Esperance Hospital

Abstract Background. Foraminal neuropathy involves stenosis at the level of the foramen leading to nerve compression causing pain, sensory disturbances, and muscle weakness. It results from the narrowing of the neural foramen due to degenerative, traumatic, or congenital factors. Quantifying nerve occupancy within the foramen can illuminate potential compression issues and guide clinical decisions, particularly in lumbar foraminal stenosis (LFS). Results. This six-year retrospective cohort study on 800 patients at NCC No. 2, Moscow, focused on quantifying nerve occupancy in the foramen using high-resolution MRI. Inclusion criteria included symptoms of nerve compression and prior spinal imaging. Advanced imaging software provided precise volumetric measurements of the foraminal spaces and nerves. The percentage of foramen occupied by the nerve was calculated to assess compression. The study found a progressive increase in nerve occupancy and symptom severity from L1/L2 to L5/S1 levels. High nerve occupancy percentages correlated with higher pain (VAS scores) and disability (ODI scores). L4/L5 and L5/S1 showed the most significant nerve compression and symptom severity, indicating critical sites for LFS diagnosis and treatment. Conclusions. This study advances understanding of lumbar foraminal stenosis by quantifying nerve occupancy. The findings highlight the importance of targeting lower lumbar levels in diagnosis and treatment, emphasizing the correlation between high nerve occupancy and symptom severity. This methodological approach enhances clinical precision and outcomes in managing foraminal stenosis.

BackgroundViscosupplementation is likely effective to alleviate pain and improve function in patients suffering from rhizarthrosis. However no study has been focused on the predictors of efficacy of the treatment.ObjectivesTo search predictive factors of success or failure 3 months after a single intra-articular injection of a mannitol-modified hyaluronic acid (HA) viscosupplement, in patients suffering from trapeziometacarpal (TMC) osteoarthritis (OA).MethodsPatients with symptomatic TMC OA were included in a 3 month prospective multicentre open-label trial. To be included in the study patients must have symptomatic TMC OA, not adequately relieved by analgesics/NSAIDs therapy and/or by the use of a thumb splint. Before treatment all patients must have had plain radiographs with the Kapandji incidences, for the Dell radiological grade assessment. (1 to 4). Primary endpoints were the variation between injection (D0) and day 90 (D90) of the thumb pain measured on 11 point-Likert scale (0 to 10) and the patient‘s self-assessment of efficacy (0 to 3). Treatment consisted in a single injection of 0.6 to 1 ml of HANOX-M-XL, a viscosupplement made of a cross-linked HA of high molecular weight, from biofermentative origin, combined with mannitol. All injections were performed under fluoroscopic or ultrasound guidance. Predictive factors of pain decrease were studied in univariate and multivariate analysis. All statistical tests were carried out two tailed at the 5% level of significance.Results122 patients (76% females, mean age 60, mean disease duration 36 months) were included and 120 (98%) were assessed at 3 months. 23% of the TMC OA were grade 1 according to Dell classification, 36.8% grade 2, 36.8% grade 3% and 3.5% grade 4. At D0, the average (SD) pain level was 6.5±1.6 without significant difference between Dell groups (p=0.21). At day 90, pain decreased from 6.5±1.6 to 3.9±2.5 (Difference −2.7±2.5; −42%; p<0.0001) without significant difference depending on the Dell grade (p=0.055), despite a seemingly smaller number of responders in stage 2 patients. The average analgesic consumption decreased in more than one out of two patients. In univariate analysis, the clinical response was significantly worse in patients taking NSAIDs at baseline (p=0.012), but this difference no longer reached the significance threshold in the multivariate analysis. In multivariate analysis no predictor of response was identified. There was no safety issue. All AEs (11%) were transient increase of pain during or following HA administration and resolved without sequel within 1 to 7 days.ConclusionsThis study, of the largest cohort of patients treated with viscosupplementation in TMC OA, suggests that a single course of HANOX-M-XL injection is effective in relieving pain, without safety concern. Interestingly patients with the more advanced stages of OA seemed to benefit the treatment as well as those with less advanced OA.Disclosure of InterestJ. DAUVISSAT: None declared, T. Conrozier Consultant for: Labrha SAS, Speakers bureau: Labrha SAS, H. Lellouche: None declared, B. MAILLET: None declared, C. Rizzo: None declared, V. Travers: None declared, V. locquet: None declared, S. Mellac-Ducamp: None declared

House mice from 24 Scottish and Faroese islands show positive correlation of skeletal size with island area, conforming to a model of resource limitation in very small islands. Molar size is not correlated with island size, suggesting greater genetic canalization; smaller individuals have larger tooth to body size ratio. The size variation may have a simple genetic basis or may be ecophenotypic. The offset between skeletal and molar size has potential use in the fossil record as a marker for these rapid effects, while longer-term evolutionary change reverts to approximate tooth—body size isometry. Collation of related studies indicates frequently deterministic relationships of small-mammal body size to island size. The parameters of the relationship (positive, negative or parabolic) vary widely with case study according to biotic and abiotic factors. In the present study there was no relationship of mouse size to any variable (e.g. presence of competitors) except island area.

Les pièces de la Bertonne sont si particulières qu’il nous a semblé utile d’exposer ici l’ensemble de la démarche qui a permis de déterminer leur véritable fonction. L’argumentation a été essentiellement construite sur la base d’un raisonnement déductif. Les trois hypothèses fonctionnelles (pièce amincie en vue d’un emmanchement, outil et nucléus à lamelles) évoquées depuis leur découverte ont été testées au fur et à mesure dans le but d’éliminer celles qui étaient improbables. La fonction de nucléus à lamelles s’est alors révélée la plus vraisemblable. Ce résultat fut ensuite confirmé par la découverte récente de quelques lamelles retouchées indubitablement obtenues à partir de ces pièces de la Bertonne. Cet article est enfin consacré à la présentation de la méthode originale de débitage de lamelles de type « Bertonne » qui présente de nombreuses analogies avec celle connue sous le nom d’Orville.

Reliability of angiographic assessment of the left main coronary artery segment was evaluated by review of 106 coronary cineangiograms from the Coronary Artery Surgery Study. The films were interpreted by three groups of angiographers: those at a clinical site, those at a quality control site, and those on a study census panel. Among the readings of these three groups, there was 41% to 59% agreement on the severity of the lesion, with 80% agreement on whether the lesion was greater or less than 50%. The severity of lesion, its location, or presence of ectasia or calcium did not affect the discrepancy rate, whereas segments that were unusually short, diffusely diseased, or obscured by overlapping vessels were especially difficult to interpret.