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Granulocytic sarcoma (GS) is a rare extramedullary tumor frequently associated with acute myeloblastic leukemia (AML). We report 3 cases of pediatric granulocytic sarcomas with various locations: skin, orbit, and bowel. Cases 1 and 2 were associated with AML; case 3 was isolated. In all 3 cases, the diagnosis was delayed or initially missed. Pathology and immunohistochemistry data identified the disease. GS is treated with chemotherapy, like AML. The prognosis of GS seems better than that of isolated AML.

Objectives Retrospective analysis of the efficiency of a protocol for care of chronic vegetative states (CVS) and minimally conscious state (MCS) in Lorraine. Material and method Two indicators are used: protocol activity (number of patients hospitalized between 1988 and 2006, number of admissions per year, of requests per year, origin of requests, waiting time) and the epidemiological data (age, sex ratio, etiology, length of stay, geographic origin, number of deaths, number of hospital discharges). The number of CVS and MCS and patients having progressed towards arousal is specified as well as the technical procedures (orthopedic surgery, number of tracheotomies). Results Forty-seven patients (30 males and 17 females) were hospitalized in a 12-bed unit. The number of admissions per year was 2.4, and the annual number of requests varied between five and 15. Hospitalization times ranged from six to 18 months. The average length of hospitalization was 41 months. Eighty-eight percent of the cases were residents of Lorraine. The etiology was traumatic (53%), vascular (38% including 12% anoxia), miscellaneous (9%). Fifteen percent rate of return to arousal (average time period: 28.41 months, traumatic etiology) with hospital discharge in four cases. Conclusion The protocol is managed as part of a local scheme and enables an appropriate response to a specific clinical profile by providing up-to-date multidiscipline follow-up care and a rapid solution should intercurrent events occur (signs of arousal, orthopedic deterioration, change of environment). Typical limitations are geographical remoteness and difficulties with family support care.

Hip dynamics in the intact limb during the beginning of stance phase in unilateral trans-tibial amputees (TTA) was studied to evaluate its contribution to compensatory function. We hypothesized (1) an increase in hip total work during H1 power phase (0-30% of gait cycle) including an initial negative phase and (2) an intensification of the hip work in response to uncomfortable gait induced by prosthesis misalignment. Three-dimensional gait analysis was conducted in 17 unilateral TTA and 15 healthy subjects walking at the same self-selected speed in three prosthetic alignments: initial alignment (IA); IA altered either by 6 degrees of internal rotation (IR) or by 6 degrees of external rotation. Patients reported best comfort of gait in IA condition and discomfort mainly in IR condition. During the H1 power phase, in intact limbs a consistent initial flexion movement of the hip (0-8% gait cycle) was associated to negative work and was followed by hip extension and positive work whereas in both prosthetic and control limbs only hip extension and positive work occurred (except in one healthy individual). Absolute value of hip work during H1 phase was significantly higher in intact and prosthetic limbs compared to control limbs in IA condition and was further significantly increased in IR condition only in intact limbs demonstrating a compensatory function of the latter. In intact limbs, early hip negative work contributed to energy absorption in addition to the knee joint probably to compensate the lower energy absorption exerted by the prosthetic limbs.

Resume Objectif Le but de cette revue generale est de faire le bilan de connaissances actuelles sur l’evolution anatomique, histologique et physiologique des muscles chez les patients amputes tibiaux. Materiel et methode Revue de la litterature de PubMed et Reedoc, concernant les publications ayant trait au moignon des amputes tibiaux, son evolution, son volume, ses modifications histologiques et aussi les modifications de l’equilibre et de la marche apres une amputation. Resultats Les muscles des patients amputes presentent, du cote lese et du cote sain, une amyotrophie avec une reduction du diametre et du nombre de fibres et, en particulier, les fibres lentes (fibres de type I). Cette amyotrophie, heterogene dans son importance et dans sa repartition, atteint 25 % sur le quadriceps ou elle predomine sur le compartiment interne alors qu’elle est non significative sur les ischiojambiers. Elle trouve ses origines, d’une part, dans des modifications anatomiques secondaires au geste chirurgical. La perte de l’insertion distale d’un muscle ou sa reimplantation non anatomique favorise son amyotrophie. Et, d’autre part, dans des modifications du schema d’activation des muscles. Les ischiojambiers assurent la propulsion en l’absence du triceps sural et les muscles residuels du moignon presentent des contractions necessaires au maintien de l’emboiture. Le patient ampute presente un nouvel etat musculaire, retentissant sur la marche qui devient asymetrique et plus exigeante en energie, la sensibilite proprioceptive modifiee necessite une periode d’apprentissage pour retrouver un controle postural optimal.

