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Biomedical subjects

G Foucher

Publications and source records attributed to G Foucher.

At least 181 records · Page 10Linked to original sources

Three-phase bone scanning in reflex sympathetic dystrophy of the hand.

Three-phase bone scanning was performed in 181 patients suffering from reflex sympathetic dystrophy (RSD) of the hand. Four quantitative parameters were defined as follows: (a) hemovelocity and (b) blood pool (determined from the Fourier processing of angiographic data); (c) early (3-5 min) and (d) delayed (2-3 hr) bone fixation. Three significant stages of RSD were demonstrated scintigraphically. Stage I (0-20 wk from onset) demonstrated increases in velocity, blood pool, and early and delayed fixations. At stage II (20-60 wk) blood velocity and blood pool were normalized, but early and delayed hyperfixation persisted. During stage III (60-100 wk) blood velocity and blood pool were reduced on the affected hand, and early and delayed fixations were normalized. Such abnormality of decreased hemodynamic parameters may become associated with bone hypofixation in stage III. Early treatment of RSD (as compared with delayed treatment) has been demonstrated to induce normalization of hemovelocity (p less than 0.05), blood pool (p less than 0.02), and joint stiffness (p less than 0.001) without any change in the bone fixation; therefore, three-phase bone scanning may provide useful information regarding the pathophysiologic and clinical evolution of RSD.

Bone and Bones↗

[A multidisciplinary approach to algodystrophy of the hand].

A multidisciplinary approach for the management of reflex sympathetic dystrophy at SOS Main of Strasbourg has been progressively adopted due to the severe functional sequelae of this disease. The TC99 bone scan in three phases has allowed us after a one week duration of the symptoms to make an early diagnosis and to start dynamic splinting in flexion. Our study compares two groups of patients, one with an early treatment and the other with delayed treatment. It shows a correlation between the stiffness of the affected hand and the isotopic findings. The benefit from an early dynamic splinting in flexion as evidenced by a clinical improvement is corroborated by the bone scan.

Combined Modality Therapy↗

Free compound transfer of the distal interphalangeal joint. A case report.

The first case of free vascularized transfer of a distal interphalangeal (DIP) joint, used to replace a severely damaged proximal one, is presented. The case is interesting not only for the procedure used, but it also illustrates the principle by which useful components of nonsalvageable digits are used to reconstruct other damaged, but still salvageable, parts of the hand.

Adult↗

Joint reconstruction following trauma: comparison of microsurgical transfer and conventional methods: a report of 61 cases.

Joint reconstruction at the metacarpophalangeal or proximal interphalangeal levels remains a difficult problem in hand surgery. The authors reviewed sixty-one joints reconstructed acutely or electively allowing to compare Swanson spacer (30 joints), interpositional arthroplasty (4), non vascularized joint transfer (5) and vascularized joint transfer (21). Among these, two different techniques have been used: island compound transfer from a finger bank (10) and free vascularized transfer from the second toe (10) or from a non replantable finger (1). It is not worth while comparing different techniques applied to different indications. The only point which can be stressed is the better average range of movement of metacarpophalangeal reconstruction compared to that obtained at the proximal interphalangeal level.

Arthroplasty↗

Sarcoid tenosynovitis in the hand. A case report and literature review.

We report a case of involvement of a finger flexor tendon by sarcoidosis. A review of twelve cases suggests that this is a rare manifestation of the illness that most often affects the finger extensors at the wrist. It tends to present in established sarcoidosis and is associated with a higher than usual incidence of polyarthritis. The main differential diagnosis would be tuberculous tenosynovitis. We suggest that a histological spectrum exists running from a predominantly cellular picture to one of fibrotic nodules, perhaps explaining previously described instances of pseudo-tumour. We would recommend tenosynovectomy in conjunction with corticosteroid therapy as the treatment of choice.

Female↗

Distal replantation.

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Amputation, Traumatic↗

[Carpal tunnel syndrome: clinical and electrologic forms. Results after neurolysis (88 cases)].

Eighty-eight neurolyses of the median nerve in the carpal tunnel were performed. Clinical, anatomical and electrological characteristics allowed to classify the carpal tunnel syndromes in painful and dysesthesial type, in types with progressive (electromyographical, clinical, complete, incomplete) or acute hand muscle atrophy. After neurolysis, clinical and electrological results were analysed and correlated with initial severity of the chronic median nerve entrapment in the carpal tunnel.

Carpal Tunnel Syndrome↗

Three phase bone scanning as an aid to early diagnosis in reflex sympathetic dystrophy of the hand. A study of eighty-nine cases.

In reflex sympathetic dystrophy, three phase radionuclide bone scanning with Tc-99m methylene diphosphonate is preferred. The first phase corresponds to the dynamic behavior of the tracer. After appropriate data processing (by Fourier's analysis), three functional images may be obtained. The second phase corresponds to the tissues fixation of the tracer 5 to 10 minutes after the injection. Based on the results of 89 cases of post-traumatic or postsurgical reflex sympathetic dystrophy observed in 128 patients investigated with this method, diagnostic sensitivity was 96%, while specificity was 86%. The scintigraphic patterns observed during the 100 week period after the initial trauma demonstrate the precocity and the significance of circulatory and tissues phenomena as well as their variations according to treatment. The scintigraphic criteria of regression or stabilization of disease are discussed.

Adolescent↗

Out-patient hand surgery. A prospective study of 588 patients.

The results of a prospective study of 588 patients operated on over a period of 4 months were analyzed. Of these patients, 6% only had to be hospitalized. The 555 other patients underwent out-patient surgery, 25% of which were emergencies. Thirty-four % of patients had one or more preexisting serious medical conditions. Ninety-one % underwent regional anesthesia. Complications were rare and did not seem to be preventable by hospitalization. While highlighting the many advantages associated with out-patient surgery, the authors stress the guidelines which must be followed as well as the pitfalls to be avoided in ambulatory surgery of the hand.

Adolescent↗

[Revascularization of digital avulsion injuries caused by rings].

The authors describe an original technique of ring fingers revascularization, avoiding two chief dangers met in the double vein grafts: the one of the joint and tendinous devascularization with its risks of stiffness, and the other one of the devascularization of the skin sheath with secondary necrosis or trophic trouble. The worse artery is resected and the defect is bridged by a long venous graft, the skin of the distal fingers being provided by the backflow.

Finger Injuries↗

Fractures of the hook of the hamate.

Fractures of the hook of the hamate are rare injuries. Six new cases are presented; the most usual mechanism is probably a direct blow to the area of the hook. The diagnosis, which can only be made by special roentgenographic techniques is usually missed at the acute phase. Most of the cases are diagnosed when painful non-union, fraying tendinitis of the flexor tendons to the ulnar fingers, ulnar or median nerve deficits appear. The adequate treatment is usually excision of the hook fragment.

Adult↗

[Hueston's flap for reconstruction of loss of distal thumb substance].

The classical rotation flap described by J. Hueston involves the advancement of a denervated skin area on the distal stump. In distal amputations of the thumb, this flap should only be used on the lateral side in order to avoid creating a blind medial pulp. Furthermore, this leaves a proximal skin defect thereby exposing the neurovascular bundles. This secondary defect is best covered by a lateral triangular rotation flap.

Humans↗