N Passuti

Hotel Dieu Hospital, Kingston, Ontario, Canada

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Publications (146)232.12 Total impact

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    ABSTRACT: Aseptic loosening as a result of wear debris is considered to be the main cause of long-term implant failure in orthopaedic surgery and improved biomaterials for bearing surfaces decreases significantly the release of micrometric wear particles. Increasingly, in-depth knowledge of osteoimmunology highlights the role of nanoparticles and ions released from some of these new bearing couples, opening up a new era in the comprehension of aseptic loosening. Mouse models have been essential in the progress made in the early comprehension of pathophysiology and in testing new therapeutic agents for particle-induced osteolysis. However, despite this encouraging progress, there is still no valid clinical alternative to revision surgery. The present review provides an update of the most commonly used bearing couples, the current concepts regarding particle-cell interactions and the approaches used to study the biology of periprosthetic osteolysis. It also discusses the contribution and future challenges of mouse models for successful translation of the preclinical progress into clinical applications.
    Clinical Science 09/2014; 127(5):277-93. · 4.86 Impact Factor
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    ABSTRACT: Recent works demonstrated the difference of calcification genesis between carotid and femoral plaques, femoral plaques being more calcified. It has been clearly demonstrated that the molecular triad osteoprotegerin (OPG)/Receptor Activator of NFkB (RANK)/RANK Ligand (RANKL) exerts its activities in the osteoimmunology and vascular system. The aim of this study was to determine their expression and their potential role in calcifications of the atheromatous plaques located in two different peripheral arterial beds, carotid and femoral. The expression of OPG, RANK and RANKL was analyzed by immunochemistry in 40 carotid and femoral samples. Blood OPG and RANKL were quantified using specific ELISA assays. OPG staining was more frequently observed in carotid than in femoral plaques, especially in lipid core. Its expression correlated with macrophage infiltration more abundantly observed in carotid specimens. Surprisingly, serum OPG concentration was significantly lower in carotid population compared to femoral population while RANK and RANKL were equally expressed in both arterial beds. Carotid plaques that are less rich in calcium than femoral specimens, express more frequently OPG, this expression being correlated with the abundance of macrophages in the lesions. These data strengthen the key role played by OPG in the differential calcification in carotid and femoral plaques.
    Cytokine 03/2012; 58(2):300-6. · 2.52 Impact Factor
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    ABSTRACT: BACKGROUND : Ceramic bearing surfaces for THA were introduced to reduce the risk of wear. However, owing to liner fracture in some of the early series and presumption that the fractures were the result of the modulus mismatch of the implant and the bone, a ceramic sandwich liner with lower structural rigidity was introduced. Fractures of these devices also were reported subsequently, although the incidence is unclear and it is unknown whether there are any risk factors associated with the fractures. We therefore determined the incidence of these fractures. We retrospectively reviewed 298 active patients in whom we implanted 353 ceramic-polyethylene sandwich liner acetabular components between November 1999 and February 2008. The mean age of the patients was 53.6 years (range, 17-84 years). The minimum followup was 6 months (mean, 41 months; range, 6-106 months). All patients were assessed clinically and radiographically. Seven of the 353 (2%) ceramic sandwich liners fractured at a mean of 4.3 years (range, 1.3-7.6 years) after surgery without trauma. Neither patient-related factors nor radiographic position of the implants were risk factors for fracture. Owing to the high rate of fractures of the sandwich ceramic polyethylene liners in our patients, we have discontinued use of this device. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 03/2012; 470(6):1705-10. · 2.79 Impact Factor
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    ABSTRACT: The aneurysmal bone cyst is a rare tumor. Its treatment is complex when localized to the lumbar spine, with neurological, mechanical, and tumoral complications. The aim of this study is to describe these tumors, their treatment, and their long-term evolution, as well as to define an appropriate therapeutic strategy. Four of the five cysts had anterior and posterior extension. Three patients had neurological symptoms at diagnosis and two of them presented with pathological fracture. Surgical treatment was performed by intralesional resection. Long-term progress was always favorable, without recurrence or functional limitation. Two patients had a stable, mild spine deformity.
