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Biomedical subjects

B M Richard

Publications and source records attributed to B M Richard.

At least 19 recordsLinked to original sources
PubMed2003

Location of the extracranial extent of leprous facial nerve pathology may allow leprous facial palsy to be reanimated by free muscle transfer.

Leprosy is a mycobacterial nerve and skin infection, which can be eradicated by antibiotics. Some patients affected by leprosy, once cured, have residual nerve impairment with paralysis and sensory neuropathy. A series of patients with facial nerve paralysis, investigated using clinical, histological and electrophysiological techniques, demonstrated that the nerve pathology was distal to the section of main trunk prior to its bifurcation. Facial reanimation was achieved with a free gracilis-muscle transfer, coapting its motor nerve to the ipsilateral facial nerve trunk proximal to the site of the leprosy pathology, with a moderate clinical result.

Adult↗
PubMed2000

Neonatal palatal cysts and their morphology in cleft lip and palate.

Palatal cysts (Epstein pearls) are occasionally noticed as white papules on the palatal mucosa of a neonate whilst having its 6-week postnatal check. We describe five cleft patients and the distribution characteristics of their palatal cysts, including the previously unrecorded observation of a submucous cleft palate with a double row of palatal cysts, one row on each side of the zona pellucida. The role of spatial morphology of palatal cysts in interpreting cleft pathogenesis is discussed.

Biopsy↗
PubMed2000

Drawover anaesthesia for cleft palate and lip surgery in Pokhara, Nepal.

We describe our experience and problems with 335 children who had general anaesthesia for cleft palate and lip surgery. Drawover anaesthesia using halothane and trichloroethylene was easy to use and safe. The main early postoperative problems were airway obstruction and bleeding. Later postoperative care in the ward was hampered by the lack of nursing care and monitoring.

Airway Obstruction↗
PubMed1999

Facial nerve pathology in leprosy: searching for the proximal extent of the lesion in facial nerve biopsies.

A light and electron microscope study was made of resin embedded facial nerves in three cases of leprosy involving the facial nerve. The patients had irreversible facial nerve palsies and had requested facial reconstruction. No consistent pattern of nerve fibre damage was found. In one case the temporozygomatic was affected, but the cervical branch was normal, suggesting the damage begins distally. In two cases the loss of nerve fibres in the trunk and all branches was similar, and is likely to emanate from damage at a more proximal site. The presence of increased numbers of unmyelinated axons, often in clusters, is evidence of regeneration. These axons probably have the potential to develop into functional myelinated fibres provided that they can innervate a viable distal target such as a muscle graft. These regenerating axons are distal to the stylomastoid foramen suggesting that the most proximal level of involvement of the facial nerve could be intracranial. The finding of a more proximal level of nerve involvement, implies that the mis-reinnervation seen in partially recovered facial nerve palsies in leprosy, could be due to some regenerating axons being mis-directed at the level of the main trunk bifurcation.

Aged↗
PubMed1998

A 3 year prospective audit of burns patients treated at the Western Regional Hospital of Nepal.

Burns in Nepal cause an estimated 1700 deaths per year and much suffering. We carried out a prospective 3 year audit of 237 burns patients admitted to the Western Regional Hospital in Pokhara. The aims were to assess the profile of burns injuries and what could be achieved in local conditions to guide colleagues in developing countries with limited medical facilities. The majority of burns occurred at home and were largely preventable. 61 per cent of patients were children under 15 years of age. There were more female patients and females had more severe burns. No patients with greater than 40 per cent body surface area burns of any age group survived. Public education on burns prevention is needed but poverty, ignorance and a fatalistic attitude are difficult underlying causes to change.

Adolescent↗
PubMed1997

Cervical branch of the facial nerve in leprosy.

This study demonstrates that the platysma is occasionally palsied in leprosy and that this only occurs when the facial nerve already has some other palsy. That there needs to be a facial palsy before there can be a platysma palsy is strongly suggested, in that there was no case of an isolated platysma palsy. Patients, regardless of age or other factors, could mimic a platysma contraction. This obviates the need for electrical testing to examine for a platysma palsy. It also means that a nonfunctioning platysma on clinical examination is, in fact, a palsied platysma. While lagophthalmos is regularly examined for, and any obvious facial paresis would be noticed, less severe forms of facial muscle paresis will only be found if formally examined for. The mechanism whereby the facial nerve is involved in leprosy is not clarified, but our findings suggest that proximal spread of a lesion that began in the zygomatico-temporal branches and reaches to the facial nerve trunk is more likely than new lesions developing de novo in other peripheral facial nerve branches. That the primary lesion is within the facial nerve trunk in all cases but we only see the frequent zygomatic sequelae due to secondary factors is not excluded.

Adolescent↗
PubMed1994

Ameloblastoma with stromal multinucleated giant cells.

We report a case of ameloblastoma which uniquely showed heavy osteoclast-like giant cell accumulation and woven bone formation in the surrounding fibrous stroma. Immunohistochemistry showed that the giant cells were non-epithelial in origin and suggested that stromal factors (i.e., the presence or absence of mineralized bone) determines whether these cells express an osteoclastic antigenic phenotype.

Adult↗
PubMed1993

Role of HDL1 in cholesteryl ester uptake in rats.

