Biomedical subjects
P Bourrel
Publications and source records attributed to P Bourrel.
Reactivation of the dorsiflexors of the foot in leprotic paralysis of the common peroneal nerve. Observations on 26 cases.
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[Strategy and tactics in leprosy surgery].
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[Form for palliative surgery of leprosy].
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[Epiperineural nerve sutures and neurilemmatic sutures. Comparative clinical results about 109 cases (author's transl)].
During the last ten years, 109 medical cases of traumatic hand nerve lesions have been observed, implicating 78 big nerves (median 35, cubital 42, radial 1) and 37 little nerves (median 35, cubital 42, radial 1) and 37 little nerves (interosseous, collateral, digital). 81 "mixte" epiperineural sutures have been realized (according to a technical proceeding purposed by one of the authors since 1970, and practised with the only aid of a simple optical increase by dissection's magnifying-glasses) : In the same time, 38 neurilemmatic sutures have been seen at second hand and their clinical results noted. 64+ of the global results are very good or "good" concerning the "mixte" epiperineural sutures against 34% for the neurilemmatic sutures. To note : the best quality of the results for the median nerve as well for the primitive sutures, and unfavourable influence of the associated lesions.
[A particular nervous traumatology: lesions of sciatic nerve by quinine intragluteal injections (author's transl)].
These lesions of the sciatic nerve have a significant frequency in Africa, as a consequence of quinine intragluteal injections made by insufficiency trained nurses. Infants and children are most frequently affected. The lesions are a sclerous scar with or without a damage of the neural trunk. The clinical aspect is that of an algo-paralysis. Medical treatment by vitamins, alphachymotrypsine and physiotherapy must be applied early and during two months to have a chance bringing recovery. If it fails, surgical neurolysis is then necessary. Results vary according to the extent of the lesions.
[Direct surgery of leprous neuritis].
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[Who operates on leprosy patients?].
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[Temporary surgical missions for leprosy. Apropos of 3 missions in the Central African Republic allowing the performance of 71 reconstructive interventions].
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[Rapid neurologic examination in leprous neuritis].
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[Thompson's operation for reestablishing thumb opposition].
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[Traumatology in the tropics].
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[Surgery of leprous neuritis (a 16 mm colour-sound film--35 minutes (author's transl)].
When medical treatment is not sufficient, surgery may still improve leprous neuritis by:--opening of osteo-fibrous tunnels where is an external compression fixing the level of physiological blockade: the elbow for the cubital nerve, the wrist for the median nerve, the peroneal neck for the peroneal nerve, the instep for the tibial nerve;--opening the thickened and consequently inextensible epineurium, inducing a release of the compression acting upon the nervous bundles and permitting their recovery if they are not yet destroyed. The film describes the various techniques immediately effective in hyperalgic neuritis and giving valuable recoveries in forms showing already a functional impairment.
The metacarpophalangeal stabilization test: its surgical interest.
If the fingers of the claw hand are stabilized in order to prevent over-extension of the metacarpophalangeal joints, the long extensors will fully extend both interphalangeal joints. Based on the proximal interphalangeal stiffness assessed by this test, a simple therapeutic plan is proposed for the choice of the appropriate techniques for palliative claw hand surgery.
Two objective "archivable" tests for voluntary muscle testing in ulnar and median nerve paralysis.
Two tests are proposed for assessment of ulnar and median nerve function for use under field conditions: (i) "flap flexion" of fingers for ulnar nerve, and, (ii) tip-to-tip thumb opposition to the fourth finger for median nerve. These tests, which are a part of a series of simple clinical tests proposed for rapid neurological evaluation of the function of the nerves involved in leprosy, are simple, objective and easy to do. Because these tests depend on the strength of muscles tested, they might spare its direct assessment. In fact, it is difficult to assess and grade the strength of the little muscles of the hand and that is very much dependent on the examiner's own experience. Therefore, it is rather subjective. The tests described here may also be used for evaluating the results of corrective surgery of the hand. Whenever possible, making photographic records of these two tests, to be archived in the forms where everyone can see and compare them, seems to be easier and more objective than the subjective transcription of the feelings of an examiner assessing the strength of the small muscles of the hand. These two tests seem to be most objective for a scientific prospective study with a long term follow up. So, they could be used in assessing the results of leprosy neuritis by medical treatment, or, by medical treatment completed (when necessary only and not routinely) by surgical decompression of nerves and also of corrective surgery of claw hand, or, loss of opposition of the thumb.