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Biomedical subjects

J Butel

Publications and source records attributed to J Butel.

At least 19 recordsLinked to original sources
PubMed2006

Endoscopic screening for esophageal squamous-cell carcinoma in high-risk patients: a prospective study conducted in 62 French endoscopy centers.

BACKGROUND AND STUDY AIMS: The prevalence of esophageal squamous-cell carcinoma in high-risk patients and the advantages of systematic Lugol staining during esophagoscopy have not yet been evaluated in a large prospective study. In this study we aimed to assess the prevalence of this type of tumor in high-risk patients, to examine the role of Lugol staining in endoscopic screening for esophageal squamous-cell carcinoma, and to establish whether it is possible to identify a particularly high-risk group which would benefit from systematic screening. PATIENTS AND METHODS: A prospective study was undertaken in 62 endoscopy centers. A total of 1095 patients were enrolled, none of whom had any esophageal symptoms. These patients had presented with either a past history of or a recent head and neck or tracheobronchial squamous-cell carcinoma (group 1), with alcoholic chronic pancreatitis (group 2), with alcoholic cirrhosis (group 3), or were alcohol and tobacco addicts (group 4). The patients underwent a meticulous endoscopic examination of the esophagus, followed by Lugol staining. RESULTS: The prevalence of esophageal squamous-cell carcinoma was 3.2 %. The group 1 patients showed the highest prevalence of carcinoma (5.3 %) and the highest prevalence of dysplasia (4.5 %). Of the 35 carcinomas detected in the 1095 patients, seven (20 %) were early lesions, and 20 % were only detected after Lugol staining (P = 0.02). High-grade dysplasia was only observed in group 1 patients and two-thirds of these lesions were only diagnosed after Lugol staining. The overall prevalence of low-grade dysplasia was 2.4 %, and 77 % of these were detected only after Lugol staining (P < 0.001). CONCLUSIONS: Lugol dye staining increases the sensitivity of esophageal endoscopy for the detection of high-grade dysplasia and cancer. The prevalence of dysplasia and cancer reached 9.9 % in group 1, and we therefore believe that an endoscopic screening program could be justified for patients with head and neck or tracheobronchial cancer.

Adult↗
PubMed1999

Hepatitis C virus infection risk factors in patients admitted in hospital emergency departments in Picardy. Value of oriented screening based on recommendations of the 'Direction Générale de la Santé'.

OBJECTIVE AND DESIGN: Oriented hepatitis C virus (HCV) screening on the basis of transfusion, previous or current parenteral drug addiction, invasive procedures, and in family members of patients with hepatitis C, was recommended in France by the 'Direction Générale de la Santé' (DGS). The aim of this study was to estimate the frequency of these risk factors in patients admitted in hospital emergency departments in Picardy. METHODS: Between 1 June and 31 July 1996, physicians of the emergency units of seven hospitals in Picardy were asked to question admitted patients about risk factors mentioned in the DGS recommendations, and to suggest a screening test when at least one of these risk factors was present. RESULTS: Among 1648 patients, 68.7% had at least one of these risk factors. Screening was accepted by 723 patients, 58.7% of those with at least one risk factor, and more than 70% of those with history of transfusion and/or drug addiction. It was immediately performed in 451, and 2.4% had anti-HCV antibodies. The prevalence of anti-HCV antibodies was 1.5% in patients without history of transfusion or drug addiction and 7.9% in those with at least one of these two risk factors. CONCLUSION: Oriented screening based on transfusion or drug addiction history seems to have better efficiency than the screening policy recommended by the DGS. Poor reliability of answers about medical history was observed probably because of stress related to emergency circumstances. A screening test proposed to patients with these major risk factors by their usual physician would be probably more efficient.

Aged↗
PubMed1995

[In vitro study of the properties of bioresorbable lactic acid polymer materials].

