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Biomedical subjects

P Carpentier

Publications and source records attributed to P Carpentier.

At least 55 records · Page 3Linked to original sources

Innervation of the human lateral pterygoid muscle.

The one- or two-headed arrangement of the lateral pterygoid m. (LPM) was analysed by studying the motor nerve distribution within the muscular tissue. In all subjects, the main innervation of the lateral pterygoid m. came from the anterior trunk of the mandibular n. by one to three nerves. These nerves divided into five or six vertical branches which ramified into parallel horizontal tiny fibers. Consequently, the lateral pterygoid m. appeared to be divided into oblique sagittal planes and horizontal layers by the nerve branches, reflecting the multipennate organisation of the muscle. These layers can be selectively recruited during mandibular movements, ensuing a fine medial-lateral control. According to its nerve supply, the LPM has to be considered as a single unit made of independent functional musulo-aponeurotic layers even though its morphologic conformation is in one, two or three heads.

Aged↗

Anatomic and mechanical properties of the lateral disc attachment of the temporomandibular joint.

PURPOSE: This study measured the strength to failure of the human temporomandibular joint (TMJ) lateral disc attachment (LDA) using a tension-compression machine. These data were correlated with the LDA location and its morphologic aspects, the age and sex of the subjects, and the amount of the lateral pterygoid muscle (LPM) inserted in the disc. METHODS: Forty-two TMJs without any obvious internal damage were carefully dissected to preserve the LDA. The width of insertion of the lateral pterygoid muscle fibers in the anterior band, as well as the width of the disc, were measured. The tension test was performed until the complete failure of the sample using a screw machine. RESULTS: Two types of LDA were recognized. In LDA 1, the anterior and posterior bands lateral disc junction were directly inserted on the lateral pole, whereas in LDA 2 this lateral junction was attached behind and below the pole through a sheet of fibrous tissue. The breaking points for LDA 1 (55.8 N) and LDA 2 (28.8 N) were significantly different (P = .03). No correlation was found between the amount of LPM discal fibers insertion, sex, age, or the LDA breaking strength point. CONCLUSION: The LDA 2 insertion strongly suggests that the lateral joint ligament together with the capsule may act as a substitute for the original disc attachment to the lateral pole of the condyle.

Age Factors↗

MR of 732 TMJs: anterior, rotational, partial and sideways disc displacements.

OBJECTIVE: The purpose of this study was to determine the prevalence of anterior, sideways, rotational and partial anterior disc displacements, as well as degenerative changes in patients with clinical signs and symptoms of internal disorders. MATERIALS AND METHODS: 732 MR Images of temporomandibular joints (TMJ) were produced for 366 symptomatic patients. Image analysis included assessment of disc positions and mobility, as well as recapture in coronal and mediolaterally divided sagittal planes in closed and open positions. RESULTS: Of these images, 545 TMJ showed an internal derangement comprised of 52% anterior disc displacements without reduction, 26% anterior disc displacements with reduction, 11% partial anterior disc displacement, 5% pure sideways displacements and 4% stuck discs. Rotational disc displacements were observed in 34% of the anterior disc displacements without reduction group and in 53% of the anterior disc displacements with reduction group. A total of 97% of the partial anterior disc displacement occurred laterally. Degenerative changes increased with age, mainly in the anterior disc displacements without reduction group. CONCLUSION: Magnetic resonance imaging (MRI) investigations show that the disc is subject to a great variety of displacements and that there is a need for further research to refine the clinical therapy for TMJ internal derangements.

Adolescent↗

Early development of deep-vein thrombosis following hip fracture surgery: the role of venous wall thickening detected by B-mode ultrasonography.

Deep-vein thrombosis (DVT) remains the most frequent complication following hip surgery. This study was designed in order to evaluate the development of DVT after hip fracture surgery, and to determine if venous wall thickening detected before surgery predisposes patients to postoperative DVT. Systematic ultrasound examinations were performed on 100 consecutive patients undergoing hip fracture surgery on the day preceding the operation, and then postoperatively on days 2, 5 and 10. A total of 12 proximal, 28 distal deep-vein and four saphenous vein thromboses were detected. Of the DVT, 19 (43%) were detected at day 2. Five out of eight patients with venous wall thickening had a previous history of DVT. Venous wall thickening was positively correlated with proximal DVT development (62.5% versus 8% incidence in the group of patients with and without venous wall thickening respectively; p<0.001, relative risk = 7.8). This study highlights the high frequency of early major thromboembolic events following hip fracture surgery. It is considered that patients with a previous history of venous thromboembolic disease should undergo B-mode ultrasonographic examination before hip fracture surgery. Patients in whom venous wall thickening is detected should have repeated postoperative ultrasonographic examinations enabling early detection of DVT.

