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M Merle

Publications and source records attributed to M Merle.

At least 37 records · Page 2Linked to original sources

Comparative analysis of 13C-enriched metabolites released in the medium of cerebellar and cortical astrocytes incubated with [1-13C]glucose.

Rat cerebellar and cortical astrocytes cultured for 15 or 35 days were incubated with [1-13C]glucose in the presence or absence of 4 mM exogenous glutamine and the release of 13C-enriched metabolites into cell media was studied by 13C-NMR spectroscopy. In the presence of exogenous glutamine, both cerebellar and cortical astrocytes consumed the amino acid. In contrast, a net production of glutamine occurred in the absence of the amino acid. Simultaneously, a release of 13C-enriched glutamine into cell media was observed and was higher in the presence than in the absence of exogenous glutamine. This demonstrated the occurrence of an isotopic-exchange process which may involve a futile cycle at the level of glutamine synthetase and glutaminase activities. The 13C-enrichment ratio between glutamine carbons C2 and C3 was close to 1 in the presence of exogenous glutamine whereas it was higher than 1 in its absence, indicating that pyruvate carboxylase was more active in the absence of glutamine. In addition to glutamine, alanine was synthesized and exported into the medium of both cerebellar and cortical astrocytes. In contrast, citrate was specifically produced by cortical astrocytes. Slight increases in alanine and glutamine productions were observed for cortical astrocyte cultures between 15 and 35 days, whereas the amino acid production by cerebellar astrocytes increased several-fold after 35 days compared with that at 15 days of culture.

Alanine

Wartenberg's sign. A new method of surgical correction.

A method of surgical correction is described for Wartenberg's sign, or persistent abduction of the little finger, using a slip of the extensor digitorum communis of the ring finger. The transferred component can be either the central slip, or the ulnar slip extended by the connexus intertendineus to the little finger. This technique maintains the integrity of the extensor mechanism of the little finger, avoiding loss of active extension, which is frequently observed when extensor digiti minimi is used. The donor site is dependable since the extensor digitorum communis tendon of the ring finger is always composed of several slips. This technique should be considered only in cases of isolated persistent abduction of the little finger, when there is no claw deformity.

Adolescent

Bioabsorbable rods and pins for fixation of metacarpophalangeal arthrodesis of the thumb.

We report results on the use of bioabsorbable pins and intramedullary rods made of high-molecular-weight polylactic acid in both experimental and clinical conditions. In the experimental study, bioabsorbable rods were implanted in rabbit femora. Histologic assessment on nondecalcified bone showed that resorption of the material began at 4 months after implantation and gradually fragmented over a period of 3 years. In 12 patients 13 metacarpophalangeal joints of the thumb were arthrodesed by using one bioabsorbable intramedullary rod with one or two oblique pins. All joints fused within 6 to 8 weeks. During that period there was no sign of inflammation, and there were no nonunions. Postoperative magnetic resonance imaging assessment was done in all rabbits and eight patients. This modality is a useful tool in postoperative evaluation of the position and shape of the rod but is not sufficiently sensitive to assess the presence of local inflammation and the rate of resorption of the rods.

Adolescent

[A simple and efficient pin guide].

The authors propose the use of the metallic trocar used for venous catheter introduction as a pin guide and protector. These trocars are available in several internal diameters, allowing the use of 8/10 mm to 15/10 mm Kirschner pins. This technique has the following advantages: easy guiding of the pins and protection of subcutaneous neurovascular structures. The disadvantages are related to overheating and its consequences due to metal-on-metal friction.

Bone Nails

Large amounts of polylactic acid in contact with divided nerve sheaths have no adverse effects on regeneration.

The stumps of divided rat sciatic nerves were coapted by suturing the epineurium to a small rectangular device made of a sheet of polylactic acid. One month later, significant degradation of the implanted material was observed. At that time, the local condition of the nerve was excellent, and the precise location of the initial injury could not be determined by examination under the operating microscope. Histology confirmed that there was no visible reaction to the biodegradable substance or its metabolites, and that neurotization of the distal stump was satisfactory. These findings were in agreement with those of other studies, and indicated that polylactic-acid devices affixed to divided nerves have no adverse effect on regeneration.