    Journal of pediatric orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America 12/2011; 21(3):269-75. · 0.66 Impact Factor
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    ABSTRACT: The aim of treatment of scolioses is to reduce deformities and restore balance in the spine. In rigid forms of scoliosis, associating anterior release could provide greater frontal and/or sagittal plane correction and improve balance in the spine. This study compared correction and long-term balance on two planes between two homogeneous groups of idiopathic rigid scolioses treated with and without thoracoscopic release. The study included rigid scolioses with less than 35% reducibility and a Cobb angle of more than 60°, who all underwent posterior correction using a rod rotation technique. There were 29 patients, 14 who underwent a one-step procedure (group A) and 15 a two-step procedure (group B), with the subgroups of kyphoscolioses and lordoscolioses determined in each group. Frontal balance, Cobb angle, thoracic kyphosis and the Jackson plumbline were measured on pre- and postoperative X-rays and at the final follow-up. The mean long-term final follow-up was 144 months for group A and 54 months for group B. Frontal plane correction was identical in groups A and B. Frontal balance was preserved in all cases at the final follow-up. Sagittal balance was not modified with or without anterior release. The thoracoscopic release step resulted in an additional correction of 15.5° (23%) of thoracic hyperkyphosis in patients with kyphoscoliosis (P=0.003). Thoracoscopy did not improve short term results in the Cobb angle or frontal or saggital balance. Nevertheless, enhanced correction of thoracic hyperkyphosis was obtained with this procedure. In this study, the association of thoracoscopic anterior release with posterior correction by rod rotation to treat rigid scolioses did not appear to improve results, except for the correction of thoracic hyperkyphosis.
    Orthopaedics & Traumatology Surgery & Research 11/2011; 97(7):734-40. · 1.06 Impact Factor
  • International Journal of Oral and Maxillofacial Surgery - INT J ORAL MAXILLOFAC SURG. 01/2011; 40(10):1095-1095.
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    ABSTRACT: L’ostéolyse périprothétique représente le principal mode d’échec des arthroplasties totales de hanche. L’incidence de l’ostéolyse acétabulaire après implantation d’une cupule Atlas™ est anormalement importante à 13 ans de recul moyen. Notre série rétrospective a regroupé 217 cupules sans ciment élastiques à fente Atlas™ posées consécutivement entre janvier 1993 et juin 1995, revues cliniquement et radiographiquement au recul moyen de 13,1 ans. L’incidence de l’ostéolyse acétabulaire a été de 16 %, principale cause des changements, survenant en moyenne à 8,8 ans. La survie actuarielle globale a été de 76 % à 13,5 ans, et de 81 % lorsque l’événement retenu était une reprise pour ostéolyse périprothétique. L’analyse univariée retrouvait un lien significatif entre l’ostéolyse géodique et une usure importante (p < 0,0001), une activité Devane 4 ou 5 (p = 0,0005), une faible épaisseur de polyéthylène (p = 0,006), et la présence de têtes zircone ou alumine versus les têtes métal (qui étaient de diamètre 22). En analyse multivariée, les seuls facteurs significativement liés à la présence d’ostéolyse étaient une usure importante et une faible épaisseur de polyéthylène (PE) dans le métal-back. Le recul moyen a été estimé suffisant pour juger de l’apparition d’une telle ostéolyse. L’ostéolyse a, malgré son incidence élevée et son apparition précoce dans notre série, été très probablement sous-estimée par l’analyse radiographique. Ces résultats incitent à rechercher, de façon régulière, des géodes de résorption avec ce type d’implant, surtout s’il existe une usure mesurable. L’analyse des explants s’impose pour expliquer un taux anormalement élevé d’échec par ostéolyse à 13 ans de recul. Cette étude a objectivé une survie actuarielle globale insuffisante et un taux d’ostéolyse périprothétique important. L’association entre taux d’usure et ostéolyse périprothétique a été confirmée. La faible épaisseur de PE semble jouer un rôle dans ces ostéolyses par le biais d’une usure anormale, et d’une mauvaise tolérance de l’os à ces débris d’usure avec ces implants. Niveau de preuve Rétrospectif, niveau IV.
