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Biomedical subjects

F Gérard

Publications and source records attributed to F Gérard.

At least 19 recordsLinked to original sources
PubMed2002

[Aseptic bone necrosis following reimplantation of a degloving finger].

We report a case of microsurgical replantation of a degloved finger in a manual worker. Four months following replantation, avascular necrosis of the middle and distal phalanges was apparent. Amputation at the level of the proximal phalanx was performed. Re-plantation is the solution of choice for such degloving injuries, but a different flap can be used if replantation is not possible. Avascular necrosis of bone is an unfrequent complication, but surgeons should be aware of it.

Accidents, Occupational↗
PubMed2002

[Hand injuries resulting from high-pressure injection: lesions specific to industrial oil].

Nineteen cases of high pressure injection injuries in the hand were treated between 1973 and 1998. Same surgical treatment plan was followed in all cases: excision of the penetration point, irrigation, debridement and synovectomy if opening of the flexor sheath was noted, and skin closure to allow early mobilisation. All cases concerned men, work injuries, and volar aspect of the hand. The elapsed time between injection and initial surgery ranged from 1 hour to 1 month with a mean of 6.5 days. Eighteen patients out of 19 were reviewed with a mean follow up of 12 years. In 11/19 cases, (58%) oil was injected. The results of oil injection cases have been analysed: the quantity of oil and the preoperative delay (if more ten hours) are associated with poor functional results or complications. Two amputations, two cases of skin necrosis at the injection point, and one case of infection are reported. One case of oleoma of the thumb is described. The specificity of injuries by industrial oil under pressure must be known: paint or white spirit are more toxic than oil which was in all cases injected in the dominant hand (no high pressure injection tool but a defect in the pipe). An important inflammatory reaction with functional sequelae is caused by foreign bodies in oil. Extraction of oil off the injured tissues is difficult because oil is not visible. A specific information is necessary for farmers and truck driver, very exposed population.

Accidents, Occupational↗
PubMed2001

[Use of distally based intermetacarpal flaps to cover dorsal traumatic defects of the middle fingers].

INTRODUCTION: The presence of distal intermetacarpal anastomoses between dorsal and palmar vascular networks makes it possible to dissect and isolate Distally Based Dorsal Hand (DBDH) flaps. Quaba and Davidson first described this possibility. The purpose of this paper is to report our experience using the DBDH flap to reconstruct complicated defects of the long fingers. MATERIAL AND METHOD: We are reporting our experience in eight cases (seven performed in emergency) where such a flap was used to cover dorsal traumatic skin defects of the long fingers. The average age was 40.3 years, ranging from 25 to 67 years. All the patients were males, seven of them had a job at the time of injury and the last one had already retired when injured. RESULTS: All the eight flaps survived, sometimes with minor complications. Only one case developed a whole-thickness distal necrosis treated successfully by regular dressings. In one case, a Z-plasty was performed to correct a retraction in the 2nd web-space two months after surgery. DISCUSSION: Many flaps have been described to cover dorsal skin defects in the fingers. All of them display some advantages and some disadvantages. The use of this flap allows coverage of vast skin defects and thereby early finger mobilisation. The surgical technique is rather easy, and it does not require microsurgical experience. Skin grafting to cover donor site is not always necessary.

Accidents, Occupational↗
PubMed2001

Non-growing Escherichia coli cells starved for glucose or phosphate use different mechanisms to survive oxidative stress.

Recent data suggest that superoxide dismutases are important in preventing lethal oxidative damage of proteins in Escherichia coli cells incubated under aerobic, carbon starvation conditions. Here, we show that the alkylhydroperoxide reductase AhpCF (AHP) is specifically required to protect cells incubated under aerobic, phosphate (Pi) starvation conditions. Additional loss of the HP-I (KatG) hydroperoxidase activity dramatically accelerated the death rate of AHP-deficient cells. Investigation of the composition of spent culture media indicates that DeltaahpCF katG cells leak nutrients, which suggests that membrane lipids are the principal target of peroxides produced in Pi-starved cells. In fact, the introduction of various mutations inactivating repair activities revealed no obvious role for protein or DNA lesions in the viability of ahp cells. Because the death of ahp cells was directly related to ongoing aerobic glucose metabolism, we wondered how glycolysis, which requires free Pi, could proceed. 31P nuclear magnetic resonance spectra showed that Pi-starved cells consumed Pi but were apparently able to liberate Pi from phosphorylated products, notably through the synthesis of UDP-glucose. Whereas expression of the ahpCF and katG genes is enhanced in an OxyR-dependent manner in response to H2O2 challenge, we found that the inactivation of oxyR and both oxyR and rpoS genes had little effect on the viability of Pi-starved cells. In stark contrast, the inactivation of both oxyR and rpoS genes dramatically decreased the viability of glucose-starved cells.