Animals

[Pseudarthrosis and delayed union of the distal phalanx of the long fingers. Apropos of 13 cases].

PURPOSE OF THE STUDY: The authors present 13 cases of delayed or non-union of the distal phalanx of the long fingers treated surgically. MATERIAL AND METHODS: The patients were all men aged from 41 years to 60 years. The involved digits were 4 second, 2 long, 5 ring, and 2 little fingers. The operated side was the right side 5 times, the left one 8 times, the dominant one 4 times. Ten cases were due to inadequate treatment of the initial fracture. The three others cases had no clear explanation. Three types of incisions were used: transverse distal, lateral or an extended one combining the two previous. Bone stabilisation was made either, by longitudinal K wires or with a small cancellous screw. In 7 cases, bone grafting was needed. RESULTS: Bone healing was obtained in 9 cases in an average time of 9 weeks. Further procedures included: 2 distal amputations after septic conditions, 2 removals of distal bone fragment and 2 fusions of the distal interphalangeal joint. Overall results evaluated by the patients themselves were fair, including 2 excellent, 6 good (but 2 after distal interphalangeal joint arthrodesis), 2 mild (1 after distal interphalangeal joint arthrodesis), 1 poor and 2 failures. DISCUSSION: The type of skin incision was chosen according to the bone condition; distal in cases of fibrous nonunion when fibrous tissue removal and bone grafting were needed. Neither the type of bone stabilisation (pinning or screwing) nor the donor site of bone grafting influenced the final result. CONCLUSION: The authors would like to stress the importance of an adequate treatment of finger injuries in a emergency situation, considering the difficulties to restore secondarily a satisfactory functional outcome.

Adult

[Injuries of the flexor tendons of the hand].

Diagnosis of clear-cut severing of the two flexor tendons is simple and obvious. This is not true for isolated injury to a single tendon and for partial severing. In this case, careful clinical examination and routine surgical exploration of any wound with regard to the course of the flexor tendon is required. Surgery should aim at the least traumatic repair possible, followed by specialised rehabilitation directed by the surgeon. In the distal region, reinsertion into the bone is required. In other regions, suture consists of a the main suture with a continuous suture of the epitendineum. The region of the digital canal requires rigourous care due to its specific anatomy. The corollary to good surgical repair is rehabilitation, understood and complied with by the patient. Early mobilisation procedures are used predominantly in order to avoid the formation of postsurgical adherences.

Hand Injuries

Postnatal decrease of acetate concentration in rat cerebellum.

We examined the evolution of 1H-NMR detectable metabolites in rat cerebellum from the postnatal day 1-25, a period associated with intense metabolic changes as well as physiological and morphological modifications. The unexpected result reported here is the existence of a high concentration of acetate in neonatal rat cerebellum, progressively decreasing with age and maturation. In contrast, the cerebellum content of various metabolites such as N-acetyl-L-aspartate (NAA), glutamate, and aspartate increases from the first day onward.

Acetates

Experimental and clinical study of the effect of naftidrofuryl on the recovery from peripheral nerve lesions.

After primary repair of lesions of nerves and vessels, patients who were administered a vasoactive drug, naftidrofuryl, postoperatively, had a better functional recovery than untreated patients. Evidence for the favourable effect of the drug on nerve regeneration was first obtained from experiments in the rat. The sciatic nerve was transected and repaired with standard microsurgical techniques. Results were evaluated by electromyography and histology. Data indicated that treated animals had better motor responses and distal latency than untreated rats. Fibre counts showed a greater number of nerve fibres in the distal stump of treated animals. The clinical study was undertaken in cases of carpal tunnel syndrome with muscle atrophy. Assessment was performed by electrophysiology: motor and sensory conduction was studied. Data showed that all treated patients recovered totally or partially from the thenar atrophy they presented before operation, whereas thenar atrophy persisted in 37% of the patients receiving placebo. In conclusion, naftidrofuryl has an experimentally and clinically favourable effect on nerve regeneration and on muscle trophicity, but the mechanism of action of this drug is not known.

Aged

The homodigital subcutaneous flap for cover of dorsal finger defects.

