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Biomedical subjects

P Beaufils

Publications and source records attributed to P Beaufils.

At least 37 records · Page 2Linked to original sources
PubMed2002

Transchondral drilling for osteochondritis dissecans of the medial condyle of the knee.

Osteochondritis dissecans is a rare condition which occurs most frequently in the medial condyle of the knee. Its prognosis remains controversial. We report our experience with transchondral drilling (TCD) for osteochondritis dissecans. The rationale for this low-morbidity procedure is to enhance the healing potential of a lesion which failed to heal after conservative treatment. This multicenter retrospective study examined 24 patients (25 medial condyles), including cases both before (juvenile osteochondritis dissecans, JOCD; n=17) and after closure of the physis (adult osteochondritis dissecans, AOCD; n=8). All patients initially underwent a prolonged conservative treatment. The mean duration of symptoms prior to surgery was 22 months in JOCD and 55 months in AOCD patients. TCD was proposed in cases of intact or almost intact articular cartilage and was initially conducted under arthrotomy and later by arthroscopy. Mean follow-up time was 11.8 years in JOCD and 6 years in AOCD, and evaluation was based on clinical examination and radiography. Excellent clinical results were only observed in the JOCD group (12/17). In the AOCD group 4 patients had a good result and the other 4 a poor result. Radiological findings matched with clinical results. Except for age, factors of poor prognosis were: fissure of the articular cartilage and anterior extension of the lesion. We do not recommend TCD for AOCD. In JOCD, failure after 12 months of conservative treatment should indicate TCD in the cases where the cartilage remains continuous. At this stage there is no indication for more aggressive procedures.

Adolescent↗
PubMed2002

Increased plasma concentrations of interleukin-18 in acute coronary syndromes.

OBJECTIVE: To examine the relation between plasma concentrations of interleukin-18 (IL-18), the interferon gamma inducing factor, and clinical instability of coronary artery disease. DESIGN AND SETTING: Observational study in a university hospital. PATIENTS: 11 patients with unstable angina and negative troponin I, 21 patients with acute non-Q wave myocardial infarction (MI), 21 patients with acute Q wave MI, 9 patients with stable angina, and 11 controls. MAIN OUTCOME MEASURES: Plasma IL-18 concentrations and their relation to clinical instability and myocardial dysfunction. RESULTS: Plasma concentrations of IL-18 were significantly increased in the unstable angina and MI groups in comparison with the stable angina and control groups (p < 0.01). No difference in IL-18 concentrations were found between patients with unstable angina, patients with non-Q wave MI, and patients with Q wave MI. Plasma IL-18 concentrations significantly correlated with decreased left ventricular ejection fraction (p = 0.01). CONCLUSIONS: Plasma IL-18 concentrations are increased in patients with acute coronary syndromes and correlate with the severity of myocardial dysfunction.

Acute Disease↗
PubMed2002

[Influence of patellar height on patellar tendon donor site closing after harvesting a bone-tendon-bone graft for ligamentoplasty].

PURPOSE OF THE STUDY: Ligamentoplasty using an autologous transplant provides an effective and long-lasting solution for anterior instability of the knee. The most widely used transplant is the mid third of the patellar tendon. The short- and long-term stability has been proven, but there are reports of morbidity at the donor site affecting the extensor system. Different attitudes have been proposed. Certain authors leave the site open, only suturing the peritendon. Others suture the two peripheral thirds together, either directly or after combing. This different therapeutic options may modify patellar height and affect the tissue at the donor site that some authors suggest can provide transplants for repeated ligamentoplasties. The purpose of this work was to assess the influence of closing the donor site of the patellar tendon on patellar height. MATERIAL AND METHOD: Two groups of 40 patients were compared. These patients underwent arthroscopic ligamentoplasty for anterior instability of the knee, excluding all other knee pathology. In the first group, the pretendon fibrous plane was closed alone at the end of the procedure without bringing together the edges of the tendon donor site. In the second group, the peripheral thirds of the patellar tendon were sutured together directly. Patellar height was assessed according to Caton, to Blackburn and to Insall and Salvati on lateral views (20 degrees flexion) of the knee six months after arthroscopy. RESULTS: Irrespective of the method used to measure patellar height, there was no statistical difference between post-operative patellar heights between the two groups (Caton=1.002 +/- 0.176/1.023 +/- 0.215; Blackburne=0.844 +/- 0.183/0.882 +/- 0.196; Insall and Salvati=1.118 +/- 0.213/1.184 +/- 0.146 for group 1 "open tendon" and group 2 "closed tendon" respectively). Pre- and post-operative heights were not different for either group (Student t - Fisher, p=0.05). DISCUSSION: Patellar height is not significantly changed after ligamentoplasty using the mid third of the patellar ligament with or without closing of the donor site.

