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Biomedical subjects

M E Faymonville

Publications and source records attributed to M E Faymonville.

At least 19 recordsLinked to original sources
PubMed2001

Psychological approaches during dressing changes of burned patients: a prospective randomised study comparing hypnosis against stress reducing strategy.

A prospective study was designed to compare two psychological support interventions in controlling peri-dressing change pain and anxiety in severely burned patients. Thirty patients with a total burned surface area of 10-25%, requiring a hospital stay of at least 14 days, were randomised to receive either hypnosis or stress reducing strategies (SRS) adjunctively to routine intramuscular pre-dressing change analgesia and anxiolytic drugs. Visual analogue scale (VAS) scores for anxiety, pain, pain control and satisfaction were recorded at 2-day intervals throughout the 14-day study period, before, during and after dressing changes. The psychological assistance was given on days 8 and 10 after hospital admission. The comparison of the two treatment groups indicated that VAS anxiety scores were significantly decreased before and during dressing changes when the hypnotic technique was used instead of SRS. No difference was observed for pain, pain control and satisfaction, although VAS scores were always better in the hypnosis group. The study also showed that, overall, psychological support interventions reduced pain and increased patient satisfaction. These results confirm the potential benefits of psychological assistance during dressing changes in burned patients.

Adult↗
PubMed2000

[[Hypnosedation, a new method of anesthesia for cervical endocrine surgery. Prospective randomized study].

UNLABELLED: Retrospective studies have confirmed the feasibility and safety of thyroid and parathyroid procedures performed under hypnoanesthesia (hypnosis, local anesthesia and minimal conscious sedation) as sole method of anesthesia. This very effective technique seems to provide physiological, psychological and economic benefits for the patient. STUDY AIM: To assess, by means of a prospective randomized study, the advantages of hypnosedation as an alternative to general anesthesia in terms of clinical and laboratory parameters. PATIENTS AND METHODS: Twenty patients operated under hypnoanesthesia were compared to 20 patients operated under conventional anesthesia. The two groups were compared in terms of inflammatory, neuroendocrine, hemodynamic and immunologic parameters and postoperative course (pain, fatigue, muscle strength and stress). RESULTS: No clinical or demographic differences were observed between the two groups. Operative times, bleeding, weight of specimens, and surgical comfort were similar. Significant differences in terms of inflammatory response and hemodynamic parameters were observed in favor of hypnoanesthesia. Neuroendocrine and immunological parameters were similar. Patients of the hypnoanesthesia group had significantly less postoperative pain. Postoperative fatigue syndrome and convalescence were significantly improved in these patients. CONCLUSION: This study confirms that, in our hands, hypnosedation presents real advantages over general anesthesia, in patients undergoing thyroid surgery.

Adult↗
PubMed2000

Auditory processing in the vegetative state.

H(2)(15)O-PET was used to investigate changes in regional cerebral blood flow in response to auditory stimulation in patients in the vegetative state. Five patients in a vegetative state of hypoxic origin were compared with 18 age-matched controls. In addition, the cerebral metabolism of these patients and 53 age-matched controls was studied using [(18)F]fluorodeoxyglucose. In control subjects, auditory click stimuli activated bilateral auditory cortices [Brodmann areas (BA) 41 and 42] and the contralateral auditory association cortices (BA 22). In the patients, although resting metabolism was decreased to 61% of normal values, bilateral auditory areas 41 and 42 showed activation as seen in the controls, but the temporoparietal junction cortex (BA 22) failed to be activated. Moreover, the auditory association cortex was functionally disconnected from the posterior parietal association area (BA 40), the anterior cingulate cortex (BA 24) and the hippocampus, as revealed by psychophysiological interaction analysis. Thus, despite altered resting metabolism, the auditory primary cortices were still activated during external stimulation, whereas hierarchically higher-order multi- modal association areas were not. Such a cascade of functional disconnections along the auditory cortical pathways, from the primary auditory areas to multimodal and limbic areas, suggests that the residual cortical processing observed in the vegetative state cannot lead to the integrative processes that are thought to be necessary for the attainment of the normal level of awareness.

Acoustic Stimulation↗
PubMed2000

Neural mechanisms of antinociceptive effects of hypnosis.

