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Biomedical subjects

P Beaufils

Publications and source records attributed to P Beaufils.

At least 91 records · Page 5Linked to original sources
PubMed1988

[Post-traumatic infection of the femur].

Thirty-two cases of post-traumatic infection of the femur are reported. Apart from antibiotic treatment, surgical treatment comprised two components: excision and stabilization followed by a second stage of reconstruction by bone grafting. The excision was as extensive as was necessary, including thirteen resections of the shaft and twelve sequestrectomies. Stabilization was preferably achieved by an ALJ external fixator applied in a single posterolateral plane leaving the quadriceps free. Two types of reconstruction were used: 24 open cancellous grafts by the Burri-Papineau method and 7 closed corticocancellous grafts. One patient was not grafted. In 5 cases of bone infection with fragility, 4 open cancellous grafts gave sound bone and a healed wound in a mean of 6 months. In 16 out of 20 septic nonunions treated by open cancellous grafts, union and wound healing was obtained in a relatively short time, a mean of 8.2 months. But in four other cases, it was a matter of saving limbs with arterial damage, major lesions of the soft tissues and involvement of the knee joint. In these the healing time was much longer. The seven closed corticocancellous grafts had less satisfactory results; three of them required multiple procedures and healing was delayed for a mean of 27 months. Amputation was needed in one case. The authors consider that closed corticocancellous grafts are only suitable for the simplest cases in which, after excision and stabilization, good bone contact remains. But when the excision requires a considerable removal of bone involving its whole circumference, open cancellous grafts are preferable and lend themselves better to secondary bony procedures. In addition, they seem to be less subject to refracture because of the histological process of bone reformation.

Adolescent↗
PubMed1987

Long-term results of emergency surgery for postinfarction ventricular septal defect.

This study assesses the long-term results of emergency surgical repair of postinfarction ventricular septal defect (VSD). The cases of 28 patients surviving early operative closure of septal rupture (within 1 day to 20 days of the infarction) were reviewed. Only 1 had concomitant coronary artery bypass grafting. Follow-up ranged from 7 to 16 years with an average of 9 years. Four patients were lost to follow-up. There were 4 late deaths, 2 of which were of cardiac origin. One was due to congestive heart failure and 1 to arrhythmia, 1 and 6 years after operation, respectively. Of the remaining 20 patients, 8 are in New York Heart Association Functional Class I and 12 are in Class II. Two patients underwent reoperation, 1 for a left ventricular false aneurysm 5 years postoperatively and the other for unstable angina 10 years postoperatively. Both had an uneventful postoperative course. Only 2 patients had late coronary events (1, nonfatal myocardial infarction; 1, unstable angina). We conclude that aggressive management of postinfarction VSD is fully justified in view of the long-term survival and functional palliation that can be anticipated for operative survivors. We advocate that preoperative coronary artery angiography and subsequent bypass grafting be performed on a selective rather than routine basis.

Aged↗
PubMed1987

[Comparative assessment of cardiac and psychologic results of aortocoronary bypass].

Two categories of criteria are used to evaluate the cardiological and psychological results of aortocoronary bypass (ACB): objective criteria, which support the clinician's judgement, and subjective criteria, which contribute to the patient's comfort. Numerous studies have revealed major discrepancies between these two modes of evaluation. A prospective study was undertaken to compare the cardiological and psychological results of ACB at 1 year. The study was based on 24 parameters collected in an ordinary cardiology consultation and from an open discussion between the patient and his (or her) partner and a psychiatrist. In the first phase of the study the results observed in 51 patients were classified as "good" in 40 and "poor" in 11 by the cardiologist, as against "good" in 32 and "poor" in 19 by the psychiatrist. The psychiatrist's assessment differed from that of the cardiologist on 22 patients, being better in 7 and not as good in 15. The second phase of the study has been devised to validate the results obtained in the first phase and to evaluate the contribution of ergonometric test to the cardiological classification of 37 new patients. This study makes it possible to analyze the reasons for the difference in assessment of the cardiological and psychological benefits of ACB, and to develop a method for measuring the impact on these results of new therapeutic measures, such as rehabilitation.

Adult↗
PubMed1987

[Postoperative infection of fractures of the upper end of the femur].

This series comprises 74 post-operative infections of fractures of the upper end of the femur, 47 associated with internal fixation and 27 with prostheses. The organisms were different in the 13 men, with a predominance of gram-positive cocci, from those in the 61 women in which the significantly high proportion of gram-negative organisms seemed to be due frequent to soiling of urinary origin. In the 47 internal fixations, local wound toilet gave 29 successful results with union in the normal time. Two patients were not able to be operated on again and died before they could be treated. Sixteen failures, including seven deaths, were due to septic arthritis of the hip. The diagnosis of septic arthritis was difficult, which explains why resection of the head and neck of femur was only made in six cases, five of them successfully. In the 27 prostheses, the best results were obtained by deep wound toilet retaining the prosthesis, with nine successes in ten cases. An acceptable functional result was compatible with a persistent grumbling infection.

Aged↗
PubMed1986

[Treatment of unstable angina. A randomized double-blind study of propranolol, diltiazem and molsidomine].

