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Biomedical subjects

B Fleury

Publications and source records attributed to B Fleury.

At least 73 records · Page 4Linked to original sources
PubMed1990

[Clinical results of the surgical treatment of 1222 cases of chronic snoring].

Uvulopalatoplasty was performed (whether or not associated with tonsillectomy and/or septoplasty) in 1,222 cases of chronic rhonchopathy. Among them, 65 cases consisted of pre- and postoperatively registered sleep apnea syndrome. Clinical results were assessed on improvement of preoperative snoring, apneas, morning asthenia, daily sleepiness. Surgery was totally successful in 50% of cases, partially in 35%. Failure was encountered in 15% of cases. Failure or partial improvement are related to the preoperative presence of one or several of five particular risk factors: neck shortness, tongue hypertrophia, retrognathia, obesity and nasal pathology. Surgical complications were rare. Severe rhinolalia occurred in five cases: only three of them were sufficiently to accept plastic reconstruction which was successful.

Adult↗
PubMed1990

[Physiopathologic value of cephalometric teleradiography study and magnetic resonance imaging in sleep apnea syndromes. Therapeutic deductions].

A cephalometric study was carried out on 98 patients assigned to 3 groups including 48 patients with sleep apnea, 25 patients with chronic rhonchopathy without apnea, and 25 controls, respectively. 44 patients benefited from lateral teleroentgenographic investigations and 54 had sagittal-median NMR sections visualized. Various distance, angle and area measurements were obtained. The authors found that anomalies were the more severe that snoring was associated with sleep apnea. These arguments speak for an evolutional character of the disease. The various cephalometric anomalies were primarily related to the hyoglossal apparatus, more rarely to the maxillary-mandibular basal bones. After this analysis, the authors propose a therapeutic strategy for the management of chronic snoring associated with sleep apnea.

Cephalometry↗
PubMed1990

[New analysis of the results of uvulo-palato-pharyngoplasty in sleep apnea syndromes. Apropos of 65 cases].

65 cases of sleep apnea syndrome due to undergo uvulo-palato-pharyngoplasty were subjected to pre-operative and then post-operatoire, after 3 months, polysomnographic recording. The authors analysed the results as a function of several criteria of success described in the literature: postoperative apnea index less than 10%, less than 20% and less than 50% of the pre-operative apnea index. They found a success rate approximately 50%. The importance of the apnea index and pre-operative weight were the only factors predicting the results of surgery. However, the spread in individual values did not allow completely reliable criteria to be established.

Adolescent↗
PubMed1990

The transition between apnoea and spontaneous ventilation in patients with coma due to voluntary intoxication with barbiturates and carbamates.

We have investigated the transition from apnoea to spontaneous breathing in five comatose patients self intoxicated with barbiturates and carbamates. All patients were apnoeic on admission, and were studied throughout the course of recovery. The transition between the first respiratory movements and a stable and nearly normal ventilation (stable respiratory activity) ranged from 15 to 105 min, a very short time compared to the duration of the apnoeic state that lasted 6 to 72 h from admission. Minute ventilation and occlusion pressure during the first respiratory movements were 6.3 +/- 2.7 l.min-1 and 1.35 +/- 0.45 kPa, respectively. These values increased by roughly 50 and 100% by the time stable respiratory activity was achieved. The increase in minute ventilation was entirely due to an increased inspiratory flow, in relation to a proportionate increase in occlusion pressure, and without significant changes in the respiratory times or in the effective elastance. We conclude that the transition between apnoea and stable respiratory activity is characterized by its rapidity, by the fact that respiratory times are fixed throughout the recovery process, and by the fact that effective elastance is high.

Adult↗
PubMed1989

[Echocardiography in anorexia nervosa].

The echocardiographic parameters of 10 patients with anorexia nervosa were studied at the time of admission and compared with those of 10 matched controls. There was a decrease of ventricular volumes and of the calculated left ventricular mass, but the haemodynamic values at rest showed a normal "pump function". The left ventricular mass correlated with the body mass, which indicates that the heart of anorectic patients is also involved by malnutrition. Two patients had asymptomatic mitral valve prolapse. These results are in agreement with the few published studies which report deep cardiac alterations with decrease of heart cavities volumes and reduction of wall thickness and myocardial mass. This results in altered exercise performance, despite a satisfactory haemodynamic status at rest. The high frequency of mitral valve prolapse due to disproportion between ventricle and valve must be noted.

Adolescent↗
PubMed1989

[Mortality of dilated myocardiopathies as a function of continuation of alcohol drinking. Multivariate analysis concerning 236 patients].

