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Biomedical subjects

M Benoist

Publications and source records attributed to M Benoist.

At least 55 records · Page 3Linked to original sources
PubMed1987

[Diagnostic value of saccoradiculography and scanner in lumbar stenoses].

Radiculographic X-rays and CAT scans of 60 patients operated on for stenosis of the lumbar canal were analyzed separately and retrospectively by rheumatologists, a radiologist and surgeons working jointly, without knowledge of findings revealed by surgery. Comparison of findings with a detailed surgical report reveals that in the case of central lumbar canal stenosis, CAT scan provides a higher degree of reliability (72%) in diagnosis than does radiculography (56%). With lateral stenosis of the lateral cleft, reliability of both tests is identical (62%). The diagnostic deficiencies of these two examinations are discussed as well as diagnostic criteria employed and possible avenues of research. Currently, in the case of stenosis of the lumbar canal, it is still necessary to perform both of these examinations in combination and to accept the fact that, in certain cases, only one of the two tests reveals the stenosis, to be able to attain a preoperative rate of correct diagnosis greater than 80%.

Evaluation Studies as Topic↗
PubMed1986

[Idiopathic diffuse polyalgia syndrome].

The term "idiopathic diffuse polyalgia syndrome" is suggested to designate an entity well known to neurologists, rheumatologists and all physicians interested in pain. In this syndrome pain is diffuse but often predominates in a given region. Physical examination shows excessive tenderness in well-defined areas. Radiological and laboratory examinations are negative. Psychological factors are not always obvious. Several arguments are in favour of dysfunction of the pain control mechanisms. The effectiveness of the various treatments prescribed is related to the quality of the doctor-patient relation.

Humans↗
PubMed1986

[Cause of failure of nucleolysis and results of surgery].

Out of a total of 435 cases of nucleolysis, 400 case-reports of which could be used, secondary surgery was performed in 48 cases or 12% of the total. Surgery was most frequently required following L4/L5 than L5/S1 nucleolysis. The most frequent causes of failure of nucleolysis were lateral osseous stenosis (19 cases) and sub-ligamentous hernia (17 cases), apparently due to the ineffectiveness of the enzyme. Excluded hernia was rare (4 cases). Hernias at another level (4 cases) required surgery since it was not possible to repeat the injection of chymopapain. Three of these explorations were of the linea alba and one failure was due to spondylolisthesis due to isthmic lysis. Some failures occurred after some delay. The sciatic relapses after a period of complete clinical cure. In some cases, the relapse was in fact at another level or involved sub-ligamentous or excluded hernia. Surgery following nucleolysis is the same as that of an uninjected hernia; there are no adherences. The results are generally the same as those obtained by primitive surgery (two thirds favorable outcome). However, this depends mainly on what has been detected. The results are very good for hernias at another level and for excluded hernias. Fair results are obtained for stenosis and for sub-ligamentous hernias but only poor results in explorations of the linea alba.

Adolescent↗
PubMed1985

[Allergy to chymopapain: value of predictive tests before chemonucleolysis].

It is possible to treat vertebral disc hernias by chemonucleolysis because of the enzymatic properties of chymopapain extracted from Carica papaya. But, 1% of the general population would seem to have a latent sensitivity to this protein, and would thus be at risk of presenting life-threatening anaphylactic shock. Recent clinical studies have identified different risk factors: atopy, previous food and drug allergies. A case is here reported of a 35 year old woman with a history of urticaria following anti-tetanus serum and penicillin injections, who frequently ate exotic fruit, and who was intolerant to alcohol. HBDT and prick tests confirmed both drug allergies. A prick test to chymopapain 1 mg X ml-1 gave a borderline result; the HBDT was positive, with 45% degranulation. Both these tests had been previously assessed by a study of 20 volunteers in good general health: negative prick tests in all 20, and negative HBDT in 19 out of the 20, with chymopapain concentrations ranging from 10 micrograms X ml-1 to 1 micrograms X ml-1. The one volunteer with a positive HBDT probably had latent sensitivity to the enzyme. The great sensitivity of both prick tests and HBDT in detecting IgE specific for food proteins is recalled. It is suggested that a routine predictive immuno-allergological assessment be carried out, with prick tests to the standard airbone allergens (to find a possible atopy), and a prick-test with 1 mg X ml-1 chymopapain, and a HBDT to the enzyme. A sample of serum should be kept for possible RAST and FAST carried out later.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Surgical findings and results of surgery after failure of chemonucleolysis.

