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Biomedical subjects

L Sedel

Publications and source records attributed to L Sedel.

At least 109 records · Page 6Linked to original sources
PubMed1988

Duchenne-Erb palsy. Experience with direct surgery.

Between 1973 and 1984, 31 direct explorations of traumatic Duchenne-Erb palsy (C5 and C6) were performed in two hospitals. Simple neurolysis was performed in 12 cases, in which C5 and C6 were found to be in continuity; the operation resulted in useful motor function in nine of the 12 cases. A cause-and-effect relationship of neurolysis to the recovery of function was difficult to prove. In five cases where only one root was completely damaged, four nerve graftings produced useful motor results but the function of one graft was not demonstrable when the other root was in continuity. In 14 cases of complete lesions of both C5 and C6 treated by nerve grafting, there were seven functional motor results that were attributable to the grafts. Both the overall results and the result of elbow flexion were statistically correlated with the number of grafts used to repair the corresponding nerve structure (p less than 0.01). Favorable results were not obtained when the graft had been delayed for more than nine months. All of the patients who had nerve grafts within five months had favorable results.

Adolescent↗
PubMed1988

Repair of severe traction lesions of the brachial plexus.

Since 1972, the author has performed 259 brachial plexus repairs and various associated secondary procedures. The best results were obtained with surgery delayed four to five weeks, because the preoperative assessment of the lesion is more accurate after wallerian degeneration has occurred. In addition, formation of a proximal neuroma allows definition of the exact limits for resection. In cases with associated vascular damage, the vessels should be repaired at the same time as the nerve grafts unless there is severe ischemia. Intraspinal exploration with cervical laminectomy is not justified because intraspinal avulsion is always due to rootlet avulsion. Division of the clavicle to facilitate exploration of the anatomy of the plexus where it is the most complex is advocated. In general, distal grafting allows the recovery of a single function, which is preferable to an attempt at total anatomic repair. The adverse effects of contractions must be avoided. The priority of restoration of functions is an important consideration. Elbow flexion should be the first priority, followed by wrist extension, finger flexion, and shoulder abduction, in that order. The results of grafting may be improved by ancillary operations such as shoulder fusion, flexor tendon tenodesis, humeral derotation, and other procedures that provide limited function for patients with various incomplete and complete avulsions. Microsurgical repairs of brachial plexus lesions currently offer the best results for patients with this type of injury.

Brachial Plexus↗
PubMed1988

[Thoracobrachial outlet syndrome. Apropos of 21 surgical cases of a neurological form].

The authors review the literature in reference to 21 cases of thoracic outlet syndrome, essentially of neurological nature. The diagnostic means are essentially clinical with various techniques demonstrating vascular and neurological signs. They stress the advantages of electromyography in normal position or in abduction, showing in half of the cases, positive signs. Finally, X-ray examination demonstrates a congenital bony abnormality. In severe forms resisting to neurological treatment, the treatment advocated is surgery. The approach is high supra clavicular, and the brachial plexus is freed, on request, from the bony, musculotendinous and/or fibrous elements compressing it. Long-term results are usually good and the authors have noticed the correlation between the immediate post-operative disappearance of the pain and the final result.

Adolescent↗
PubMed1987

Spherocylindric (Luck) cup arthroplasty for osteonecrosis of the hip.

Osteonecrosis (ON) in young adults is a serious condition causing pain and functional disability. Thirty-eight hips with ON were treated, beginning in 1972, with a spherocylindric cup (SCC) derived from the original Luck. The mean follow-up time was six years, 11 months (minimum, one year; maximum, 12 years). The overall results, using the Merle d'Aubigne grading system, were excellent in four, very good in nine, good in nine, fair in one, and failure in seven. No acetabular protrusio was observed. The seven failures were associated with deep infection in one case and unsatisfactory technique in three. One failure was unexplained, except that the ON was Grade IV. Two failures occurred in one patient with predisposing factors, such as hyperlipidemia, hyperuricemia, and exogenous hypercortisonism. Although the results are not as satisfactory as those of total hip arthroplasty (THA) with respect to relief of persistent pain, some patients remain stable with time even after more than ten years. With correct indications and good surgical technique, SCC arthroplasty is a justifiable alternative to THA in young adults.

Adolescent↗
PubMed1986

Semi-automatic image-analysis applied to the quantification of bone microstructure.

Bone microstructure can be quantified by methods ranging from simple manual techniques to fully automatic image analysis systems. We describe a semi-automatic method, developed in BASIC and running on a laboratory microcomputer. Its core is based on two special algorithms for image conversion and for calculation. These two algorithms produce quantifying characteristics for any irregularly shaped structure, as defined by one or more open or closed contour lines. The quantification of these structural parameters relies only on contour line digitization. The improved efficiency of this semi-automatic method is a consequence of combining automatic calculations and human assistance. The structural parameters chosen were for a specific research project; the correlation between mechanical and microstructural properties of cortical bone, but they may readily be changed as circumstances demand.

