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Saint-Fargeau-Ponthierry, France

Alova I.,Hop Necker Enfants Malades | Margaryan M.,Hop Necker Enfants Malades | Verkarre V.,Hop Necker Enfants Malades | Bernuy M.,Fondation Ellen Poidatz | And 2 more authors.
Journal of Pediatric Urology | Year: 2012

Purpose: To evaluate outcome of further continence procedures after failure of endoscopic injections of dextranomer-based bulking agent. Materials and methods: From 1997, 89 children (3-18 years) and one young adult were treated for incontinence with 145 endoscopic injections of dextranomer. On evaluation, each patient was classified as: dry, significantly improved, or treatment failure. Eighty-five patients had at least 12 months of follow up. Out of 34 (40%) treatment failures, 24 patients had a subsequent bladder neck procedure: artificial urinary sphincter (7), bladder neck plasty (9), bladder neck closure (1), fascial sling (3). Six patients had further endoscopic treatment (including 2 after bladder neck plasty). Results: At surgery, Deflux® paste was easily identified with minimal surrounding tissue inflammatory reaction. Artificial urinary sphincter: all 7 dry; bladder neck plasty: 7 dry, 1 improved and 1 still incontinent; 1 bladder neck closure patient dry; fascial sling: 1 significantly improved and 2 dry. Repeated endoscopic treatment: 1 dry, 1 improved and 4 failed. Eleven of the 21 (52%) patients who are either dry or improved have voiding abilities. Conclusion: Endoscopic injections with dextranomer do not adversely affect the outcome of further surgical procedures. Repeated injections after a previous endoscopic treatment failure have a low success rate. © 2011 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Khouri N.,University Paris Est Creteil | Khalife R.,University Paris Est Creteil | Desailly E.,Fondation Ellen Poidatz | Thevenin-Lemoine C.,University Paris Est Creteil | Damsin J.-P.,University Paris Est Creteil
Journal of Pediatric Orthopaedics | Year: 2010

Background: Proximal femoral osteotomy (PFO) is a widely performed reconstructive surgery in pediatric patients with diagnosis of neurologic abnormalities. Many implants have been used for the fixation of these osteotomies. These devices have been evolved to provide stable fixation. A novel fixation system, the proximal femoral locking compression plate (LCP), which has a low lateral profile system, has been developed to address the problem of loosening in the osteoporotic bone, and to reach a more precise angular reduction and fixation stability through the use of locking screws. In this study, we report the surgical technique and results of PFO in children with a neurologic diagnosis. Methods: Fifty-two children with a primary neurologic diagnosis had a femoral osteotomy with the LCP device. Clinical records and radiographs, neck-shaft angle (NSA), acetabular slope, the Reimer migration percentage, and healing of the osteotomy site were studied. Among the 70 operated hips, 59 operated hips had a follow-up superior to 1 year and were included in this study. Results: Among the 59 operated hips, 25 operated hips presented with subluxations. NSA improved from 145 degrees (130 degrees to 165 degrees) to 120 degrees (110 degrees to 125 degrees) and to 125degrees (115 degrees to 130 degrees) on last follow-up. The Reimer migration percentage improved from 60% (35% to 90%) to 25% (15% to 35%). Ten operated hips presented with dislocations. Their NSA improved from 150 degrees (145 degrees to 170 degrees) to 122 degrees (115 degrees to 125 degrees) and to 125 degrees (118 degrees to 130 degrees) at last follow-up. The stability of the operative reduction was maintained and full range of motion was preserved. Five operated hips presented with dysplastic hips with NSA > 130 degrees without associated subluxation, 6 operated hips presented with windswept deformities, 10 operated hips presented with excessive femoral anteversion, and 3 operated hips presented with pseudarthrosis after earlier PFO were also treated and neither presented angular loosening at last follow-up. No major complications were observed. Conclusions: The LCP system may be used for a wide range of indications if precise preoperative planning was achieved. Rigid primary fixation allows early mobilization and weight bearing in ambulant patient. Level Of Evidence Level IV: Therapeutic study investigating the results of a treatment studying a case series. Copyright © 2010 by Lippincott Williams & Wilkins.