A randomized, multicentric, double blind study attempted to compare in 41 patients hospitalized for unstable angina, the efficacy of diltiazem (D) 240 mg/day, propranolol (P) 160 mg/day and molsidomine (M) 8 mg/day. The patients included in the study presented one or several spontaneous angina episodes accompanied by a transient and significant lowering of ST and/or an inverted T wave without necrosis. The evaluation criteria were the occurrence of new angina pain and electrical alterations on a continuous Holter for 5 days. 11 patients received diltiazem, 13 patients received propranolol and 15 patients received molsidomine (including an early death). Clinically, the number of painful episodes per day and per patient goes, in an average, from 1.2 to 0.23 diltiazem, from 2.2 to 0.44 for propranolol and from 2.2 to 0.45 for molsidomine. Pain disappeared on the 5th day in 54.5 per cent of patients under diltiazem, 58.8 per cent of patients under propranolol and 53.5 per cent of patients under molsidomine. Electrically, the number of ischemic accidents per day and per patient was 0.45 under diltiazem, 2.12 under propranolol (0.53 in excluding one patient with latent angina) and 0.81 under molsidomine. The number of patients without any ischemic accident was 63.6 per cent under diltiazem, 53.8 per cent under propranolol and 40 per cent under molsidomine. In conclusion, diltiazem, propranolol, and molsidomine have a comparable efficacy in unstable angina. The association of these medications could have a synergistic effect.

Angina Pectoris↗
PubMed1986

[Fracture-separation of the atlas. A case].

A case of fracture-separation of the atlas is presented. The diagnosis, suspected on the antero-posterior open-mouth film and the frontal tomograms, was confirmed by computed tomography which showed the double fracture of the anterior and posterior arches of the atlas and demonstrated that the transverse ligament, factor of stability of this fracture, was intact.

Adult↗
PubMed1986

[Long-term course of septal rupture operated on during the acute phase of a myocardial infarct].

Between 1970 and 1979, 28 patients (18 men and 10 women, aged 46 to 76 years, average 62 years) with acute myocardial infarction complicated by septal rupture survived surgery performed during the acute phase. In the same period 62 patients were admitted to the Cardiology Department and were operated early for septal rupture complicating myocardial infarction. The site of infarction was the anterior wall in 22 cases and the posterior wall in 6 cases; septal rupture occurred on average after 4.2 days (range 1 to 10 days); 15 patients including 13 with cardiogenic shock underwent intraaortic balloon pumping for an average of 3:7 (range 1 to 11 days) before surgery; the operation performed after an average interval of 11 days consisted in direct suture of the defect in 3 cases and a patch repair in the other 25 cases, associated in all cases with infarctectomy and LAD coronary bypass grafting in 1 case. The immediate postoperative course was simple; three patients with residual shunts were not reoperated. Five to 14 years later, in 1984, 4 patients had been lost to follow-up; 4 patients had died, 2 of cardiac causes (LVF after 1 year and an arrhythmia after 4 years). Of the 20 survivors, 2 were successfully reoperated (1 coronary bypass after 10 years and 1 false aneurysm after 5 years). Only one patient had recurrent myocardial infarction. The quality and longevity of long-term survival encourage early surgery. The factors affecting long-term survival are discussed: correction of associated valvular defects, resifual shunts, conservation of left ventricular function and evaluation of the coronary circulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

[A new cause of acute transitory auriculoventricular block: Lyme disease].

A young man developed syncopal complete paroxysmal atrioventricular block (AVB) over a 36 hour period, on a background of 1st degree AVB which persisted for 6 weeks. During the 3rd week, electrophysiological studies showed an isolated prolonged AH interval. This episode followed skin and articular manifestations occurring one month after being bitten by a tick in Corsica. The clinical picture suggested Lyme's disease which was confirmed serologically. This condition transmitted bu Ixodes ricinus, a tick present in country districts, is due to spirochetal infection. It is characterized by a chronic migrating erythema, and may sometimes be complicated by severe AV conduction defects which are always regressive, as in our case.

Adult↗
PubMed1986

[Thrombolysis in acute myocardial infarction. Re-evaluation].

The responsibility of a thrombus and the feasibility of saving an ischemic myocardium by early revascularization explain the development of thrombolysis. Streptokinase administered intravenously rather than intracoronary restores coronary patency in 45 p. cent of the cases, improves the total and segmental left ventricular function if an early and complete revascularization is performed before the 3rd hour, helped eventually by a sequential angioplasty. At the cost of an acceptable hemorrhagic risk, thrombolysis reduces in-hospital mortality in patients under 65 years, with anterior primary infarctions. New thrombolytic agents, standardized protocols, decreased length of hospitalization and optimization of infrastructures should improve these first results.

Fibrinolytic Agents↗
PubMed1986

[Infection following centro-medullary nailing of diaphyseal femoral and tibial fractures].

The authors have treated 51 cases of infection arising after intramedullary nailing of the femur or tibia. In 3 cases amputation was required, 48 united, but 10 were still draining. The final result was obtained after an average of 15 months. An average of four procedures per patient were needed. All the cases were septic non-unions at the onset of treatment, except 18 cases which had already united. In these cases, simple removal of the femoral nail led to rapid healing. In contrast, healing was less easy to obtain in the tibia. In 33 septic non-unions, 12 femoral and 21 tibial, the best results at the femoral level were obtained by retaining the nail in situ. At the tibial level, retention of the nail was rarely followed by bony union. Removal of the nail and the use of external fixation gave good results for the infection, but rarely resulted in bony union (1 case out of 14). The failures were treated by further operation of bone resection and grafting. The authors recommend, in cases of tibial septic non-union after nailing that primary removal of the nail should be associated with bony resection and external fixation, followed by reconstructive grafting, either by open cancellous grafting extending to the fibula or conventional tibio fibular grafting. In 8 cases, 7 in the femur and 1 in the tibia, the infection extended throughout the entire diaphysis and in 3 of these cases, a large diaphyseal resection was required.

Adolescent↗