Nocardiosis is a rare infectious disease in children. We report here a disseminated nocardiosis in a child with acute lymphoblastic leukemia. The patient presented prolonged febrile neutropenia and nodular pneumopathy. Based on the amplification of a 16S rDNA, a PCR assay detected Nocardia sp. in the patient's bronchoalveolar lavage (BAL) fluid. Culture of BAL samples yielded Nocardia nova colonies after 2 weeks of incubation. Hepatic, splenic, renal and cerebral localisations were detected on extension checkup. trimethoprime-sulfamethoxazole and amikacine were started given the results of PCR assay, with a good response. Improvement of the patient's general condition led to complete chemotherapy under ciprofloxacine and ceftriaxone treatment, without nocardiosis reactivation. Nocardiosis is a rare complication in children with acute lymphoblastic leukemia. trimethoprime-sulfamethoxazole prophylaxis is widely used to prevent Pneumocystis jiroveci infection in children with haematologic malignancies. As Nocardia species are usually sensible, trimethoprime-sulfamethoxazole could play a role in Nocardia prophylaxis in such population. In our patient, compliance with trimethoprime-sulfamethoxazole had been low. Nocardia species are relatively fastidious growth bacteria and are difficult to isolate with classical bacteriological techniques. Molecular methods are now available, with a good sensitivity and fast results allowing to start an appropriate antibiotherapy before culture results, as early treatment is a major prognosis factor in nocardiosis. Nocardia infection should be suspected in case of nodular pneumopathy in immunocompromised children. An extension checkup should be performed to detect secondary localisations.

Objective: To search for specular disorders of body representations in right hemisphere stroke. Background: Mirror self-misidentification, asomatognosia, and personal confabulation are similar to body illusions or changes in sensorial or sensorimotor perceptions generated by mirror in right brain damage patients with body image disorders. Method: Prospective study. Ten consecutive right-handed patients (1) performed body part naming and localization tasks and (2) were examined for asomatognosia at the acute phase of stroke, then at least 3 months after stroke, under 3 test conditions: without a mirror, with a conventional mirror, and with an inverted mirror. Video recordings of the tests were analyzed to assess performance. Results: Analysis of variance of the data confirmed that the interaction of mirror's conditions (specifically without a mirror vs. an inverted mirror) with subtest type was significant. The errors are symmetrically distributed. Asomatognosia was "reactivated" in 10 patients who experienced asomatognosia during the acute phase. No particular pattern characterized the clinical manifestations of asomatognosia. Conclusions: A causal conflict of sensorial input is proposed. The specific symptoms observed would suggest the existence of an incomplete specular Gerstmann syndrome and/or Anton Babinski syndrome. These results emphasize the role of specular input in the generation of body representations and self-awareness.

This prospective study examined the effects of prismatic adaptation on visual exploration strategies in patients with left unilateral spatial neglect (USN). Photo-oculo-graphic gaze recordings were obtained, as the subjects (28 brain-damaged; 15 control) performed a free visual exploration task before and after a session of prismatic adaptation. (i) Before prismatic adaptation, the pattern of visual exploration described two subgroups of patients (symmetrical exploration of hemispaces - similar to the control subjects, deficient exploration of left hemispace). Twelve of 20 patients failed to describe significant elements in the left part of the displayed image. Several visuoverbal patterns were observed, some dissociating visual exploration and verbal description. (ii) Immediately after prismatic adaptation, patients with asymmetrical visual exploration presented a significant increase in the number of point fixations and saccades in the left hemispace. Patients with symmetrical exploration presented the opposite pattern. Improved pattern of visual exploration contrasted with an absence of improved verbal description. Eye movements and visuoverbal descriptions exhibit heterogeneous and dissociated patterns before and after prismatic adaptation. This results demonstrate that prismatic adaptation has no effect in certain patients, suggesting that therapeutic indications and evaluation of prismatic test results should take into consideration the heterogeneous nature of USN.

