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J M Farcot

Publications and source records attributed to J M Farcot.

15 recordsLinked to original sources
PubMed1991

[Sympathetic nervous system, pain and epidural administration of morphine].

There are multilevel intrications between nociceptive afferences and sympathetic efferences: anatomical vicinity in visceral innervation; systemic and local activation of the sympathetic efferences in response to nociceptive stimulation; major role of sympathetic activation in the perpetuation of sympathetic dystrophies. The analysis of a retrospective series of 10 patients suffering from algodystrophia revealed that epidural morphine administration had a beneficial effect only in those which were treated at an early stage of their illness. Despite epidural morphine has been claimed to be without effect on the efferent sympathetic tone in normal animals and individuals, it seems that in some pathologic states, the sympathetic output can be depressed. Recent anatomical and neurophysiological evidences argue for such a possibility.

Analgesia, Epidural↗
PubMed1990

[Local intravenous treatment of algodystrophy of the hand: buflomedil versus guanethidine, long term follow-up].

This report compares the results obtained after treatment of reflex sympathetic dystrophies (algodystrophies) of the hand by pharmacological segmental blocks with buflomedil (51 cases) versus guanethidine (30 cases). The results were similar for all the different stages of algodystrophies treated: 65% satisfactory to excellent results with buflomedil, versus 63% with guanethidine. The sooner the algodystrophy is treated after its onset, the better the results. On TPBS, when the technique is effective, both hemovelocity and blood pool return to normal, along with the improvement in the patient's condition. Early and delayed bone fixations evolve independently of the treatment. These techniques should always be associated with active, mild physiotherapy, and in some cases with dynamic splints in order to prevent the development of functional sequelae in the form or capsulo-aponeurotic retraction.

Adult↗
PubMed1990

[Pain after sympathectomy].

Surgical sympathectomies and chemical sympatholyses bring about a true sympathetic deafferentation. This leads to central retrograde degenerescence reactions of the pre-ganglionic neurons, to a reduction of the muscular tone and to a secondary neurovascular disorder at the edge of the sympathetic denervation zone. In a limited number of cases, a radiculalgia-like functional painful syndrome may develop. There are variations in the degree of seriousness and evolution, but the outcome is always spontaneously favourable. Forty seven cases of radiculalgias are reported; the onset is sudden, most often at night, and the untoward effects gradually wear off with the recovery of some degree of peripheral vasomotor tone. Although classical antalgic therapies do not seem to affect the spontaneous evolution of this syndrome, the use of membrane stabilizers such as nifedipine does however induce an immediate functional improvement of the neurovascular disorders. This leads to a dramatic sedation of the pain, provided calcium inhibitors were not administered prior to the sympathectomy.

Aged↗
PubMed1989

[Thoracolumbar or sacral epidural administration of clonidine in deafferentation pain: possibilities, limits and long-term follow-up].

Clonidine was administered by epidural injections with per os relay and long term therapeutic follow-up to 38 patients with deafferentation neurological sequellar pain either fully or partly intractable to classical pain treatments. In such types of pain, this technique provides hypoalgesia which can be enhanced by the administration of serotoninergic anti-depressants or low dose tricyclics. However, side effects may occur. After some time, a tolerance develops with a lesser antalgic efficiency, as well as rare cases of withdrawal syndromes when the treatment is suddenly discontinued.

Chronic Disease↗
PubMed1988

Three-phase bone scanning in reflex sympathetic dystrophy of the hand.

Three-phase bone scanning was performed in 181 patients suffering from reflex sympathetic dystrophy (RSD) of the hand. Four quantitative parameters were defined as follows: (a) hemovelocity and (b) blood pool (determined from the Fourier processing of angiographic data); (c) early (3-5 min) and (d) delayed (2-3 hr) bone fixation. Three significant stages of RSD were demonstrated scintigraphically. Stage I (0-20 wk from onset) demonstrated increases in velocity, blood pool, and early and delayed fixations. At stage II (20-60 wk) blood velocity and blood pool were normalized, but early and delayed hyperfixation persisted. During stage III (60-100 wk) blood velocity and blood pool were reduced on the affected hand, and early and delayed fixations were normalized. Such abnormality of decreased hemodynamic parameters may become associated with bone hypofixation in stage III. Early treatment of RSD (as compared with delayed treatment) has been demonstrated to induce normalization of hemovelocity (p less than 0.05), blood pool (p less than 0.02), and joint stiffness (p less than 0.001) without any change in the bone fixation; therefore, three-phase bone scanning may provide useful information regarding the pathophysiologic and clinical evolution of RSD.

Bone and Bones↗
PubMed1987

[A multidisciplinary approach to algodystrophy of the hand].