    Resuscitation 01/2011; 97(4). · 4.10 Impact Factor
  • Resuscitation 01/2011; 97(7). · 4.10 Impact Factor
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    ABSTRACT: Introduction Le but du traitement des scolioses est de réduire les déformations et de rétablir l’équilibre rachidien. Hypothèses Dans les formes raides, la libération antérieure associée permettrait une réduction plus importante dans le plan frontal et/ou sagittal, avec un bénéfice potentiel pour l’équilibre rachidien. Patients et méthode Cette étude a comparé réduction et équilibre à long terme dans les deux plans entre deux groupes homogènes de scolioses raides idiopathiques avec et sans libération par thoracoscopie. Les scolioses raides, toutes réduites par voie postérieure par rotation de tige, avaient moins de 35 % de réductibilité et un angle de Cobb supérieur à 60°. L’étude comprenait 29 patients, 14 opérés en un temps (groupe A) et 15 opérés en deux temps (groupe B), avec séparation entre cyphoscolioses et lordoscolioses. L’équilibre frontal, l’angle de Cobb, la cyphose thoracique et l’aplomb de Jackson ont été mesurés sur des clichés pré- et postopératoires et au plus long recul. Résultats À long terme, les reculs moyens étaient de 144 mois pour le groupe A et de 54 mois pour le groupe B. La réduction dans le plan frontal était identique entre A et B. L’équilibre frontal était respecté dans tous les cas au plus long recul. L’équilibre sagittal n’a pas été modifié avec et sans libération antérieure. Pour les cyphoscolioses, la thoracoscopie a permis une réduction supplémentaire de 15,5° (23 %) de l’hypercyphose thoracique (p = 0,003). Discussion La thoracoscopie n’a pas apporté de bénéfice ni à court terme sur l’angle de Cobb, ni à long terme sur l’équilibre frontal et sagittal. Néanmoins, elle a permis un gain de réduction de l’hypercyphose thoracique. La libération antérieure des scolioses raides, hormis pour la réduction des hypercyphoses thoraciques, est apparue non bénéfique dans les conditions de notre étude : thoracoscopie associée à une rotation de tige postérieure. Niveau de preuve Niveau IV. Étude comparative et rétrospective.
    Resuscitation 01/2011; 97(7):717-723. · 4.10 Impact Factor
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    ABSTRACT: Valgus tibial osteotomy (VTO) is a well-known procedure for the treatment of medial compartment femoro-tibial osteoarthritis. Good and very good results have been reported with calcium phosphate wedges, which avoid the inconveniences of autologous grafts use. The hypothesis of this study is that with equivalent results in the treatment of osteoarthritis of the knee, the use of calcium phosphate wedges (BMCaPh) to fill the bone defect created by osteotomy would result in fewer specific complications and less pain associated with autologous grafts (AUTO) harvesting. This prospective, controlled, randomised study included one arm that received a macroporous, biphasic calcium phosphate wedge (BMCaPh group) and one arm that received an autologous tricortical graft (AUTO group) for filling. The same plate with locked screws was used for fixation in all cases. All patients underwent at least two years of clinical and radiographic post-operative follow-up. Forty patients were included. Loss of correction occurred in six of the twenty-two patients in the BMCaPh group (27%), resulting in three early surgical revisions, compared to one loss of correction in the AUTO group. Lateral cortical hinge tears were a risk factor for loss of correction for the entire cohort and in the BMCaPh group. (relative risk 13.3 [1.9-92]. Moreover, union took significantly longer and pain lasted significantly longer in the BMCaPh group, although results were comparable at 6 months. A significant number of undesirable events (loss of correction) occurred in this study, limiting the number of included patients. Nevertheless, the results show that although there was no difference in the two groups for overall complications, number of revisions all causes combined, or clinical results, filling with BMCaPh was less tolerated and increased the risk of loss of correction when local mechanical conditions of the knee were unfavourable (lateral cortical hinge tears). Moreover, although it is not possible to draw a conclusion because of methodology bias in this study, early weight-bearing resumption on the knee also seemed to favour these complications. Level II. Prospective randomized study.
