Biomedical subjects
T Fabre
Publications and source records attributed to T Fabre.
[Surgical management of traumatic lesions of the axillary nerve: 83 cases].
Axillary nerve injuries still go undiagnosed far too often despite their frequency. However the quality of the outcome depends on expert management and prompt surgery. To optimise the latter, we re-examined 83 operated cases of traumatic lesions of the axillary nerve. We analysed the neurological and functional recovery of these patients by means of a follow-up evaluation at 6 years postop. The results were classified by age, mechanism of injury, delay to surgery and the presence or otherwise of associated neurological or osteo-articular lesions. We highlighted that a high index of suspicion ought to exist in all cases of trauma to the shoulder in a patient aged more than 40, any injury associated with palsy of the long head of triceps and in the case of an osteo-articular lesion due to high-velocity trauma. A complete lack of shoulder abduction must always prompt a search for a lesion of the axillary nerve as well as a suprascapular nerve palsy or rotator cuff lesion. There are few literature reports of surgical management of this particular nerve injury. An early MRI scan as part of the management should improve results by a reduction in the delay before surgery. As a result of our investigation we conclude that a lesion of the axillary nerve without signs of recovery at 3 months should be referred to a centre specialized in peripheral nerve surgery.
[Long head of the triceps brachii in axillary nerve injury: anatomy and clinical aspects].
PURPOSE OF THE STUDY: Earlier work has demonstrated possible paralysis of the long head of the triceps brachii (LTB) after surgical repair of traumatic injury to the axillary nerve. Anatomy textbooks describe the motor branch of the LTB arising from the radial nerve within the body of the triceps. We studied the position of the motor branch for the LTB to determine its exact origin. MATERIAL AND METHODS: Three groups were studied: Group I included 9 traumatic injuries of the axillary nerve associated with clinical involvement of the LTB; Group II included 20 secondary posterior trunks dissected from cadaver specimens; Group III included 15 dissections of the infraclavicular plexus with complete dissection of the secondary posterior trunk. The position of the axillary nerve injury was retrieved from the operative reports for Group I. The precise origin of the motor branch for the LTB was identified for Group II. Neurostimulation was used to identify the origin of the motor branch for the LTB in Group III. RESULTS: For Group I: injury to the axillary nerve was situated 10 mm (mean) from the bifurcation of the secondary posterior trunk in 6 cases and at the bifurcation in 3. Type IV injury was identified in 4 cases and type V in 5. For Group II: the motor branch for the LTB arose 6 mm (mean) from the bifurcation of the secondary posterior branch in 13 cases, at the bifurcation in 5, and 10 mm proximally in 2, but never from the radial nerve. For Group III: the motor branch for the LTB arose 4.5 mm (mean) from the bifurcation of the secondary posterior trunk in 11 cases, at the bifurcation in 4, and never from the radial nerve. DISCUSSION: Observed injuries to the axillary nerve with an associated paralysis of the long head of the triceps brachii were located proximally and were severe. Our dissections always located the motor branch of the LTB arising from the axillary nerve or the secondary posterior branch. We thus deducted that associated LTB paralysis is a sign of poor prognosis. In patients with axillary nerve injury it is a sign favoring a proximal and severe lesion of the axillary nerve. CONCLUSION: When examining patients with traumatic injury involving the axillary nerve, it is important to search for paralysis of the long head of the triceps brachii. If present, it is a sign of a severe axillary nerve lesion requiring early repair at 3 months.
[Persistent radial palsy after humeral diaphyseal fracture: cause, treatment, and results. 30 operated cases].
