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Biomedical subjects

J Bérard

Publications and source records attributed to J Bérard.

At least 19 recordsLinked to original sources
PubMed2004

[Avulsion fractures of the greater trochanter in children: two cases, review of the literature and proposition for a classification].

Avulsion fractures of the greater trochanter are very rare in children. We report two such cases which led to femoral head necrosis. Based on these two cases and an extensive review of the literature, we discuss the pathophysiology of this complication and propose a new classification system. Three types of lesions can be identified as a function of the mechanism causing fracture. Type 1 lesions are avulsion fractures of the greater trochanter secondary to acute contraction of the gluteus muscles. This contraction produces a vertical displacement of the greater trochanter. Femoral head necrosis has never been reported as a complication after this type of fracture mechanism. Type 2 avulsion fractures are associated with fracture of the femoral neck with a subsequent risk of femoral head necrosis. Type 3 associates hip dislocation with apophyseal avulsion with, according to the literature, an inevitable progression to head necrosis. The two cases reported look identical with those described by Linhart and Kawenblum illustrate type 3 avulsion fractures of the greater trochanter.

Adolescent↗
PubMed2002

[Dual energy x-ray absorptiometry assessment of the bone mineral content and body composition during growth].

PURPOSE: To propose a simple method of analysis of whole body DXA scan results, for the bone mineral content of the entire skeleton (BMCt) and the arms and legs (BMCa and BMCl), as well as the analysis of the body composition in lean (Lt, La and Ll) and fat (Ft, Fa and Fl) in children and adolescents with normal growth. Materials and methods. A whole body DXA scan (Norland XR36(TM) DXA system) was performed in 90 control females and 76 control males aged from 2.3 y to 21.0 y, and from 2.3 y to 20.1 y, respectively. BMC values, as well as L and F values were correlated with the body weight (BW) of the measured subjects. BMCt, Lt and Ft values corrected for the body surface area (BS), and the ratio BMCl/BMCa, were also calculated. RESULTS: High linear correlations (r>0.9) were found between BMCt, Lt or Ft values and BW, as well as between BMC (a & l) and BMCt, L (a & l) and Lt, F (a & l) and Ft. The ratios BMCt/BS(1.5), Lt/BS(1.5), and Ft/BS(1.5) had constant values of 1.2+/-0.1, 17.5+/-1.9, and 8.7+/-2.0, respectively, in females, and 1.2+/-0.1, 18.9+/-1.3, and 7.3+/-1.4, in males. The ratio BMCl/BMCa had a constant value of 2.8+/-0.4 in both sexes. CONCLUSION: The reference values obtained by DXA for the bone mineral content, lean and fat masses of the entire body and limbs are of interest, in our experience, to follow-up the growth in patients with long-term treatments, and to quantify orthopedic disorders and treatments.

Absorptiometry, Photon↗
PubMed2002

[Pelvic obliquity and scoliosis in non-ambulatory patients with cerebral palsy: a descriptive study of 234 patients over 15 years of age].

PURPOSE OF THE STUDY: Children with cerebral palsy who cannot walk have an oblique pelvis and scoliosis. There is a certain degree of controversy in the literature on the best way to manage this difficult situation. We present a descriptive analysis of a population of non-ambulatory adults with cerebral palsy in order to formulate hypotheses concerning the factors determining scoliosis. MATERIAL AND METHODS: This descriptive cross-sectional study was conducted in 234 patients aged over 15 years who had cerebral palsy and could not walk. Physical examination and an x-ray of the pelvis and spine in the reclining position were obtained for all patients. The following variables were recorded: luxation and subluxation of the hip, spontaneous deviation attitude, ability or not to turn over in bed, pelvic obliquity, history of bone surgery, defective hip abduction. The statistical analysis accounted for laterality and pelvis obliquity to the scoliosis convexity and the laterality of the hip excentration. RESULTS: Scoliosis was observed in 66.2% of the patients; it was more than 60 degrees in 34.5%. Two basic groups were distinguished: thoracolumbar scoliosis (41.6%) and lumbar scoliosis (41.6%). The prevalence of oblique pelvi was 59.9% with important difference by side: 31.6% right oblique and 68.4% left oblique pelvi. We were unable to find any relationship between the side of the pelvic obliquity and the side of the scoliosis convexity, the side of the hip excentration, or the deviation attitude, but the deviation attitude appeared to be a risk factor for pelvic obliquity, which itself was a risk factor for excentration, which was a risk factor for scoliosis. DISCUSSION: Scoliosis is an important problem in this population. Hip luxation is a direct risk factor for scoliosis, but the deviation attitude and pelvic obliquity are intermediary stages. The prevalence of oblique pelvi was greater on the left than the right. This finding should be confirmed in other series before hypotheses can be formulated concerning this difference.