Degenerative osteoarthritis in subtalar and midtarsal joints occurring after tibiotalar arthrodesis may be related to biomechanical factors. For patients with tibiotalar arthrodesis walking with their everyday shoes, the ground reaction force is posterior at heel-off and the maximal foot-tibia dorsiflexion is at its upper limit. We hypothesized that increasing the instep of the shoes would improve these abnormalities. Three-dimensional gait analysis was done in nine patients with ankle arthrodesis fused in the neutral position and for 10 control subjects. Four conditions of walking were tested: barefoot, wearing everyday shoes, wearing everyday shoes with the instep increased by 1 cm, and wearing everyday shoes with the instep increased by 2 cm. In the arthrodesis group, the two modified delayed heel-off shoe conditions shifted the ground reaction force closer to the metatarsal heads at heel-off to a normal range, and reduced the maximal foot and tibia dorsiflexion angle. Based on these results, patients with a tibiotalar arthrodesis in the neutral sagittal position may be advised to choose shoes with an instep of approximately 25 mm.

Introduction. – Review of the literature about evaluation of amputees. Materials and methods. – A search of the Medline and Reedoc databases with the key words lower limb amputee, upper limb amputee, evaluation of lower limb amputee, evaluation of upper limb amputee, survey of lower limb amputee, survey of upper limb and the same words in French for reports on the evaluation of amputees. Results. – Evaluations of amputees differ according to the level of amputation (lower or upper limb) and age (adult or child). They concern standing balance, walking (lower limb) and the mono- or bimanual prehensile capacities with or without prostheses in daily living activities and leisure (upper limb) as well as quality of life, personal satisfaction, psychological impact and, in particular, coping strategies. Discussion. – For lower-limb amputees, tools to evaluate include scales of deambulation, of which few are valid in French, and global scales (on locomotor capacities, quality of life and satisfaction), which have been recently validated, but only one of them is valid in French. For upper-limb amputees, specific and valid tools are not available for adults; however, for children some functional capacity scales in daily activities have been validated and take into account psychomotor development. None of these tools are valid in French, and their use is scattered and limited to validation studies. Conclusion. – Only a few tools to evaluate amputees are valid in French for adults, and they concern lower-limb amputees only. Validating some of these tools in French is necessary.

Paysant J, Andre J-M, Martinet N, Beis J-M, Datie A-M, Henry S, Dap F. Transcranial magnetic stimulation for diagnosis of residual limb neuromas. Arch Phys Med Rehabil 2004;85:737–42. Objective To analyze the mechanism and examine the potential diagnostic contribution of transcranial magnetic stimulation (TMS) in diagnosing painful, clonic, and/or autonomic manifestations in amputees' residual limbs. Design Prospective study. Setting Regional rehabilitation institute at a medical school in France. Participants Thirty-four amputees (24 with myoclonus, stump pain, or trophic skin disorders; 10 controls with no stump symptoms). Interventions Not applicable. Main Outcomes Measures TMS performed before and after correcting prosthesis adaptation. Results TMS induced pain in 12 amputees, clonic manifestations in 4, and autonomic manifestations in 2. Twelve patients underwent magnetic resonance imaging that showed neuromas in all 12. After neuroma resection in 9 amputees, TMS no longer provoked abnormal manifestations. TMS did provoke abnormal manifestations after resection in 3 patients who had postoperative recurrent neuromas. The response to TMS was negative in subjects with a clinically silent neuroma (n=7). The response was also negative in all patients with other stump anomalies whose clinical manifestations fully regressed after conservative treatment. There was a highly significant correlation between the presence of a pathologic neuroma and TMS-induced abnormal manifestations ( P Conclusions TMS can provoke symptoms in patients who experience spontaneous or evoked symptoms related to a neuroma. Induced symptoms are proportional to spontaneous symptoms. Removing the neuroma can stop stump symptoms and reverse the TMS effect. The response to TMS was negative in the control subjects with clinically silent neuromas; conservative treatment was successful in these cases. TMS-induced abnormal manifestations underlying mechanisms are discussed (ephaptic transmission in neuromas).

