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Biomedical subjects

B Bayle

Publications and source records attributed to B Bayle.

12 recordsLinked to original sources
PubMed2001

Electrophysiological analysis of pudendal neuropathy following traction.

Pudendal neuropathy is an unusual but important complication of orthopedic surgical procedures involving traction on the fracture table. We describe the clinical and electrophysiological features in six patients presenting with perineal sensory disorders and sexual dysfunction following surgical repair of femoral fracture, hip dislocation, or intra-articular foreign body, in which the traction table was used. All underwent electrophysiological recordings: bulbocavernosus muscle electromyography (EMG), measurements of the bulbocavernosus reflex latencies (BCRLs), somatosensory evoked potentials of the pudendal nerve (SEPPNs), sensory conduction velocity of the dorsal nerve of the penis (SCVDNP), and pudendal nerve terminal motor latencies (PNTMLs). Signs of denervation localized to the territory of the pudendal nerve were found in 3 patients, normal BCRL in 6, abnormal SEPPNs in 4, and abnormal SCVDNPs and PNTMLs in all cases. The outcome at 2-year follow-up was good, except in one patient with initially unrecordable PNTML. Perineal electrophysiological examination can thus confirm the pudendal neuropathy and give prognostic information.

Adolescent↗
PubMed2001

[Suprapubic reflex. Electrophysiological study in normal patients].

INTRODUCTION: In spinal cord injuries patients, tapping the suprapubic aera is a strong stimulus to ellicit detrusor contraction and can be used in the management of neurogenic bladder. This stimulation also determines a perineal muscles contraction. This striated response was mentionned in animal studies but never specifically analysed in men especially in normal subjects. AIMS OF THE STUDY: Our objective was to describe pelvic floor responses with measurement of reflex latency following suprapubic mechanical stimulation. METHODS: 21 patients without neurological disease were studied. They were 14 women and 7 men. Mean age was 51 (SD=14,2). Motor responses were recorded with a needle electrode inserted in the left bulbocavernosus muscle. Stimulation was delivered with an electromechanical hammer, tapping directly on the suprapubic aera. RESULTS: A polyphasic muscular response was always and easily elicited in all patients. Mean latency was 67,5 ms. (SD = 14,7). The reproducibility between the first and second mechanical responses was good with no statistical difference (r=0,966; p=0,0001). DISCUSSION: Our study clearly demonstrates a suprapubic bulbocavernosus reflex (SBR). Many arguments can be retained for a polysynaptic reflex (polyphasic response, habituation and short latency of the reflex, mean latency in the habitual values of R2 responses following electrical stimulation of the dorsal nerve of the penis). We hypothetize that: the true stimulus is the stimulation of the bladder wall tenso-receptors; integration level of the SBR is the sacral segments and the efferent limb the pudendal nerve; afferent pathways could be vehicled by pelvic nerve fibers. CONCLUSION: Competition between a preponderant (or exaggerated) SBR and a bladder contraction following suprapubic tapping, may constitute a real functional outlet obstruction giving incomplete or complete retention in some suprasacral bladders. In normal subjects, SBR can be considered as a continence reflex with increase of perineal tone following the stimulation of the bladder wall tenso-receptors during stress.

Analysis of Variance↗
PubMed2000

[Clinical evaluation of female urinary incontinence].

EXAMINATION: Clinical evaluation of stress and urge incontinence is always necessary before therapeutic decisions. Full bladder examination may reveal stress incontinence during cough when cervico-urethral hypermobility is suspected, and leak during Vasalva manoeuvre when incontinence is due to intrinsic sphincter deficiency. OBJECTIVE SCORES: Pad test objectives the quantitative importance of incontinence. Symptom scores allow intra and inter individual comparisons. Psychosocial implications are studied with specific quality of life scales. They allow better therapeutic strategies in the management of urge and stress urinary incontinence. Objective evaluation of the different treatments and medico-economic approach of incontinence are thus possible.

Diagnosis, Differential↗
PubMed2000

Postpartum lumbosacral plexopathy limited to autonomic and perineal manifestations: clinical and electrophysiological study of 19 patients.

The objective was to describe perineal electrophysiological findings and to determine their diagnostic value in a type of lumbosacral plexopathy after vaginal delivery, which only involves the lower part of the plexus (S2-S4). Consecutive female patients referred to an outpatients' urodynamic clinic were the source. Nineteen previously healthy women, 13 multiparae and six para 1, were investigated. Mean age was 33.7 (SD 5.4) (range 28-41) years. All of them presented with urinary (stress incontinence 14, dysuria five), anorectal (faecal incontinence eight, dyskesia one), or sexual dysfunctions (hypoorgasmia or anorgasmia six) after vaginal delivery. No associated lower limb sensory or motor deficits were noted. All the patients had electrophysiological recordings (bulbocavernosus muscle EMG, measurements of the bulbocavernosus reflex latencies (BCRLs), somatosensory evoked potentials of the pudendal nerve (SEPPNs), and pudendal nerve terminal motor latencies (PNTMLs)). Cystometry and urethral pressure profile (UPP) were performed in the 14 patients with stress urinary incontinence. Perineal electrophysiological examination disclosed signs of denervation in the perineal muscles in all the cases, prolonged BCRLs in 17/19, and abolished BCRLs in 2/19, abnormal SEPPN in 1/19, and normal PNTMLs in all the patients. Urodynamic investigations disclosed low urethral closure pressure for age (< 50 cm H(2)O) in half of the patients. In conclusion, Lower postpartum lumbosacral plexopathy is evoked when perineal sensory disturbances whether or not associated with urinary or faecal incontinence persist after a history of a difficult vaginal delivery. Electrophysiological investigations precisely identify the site of the lesion and demonstrate distal innervation integrity.