PURPOSE OF THE STUDY: Radial palsy is a serious complication of humeral shaft fractures. The risk results from the anatomic position of the radial nerve which turns around the distal portion of the humeral shaft, in contact with the bone. As a rule, radial palsy regresses spontaneously, but in a few cases surgery may be required to achieve neurological recovery. We conducted a retrospective study of thirty cases of radial palsy after humeral fracture treated surgically. Our objective was to define causes of non-recovery and assess therapeutic efficacy, searching for the characteristic features of the fractures involved. MATERIAL AND METHODS: We limited our analysis to post-humeral fracture radial palsies, which were operated due to the absence of neurological recovery. We recorded the type of fracture, treatment used to achieve bone healing, surgical approach, and type of radial nerve surgery. The series included 30 patients, predominantly male, mean age 38.4 years. The fractures were situated in the middle or lower third of the humeral shaft. Most were spiral fractures. Plate fixation (30%) or nailing (33%) were generally used for fixation. There were six cases of iatrogenic palsy, all after plate fixation. A revision procedure was required in one-third of the cases due to nonunion. Exploration of the radial nerve demonstrated compression at the intermuscular septum in one-third of the cases and a direct conflict with the fixation plate in one-fifth of the cases. Neurolysis was required in 23 cases, nerve grafts in five and first-intention tendon transfer in two. RESULTS: Results of nerve surgery were assessed with the Alnot classification at a mean follow-up of 6.3 years. Outcome was rated good or very good in 22 patients, fair in one and poor (failure) in three. First-intention tendon transfers were performed in two patients and two patients were lost to follow-up. Mean delay to recovery was seven months after neurolysis and fifteen months after nerve grafts. DISCUSSION: Our experience and data in the literature suggest that several factors could be involved in persistent radial palsy after humeral shaft fracture. The greatest risk of radial nerve injury or absence of recovery after the primary lesion is encountered after fracture of the lower third of the humerus, spiral fracture, and plate fixation. Particular features observed in our series were nonunion and compression in the intermuscular septum.
Study of a (trimethylenecarbonate-co-epsilon-caprolactone) polymer--part 2: in vitro cytocompatibility analysis and in vivo ED1 cell response of a new nerve guide.
Future surgical strategies to restore neurological function in peripheral nerve loss may involve replacement of nerve tissue with cultured Schwann cells using biodegradable guiding implants. Random copolymers of trimethylene carbonate and epsilon caprolactone (P(epsilonCL-TMC), 50: 50) have been synthesized by ring opening polymerization using rare earth alkoxides as initiator. Their potential use as nerve guide repairs has been assessed through indirect and direct in vitro biocompatibility tests and in vivo soft tissue response to EDI subclass macrophages. In vitro, we exposed monolayers of human skin fibroblasts and an established continuous cell line (Hela) to liquid extracts (either pure or diluted in the culture medium) of epsilonCL-TMC copolymer including positive (phenol) and negative controls. Then, colorimetric assays (Neutral red and MTT) were performed. The extracts of epsilonCL-TMC induced no significant cytotoxic effect. We also exposed in vitro Schwann cells to pieces of P(epsilonCL-TMC) and P(LA-GA) copolymers. We evaluated cell attachment at 1 and 3 h by measuring the activity of the lysosomal enzyme (N-acetyl-beta-hexosaminidase) and cell proliferation at 1, 3, 6 and 9 days by measuring the cell metabolic activity (MTT assay). Values for attachment slightly decreased between 1 and 3 h but were significantly higher than on agars (negative control). Cells plated on epsilonCL-TMC showed a rate of proliferation comparable with that of normalized controls and higher than on PGA-PLA at day 9. Finally, we evaluated in vivo the soft tissue response after implantation of cylindrical tubes of P(epsilonCL-TMC) and P(LA-GA) copolymers with an immunohistochemistry staining procedure for the newly recruited ED1 macrophages. An image analysis system automatically measured the optical density of labelled positive ED1 cells at 9, 21 and 60 days after implantation. epsilonCL-TMC copolymer showed a mild soft tissue reaction with no adverse chronic inflammatory reaction. These data allowed us to consider this conduit as a potential effective substitute in nerve repair. El sevier Science Ltd. All rights reserved.
Study of a (trimethylenecarbonate-co-epsilon-caprolactone) polymer part 1: preparation of a new nerve guide through controlled random copolymerization using rare earth catalysts.
Random copolymers of trimethylene carbonate and epsilon-caprolactone have been synthesized through ring-opening polymerization using rare earth alkoxides as initiator. The structure of the copolymers has been characterized by 1H and 13C NMR. Their thermal behaviour, their permeability to liquid and their mechanical properties have also been evaluated. These copolymers have been used to process a new nerve guide.
In vitro distribution of ketoprofen enantiomers in articular tissues of osteoarthritic patients.