Bacterial Proteins↗
PubMed1998

Cellular expression of growth hormone and prolactin receptors in human breast disorders.

Growth hormone (GH) and prolactin (PRL) exert their regulatory functions in the mammary gland by acting on specific receptors. Using isotopic in situ hybridization and immunohistochemistry, we have localized the expression of hGH receptor (hGHR) and hPRL receptor (hPRLR) in a panel of human breast disorders. Surgical specimens from adult females included normal breast, inflammatory lesions (mastitis) benign proliferative breast disease (fibroadenoma, papilloma, adenosis, epitheliosis), intraductal carcinoma or lobular carcinoma in situ, and invasive ductal, lobular or medullary carcinoma. Cases of male breast enlargement (gynecomastia) were also studied. In situ hybridization analysis demonstrated the co-expression of hGHR and hPRLR mRNA in all samples tested. Epithelial cells of both normal and tumor tissues were labelled. Quantitative estimation of receptor mRNA levels was regionally measured in areas corresponding to tumor cells and adipose cells from the same section. It demonstrated large individual variation and no correlation emerged according to the histological type of lesion. Receptor immunoreactivity was detected both in the cytoplasm and nuclei or in the cytoplasm alone. Scattered stromal cells were found positive in some cases, but the labeling intensity was always weaker than for neoplastic epithelial cells. Our results demonstrate the expression of the hGHR and hPRLR genes and their translation in epithelial cells of normal, proliferative and neoplastic lesions of the breast. They also demonstrate that stromal components express GHR and PRLR genes. Thus the putative role of hGH or hPRL in the progression of proliferative mammary disorders is not due to grossly altered levels of receptor expression.

Adult↗
PubMed1998

Immediate active mobilisation after flexor tendon repairs in Verdan's zones I and II. A prospective study of 20 cases.

The authors report their experience with early active mobilisation after repair of complete sections of the flexor tendons within the digital tendon sheath. This is a prospective study carried out over 2 years and represents 20 repairs. The tendons were repaired using a double-loop looking suture of Tsuge (with PDS 4/0) associated with a peritendinous overrun using Prolene 6/0 via a volar Bruner-type incision. Post-operatively, a plaster splint holding the wrist in 30 degrees of flexion, the MP joints in 90 degrees of flexion and allowing complete active flexion of the finger protected the suture site. As soon as the dressings could be reduced (the 5th day post-operatively), the patient was encouraged to actively and synchronously flex all the fingers together as many times as possible during the day. After removal of the plaster splint at one month, the patients were entrusted to a physiotherapist with a view to regain full extension of the wrist and the fingers. We did not note a single case of breakdown of the repair. The mean active mobility (TAM according to Strickland) of the repairs in zone I was of the order of 70% while that for repairs in zone II was 85%. Immediate active mobilisation was not found to compromise, in any way, the results of associated digital nerve repairs. Despite the modest results, this simple-to-understand protocol is directed at present for injuries with a poor initial prognosis (contused and lacerated tendons, associated fractures, and non-motivated patients). Improvement in the quality of suture material should, in future, extend the indications for immediate active mobilisation to all fresh sutures of the flexor tendons.

Adolescent↗
PubMed1997

[Recent, closed trapezio-metacarpal luxation, treated by pinning.Apropos of 7 cases with a median follow-up of 8 years].

Seven cases of acute and closed traumatic dislocation of the trapezio-metacarpal joint treated by percutaneous pinning adapted by Wiggins are reported with an average follow-up of eight years. Seven patients (five men and two women) aged 18 to 62 were treated. The injury was due to a road traffic accident in four cases. The dominant hand was injured in six cases. The metacarpal base was always dislocated dorsally and closed reduction always remained unstable. All cases consisted of closed dislocation but in two cases dislocation was associated with upper limb fractures. On the initial radiographs no patients had degenerative changes. All patients were treated as an emergency or the following during the days injury by reduction and stabilization by one or two percutaneous kirschner wires followed by a scaphoid cast for three to six weeks. All patients were followed and reviewed for this study between two and thirteen years (mean eight years) after injury. Enquiries were made about return to work, pain, stability, range of movement, key-pinch and grasp compared with the uninjured side. The joint was examined radiographically with particular attention to the presence of subluxation and degenerative changes. 2 patients with associated complex injury of the upper limb developed reflex sympathetic dystrophy. 2 patients had moderate pain, 2 patients had limitation of joint movement, 1 patient presented a reduction of strength (pinch and grasp) but none had subluxation, instability, or degenerative changes. Closed reduction and stabilization by percutaneous pinning is a simple method and gives good or excellent results in the treatment of acute traumatic dislocation of the trapezio-metacarpal joint.