PURPOSE OF THE STUDY: The potential applications of biodegradable osteosynthesis implants present many advantages over conventional metallic devices. Polyesters of the poly and hydroxy-acid type were recognized early as serious candidates. These polymers have demonstrated a very good biocompatibility and are biodegradable in vivo. After biological and chemical testing poly L. lactic acid 98 (PLA 98) was selected as a candidate. We used a static and dynamic investigation in vitro to assess firstly the material properties of PLA 98 and secondly how its characteristics could be modified within a physiological environment. MATERIAL: Michel Vert and colleagues have shown that polymers of lactic acid have a similar time to resorption providing they contain 98 per cent of the "L" form of the polymer. In vitro studies were assessed on bars made in PLA 98. METHODS: In a first time in vitro studies in traction and flexion on bars allowed an assessment of mechanical properties of PLA 98. In a second time stresses were applied on bars using a physiological environment (Haemacel - 37 degrees C). In a third time we assessed the mechanical properties at the temperature of 37 degrees C with dynamic tests on bars in traction and flexion. RESULTS: The stress-strain curves on bars showed that the material is fragile. Sterilisation with ethylene-oxide did not affect the mechanical properties. When bars were placed in a thermostatically controlled (37 degrees C) physiological environment, the stress-strain curve showed that the material became ductile. With a temperature of 37 degrees C and with a frequency better than one hertz, the dynamic tests on bars showed that the material endurance is good up to 20,000 cycles. At 37 degrees C and at the end of one month, the Young modulus and the maximal strain before breaking lose 50 per cent of their initial value. DISCUSSION: All things considered and as the digital value showed, the PLA 98 appear to be ten times less strong than steel. In a physiological environment the mechanical properties improved due to hydratation of the polymer. The material become quickly ductile or malleable. This allowed transient loading without causing breakage. CONCLUSION: The mechanical properties of bioresorbable materials are very different from those of stainless steel and there is a learning curve in their utilisation. The PLA 98 polymer has demonstrated a very good biocompatibility and is totally biodegradable in vivo. With these results we think that PLA 98 can be used in clinical practice. Indications and clinical use should remain limited to bones regions with low applied stresses.

Biocompatible Materials↗
PubMed1994

[Pancreatic-portal fistula and subcutaneous fat necrosis].

The pancreaticoportal fistula is a very uncommon complication of pancreatic diseases, mostly occurring in the course of chronic pancreatitis. From 2 findings of pancreaticoportal fistula and a literature review, we emphasize in this study the frequency of subcutaneous fat necrosis during pancreaticoportal fistula, the pathogenic role of the pancreaticoportal fistula to induce a subcutaneous fat necrosis by means of a massive enzyme release in the systemic circulation, the protective role of portal thrombosis, and finally the diagnostic and therapeutic value of endoscopic retrograde cholangio-pancreatography in pancreaticoportal fistula.

Adult↗
PubMed1991

[Desmoid fibroma of soft tissues of extra-abdominal site: review of the literature apropos of a case of a tumor situated at the posterior side of the thigh].

The authors report a case of desmoid fibroma on the posterior surface of the thigh in a woman during the post-partum period. This is a rare site for this tumour. CT scan combined with MRI appears to be useful for diagnosis. Treatment is strictly surgical, but depends on the histological benign nature and the local malignancy. Surgery is generally conservative with risks of recurrence and occasionally amputation is necessary.

Adult↗
PubMed1991

[Three-dimensional rigidity of the Ilizarov external fixator (original and modified) implanted at the femur. Experimental study and clinical deductions].

The application of the Ilizarov device to the femur creates several problems: anatomical (transfixion of the thigh), mechanical (asymetrical assembly) and clinical (patient acceptability and duration of treatment). Geometric modifications of the original fixator are proposed. These comprise the use of threaded pins proximally and special connecting pieces. Two large fixators were tested under load and after the introduction of certain variables led the authors to experiment with 18 different assemblies. Four loads were used (compression, flexion in the sagittal and coronal planes and torsion) and stiffness calculated in three dimensions. Three linear and three angular displacements were defined for each type and magnitude of external load. The following sequence of analysis was followed to select the best type of assembly; increased ridigity in torsion; moderate displacement in flexion and axial elasticity. These considerations also apply to the mechanics of fracture healing. After testing under load it was concluded that the original assembly gave the best compromise. The modified assemblies gave a slightly inferior mechanical performance but their geometrical configuration should give better patient tolerance if the following items are used: a proximal arc of 120 degrees, 5 mm diameter threaded pins for the adult and 4 mm diameter for the child.

