RESUMEN
Chronic hepatitis B virus (HBV) infection leads to a risk of developing cirrhosis and hepatocellular carcinoma. In France, where the prevalence of HBV is low, mother-to-child transmission is the cause of chronic infection in more than one-third of cases. After exposure, the risk of chronic infection is the highest for newborns (90 %). The World Health Organization implemented a global immunization program in 1991, applied in France in 1994. A significant number of children are infected each year, however, and failure of postexposure prophylaxis is reported in 4-10 % of newborns. We report 11 children with chronic HBV infection due to failure of serovaccination, followed up in two centers between 1993 and 2015. We discuss maternal screening, serovaccination, and follow-up conditions, as well as the role of maternal viral load, amniocentesis, and mode of delivery as risk factors. These observations confirm that serovaccination failures are related to the nonobservance of recommendations for maternal screening or postexposure prophylaxis, and to a high maternal viral load (>106 copies/mL). We therefore recommend improving the screening strategy, with control of the hepatitis B antigen in early pregnancy, and discussion of treatment with a nucleoside analog during the last trimester of pregnancy. Serovaccination should be enforced. Its efficacy should be controlled when the child reaches 9 months of age, in order to organize the follow-up if infection occurs.
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Hepatitis B Crónica/prevención & control , Hepatitis B Crónica/transmisión , Inmunización Pasiva/métodos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Profilaxis Posexposición , Amniocentesis , Parto Obstétrico , Femenino , Estudios de Seguimiento , Francia , Hepatitis B Crónica/inmunología , Humanos , Recién Nacido , Tamizaje Masivo , Embarazo , Factores de Riesgo , Seroconversión , Insuficiencia del Tratamiento , Carga Viral/inmunologíaRESUMEN
INTRODUCTION: Congenital scoliosis, carrying an incidence between 0.5 and 1 per 1000 births, raise the problem of their evolutive potential. HYPOTHESIS: Some predictive factors for the evolution of scoliotic curvature due to congenital vertebral malformation (CVM) can be found. MATERIAL AND METHODS: This was a retrospective multicenter study of 251 patients, at least 14 years old when evaluated at end of follow-up, with CVM and spinal deformity predominating in the frontal plane. RESULTS: 38.8% of patients showed associated neurologic, visceral or orthopedic abnormalities. CVM was single in 60.6%, double in 20.3%, triple in 6.4% and multiple in 12.7% of cases. 34.1% of CVMs were thoracic. Congenital scoliosis curvature was single in 88.8% of patients, double in 10% and triple in 1.2%. Mean curvature angle was 31.7° at diagnosis (range, 0-105°) and 41.3° preoperatively (range, 10-105°). Sixty-one patients showed associated kyphosis. Mean change in postoperative curvature angle over follow-up was 1.6° (range, -20° to 38°) in the 73 patients managed by arthrodesis, -0.4° (-24° to 30°) in the 64 managed by epiphysiodesis, and 0.4° (-18° to 35°) in the 49 managed by hemivertebral (HV) resection. Results were found to correlate significantly with age at surgery for patients managed by epiphysiodesis, but not for those managed by HV resection or arthrodesis. DISCUSSION: More than 30% of congenital scolioses involve associated intraspinal abnormality. All CVM patients should therefore undergo medullary and spinal MRI to assess the CVM in all three planes, and the medullary canal and its content. The evolution of scoliotic curvature induced by CVM is hard to predict. Several factors are to be taken into account: CVM type, number and location, and patient age. Curvature progression may be slow or very fast. It accelerates during the peak of puberty, stabilizing with bone maturity. Surgery is mandatory in evolutive scoliosis. Four procedures may be recommended, according to type of CVM and especially to patient age: arthrodesis, convex epiphysiodesis, HV resection or rib distraction. Surgery seeks to correct the spinal deformity induced by the CVM and prevent compensatory curvature and neurologic complications, while conserving sagittal and frontal spinal balance and sparing as many levels as possible. In case of HV involvement, the procedure of choice is CVM resection, which provides 87.5% good results in this indication; the procedure is relatively safe, conservative of spinal levels, and without age limit. LEVEL OF EVIDENCE: Level IV. Retrospective study.