Foisneau-Lottin A, Martinet N, Henrot P, Paysant J, Blum A, Andre J-M. Bursitis, adventitious bursa, localized soft-tissue inflammation, and bone marrow edema in tibial stumps: the contribution of magnetic resonance imaging to the diagnosis and management of mechanical stress complications. Arch Phys Med Rehabil 2003;84:770-7 Objective: To assess the contribution of magnetic resonance imaging (MRI) in the diagnosis of tibial stump bursitis, in the establishment of differential diagnosis, and in the therapeutic management prosthetic-stump interface, mainly by adaptation of the prosthetic device. Design: Two-year, prospective, consecutive series. Setting: University-affiliated prosthetic and rehabilitation center and university department of radiology. Participants: A group of 17 persons with stump problems identified from a total of 139 consecutive below-knee amputees with prosthesis problems. Interventions: Not applicable. Main Outcome Measures: Clinical symptoms and MRI. Results: Clinical symptoms (variable stump volume, fluctuating mass at palpation with or without mechanical pain) were suggestive of bursitis in 10 patients. MRI confirmed bursitis in 9 and identified 1 in whom clinical signs suggested neuroma, giving an incidence of 10 of 139 amputees (7.2%). MRI identified 13 sites of bursitis (adventitious bursa, 11; synovial bursitis, 2) and 5 localized areas of soft tissue inflammation. MRI showed diffuse muscular edema at 1 site of clinically suspected bursitis, and bursitis at another site of suspected neuroma. Calcified bursitis was observed in 1 case. Bone abnormalities associated with bursitis (n=7) included osteophytes or fracture (n=4) or bone marrow edema (n=3). Two asymptomatic neuromas were also identified. MRI-guided modifications of the prosthetic interface led to favorable outcome in all cases. Conclusion: Bursitis, adventitious bursae, and areas of localized soft-tissue inflammation are different aspects of the same disorder resulting from a mechanical conflict between the stump and the prosthesis socket. Besides contributing to diagnosis, MRI provides a precise assessment necessary for correcting the prosthesis-stump interface in a way that reduces mechanical stress and subsequently cures bursitis.

Objectives: To study different typolologies from visuo-verbal behavior concerning the arrest and the treatment of visual information in patients with spatial hemineglect. Methods: Ocular movements were monitored by photo-oculography in thirty controls and twenty-three patients with neglect. During a letter reading task, the movements, number of entries into predetermined zones of the visual field, time spent in each zone, and the verbal responses were recorded. Four profiles may be anticipated for such trials: normal scanning and reading (S+R+), normal scanning without reading (S+R�), absence of both scanning and reading (SR�), abnormal scanning with reading (SR+). Results: The letter projected in each of the 4 quadrants was scanned and correctly identified by all of the controls with no differences in scanning times. Among patients, the 4 possible behavior patterns were found along with differences in exploration duration per zone ( p< 0.05) and number of times specific zones were attained ( p< 0.05). Conclusions: Our results confirmed the heterogeneity of the mechanisms of neglect and suggest that rehabilitation procedures adapted to each profile might be useful.

Resume OBJECTIF : Evaluer les benefices apportes par une chirurgie precoce des escarres pelviennes par rapport a la cicatrisation dirigee dans une population de sujets medullo-leses. MATERIEL ET METHODE : La population etudiee est constituee de 53 patients (62 escarres) repartis en deux groupes : le groupe 1 comprend 30 patients (34 escarres) presentant des escarres pelviennes de stade III ou IV (NPUAP) traitees en premiere intention chirurgicalement, inclus consecutivement pendant une periode de 2 ans ; le groupe 2 comprend 23 patients (28 escarres) inclus de facon retrospective presentant des escarres pelviennes de stade III ou IV traitees en premiere intention par cicatrisation dirigee par la meme equipe de soins. Les criteres de jugement retenus sont le delai de cicatrisation et le delai de reprise de la station assise au fauteuil. L’analyse statistique fait appel au calcul de l’ecart reduit. RESULTATS : Dans le groupe 1 le delai moyen de cicatrisation quelle que soit la localisation de l’escarre est de 42 jours et le delai moyen de remise au fauteuil de 39 jours. Dans le groupe 2 la cicatrisation ne peut etre obtenue medicalement que dans 13 cas et dans un delai moyen de 180 jours. Les differences sont statistiquement significatives (p DISCUSSION - CONCLUSION : L’originalite de cette etude resulte dans la comparaison de deux traitements au sein de deux groupes de patients ayant des caracteristiques demographiques proches. Elle demontre clairement l’interet de la chirurgie precoce de l’escarre par rapport a la cicatrisation dirigee et illustre la necessite de filieres medico-reeducatives specialisees.