Activities of Daily Living↗
PubMed2002

[Initial management of congenital varus equinus clubfoot by Ponseti's method].

The choice of first-line treatment for congenital varus equine clubfoot remains a controversial issue largely dependent on experience. In France, functional treatment predominates. In 1948, Ponseti proposed reducing the deformity with successive casts. Although cast treatment is a very old method, Ponseti's method is original because it is based on strict rules established from anatomic evidence. The goal is not to correct the apparent deformation, but on the contrary to impose a simultaneous supination and abduction of the foot. Once the calcaneopedal block has been derotated, percutaneous tenotomy of the Achilles tendon is performed. We relate our experience with this method and recall the precise technique used to make the casts. After the cast, derotation braces are worn at night but rehabilitation exercises are not required. We emphasize the quality of the clinical reduction achieved as well as the smaller number of patients who require surgery at walking age.

Achilles Tendon↗
PubMed2001

The value of early postoperative bone scan in slipped capital femoral epiphysis.

The purpose of this study was to evaluate the sensitivity and predictive value of early postoperative bone scan for detection of avascular necrosis (AVN) of the femoral head after surgical treatment of slipped capital femoral epiphysis. We reviewed records of 49 patients (64 hips) operated on between 1980 and 1997 with a mean follow-up of 3 years. Sixty-one out of 64 hips went through an early postoperative bone scan. The three hips that developed AVN showed significant loss of radionuclide uptake. There were neither false-positive or false-negative cases in this series. Early postoperative bone scan has an excellent sensitivity and predictive value for detection of AVN after surgical treatment of slipped capital femoral epiphysis.

Epiphyses, Slipped↗
PubMed1998

Fetal macrosomia: risk factors and outcome. A study of the outcome concerning 100 cases >4500 g.

OBJECTIVE: Because difficult vaginal delivery is more frequent with macrosomic fetuses, some authors recommend routine caesarean section for the delivery of fetuses >4500 g. The purpose of this study was to evaluate the appropriateness of this recommendation, in particular, to analyze maternal and fetal complications according to the mode of delivery. METHOD: Maternal and neonatal records of 100 infants with weights of at least 4500 g were identified retrospectively from January 1991 to December 1996. Outcome variables included the mode of delivery and the incidence of maternal and perinatal complications. RESULTS: The study sample consisted of 100 infant and mother pairs. Macrosomic fetuses represented 0.95% of all deliveries during this period and only ten were >5000 g. Mean birth weight was 4730 g (maximum, 5780 g). Gestational diabetes was present in nineteen patients. Diabetes was present in three patients. A trial of labour was allowed in 87 women, and elective caesarean delivery was performed in thirteen patients. The overall cesarean rate, including elective caesarean delivery and failed trial of labour, was 36%. Of those undergoing a trial of labour, 73% (64/87) delivered vaginally. Shoulder dystocia occurred fourteen times (22% of vaginal deliveries) and it was the most frequent complication in our series. There were five cases of Erb's palsy, one of which was associated with humeral fracture, and four cases of clavicular fracture. By three months of age, all affected infants were without sequelae. There was no related perinatal mortality and only two cases of birth asphyxia. Maternal complications with vaginal delivery of macrosomic infants included a high incidence of lacerations requiring repair (eleven cases). No complications were noticed in the patients who had a caesarean section. CONCLUSION: Vaginal delivery is a reasonable alternative to elective cesarean section for infants with estimated birth weights of less than 5000 g and a trial of labour can be offered. For the fetuses with estimated birth weight >5000 g, an elective caesarean section should be recommended, especially in primiparous women.

Adult↗
PubMed1998

Aneurysmal bone cysts: percutaneous embolization with an alcoholic solution of zein--series of 18 cases.