Asunto(s)
Escoliosis/congénito , Escoliosis/cirugía , Columna Vertebral/anomalías , Adolescente , Adulto , Factores de Edad , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To describe the movement of the trunk in adults with untreated adolescent idiopathic scoliosis (AIS) and to evaluate their relationship with the age of the patients, the location and angle of the curve, and the number of involved intervertebral segments. MATERIALS AND METHODS: Two hundred adult subjects with untreated AIS, without associated signs, were analyzed with rachimetry. The flexion, extension, bending, and rotation of the trunk were determined for each patient. The results were compared with a different sample: healthy subjects without spinal disease/other groups with more severe scoliosis (treated). RESULTS: In the absence of discopathy, regardless of the angle, location of the curve, or age of the patient, adults with untreated AIS demonstrated a 24% increase in truncal flexion, and a 30% decrease in hip flexion. The other movements studied with rachimetry were comparable to normal subjects. Lesions of the intervertebral segments increased in number and severity with age. These lesions progressively limited the mobility of the spine, initially in extension; and then in bending and flexion. CONCLUSIONS: The measurement of the mobility of the spine and the pelvis is part of the systematic examination of patients with adult scoliosis. This information can be used to improve the patients' health and spinal function; independent of their age and degree of spinal deformity.
Asunto(s)
Rango del Movimiento Articular , Escoliosis/fisiopatología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antropometría , Tirantes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Docilidad , Rotación , Escoliosis/cirugía , Escoliosis/terapia , Fusión VertebralRESUMEN
The aims of our study were to find out, in 15 female volunteers with untreated structural lumbar idiopathic scoliosis, through dual-photon X-ray absorptiometry measurements, whether femoral bone mineral density (BMD) was different between the right and the left side and whether this difference was related to scoliosis convexity. We showed that no statistical significant difference between femoral neck BMD measured on both sides of the same patient (p = 0.6). However, neck BMD from the same side as the convexity side was significantly lower than the opposite one.
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Densidad Ósea/fisiología , Fémur/fisiopatología , Escoliosis/etiología , Absorciometría de Fotón , Adulto , Femenino , Humanos , Modelos Lineales , Región Lumbosacra , Persona de Mediana Edad , Osteoporosis/complicaciones , Posmenopausia/fisiología , Premenopausia/fisiología , Escoliosis/fisiopatologíaRESUMEN
The authors report a case of severe Recklinghausen's disease, revealed early in infancy, by spinal deformities and then by severe dislocations with kypho-scoliosis surgically treated by anterior and posterior fusion. Other localisations of neurofibromatosis were present, especially bones and skin. During the disease's course a wide sub-cutaneous tumor of the chest wall was removed. Two years later a large abdomino-pelvic tumor of the mesentery was discovered and also removed. Histologic examination showed it to be related to Recklinghausen's disease and malignant. The authors analyse the risk of malignant degeneration of this tumor with relation to previous surgical treatment.
Asunto(s)
Mesenterio , Neurofibromatosis 1/cirugía , Neoplasias Peritoneales/cirugía , Femenino , Humanos , LactanteRESUMEN
Most severe scoliosis and kyphoscoliosis are not unfrequent in European countries. The purpose of their treatment is not only cosmetic but, often, vital. Patients are hypotrophic and their vital capacities usually very poor. Since 1952, the authors have treated (partial, reduction and fusion) 183 patients: with curves above 100 degrees (101 degrees-203 degrees). Reduction was obtained by distraction cast or halo-traction. Surgical treatment (one or two stages) used Harrington rods and fusion with a large amount of iliac bone. These procedures are dangerous for the medullary function. Controls must be performed during the operative distraction. Follow up studies demonstrated the stability of the obtained reductions.
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Escoliosis/cirugía , Adulto , Moldes Quirúrgicos , Femenino , Humanos , Cifosis/complicaciones , Cifosis/cirugía , Masculino , Persona de Mediana Edad , Equipo Ortopédico , Complicaciones Posoperatorias , Cuidados Preoperatorios , Escoliosis/complicaciones , Fusión Vertebral/métodos , Tracción/métodos , Capacidad VitalRESUMEN
Scoliosis is a complication of spinal lesions in neurofibromatosis, and leads frequently to major deformities with dislocations. The authors conducted a critical study of 31 cases surgically treated during the 1954-73 period of time. The techniques of spine straightening and of arthrodesis were recalled. The authors conclude that in case of moderate deformity (less than 100 degrees) Harrington's operation was satisfactory enough when correctly conducted. In case of severe dislocation and kyphosis, straightening was obtained after long lasting casts and halo tractions. Then posterior fusion using Harrington's rods had usually to be completed by anterior, transthoracic fusion for better solidity.