Aim. To show asymmetric leg activity during walking in healthy subjects. Design. Two electrogoniometers were used to measure the amplitude of the flexion-extension movements of both knees during walking. Background. Walking is considered to be a symmetrical activity. Quantitative studies of walking often only consider one side of the body or remove differences between individuals by averaging results. Methods. The handedness, lateral eye dominance and footedness of 31 healthy subjects were determined. A strain gauge electrogoniometer was then fitted to the outside of each knee to analyze the flexion-extension movements. The results were recorded automatically. The subject walked a distance of 30 m three times, with different attention levels: free walking (with no other task assigned), walking with attention diverted (whilst performing a mental task), and focused walking (walking as straight as possible in a straight line). Results. 51.6% of the subjects tested displayed asymmetry of the total flexion-extension movement of more than 5° between the two knees during free walking. The side favored (preponderance) by this asymmetry was not related to the handedness or other lateral dominance. The different attention levels did not significantly affect the characteristics of motion of the sub-groups studied (symmetric, right-favoring and left-favoring). Conclusions. The origin of this asymmetry, which is independent of handedness or attention level, could be the spinal stepping generator for which there is evidence in both animals and humans. Walking should not be considered to be a strictly symmetrical phenomenon. Relevance The demonstration of asymmetric leg activity during walking may lead to a better understanding of the way in which walking controlled. The presence of such asymmetry is normal, and it should be borne in mind during explorations of walking in both healthy and pathologic individuals.

A computer test for visual field deficits and visual neglect was developed and evaluated by testing 63 patients with brain damage. This computer test controls the sequence of unilateral or bilateral lights series, and stores the responses. Test results are compared to clinical and ophthalmological tests and neuropsychological assessment. Visual field deficits were present in 17 patients on the computerized test, in 16 patients on ophthalmological test, and in 13 patients on clinical examination. Neglect was present in 12 patients on the computerized test, and in 10 patients on the neuropsychological assessment. Eighteen patients had mixed disorder (hemianopia and neglect). Results of the chi 2 statistic confirm the greatest correlation between the computerized test and the ophthalmological (phi = 0.93; p < 0.001) and neuropsychological (phi = 0.90; p < 0.001) tests. Correlation between the computerized test and the clinical examination was poorer (phi = 0.85; p < 0.001). The computerized test makes it possible to detect mixed disorder with the same tool, during the same examination.

Study design: Prospective study. Objectives: To determine the mechanisms of body illusions in paraplegia patients as compared with the amputee phantom phenomena. Methods: A vestibular caloric stimulation was performed in 10 consecutive patients with complete section of the spinal cord. Perception of body, before and after stimulation, was classed as illusion of a normal body (lower limbs with normal morphological, postural and kinetic characteristics perceived as before spinal injury), normal phantom (overly vivid perception of all or part of the lower limbs), deformed phantom (perception of all or part of the limbs below the injury level as abnormal in shape, posture, movement or even number), or painful phantom. Results: After vestibular caloric stimulation, nine out of 10 patients stated their perception of body segments below the injury level had changed to normal phantoms or to deformed phantoms (morphological, postural or kinetic changes). Among the four patients who initially had painful limbs, two stated the stimulation greatly relieved their pain. Conclusion: The normal or deformed phantom evoked by vestibular stimulation would result from use of identity data or instantaneous data as is observed in amputees. Cerebral remapping following deafferentation could be the origin of the deformed phantoms. Illusions corresponding to phenomena perceived at the time of the accident corresponding to autobiographical engrammes do not appear to be evoked by vestibular stimulation, as is also the case in amputees. Spinal Cord (2001) 39, 85–87.