Biomechanical Phenomena↗
PubMed1991

[Osteosynthesis of forearm fractures using a P.C.D. "Small fragments" plate from A.O instruments. Apropos of 283 screwed plates].

The authors report the results of using 283 P.C.D. "petits fragments" plates by A.O. instruments, inserted between 1980 and 1989 for internal fixation of 207 forearm fractures. These included 97 double forearm fractures, 34 isolated ulnar fractures, 30 isolated radial fractures, 24 Monteggia fractures, 13 Galeazzi fractures and 9 pseudoarthroses of the radius or ulna. The mean delay to consolidation was 3.3 months with a range of 2 to 15 months. Complications included 1 hypertrophic callus of the ulna; 3 pseudoarthroses, 7 cases of sepsis (6 ulnar, 1 radius i.e. 2.5%); no plate ruptures occurred in this series. 125 plates were removed after consolidation (after 18 months); the fracture recurred in only one case where the plate was removed after 8 months. Results are based on 203 operated patients (4 lost to follow up). Before treatment of the complication, results showed 150 very good results (73.2%), 44 good results (21.5%) 1 moderate (0.5%) and 10 poor results (4.8%). After treatment of the complications there were 156 very good results (77%), 46 good results (22.5%) and 1 moderate result. In summary, forearm fractures are no longer a problem in traumatology. The P.C.D. "petits fragments" plate of A.O. instruments would appear to be particularly adapted and a bulkier implant (4.5 screw) is not required.

Adolescent↗
PubMed1990

[Villonodular synovitis. An uncommon localization: the ankle. Apropos of a case].

The authors report an uncommon soft tissue tumor, a diffuse giant cell tumor of tendon sheath. The location is uncommon too, the ankle, behind tibial shaft and forward achilleus tendon. The primary diagnosis of ankle and leg lymphoedema, has been for a long time. But CT Scan and MRI allowing the discovery of a firm and multinodular mass, have permitted surgical excision and histological diagnosis. This case agrees with the literature review. The pigmented villonodular synovitis is rather uncommon in comparison to localized form. Young people and lower extremities are more affected; symptoms are of relatively long duration. Histological examination gives diagnosis but surgical excision has to remove the tumor completely as possible because of local recurrence rate of about 50%.

Adult↗
PubMed1990

[Meniscal sutures combined with the reconstruction of the anterior cruciate ligament. Comparative results between sutures of chronic and recent lesions: 102 cases].

The authors report the results of 102 meniscal sutures (53 lateral meniscus and 49 medial meniscus) done on 85 persons (86 knees) with laxity of the knee (54 acute laxities and 32 chronic laxities). All the sutures were done by posterior arthrotomy, while reconstruction of anterior cruciate ligament. Among the operations done on anterior cruciate ligaments, we find 45 reconstructions using MacIntosh procedure, 37 CHO method and 3 reconstructions using Lemaire procedure. 78 per cent of the sutures of the recent injuries were placed in a post-operative plaster cast, on the other hand, none of the chronic injuries was splinted. All the knees (except 1) were followed up within an interval of time of 1 year minimum to 4 years maximum. 3 sutures of fresh medial meniscus tear were reoperated on and one suture of old tear was reoperated. None of the lateral meniscus sutures, old or new was reoperated. 27 "objective" controls were done: 5 by arthrography, 4 by arthroscopy and 18 by magnetic resonance imaging (M.R.I.). Of the 18 controlled sutures by M.R.I., 13 (that is, 76, 5 per cent) presented a high signal as if they had a "wound" or persistent injury, this was found within a context of knees without any symptoms. Therefore the sutures of medial meniscus associated with laxity heal very well. It would be even better if they were in the chronic laxity stage (1 did not succeed out of the 22) than in the acute laxity stage (3 failures out of 27). The sutures of lateral meniscus healed very well in the chronic and in the old laxity stages (total success in both stages). The M.R.I controls for the 18 meniscus sutures presented the problem of the sutured meniscus future.

Adolescent↗
PubMed1990

[Rehabilitation of the knee movement after ligamentoplasty using Mac Intosh's procedure augmented by Kennedy-Lad: a comparison between recent and old rupture of the anterior cruciate ligament].