The distribution of ketoprofen enantiomers in joint tissues was studied as a function of their relative tissular affinities using the multi-chamber distribution dialysis system described by Bickel et al. Selected off-cuts of synovial membrane, joint capsule, cartilage and ligament were obtained from ten patients suffering from osteoarthritis of the knee (n=3) or hip (n=7). Sörensen solution (4 ml) spiked with racemic ketoprofen (2 microg ml(-1)) was dialysed against 1 ml of the four solutions of tissue homogenates (0.4 g ml(-1)). Ketoprofen enantiomers were quantified in buffer and tissue solutions by high-performance liquid chromatography. The distribution of ketoprofen enantiomers in the Bickel's multi-compartment model indicated that there was a non-stereoselective affinity of ketoprofen enantiomers for their potential target tissues. Despite the interindividual variability in articular tissues, the concentrations (+/-S.D.) of R- and S-ketoprofen were significantly higher in synovial membrane (8.69 (4.76) microg g(-1) for S, 9.14 (5.57) microg g(-1) for R), joint capsule (5.71 (2.49) microg g(-1) for S, 5.49 (2.62) microg g(-1) for R) and ligament (6.28 (3.61) microg g(-1) for S, 6.40 (3.64) microg g(-1) for R) than in articular cartilage (3.67 (1.75) microg g(-1) for S, 3.70 (1.67) microg g(-1) for R). There were no significant differences in the distribution of R- and S-ketoprofen between the solutions of joint capsule, synovium and ligament tissues. These data may be related to differences in ketoprofen affinity for the different constituents of joints. This in vitro distribution profile is similar to that reported in vivo for other non-steroidal anti-inflammatory drugs.
[Neurolysis of the median nerve in the carpal canal using a mini-invasive approach. Apropos of a prospective series of 138 cases].
INTRODUCTION: The aim of this study was to assess the results of a prospective study of 138 cases with carpal tunnel syndrome operated on by a percutaneous technique. METHOD: One hundred and twenty-nine patients (108 women and 21 men, with a mean age of 49.9 years) underwent preoperative assessment via a questionnaire and a clinical examination (the Weber test, buckle test, Kapandji test, Tinel test, Phalen test, Vainio test and grip force assessment). The surgical technique was singularised by the insertion of a probe cannula in the carpal tunnel so that the blade could be guided during annular ligament section. RESULTS: The results were assessed at one, three and six months follow-up: 98.5% very good and good results were obtained (Kelly criteria); two patients presented with an algodystrophic syndrome. No vascular, tendinous or neurological complications were noted, and the procedure was in no instance switched to an open technique. DISCUSSION: The main advantages of this technique are a rapid recuperation of hand function, with an average of 22.6 days off work, a low complication rate, and simple equipment.
Polymorphonuclear cell apoptosis in exudates generated by polymers.
Flow cytometry was used to quantify apoptotic and necrotic polymorphonuclear (PMN) cells in an exudate generated by biomaterials, and the results were compared with determinations of spontaneous apoptosis and necrosis in PMN cells from the bloodstream. The exudate formed inside cylindrical tubes subcutaneously implanted in the dorsal region of rats was collected over a 1-week period. A rapid and simple staining procedure based on the spectral properties of the bisbenzemide Hoechst 33342 was used to identify apoptotic PMN cells. Quantification of permeabilized PMN cells stained by propidium iodide was possible in the same unfixed specimens. The percentages of apoptotic and permeabilized PMN cells in peripheral rat blood were low (1.8 +/-0 0.5% and 1.7 +/- 0.7%, respectively), similar to results found in humans. In exudates generated by polyvinyl chloride (PVC), the percentages of apoptotic and permeabilized PMN cells were higher than in the blood. The percentage of PMN cells undergoing apoptosis progressively increased with time and reached a maximum at day 2 (27% +/- 6%). The percentage of permeabilized cells progressively increased with time and was much higher than the percentage of apoptotic cells on days 4 and 8. Apoptosis and necrosis of PMN cells at day 2 were inhibited when tubes were filled with 10% serum. Selective inhibition of apoptosis with a caspase inhibitor in vivo indicated that apoptosis and necrosis are two separate pathways leading to the death of PMN cells in the exudate. At day 2, polyurethane (PU) was associated with a lower rate of apoptosis than PVC or a random copolymer of trimethylene carbonate (TMC) and epsiloncaprolactone (ECL). Apoptosis was interpreted as an organized cell removal process that limits inflammation. Apoptosis was the natural route of PMN cell death at the early stage of inflammation.
Entrapment of the suprascapular nerve.