Adult↗
PubMed2002

[Arthroscopic treatment of hematogenous infected total knee arthroplasty: 5 cases].

PURPOSE OF THE STUDY: The purpose of this retrospective study was to assess the contribution of arthroscopic treatment on hematogenous infected total knee arthroplasty. MATERIAL AND METHODS: Five patients were treated for hematogenous infected total knee arthroplasty. All patients had a posterior stabilized prosthesis that had been implanted without any element suggesting primary infection. Delay to infection after arthroplasty was 25 months on the average. Arthroscopic treatment included joint wash-out and synovectomy in combination with prolonged antibiotic therapy. RESULTS: One female patient, treated within 24 hours of the onset of infection, achieved cure without recurrence at 6 months follow-up. One other female patient died. Three patients required revision surgery after failure (two reimplantations in two procedures and one reimplantation in one procedure). DISCUSSION: The gravity of hematogenous infections of total knee arthroplasty is well known. Cure requires insertion of a new implant in three-quarters of the cases. Local arthroscopic treatment is not effective unless performed very early. Beyond this delay, it can at best limit local symptoms.

Aged↗
PubMed2002

Procedural characteristics of primary coronary angioplasty in diabetic patients with acute anterior myocardial infarction.

BACKGROUND: Mortality and morbidity rates are higher in diabetics compared to non-diabetics after acute myocardial infarction (AMI). Previous angiographic studies regarding primary angioplasty for the treatment of AMI found that angioplasty was similarly successful in diabetics and non-diabetics. However, it is noteworthy that patients of "real life" are often far from the population randomised in prospective protocols. The aim of this study was to examine the procedural characteristics of consecutive diabetic patients hospitalised for anterior AMI and treated with primary angioplasty as compared to non-diabetics. METHOD: We analysed 28 consecutive diabetics and 74 non-diabetics who underwent primary angioplasty for anterior AMI (< 12 h from the onset of symptoms) during 15 consecutive months between 2000 and 2001 in our institution, depending on the presence or absence of diabetes. RESULTS: Among analysed data, we found that in diabetics compared to non diabetics: (i) the delay before arrival in the cath-lab was significantly longer (5.5 +/- 2.7 vs 4.2 +/- 2.8 h); (ii) there was a less important collateral flow coming from the non-culprit arteries towards the culprit artery; (iii) there was a less important rate of recovery of a normal flow (TIMI 3) in the culprit artery after coronary angioplasty (67% vs 91%). CONCLUSION: Our study demonstrates that several procedural characteristics could explain the poorer prognosis of AMI treated by primary angioplasty in the diabetic population. The longer delay found in diabetics before arrival in hospital could probably be improved.

Angioplasty, Balloon, Coronary↗
PubMed2001

[Epiphyseal distal torsion of the femur in osteoarthritic knees. A computed tomography study of 75 knees with medial arthrosis].

PURPOSE OF THE STUDY: We used computed tomography (CT) to measure external torsion of the distal femur preoperatively in patients with osteoarthritic knees presenting genu varum in order to assess the correlation between femoral distal external torsion (FDET) and radiological or epidemiological data obtained during the general preoperative work-up. MATERIAL AND METHODS: Seventy-five knees were studied in 38 patients. Mean age was 70.4 years; there were 13 men and 25 women. The degree of external torsion of the distal femur was defined as the angle measured on the CT-scan between a line drawn tangent to the most posterior part of the condyles and the epidondylar line drawn from the lateral epicondyle to the most prominent point of the medial epicondyle. This angle was compared with the angle of the epiphyseal tibial varum measured on the anteroposterior radiograph and the overall deviation of the lower limb (HKA), and with the angle between the mechanical axis and the femoral shaft axis (HKS). We assessed the effect of gender and sex and looked for correlations between the FDET angle and measurements made on standard radiographs. Student's t test was used compare the FDET angle by sex and side. The alpha risk was set at 5%. RESULTS: The FDET angle measured a mean 5.36 +/- 1.87 degrees (0-9 degrees ). We did not find any correlation between the FDET angle and tibial epiphyseal varum or HKS angles. A weak statistical correlation between the FDET and the HKA angles had no clinical value. Finally, the FDET angle was not correlated with sex or side. DISCUSSION: Computed tomography provides reliable and reproducible measurements. Our work clearly demonstrated the wide interindividual variability of the FDET angle. We were unable to identify any measurement on standard radiographs allowing an indirect prediction of the FDET angle. CONCLUSION: Our findings suggest that measuring the FDET angle on preoperative CT-scans in candidates for total hip arthroplasty can be useful for adapting the angle of rotation for the femoral component to each patient.