Adult↗
PubMed2000

Comparison of two modes of administration of a personalized quality of life scale in a longitudinal study of total hip arthroplasty.

UNLABELLED: Quality of life scales are being increasingly used to evaluate patients. The earliest scales were standardized questionnaire that did not necessarily provide an optimal evaluation of the quality of life of each individual patient. A number of personalized scales are now available, including the SEIQoL, in which the patients nominate the five quality of life areas most important to them. The SEIQoL has been validated. We tested the SEIQoL in patients treated by total hip arthroplasty, a procedure that is expected to improve quality of life. OBJECTIVE: To compare two methods of administration of the SEIQoL several months after total hip arthroplasty. METHODS: The SEIQoL was administered before and after the arthroplasty. During the postoperative test session, the SEIQoL was administered twice, once using the items nominated preoperatively and once after allowing the patient to repeat the nomination procedure. RESULTS: With both methods, significant improvements in quality of life were demonstrated (P < 0.05). There was no significant difference between the two methods. CONCLUSION: Changing the items of the SEIQoL during prospective studies does not modify the overall quality of life score. Keeping the same items throughout the study is nevertheless warranted.

Hip Prosthesis↗
PubMed2000

Bladder cooling reflex in patients with multiple sclerosis.

PURPOSE: We describe the effect of intravesical ice water instillation in patients with multiple sclerosis and without an overactive bladder. MATERIALS AND METHODS: Of 131 consecutive patients with multiple sclerosis who presented with a urinary disorder we selected for study 10 men and 29 women with a mean age plus or minus standard deviation of 50 +/- 9 years who had multiple sclerosis without an overactive bladder. Nonoveractive bladder was defined as no involuntary detrusor contraction up to 400 ml. of maximum fill on routine cystometry. We performed cystometry with saline at 25 to 30C at an infusion rate of 50 and 100 ml. per minute, and with ice water at 0 to 4C at a rate of 100 ml. per minute. Ice water cystometry was considered positive when an involuntary detrusor contraction occurred before 200, and between 200 and 400 ml. of filling. Ice water cystometry was considered negative when there was no involuntary detrusor contraction during ice water filling up to 400 ml. RESULTS: Ice water cystometry enabled us to elicit involuntary detrusor contractions in 21 patients, which remained undetected by warm water cystometry at rates of 50 and 100 ml. per minute. The test was positive before 200, and between 200 and 400 ml. in 10 and 11 cases, respectively. Positive ice water cystometry was significantly associated with irritative signs or significant post-void residual urine volume. CONCLUSIONS: An involuntary detrusor contraction was not elicited by cystometry at 50 or 100 ml. per minute, implying that the afferent mechanoreceptor reflex limb via ADelta fibers is not involved. In contrast, ice water cystometry at 100 ml. per minute elicited an involuntary detrusor contraction, suggesting involvement of an afferent reflex limb via capsaicin sensitive C fibers. These involuntary detrusor contractions revealed by ice water cystometry are probably relevant to an overactive bladder. In urinary disorders such a positive test indicates a spinal lesion. In multiple sclerosis it may have pathophysiological value, indicating a spinal rather than cerebral mechanism of overactive bladder, and diagnostic value, indicating multifocal demyelination.

Cold Temperature↗
PubMed1999

Analysis of the perception of and reactivity to pain and heat in patients with wallenberg syndrome and severe spinothalamic tract dysfunction.

BACKGROUND: The aim of the study was to assess the consequences of severe spinothalamic tract lesions resulting from lateral medullary infarct and to show that a specific pain perception can be elicited by strong thermal stimulation. CASE DESCRIPTIONS: Both patients examined presented with severe thermoalgic dissociation of the limbs contralateral to the lesion, with normal discriminative somatosensory perception and motor strength. They reported pain perception when touching very warm (>50 degrees C to 60 degrees C) objects and a brisk, occasionally uncontrolled withdrawal reaction of the arm and hand under the same conditions, without any perception of the heat nature of the stimulus. Warm stimulation, <45 degrees C, elicited no thermal perception or discrimination. Pain perception could be elicited in both patients by increasing the temperature, with a reproducible threshold of 47 degrees C to 49 degrees C. Pain always occurred after a prolonged delay of 8 to 10 seconds in response to threshold heat, and was described as deep and osseous, and clearly different from that perceived on the nonaffected side. The delay was much shorter when the temperature was increased by 4 degrees C to 5 degrees C. Cold stimulation elicited similar pain perception in one patient. Analysis of subjective perception of laser stimulation showed a much higher pain threshold on the affected hand. There were no laser-evoked potentials on this side, which suggested major spinothalamic injury. Assessment of the RIII noxious reflex revealed persistent response withdrawal reactions, with an increased threshold on the affected side, and partial consciousness of the noxious nature of the stimulus. CONCLUSIONS: To our knowledge, this is the first description of the appearance of pain perception of high temperatures in patients with severe spinothalamic injury who are suffering from a complete loss of temperature perception. This implies that noxious thermal stimulation can still be perceived via extra spinothalamic pathways (which are slow and multisynaptic), such as the spinoreticulothalamic tract. Patients with Wallenberg syndrome should be informed and made aware of their residual perception of and reactions to noxious stimulation.

Central Nervous System Diseases↗
PubMed1994

[Anti-nidation activity of oral contraceptives].

The antinidatory activity of the oral contraception is generally unknown: the contraceptive pill mainly prevents the gametes from meeting. However, pregnancies under pill indicate conception of embryos. Besides, missed pills protocols sometimes record ovulatory escape. We suggest the computation of an Embryo Destruction Index (EDI), in order to measure the antinidatory effect of two categories of oral contraceptives: combined estroprogestatives and microprogestatives.

Contraceptives, Oral, Combined↗