The authors propose a volar subcutaneous pedicled flap to cover skin defects over the dorsum of the same finger. This flap includes all the subcutaneous (adipofascial) tissues from the reticular dermis to the synovial sheath of the flexor tendons. After elevation of the dermo-epidermal flap, the subcutaneous tissues are raised as a flap pedicled laterally on one of the collateral arteries which constitutes the axis of rotation and transposition. After release of the collateral neurovascular bundle from its connections with the skeleton, the skin and the synovial sheath, the flap can be transposed to the dorsum of the finger and then covered with a split thickness skin graft. The advantages of this technique are: (1) No functional or cosmetic sequelae at the donor site which is closed by the volar dermo-epidermal flap; (2) Homodigital flap. This is particularly helpful in cases of multidigit involvement where cross-finger flaps cannot be performed; (3) Vascular reliability; (4) Preservation of both collateral arteries.

Adult

[Absorbable osteosynthesis: experimental and clinical approach in surgery of the hand].

Given the advances in the field of high molecular-weight polylactides, it is now possible to obtain biomaterials of great strength with a resorption rate that ranges from a few months to several years. Experimental evaluation of the biomaterials was done in rabbits with implantation of intramedullary rods after fracture of the knee. The results of histological studies and assessment, using MR imaging, indicated good compatibility of the intramedullary rods. Applications for human clinical practice centered on metacarpophalangeal arthrodesis of the thumb performed for rheumatoid polyarthritis and intractable sprains of the metacarpophalangeal. Operations were performed on 52 patients with a rate of consolidation of 96%. No synovitis-like reactions were observed concurrent with massive release of the biomaterial. As a first step, this type of osteosynthesis could be applied to the upper extremity where stresses are relatively minimal. Eventually, screws of reduced diameter could be developed for the treatment of articular and unstable fractures of the metacarpophalangeals. There are already 3.5 mm-screws that can be used for malleolar fixation at the level of the lower extremity. Because of the wide variety of biomaterials that are currently available, it is important to be familiar with their composition, so that patients will be spared certain complications linked to resorption, especially inflammatory reactions. The biomaterials presented here belong to a class of biomaterials that have demonstrated good compatibility. At the present time, the cost of biodegradable materials remains high but it is important to emphasize the social and economic consequences of their use, since there is no need for a secondary procedure to remove them.

Absorption

[The "star": a design principle of antebrachial radial fasciocutaneous flap. Technical note].

In performing a fasciocutaneous radial forearm flap to cover the dorsum of the hand, the authors suggest to draw the flap as an eight-tip star. This technical tip allows to minimize the centripetal skin healing process at the recipient site (currently observed in case of circular or ovoid defect) and to reduce the scared aspect at the donor site, by first closing of the four cardinal tips.

Burns, Chemical

[Microsurgical coverage of proximal amputation of the forearm. Functional value of preservation of the elbow joint].

The authors reported three traumatic cases of below-elbow amputation. The proximal squeleton of the forearm was bare-exposed and the replantation was not done due to the mechanism of the injury. To preserve the function of the elbow joint which the main components were safe, the soft tissue coverage was realized by a musculocutaneous latissimus dorsi free flap in each case. A body-powered forearm prosthesis was adapted for the three patients who were able to return to an adapted job in an average time of 8 months. The importance of the preservation of the elbow joint to improve the function in upper limb amputees is discussed.

Adult

[Emergency services for the hand: a necessity].

Every year in France there are 500,000 hand injuries; the number of injuries has remained constant over the last ten years and constitutes one-third of all work-related accidents. At the emergency department for hand surgery from Nancy University Hospital the treatment of hand injuries is the third part of the global activity. There have been significant advancements in the field of hand surgery in the last twenty years due to development of microsurgical techniques which make it possible to revascularize tissue that otherwise would die. Surgeons who treat hand injuries usually have been trained in the fields of orthopedics, traumatology, plastic surgery, and microsurgery. The improved results--attributable to new techniques and early treatment--pointed to the need for organizing emergency services for hand injuries that would operate on a 24-hour basis. In 1979, a group of French surgeons founded the Federation of Emergency Treatment of Hand Injuries that today represents 27 centers in France and 19 others in countries of the European Community. These emergency wards work in conjunction with other centers dealing with emergency service, e.g., the Fire Department, Ambulance service, Industrial Medicine, etc... Over a period of 15 years, the benefits reaped from treating these injuries as true emergencies (less than 6 hours ischemia) based on the principle of Immediate Repair with Early Mobilization (IREM) are both functional and social in nature: in 90% of cases, the patient resumes professional and economic activity and the rate of partial disability is 30% lower than that observed in cases treated in non-specialized centers. Given these results that are acknowledged by all who work in emergency service in general, we think that emergency wards for hand injuries should be an integral part of the overall plan coordinating emergency services in France.