Adult↗
PubMed2000

A green fluorescent protein enhancer trap screen in Drosophila photoreceptor cells.

The Drosophila ommatidia contain two classes of photoreceptor cells (PR's), the outer and the inner PR's. We performed an enhancer trap screen in order to target genes specifically expressed in PR's. Using the UAS/GAL4 method with enhanced green fluorescent protein (eGFP) as a vital marker, we screened 180000 flies. Out of 2730 lines exhibiting new eGFP patterns, we focused on 16 lines expressing eGFP in particular subsets of PR's. In particular, we describe three lines inserted near the spalt major, m-spondin and furrowed genes, whose respective expression patterns resemble those genes. These genes had not been reported to be expressed in the adult eye. These examples clearly show the ability of our screen to target genes expressed in the adult Drosophila eye.

Animals↗
PubMed2000

[Screws versus screw-plate fixation of type 2 Schatzker fractures of the lateral tibial plateau. Cadaver biomechanical study. Arthroscopy French Society].

PURPOSE OF THE STUDY: We compared in vitro the efficacy of screw-plate fixation versus double screw fixation on a model of type 2 Schatzker fracture of the lateral tibial plateau. MATERIALS AND METHODS: Ten screw-plate fixations using a lateral prebent plate and 10 double-screw fixations (6.5 mm screws) were made on 10 pairs of non-embalmed cadaver knees after simulation of type 2 Schatzker fractures. The strength of each fixation was tested with a compression device. Criteria indicating failure were displacements greater than 2 mm of one or more fracture lines. The force applied at rupture and the stiffness of each type of fixation were compared. Wilcoxon's test was used for statistical analysis. RESULTS: Force at rupture and stiffness of the fixation were similar for the two types of fixation. There was no statistical difference (p > 0.05) between the screw-plate and the double-screw fixations. DISCUSSION: Our findings on a model of type 2 Schatzker fractures are in agreement with previous data obtained by other authors working on models of type 1 Schatsker fractures. The biomechanical stability of the double-screw fixation is as good as that obtained with screw-plate fixation for the treatment of fractures of the lateral tibial plateau.

Aged↗
PubMed2000

[Malignant non-Hodgkin's lymphoma presenting with arrhythmia and conduction defects. Report of 2 cases].

Primary cardiac lymphoma is very rare. Secondary localisations are more common, observed in 15 to 30% of autopsy series. Clinical symptoms of cardiac involvement are rare, explaining the usual post-mortem diagnosis. The presentation of cardiac involvement by arrhythmias and conduction defects is very uncommon. The authors report two cases, the first of a 35 year old man in whom primary cardiac lymphoma presented with ventricular tachycardia complicated secondarily by complete atrioventricular block (AVB) with pseudo-inferior wall infarction. The second case was a 37 year old man with a cutaneous T cell lymphoma in whom complete AVB was the first sign of a secondary cardiac localisation of his disease. The finding of cardiac lymphoma should lead to aggressive chemotherapy as soon as possible.

Adult↗
PubMed1999

[Osteosynthesis under arthroscopic control of separated tibial plateau fractures. 26 case reports].