A multidisciplinary approach for the management of reflex sympathetic dystrophy at SOS Main of Strasbourg has been progressively adopted due to the severe functional sequelae of this disease. The TC99 bone scan in three phases has allowed us after a one week duration of the symptoms to make an early diagnosis and to start dynamic splinting in flexion. Our study compares two groups of patients, one with an early treatment and the other with delayed treatment. It shows a correlation between the stiffness of the affected hand and the isotopic findings. The benefit from an early dynamic splinting in flexion as evidenced by a clinical improvement is corroborated by the bone scan.

Combined Modality Therapy↗
PubMed1986

Three phase bone scanning as an aid to early diagnosis in reflex sympathetic dystrophy of the hand. A study of eighty-nine cases.

In reflex sympathetic dystrophy, three phase radionuclide bone scanning with Tc-99m methylene diphosphonate is preferred. The first phase corresponds to the dynamic behavior of the tracer. After appropriate data processing (by Fourier's analysis), three functional images may be obtained. The second phase corresponds to the tissues fixation of the tracer 5 to 10 minutes after the injection. Based on the results of 89 cases of post-traumatic or postsurgical reflex sympathetic dystrophy observed in 128 patients investigated with this method, diagnostic sensitivity was 96%, while specificity was 86%. The scintigraphic patterns observed during the 100 week period after the initial trauma demonstrate the precocity and the significance of circulatory and tissues phenomena as well as their variations according to treatment. The scintigraphic criteria of regression or stabilization of disease are discussed.

Adolescent↗
PubMed1986

Out-patient hand surgery. A prospective study of 588 patients.

The results of a prospective study of 588 patients operated on over a period of 4 months were analyzed. Of these patients, 6% only had to be hospitalized. The 555 other patients underwent out-patient surgery, 25% of which were emergencies. Thirty-four % of patients had one or more preexisting serious medical conditions. Ninety-one % underwent regional anesthesia. Complications were rare and did not seem to be preventable by hospitalization. While highlighting the many advantages associated with out-patient surgery, the authors stress the guidelines which must be followed as well as the pitfalls to be avoided in ambulatory surgery of the hand.

Adolescent↗
PubMed1985

[Analgesia with an implanted device for repetitive intrathecal injections of morphine].

The use of intraspinal narcotics has been widely accepted as pain relief treatment for intractable cancer pain. Intraspinal low doses of morphine induce a potent selective long lasting analgesia. To avoid repetitive lumbar puncture, a drug delivery device was surgically implanted in 41 patients. The surgical procedure is described. The mean amount of morphine needed was 1.48 +/- 0.25 mg per day at time of surgery, rising to 6.86 +/- 1.47 mg per day after a mean survival time of 65 days. Tolerance became a major problem in 18 patients, which nearly all were selected at a late disease stage and previously received narcotics for pain relief. However, no clear-cut prognostic factor had a predictive value for the appearance of tolerance. In some cases, it could be successfully treated by intraspinal injection of local anaesthetics or clonidine. CSF leakage was noted in 11 patients; this was a challenge for us, as no other authors reported such a high rate for this complication. Aseptic meningitis was noted three times. In all cases but one, the symptoms resolved with appropriate treatment.

Adolescent↗
PubMed1981

[Transnasal and transsphenoidal neuroadenolyses with alcohol. Indications. Technics. Results. Remarks about action mechanism (27 cases) (author's transl)].

The technique is of interest in deep bone pain in terminal metastasized cancer, but early relapses often occur. The hypoalgesia or analgesia obtained does not seem to result from endocrine mechanisms only, nor from the release of endogeneous opioid peptides. This neuroadenolysis seems to interfere in the pain pattern either through still unknown neurotransmitters, or through the dissociation of fibers transmitting pain to the floor of the diencephalon.

Endorphins↗
PubMed1979

[Pain due to bone metastasis in hormonodependent cancer. Treatment by intrasellar injection of alcohol (author's transl)].

Pain due to bone metastasis in hormonodependent cancer (of the breast or the prostates more particularly) can be relieved by surgery directed at the endocrinic system. The most efficient techniques are hypophysectomies and hypophysiolysis (or neuroadenolysis). The intrasellar injection of alcohol through the transnasal-transsphenoidal route is a fairly simple procedure which can be carried out on such fragile patients without too much risk. The authors here report the first results obtained with this procedure in 12 pateints. Full sedation of pain is achieved in 30 to 40 p. cent of the cases. The duration of analgesia varies and pain frequently returns. One of the advantages of this procedure lies in the fact that such an injection may be repeated if necessary. The intrasellar injection of alcohol is but one of the many techniques available to practitioners working in the field of intractable pain.

Aged↗