It has been suggested that apoE may play a central role in reverse cholesterol transport in rats. By this hypothesis, cholesteryl esters (CE) accumulate in high density lipoprotein (HDL) particles, which acquire apoE at the expense of apoA-I, and the apoE targets them for rapid hepatic uptake. However, the pathway has not been directly assessed in vivo. We directly traced the metabolism of HDL1 cholesteryl esters in rats. To do this, rat HDL1 was labeled in its apoE and CE moieties, and HDL2 free of apoE was labeled in its apoA-I and CE moieties; 14C- or 3H-labeled cholesteryl-oleyl ether traced the CE moieties and the 125I- or 131I-labeled N-methyltyramine cellobiose (NMTC) ligand traced the apolipoprotein moieties. The labeled HDLs were injected, plasma decays were followed, and tissues were examined after 24 h. ApoE tracer decayed from plasma 2.4-times faster than HDL1 CE and 1.8-times faster than HDL2 CE. HDL1 CE decayed significantly more slowly than HDL2 CE (0.75-times). As expected, hepatic uptake of HDL2 CE was mostly by selective (indirect) uptake. However, hepatic uptake of HDL1 CE was at a fractional rate significantly lower than that of HDL2 CE (0.69-times), even though the uptake of apoE was much higher. The plasma decay of HDL1 apoE evidently reflects in large part the uptake of apoE after transfer to other fractions, and it over-estimates the clearance of HDL1 CE. Selective uptake plays the major role in hepatic HDL CE uptake in rats.

Animals↗
PubMed1992

Transport of HDL cholesterol esters to the liver is not diminished by probucol treatment in rats.

This study examined the relation of decreased high density lipoprotein (HDL) levels in probucol-fed rats and the transport of HDL cholesterol esters (CEs) to the liver. HDLs from both control rats and rats fed 1% probucol for 3 weeks were doubly labeled in their CE and apolipoprotein A-I moieties with intracellularly trapped tracers and then intravenously injected into probucol-fed or control rats for determination of plasma decay kinetics and sites of tracer uptake. Results for HDL from control and probucol-fed rats were not different. The fractional catabolic rate (FCR) of plasma HDL CE was significantly increased by probucol feeding (23%) so that mass transport of HDL CE through the plasma compartment was not significantly different from that in control rats. The plasma FCR for apolipoprotein A-I did not change. Similarly, the FCR for uptake of HDL CE by the liver increased on probucol feeding (20%), resulting in a near-normal rate of HDL CE mass uptake, whereas the FCR for HDL particle uptake (measured by apolipoprotein A-I uptake) did not change. Thus, the maintenance of near-normal HDL CE uptake by the liver was exclusively due to increased selective uptake (32%). To the extent that hepatic uptake of HDL CE mediates reverse cholesterol transport, that process was not significantly compromised in rats fed 1% probucol.

Animals↗
PubMed1992

Probucol increases the selective uptake of HDL cholesterol esters by Hep G2 human hepatoma cells.

A previous study in rats showed that even though probucol substantially lowers high density lipoprotein (HDL) levels, near-normal mass transport of HDL cholesterol esters (CE) to the liver is maintained by the induction of "selective" (direct) uptake of HDL CE. The present study describes a parallel result in cultured Hep G2 human hepatoma cells. Cells were preincubated in the presence or absence of probucol before measuring the uptake of doubly labeled HDL3 in the absence of probucol. Preincubation with probucol decreased the uptake of HDL3 particles (iodine-125-labeled N-methyltyramine cellobiose-apolipoprotein [125I-NMTC-apo] A-I uptake) but increased the uptake of [3H]cholesteryl oleyl ether in excess of 125I-NMTC-apo A-I (i.e., selective uptake) in a dose-dependent fashion. The reversibly cell-associated pool of CE tracer, a precursor for selective uptake, enlarged on probucol treatment, but the increase was not in proportion to the increase in selective uptake. HDL3 particle uptake decreased on probucol treatment. The decrease was evident after less than 20 minutes of probucol exposure and was maximal after 6 hours; in contrast, HDL3 CE selective uptake increased only after greater than 13 hours and had not reached a plateau after 20 hours. Thus, effects on particle uptake and selective uptake were dissociated in time.

Carcinoma, Hepatocellular↗
PubMed1989

Interosseous transfer of tibialis posterior for common peroneal nerve palsy.

The interosseous route remains popular for tibialis posterior tendon transfer for drop-foot. It leaves a smaller range of movement than the circumtibial route, but lengthening the calcaneal tendon may improve this. The results of this present series indicate that, in order to predict a good functional result, the ankle must be held in at least 20 degrees of dorsiflexion at the time of tendon transfer.

Adolescent↗
PubMedDate not supplied

The distally based posterior interosseous fasciocutaneous island flap in reconstruction of the hand in leprosy.

In leprosy a functionally useless hand can be the sequelae of resorption of the sensation-impaired thumb and fingers resulting from repeated trauma and infection. When this process shortens the thumb to the level of the proximal phalanx or metacarpal, the effect is to produce a relatively shallow first web space which together with the shortening, can prevent the most basic hand manoeuvre of a pincer or pinch grip. The reconstructive procedure commonly used in this situation is to widen and deepen the web space with a z-plasty combined with excision of the second metacarpal but the result can be inadequate. We have used the posterior interosseous fasciocutaneous island flap, both as a simple and a compound flap, to solve this challenging problem and we report here our experience with four patients.

Adult↗