About 60 ligamentoplasties of the A.C.L. using the Mac Intosh procedure with augmentation by the Kennedy-Lad, the authors compare the rehabilitation of knee motion between fresh tears (30 cases) and old tears (30 cases) of the A.C.L. operated on by the same procedure. All the operations were performed by the same surgeon. The rehabilitation program was the same for everybody; no plaster cast, total weight-bearing after the 15th day, no more crutches-stick after the 21th day and beginning of flexion on the 12th day, 88 per cent of the knees were rehabilitated by the same physiotherapists. The plaster cast is usually incriminated to be the main reason of post-operative knee stiffness. But no plaster cast for fresh A.C.L. tear also give such a stiffness (16.5 per cent). The authors think that the initial injury increased by the surgical trauma, for a non conditioned patient are the main factors of post-operative stiffnesses. This study justifies the late reconstruction of "isolated" A.C.L. tears (between the 2nd and 3rd month), after "cooling down" of the lesions.

Adolescent↗
PubMed1990

[Congenital bowing and pseudoarthrosis of the tibia in children].

Congenital pseudarthrosis of the tibia is nearly always the result of a congenital bowing of the tibia when it is unilateral and with an antero-external angle. There is no possible spontaneous consolidation and there may be several associated sequellae (shortening and trophic disorders of the limb). The etiological and therapeutic aspects of the affection are reviewed.

Bone Diseases↗
PubMed1990

[Value of Illizarov's method in the treatment of long bone pseudarthrosis. Apropos of a A.S.A.M.I.F series of 87 cases].

This study is the outcome of multicenter endeavour compiling 87 cases of pseudoarthrosis managed according to principles set forth by G.A. Ilizarov. All clinical forms are described: simple pseudoarthrosis (non-infected and without loss of substance); septic pseudoarthrosis; pseudoarthrosis with loss of bone substance, both septic and aseptic. This method is used in the majority of cases. This method is used in the majority of cases after several consecutive unavailing attempts with conventional therapeutical procedures. Considering all situations, the lesions heal in over 90% of cases and the infection subsides with an equal rate of success. Such results are achieved within a period of 5 months. Sequelae or complications imputable to the method are few. Indications are specified, which depend upon the clinical form of the treated pseudoarthrosis, as well as upon the surgeon's personal skill.

Adolescent↗
PubMed1990

[The role of a shortening osteotomy of the first phalanges associated with soft-tissue release in the surgical treatment of hallux valgus].

The Authors report the results of 120 hallux valgus operated on 76 patients from January 1983 to June 1988. The operative procedure associated bunionectomy, tenotomy of the abductor hallucis which was resected from the base of the first phalanx and from the lateral sesamoid, shortening osteotomy of the proximal phalanx and finally adjustment of the sesamoids under the head of the first metatarsal. When there was an important metatarsus varus, a basilar osteotomy of the first metatarsal was associated (10 cases about 120). The results were appreciated functionally (pain, range of motion, easiness for putting on one's shoes) and anatomically (radiological correction of the deformity). The total result included anatomical and functional results. Anatomically, 110 feet had sesamoids perfectly adjusted (that is 92.5 per cent), 9 had an inadequate adjustment (first degree). The metatarsus varus was always improved except 3 cases; in these cases a basilar metatarsal osteotomy would have to be performed. The valgus of the big toe was corrected in 88 per cent of the cases (104 feet had a valgus lower than 15 degrees). A varus of the big toe was found in 6 cases (5 per cent). One was lower than 5 degrees; it was nevertheless included with the good results (very well endured). 5 were more than 10 degrees and were included with the poor results. Finally, we took notice of 4 degenerative changes of the first metatarso-phalangeal joint. The total results found 90 per cent of good and very good results, 6 per cent of fair results and 4 per cent of poor results.

Adolescent↗
PubMed1990

[Osteosynthesis of thalamic fractures of the calcaneus using triangulation-fixed 1/4-tube plates. Preliminary results of 32 osteosyntheses].