Emergency Medical Services

[1-13C]glucose metabolism in rat cerebellar granule cells and astrocytes in primary culture. Evaluation of flux parameters by 13C- and 1H-NMR spectroscopy.

The metabolism of [1-13C]glucose in rat cerebellum astrocytes and granule cells was investigated using 13C- and 1H-NMR spectroscopy. Near homogeneous primary cultures of each cell type were incubated with [1-13C]glucose, under the same conditions. Analysing the relative 13C enrichments of metabolites in spectra of cell perchloric acid extracts, on the one hand, the 13C-1H spin-coupling patterns in 1H-NMR spectra of cell medium lactate and the 13C-13C spin-coupling patterns in 13C-NMR spectra of purified cell glutamate, on the other hand, showed significant differences, between the two cell types, in the activity of various metabolic ways. First, the carbon flux through the oxidative branch of the hexose monophosphate shunt, which leads to unenriched lactate, was found higher in granule cells than in astrocytes. Second, although the specific 13C enrichment of lactate was higher in astrocytes than in granule cells, the fraction of 13C-enriched acetyl-CoA entering the citric acid cycle was more than twice as high in granule cells as in astrocytes. Lactate C3 and acetyl-CoA C2 enrichments were very similar in granule cells, whereas acetyl-CoA C2 enrichment was 60% lower than that of lactate C3 in astrocytes. These results can be explained by the fact that granule cells used almost exclusively the exogenous glucose to fuel the citric acid cycle, whereas astrocytes used concomitantly glucose and other carbon sources. Last, in the case of granule cells, glutamate C2 and C3 enrichments were equivalent; the carbon flux through the pyruvate carboxylase route was evaluated to be around 15% of the carbon flux through the citrate synthetase route. In astrocytes, glutamate C2 enrichment was higher than that of C3, which could be explained by a pyruvate carboxylase activity much more active in these cells than in granule cells.

Animals

Metabolic flux determination in C6 glioma cells using carbon-13 distribution upon [1-13C]glucose incubation.

A mathematical model of mammalian cell intermediary metabolism is presented. It describes the distribution of the carbon-13 isotope (13C) at the different carbon positions of metabolites in cells fed with 13C-enriched substrates. The model allows the determination of fluxes through different metabolic pathways from 13C- and 1H-NMR spectroscopy and mass spectrometry data. The considered metabolic network includes glycolysis, gluconeogenesis, the citric acid cycle and a number of reactions corresponding to protein or fatty acid metabolism. The model was used for calculating metabolic fluxes in a rat tumor cell line, the C6 glioma, incubated with [1-13C]glucose. After evolution to metabolic and isotopic steady states, the intracellular metabolites were extracted with perchloric acid. The specific enrichments of glutamate, aspartate and alanine carbons were determined from 13C-, 1H-NMR spectroscopy, or mass spectrometry data. Taking into account the rate of glucose consumption and of lactate formation, determined from the evolution of glucose and lactate contents in the cell medium, and knowing the activity of the hexose monophosphate shunt, it was possible to estimate the absolute values of all the considered fluxes. From the analysis the following results were obtained. (a) Glucose accounts for about 78% of the pyruvate and 57% of the CoASAc. (b) A metabolic channelling occurs at the citric acid cycle level; it favours the conversion of carbons 2, 3, 4, and 5 of 2-oxoglutarate into carbons 1, 2, 3, and 4 of oxaloacetate, respectively. The percentage of channelled metabolites amounts to 39%. (c) The pyruvate carboxylase activity and the efflux from the citric acid cycle are estimated to be very low, suggesting a lack of glutamine production in C6 cells. The results emphasize different metabolic characteristics of C6 cells when compared to astrocytes, their normal counterpart.

Alanine