    Orthopaedics & Traumatology Surgery & Research 10/2010; 96(6):637-45. · 1.06 Impact Factor
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    ABSTRACT: The identification of Propionibacterium acnes in cultures of bone and joint samples is always difficult to interpret because of the ubiquity of this microorganism. The aim of this study was to propose a diagnostic strategy to distinguish infections from contaminations. This was a retrospective analysis of all patient charts of those patients with >or=1 deep samples culture-positive for P. acnes. Every criterion was tested for sensitivity, specificity, and positive likelihood ratio, and then the diagnostic probability of combinations of criteria was calculated. Among 65 patients, 52 (80%) were considered truly infected with P. acnes, a diagnosis based on a multidisciplinary process. The most valuable diagnostic criteria were: >or=2 positive deep samples, peri-operative findings (necrosis, hardware loosening, etc.), and >or=2 surgical procedures. However, no single criterion was sufficient to ascertain the diagnosis. The following combinations of criteria had a diagnostic probability of >90%: >or=2 positive cultures + 1 criterion among: peri-operative findings, local signs of infection, >or=2 previous operations, orthopaedic devices; 1 positive culture + 3 criteria among: peri-operative findings, local signs of infection, >or=2 previous surgical operations, orthopaedic devices, inflammatory syndrome. The diagnosis of P. acnes osteomyelitis was greatly improved by combining different criteria, allowing differentiation between infection and contamination.
    Scandinavian Journal of Infectious Diseases 02/2010; 42(6-7):421-5. · 1.71 Impact Factor
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    ABSTRACT: Introduction L’ostéotomie tibiale de valgisation (OTV) est une intervention reconnue pour le traitement de l’arthrose fémoro-tibiale médiale. De bons et très bons résultats ont été rapportés avec des coins de céramiques phosphocalciques, évitant les inconvénients des autogreffes. L’hypothèse de travail est qu’à résultats équivalents sur le traitement de la gonoarthrose, l’usage de coins de céramiques phosphocalciques macroporeuses biphasées (BMCaPh) entraînait moins de complications spécifiques et de douleurs liées à l’utilisation d’autogreffes pour combler l’ouverture de l’ostéotomie (autogreffe [Auto]). Patients et méthodes Cette étude prospective, randomisée contrôlée, comprenait un bras comblement par un coin de céramique macroporeuse biphasée phosphocalcique (groupe BMCaPh) et un bras de comblement par un greffon tricortical autologue (Auto). L’ostéotomie était fixée dans tous les cas par une même plaque à vis bloquée. Les patients ont été évalués sur le plan clinique et radiographique jusqu’à deux ans post-opératoire minimum. Résultats Quarante patients ont été inclus. Six sur 22 (27 %) du groupe BMCaPh ont eu une perte de correction, entraînant trois reprises chirurgicales précoces versus une perte de correction dans le groupe Auto. La rupture de la charnière latérale était un facteur de risque de perte de correction pour l’ensemble de la cohorte et dans le groupe BMCaPh (risque relatif 13,3 [1,9 à 92]. Par ailleurs, les délais de consolidation ainsi que la diminution de la douleur de genou étaient significativement plus tardifs pour le groupe BMCaPh, les résultats étant comparables à partir de six mois. Discussion La survenue d’un nombre important d’évènements indésirables (perte de correction) a limité le nombre de patients inclus. Les résultats ont cependant mis en évidence que s’il n’y avait pas de différence entre les deux groupes en termes de complications globales, nombre de reprises toutes causes confondues et résultats cliniques, les comblements par BMCaPh étaient moins tolérants et exposaient à plus de risque de perte de correction lorsque les conditions mécaniques locales étaient défavorables (rupture charnière latérale). De plus, si la méthodologie de l’étude ne permet pas de conclure, une remise en charge précoce semble également pouvoir favoriser ces complications. Niveau de preuve Niveau II, prospective randomisée.
    Resuscitation 01/2010; 96(6):710-718. · 4.10 Impact Factor
  • Revue de Chirurgie Orthopédique et Traumatologique 12/2009; 95(8):782-786.
