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Biomedical subjects

F Langlais

Publications and source records attributed to F Langlais.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Socio-professional evaluation of 184 patients with hand injuries treated at an emergency microsurgery service].

184 consecutive patients were operated for severe industrial injuries of the hand. Microsurgical techniques were used in 86% of cases, with 41% of replantation (with about 1/3 of failures), and revascularization, and 17% of sutures of median and ulnar nerves. These patients were examined by medical experts from the French National Health Service, independently of their surgeons, in order to determine under which conditions they could resume their professional activities (changes of their working conditions or not, reduction in their wages or not, etc.). Moreover the duration of work interruption, as well as the percentage of professional disabilities, were known for more than 90% of the 115 patients who underwent an official assessment. The average percentage of professional disability was 19%, whereas without specialized surgery it used to be roughly 30 to 40% for the same lesions. The value of microsurgical techniques was obvious when considering the ability of the patients to resume their previous activities, especially as 96% of them were manual workers. Only 12% of the patients did not resume their work (5% were unemployed, and 7% retired or were too disabled to work). 18% were able to return to work, but with modifications of their working conditions or their wages. But, most important, 70% of the patients resumed their previous work with the same pay. On average, they had to stay for ten days in the surgical department and had to stop work for 3 months. This may be due to our great concern with early rehabilitation, aimed at manual work, with early transfer of patients to specialized rehabilitation centers.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Occupational↗
PubMed1990

Comparative study of gentamicin release from normal and low viscosity acrylic bone cement.

The pharmacokinetics of gentamicin were studied after total hip joint arthroplasties in 2 groups of 10 patients. The prosthesis was performed in the first group with 'Palacos R plus gentamicin' (normal viscosity), manufactured by Schering, and in the second group with 'Cerafix genta R' (low viscosity) manufactured by Ceraver-Osteal. Both cements included similar concentrations of gentamicin. Urine was collected at 12-hour intervals for 15 days after operation, and drainage fluids for 48, 72 or 108 hours. Blood samples were taken 3 and/or 5 hours after prosthesis implantation. In both cases, high concentrations of gentamicin were found in drainage fluids and urine during the early postoperative period. Mean gentamicin excretion curves were calculated by a computer-aided design program (SIAM) for the 2 cements. The release of gentamicin was biphasic in both cases, although the slow elimination phase appeared to be longer for 'Cerafix'. In the first postoperative period, the drug had a better bioavailability during the rapid elimination phase in the case of 'Palacos'. The calculated peak blood concentration was in the same range for both compounds. The conclusion is drawn that, in patients undergoing total hip joint arthroplasties, gentamicin concentrations reach local levels higher than the minimum inhibitory concentrations of most of the likely sensitive pathogens. However, in both cases, as blood concentrations appear to be low, patients will not be protected against systemic infections. Both cements have similar antibacterial properties but the mechanical properties of 'Cerafix' are the better of the two.

Adult↗
PubMed1989

Early mobilisation after primary flexor tendon repair in 152 fingers (excluding zone II) and in 60 thumbs. "France Ouest Main Service".

The results of classical treatment (suture plus immobilisation) and of Kleinert's technique (suture under magnification with early semipassive movement), were compared in 290 primary flexor tendon repairs. The site of injury and the nature of associated injuries were the major prognostic factors. Kleinert's rehabilitation program was of particular value when a large range of movement was needed in simple lesions of zones III and IV. When tendon rupture must be avoided and preservation of strength is more important than achieving a full range of movement, immobilisation after an atraumatic suture is preferred.

Adult↗
PubMed1989

Allografts of the hemipelvis after tumour resection. Technical aspects of four cases.

Four en-bloc resections for malignant tumours of the hip, the peri-acetabular region and the iliac wing were reconstructed using an irradiated hemipelvic allograft together with a total hip prosthesis. Technical aspects include the use of an anterior Enneking approach which excises the previous biopsy site, division and re-attachment of the iliac crest and fixation of the prosthesis using a modified acetabular cup and three polypropylene artificial ligaments to increase the stability of the joint. Weight-bearing was allowed at three months. The oncological and clinical results were satisfactory after a mean follow-up of 19 months, with walking distances of 500 metres to two kilometres without pain.

Adult↗
PubMed1989

Release of gentamicin from acrylic bone cement.