Adult↗

[MRI study of temporomandibular joint disk behavior in chilren with hyperpropulsion appliances].

Orthodontic and orthopaedic effects of hyperpropulsors have been studied, evaluating the possible adaptation of the temporo mandibular joint. Before the event of MR imaging, the positional modification of the disc could not be seen. The study has been carried out on 15 subjects, skeletal Class II, with a mean age of 11.6 years (SD = 1 year). A bilateral MR investigation has been done before and after the wear of an activator (Herbst or Monobloc with Head Gear). All patients underwent bilateral imaging in sagittal and modified coronal planes in closed and opened mouth. The qualitative analysis of the temporo-mandibular joints reveals the appearing of internal derangements, often asymptomatic, in one case out of five; the disc being anteriorly displaced on an average of 8.3 degrees (p = 0.023). These results need to be confirmed on larger samples but may modified functional approach of orthopaedic treatments in order to take into account the TMJ change.

Activator Appliances↗

[Combination treatment for pilocytic astrocytoma: stereotaxic radiosurgery and endocavitary radiotherapy].

The treatment of a pilocytic astrocytoma located in a functional area can be performed using radiosurgery. We report a 7 year old male, right-handed, who presented with a pilocytic astrocytoma in the left parieto-occipital lobe. After a 7 year follow-up, the tumor became symptomatic (partial and generalized seizures). The CT scan and nuclear magnetic resonance imaging revealed an increased size of the mural tumor and the development of a cystic component. Multi-beam irradiation of the tumor (dose of 30 Gy at the center with 21 Gy on the isodose 70%) was performed with a LINAC for radiosurgery coupling a modified Saturne 18 MeV linear accelerator and a Talairach stereotactic frame. Following multi-beam irradiation, the increase in size of the cyst imposed further intracavitary radiation using Rhenium 186 (186Re) to deliver 400 Gy to the cyst wall. After a period of intense cerebral edema, resolutive with steroid treatment, we obtained progressive cyst disappearance and mural nodule retraction. A PET scan, performed 3 years after this treatment, revealed no metabolic activity in the persistent mural nodule. The patient remains totally asymptomatic.

Astrocytoma↗

Heat stress, even extreme, does not induce penetration of pyridostigmine into the brain of guinea pigs.

Stress due to forced swimming was recently shown to allow penetration of pyridostigmine (PYR) into the brain of mice. Accordingly, it was suggested that in troops exposed to emotional stress under conditions of war, as during the Gulf War, the BBB may have unexpectedly become permeable to PYR thus leading to an increased frequency of CNS symptoms. In this study, the entry of PYR into the brain was investigated in guinea pigs subjected to different heat stress levels. In a first group, guinea pigs were maintained at room temperature for 2 hours, their core temperature remaining stable at about 39.8 degrees C. In a second group, animals were placed in a climatic chamber in order to keep their core temperature at 41.5 degrees C for 2 hours. In a third group, animals were subjected to a high ambient temperature (42.6 degrees C) during about 2 hours and developed heatstroke symptoms, their core temperature progressively increasing and reaching around 44.3 degrees C. In each group, the stress of the animals was assessed by measuring the increase of plasma cortisol level. PYR (0.2 mg/kg, s.c.) was injected 90 minutes after beginning the experiment. Penetration of the drug into the brain was examined by measurement of acetylcholinesterase (AChE) activity in the cortex, the striatum and the hippocampus of the animals 30 minutes after PYR administration. A passage of this drug into the brain was also evaluated autoradiographically after i.v. injection of tritiated PYR 90 minutes after the beginning of the experiment (100 microCi/animal). Whatever the group examined, no entry of PYR into the CNS could be detected. Exposure to an ambient temperature at 42.6 degrees C for 2 hours resulted by itself in a partial inhibition of cerebral AChE activity. Our results, which agree with previous data obtained in humans exposed to heat stress, are opposite to the recent research showing a central passage of PYR in mice following a forced swim stress test. This demonstrated that the penetration of PYR into the brain of rodents under stress depends on the experimental conditions used (animal species, nature of the stressor, etc.). Extrapolations to humans of results primarily obtained in rodents about central passage of a drug under stress must thus be done very carefully.