Operative release for entrapment of the suprascapular nerve was carried out in 35 patients. They were assessed at an average of 30 months (12 to 98) after operation using the functional shoulder score devised by Constant and Murley. The average age at the time of surgery was 40 years (17 to 67). Entrapment was due to injury in ten patients and no cause was found in three; 34 had diffuse posterolateral shoulder pain. The strength of abduction was reduced in all the patients. The average Constant score, unadjusted for age or gender, before operative release was 47% (28 to 53). In 25 of the patients both the supraspinatus and infraspinatus muscles were atrophied and seven had isolated atrophy of the infraspinatus muscle. The average conduction time from Erb's point to the supraspinatus muscle and to the infraspinatus muscle was 5.7 ms (2.8 to 12.8) and 7.4 ms (3.4 to 13.4), respectively. In two patients MRI revealed a ganglion in the infraspinatus fossa and, in another, a complete rupture of the rotator cuff. The average time from the onset of symptoms to operation was ten months (3 to 36). A posterior approach was advocated. The average Constant score, after operative release, unadjusted for age or gender was 77% (35 to 91). The overall result was excellent in ten of the patients, very good in seven, good in 14, fair in two, and poor in two. The symptomatic and functional outcome in our series confirmed the usefulness and safety of operative decompression for entrapment of the suprascapular nerve.
Quantification of the inflammatory response in exudates to three polymers implanted in vivo.
Flow cytometry was used to quantify an inflammatory reaction in vivo as a new approach to evaluating the biocompatibility of biomaterials. The exudate formed inside cylindrical tubes composed of polyvinyl chloride (PVC), silicone elastomer (SIL), or polyurethane (PU) implanted subcutaneously in the dorsal region of rats was collected over a 3-week period. The volume, number of cells, and concentration of fibrinogen were determined in the exudate for the three biomaterials. The exudate was analyzed using a flow cytometry technique after labeling of the leukocytes with a monoclonal anti-CD45 antibody. Fibrinogen rose progressively over the 3-week period for the three polymers. After the different leukocyte lines were identified in rat blood samples, their determination in the exudate revealed differences among the three biomaterials. At day 2, PVC induced a predominantly neutrophilic inflammatory reaction whereas PU and SIL gave a mixture of monocytes and neutrophils. At day 9, the aspect of the cytograms was different, but the identification of the subpopulations was still possible. At day 23, the number of cell events became too low to distinguish the subpopulations. An even more detailed approach might be possible using specific labeling for each leukocyte line to establish a comparison among the three biomaterials. Flow cytometry associated with histomorphometric assessment might provide a precise quantitative in vivo test for determining the biocompatibility of materials.
Peroneal nerve entrapment.
Sixty patients (sixty-two limbs) who had entrapment of the peroneal nerve were managed with operative decompression, and the results were evaluated after an average duration of follow-up of forty-two months (range, twenty-five to 162 months). The entrapment was postural in five patients, dynamic in two (one of whom had bilateral entrapment), and idiopathic in fifty-three (one of whom had bilateral entrapment). Fifty-eight patients (including the two who had bilateral entrapment) had a positive Tinel sign. Twenty-two patients (including the two who had bilateral entrapment) had sensory symptoms only, and thirty-eight had both sensory and motor symptoms. Electrophysiological studies were performed for all patients in order to confirm the diagnosis. Sensory deficits were confirmed on the basis of a marked decrease in the amplitude of sensory potentials, and motor deficits were confirmed on the basis of decreased nerve-conduction velocities. The common peroneal nerve was decompressed by division of both edges of the fibular fibrous arch. The average time from the onset of symptoms to the operation was fourteen months (range, one to 120 months), primarily because of delayed referrals. Twelve of the twenty-two patients who had had only sensory symptoms preoperatively had complete recovery by the time of the latest follow-up. The average delay from the onset of symptoms to the operation was thirty months (range, six to eighty-six months) for the ten patients (eleven limbs) who did not have full recovery compared with nine months (range, four to thirty-six months) for the twelve patients (thirteen limbs) who did. The postoperative recovery of motor function, as determined with use of the grading system of the Medical Research Council, was good for thirty-three (87 per cent) of the thirty-eight patients who had had both sensory and motor symptoms preoperatively. All seven patients who had peroneal nerve entrapment of known etiology had improvement postoperatively. We recommend operative decompression when symptoms persist or recovery remains incomplete for three to four months, provided that the diagnosis has been confirmed with electrophysiological studies.
[Common fibular nerve lesions. Etiology and treatment. Apropos of 146 cases with surgical treatment].