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    ABSTRACT: Propionibacterium acnes is the most frequent anaerobic pathogen found in spondylodiscitis. A documented case required microbiological proof of P. acnes with clinical and radiological confirmation of inflammation in a localized region of the spine. Microbiological samplings were obtained by surgery or aspiration under radiological control. Twelve males and 17 females (median age, 42 years) with spondylodiscitis due to P. acnes were diagnosed within the last 15 years. Three patients were immunosuppressed. All patients reported back pain as the main symptom, and most were afebrile. Three patients had a peripheral neurological deficit, one a motor deficit, and two a sensory deficit attributable to the infection; and six patients had an epidural abscess. The most frequent risk factor was surgery, which was present in the history 28 of 29 (97%) patients. The mean delay between spinal surgery and onset of disease was 34 months, with a wide range of 0-156 months. Osteosynthesis material was present in twenty-two cases (76%). In 24 (83%) patients, additional surgery, such as débridement or spondylodesis, was performed. Previous osteosynthesis material was removed in 17 of the 22 (77%) patients where it was present. Total cure was reported in all patients, except one, after a mean duration of antibiotic therapy of 10.5 weeks (range, 2-28 weeks). In conclusion, spondylodiscitis due to P. acnes is an acute infection closely related to previous surgery. The most prominent clinical feature is pain, whereas fever is rare, and the prognosis is very good.
    Clinical Microbiology and Infection 07/2009; 16(4):353-8. · 4.58 Impact Factor
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    N Passuti, Jm Philippeau, F Gouin
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    ABSTRACT: The problem of friction couples remains unresolved to this day. Improvements in femoral and acetabulum implant anchorage over the last 20 years have significantly extended total hip replacement (THR) implant lifespan; the formation of wear debris, however, leads to resorption and osteolysis, considerably shortening implant lifespan in active patients. Alumina-alumina friction couples provide an excellent friction coefficient, with wear particles that do not cause any osteolysis. There is, however, a problem of acetabulum anchorage of solid alumina, and the risk of fracture persists with ceramic implants despite improvements in their mechanical properties. Metal-metal couples also display very good tribological behavior, but at the cost of the formation of Co and Cr ions impacting surrounding bone tissue and accumulating in remote organs. The behavior of such "hard-hard" couples greatly depends on implant component positioning and on the consequences of repeated neck-insert contact. Very highly crosslinked polyethylene (PE) shows very significant improvement in terms of wear at five years' follow-up compared to conventional PE, but the behavior of this new concept will need to be monitored in the clinical situation if the disappointments experienced with previous hylamer-type improved PE are to be avoided. All these friction couples need to be validated by prospective clinical studies conducted over more than five years, to provide orthopedic surgeons with an eclectic choice of friction couples adapted to the patient's activity.
    Orthopaedics & Traumatology Surgery & Research 06/2009; 95(4 Suppl 1):S27-34. · 1.06 Impact Factor
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    ABSTRACT: A retrospective study about Propionibacterium acnes infections after Cotrel-Dubousset (CD) instrumentation. To analyze the significance of P. acnes-positive deep samples after CD. The diagnosis of spinal infections to P. acnes after CD is difficult. Patients with revision surgery and at least 1 P. acnes-positive deep sample, between 2000 and 2006 were included. Group A had 1 revision surgery and group B had 2 successive revision surgeries, with P. acnes-positive deep samples. Group A was divided into 2 subgroups according to the peroperative macroscopic aspect, subgroup A1 with septic tissues, subgroup A2 without septic tissues. The biologic characteristics of the patients and the surgical and medical treatments were assessed. Sixty-eight patients were included, 60 in group A (A1 = 33, A2 = 27) and 8 in group B. Group A: 26 patients had 1 or 2 P. acnes-positive samples and 34 had at least 3 P. acnes-positive samples. Histology showed chronic inflammatory changes. C-reactive protein value median rate was 42 (A1) and 5 mg/L (A2). Twenty-two patients had a complete implant removal (14 with antibiotics, A1 = 12, A2 = 2). Nine patients had a total implant replacement (7 with antibiotics). Twenty-two patients had a partial implant removal (17 with antibiotics, A1 = 5, A2 = 12). Seven A1 patients had an irrigation and debridement (6 with antibiotics). The evolution was favorable for 28 patients. Seven patients had a documented sepsis. Group B: during the first revision, 8 patients had a partial implant removal (2 with antibiotics); during the second revision, all patients received antibiotics 4 of whom had a total implant removal. The long-term evolution was favorable for 6 patients. P. acnes infection of spinal instrumentation is difficult to diagnose. Results of at least 4 deep sample cultures, histology, and C-reactive protein values must be compared to the peroperative macroscopic aspect.