PURPOSE: To assess the efficacy of percutaneous embolization with an alcoholic solution of zein in the treatment of aneurysmal bone cysts. MATERIALS AND METHODS: Eighteen patients with aneurysmal bone cysts were treated percutaneously with alcoholic zein. The cysts were in the lower limb (n = 7), upper limb (n = 5), pelvis (n = 3), cervical spine (n = 2), and mandible (n = 1). All patients were symptomatic, three had previously undergone surgery. Percutaneous embolization was performed with fluoroscopic or computed tomographic guidance with the patient under general anesthesia. Clinical and imaging follow-up lasted 18 months to 4 years. RESULTS: Percutaneous embolization was performed in 16 cases. In two cases, cystograms showed marked venous drainage and thus embolization was not attempted. Six patients underwent repeat embolization. Complications consisted of a local transitory inflammatory reaction (n = 5), aseptic osteitis (n = 1), and a small pulmonary infarct without sequelae (n = 1). Relief of symptoms was achieved in all patients except one, who underwent surgery. At imaging, improvement was total in 13 cases (87%) and partial in two cases (13%). No recurrence was noted during follow-up. CONCLUSION: Percutaneous embolization of aneurysmal bone cysts with alcoholic zein should be considered a reliable alternative to surgery, especially in cases with a difficult surgical approach or cases of postsurgical recurrence.

Adolescent↗
PubMed1998

[Percutaneous epiphysiodesis. Analysis of a series of 60 full-grown patients].

PURPOSE OF THE STUDY: Percutaneous epiphysiodesis is the actual treatment for mild leg length discrepancy. The authors discuss complications and efficiency of this technique and its accuracy for the prevision of leg length discrepancy. MATERIAL AND METHOD: We reviewed 60 skeletally mature patients (35 boys, 25 girls). Limb length was defined by clinical and teleradiographic evaluation. Bone age was recorded using Sempé's and Pavia's atlas, using the hand, and Sauvegrain's method, using the elbow. Anticipated discrepancies and timing of epiphysiodesis were calculated using Héchard and Carlioz's graph. The percutaneous curetage was employed in all cases. RESULTS: The treatment was successful for all cases. Complications occurred postoperatively in 2 children who developed an hematoma. 10 children required a surgical revision: 2 cases had an inverted discrepancy, 4 patients were found to have limb deviation, and in four children this treatment was not adequate. The outcome was excellent in 48.3 per cent of cases, satisfactory in 31.7 per cent, acceptable in 6.7 per cent and bad for 13.3 per cent of cases. DISCUSSION: Percutaneous epiphysiodesis is well tolerated in childhood with similar results to other techniques (stapling and Phemister's technique). Our experience suggest that:--complications are rare--this treatment is a satisfactory surgical solution--effective previsions for the best time for surgery have not yet been defined.

Adolescent↗
PubMed1997

Early postnatal lethality in Hoxa-5 mutant mice is attributable to respiratory tract defects.

To uncover roles for the Hoxa-5 gene during embryogenesis, we have focused on identifying structural and functional defects in organ systems underlying the perinatal lethality in Hoxa-5 homozygous mutants. Analysis of the mutant phenotype shows that Hoxa-5 is essential for normal organogenesis and function of the respiratory tract. In homozygous newborn mutants, improper tracheal and lung morphogenesis can lead to tracheal occlusion, and to respiratory distress associated with a marked decrease in the production of surfactant proteins. Collectively, these defects likely underlie the pronounced mortality of homozygous mutant pups. Furthermore, the loss of Hoxa-5 function results in altered TTF-1, HNF-3 beta, and N-myc gene expression in the pulmonary epithelium. Since expression of Hoxa-5 is confined to the mesenchymal component of the developing trachea and lung, the effects observed in epithelial cells may result from a disruption of normal epithelial-mesenchymal interactions.

Animals↗
PubMed1997

Abnormal regulation of retinoic acid receptor beta2 expression and compromised allograft rejection in transgenic mice expressing antisense sequences to retinoic acid receptor beta1 and beta3.

Transgenic mice carrying antisense sequences common to the retinoic acid receptors (RAR) beta1 and beta3 were produced to examine roles of RARbeta1 and beta3 in the immune system. There were no significant changes of endogenous RARbeta1/beta3 expression at the mRNA level in T cells, B cells, and macrophages of the transgenic mice (AS-RARbeta1/beta3 mice). However, there was a decrease of RARbeta1/beta3 protein in the T cells, as expected. Interestingly, a drastic up-regulation (7-10 fold) of RARbeta2 messages and a significant decrease of RARbeta4 messages in AS-RARbeta1/beta3 macrophages were observed compared with that of nontransgenic macrophages. RARbeta2 protein in the transgenic macrophages was also up-regulated. This suggests that there is a dual feedback control for the RARbeta expression. A repressed RARbeta1 and beta3 expression, presumably at the protein level, likely leads to a compensatory up-regulation of RARbeta2 and repression of RARbeta4, which is less active than RARbeta2. The AS-RARbeta1/beta3 mice had no gross abnormality. However, they had compromised rejection response to cardiac allografts. The alloantigen-specific T cell cytotoxicity was reduced, and the macrophage population in the spleen was decreased in these mice. These defects likely contribute to the slower rejection response in the AS-RARbeta1/beta3 mice, the existence of other defects not being excluded. Our study has suggested that RARbeta1 and RARbeta3 are necessary to optimize immune responses.

