of the gene translated in the organ considered.
Alleles↗
Chronic septic arthritis and osteomyelitis in a prosthetic knee joint due to Clostridium difficile.
A case of chronic septic arthritis and osteomyelitis in a prosthetic knee joint due to Clostridium difficile is reported. A knee prosthesis was installed in a 16-year-old boy for surgical treatment of an osteosarcoma of the femur. Later, the patient suffered a traumatic closed fracture of his patella, and a sterile fluid was aspirated. One month later, the joint displayed inflammation. Culture of the articular fluid yielded a nontoxigenic Clostridium difficile strain. Despite several attempts using conservative medical treatment with penicillins and ornidazole, Clostridium difficile strains with the same antibiotic susceptibility pattern were repeatedly isolated from the joint over an eight-month period. The foreign material was then ablated, and finally, the patient's leg was amputated one year after Clostridium difficile was first isolated. The possible sources of contamination in our case and other reported cases of extraintestinal infection due to Clostridium difficile are discussed.
Adolescent↗
Osteoarticular infection due to Coxiella burnetii in children.
We report three cases of chronic osteoarticular infections associated with Q fever in children. In two of them, serologic diagnosis was confirmed by direct immunofluorescence of Coxiella burnetii in the synovial and bone biopsy specimen. We suspect that bone infections due to Coxiella burnetii could be underdiagnosed because this etiology is not frequently seen.
Abscess↗
[Essential bone cysts in children. Value of systematic cystography. Apropos of a series of 42 cysts].
INTRODUCTION: The treatment of children's essential bone cysts, is controversial. Intra focal injection of a corticoid, the Methylprednisolone, described by Scaglietti in 1974, given in most of the case serials, a rate of healing of more than 30 per cent. MATERIAL AND METHODS: The case serial we present include 42 essential bone cysts treated between 1975 and 1992 in the orthopaedic department of Necker Enfants Malades hospital. These children have been reviewed with a mean follow up of 4 years. A healing rate over 35 per cent has been noticed. However, some failures stayed completely an understanding even if nothing at the beginning let suppose a slower evolution. RESULTS: Attempting to explain those phenomenes, the authors realised in 70 per cent cases, an opaque cystography, before the Methylprednisolone injection. This simple radiological technique permitted to reveal abnormal aspect in 75 per cent cases. Most of the time, it shows massive-veinous licks in an abnormal veinous system or one or plurial separations of the cystic area. This type of picture could perfectly explain the defect of the corticoids action by a lick of the solution or by a partial unefficacity of the solution because of the separation in the cyst area. The hypothetic idea has been completed by the calcul of the duration of the evolution. Effectively, the cysts showing an abnormal cystography had a longer healing delay compared to the cyst whose cystography was normal. CONCLUSION: The opaque cystography is for us a necessary element in the treatment of essential bones cysts, once the diagnostic is certain and the indication of intra focal corticoid injection has been retained. The radiographic study of the cyst area permits to precise the treatment; for example multiplying the injections in the areas of the cysts when there is separations and overseing the evolution.
Adolescent↗
[Value of pelvic osteotomy in the management of the hip in children with cerebral palsy].
PURPOSE OF THE STUDY: The authors analyzed the effectiveness of pelvic osteotomy for the treatment of hip dislocation or subluxation in CP children. MATERIAL: Fifteen pelvic osteotomies were performed on 11 children aged 30 months to 12 years (mean age 6 years). Seven children suffered from Little's disease. Follow-up averaged 10 years (from 2 to 16). Six children were reviewed at the end of growth (9 cases). METHODS: A Salter or triple osteotomy with adductor release was performed. Four cases had also a proximal femoral osteotomy. RESULTS: Following surgery, the mean Reimers' percentage decreased from 55 to 0 per cent. Correction was perfect in 11 cases, incomplete in 4 but excentration remained under 20 per cent. At the end of growth, 6 out of 9 hips remained stable without any further surgery, 2 hips developed slight excentration (less than 20 per cent) and one recurrent subluxation was treated by proximal femoral osteotomy. Six hips remained stable but their growth was not ended at last review. DISCUSSION: This surgical procedure is compared to others described in literature. Pelvic osteotomy with tenotomy improves acetabular cover and corrects muscle imbalance. Its risks seem overestimated in the literature. Both pelvic and femoral osteotomies are useful in specific cases. CONCLUSION: Triple or Salter osteotomy with adducter release seems to be a useful procedure to restore good hip morphology at the end of growth. No posterior dislocations following this osteotomy were seen in spite of the important correction. Proximal femoral osteotomy is not always necessary.
Cerebral Palsy↗
[Role of surgery in the treatment of juvenile chronic arthritis].
