Biomedical subjects
Publications and source records attributed to J Isselin.
The author introduces a novel concept, namely the partial wrist prosthesis. This new technique combines a proximal row carpectomy with resurfacing of the lunate fossa of the radius and the head of the capitate. Results of the first 13 cases are reported with a mean follow-up of 32.7 months (13-72 m). This prosthesis can be used in degenative arthritis of the wrist instead of total fusion.
Digital pictures are performed on patients in the pre and postoperative periods, and sometimes during surgery. Seven thousand fourty eight records have been recorded. This method is useful for a multidisciplinary responsibility, particularly for the hand therapist and the splint follow-up. It is also good for patient information, for Workman's compensation doctors and for experts. The pitfall is that one have to manage the records on a strict day by day base.
Preliminary results of 45 trapeziometacarpal "ARPE" prostheses are reported with a mean follow-up of 22.4 months. Pain and mobility before and after operation were analysed. A special questionnaire was used to assess the result in activity of daily living. Pre and postoperative special X rays were also compared. Pain decreased in frequency and intensity and mobility improved. 97.1% of the patients were satisfied with their prosthesis after the operation. Comparison are pre- and postoperatives radiographs showed a tendency for both cup and stem to progressively sink into the bone.
We present five cases of mycobacterial tenosynovitis of the flexor tendons of the fingers. These cases were observed during the last 12 years and treated by the same surgeon. This pathology is uncommon now, but it is becoming more frequent, especially in patients with diminished immunity. The diagnosis was most commonly made after synovectomy in patients presenting with carpal tunnel syndrome associated with slightly painful swelling at the wrist. Histological and bacteriological examinations are very important and revealed tuberculosis in four of our patients and mycobacterium in one, and the treatment consists of synovectomy and appropriate antibiotics. The functional result is usually good, but recurrence is not uncommon. Long-term follow-up is necessary. Local corticosteroid therapy could have a part in the causation of this condition.
The fasting blood glucose was studied in 406 patients with carpal tunnel syndrome. We found 3.3% patients with diabetes mellitus and 15% with abnormal blood glucose levels. A prospective study was performed in 36 patients (oral glucose tolerance test, and blood lipid parameters). 45% of the patients in this group had an abnormal OGTT and 52% presented with hyperlipoproteinemia.
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Digital sympathectomy as proposed by Flatt and al. was performed on 12 Raynaud's diseases, 6 distal arteriopathy and 4 post-trauma ischemic syndrome. Operation was performed under tourniquet. The approach depends on the number of digits involved (Brünner at the proximal part of P1, transversal in the distal palmar crease, zigzag incision at the level of each intermetacarpal space). Under microscope, adventisectomy is started on a lateral side of the artery followed by the posterior side on at least 1 cm, using the adventitia avoid all direct manipulation of the vessels. Closing skin on an aspirative drainage and simple non compressive drainage is maintaining 4 days. Index pressure and arterial blood flow are measured. Results are bad for post-trauma ischemic syndrome and arteritis but encouraging in Raynaud's disease (7 patients asked for the same operation on the opposite side).
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