BACKGROUND: The neural mechanisms underlying the modulation of pain perception by hypnosis remain obscure. In this study, we used positron emission tomography in 11 healthy volunteers to identify the brain areas in which hypnosis modulates cerebral responses to a noxious stimulus. METHODS: The protocol used a factorial design with two factors: state (hypnotic state, resting state, mental imagery) and stimulation (warm non-noxious vs. hot noxious stimuli applied to right thenar eminence). Two cerebral blood flow scans were obtained with the 15O-water technique during each condition. After each scan, the subject was asked to rate pain sensation and unpleasantness. Statistical parametric mapping was used to determine the main effects of noxious stimulation and hypnotic state as well as state-by-stimulation interactions (i.e., brain areas that would be more or less activated in hypnosis than in control conditions, under noxious stimulation). RESULTS: Hypnosis decreased both pain sensation and the unpleasantness of noxious stimuli. Noxious stimulation caused an increase in regional cerebral blood flow in the thalamic nuclei and anterior cingulate and insular cortices. The hypnotic state induced a significant activation of a right-sided extrastriate area and the anterior cingulate cortex. The interaction analysis showed that the activity in the anterior (mid-)cingulate cortex was related to pain perception and unpleasantness differently in the hypnotic state than in control situations. CONCLUSIONS: Both intensity and unpleasantness of the noxious stimuli are reduced during the hypnotic state. In addition, hypnotic modulation of pain is mediated by the anterior cingulate cortex.

Adult↗
PubMed1999

Functional neuroanatomy of hypnotic state.

BACKGROUND: The aim of the present study was to describe the distribution of regional cerebral blood flow during the hypnotic state (HS) in humans, using positron-emission tomography (PET) and statistical parametric mapping. METHODS: The hypnotic state relied on revivification of pleasant autobiographical memories and was compared to imaging autobiographical material in "normal alertness." A group of 9 subjects under polygraphic monitoring received six H215O infusions and was scanned in the following order: alert-HS-HS-HS with color hallucination-HS with color hallucination-alert. PET data were analyzed using statistical parametric mapping (SPM95). RESULTS: The group analysis showed that hypnotic state is related to the activation of a widespread, mainly left-sided, set of cortical areas involving occipital, parietal, precentral, premotor, and ventrolateral prefrontal cortices and a few right-sided regions: occipital and anterior cingulate cortices. CONCLUSIONS: The pattern of activation during hypnotic state differs from those induced in normal subjects by the simple evocation of autobiographical memories. It shares many similarities with mental imagery, from which it differs by the relative deactivation of precuneus.

Adult↗
PubMed1999

Hypnoanesthesia for endocrine cervical surgery: a statement of practice.

OBJECTIVES: To assess the feasibility of endocrine cervical surgery under hypnoanesthesia as a valuable, safe, efficient, and economic alternative to general anesthesia. METHODS: Between April 1994 and June 1997, 197 thyroidectomies and 21 cervical explorations for hyperparathyroidism were performed under hypnoanesthesia (HYP) using Erikson's method. Operative data and postoperative course of this initial series were compared to a contemporary population of patients (n = 119) clinically similar except that they declined HYP or were judged unsuitable for it, and who were therefore operated on under general anesthesia (GA). RESULTS: The surgeons all reported better operating conditions for cervicotomy using HYP. Conversion from hypnosis to GA was needed in two cases (1%). All patients having HYP reported a pleasant experience and, keeping in mind that the GA group is not a randomly assigned control group, both had significantly less postoperative pain and analgesic use. Hospital stay was also significantly shorter, providing a substantial reduction in the costs of medical care. The postoperative convalescence was significantly improved after HYP and a full return to social or professional activity was significantly quicker. CONCLUSION: From this study, we conclude that HYP is an effective technique for providing relief of intraoperative and postoperative pain in endocrine cervical surgery. The technique results in high patient satisfaction and better surgical convalescence. This technique can therefore be used in most well-chosen patients and reduces the socioeconomic impact of hospitalization.

Adult↗
PubMed1999

Bilateral neck exploration under hypnosedation: a new standard of care in primary hyperparathyroidism?