Accidents, Traffic↗
PubMed1997

[Late effects of radiations on the liver].

Until recently, the liver was classified as a radioresistant organ, although it is in fact highly radiosensitive. The realization that the whole liver could be treated safely only with low doses of radiation led to the conclusion that radiation therapy had an extremely limited role in the treatment of intrahepatic malignancies. A resurgence of interest has been observed with the advent of conformal radiotherapy and the introduction of bone marrow transplantation with total body irradiation. The radiation-induced liver disease, often called radiation hepatitis, is a syndrome characterized by the development of anicteric ascites, approximately 2 weeks to 4 months after hepatic irradiation. Immediate tolerance is generally surprisingly good, and the subacute radiation injury is followed by a complete asymptomatic healing, although the late lesions may be associated with signs of chronic radiation hepatitis. Radiation hepatitis must be distinguished from chemoradiation-induced-hepatitis occurring in patients undergoing bone marrow transplantation and total body irradiation. Both syndromes demonstrate the same pathological lesion: veno-occlusive disease. The main treatment for radiation hepatitis is diuretics, although soma advocate steroids for severe cases.

Dose-Response Relationship, Radiation↗
PubMed1997

[Complex injuries of the dorsum of the hand. Therapeutic reflections apropos of 2 cases].

UNLABELLED: We report 2 similar cases of severe injury of the dorsum of the hand, both treated in emergency. FIRST CASE: A 37-year-old right handed male truck driver was admitted with a complex severe injury of the dorsum of his right hand following a traffic accident. He had a combined large defect involving skin, tendons and bone. A complex reconstruction was performed using a massive iliac crest allograft, a tendon graft and a free serratus anterior flap in a one stage procedure, eight hours after the injury. A skin graft was done later. Two years later the functional and esthetic results are good. SECOND CASE: A 37-year-old woman was admitted with a severe injury of the dorsum of her right hand following a traffic accident. She had a large combined defect involving skin, tendon and bone. A complex reconstruction was carried out using a large iliac crest autograft, a multiple tendon graft and a free latissimus dorsi flap, in one stage 6 hours after the trauma. Eight months later the functional result is partial but useful for the daily activities of the patient.

Adult↗
PubMed1996

[Value of Swanson implants in complex traumatic lesions of the proximal interphalangeal joint].

The authors report the results of 30 Swanson implants, inserted immediately, or secondarily in complex trauma of the proximal interphalangeal joint of long fingers in 24 patients (19 men, 5 women). All patients were reviewed by the same examiner with a mean follow-up of 7 years (range: 17 months-17.2 years). All implants were inserted secondarily after the accident, except in 7 cases in which the local conditions led the operator to insert the implant immediately. At review, 20 implants were still in place, 6 patients had requested amputation, and arthrodesis had been performed in 4 cases. The mean range of movement was -13,4 degrees to 37 degrees, i.e. a mean amplitude of 23.6 degrees. The lateral stability of the operated finger was considered to be satisfactory in 50% of cases, and the patient was satisfied with the operation in 65% of cases. The authors consider that useful mobility of the proximal interphalangeal joint should be preserved whenever possible. The Swanson implant is currently a useful alternative to amputation or arthrodesis, especially as it does not compromise these procedures if they are required subsequently.

Adult↗
PubMed1996

[Results of primary repair of isolated flexor digitorum profundis lesions in the digital canal. 51 cases].

Isolation section of the flexor tendon in the digital canal of the long fingers is classically considered to have a good prognosis. The authors evaluate the repercussions on the mobility of the proximal and distal interphalangeal joints, based on a series of 51 sections (44 patients). The mean follow-up at the time of review was 7.7 years. 84% good or very good results were observed in this homogeneous series of simple lesions. Poor results included 2 cases of secondary rupture and 2 infections. They were essentially due to "whiplash" retraction of the proximal end in the palm for lesions in zone 1, and contuse section of tendons in poorly motivated patients. The results of sections in zone I are comparable to the results of sections in zone II. Stiffness of the PIP joint, even moderate, is frequent, whether the lesion is situated in zone I or zone II. The mobility of the metacarpophalangeal joint remains normal in every case. The authors did not observe better results in cases mobilized according to Kleinert's procedure compared to cases immobilized by plaster, and do not have a satisfactory explanation for this result.

Adolescent↗
PubMed1995

Co-infection by hepatitis B virus and hepatitis C virus in renal transplantation: morbidity and mortality in 1098 patients.