Animals↗

c-fos antisense oligonucleotide prevents delayed induction of hsp70 mRNA after soman-induced seizures.

Previous studies have shown the successive expression of c-fos and hsp70 genes, especially in the hippocampal formation, during soman-induced seizures. In order to detect a possible link between the induction of these two genes, antisense strategies have been used. First, the ability of unilateral intrahippocampal infusion of c-fos antisense oligonucleotides to inhibit ipsilateral, seizure-related, c-FOS-like immunoreactivity, was verified. Second, induction of hsp70 mRNA was investigated using in situ hybridization. Unilateral inhibition of c-fos induction clearly reduced levels of hsp70 mRNA in the c-fos antisense-infused hippocampus relative to the non-infused contralateral side. Infusion of c-fos sense probe or vehicle did not affect bsp70 mRNA induction. This study suggests a role of c-FOS in regulating bsp70 mRNA induction.

Animals↗

Acute pulmonary embolism: role of helical CT in 164 patients with intermediate probability at ventilation-perfusion scintigraphy and normal results at duplex US of the legs.

PURPOSE: To assess prospectively the clinical effectiveness of helical computed tomography (CT) in the evaluation of patients with unresolved suspicion for pulmonary embolism (PE). MATERIALS AND METHODS: Helical CT was performed in 164 consecutive patients suspected of having acute PE, intermediate probability at ventilation-perfusion (V-P) scintigraphy, and normal findings at duplex ultrasonography (US) of the legs. Fifteen patients also underwent pulmonary angiography. Helical CT results were analyzed immediately to help plan anticoagulant treatment. If helical CT did not show PE, anticoagulant treatment was not indicated. Clinical outcome for these patients was assessed during 3-month follow-up. RESULTS: In 40 (24.4%) of 164 patients, the diagnosis of PE was based on results at helical CT (n = 39) or pulmonary angiography (n = 1). Repeated Doppler US of the legs depicted one thrombus in the calf of three patients with normal results at helical CT that could have been responsible for PE. During 3-month follow-up, three patients experienced recurrent PE (one death, two recurrences). Therefore, PE occurred in six (5.4% [95% confidence interval, 1.3%, 9.7%]) of 112 patients with normal findings at helical CT who did not receive anticoagulant treatment. CONCLUSION: Findings at helical CT allowed accurate diagnosis of acute PE in patients with intermediate probability at V-P scintigraphy and without deep venous thrombosis at duplex sonography of the legs.

Acute Disease↗

Pulmonary embolus as a complication of femoral venous catheter removal.

The case of a 31 year old woman who developed asymptomatic pulmonary emboli after removal of a femoral venous catheter is reported. A deep venous thrombus had previously been shown to be associated with the catheter. Therefore it is argued that care should be taken when removing femoral lines especially in patients at high risk of thrombosis and that femoral venous duplex scan may be warranted prior to line removal in these high risk patients.

Adult↗

GK 11: promising additional neuroprotective therapy for organophosphate poisoning.

Recent experiments with primates have demonstrated that treatment with atropine/pralidoxime/diazepam, even if administered immediately after organophosphate exposure, does not totally prevent neuronal brain damage. Using primates, we have studied, for the first time, the ability of GK-11 (gacyclidine), an antiglutamatergic drug in the process of agreement for human use, given as an additional therapy, to counteract the neuropathology due to organophosphate exposure that persists after classical treatment with oxime/atropine/benzodiazepine. We have also examined the recovery of the organophosphate-intoxicated primates. Male Cynomolgus monkeys were pretreated 1 hour before poisoning with pyridostigmine, then intoxicated with 8 LD50 of soman and immediately treated with the combination pralidoxime/atropine/diazepam. Some of the animals also received GK-11 at 0.01; 0.03 or 0.1 mg/kg (i.v.) 10 minutes after soman challenge. Recovery of the primates (reflexes, movements, feeding) and the neuropathological changes that occurred three weeks after intoxication (histological examinations and neuronal cell density measurement) were compared in GK-11-treated and control animals. At all doses tested, GK-11 prevented the neuronal rarefaction of the frontoparietal cortex that was observed in soman-intoxicated animals that received only oxime/atropine/diazepam. Moreover, the 0.01 mg/kg dose of GK-11 improved the early recovery of intoxicated primates from 1 day after intoxication. In the view of the most effective management of organophosphate intoxication that is currently available, GK-11 thus appears to be a promising additional neuroprotective therapy. This drug is presently being evaluated in a human clinical trial for a different neuroprotective indication.