PURPOSE OF THE STUDY: Arthroscopic treatment of tibial plateau fractures may reduce morbidity compared to open articular surgery. But bony fixation is necessarily percutaneous and minimal. The purpose of our study was not only to assess immediate results but also long term functional and anatomic results after arthroscopic treatment of tibial plateau fractures, with special reference to radiographical results. MATERIAL AND METHODS: Twenty-six patients (mean age 42 years, range 18 to 70 years, 17 men, 9 women) were arthroscopically treated for a fresh tibial plateau fracture. According to Schatzker classification, there was 2 type I, 17 type II, 6 type III and 1 type IV. No type V or VI were treated in this series. The fixation device was: percutaneous cannulated screw in 23 cases, Kirchner wire in 2 cases, and bone cement filing of the fracture site in 1 case. We did not use cancellous bone graft but we used a hydroxyapatite plug in one case. There were 8 meniscal injuries: 2 underwent arthroscopic suture, 1 had partial meniscectomy and 5 were left in place. Twenty-six cases were suitable for immediate post op follow up. 19 were reviewed at long term. A clinical (Knee Society scoring system) and radiographical examination were done with an average follow-up of 32.7 months. RESULTS: There were no complications except one immediate postoperative septic osteoarthritis (case with hydroxyapatite plug) and one bony depression of the lateral tibial plateau at the fourth month. Passive motion of the knee started at 1.8 days postop with no pain. Mean flexion at 3 months was 130 degrees. At revision, the average score was: 94.1 for the knee, 94.7 for the function. In two cases we found early signs of osteoarthrosis. There were no secondary bony depression or significant valgus deformity on X-rays. CONCLUSION: Arthroscopic management of tibial plateau fractures allows a complete articular screening. Rapid rehabilitation, short hospital stay, and low rate of complications reduce morbidity. The long term results are as good as those with open surgical technique for the types of fracture that we have treated (type III and IV). A minimal, percutaneous osteosynthesis which was the only possibility under arthroscopic control, did not modify the anatomical results.

Adolescent↗
PubMed1999

[Arthroscopic meniscectomy with Ho-Yag laser versus mechanical meniscectomy. Mid-term results of a randomized prospective study of 80 meniscectomies].

INTRODUCTION: The theoretical advantages of the Ho-Yag laser make it the ideal instrument for current use in arthroscopic meniscectomy. Short term results showed less patient discomfort, rapid recovery and less post operative pain and swelling. The purpose of this single blind prospective randomized study was to compare the results of arthroscopic meniscectomy performed mechanically to those obtained with the Ho-Yag laser, with a minimum follow up of one year. MATERIALS AND METHODS: Eighty meniscectomies in 76 patients were included with a mean follow up of 19.5 months (extremes 12-35 months). The mean age was 42.5 years (extremes 18-65 years). The laser group included 39 patients while the mechanical group included 37 patients. In the Ho-Yag laser group, energy never exceeded 30 watts. During arthroscopic meniscectomy, no other surgical procedure was allowed i.e. chondroplasty, ligament surgery. Prior to arthroscopy, all patients underwent a clinical evaluation including: Pain and Lysholm score assessment. This was repeated in the post operative period at the 10th, 30th day and at last follow up. 37 patients also had a standard X ray at last follow up (anterior-posterior, lateral, and schuss views). RESULTS: No statistically significant difference was observed in global clinical results between both techniques. Even if mechanical meniscectomy showed better results, the laser remained best when used in degenerative medial meniscal tears with minimal cartilaginous lesions. In degenerative medial meniscal tears with severe cartilaginous lesions, mechanical meniscectomy showed significantly better results (p = 0.048). X ray control was normal in 47 p. 100 of the laser group and in 80 p. 100 of the mechanical group. The difference was statistically significant (p = 0.038). Narrowing of the joint space was observed in 45 p. 100 of laser group and in 18 p. 100 of mechanical group. Iterative arthroscopy was necessary in 4 cases (3 laser and 1 mechanical) for residual pain. Severe chondrolysis was present in 2 cases following laser meniscectomy. In the 2 other cases a complement of meniscectomy for residual lesions allowed good results. No bony necrosis was observed after laser meniscectomy. CONCLUSION: According to the results of this study and the high cost of the laser, we do not recommend the laser as a routine technique for arthroscopic meniscectomy.

Adolescent↗
PubMed1999

[Role of arthroscopy in the treatment of pyogenic arthritis of the knee in adults. Report of 16 cases].