OBJECTIVE: The authors review their experience with initial bilateral neck exploration under local anesthesia and hypnosedation for primary hyperparathyroidism. Efficacy, safety, and cost effectiveness of this new approach are examined. BACKGROUND: Standard bilateral parathyroid exploration under general anesthesia is associated with significant risk, especially in an elderly population. Image-guided unilateral approaches, although theoretically less invasive, expose patients to the potential risk of missing multiple adenomas or asymmetric hyperplasia. Initial bilateral neck exploration under hypnosedation may maximize the strengths of both approaches while minimizing their weaknesses. METHODS: In a consecutive series of 121 initial cervicotomies for primary hyperparathyroidism performed between 1995 and 1997, 31 patients were selected on the basis of their own request to undergo a conventional bilateral neck exploration under local anesthesia and hypnosedation. Neither preoperative testing of hypnotic susceptibility nor expensive localization studies were done. A hypnotic state (immobility, subjective well-being, and increased pain thresholds) was induced within 10 minutes; restoration of a fully conscious state was obtained within several seconds. Patient comfort and quiet surgical conditions were ensured by local anesthesia of the collar incision and minimal intravenous sedation titrated throughout surgery. Both peri- and postoperative records were examined to assess the safety and efficacy of this new approach. RESULTS: No conversion to general anesthesia was needed. No complications were observed. All the patients were cured with a mean follow-up of 18 +/- 12 months. Mean operating time was <1 hour. Four glands were identified in 84% of cases, three glands in 9.7%. Adenomas were found in 26 cases; among these, 6 were ectopic. Hyperplasia, requiring subtotal parathyroidectomy and transcervical thymectomy, was found in five cases (16.1%), all of which had gone undetected by localization studies when requested by the referring physicians. Concomitant thyroid lobectomy was performed in four cases. Patient comfort and recovery and surgical conditions were evaluated on visual analog scales as excellent. Postoperative analgesic consumption was minimal. Mean length of hospital stay was 1.5 +/- 0.5 days. CONCLUSIONS: Initial bilateral neck exploration for primary hyperparathyroidism can be performed safely, efficiently, and cost-effectively under hypnosedation, which may therefore be proposed as a new standard of care.

Adult↗
PubMed1999

Hypnosedation: a valuable alternative to traditional anaesthetic techniques.

Hypnosis has become routine practice in our plastic and endocrine surgery services. Revivication of pleasant life experiences has served as the hypnotic substratum in a series of over 1650 patients since 1992. In retrospective studies, followed by randomised prospective studies, we have confirmed the usefulness of hypnosedation (hypnosis in combination with conscious IV sedation) and local anaesthesia as a valuable alternative to traditional anaesthetic techniques. The credibility of hypnotic techniques and their acceptance by the scientific community will depend on independently-confirmed and reproducible criteria of assessing the hypnotic state. Based on the clinical success of this technique, we were interested in confirming this phenomenon in healthy volunteers. The revivication of pleasant life experiences thus served as the cornerstone of a basic research program developed to objectify the neurophysiological attributes of the hypnotic state. We compared hypnosis to normal alertness with similar thought content. In our experience, the activation profile obtained during the hypnotic state was completely different from simple re-memoration of the same subject matter during normal alertness. This represents an objective and independent criteria by which to assess the hypnotic state.

Anesthesia, Local↗
PubMed1999

Hypnosis with conscious sedation instead of general anaesthesia? Applications in cervical endocrine surgery.

Between April 1994 and June 1997, 197 thyroidectomies and 21 cervical explorations for hyperparathyroidism were performed under hypnosedation (HYP) and compared to the operative data and postoperative courses of a closely-matched population (n = 121) of patients operated on under general anaesthesia (GA). Conversion from hypnosis to GA was needed in two cases (1%). All surgeons reported better operating conditions for cervicotomy using HYP. All patients having HYP reported a very pleasant experience and had significantly less postoperative pain while analgesic use was significantly reduced in this group. Hospital stay was also significantly shorter, providing a substantial reduction of the medical care costs. The postoperative convalescence was significantly improved after HYP and full return to social or professional activity was significantly shortened. We conclude that HYP is a very efficient technique providing physiological, psychological and economic benefits to the patient.

Acetaminophen↗
PubMed1998

[Surgery under hypnosedation. A new therapeutic approach to hyperparathyroidism].