The pharmacokinetics of gentamicin were studied after total hip joint arthroplasties performed with "Palacos R plus gentamicin' in 10 patients. Urine was collected at 12-hour intervals for 15 days after operation, and drainage fluids for 48, 72 or 108 hours. Blood samples were taken 3 and/or 5 hours after prosthesis implantation. High concentrations of gentamicin were found in drainage fluids. Excretion curves in drainage fluids or urine were fitted by a computer-aided design program (SIAM) and the mean curves established. Elimination of gentamicin was biphasic in both cases. The rapid phases had a half-life of 2.97 hours in drainage fluids and 7.16 hours in urine. Half-lives of the slow phases were 13.5 and 47.12 hours, respectively. The mean percentage of total gentamicin released by the two routes was 5.78% of the quantity implanted. The calculated peak blood concentration was 0.12 mg/L. It is concluded that gentamicin concentrations locally reach levels higher than minimum inhibitory concentrations of most of the likely pathogens in patients undergoing total hip joint arthroplasties with "Palacos R plus gentamicin' bone cement. However, as blood concentrations appear to be low, patients may not be protected against systemic infections.

Adult↗
PubMed1988

[Antibiotic-loaded orthopedic cements. Pharmacokinetics and bone level].

A mechanical study in the laboratory of 10 types of cement has shown that the characteristics of low viscosity antibiotic-loaded cements are comparable with those of standard cement without antibiotic and of standard viscosity. A study of the release of Gentamycin in 26 patients treated by total hip replacement showed that the concentration of antibiotic in the drainage fluid was much greater than the minimum inhibitory concentration whereas the low blood concentration gave no risk of ototoxicity or nephrotoxicity. This method of administration achieved antibiotic concentrations in the tissues in contact with the prosthesis 10 times greater than those obtained by injection. In sheep, the intra-osseous concentration was studied in 32 femora after insertion of low viscosity Gentamycin-loaded cement. The levels remained raised to 4 times the minimum inhibitory concentration for up to one year after operation, even with cements with a low concentration of antibiotic of 0.6 g/dose. The concentrations obtained in the drainage fluid, in the peri-prosthetic tissues and especially in bone, confirm the effectiveness and the prolonged action of antibiotic therapy by cement and its value in the revision of infected prostheses and in prophylaxis in primary surgery. This justifies the further study of combinations of cement with new antibiotics with a broader spectrum than Gentamycin since there is no concern with the cements currently in use that the mechanical quality is less than that of standard cement.

Animals↗
PubMed1987

[Comparative study of ketoprofen and pethidine in severe postoperative pain].

A double-blind study was conducted to compare the efficacies of a non steroid antiinflammatory drug (ketoprofen) and a central analgesic drug (pethidine). The series included 59 patients who had undergone especially painful joint surgery (knee arthrolysis and ligamentoplasty, carpal or foot surgery). Main pain relief as assessed by the patients was the same in both groups (67% with ketoprofen or 63% with pethidine). It lasted the same length of time in both groups: 9.2 h with ketoprofen and 8 h with pethidine. An identical efficacy was observed in the most painful surgery, i.e. arthrolysis (efficacy 57% for a period of 8 h in both groups), as well as in the better tolerated procedure, i.e. carpal surgery; in this case, however, the pain relief seemed to last longer with the ketoprofen (10 h) than with the pethidine (8 h). Ketoprofen probably acts more through its central analgesic effect than its antiinflammatory effect. It has few side-effects. It does not have the risks of respiratory depression or tolerance unlike the opiate drugs. This drug could therefore be interesting in elderly patients and in surgical procedures where the active participation of patients is required for early rehabilitation, e.g. joint mobilization.

Double-Blind Method↗
PubMed1987

[Weight-bearing early after osteosynthesis of the femoral neck by nail-plate (100 cases)].

One hundred trochanteric or transcervical fractures, 64 of which were in patients more than 75 years old, were treated by internal fixation with a THS nail-plate. This device is characterised by a better bending strength than a one-piece nail-plate and a design which limits the risk of displacement of the screw in the head so that immediate weight-bearing can be allowed. Weight was borne on the limb in 81 cases at the tenth post-operative day. It did not improve the mortality, there being 17 deaths by the third month but it greatly helped post-operative care and rehabilitation without producing any additional complications. As a result, 43 per cent of patients could return home by the 45th post-operative day and 74 per cent had recovered their previous level of autonomy within three months of operation. There were only four mechanical complications, all in transcervical fractures: one crack fracture in the femoral head and three displacements following inadequate reduction, treated by prosthetic replacement. The follow-up of 80 patients at three months showed that consolidation always developed between the 45th and 90th day with full weight-bearing and a stable radiological picture. There was no intra-articular penetration or bending of the screw and no break-out of the implant. Whilst it is a definite advance in the treatment of trochanteric fractures, a longer follow-up is needed to determine its place compared with prostheses in transcervical fractures.

Aged↗
PubMed1986

[Preservation of the limbs in osteosarcoma and other primary tumors of bone].