    Spine 01/2009; 33(26):E971-6. · 2.16 Impact Factor
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    ABSTRACT: The authors report an isolated case of right sacrospinous ligament ossification causing sciatic pain because of compression of the proximal sciatic nerve. The initial conservative treatment of injections in the conflict zone and the intervertebral joints was insufficient. Surgical exploration was undertaken via a posterior approach, demonstrating the conflict between the nerve and the ossified ligament. Resection of the ossified ligament eliminated the symptoms at the cost of transitory buttock hypesthesia. The anatomic and pathologic exam identified simple osseous metaplasia. Lumbar-pelvic coxometry analysis showed sagittalization of the acetabular roofs, excessive bilateral femoral torsion, and a step-off attenuation at the anterior cervicocephalic junction (low anterior cervico-cephalic femoral offset). In addition, reduced lumbar lordosis and accentuated sacral slope were noted, factors that could be related to modifications in the static balance of the lumbar-pelvic complex. This imbalance could be correlated to an increase in the forces applied to the pelvic ligament layers. The etiological hypothesis retained was that this osseous metaplasia was a reaction to excessive stresses on the sacrospinous ligament.
    Orthopaedics & Traumatology Surgery & Research 01/2009; · 1.06 Impact Factor
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    N. Passuti, J.-M. Philippeau, F. Gouin
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    ABSTRACT: Les couples de frottement demeurent un problème non résolu à ce jour, en effet, l’optimisation des ancrages des implants fémoraux et cotyloïdiens depuis 20 ans a permis d’améliorer de façon notable la survie des prothèses totales de hanche mais le relargage des particules d’usure, source de résorption et d’ostéolyse a considérablement diminué la courbe de survie des prothèses chez des patients actifs. Les couples de frottement alumine–alumine assurent un coefficient de friction excellent et les particules relarguées n’entraînent aucun processus d’ostéolyse. Cependant, il existe un problème d’ancrage cotyloïdien face à une alumine massive et le risque de fractures des implants céramique demeure, malgré une amélioration des propriétés mécaniques de ces matériaux. Le couple métal–métal offre aussi un très bon comportement tribologique au prix d’un relargage des ions Co et Cr pouvant avoir des conséquences sur le tissu osseux autour des implants et pouvant s’accumuler dans des organes à distance de la prothèse. Le comportement de ces couples « dur–dur » est très dépendant du positionnement des pièces prothétiques et des conséquences du contact répété col-insert. Le polyéthylène (PE) très hautement réticulé démontre à cinq ans de recul une amélioration très significative de l’usure par rapport à un PE conventionnel, mais il sera nécessaire de surveiller le comportement de ce nouveau concept en situation clinique pour éviter les désillusions causées par les tentatives anciennes de PE amélioré type hylamer. Tous ces couples de frottement doivent être validés par les études cliniques prospectives supérieures à cinq ans, ce qui doit permettre au chirurgien orthopédiste de choisir avec éclectisme un couple de frottement adapté à l’activité du patient.
    Revue de Chirurgie Orthopédique et Traumatologique. 01/2009; 95(4).
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    ABSTRACT: To study the electrophysiologic and clinical effects of epidural morphine combined with either bupivacaine 0.125% or ropivacaine 0.2%. Comparative, randomized, double-blind study. Intensive care unit and hospital ward of a university hospital. 18 adult ASA physical status I and II patients with degenerative or idiopathic scoliosis, undergoing posterior spinal fusion with instrumentation. Patients received epidural administration of 10-mL bolus of either bupivacaine or ropivacaine followed by a 6-mL/h infusion for 48 hours of unlabeled local anesthetic. In all patients, epidural morphine 5 mg was added daily. Assessment was focused mainly on somatosensory cortical evoked potentials, soleus H-reflex, and F waves. These electrophysiologic data were recorded before and after epidural medications. Second, respiratory rate, Paco(2), visual analog score (VAS), and side effects such as postoperative nausea and vomiting (PONV), gastrointestinal (GI) transit delay, and urinary retention were noted. Bupivacaine 0.125% + morphine was given to 9 patients, and ropivacaine 0.2% + morphine was given to 9 other patients. H-reflex, F waves, and somatosensory cortical evoked potential recording remained unchanged across the time of assessment. Respiratory rate and Paco(2) values were normal. VASs were indifferently low at rest, but they were lower with bupivacaine than with ropivacaine on mobilization. The frequency of PONV was indifferently high. No altered GI transit or urinary retention was noted. After epidural administration during the study conditions, bupivacaine 0.125% and ropivacaine 0.2% combined with morphine allow for neurologic examination.