The elective unilateral approach, sometimes under local anaesthesia, offers many advantages in terms of less invasive and faster surgical approach compared to the conventional surgery under general anaesthesia. Nevertheless this approach is restricted to patients unsuspected of multiglandular disease, free from thyroid disease and for whom localization studies are contributive. Surgery under hypnosedation offers the same advantages and provides the possibility of not only exploring the four glands but also of performing a partial thyroidectomy if needed. In our experience 21 patients underwent a cervicotomy under hypnosedation for primary hyperparathyroidism (HPT). No conversion to general anaesthesia was needed; mean operative time was 52 +/- 16 min. In 17 cases, HPT was due to a single adenoma, in 3 cases to hyperplasia (among them a MEN-1 case), and in one last case to a double adenoma. The four glands were identified in 85%. With a follow-up running from 4 to 45 months, all patients are cured. Hypnosedation offers the same medical and economic advantages than the unilateral access under local anaesthesia. Moreover indications are not restricted to selected patients.

Adult↗
PubMed1998

[Hypnosis and its application in surgery].

Since 1992, we have used hypnosis routinely in more than 1400 patients undergoing surgery. We found that hypnosis used in patients as an adjunct to conscious sedation and local anesthesia was associated with improved intraoperative patient comfort, and with reduced anxiety, pain, intraoperative requirements for anxiolytic and analgesic drugs, optimal surgical conditions and a faster recovery of the patient. We reported our clinical experience and our fundamental research.

Anesthesia, Local↗
PubMed1996

[Endocrine surgery by hypnosis. From fiction to daily clinical application...].

Between April 1994 and March 1996, 108 thyroidectomies (97 partial or unilateral lobectomies and 11 bilateral lobectomies) and 13 cervical explorations for hyperparathyroidism were performed under hypnosedation (HS) technique combining hypnosis and light conscious sedation. Informed consent was obtained from each patient. None of these patients underwent preoperatively standard susceptibility test score or preparatory hypnotic session. Nevertheless, no patient required conversion to general anesthesia. Operative data and postoperative courses were compared to a well-matched population (n = 70) of patients operated on for thyroid diseases under general anesthesia (GA). Under HS, mortality was zero and surgical management was only complicated by unilateral definitive recurrent laryngeal nerve paralysis in one case (0.8%) and the need for neck reexploration for severe hematoma after parathyroidectomy in another case. Hyperparathyroidism was cured in all cases. The surgeons all reported better operating conditions, estimated by visual analog scale (VAS), for cervicotomy using HS (8.9 +/- 0.6 cm vs 8.0 +/- 1.2 cm in the GA group, p < 0.01). This is probably related to reduced bleeding in the operative field. All the patients reported a very pleasant experience and enjoyed having their surgery performed under HS (VAS of satisfaction: 9.35 +/- 0.99 vs 2.88 cm +/- 2.8 cm in the GA group, p < 0.001). Patients having HS had less postoperative pain (VAS of pain: 2.2 +/- 1.6 cm vs 3.2 +/- 2.0 cm in the GA group, p < 0.01), whereas antalgic consumption was significantly reduced in the HS group compared with the GA group (paracetamol on first postoperative day was, 932 +/- 519 mg vs 1437 +/- 622 mg in the GA group, p < 0.001). Hospital stay was also significantly lower (46.3 h +/- 14.6 vs 74.2 +/- 9.5 h in the GA group, p < 0.001), providing a substantial reduction of the costs of medical care. The postoperative fatigue syndrome and surgical convalescence were significantly improved after HS (VAS of fatigue: 2.05 +/- 2.01 cm vs 4.7 +/- 2.4 cm in the GA group, p < 0.001, hand grip test: 95.5% of preoperative muscular maximum force vs 89.9% in the GA group, p < 0.01). Full return to social or professional activity was usually accomplished after 10.3 +/- 10.2 days in the HS group vs 36 +/- 8 days in the GA group, p < 0.001). From this study, we concluded that HS is a very effective technique for providing relief of intra- and postoperative pain in endocrine surgery. This technique results in high patient satisfaction and better surgical convalescence. This technique therefore can be used in most motivated patients and reduces the socio-economic impact of hospitalization.

Activities of Daily Living↗
PubMed1993

Multiple system organ failure after open heart surgery in infants and children.