PURPOSE OF THE STUDY: The goal of this study was to determine the place and the limit of the arthroscopic management of septic knee arthritis. This procedure is an alternative treatment to needle aspiration and to open arthrotomy drainage. MATERIAL AND METHODS: Sixteen adult patients were treated between 1993 and 1997 for pyogenic septic arthritis of the knee. The duration of symptoms prior to arthroscopic debridement was 4.5 days (range, one to 14 days). In 8 patients the infection was hematogenous. 5 patients had post-operative infection, 2 had post-traumatic infection and one infection followed an intraarticular injection. All the patients were treated by arthroscopic debridement and irrigation of the knee. A partial synovectomy of the anterior compartment was carried out in 4 cases in which the infection diagnosis was delayed. In 6 patients with resistant germ or early unfavorable course (clinically or biologically), an early iterative arthroscopy was performed between 2 and 7 days after the first procedure. The medical treatment consisted in a double systemic antibiotherapy for an average duration of 4 weeks, followed by oral treatment for 3 weeks. The patients were encouraged to mobilize their knee as soon as C Reactiv Protein was normal (average 3 weeks, 0 to 12). RESULTS: The average follow up was 20.5 months (2 to 60). Two elderly patients died, one directly related to knee infection. One patient with prior patella osteosynthesis had a recurrent infection 10 months after the arthroscopy. Thirteen out of 14 patients had an excellent or good functional result. DISCUSSION: Arthroscopic drainage is a valuable alternative procedure for the treatment of the septic arthritis. Arthroscopic treatment leads to a more effective infectious result than needle aspiration procedure and the functional result is better than with open drainage. Septic arthritis in the elderly or in patients with multiple organ failure have a poor prognosis. The treatment of pyoarthrosis of the knee must be aggressive and we frequently propose an iterative arthroscopic drainage, specially in case of delayed treatment, early unfavorable course or multiresistant germ.

Adolescent↗
PubMed1998

Evaluation of a weight-adjusted single-bolus plasminogen activator in patients with myocardial infarction: a double-blind, randomized angiographic trial of lanoteplase versus alteplase.

BACKGROUND: Lanoteplase (nPA) is a rationally designed variant of tissue plasminogen activator with greater fibrinolytic potency and slower plasma clearance than alteplase. METHODS AND RESULTS: InTIME (Intravenous nPA for Treatment of Infarcting Myocardium Early), a multicenter, double-blind, randomized, double-placebo angiographic trial, evaluated the dose-response relationship and safety of single-bolus, weight-adjusted lanoteplase. Patients (n=602) presenting within 6 hours of acute myocardial infarction were randomized and treated with either a single-bolus injection of lanoteplase (15, 30, 60, or 120 kU/kg) or accelerated alteplase. The primary objective was to determine TIMI grade flow at 60 minutes. Angiographic assessments were also performed at 90 minutes and on days 3 to 5. Follow-up was continued for 30 days. Lanoteplase achieved its primary objective, demonstrating a dose-response in TIMI grade 3 flow at 60 minutes (23.6% to 47.1% of subjects, P<0. 001). Similar results were observed at 90 minutes (26.1% to 57.1%, P<0.001). At 90 minutes, coronary patency (TIMI 2 or 3) increased across the dose range up to 83% of subjects at 120 kU/kg lanoteplase compared with 71.4% with alteplase. Thus, at this dose, lanoteplase was superior to alteplase in restoring coronary patency (difference, 12%; 95% CI, 1% to 23%). The early safety experience in this study suggests that lanoteplase was well tolerated at all doses with safety comparable to that of alteplase. CONCLUSIONS: Lanoteplase, a single-bolus, weight-adjusted agent, increased coronary patency at 60 and 90 minutes in a dose-dependent fashion. Coronary patency at 90 minutes was achieved more frequently with 120 kU/kg lanoteplase than alteplase. In this study, safety with lanoteplase and alteplase was comparable. InTIME-II, a worldwide mortality trial, will evaluate efficacy and safety with this promising new agent.

Adolescent↗
PubMed1998

[Congenital quadricuspid aortic valves].