Biomechanical Phenomena↗
PubMed1986

[Modern technics for studying injuries of the lumbo-ischiatic plexus. Apropos of a new case].

A 22 year old patient was admitted with multiple lumbosacral root meningoceles following a motorbike accident. Because of the marked neurologic deficit in left lower limb a radiculographic exploration was completed by a CT scan, with improvement in analysis of images, post-traumatic pseudo-meningoceles being neither an absolute proof nor the unique lesion responsible for the clinical picture. They may be missing whereas the root is absent. Combining these two examinations provides for total screening of lesions and more selective choice of therapy.

Accidents, Traffic↗
PubMed1985

The surgical management of nerve lesions in the lower limbs. Clinical evaluation, surgical technique and results.

The author present his experience of the repair of nerve lesions in the lower limb. The cases are classified into four main groups: traumatic lesions; acute and chronic compression; tumours and leprosy. The traumatic lesions include those associated with a clean wound, missile injuries, traction injuries and a miscellaneous group. The diagnosis and treatment of the different lesions are discussed. The results of nerve grafting using microsurgical techniques are presented. The results are good enough, even in severe traction injuries, to recommend the repair of nerve lesions of the lower limbs in the circumstances which are outlined.

Adolescent↗
PubMed1985

[Cervical myelography and x-ray computed tomography in arm paralysis of traumatic origin].

Results of cervical myelography by the lumbar approach were compared with those of CT scan imaging after subarachnoid metrizamide by the lumbar route, in 16 patients operated upon for post-traumatic cervical spine lesions. Examination in each patient included the last four cervical and first thoracic roots on the injured side, making a total of 80 roots. Lesions detected by myelography and CT scanning are described, comparison of semiologic data with gross findings at operation showing poorer diagnostic accuracy for myelography (86%) than for myelography and a CT scan combined (97%). Sensitivity of the former varied between 70 and 90%, depending on whether doubtful forms were classed as normal or pathologic, but was lower than that of the CT scan (96%). This also applied to specificity (90% as against 96%) and diagnostic accuracy (86% to 90% as against 97%). Combining myelography with a CT scan after subarachnoid contrast injection provides complementary very precise data allowing improved therapeutic results.

Adolescent↗
PubMed1984

[Isolated compression of the motor branch of the ulnar nerve].

This paper reports four cases of isolated compression of the deep branch of the ulnar nerve, and reviews the various etiologies (tumor, malformation and microtraumatism). The authors stress the importance of the electric examination, particularly conduction velocity in the palm in localizing the nerve lesion. Surgical exploration in these cases revealed a Giant cell tumor, two synovial cysts, and an abnormal fibrous band stretching between the flexor digiti quinti brevis and the opponens digiti quinti. Postoperative courses were uncomplicated and every patient recuperated quickly and completely. Early surgical exploration in such cases is mandatory.

Adult↗
PubMed1984

Callus characteristics following intramedullary nailing with stainless steel or epoxy-carbon nails.

Biological mechanical improvements of osteosynthesis make intramedullary nailing an attractive alternative to bone plate fixation. However, little is known about stress shielding induced by intramedullary implantation of a nail. To evaluate the effect of the nail rigidity on bone healing, mid-metatarsal osteotomies were performed in sheep and fixed with either stainless steel or epoxy-carbon composite V-shaped nails. Mechanical and histomorphometric features of the callus were evaluated 4 months postoperatively. No statistical difference between the two groups were demonstrated for either mechanical or microstructural characteristics. The presence of a fibrous membrane filling the bone/nail interface and allowing sliding micromotions of the implants and the much smaller effect of nail rigidity, as compared to bone plate after implantation, were assumed to be the main reason for this uniformity. At this stage of healing, bone characteristics were more related to a nonspecific (vascular) bone remodeling phenomenon than to a stress-shielding effect.

Animals↗
PubMed1984

[Evaluation of carpal tunnel and subepineural pressures in leprous neuropathies of the median nerve at the wrist].

The authors measured the carpal tunnel and intraneural pressures with a soft catheter in fifteen cases of leprous neuritis of the median nerve at the wrist. In the carpal tunnel, the pressure was about 40 mm of mercury, while within the nerve, the pressure was about 25 mm of mercury. In five healthy male volunteers, the same pressures were measured: the results were much lower (2 to 4 mm of mercury). The authors call attention to the high pressures found in acute leprous neuritis. They conclude that the sooner a surgical procedure (careful neurolysis) is performed, the better the results, before irreparable nerve damage occurs.

Adolescent↗