Animals↗
PubMed1997

Compromised allograft rejection response in transgenic mice expressing antisense sequences to retinoic acid receptor beta2.

Transgenic mice expressing antisense sequences to retinoic acid receptor beta2 (AS-RARbeta2 mice) were generated. The transgene was expressed in T cells, macrophages, and non-T spleen cells. These AS-RARbeta2 mice had four- to sevenfold higher endogenous RARbeta2 messages in their macrophages, comparing with their nontransgenic littermates, but the RARbeta protein level was significantly lower in these cells. This suggests that the antisense message interferes with RARbeta2 translation, and there is a feedback control of the RARbeta2 mRNA level in the macrophages. The endogenous RARbeta2 message was not detectable in T and B cells of either the transgenic or nontransgenic mice. These mice appeared to be healthy upon visual inspection. When transplanted with allogenic cardiac grafts heterotopically, the mice showed significantly compromised rejection response. These mice had a decrease of the macrophage population in spleen, using the nontransgenic littermates as references. The generation of alloantigen-specific T cell cytotoxicity was decreased in these AS-RARbeta2 mice. These results suggest that macrophage development and T cell function are affected by antisense expression of RARbeta2, and that anomaly in these cells might be contributing factors to the compromised immune response observed in the AS-RARbeta2 mice.

Animals↗
PubMed1997

Rapamycin inhibits proteasome activator expression and proteasome activity.

Rapamycin (RAPA) is a potent immunosuppressive drug, and certain of its direct or indirect targets might be of vital importance to the regulation of an immune response. In this study, we used differential hybridization to search for human genes whose expression was sensitive to RAPA. Seven RAPA-sensitive genes were found and one of them encoded a protein with high homology to the alpha subunit of a proteasome activator (PA28 alpha). This gene was later found to code for the beta subunit of the proteasome activator (PA28 beta). Activated T and B cells had up-regulated PA28 beta expression at the mRNA level. Such up-regulation could be suppressed by RAPA, FK506, and cyclosporin A. RAPA and FK506 also repressed the up-regulated PA28 alpha messages in phytohemagglutinin (PHA)-stimulated T cells. At the protein level, RAPA inhibited PA28 alpha and PA28 beta in the activated T cells according to immunoblotting and confocal microscopy. Probably as a consequence, there was a fourfold increase of proteasome activities in the peripheral blood mononuclear cell lysate after the PHA activation. RAPA could inhibit the enhanced part of the proteasome activity. Considering the critical role played by the proteasome in degrading regulatory proteins, our data suggest that the proteasome activator is a relevant and important downstream target of rapamycin, and that the immune response could be modulated through the activity of the proteasome.

Cysteine Endopeptidases↗
PubMed1997

Functional IL-2 receptors are expressed by rat lung type II epithelial cells.

Interferon (IFN)-gamma-induced inhibition of type II epithelial cell thymidine incorporation (45% decrease vs. control) was restored by cocultures with mitogen-activated peripheral blood mononuclear cells (PBMC) and conditioned media (CM) from mitogen-activated PBMC. Successive exposure of type II cells to IFN-gamma and interleukin (IL)-2 produced similar alterations in thymidine incorporation. Given that IL-2 is a powerful pleiotropic cytokine produced by lymphoid and myeloid cells, the presence of IL-2 receptors (IL-2R) was assessed in primary cultures of rat type II pneumocytes (TIIP) and the nontransformed alveolar type II epithelial cell line L2. The presence of IL-2R membrane protein on rat type II cells was established by immunodetection assays. The expression of all three murine IL-2R alpha-, beta-, and gamma-chain RNA transcripts in primary TIIP cultures and L2 cells was highlighted by reverse transcriptase-polymerase chain reaction analysis. Overall, these experiments demonstrate, for the first time, that type II epithelial cells can express functional IL-2R, confirming TIIP as a potential "partner" in the lung immune system. Consequently, it can be speculated that TIIP are new cellular targets for lymphokines using (IL-2R) gamma-chain-bearing receptors in lung distal air-spaces.

Animals↗
PubMed1997

Selective dorsal rhizotomy in children with cerebral palsy. Results in 18 cases at one year postoperatively.

