Recurrence of heterotopic ossification after removal in patients with traumatic brain injury: A systematic review

AbstractObjectiveA systematic review of the literature to determine whether in patients with neurological heterotopic ossification (NHO) after traumatic brain injury, the extent of the neurological sequelae, the timing of surgery and the extent of the initial NHO affect the risk of NHO recurrence.Data sourcesWe searched MEDLINE via PubMed and Cochrane library for articles published up to June 2015. Results were compared with epidemiological studies using data from the BANKHO database of 357 patients with central nervous system (CNS) lesions who underwent 539 interventions for troublesome HO.ResultsA large number of studies were published in the 1980s and 1990s, most showing poor quality despite being performed by experienced surgical teams. Accordingly, results were contradictory and practices heterogeneous. Results with the BANKHO data showed troublesome NHO recurrence not associated with aetiology, sex, age at time of CNS lesion, multisite HO, or “early” surgery (before 6months). Equally, recurrence was not associated with neurological sequelae or disease extent around the joint.ConclusionsThe recurrence of NHO is not affected by delayed surgery, neurological sequelae or disease extent around the joint. Surgical excision of NHO should be performed as soon as comorbid factors are under control and the NHO is sufficiently constituted for excision

Troublesome Heterotopic Ossification after Central Nervous System Damage: A Survey of 570 Surgeries

BACKGROUND: Heterotopic ossification (HO) is a frequent complication after central nervous system (CNS) damage but has seldom been studied. We aimed to investigate features of HO for the first time in a large sample and the rate of early recurrence of HO in terms of the time of surgery. METHODOLOGY/PRINCIPAL FINDINGS: We retrospectively analyzed data from an anonymous prospective survey of patients undergoing surgery between May 1993 and November 2009 in our institution for troublesome HO related to acquired neurological disease. Demographic and HO characteristics and neurological etiologies were recorded. For 357 consecutive patients, we collected data on 539 first surgeries for HO (129 surgeries for multiple sites). During the follow-up, recurrences requiring another surgery appeared in 31 cases (5.8% [31/539]; 95% confidence interval [CI]: 3.8%-7.8%; 27 patients). Most HO requiring surgery occurred after traumatic brain injury (199 patients [55.7%]), then spinal cord injury (86 [24.0%]), stroke (42 [11.8%]) and cerebral anoxia (30 [8.6%]). The hip was the primary site of HO (328 [60.9%]), then the elbow (115 [21.3%]), knee (77 [14.3%]) and shoulder (19 [3.5%]). For all patients, 181 of the surgeries were performed within the first year after the CNS damage, without recurrence of HO. Recurrence was not associated with etiology (p = 0.46), sex (p = 1.00), age at CNS damage (p = 0.2), multisite localization (p = 0.34), or delay to surgery (p = 0.7). CONCLUSIONS/SIGNIFICANCE: In patients with CNS damage, troublesome HO and recurrence occurs most frequently after traumatic brain injury and appears frequently in the hip and elbow. Early surgery for HO is not a factor of recurrence

Les troubles de la deglutition et de l'alimentation chez l'enfant et l'adulte polyhandicapes Le Kremlin Bicetre, 28-29 septembre 2000, resumes

Available from INIST (FR), Document Supply Service, under shelf-number : Y 33399 / INIST-CNRS - Institut de l'Information Scientifique et TechniqueSIGLEAssistance Publique - Hopitaux de Paris, 75 - Paris (France). Mission HandicapsFRFranc

Jeu et maladie d’Alzheimer, le cadre ludique dans la prise en charge de la démence

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Plaisir et vieillissement chez les plus de 65 ans

International audienceA survey carried out of people aged 65 and over aimed to provide a clearer picture of the older population's relationship with pleasure. How do they feel as they age? Do they still find pleasure in things? In what ways? If there a certain self-censorship among the older population with regard to the subject? Or, on the contrary, do they make the most out of life without any complexes or limits? A sample of people aged between 15 and 64 were also surveyed for their opinion on the following questions: do they feel that older people still find pleasure in things? How do senior citizens enjoy themselves today

Effectiveness and Complications of Percutaneous Needle Tenotomy with a Large Needle for Muscle Contractures: A Cadaver Study.

