Spontaneous clearance of hepatitis C virus after long-term opiate dependence therapy with buprenorphine.
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Adult↗
Biomedical subjects
E Brunelle
Publications and source records attributed to E Brunelle.
Differences between general practitioner- and addiction centre-prescribed buprenorphine substitution therapy in France. Preliminary results.
The treatment of heroin addiction in France relies on either general practitioners (GP) or specialist Addiction Centres (ACs). In general, the GPs offer a more flexible approach regarding frequency of consultations, urine tests and dosing regimen while the AC approach is more structured. A cohort study was undertaken to compare the treatment strategies of buprenorphine therapy between these medical environments. To determine the efficacy of each treatment, a number of outcomes were measured including the Addiction Severity Index, retention rates at 90 and 180 days, the average dose prescribed, quality of life assessment, body weight and two self-reported measures: treatment perception and predictive total duration. A total of 69 patients were enrolled; 32 treated by GPs and 37 treated in ACs. Significant differences, including average age, addiction severity and employment status were apparent between each group. Nevertheless, significant improvements in the social and medical status were observed in all patients after 3 months, continuing after 6 months in both groups. Treatment retention was good in both groups with 65% of the total sample remaining after 180 days. The usually more flexible GP approach was more rigid in this study, resulting in an equally positive treatment outcome as seen in the ACs. The study highlights the effectiveness of buprenorphine in addicts with different social and medical backgrounds, regardless of the therapeutic approach.
Adult↗
[Simplified locoregional anesthetic technique for the surgery of the thumb].
Finger surgery is a frequent procedure, of short duration unless in case of major trauma, and often performed in emergency circumstances. In order to improve this type of treatment, we have developed distal blockade techniques. The double innervation in the thumb requires two punctures; a) dorsal, in order to block the superficial branch of the radial nerve; b) palmar, through the flexor tendon sheath, allowing the blockade of the digital nerves, outing from the median nerve. We use bupivacaine 0.5% without adrenaline, which offers high quality anaesthesia and analgesia. This technique can be used outside the operating room, in emergency or X-ray rooms. It allows thumb anaesthesia, either alone for short duration or in an addition to a plexus blockade whose effect in the radial nerve area would be insufficient.
Adolescent↗
[Local anesthesia of the finger through the flexor tendon sheath].
A series of 350 cases of local anaesthesia of the finger using the flexor tendon sheath is reported. The patients were ranked ASA 1 or 2 and the youngest was 12 months old. This technique was used for day case surgery, such as nail trauma and tumours, wound exploration, tumour and cyst removal, tenolysis and neurolysis. The needle was inserted on the palmar aspect of the metacarpophalangeal joint, into the digital flexor tendon of the corresponding finger. Thereafter the needle was withdrawn very slightly in order to inject the local anaesthesia solution within the sheath, and not the tendon. The volumes were respectively 1 ml in children and 3 to 4 ml in adults of either 2% lignocaine or 0.5% bupivacaine without adrenaline. As palmar injections are painful a freezing spray solution was used prior to insertion of the needle. There was no anaesthesia of the dorsal digital nerves, as opposed to the findings of the author of the first series. This technique, which can be qualified as being easy and reliable, could be a valuable alternative for the ring or interdigital blocks, which carry a significant risk of vascular and neurological complications.
Adolescent↗