Between January 1985 and March 1989 we retrospectively observed multiple system organ failure (MSOF) in 16 of 460 children (3.5%) who underwent cardiac surgery with cardiopulmonary bypass for congenital heart disease. MSOF was arbitrarily defined as a clinical entity with failure of two or more vital organ systems associated with high fever, thrombocytopenia, and cardiocirculatory insufficiency and occurring within the first postoperative week. In 13 children the first clinical manifestations of MSOF were evident on the first post-operative day and in the other 3 on the second or third post-operative day. All children showed acute renal failure, acute hepatic failure, high fever, and thrombocytopenia. Most of them showed respiratory insufficiency and neurological involvement. Seven of the 16 children died. Four of the 9 surviving patients had neurological sequelae still present 6 months after the operation, and the others recovered completely.

Cardiac Surgical Procedures↗
PubMed1991

Fast double antibody radioimmunoassay of human granulocyte myeloperoxidase and its application to plasma.

The haem enzyme myeloperoxidase (MPO) (EC 1.11.1.7) with a spectral A430/A280 ratio greater than 0.7 and a specific activity of 125 U/mg was purified from isolated human neutrophils. To obtain a radioimmunoassay (RIA) for this enzyme, a specific antiserum against human neutrophil MPO was raised in rabbits and used at an initial dilution of 1/10,000. MPO labelled with 125iodine by a technique of self-labelling in the presence of H2O2, had a specific activity of 24 mCi/mg. After incubation at room temperature (2 h) and separation by double antibody precipitation in the presence of polyethylene glycol, the sensitivity of the RIA was 21 ng/ml. The RIA showed good precision and accuracy with intra- and interassay coefficients of variation of less than 7% for MPO concentrations ranging from 100 to 800 ng/ml, and satisfactory recoveries of known amounts of exogenous MPO in plasma. For the measurement of MPO in blood, the best sampling technique was to collect blood into EDTA. Rapid centrifugation (within 20 min) was necessary for blood collected into heparin. Mean MPO values in normal individuals were 340 +/- 98 ng/ml in EDTA plasma (n = 152) and 332 +/- 82 ng/ml in heparinized plasma (n = 34). When MPO was measured 12-6 h after injury in critically ill patients high values (above 1000 ng/ml) were found in 6/15 patients with multiple injuries. In patients with sepsis (n = 22), MPO values were always above 1000 ng/ml.

Animals↗
PubMed1991

Myeloperoxidase and elastase as markers of leukocyte activation during cardiopulmonary bypass in humans.

To assess leukocyte activation during cardiopulmonary bypass, we measured white blood cell and neutrophil counts and lysosomal enzyme release, especially myeloperoxidase and elastase, throughout the operation and for 5 days postoperatively. A newly developed double antibody radioimmunoassay of myeloperoxidase and an enzyme-linked immunosorbent assay for detection of the polymorphonuclear elastase-alpha 1-proteinase inhibitor complex were used to determine their plasma levels in 15 patients undergoing elective aorta-coronary bypass grafting. Preoperatively white blood cell counts and plasmatic levels of myeloperoxidase and elastase-alpha 1-proteinase inhibitor were normal. Because no correlation has yet been established between levels of myeloperoxidase and elastase-alpha 1-proteinase inhibitor, the aim of this prospective study was to evaluate the use of these enzyme levels as markers for leukocyte activation in vivo. We addressed the clinical situation of cardiopulmonary bypass because it offered the possibility of monitoring the comparative evolution of blood levels of these enzymes in parallel to white blood cell counts through well-defined steps corresponding to known events. We document the advantages of myeloperoxidase blood levels over elastase measurement as reflecting more rapidly the in vivo activation of leukocytes. The time course kinetics of these three measurements were not parallel. White blood cell counts remained stable at the beginning of bypass, whereas myeloperoxidase levels increased sharply and continuously as soon as bypass was instituted until the end of bypass. Elastase levels also increased, but later than myeloperoxidase, beginning when the patients was rewarmed. High elastase plasma levels persisted later than myeloperoxidase after bypass, in parallel with white blood cell counts. It thus clearly appears that changes in myeloperoxidase levels more rapidly reflect the activation state of leukocytes induced by cardiopulmonary bypass and surgery, whereas peak levels of elastase were delayed and parallel to white blood cell counts. From this model, in which the evolution of leukocyte numbers could be followed in relation with known steps of stimulation, it appears that myeloperoxidase is a sensitive marker for monitoring in vivo activation of white blood cells.

Adult↗