The authors present a new type of osteosynthesis fixture used in calcaneal thalamus fracture repair. This consists in triangulation fixation, the upper- and retromost part of the thalamus being the apex of the triangle. This is performed using 2 or 3 1/4-tube A.O. instrumentation plates, with adaptable positioning according to the type of fracture. This system presents two advantages compared to currently used fixation components: it is less bulky and is associated with a reduced risk of skin-related complications. Calcaneal reconstruction is much more stable because the plates are in alignment with talocalcaneal stress lines, on the one hand, and because they form a truss that counteracts secondary displacement of the reconstructed thalamus. 32 calcaneal syntheses were thus performed during the period between July 1983 and July 1988. These included 8 stage III DUPARC fracture cases (25%), 21 stage IV cases (65.6%), and 3 stage V cases (9.4%). Nine 2-plate fixtures were assembled in an circumflex-like manner and 23 operations involved setting up the fixation components in a "closed triangle". Cuboid anchorage was necessary in 11 cases. Uncomplicated cutaneous necrosis occurred only once in this series (i.e., 3.2%). The stability of this operative procedure was assessed by measurements of Boehler's angle in the immediate postoperative period and after consolidation. The fixation was perfectly stable in 94% of cases (angle loss less than or equal to 5 degrees). Secondary angle loss occurred in 6% of cases (i.e., 2 cases, 8 degrees and 12 degrees respectively), one of which was caused by untimely weight-bearing. Moreover, no case of plate disruption was reported in this series.

Adult↗
PubMed1990

[Axial correction of the legs of children using the Ilizarov method. Apropos fo 22 cases].

22 axial corrections of limbs in children were performed using the Ilizarov technique between 1984 and 1986. This prospective study has been performed under the auspices of the Association pour l'Etude Systémique et l'Application de la Méthode d'Ilizarov en France (ASAMIF). Total correction of deformity was achieved in 20 cases. A minimal angulation (less than 5 degrees) was observed in two cases. In 9 cases tibia or femoral lengthening was performed simultaneously. After corticotomy and placement of the stimulant effect of limb distraction. The mean lengthenings achieved was 30 mm. Serious complications were are: there was one case of fracture of the regenerating bone. We deplore only two superficial pin track infections, two cases of rarefaction of bone. The bone consolidation was obtained on an average of two months. If inequality was associated (more than 40 mm) technique of double corticotomy was performed. The best and more results were certainly performed in great deformities. On the other hand the Ilizarov method addresses all inequalities of leg length, whatever the aetiology, who are associated with common deformity.

Bone Diseases↗
PubMed1989

[Impingement syndrome of the shoulder. 50 cases treated by Neer's anterior acromioplasty].

The authors present the preliminary results of 50 cases of impingement syndrome treated surgically using an operative technique which at least included an anterior Neer acromioplasty. Surgery was performed after a period of progression ranging from several months to several years. These included 2 Neer stage 1 (4%), 29 stage II (58%) and 19 stage III (38%). In all cases an anterior Neer acromioplasty was carried out. In 18 cases, an additional procedure was also performed (resection of the acromial extremity of the clavicle, suture of a rotator cuff rupture, resection reinsertion of the long head of biceps and an Apoil and Augereau deltoid flap procedure). Results could be assessed in 48 cases (2 cases lost to follow up). They demonstrated 31 very good (i.e. 64.5%), 12 good results (i.e. 25%) and 5 poor results (i.e. 10.5%).

Acromioclavicular Joint↗
PubMed1989

[Magnetic resonance imaging in studying injuries of the ligaments and menisci of the knee. 85 cases controlled by arthroscopy].

The authors report a prospective study of eighty-five patients with suspected meniscal or ligament lesions examined using Magnetic Resonance Imaging (MRI). In all cases, the results were compared with the findings at arthroscopy. The technique seems to be a good non-invasive diagnostic procedure, whose accuracy is 87 p. cent for the medial meniscus, 95 p. cent for the lateral meniscus and 100 p. cent for the anterior cruciate ligament (ACL). The most interesting indications at the present time are in the diagnosis of meniscal lesions, the evaluation of the menisci in chronic cruciate ligaments insufficiency, and the diagnosis of acute tears of the ACL (especially when examination is limited by pain or muscle spasm). In the future, MRI should take the place of arthrography. The total scanning time is rather short, as most lesions are detected by T1 weighted sagittal images.

Adolescent↗