Bourlon C.,Service de Reeducation et de Readaptation Fonctionnelle | Lehenaff L.,Service de Reeducation et de Readaptation Fonctionnelle | Batifoulier C.,Service de Reeducation et de Readaptation Fonctionnelle | Bordier A.,Service de Reeducation et de Readaptation Fonctionnelle | And 10 more authors.
Gait and Posture | Year: 2014

The control of dual-tasking effects is a daily challenge in stroke neurorehabilitation. It maybe one of the reasons why there is poor functional prognosis after a stroke in the right hemisphere, which plays a dominant role in posture control. The purpose of this study was to explore cognitive motor interference in right brain-lesioned and healthy subjects maintaining a standing position while performing three different tasks: a control task, a simple attentional task and a complex attentional task. We measured the sway area of the subjects on a force platform, including the center of pressure and its displacements. Results showed that stroke patients presented a reduced postural sway compared to healthy subjects, who were able to maintain their posture while performing a concomitant attentional task in the same dual-tasking conditions. Moreover, in both groups, the postural sway decreased with the increase in attentional load from cognitive tasks. We also noticed that the stability of stroke patients in dual-tasking conditions increased together with the weight-bearing rightward deviation, especially when the attentional load of the cognitive tasks and lower limb motor impairments were high. These results suggest that stroke patients and healthy subjects adopt a similar postural regulation pattern aimed at maintaining stability in dual-tasking conditions involving a static standing position and different attention-related cognitive tasks. Our results indicate that attention processes might facilitate static postural control. © 2013 Elsevier B.V.

Cai V.A.D.,University Pierre and Marie Curie | Bidaud P.,University Pierre and Marie Curie | Hayward V.,University Pierre and Marie Curie | Gosselin F.,CEA Fontenay-aux-roses | Desailly E.,Fondation Ellen Poidatz
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS | Year: 2011

A knee-joint exoskeleton design that can apply programmable torques to the articulation and that self-adjusts to its physiological movements is described. Self-adjustment means that the articular torque is automatically produced around the rotational axis of the joint. The requirements are first discussed and the conditions under which the system tracks the spatial relative movements of the limbs are given. If these conditions are met, the torque applied to the joint takes into account the possible relative movements of the limbs without introducing constraints. A prototype was built to demonstrate the applicability of these principles and preliminary tests were carried out to validate the design. © 2011 IEEE.

Desailly E.,Fondation Ellen Poidatz | Khouri N.,University Paris Est Creteil | Sardain P.,University of Poitiers | Yepremian D.,Fondation Ellen Poidatz | Lacouture P.,University of Poitiers
Gait and Posture | Year: 2011

Spasticity of the rectus femoris (RF) is one of the possible causes of stiff knee gait (SKG) in cerebral palsy. Musculoskeletal studies have shown that in SKG, length and speed of the RF are affected. No evaluation had been made to quantify the modifications of those parameters after surgery. The effect of this operation on gait quality and on RF kinematics was assessed in this study in order to identify kinematic patterns that may aid its diagnosis.For 26 transfers, clinical gait analysis pre- and post-surgery was used to compute the Gait Deviation Index (GDI) and Goldberg's index. The kinematics of the Original RF path (ORFp) was studied before and after surgery. The expression ORFp was chosen to avoid any confusion between this modeling parameter, whose computation was unchanged, and the actual anatomical path that was modified by surgery.The gait quality was improved (+18 ± 12GDI) and there was an inverse relation between the pre-operative GDI and its improvement. The Golberg's index was improved (88% of the cases). The operation had a significant effect on the normalization of the timings of maximum length and speed of the ORFp. The improvement of SKG was correlated with the normalization of the timing of the ORFp's maximum length.The global improvement of the gait quality and of the SKG was demonstrated. Some parameters of muscular kinematics (RF length and velocity) have been standardized, showing an effect of the transfer not only during the swing, but also during stance. The premature timing of the ORFp peak length has been identified as a prognostic factor of a successful surgical outcome. © 2011 Elsevier B.V.

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