Mâaref K, Martinet N, Grumillier C, Ghannouchi S, Andre JM, Paysant J. Kinematics in the terminal swing phase of unilateral transfemoral amputees: microprocessor-controlled versus swing-phase control prosthetic knees. Objectives To analyze the spatiotemporal parameters in the terminal swing phase of the prosthetic limb in unilateral transfemoral amputees (TFAs) compared with a group of asymptomatic subjects, and to identify a latency period (LP) in the TFA between the full extension of the prosthetic knee and the initial ground contact of the ipsilateral foot. To study the correlation between the LP and the duration of the swing phase. To evaluate the influence of the type of knee, the time since amputation, and the amputation level on the latency period. Design Three-dimensional gait analysis with an optoelectronic device. Setting Gait analysis laboratory of a re-education and functional rehabilitation service. Participants TFA (n=29) and able-bodied (n=15) subjects. Interventions Not applicable. Main Outcome Measures Spatiotemporal and kinematics gait parameters. Results The swing phase and the LP of the prosthetic limb, associated with a consequently longer single-limb stance phase in the intact limb, were significantly longer than those measured in the intact limbs of these subjects, as well as those measured on both lower limbs of the able-bodied subjects ( P P r 2 =.58 between the LP and the swing phase on the TFA's prosthetic side. The LP measured in the prosthetic limb of TFA with a swing-phase control prosthetic knee is significantly greater than in those using the microprocessor-controlled prosthetic knee ( P Conclusions Of negligible duration in able-bodied subjects and in the intact limb of TFA, the LP is significantly greater in the prosthetic limb. It can explain the lengthened swing phase on the prosthetic side of those subjects. The use of a microprocessor-controlled prosthetic knee allows the LP to be reduced. This LP appears to be necessary to insure the stability of the prosthetic knee. We suggest calling this time "confidence time."

This study evaluated the asymmetry of knee kinetics during uncomfortable gait induced by prosthesis misalignment to further demonstrate the compensatory function of the knee joint of the intact limb during gait. Three-dimensional gait analysis including knee kinematics and kinetics at the beginning of stance phase was conducted in 15 healthy subjects and 17 unilateral trans-tibial amputees (TTA) walking at self-selected speed in three conditions of prosthetic alignment: initial alignment (IA); initial alignment altered either by 6 degrees of internal rotation (IR) or by 6 degrees of external rotation (ER) applied on the pylon. Patients reported best comfort of gait in IA condition and discomfort mainly in IR condition. Maximum knee flexion and knee total work at power phases K0-K2 were significantly higher in intact limbs compared to prosthetic and control limbs. In intact limbs, these variables had significantly higher values (+10-35%, p

OBJECTIVE: Violence to disabled persons constitutes a major ethical problem. The European Academy of Rehabilitation Medicine has debated the matter; it presents this short report to alert a wider audience to the problem, with the aim of provoking debate and facilitating prevention. DESIGN: The Academy has produced a full report on the literature. The present short report summarizes the essential features of this and significant references to violence. This is defined, types described, and risk factors and signs identified with the aim of informing rehabilitation practitioners. CONCLUSION: Violence may take many forms, often being subtle, insidious and difficult to recognize. However, the members of the rehabilitation team may be able to provide significant help and act preventively as they work towards the better social integration of the disabled individual helping them gain more control of their lives. European legislation may help us in this task; we are reminded that our roles are set within the context of our civic duties of respect for and tolerance of all.

To evaluate the feasibility and safety of totally robotic laparoscopic cystoprostatectomy for neurogenic bladder, with intracorporeal ileal-conduit urinary diversion in tetraplegic patients with severe neurogenic bladder complications.Two men, 41 and 38 years old, with complete post-traumatic C7-C8 quadriplegia and poor lower urinary-tract condition underwent totally transperitoneally performed cystoprostatectomy and ileal-conduit urinary diversion with robotic assistance (Da Vinci).The procedures were completed without open conversion. The total surgical time was 9.25 and 6.75 hours, respectively. There were no intraoperative complications. In the postoperative period, both patients had mild complications (pulmonary and urinary infections) that were treated successfully medically. The postoperative hospital stay was 13 days in both cases.Our results demonstrate the safety and feasibility of robot-assisted laparoscopic cystoprostatectomy with ileal-conduit urinary diversion in two tetraplegic patients.