    Journal of Clinical Anesthesia 03/2008; 20(1):17-24. · 1.15 Impact Factor
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    ABSTRACT: The aim of this study was to determine the predictive value of the traction radiograph in adults with stiff curve (preoperative Cobb angle>60 degrees and reduction of less than 35% with traction) thoracic scoliosis. We wanted to compare this predictive value with that observed in reducible scoliosis. A traction radiograph was obtained using a standard protocol with dynamometric control of the force applied. Patients with stiff scoliosis had 47 thoracic curves and 11 thoracolumbar curves (with primary anterior release for ten thoracic curves and eight thoracolumbar curves) and patients with reducible scoliosis had 56 thoracic curves. Cortre-Dubousset instrumentation was used for treatment in all patients. The postoperative Cobb angle for the stiff curves (without anterior release) was strongly correlated with the preoperative angle with traction (r=0.91; p<0.0001). The correlation between the postoperative Cobb angle and the preoperative Cobb angle without traction was less pronounced (r=0.86; p<0.0001). The traction radiographs were less predictive of the Cobb angle correction than the postoperative Cobb angle. The difference was 17.5+/-7 degrees , which corresponds to a supplementary gain in reduction after surgery. For the thoracic curves alone, the differences between the traction Cobb angle and the postoperative Cobb angle was 14.5 degrees for stiff curves and 6.5 degrees for reducible curves. Furthermore, the correlation between the Cobb angle with traction and the postoperative Cobb angle was stronger for stiff curve thoracic scoliosis (r=0.90) than reducible thoracic scoliosis (r=0.78). The standard traction radiographs were highly predictive of postoperative reduction of stiff thoracic and thoracolumbar curves treated by segmental instrumentation. The postoperative result can thus be estimated with a margin of error of +/-7 degrees . For the stiff curves, the postoperative Cobb angle was 17.5 degrees on average less than predicted on the traction radiograph (on average 20% supplementary gain in reduction). This angle gain, which was greater for stiff than reducible curves, corresponds to the determining effect of release occurring with stiff curves. Finally, because of the stronger correlation between the traction Cobb angle and the postoperative Cobb angle for stiff curves, the predictive value of the traction radiograph is greater for stiff curves than for reducible curves. In conclusion, one of the contributions of the traction radiograph, which results from the predictability of the postoperative angle with a small margin of error, is to enable adequate prediction of the postoperative outcome for a given patient or a specific sub-group of patients, e.g. with or without anterior release.
    Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 12/2007; 93(8):783-8. · 0.37 Impact Factor

Publication Stats

2k Citations
232.12 Total Impact Points

Institutions

  • 2012
    • Hotel Dieu Hospital
      Kingston, Ontario, Canada
  • 1989–2012
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 1989–2007
    • Centre Hospitalier Universitaire de Nantes
      • • Service de chirurgie orthopédique et traumatologique
      • • Service d'orthopédie
      Naoned, Pays de la Loire, France
  • 2006
    • Centre Hospitalier Nord-Mayenne
      Pays de la Loire, France
  • 1997–2005
    • University of Nantes
      • • Faculté de Médecine
      • • Faculté de Chirurgie Dentaire
      Nantes, Pays de la Loire, France
  • 2002
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 1998
    • Centre Hospitalier Régional et Universitaire de Besançon
      Becoinson, Franche-Comté, France
  • 1996
    • Ecole Centrale de Nantes
      Naoned, Pays de la Loire, France
  • 1995
    • CHRU de Strasbourg
      Strasburg, Alsace, France