OBJECTIVE: Effects of selective dorsal rhizotomy (SDR) were studied in children with spastic cerebral palsy in orthopaedic and functional fields. METHODS: In a prospective study, we compared the same population before SDR and 1 year after SDR. This population included children with spastic cerebral palsy, when spasticity was responsible for a halt in the motor skill acquisitions or for orthopaedic complications. All the children had intensive physiotherapy for 6 months postoperatively. We observed spasticity by a 4-point scale, isolation of movement by a 3-point scale, and orthopaedic status by the measure of range of motion, hip migration on the radiography, and function by Gross Motor Function Measure (GMFM) and Abbott scale. All the assessments were done by the same physiotherapist. We compared the results with a Wilcoxon statistic test. RESULTS: 18 quadriplegic children had spastic cerebral palsy; their mean age was 9 years (5.5-16.5 years). We observed a decrease in spasticity in all the muscular groups; increase in range of motion only on abduction and extension of the hips; no evolution of hip migration; an increase of 3.2% in the total GMFM score; 1 child was classified IV before SDR and V after SDR on the Abbott scale; 3 children had planned orthopaedic surgery in the year after SDR; 16 children and their families were highly satisfied with the result of the surgery. CONCLUSIONS: The decrease in spasticity does not entail prevention of orthopaedic problems in children with quadriplegic spastic cerebral palsy. However, we observed an improvement in qualitative function that is outside the scope of current assessment scales.

Cerebral Palsy↗
PubMed1996

Utilization of intravenous nitroglycerin for obstetrical emergencies.

OBJECTIVE: The authors investigated, by reviewing publications and their personal experience, opportunities for the use of nitroglycerin to manage several obstetric emergencies. METHODS: A retrospective study of 10 observations of internal podalic versions of the second non-vertex twin, with administration of intravenous nitroglycerine, performed between August 1994 and March 1996, was undertaken. The authors compared their results with those reported elsewhere. The indications of nitroglycerin have been extended to intrapartum external version of the second twin, retained placenta, and uterine inversion. RESULTS: Only one failure of internal podalic version due to failure of uterine relaxation was observed. CONCLUSION: From both experience and published reports it was confirmed that intravenous nitroglycerin (NTG) injection induces a transient and prompt uterine relaxation without affecting maternal and fetal prognosis.

Adult↗
PubMed1996

Lung tumors in mice expressing an antisense RARbeta2 transgene.

Retinoic acid has been shown to be an anticancer agent, and a growing literature suggests that it is the nuclear retinoic acid receptor beta2 (RARbeta2) that is primarily responsible for mediating this effect, at least in some systems. To determine whether partial inactivation of RARbeta2 would predispose to lung cancer in mice, we generated three transgenic lines expressing antisense sequences. When killed at 13-3/4-18 months of age, 21/36 animals had a total of 43 pulmonary tumors superficially visible upon necropsy, whereas among 23 nontransgenic mice, only 1 had a single visible lung tumor. A twofold higher incidence of lung tumors was seen in homozygous vs. hemizygous antisense mice. The endogenous RARbeta2 message level was reduced in transgenic lung tissue and further reduced in the tumors. RARbeta4, a truncated isoform derived from the same transcript as RARbeta2, does not carry the sequence identified by the antisense construct and its message was not as strongly affected. Immunofluorescence studies showed that RARbeta was virtually undetectable in the tumors, but present in normal tissue. We conclude that RARbeta2, but probably not RARbeta4, plays an important role in suppression of murine lung tumorigenesis.

Animals↗
PubMed1995

[Are there still indications for cerclage in 1995?].

AIM: In order to assess their undertook a retrospective study in their department over a 4 year period: from January 1991 to December 1994. METHOD: the study concerned 129 patients who were treated by cerclage. This procedure was performed prophylactically in the great majority of them (97), while it was carried out as an emergency in 32 (25%). RESULTS: the authors drew a distinction between two groups (prophylactic and emergency suture) when analyzing the various results: complications due to suture, mean age of pregnancy at delivery, threatened premature labor, mean length of prolongation obtained. These personal data formed the basis of a review of the literature, in order to specify the indications for suture adopted by various authors at the present time. CONCLUSION: the authors found themselves to be in agreement with data from the literature, considering a history of at least two obstetric accidents (late abortions) and/or the existence of a severe uterine malformation to be the principal indication for prophylactic suture. "Emergency" suture should be performed whenever there is a serious threat of early premature labor in the presence of cervical changes such that suture offers the only chance of prolonging the pregnancy.

Emergencies↗