The objectives of this prospective study were: to search for mirror-induced disorders of the body image in right hemisphere stroke victims using a description task of the contralateral upper limb, to analyze their clinical features, and to discuss possible mechanisms. Sixteen consecutive patients with documented unilateral right hemisphere stroke were examined for asomatognosia at the acute phase of stroke, then at least 2 months after stroke under three test conditions: without a mirror, with a conventional mirror, with an inverted mirror. Video recordings of the tests were analyzed to assess performance. The diagnosis of asomatognosia was retained if the subject reported at least one of three sensations: limb transformation, limb strangeness, and/or limb alienation. During the acute phase, 14/16 patients presented manifestations of asomatognosia. All of these spontaneous manifestations had disappeared 2 months later, but were reactivated in 12 patients when exposed to mirror images. The mirror tests revealed four situations: no disorder (n = 4), asomatognosia with both mirrors (n = 5), asomatognosia with the conventional or inverted mirrors (n = 1 and 5), and asomatognosia with the inverted mirror (n = 1). These manifestations were designated as mirror-asomatognosia, a disorder resulting from adaptations of the procedures leading to reorganization of the internal representations of the body image. These findings suggest there are several such internal representations of the body image and that direct body image and mirror body image would be two specific ones. These clinical manifestations and their evolution over time are an expression of the progressive nature of the underlying compensatory mechanisms made possible by brain plasticity.

Foot anatomy and lower limb function were analyzed in 11 children (aged 6.5-12.5 y) 5 years after removal of one or two second toes for digital reconstruction. In addition to physical examination and x-rays, postural balance and three-dimensional measurements of gait were analyzed. Among the 15 operated feet, five had bridle scars, three had claw deformities of the third toe, five had pain in the first intermetatarsal space, and seven had overt or early-stage hallux valgus (including five after unilateral toe removal). Hallux valgus deformation was also observed in three nonoperated feet. Maintenance of balance and rate of displacement of the center of pressure when standing on one foot with eyes closed were significantly altered for operated limbs compared with nonoperated limbs. Gait was rapid because of increased step cadence. Foot progression angle and ankle and knee joint sagittal kinematics during walking were normal. Although children appeared to not be affected in their daily life by the removal of the second toe(s), related foot anatomic and functional modifications require further follow-up.

Objectives: To determine whether patches obscuring half the visual field affect eye movement in subjects with unilateral spatial neglect and whether there is consequent improvement in the subject's everyday life, and to interpret the potential changes observed with the aid of a theoretical model. Design: Prospective and randomized study. Setting: Rehabilitation medicine department in an urban general hospital. Patients: Twenty-two subjects with left unilateral neglect. Intervention: Two eye-patching procedures—right half-field patches ( n = 7) and right mononuclar patch ( n = 7)—and control group ( n = 8). Main Outcome Measures: Functional tests (FIM) and analytical tests (measurement of right eye movements by photo-oculography) at admission and after 3 months. Results: Results of the paired comparison tests showed (1) significant differences between the control group and the group with the half-eye patches for total FIM score ( p = .01) and the displacements of the right eye in the left field ( p = .02), and (2) no significant differences between the control group and the group with the right monocular patch. Conclusion: Patching the right half-field helped subjects initially regain voluntary control over the deficit. The actual interpretation is based on physiologic and psychophysiologic models.

