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Biomedical subjects

A Gilbert

Publications and source records attributed to A Gilbert.

At least 73 records · Page 4Linked to original sources

Calcification associated with terminal defects of the upper extremity.

Four children who had calcifications associated with terminal defects of the upper extremity are reported. A review of the literature has revealed no previous report. Moreover, an examination of the radiographs of 65 children who had terminal defects of the upper limb failed to show any such calcifications. The exact cause of this association remains unknown.

Arm

Tracheal sleeve pneumonectomy for carcinomas of the proximal left main bronchus.

Although most primary cancers of the left main bronchus extending to the carina are inoperable, some patients with such a tumour may benefit from an extended, curative surgical procedure. This type of resection presents specific problems in reconstruction and physiologic management during operation. Between 1977 and 1983, five such patients were managed by left pneumonectomy followed by resection of the carina. They ranged in age from 49 to 65 years. None were irradiated before the procedure. In all cases, an end-to-end anastomosis was made between the right main bronchus and the mediastinal trachea. The high-flow catheter technique was used for ventilation during reconstruction. There were no operative deaths. Excessive bronchorrhea was noted in all patients and was aggravated by left recurrent nerve palsy in two. This report indicates that modern techniques of tracheobronchial reconstruction can be successfully applied in patients with locally advanced carcinoma of the proximal left main bronchus. This type of resection may be the treatment of choice in selected cases.

Aged

Pedicle graft epiphysis transplantation.

Transfer of a graft taken from the iliac crest apophysis of 48 immature dogs was studied as a means of repairing an epiphysiodesis constituting more than 50% of the growth plate area. Four groups of dogs were studied. In Group I the graft was pedicled on the superficial circumflex iliac vessels and reimplanted in situ. In Group II the pedicled graft was transferred to the groin area as an island graft. These two control groups demonstrate the conservation of growth activity when the graft is pedicled on its epiphyseal vessels. In Group III the graft was transferred to the distal epiphyseal area of the femur after resection of the portion of the growth plate (approximately 2/3) located inside the perichondrial ring, with conservation of 80% of the outer portion of the cylinder. Microsurgical revascularization was achieved by using the saphenous vessels. In Group IV (the control group for Group III) the latter technique was used without revascularization. Roentgenography was performed for nine months after operation. The specimens were studied by tetracycline labeling and histologic and histochemical examinations. Results indicate that a well vascularized graft functions as a dynamic catalyst for regeneration of the resected portion of the growth plate and prevents the formation of bony bridges between the epiphysis and metaphysis by possible activation of the peripheral groove of Ranvier.

Animals

[Sleep and dreams in patients with parietal and frontal lobe lesions].

Polygraphic recordings, psychological tests, and analyses of dreams during paradoxical sleep were conducted in 9 patients with parietal lobe, in 7 with frontal lobe lesions and in a control group. No significant differences in sleep organization were observed in the parietal group, but there was a considerable reduction in oneiric activity and alterations in results of some psychological tests. Several correlations based on statistical data are discussed. Oneiric activity was disorganized to a much lesser degree in patients with frontal lesions.

Adult

Toe transfers for congenital hand defects.

From 1977 to 1980, 21 second toes were transferred with microvascular anastomoses for congenital hand defects in 17 patients. There have been no vascular failures. Four thumbs were reconstructed with very good functional and cosmetic results. Active motion of the transplanted toe is limited, and the functional results depend on the mobility and musculature of the metacarpal remnant. Growth has been continuous and at least equal to the other toe. Cosmetic results have been very good. It is essential to distinguish between patients showing aplasia and those presenting amniotic band "amputation" syndrome. In the latter case, all structures are close to normal and the results are therefore better. Operative indications must be carefully appraised. If surgical intervention is decided upon, the ideal age is about 18 months, at which time the best integration of the toe is observed.

Adolescent

Self-regulation of chronic arthritic pain and long-term analgesic dependence in a haemophiliac.

Haemophilia is characterized by recurrent internal bleeding episodes, with repeated haemorrhages into the joint areas eventually resulting in a chronic condition similar to osteoarthritis. A 31-year-old haemophiliac, with a nine-year history of narcotic analgesic dependence secondary to chronic arthritis pain, learned self-regulation techniques consisting of progressive muscle relaxation exercises, meditative breathing, and guided imagery. Long-term follow-up evidenced clinically significant decreases in arthritic pain intensity and analgesic intake subsequent to self-regulation training.

Adult

The free scapular flap.

The scapular flap is described, based on the posterior cutaneous branch of the inferior scapular artery. This flap has been successfully used in four clinical cases. The advantages of this flap lie mostly in its large, long, and very dependable vascular pedicle. It can be taken with the patient on his side or prone. The skin is thin and does not need defatting. The main disadvantage is the scar, which is on the posterior aspect of the scapula. This flap is very useful in the treatment of small defects of the ankle or lower leg.

Amputation, Surgical

[Epiphyseal vascularization during growth. Study preliminary to transplantation].

A study was conducted of 50 cadavers in children and 25 immature dogs to discover more precisely the vascularization of the lower end of the femur and the iliac crest. It was concluded that it is possible to transplant these epiphyses with anastomosis of three pedicles in the same line. It was also concluded that the vascularisation differs before and after the formation of the bony epiphyseal nucleus. The cartilaginous canals which preclude the vascularisation of hyaline cartilage, the formation of the bony nucleus and the nutrition of the germinal layers of the growth plate are described.

Animals

[The place of Gelineau's syndrome (narcolepsy) among diurnal attacks of sleep and somnolence (author's transl)].

A clinical and electroencephalographic study was conducted in 41 patients (25 men and 16 women) complaining of diurnal attacks of sleep, and the results were compared with those obtained in 15 control subjects (7 men and 8 women) of the same age. EEG tracings were recorded during 33 hours in each subject. The total duration of the various phases of nocturnal sleep and the mean duration of each phase were the same in both groups. The incidence of EEG peculiarities, such as short delay in the onset of sleep and in the first stage of desynchronized sleep, and prolonged nocturnal periods of vigilance, was assessed in both groups, but no correlation was found between clinical and electrical data. The three criteria of Gelineau's syndrome (irresistible sleepiness, cataplexy and onset of sleep in desynchronized phase) were present in 35% of the patients.

Adult