Animals↗

Genitourinary group phase II study of chemotherapy in stage T3-4 N0-X M0 transitional cell cancer of the bladder: prognostic factor analysis.

The aim of this study was to examine prognostic factors for survival of patients with invasive bladder cancer who had received neoadjuvant chemotherapy followed by further treatment. From 1986 to 1990, 149 eligible patients with T3-4 N0-X M0 bladder cancer were entered into a phase II trial of neoadjuvant chemotherapy, consisting of cisplatin and methotrexate. Patients received two or four courses of chemotherapy, depending on the absence or presence, respectively, of a major clinical response after two courses. 136 patients were evaluable for clinical response after two courses of chemotherapy, and 75 patients were evaluable for pathological response after two or four courses. A multivariate analysis, based on pretreatment variables and the post-treatment variables, clinical response and pathological response, showed that performance status, tumour size and clinical response after two courses of chemotherapy were the only independent prognostic factors for all eligible patients. A second multivariate analysis in the selected subgroup of patients, who underwent a cystectomy, showed that the G-cagetory and pathological response were the only independent prognostic factors. In conclusion, in this group of patients, the response to chemotherapy was a strong and independent prognostic factor in addition to other independent variables. However, it was not accurate or strong enough to allow an impact on the choice of locoregional therapy.

Aged↗

Early regional changes of GFAP mRNA in rat hippocampus and dentate gyrus during soman-induced seizures.

We investigated the time course of GFAP levels in the hippocampal formation during the first 24 h following soman intoxication in rats. GFAP mRNA expression was detected by in situ hybridization. Intense GFAP mRNA expression was present in the molecular layer of the dentate gyrus as early as 6 h after intoxication. This expression was comparatively lower in other dentate gyrus layers and hippocampal CA1, CA3 and CA4 areas and seemed to be related to excessive neuronal activity. Histopathological examination demonstrated that GFAP expression in dentate gyrus is not correlated with lesions. The high astrocytic reactivity in the molecular layer of the dentate gyrus is discussed in relation to the maintenance of the homeostasis of glutamate and of synaptic plasticity in this area during soman intoxication.

Animals↗

Involvement of non-muscarinic receptors in phosphoinositide signalling during soman-induced seizures.

Previous investigations have indicated that soman-induced convulsions involve the inositol lipid signalling system. We previously reported that 10 min after the onset of seizures, inositol 1,4,5-triphosphate (IP3) build-up was coupled to activation of non-muscarinic receptor subtypes. In the present study, we demonstrate that (1) in addition to muscarinic receptors, histamine H1 subtypes and glutamate metabotropic receptors contribute to the first IP3 increase (first 10 min of seizures) and (2) the histamine H1 subtype and glutamate metabotropic receptors are also involved in the second step of inositol phosphate response (after 10 min of seizures). alpha 1-adrenoceptor and 5-HT2 receptors, known to be coupled to phosphoinositide turnover, did not participate in soman-induced IP3 response. Neurochemical interactions between cholinergic, histamine H1 and glutamate metabotropic systems, responsible of the phosphoinositide hydrolysis under soman are envisaged.

Animals↗

[The temporomandibular joint meniscus in MRI].

The continuing improvement of the MRI's equipment and software led us to a continuous adaptation of the exam technique. We use today a bilateral coil technique, 3 inches in diameter. Four slices are performed for each articulation (4 mm thick) in the true sagittal plane. A fast spin echo, balanced in proton density, for one minute, allows the study of 15 steps inside a full open/close cycle. Oblique coronal cuts are also performed parallel to the long axis of the condyle in a T1-weighted spin echo sequence in close and half-open positions. The analysis of 350 subjects allows to detail more precisely the meniscal displacement. Beside the classic anterior luxation, the meniscus slips medially, laterally and may rotate. These different situations may be isolated or combined. The dynamic study is specifically useful in the displacement with reduction exams. It enables permits to point out the timing of the disk disturbance: this information may be of great help in therapeutic decisions.

Adolescent↗