[Kinematics of the pelvic girdle and the thoracic and lumbar segments in the course of the lateral inclinations and rotations of the spine]

Physiological displacements of the trunk are the addition of these of the pelvic girdle and thoracic and lumbar spine segments. For a long time (3), this conjunction had been noticed but without numbered precisions. The purpose of this communication is to appreciate quantitatively, from a series of 16 subjects, the respective share of each components during lateral bending movements in the frontal plan and movements of rotation in the transverse plan. It results from this work that the pelvic girdle presents as reduced amplitude (4 degrees) in lateral bending on the other hand, displacement predominate to the level of thoracic spine (50 degrees). In rotation pelvic displacements are very important (30 degrees), while the spine so thoracic that lumbar has a weak participation (inferior to 5 degrees). Moderated abduction of hips increases by significant manner the motility of the pelvic girdle.

The triangular test to assess the efficacy of metoclopramide in gastroesophageal reflux

BACKGROUND

Sequential methods are particularly interesting when recruitment is difficult because they may allow a study to be stopped early while maintaining type I and II error rates.

METHODS

This placebo-controlled, randomized double-blind study was aimed at assessing the efficacy of metoclopramide (0.2 mg/kg three times daily during 14 days) on gastroesophageal reflux in infancy. The main end point was the relative variation of the percentage of time at pH < 4 between inclusion (day 0) and evaluation (day 14) assessed on two 24-hour esophageal pH recordings. Statistical analysis was performed with use of a sequential method, the triangular test.

RESULTS

The study was stopped after the seventh analysis (39 infants evaluated: 20 placebo and 19 metoclopramide) without showing the expected benefit. Improvement on the main end point was 30% +/- 48% (mean +/- SD). Corresponding unbiased median estimates were 22% for placebo and 39% for metoclopramide (p = 0.28, sequential analysis). On day 14, the percentage of time at pH < 4 was 8.1% +/- 11.7% for placebo and 6.7% +/- 9.2% for metoclopramide (p = 0.68, t test), and the number of reflux episodes > 5 minutes was 3.0 +/- 3.5 for placebo and 1.9 +/- 3.0 for metoclopramide (p = 0.33, t test).

CONCLUSION

If a tendency for a superior improvement with metoclopramide than with placebo was observed on the main end point, it was lower than expected and the difference was not significant. Compared with the corresponding single-stage design, the triangular test allowed to stop the study with a 15% reduction in sample size.

[Post-traumatic pulmonary pseudocysts]

BACKGROUND

Pulmonary pseudocyst is an unusual complication of chest trauma.

CASE REPORT

A 12-year-old boy suffered from a non penetrating chest trauma. Examination was normal except mild hemoptysis. Chest X-rays and tomodensitometry showed several cystic lesions surrounded by areas of pulmonary contusion in the right lower lobe. X-rays performed a few years before the trauma were normal. The cystic lesions progressively disappeared within a few months.

CONCLUSION

This is a new case of post-traumatic pulmonary pseudocyst whose diagnosis may be difficult until spontaneous cure.

A randomized, double-blind, multicentre controlled trial of ibuprofen versus acetaminophen and placebo for symptoms of acute otitis media in children

Two hundred and nineteen children (boys: 56%, girls: 44%) were included in a randomized, double-blind, multicentre (4 centres) controlled trial designed to assess the efficacy and safety of ibuprofen (IBU) in the treatment of 1 to 6 year-old children with otoscopically proven acute otitis media (AOM), either unilateral or bilateral. They randomly received 10 mg/kg IBU (n = 71), or acetaminophen (PARA) (n = 73) or placebo (PLA) (n = 75), orally, tid, for 48 hours. All received oral cefaclor (Alfatil, Lilly, France) for seven days. They were evaluated before (D0) and at the end of treatment (D2). The main criterion of response was the aspect (landmarks and color) of the tympanic membrane assessed on a semi-quantitative scale from 0 to 6. Other criteria, assessed on semi-quantitative scales, included relief of pain (0 or 1), rectal temperature (0 to 2), and overall evaluation by parents of the improvement of quality of life on three items: appetite (0 to 2), sleep (0 to 2), and playing activity (0 to 2). The results at D2 were as follows: there was no significant difference between treatment groups as to the main criterion, but only a trend for IBU and PARA to do better than PLA but not for IBU to do better than PARA. From these data there is no argument to emphasize the utility of non-steroidal anti-inflammatory drugs (NSAIDs) in treating the inflammatory signs of the tympanic membrane in otitis. There was a statistically significant difference between treatment groups at D2 for pain, IBU being superior to PLA (P < 0.01): 7%, 10% and 25% of the children were still suffering at D2 in the IBU, PARA and PLA treatment groups, respectively. The difference between PARA and PLA for pain was not statistically significant. There was no significant difference between treatment groups for the other criteria. All treatments were well and equally tolerated. Although no significant difference was found between the treatment groups on the aspect of the tympanic membrane, the efficacy of IBU was evidenced on the relief of pain, the symptom that most disturbs the child.