Eye patching in unilateral spatial neglect: efficacy of two methods [Archives of Physical Medicine and Rehabilitation 1999;80:71-6]

The difficulties confronted by amputees during overground walking are rarely investigated. In this study, we evaluated, in real-world situations, the influence of ground surface on walking in young, active amputees by measuring temporal and spatial gait parameters (free walking speed [FWS], step length [SL], step rate), energy expenditure (EE) (e.g., oxygen uptake, oxygen cost [O(2)C]), and Rating of Perceived Exertion (RPE). Ten active transtibial amputees and ten nondisabled control subjects walked at self-selected speeds on three types of ground surface (asphalt, mown lawn, and high grass). No significant differences were observed between the two groups on asphalt and mown lawn. Differences between nondisabled subjects and amputees occurred for FWS (p = 0.03) and O(2)C (p = 0.04) on asphalt and mown lawn and for all variables in high grass. When amputees (even though very active) were exposed to a particularly difficult environment, their FWS decreased (p = 0.008) and their EE and RPE increased (p = 0.005) compared with nondisabled subjects. In high grass, both groups reduced their self-selected speeds (-15% for control subjects and -16% for amputees). Control subjects reduced their velocity by reducing both SL (-8.7%) and cadence (-7.1%), whereas amputees reduced their velocity by reducing SL (-17%) only.

Urinary diversion is a therapeutic option in quadriplegic patients with poor lower urinary tract conditions, but it is an invasive procedure. Laparoscopic techniques are less invasive, but are technically demanding, and only a few surgical teams are able to complete such a complex procedure endoscopically. Robotics bring an unprecedented control of surgical instruments, shorten the learning curve, and allow open surgeons to apply more easily their technical skill to the laparoscopic approach. This complex case of laparoscopic ileal conduit in a quadriplegic woman was completed by our team with the Da Vinci system after 6 months of clinical experience in robotic surgery.

Le granulome eosinophile de l'estomac est une affection rare a distribution geographique particuliere. Les auteurs rapportent un cas de granulome eosinophile a forme nodulaire, revele par une hemorragie digestive. L'interet de l'endoscopie est envisage dans la forme nodulaire de la maladie, la forme diffuse restant d'une approche diagnostique plus delicate.

Endarterial occlusion of carotid-cavernous fistulas using a balloon tipped catheter seems to be, at present, the best technique for the definitive treatment of the disorder without any sequela. A Fogarty catheter is placed in the internal carotid artery to reach the carotid siphon; the balloon is inflated at the orifice of the fistula and left there. Clinical results are excellent. In case of insufficient occlusion, a second balloon can be placed.

158 pneumoencephalographies of infants less than 2 years old were examined and 53 of them had a large cavum veli interpositi. A neuroradiological description of this cistern is given and a comparison made with injected anatomical specimens. A statistical comparison with 105 pneumoencephalographies without a cavum veli interpositi does not shown any correlation between the presence of this cistern and pathological conditions. This investigation indicates that a large cavum veli interpositi in the newborn has no relation to hydrocephalus or cerebral atrophy. The younger the child, the more frequent is the presence of this cistern, especially under eight months of age.

A technique for the extraction of intravascular foreign bodies, in particular ventriculoatrial shunt catheters which have migrated accidentally into the cardiac cavities, is described.

Deux patientes presentent des brulures epigastriques et une dysphagie apres absorption de bromure de pinaverium.

We review 258 cases of craniofacial vascular lesion treated by endovascular occlusion in the past 7 years in the Neuroradiology Departments of Nancy, Nantes, and Toulouse. Dural fistulas very often need both embolization and surgery. Craniofacial angiomas are not straightforward indications for therapy: the age of the patient, the unpredictability of evolution, and possible sequelae have to be taken into account; embolization is very successful in counteracting hemorrhage. Angiomatoses such as Rendu-Osler disease can respond well to repeated embolizations over several years. Lesions such as hemolymphangiomas are also excellent indications for embolization, either alone or with surgery. Occlusion by detachable balloon is ideally the most elegant method, but it is not always technically feasible, nor free from complications.

We review 258 cases of craniofacial vascular lesion treated by endovascular occlusion in the past 7 years in the Neuroradiology Departments of Nancy, Nantes, and Toulouse. Dural fistulas very often need both embolization and surgery. Craniofacial angiomas are not straightforward indications for therapy: the age of the patient, the unpredictability of evolution, and possible sequelae have to be taken into account; embolization is very successful in counteracting hemorrhage. Angiomatoses such as Rendu-Osler disease can respond well to repeated embolizations over several years. Lesions such as hemolymphangiomas are also excellent indications for embolization, either alone or with surgery. Occlusion by detachable balloon is ideally the most elegant method, but it is not always technically feasible, nor free from complications.