The orthopaedic surgeon intervenes in the diagnosis by performing open surgical or arthroscopic biopsies, which entail the main risk of joint stiffening; to treat the disease locally at the inflammatory stage either by synoviorthesis or by tenosynovectomy or open or arthroscopic synovectomy; in case of sequela, when the orthopaedic surgeon may propose surgery aiming to recuperate function of the limbs or the spine. Such surgery includes soft tissue (tenocapsulotomy), osteotomy, arthrodesis, and prosthetic arthroplasty. At the spine, we are faced with three problems: cervical instability, spinal fractures and scolioses. Only teams experienced in heavy paediatric orthopaedic surgery of this type should attempt surgery in chronic inflammatory rheumatism.
Anesthesia↗
[Foot deformities in longitudinal ectromelia of the lower limbs].
We have studied 204 feet in 181 children with congenital limb shortening. There were 17 short femurs in 11 children in whom it was impossible to lengthen the leg. Thirteen feet were abnormal. It was necessary to adapt the foot to fit the chosen prosthesis. In 34 children it was possible to correct the length of the short femur. In 21 the feet were normal. 13 had abnormal feet associated with fibular aplasia and deformities included equinovalgus, hind foot synostosis, and deficient rays. In 72 children with congenital hypoplasia or aplasia of the fibula, 76 feet were affected. The function of the foot depends on attaining a stable position beneath the tibia. In 34 children (35 feet), the feet were in a stable position. There were 22 ball and socket ankle joints. Before carrying out leg lengthening, operation was necessary on 9 feet, and a further 13 required operation after lengthening had been carried out. In 34 children (41 feet) there was fibular aplasia. The feet lay in equinovalgus and were often narrow. Only 5 did not have a degree of synostosis. Twenty-three feet in twenty two children were operated on with early soft tissue release, tendon transfer and tibiotalar arthrodesis. This is our treatment of choice. Twenty-seven children had tibial dysplasia which affected 37 feet. The feet lay in equinovarus and in 5 there was partial diplopodia. In the absence of a tibia (19 feet) disarticulation of the knee was carried out. In 12 there was proximal shortening of the tibia which in 9 cases was treated by tibiofibular union. It was possible to retain only 2 feet in a proper position in a lengthened leg. In 30 children (33 feet) both fibular and tibial hypoplasia was present. The feet functioned well. There were 22 ball and socket ankles, 28 narrow feet and numerous synostoses. In limbs with atypical dysplasia 7 abnormal feet were noted. If it is possible to preserve or lengthen the limb it is vital that the foot is retained in a stable position beneath the tibia in order that satisfactory function be obtained. If limb lengthening is impossible, the foot must be adapted to match the prosthesis.
Adolescent↗
Desepiphysiodesis--elimination of partial premature epiphyseal closure. Experience of 17 cases.
Between 1975 and 1990, 17 growth plates have been operated on by epiphyseal bridge resection. The children were from 4 years and 10 months to 13 years and 10 months old. The etiology of partial closure was traumatic (10 times), caused by therapeutic mistakes (3 times), septic osteomyelitis (1 case), purpura fulminans (1 case), unknown (2 cases). There was always length discrepancy or deformity of bone. The regions that have been subjected to treatment were distal femur, proximal tibia, distal tibia, distal radius. Evaluation of the bone bridge was made by tomoscintigraphies and recently by MR imaging and computed tomoscintigraphy. The bone bridge size was from 2.5% to 60% of the growth plate surface; surgical technique consists of resection of bone bridge connecting epiphysis and metaphysis which is replaced by methyl metacrylate. In 16 cases simultaneous corrective osteotomy was performed. Results are poor, there were only two good results and 8 failures; seven results were medium. The failures can all be explained by mistakes in technique or indication, except one. Indications are post-traumatic narrow bridges in young children. It would be useful to know the vitality of the residual growth plate.
Adolescent↗
[Treatment of malignant bone tumors in children: osteosarcoma and Ewing's sarcoma].
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Adult↗
Osteochondritis dissecans of the humeral capitellum in children.
We studied 13 cases of osteochondritis dissecans of capitellum humeri in 12 children, 11 boys and 1 girl, aged between 10 and 15 years. We distinguished this affection from Panner's disease which affects young children and resembles Legg-Perthes-Calvé disease of the hip. Operative treatment was performed in 7 out of 13 elbows for removal of loose bodies or excision of osteochondritis in situ with cartilage damage. In other cases, functional treatment was carried out. At long-term follow-up, ranging from 2 to 13 years, clinical examination demonstrated satisfactory results in 9 cases; in 3 cases limitation of movement was related to fracture of the radial head or to delay in operative treatment for too long. Roentgenographically, changes related to growth disturbance were constantly observed; they involved the radial head, the olecranon, the trochlea and the proximal end of the ulna.
Adolescent↗