[Comparative study of static curves of the human spine in vivo during exercise and stretching in men and women]

Comparative study of static curves of the thoracic and lumbar spine in men and women has been realized under constraints of compression by weightlifting and elongation by exercise to parallel bars. In two athletic practices, curves decrease their arrow, ending to a straighter and more rigid column. This behavior expresses muscular actions. The greatest amplitude of displacement, observed in female series, shows lesser muscular forces in connection with a poor practice of exercises of body building.

[Nursing staff and volunteers in a geriatric institution: how do they collaborate?]

Nursing staff and voluntaries in hospital have relationships which reflect the idea they have of their own place in the system. The professionnal identity is particularly at stake especially for nurses. It is built up from everyone's values and logic. Should the outside and inside perceptions be contradiction then the relationship is strained. The sharing of care among a vast number of actors creates a parcelling and makes the situation complicated. Therefore, coordination and collaboration are necessary. Because of their position called "marginal-sécant", some actors are able to articulate better those different logics. Through the description of a voluntary body in a geriatric hospital, actors' points of view are analysed by means of interviews or questionnaires. Those elements enable us to understand the way the voluntary help is developing. This concept is a current topic in society and in hospitals.

A method for the evaluation of tensile properties of skin equivalents

In vitro production of anchored skin equivalent is a new therapeutical option for burn patients. A skin equivalent is a combined culture of dermal and epidermal layers. The dermal layer provides important mechanical properties, such as tensile resistance and nonlinear elasticity, to the skin equivalent during its development. Prior to any in vivo human transplantation, the tensile properties of cutaneous equivalents have to be evaluated as a function of its structural components, in view of establishing the culture conditions leading to the best mechanical resistance and stretchability characteristics. However, the handling and clamping of skin equivalents are frequent causes of tearing and lack of repeatability in the measuring of tensile properties. A new indentation method involving a specially designed culture dish has been developed to minimize the risk of damage. Using this new culture dish, cutaneous equivalents were installed on an indentation apparatus. The central loading of a spherical tip was transmitted to the central area of a circular anchored cutaneous equivalent and was recorded with tip position. The tests were achieved at a constant low deflection rate of the tip. This new and accurate method gave repeatability in three central load-deflection characteristics of anchored dermal equivalent: the high-modulus (0.15 g mm-1), the central load of rupture (1.49 g), the rupture deflection (0.470 mm). This indentation test is expected to be an efficient tool in the evaluation of various skin equivalent models tensile properties.

Preliminary study of the human lumbar spine using speckle technique. Limits of compression, shear and torsion. Speckle photography--electronic speckle pattern interferometry

Optical techniques using single wavelength lasers allow precise study of the superficial displacements of deeper anatomical structures through direct mechanical pull. Two techniques have been used in this study: 1. Double exposure speckle photography. Since 1980 the relationship between the surface displacements and minimal traction applied to the transverse processes of the spine, either unilateral or bilateral, was studied in an attempt to simulate muscular action exerted at this level. 2. Computerised speckle interferometry. This allowed analysis of the deformations between the lumbar vertebrae under vertical compression, shear or torsion outside the usual anatomical planes. This preliminary study outlines the mechanical behaviour and the plasticity of the vertebral structures but has been performed on only a few anatomical specimens thus not allowing statistical analysis. This would require a larger series.

A model of the human lumbar vertebral column: a preliminary study

Finite element modelling of the human lumbar vertebral column employs data-processing procedures for study of the linear and nonlinear elasticity of materials such as are currently used in mechanics or in civil engineering. Thanks to developments in computer science, requiring a close collaboration between doctors and engineers, we put forward in this preliminary study a linear computerised model of the lumbar column comprising 4824 meshes and 6813 nodes. By reducing the simplificatory hypotheses and integrating new parameters, this model as developed is capable of important clinical applications in surgery and ergonomics.

[The intervertebral disk. Attempt at a "finite element" model]

Intervertebral disk composite model is unsatisfactory definite in biomechanical behaviour despite multiples technics used. Using histologic and histoenzymology it's possible to determinate proportions of collagen fibers in the different parts of the disk. A trustworthy finite element 3D model is proposed and tried by real experiments.

Deletions of both alpha 5(IV) and alpha 6(IV) collagen genes in Alport syndrome and in Alport syndrome associated with smooth muscle tumours

Diffuse oesophageal leiomyomatosis (DL), an inherited smooth muscle proliferation process, has been reported to be associated with Alport syndrome (AS), a familial nephropathy, mainly dominant X-linked inherited, and characterized by ultrastructural changes of the glomerular basement membrane. The COL4A5 gene, encoding the alpha 5 chain of type IV collagen, has been identified as the site of mutations in families with X-linked AS. Recently, a novel alpha 6(IV) collagen chain encoding gene has been mapped closely upstream of COL4A5, and disruption of the 5' end of both genes has been reported in four patients with DL and AS (DL-AS). Here, we report a long-range restriction map around the COL4A6 locus, and show that the COL4A5/COL4A6 deletion observed in seven patients with DL-AS encompasses only the two first exons of COL4A6, with a breakpoint located in the second intron of COL4A6, whose size exceeds 65 kb. Furthermore, we demonstrate that three patients with AS without DL, known to have a deletion of the 5' part of the COL4A5 gene, display a larger deletion in COL4A6. Moreover, a COL4A6 mRNA product was detected by reverse-transcription-polymerase chain reaction in an oesophageal tumour sample of a patient with DL-AS. These results suggest that DL-AS could be caused by an abnormal truncated alpha 6(IV) chain.