A retrospective study was conducted in 236 consecutive patients with dilated cardiomyopathy to determine the characteristics of the disease in heavy alcohol drinkers (n = 110) and to study its outcome, using a Cox model, according to whether the patients were abstainers (n = 49) or continued to indulge drinking (n = 61). At the time of diagnosis, pulmonary pressures were higher in heavy drinkers than in abstainers. During a mean follow-up period of 39 +/- 27 months, 80 patients died of heart disease, viz.: 46 out of 127 non-alcoholic patients (36.2 per cent), 31 out of 61 heavy drinkers (50.8 per cent) and 3 out of 49 patients who had given up alcohol (6.12 per cent). Thus, independently of other parameters, abstinence is a highly significant (P less than 0.001) factor of favourable prognosis in dilated cardiomyopathy.

Adult↗
PubMed1989

Cervical magnetic stimulation: a new painless method for bilateral phrenic nerve stimulation in conscious humans.

Assessing diaphragmatic contractility is a common goal in various situations. This assessment is mainly based on static or dynamic maximal voluntary maneuvers and twitch transdiaphragmatic pressures (Pdi) obtained by stimulation of the phrenic nerves (PS). PS eliminates the central components of diaphragmatic activation, but the available techniques of PS remain subject to some limitations. Transcutaneous PS is painful, and needle PS is potentially dangerous. Time-varying magnetic fields can stimulate nervous structures without pain and without adverse effects. In six subjects, we have studied cervical magnetic stimulation (CMS) as a method of PS. We have compared the stimulated Pdi (Pdistim) with the maximal Pdi obtained during static combined expulsive-Mueller maneuver (Pdimax) and with the Pdi generated during a sniff test (Pdisniff). CMS produced twitch Pdi averaging 33.4 +/- 9.7 cmH2O. Pdistim/Pdimax and Pdistim/Pdisniff were 24 +/- 6 and 41 +/- 14%, respectively. These values are comparable to those obtained in other studies with transcutaneous PS. They were highly reproducible in all the subjects. Electromyographic data provided evidence of bilateral maximal stimulation. CMS is a nonspecific method and may stimulate various nervous structures. However, diaphragmatic contraction was elicited by stimulation of the phrenic trunk, since the phrenicodiaphragmatic latencies (less than 7 ms) were in the range of values reported with direct stimulation of the trunk. Cocontraction of neck muscles, including the sternomastoid, was present, but its influence in the CMS-induced Pdi seems minimal. We conclude that magnetic stimulation is an easy, well-tolerated, reproducible safe, and valuable method to assess phrenic conduction and diaphragmatic twitch response.

Action Potentials↗
PubMed1989

[Effects after 3 months of uvulopalatopharyngoplasty in the treatment of obstructive sleep apnea syndromes in adults].

The results at three months of uvulopalatopharyngoplasty (UPPP) have been evaluated in thirty adult patients with an obstructive sleep apnoea syndrome (SAOS). For the group overall the mean apnoea index (IA) decreased from 57 apnoeas per hour and the mean maximal desaturation decreased to 60% post operatively. However in the overall results different individual facts overlap. 20 of the 30 patients, or 67%, have an IA post operatively of less than 50% of the pre-operative value (responders). 14 of these or 47% have a post operative IA of less than 10 apnoeas per hour, a value considered as non pathological. Finally 33% of the patients have no improvement in their post operative IA (non responders). A stricking diminution of nocturnal desaturation and of the disorganisation of sleep was seen in responders to UPPP. No predictive factor for the results of UPPP could be determined. This study shows that UPPP is an effective treatment in a large number of patients having SAOS at the price of minor and transitory complications.

Adult↗
PubMed1988

[Cervical magnetic stimulation. A new method of bilateral phrenic nerve stimulation for use in clinical practice].

The stimulation of the phrenic nerves in the neck is one of the techniques for the examination of diaphragmatic contractility. Current methods are restricted by their painful (transcutaneous stimulation) or even potentially dangerous nature (needle stimulation). We have tested both the feasibility and the validity of using magnetic stimulation (SMC) to stimulate the phrenic nerves. This method is painless and devoid of any side effects. Three healthy subjects have been studied using an EMG and transdiaphragmatic pressure measurements (Pdi.) Pdi values obtained by SMC (36.5 +/- 13.5 cm H2O) and their relation to maximal Pdi (22.6 +/- 7%) and to the Pdi at the time of maximal sniff-Pdi sniff (34.7 +/- 8%) were comparable to those values obtained using other methods and were reproducible. The preliminary results show that SMC is a technique for the study of the phrenic nerve and diaphragm which has the advantage of simplicity in use, is repeatable and is completely innocuous.

Adult↗
PubMed1988

[Results of uvulopalatopharyngoplasty in sleep apnea syndromes. Apropos of 33 cases].

Thirty-three patients with the sleep apnea syndrome were operated upon by uvulopalatopharyngoplasty and clinical and multiple sleep recording findings compared at follow up after 3 months. No exact correlation was noted between the clinical condition and recordings during sleep. The only predictive criterion for the result of this operation is the preoperative weight, and this procedure is proposed as a routine treatment as long as no better method exists to determine the obstructive site. Therapy of the sleep apnea syndrome is described.

Adult↗