Twenty-two percent of institutionalised elderly persons have muscle contractures. Contractures have important functional consequences, rendering hygiene and positioning in bed or in a chair difficult. Medical treatment (such as botulinum toxin injections, physiotherapy or positioning) is not very effective and surgery may be required. Surgery is carried out in the operating theatre, under local or general anaesthesia but is often not possible in fragile patients. Mini-invasive tenotomy could be a useful alternative as it can be carried out in ambulatory care, under local anaesthesia.To evaluate the effectiveness of percutaneous needle tenotomy and the risks of damage to adjacent structures in cadavers.Thirty two doctors who had never practiced the technique (physical medicine and rehabilitation specialists, geriatricians and orthopaedic surgeons) carried out 401 tenotomies on the upper and lower limbs of 8 fresh cadavers. A 16G needle was used percutaneous following location of the tendons. After each tenotomy, a neuro-orthopaedic surgeon and an anatomist dissected the area in order to evaluate the success of the tenotomy and any adjacent lesions which had occurred.Of the 401 tenotomies, 72% were complete, 24.9% partial and 2.7% failed. Eight adjacent lesions occurred (2%): 4 (1%) in tendons or muscles, 3 (0.7%) in nerves and 1 (0.2%) in a vessel.This percutaneous needle technique effectively ruptured the desired tendons, with few injuries to adjacent structures. Although this study was carried out on cadavers, the results suggest it is safe to carry out on patients

Psycho-oncology: understanding the processes involved in the experience of users of Complementary or Alternative Medicine (MCA)

Objet : Cet article vise à proposer une définition et une catégorisation des médecines complémentaires et alternatives (MCA). En effet, l’absence de critères précis de définition limite la compréhension de ce mouvement hétérodoxe et des pratiques qui en sont issues. Objectifs : Ce travail répond à un objectif triptyque visant à apporter des repères, à la fois aux usagers, aux professionnels de santé tout en proposant un référentiel commun pour la recherche. Méthode et matériel : L’élaboration de la définition s’est appuyée sur l’analyse de 62 publications francophones issues des sciences médicales et pharmacologiques, des sciences humaines et sociales ainsi que des sciences politiques et juridiques. La mise en œuvre de la catégorisation a reposé sur l’analyse de 9 classifications nationales et internationales. Après avoir synthétisé l’ensemble des corpus, nous avons procédé à une analyse critique permettant de mettre en lumière les lignes de force et les limites des différentes définitions et classifications. Nous avons ensuite répertorié les principaux éléments structurants des MCA permettant de les conceptualiser (définition) et de les délimiter (catégorisation). Résultats : L’analyse des publications apporte des repères théoriques structurants mais pointe la logique de segmentation des approches conceptuelles et le cloisonnement de la pensée qui en découle. L’analyse des classifications montre une tentative utile d’objectivation de ces recours mais révèle la difficulté d’établir une délimitation hermétique des pratiques. Conclusion : La définition et la catégorisation proposées constituent deux outils utiles pour les usagers, les soignants et les chercheurs, contribuant ainsi à la structuration de ce champ.Purpose: This article aims to propose a definition and categorization of complementary and alternative medicine (MCA). Indeed, the absence of precise definition criteria limits the understanding of this heterodox movement and of the practices which have resulted from it. Objectives: Thus, this work responds to a triptych objective aimed at providing benchmarks, both to users, to health professionals while proposing a common reference for research. Method and material: The development of the definition was based on the analysis of 62 French-language publications from the medical and pharmacological sciences, the human and social sciences as well as the political and legal sciences. The implementation of the categorization was based on the analysis of 9 national and international classifications. After having synthesized all the corpora, we proceeded to a critical analysis allowing to highlight the main lines and the limits of the different definitions and classifications. We then listed the main structuring elements of MCA allowing to conceptualize them (definition) and delimit them (classification). Results: The analysis of the publications provides theoretical benchmarks structuring but points to the logic of segmentation of the conceptual approaches and the compartmentalization of the thought which results from it. Analysis of the classifications shows a useful attempt to objectify these remedies but reveals the difficulty of establishing a hermetic delimitation of practices. Conclusion: The proposed definition and classification are two useful tools for users, caregivers and researchers, thus helping to structure this field

Jeu et maladie d’Alzheimer, le cadre ludique dans la prise en charge de la démence

International audienc

Démence et thérapeutique non-médicamenteuse, efficacité du cadre ludique

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