Preliminary opto-electronic study on vertebral movement

Opto-electronic systems utilising measurement of displacement of skin markers allows study of movement in the living subject. The authors have used this method in a kinematic study of the thoracic and lumbar spine measuring the displacement of skin markers placed over the spinous processes. It was possible to approach the physiological state of these complex movements once the apparatus had been calibrated to the correct level, and the error margins minimised. Repeated measurements confirmed the reliability of this method even if movement of the skin with respect to the bony reference points introduced some margin of error. Three dimensional displacement of the vertebrae were measured during voluntary movements of the spine demonstrating the complex geometry. Since opto-electronics are non-invasive they constitute an important advance in the study of the kinematics of the spine.

[Anatomic bases of groin strain]

It was attempted to identify the anatomical bases of the syndrome frequently encountered in sportsmen and women and commonly known under the all-encompassing term of "groin strain". The continuity of fasciae and the intersection of the insertion tendinous fibers of the abdominal and thigh muscles in the pre-pubic region binds the muscle elements firmly together and helps to understand why the disorder occurs and how to treat it. In contrast, the articular portion made up of the symphysis pubis, which is greatly exerted both during movement and at rest, has early signs of ageing making articular strain much more difficult to treat.

[The capsulo-synovial folds of the intercondylar fossa of the human knee]

The study of the capsular insertions of the synovial membrane in the intercondylar fossa of the knee yielded information on the much debated anatomy of this area. In the cranial region, the insertions are found on the axial surface of each condyle, strengthening the dorsal attachment of the cruciate ligaments but remaining separate from these structures. In contrast, more caudalward, the cruciate ligaments, which are partly bordered by synovial lods recesses, are embedded in the posterior adipose mass and distinct from the bridging passage at a distance from the capsula.

[Reliability of cutaneous markers in kinetic studies of the human thoracic and lumbar spine]

The use of cutaneous markers as an accurate method of measuring spine motion was studied in five cadaveric spine samples and two live subjects. The markers were placed on the skin over the spinous processes, a particularly suitable site in thin subjects for determining the displacement of the underlying skeletal segments because the deep layer of the skin is in adherence with their fibrous surrounding sheath. Fairly close correlations were obtained in the sagittal and frontal planes between the two sets of measurements. However in the transversal plane the technique is unreliable because of tightening of the skin.

The anatomical basis for ultrasonography of the lateral pterygoid muscle and the infratemporal fossa

The infratemporal fossa and its contents (particularly the pterygoid muscles) is a region difficult to explore, in spite of its importance in odontostomatological pathology. In order to reduce the indications that justify examination by computed tomography and magnetic resonance imaging, for reasons of economy of health, the authors describe by application of orientated anatomical slices the way in which ultrasonography can be performed. Only the posterior approach between the mandible laterally and the mastoid process medially provided consistently adequate exploration of the infratemporal fossa and the pterygoid muscles.

[Critical view of methods for studying the motion of the thoracic and lumbar spine in man]

The study on motion of human thoracic and lumbar spine is difficult. To examine this point, technology will be divided in six class and each of them being benefits and disadvantages. Owing to ethics, authors agree with skin tapes allowing to know imperfectly freeness of motion without risks.

Dose-response study of metoclopramide in gastroesophageal reflux in infancy

Twenty-four infants, 1 to 18 months-old, who were referred to four centers for suspected gastroesophageal reflux and whose esophageal pH after a standard formula meal given at 9 to 10 am (Ho-day 1) fulfilled the criterion of being < 4 for more than 5% of the time between H1 and H6, entered a double-blind placebo-controlled dose-response trial of metoclopramide (M). Twenty-four hours later (day 2), patients were randomly assigned to receive either placebo or a single 0.1, 0.2, or 0.4 mg/kg dose of metoclopramide, 30 min before the formula meal (n = 6/group) and the procedure was repeated. Metoclopramide plasma concentration was measured 1 h after dosing (C1h). On day 1, the time during which the esophageal pH was < 4 (time pH < 4), and five other parameters, were not significantly different in the treatment groups. On day 2, time pH < 4 (m(SD)) decreased from 33(13) to 30(33), 39(27), to 36(47), 42(15) to 18(13) and 48(25) to 31(46) min in the placebo, 0.1, 0.2, and 0.4 mg/kg metoclopramide groups, respectively. Possibly due to the large interindividual variability, no significant differences in parameters were observed between the different groups. None of the parameters correlated with the metoclopramide dose. Time pH < 4 expressed as the difference between day 1 and day 2, relative to day 1, decreased significantly as a function of C1h. No side effects were observed. A similar study should be performed after repeated dosing regimen.