Resection of primary malignant bone tumours, followed by reconstruction and functional preservation of the limbs, seems to give oncological results that are at least equivalent to those of radical amputation surgery. The psychological and functional benefits are obvious: 30% of the patients operated upon recover with a very satisfactory function and resume professional activities or even games; 60% revert to their previous familial and social activities, and 10% only remain severely handicapped. However, numerous problems still have to be solved: the value of this conservative surgery must be demonstrated statistically; the incidence of its complications, notably in the knee, must be reduced; the fate of homografts must be known; its indications must be extended by improving its results in areas where these are still uncertain (e.g. pelvis, lower end of the leg) or functionally mediocre (shoulder). Only comparisons within study groups, either national (such as the PETAL group), or international (such as the Muscule Skelatal Tumor Society), can provide positive answers in a field where question marks are more frequent than certainties.

Arm↗
PubMed1986

[Primary suturing of zone II flexor tendons (103 digits). Results and Kleinert's limitations].

One hundred and sixty-two instances of traumatic division of the flexor tendons in zone 2 occurring in 103 injured digits were studied in 88 patients with at least 6 months follow-up. Motion and sensibility studies as well as trophic evaluation were available for all patients. Sixty-eight patients underwent repair according to Kleinert's technique. Overall results in these cases showed a 58% rate of "satisfactory" results versus 34% when classic techniques had been employed (35 cases). Kleinert's technique afforded the highest percentage of "good" results (75%) when tendon division was isolated whereas the rate of "good" results dropped to 23% when the injury went through to the floor of the digital tunnel. Complications included joint stiffness due to adhesions (19%) mainly related to the magnitude of the initial trauma, fixed flexion deformities (15%) and secondary rupture of the tendon (7%). Excision of the superficial flexor tendon was invariably associated with a poor results. Secondary treatment of these lesions was disappointing. While we agree that Kleinert's operative technique be used whenever feasible, semipassive mobilization as indicated by Kleinert, should however be reserved for isolated lesions in cooperative patients treated in centers where closely supervised rehabilitation is available. Immobilization of the interphalangeal joints in flexion together with their separate passive mobilization according to the method of Duran and Strickland, may reduce the number of complications observed with Kleinert's technique in the following circumstances; severe lesions (groups 3 A, 3 B), inadequate healing, an uncooperative patient. It is of paramount importance to look for and repair concomitant nerve injuries. Inadequate nerve management alone in these circumstances can account for up to 25% of overall functional failures. When bilateral vascular lesions are present, it is essential that vascular repair of the digital arteries be performed at once. Unilateral arterial insult does not seem to significantly affect results in terms of active motility.

Evaluation Studies as Topic↗
PubMed1986

[Reconstruction prosthesis of the upper part of the femur. Intermediate results in 20 resections for tumor. Current trends].

Twenty total hip prostheses inserted after massive resection of the upper part of the femur for tumour have been reviewed after a 3 year mean follow-up. Fifteen cases were of primary malignant tumour. The mean resection of the femur measured 175 mm in length and was reconstructed using Cochin prostheses. From the oncological standpoint, the results were comparable with those obtained after disarticulation of the hip, but the functional results were, of course, much better. Five patients were able to resume their previous professional work; 13 were able to have a normal type of life and only 2 were severely crippled. Nineteen hips were painless. Nine patients could walk without a stick, 9 used one stick for walking outside and 2 used sticks permanently. Two cases were complicated by dislocation. Despite an extensive resection of the greater trochanter, one third of the hips were stable on standing on one leg, thanks to the design of the prostheses. No prostheses broke. Two loosenings of the acetabular cup had to be revised. No loosening of the femoral stem was found, despite the frequency of osteolysis of the diaphysis to 4-5 cms below the level of resection. The authors intend now to improve the design of the prostheses and to aid the reinsertion of the muscles, which can be improved by using homografts surrounding the femoral prostheses.

Femoral Neoplasms↗
PubMed1985

[New biomaterials in orthopedics].

To develop new materials for articular prostheses seems particularly desirable since at present these do not appear to last for more than 1 or 2 decades. Improvements in our knowledge of prosthesis degradation has resulted in new, so-called "biomaterials" being proposed to cope with the various factors involved in disinsertion of artificial joints, viz, body tolerance to debris from wear or corrosion (biocompatibility), mechanical properties of the material, such as resistance to fatigue and wear and elasticity (biocompetence) and mechanical principles underlying arthroplasties (biomechanics). Current trends therefore are towards titanium alloys which are both resistant and similar to bone in elasticity, towards friction torques producing fewer or better tolerated debris (aluminium-coated polyethylene) and towards better means of fixation. Owing to the great complexity of tolerance mechanisms and to the functional character of orthopaedic surgery, very stringent testing is required before new products are in clinical use. While these products are slowly made available to surgeons, many significant improvements in existing materials (polyethylene and cements) are being achieved.

Aluminum Oxide↗