BACKGROUND: Quadricuspid aortic valve is an uncommon congenital anomaly. We report a case in a patient hospitalized for heart failure. CASE REPORT: A 62-year old patient with exercise-induced dyspnea was hospitalized for heart failure. Heart auscultation revealed a diastolic aortic murmur attributed to a quadricuspid aortic valve evidenced at echocardiography. DISCUSSION: Quadricuspid aortic valves usually have three cusps of equivalent size and a small fourth cusp between the right coronary cusp and the non-coronary cusp. Aortic regurgitation is usually observed requiring valve replacement in 50% of the cases. The anomaly may be associated with other congenital anomalies of the coronary arteries warranting systematic coronarography prior to valve replacement.

Aortic Valve↗
PubMed1998

[Meniscal lesions].

The menisci of the knee play an important role in joint congruence, stability and absorption. They thus contribute to cartilage preservation. This is why current treatment of meniscal lesions is based on the notion of maximum preservation of the menisci: meniscectomy as partial as possible, but also whenever possible, meniscal repair (meniscal suture), or abstention from surgery (the lesion left in place). The type of therapy depends on the one hand on the type of meniscal lesion (traumatic or degenerative), but also on the context (age, state of the cartilage, and especially state of the ligaments). In case of associated rupture of the anterior cruciate ligament, treatment of the ligament lesion (ACL reconstruction) usually takes precedence over treatment of the meniscal lesion; the latter, whenever possible, is preserved (suture or abstention). In the case of meniscal lesion on an otherwise intact knee, the usual approach is very partial arthroscopic meniscectomy. Arthroscopy has shortened the immediate postsurgical effect, but long-term results still show a certain percentage of narrowing joint's space, in particular on the lateral meniscus.

Anterior Cruciate Ligament↗
PubMed1998

[Rapid chondrolysis after arthroscopic external meniscectomy. Apropos of 4 cases].

The authors report 4 cases of rapid lateral femoro-tibial chondrolysis following arthroscopic lateral meniscectomy. All patients were young athletes. At the time of meniscectomy, the cartilage of the lateral compartment was normal. Only one meniscectomy was done with the Ho Yag laser. Clinical symptoms were always identical: pain and important swelling, persisting despite intra articular injections of corticosteroids. A second-look arthroscopy was performed after a mean delay of 6 months (5 to 8), showing numerous cartilaginous debris floating in the joint (like in a chondromatosis disease) and a severe cartilaginous damage in the lateral compartment (grade 3 or 4). Swelling disappeared after arthroscopic lavage followed in two cases by a non weight bearing period of one to two months. But X-rays always demonstrated a narrowing of the lateral joint line on flexion-full weight bearing AP views. Rapid chondrolysis is a rare and severe complication of lateral meniscectomy. The etiology, which is mechanical, is not known. It probably represents an acute form of chronic, slow chondrolysis which is frequent after lateral meniscectomy. Rapid chondrolysis should be treated urgently by the following protocol: arthroscopic lavage, intra articular injections of corticosteroids and non weight bearing period.

Adult↗
PubMed1998

[Single-portal endoscopic treatment of carpal tunnel syndrome. Results of a preliminary series].

UNLABELLED: The aim of this study was to describe the single-portal endoscopic technique developed by J. Menon for the treatment of carpal tunnel syndrome and to evaluate its results in our first 82 patients. PATIENTS AND METHODS: The technique involved insertion of a split cannula into the previously dilated carpal tunnel, followed by section of the transverse carpal ligament from its proximal to its distal edge under visual guidance via a standard arthroscope. No immobilization was used postoperatively. A homogeneous population composed of 82 consecutive patients (71 female and 11 male) with a mean age of 51 years was studied. Mean follow-up was 15 months. A questionnaire was used to evaluate results at last follow-up, and patients were categorized into four groups based on Kelly's criteria. RESULTS: Fifty one patients (62 per cent) reported complete relief of symptoms and 29 (35 per cent) a substantial improvement, for a total of 97 per cent good and very good results. The symptoms remained unchanged in two patients, of whom one underwent revision. One patient was reoperated because of symptoms due to section of the thenar branch. The arthroscopic procedure was converted to an open procedure in 3.6 per cent of cases. DISCUSSION: The main advantage of the arthroscopic method is a faster recovery. The method developed by Menon and the material it requires are simple. Complications may be less common than with the two portal method. CONCLUSION: The single portal endoscopic technique developed by Menon for the treatment of carpal tunnel syndrome is effective and safe when it is performed in carefully selected patients using a faultless technique.

Adult↗