PURPOSE OF THE STUDY: Common peroneal nerve lesion on the lateral aspect of the knee is one of the most frequent neurologic injury of the lower limb. We reported the results of surgical procedure for each etiological group. MATERIAL AND METHODS: In the peroneal nerve entrapment group, we individualised 62 fibular tunnel syndroms (55 idiopathic, 4 postural, 3 dynamic), and 16 external compression. Traumatic causes were represented by 22 varus injuries of the knee and by 11 fractures, 16 iatrogenic lesions, 2 wounds, 5 wound sequelae, 2 contusions and 1 burn. Tumoral group was represented by 7 intraneural ganglionic cyst and 2 extraneural tumour (1 exostosis and 1 chondromatosis of the proximal tibio fibular joint). All patients underwent surgical procedure. Neurolysis was performed when the nerve was in continuity. Suture or nerve grafting was performed in the other cases. In the case of intraneural ganglionic cyst, a complete tumoral excision was realised. RESULTS: Eighty-three per cent of excellent and good results were obtained for the fibular tunnel syndrom, 62.5 per cent for external compression, 36 per cent for varus injury of the knee, 78 per cent for the other traumatic causes and 89 per cent for tumoral lesions. DISCUSSION: This report confirms that the result depends on the etiology of the common peroneal nerve lesion. We propose surgical treatment within 2 to 4 months for the patients without clinical and electrophysiological improvement. If there is doubt on the continuity of the nerve, we propose an earlier surgical treatment. Our results were in general satisfactory except when a nerve graft was necessary furthermore if it was a traction injury and if the length of the graft was longer than 6 centimeters.
Complete femoral nerve division at total hip arthroplasty.
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Buspirone's efficacy in organic-induced aggression.
The objectives of this study were to (1) identify and characterize hospitalized patients with an organic-related psychiatric diagnosis who had received buspirone therapy and (2) assess the effect of buspirone on aggressive behaviors. A retrospective medical records review was conducted on all patients who were admitted to our psychiatric/rehabilitation facility over a 36-month period and who had received buspirone therapy. Monthly behavioral therapy records were used to determine the quality and quantity of aggressive-related behaviors. Study endpoint was reached in each subject when buspirone was discontinued or when records were unavailable. Twenty subjects, ranging in age from 15 to 55 years old (mu = 26.1 +/- 9.8), were identified for study. Nine (90%) of 10 subjects for whom data were available for at least 3 months showed an improvement in behavior by study endpoint, and 6 (60%) showed at least a 50% reduction in behavioral symptoms by study endpoint. Results from this study suggest that buspirone is well tolerated and may be effective in the treatment of aggressive and other maladaptive behaviors in individuals with an organic component to their psychiatric illness, particularly traumatic brain injury. Prospective, controlled trials are needed to validate these findings.
Memory-For-Designs, Bender-Gestalt, Trail Making Test, and WISC-R performance or retarded and adequate readers.
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Stability of direct and transfer effects of number-conservation training with mentally retarded adults.
Twenty nonconserving retarded adults were assigned to equated training and control groups (n = 10 in each group). Training-group subjects were given multiple-strategy training for number conservation consisting of: demonstrating effects of addition-subtraction; negation of addition-subtraction by inverse operations; and addition-subtraction combined with perceptually induced cognitive conflict, reversibility, and verbal-rule instruction. Analyses of variance and critical difference multiple comparisons showed significant direct-training effects immediately after training and after 8 monhts. Significant short-term transfer was obtained on other types of conservation (discontinuous quantity, substance, liquid quantity, length, and weight), but long-term transfer was much weaker and less consistent. Transfer resulted primarily from gains in correct conservation judgements, with a majority of trained subjects failing to give any acceptable conservation explanations.
Chronic calf pain in athletes due to sural nerve entrapment. A report of 18 cases.
We retrospectively analyzed the charts of 13 athletes (18 limbs) who had sural nerve entrapment localized in the passage of the nerve through the superficial sural aponeurosis. There were 11 men and 2 women (average age, 43 years; range, 31 to 59). All patients reported chronic calf pain that was exacerbated during physical exertion. Delay to diagnosis averaged 9 months (range, 5 to 24). Tenderness in the calf was identified along the course of the sural nerve in all cases. In 10 patients (15 limbs) electrodiagnostic testing before surgery was positive. After failure of nonoperative treatment, surgery was conducted under local anesthesia. Neurolysis was performed by incising the superficial sural aponeurosis and the fibrous band in it through which the nerve passes. The results of the operation were evaluated in terms of residual symptoms, ability to return to the former sport, and degree of patient satisfaction. A final follow-up examination was performed an average of 14 months (range, 6 to 30) after the operation. The final result was excellent in 9 limbs (2 bilateral), good in 8 limbs (2 bilateral), and fair in 1 case. The differential diagnosis of sural nerve entrapment in athletes is discussed. Increase in sural muscle mass or development of local fibrous scar tissue compromised the sural nerve in its course through the unyielding and inextensible superficial sural aponeurosis.