The aim of the study was to analyse the influence of co-infection by hepatitis B virus (HBV) and hepatitis C virus (HCV) as compared with HCV infection alone in 1098 patients who received a kidney transplant between 1 January and 31 December 1991. At transplantation, the prevalence of anti-HCV antibodies was 21.40% (235/1098) while the prevalence of HBV infection was 9.85% (108/1096); 46 patients were co-infected with HBV and HCV, either 19.70% of HCV-infected patients and 42.60% of HBV-infected patients. Liver tests, galactose clearance and liver biopsy were compared in the 46 co-infected patients (HCV+HBV+) and in the 189 HCV-infected patients (HCV+HBV-). At the time of transplantation, cytolysis was present in 31.45% of HCV+HBV- patients (50/159) and in 40% of HCV+HBV- patients (16/40); cholestasis was present in 34.18% of HCV+HBV- patients (34/158) and 42.11% of HCV+HBV+ patients (16/38). At 6 months the incidence of biological abnormalities increased to 37% in HCV+HBV- patients (55/150) and to 52.5% in HCV+HBV+ patients (21/40), suggesting a more deleterious effect of the immunosuppressive therapy in the co-infected group. Over the course of transplantation, chronic hepatitis was present in 50% of HCV+HBV- patients and in 64.1% of HCV+HBV+ patients. Liver failure occurred in 7% of HCV+HBV- patients (12/156) and 17% of HCV+HBV+ patients (7/41). Galactose clearance was performed as a functional test in 68 patients: it was not significantly different in either group. Liver biopsy was performed in 108 patients at least once.(ABSTRACT TRUNCATED AT 250 WORDS)

France↗
PubMed1995

[Value of early stress test during treatment after myocardial infarction with Q wave in patients under 55 years of age].

We studied one hundred consecutive patients, under the age of 55 years (mean age: 45.6 years), with myocardial infarction and a Q wave, in order to assess the prognostic value of an early stress test. Thirty five patients were excluded: 2 deaths, 21 revascularizations during the acute phase, 4 tests were performed without treatment, 6 tests were unable to be performed and 2 patients left hospital against medical advice. Sixty five patients [males, n = 60 (92.2%), anterior infarction, n = 25 (38.5%), thrombolysed n = 35 (53.8%), intact left ventricular ejection fraction (mean: 54.7%)] systematically underwent a stress test limited by symptoms, in hospital, on the tenth day of infarction, using an ergometric bicycle and under medical treatment (including beta blockers n = 47 (72.2%)] and cardiac catheterization. The test was considered positive when it was accompanied by angina and/or ST depression (n = 19), negative in the absence of these criteria for a level of 120 watts (n = 23), inadequate when the duration was less than 9 minutes and when the heart rate was less than or equal to 70% of the theoretical maximal heart rate (n = 11), doubtful when there was accentuation of ST elevation in the infarcted territory with mirror ST depression (n = 12). Only 30.7% of patients had multi-vessel coronary lesions (two- and three-vessel disease). The mortality was 4.6% with a mean follow-up of 27.4 months (range: 3-38). The sensitivity of the test for detection of multi-vessel disease was 62.5%, the specificity was 65.3%, the positive predictive value was 52.6%, and the negative predictive value was 73.9%. The sensitivity of this test, with beta-blocker treatment, to predict coronary lesions or cardiac events, fell to 33.3% and 37.5%, respectively. The stress test during the post-infarction period, with beta-blocker treatment, appears to be less sensitive for the identification of multivessel disease and cardiac events: this treatment should therefore be suspended before performing this test when allowed by the patient's clinical state.

Adrenergic beta-Antagonists↗
PubMed1993

Cellular and matrix changes in drug abuser liver sinusoids: a semiquantitative and morphometric ultrastructural study.

The aim of the present work was to analyse, at the ultrastructural level, the action of heroin of 150 centrilobular sinusoids from liver biopsies of five intravenous drug abusers, who presented clinical and biological manifestations of hepatic impairment. A comparative study of 90 sinusoids from liver biopsies of three control patients was performed. Electron microscopic observations showed a thickening of the sinusoidal wall related to endothelial cell hypertrophy and to fibrosis of the space of Disse. This was generally associated with basement-membrane-like material and hepatocyte microvilli flattening. In addicts, hepatic vascular pole changes were a constant finding, accompanied by interhepatocyte space disjunction and perisinusoidal collagenization. Morphometric assessment confirmed a significant increase of sinusoidal wall surface, endothelial cell body and processes and Ito cell process surface was significantly different between the patient groups. This cellular hypertrophy may represent hyperactivation of the sinusoidal cell functional capacity, triggering the fibrogenesis in the space of Disse. While this mechanical barrier might hinder the free exchange through the space of Disse, it may equally well protect the liver against heroin toxicity.

Adult↗