The purpose of this study, based on a consecutive series of 350 patients treated by chemonucleolysis in a 6-year period, is to analyze the causes of failure in 38 patients who underwent subsequent surgery. The most common cause of failure in this series was lateral recess stenosis, encountered in 16 of 38 patients. In contrast a sequestrated disc was found in only four patients. Failure of the enzyme to "digest" the protruded fragment was the cause of persisting sciatica in 11 other patients. No abnormality or recurrence at another level was found in the remaining patients. The success rate of surgery was 70%. The best results were obtained when a sequestrated disc or lateral stenosis was disclosed.

Adolescent↗
PubMed1985

[Long-term results of the surgical treatment of lumbar stenosis].

Among 163 patients who underwent surgery for a degenerative lumbar stenosis, 79% were re-examined and evaluated retrospectively (2 to 14 years following surgery), using a functional grading scale. The grading scale (up to 20) assessed limping, radicular pain at rest and with effort, back pain, motor deficits, sphincter dysfunction, medication required, and quality of life. Satisfactory results were obtained in 83% with 87% reporting substantial functional improvement. Limping and radicular pain at rest responded most rapidly to surgical intervention. Subsequent disappearance of residual radicular pain occurred in 13% whether present at rest or with effort. Episodic radicular pain with effort persisted however, in approximately one-quarter of all patients, generally in those with more pronounced pain before surgery. One out of four patients had complete relief of back pain and most often without performing an arthrodesis. Major neurological deficits resolved extremely slowly but completely in six out of ten patients. On the grading scale of 20, four recovery profiles could be identified: a perfectly stable result (60%), regular improvement (14%), improvement with episodic aggravation of symptoms (19%) and subsequent worsening (8%). Overall, a second surgical intervention had to be performed in 5% of patients with complete bony excision or arthrodesis (for vertebral slippage or for back pain).

Adult↗
PubMed1984

[Multiple hyperostosis with unilateral sacroiliitis. A new spondyloarthropathy].

Six patients (4 male and 2 female) presenting with an original, predominantly osseous disease are reported. The disease is characterized by a chronic inflammatory process affecting the thorax, the spine, the femur in 1 case and in all patients only one of the sacro-iliac joints. The condition had begun 11 to 28 years previously and had been active for 6 to 24 years. One case started with regressive polyarthritis. There was no visceral involvement. Radiograms showed bone condensation with hyperostosis, sometimes hypertrophic, unrelated to any articular space. Depending on each patient, the lesions involved the clavicles, the sternum, the posterior arch of the ribs, the vertebrae, the inferior femoral metaphysis. The only joints involved were the sacro-iliac and anubrio-sternal joints. The areas affected showed high radioisotope uptake. There was discrete biochemical inflammatory syndrome. Three of the 6 patients belonged to the HLA group B 27. The multiple biopsies performed showed no specific lesions. The disease proceeds by successive attacks lasting several months and responding poorly to anti-inflammatory drugs. One patient developed Crohn's disease, another, retroperitoneal fibrosis. In some respects, this condition is remindful of sterno-clavicular hyperostosis and of the osteo-arthropathy in palmoplantar pustulosis or acne conglobata. It seems to constitute a new variety of spondylo-arthropathy intermediate between the above-mentioned diseases and genuine ankylosing spondylitis.

Adolescent↗
PubMed1984

[Chemonucleolysis in the treatment of sciatica caused by herniated disk].

Chemonucleolysis is an effective treatment of sciatica due to herniated lumbar disc after conservative treatments have failed. Provided the proper technique is applied and the patients are well selected (complete herniation or herniation within a narrow spinal canal being excluded), surgery can be avoided in the majority of cases. Chemonucleolysis does not in any way complicate subsequent surgery if required and post-nucleolysis surgery gives the same results as first intention surgery. The method, therefore, should not be regarded as an alternative to surgery but as the last stage of conservative treatment. Allergic reactions are the only true side-effects and require special precautions.

Anaphylaxis↗
PubMed1984

[Surgery in failure of nucleolysis of lumbar disk hernia].

The authors have reviewed 206 cases of sciatica treated by Chemonucleolysis. Thirty-two had to be operated on later. This treatment was more frequently needed at L4/L5 level than at the lumbosacral level. Most of the failures of Chemonucleolysis were related to lateral spinal stenosis (13 cases). In 4 cases it was due to disc extrusion either at the time of the Chemonucleolysis (2 cases) or appearing later (2 cases). Nine failures were due to subligamentous disc herniation. Two cases were operated on for the onset of sciatica at another level, repeated treatment with Chemonucleolysis being contra-indicated. In 3 cases, the surgical exploration did not discover the cause of the sciatica. The surgical cases were not impeded by the preceding Chemonucleolysis and no adhesions were found. The results were similar to those observed after primary surgery - about two-thirds of satisfactory results. They were better when a herniation at another level was found or in cases of disc extrusion than in cases of spinal cord stenosis or sub-ligamentous herniae. They were poor when the cause of the sciatica was not found.

Adolescent↗