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Biomedical subjects

J Pélissier

Publications and source records attributed to J Pélissier.

At least 19 recordsLinked to original sources
PubMed2006

[Does the quality of Web sites related to low back pain meet patients expectations? A systematic review].

INTRODUCTION: An assessment of 36 back-pain-related French-language Web sites, miming a patient search strategy, was previously done by use of evidence-based items. Medical information quality was poor, as already noted about English-language Web sites. Thus, patients' expectations may exceed that provided by Web sites with simple medical information. OBJECTIVES: To study whether French-language Web sites related to low back pain meet patients expectations and to valid a rating scale including patients' expectations. MATERIALS AND METHOD: First we reviewed French-language Web sites with new keywords and medical gateways. Second, we systematically double assessed back pain-related Web sites with a health care professional and patient-centered scale. RESULTS: We found 30 additional Web sites not found with the previous search, 7 focusing on patient information. The rating scale is valid, and its use on a Web site sample leads to results different from those generated by an evidence-based medicine rating scale but close to a more global assessment. DISCUSSION: French-language Web sites related to low back pain do not meet patients' expectations. Patients participation in Web site assessment or construction could help to close the gap between the expectations of people with low back pain and information delivered by doctors.

Evidence-Based Medicine↗
PubMed2006

[Camptocormia disclosing Parkinson's disease].

Camptocormia is characterised as an extreme bent-forward posture of the trunk that disappears in the recumbent position. On X-ray, trunk flexion appears without vertebral rotation as in scoliosis. The condition is a well-known complication of Parkinson's disease (PD) at the late stage. The authors present the case of a 77-year-old woman affected by severe camptocormia, which appeared and worsened in less than 6 months and hindered gait. Despite no signs of PD, neuro-imaging (DAT-Scan) showed an L-Dopa transducer decrease in putamens. A few weeks later, bradykinesia appeared and the clinical diagnosis of PD became more obvious. L-Dopa improved bradykinesia but did not change the bent-spine posture. A 1-year follow-up showed no other signs of PD other than bradykinesia, but the camptocormia was unchanged.

Aged↗
PubMed2005

[About two big buttocks: an erysipelas with lymphoedema after pelvis surgery].

We report the case of a 58-year-old man with erysipelas of both buttocks secondary to lymphoedema after pelvis surgery for prostatic cancer and multiple vascular interventions for iliofemoral thrombosis. The diagnosis was based on clinical examination and lymphoscintigraphy. This location of lymphoedema, limited to the buttocks, is uncommon; lower limbs are usually affected. This location needs a specific curative and preventive treatment, including antibiotic therapy, lymphatic drainage and contention to abate the condition and prevent a relapse.

Buttocks↗
PubMed2005

Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis.

Pelvis and spinal curves were studied with an angular parameter typical of pelvis morphology: pelvic incidence. A significant chain of correlations between positional pelvic and spinal parameters and incidence is known. This study investigated standards of incidence and a predictive equation of lordosis from selective pelvic and spinal individual parameters. One hundred and forty nine (78 men and 71 women) healthy adults, aged 19-50 years, with no spinal disorders, were included and had a full-spine lateral X-ray in a standardised upright position. Computerised technology was used for the measurement of angular parameters. Mean-deviation section of each parameter and Pearson correlation test were calculated. A multivariate selection algorithm was running with the lordosis (predicted variable) and the other spinal and pelvic parameters (predictor variables), to determine the best sets of predictors to include in the model. A low incidence (<44 degrees ) decreased sacral-slope and the lordosis is flattened. A high incidence (>62 degrees ) increased sacral-slope and the lordosis is more pronounced. Lordosis predictive equation is based on incidence, kyphosis, sacral-slope and +/-T9 tilt. The confidence limits and the residuals (the difference between measured and predicted lordosis) assessed the predicted lordosis accuracy of the model: respectively, +/-1.65 and 2.41 degrees with the 4-item model; +/-1.73 and 3.62 degrees with the 3-item model. The ability of the functional spine-pelvis unit to search for a sagittal balance depended both on the incidence and on the variation section of the other positional parameters. Incidence gave an adaptation potential at two levels of positional compensation: overlying state (kyphosis, T9 tilt), underlying state (sacral slope, pelvic tilt). The biomechanical and clinical conditions of the standing posture (as in scoliosis, low back pain, spondylisthesis, spine surgery, obesity and postural impairments) can be studied by comparing the measured lordosis with the predicted lordosis.

Adult↗
PubMed2005

[Feet insoles and knee osteoarthritis: evaluation of biomechanical and clinical effects from a literature review].

OBJECTIVE: To determine the biomechanical and clinical effectiveness of foot insoles in patients with knee osteoarthritis. MATERIALS AND METHODS: A systematic review of the literature (Medline, Pascal and Embase) using the MESH words knee, and insole and plantar orthosis for the biomechanical part and osteoarthritis, and insole and plantar orthosis for the clinical part. Clinical studies were classified by 2 independent readers using the Jadad scale. RESULTS: Two biomechanical theories were found: the adduction moment theory, which explains the effect of heel wedging, and articular chain theory, which explains the effect of lateral wedged insoles. The clinical effect was explained more by an anti-algesic effect than an anatomic or functional effect: the treated group consumed fewer nonsteroidal anti-inflammatory drugs than the placebo group for up to 2-years of treatment. Evidence is lacking because of methodological weakness and few clinical trials. The information on side effects is limited. DISCUSSION: Laterally wedged foot insoles are proposed for the treatment of knee medial compartment osteoarthritis. The clinical effect is probably limited, but the treatment may reduce the digestive and renal side effects of prolonged use of nonsteroidal anti-inflammatory drugs. Foot insoles could be recommended in clinical practice despite the lack of evidence in comparing the effectiveness of other therapeutics in knee osteoarthritis. CONCLUSION: Use of foot insoles is a nonpharmacologic treatment of osteoarthritis of the knee medial compartment.

Biomechanical Phenomena↗
PubMed2005

[The assessment of autonomy in elderly people].

The assessment of autonomy in elderly people relies on various instruments that aim to evaluate and follow up patients, to measure the burden of care for the medical staff, or to properly distribute health budgets. In this article, we describe 3 clinical scales traditionally employed by gerontologists and specialists in geriatric rehabilitation. We intentionally left out generic scales such as the Barthel index and the Functional Independence Measure, which are well known by physiatrists. The Katz index is a scale of Activities of Daily Living, and the Lawton test is a scale of Instrumental Activities of Daily Living. We paid special attention to the AGGIR classification, which is the actual legal instrument for evaluating dependency in elderly in France, and whose first application is health resources management.

Activities of Daily Living↗
PubMed2005

[Peripheral neurolytic blocks and spasticity].

Peripheral nerve blockade is one of the therapeutic possibilities to treat spasticity of various muscles. Percutaneous nerve stimulation allows accurate location of nerves and neurolysis can be performed using intraneural injection of 65% ethanol or 5 to 12% phenol. Spastic contraction of various muscle groups is a common source of pain and disability which prevents from having efficient rehabilitation. Test-blocks as well as neurolytic blocks are possible in most of motor nerves of the upper and lower limbs and main indications are spastic sequelae of stroke and spinal trauma but also of multiple sclerosis, cerebral palsy and chronic coma. The use of percutaneous nerve stimulation allows accurate location and four nerves are more frequently treated: pectoral nerve loop, median, obturator and tibial nerves. In patients with spasticity of the adductor thigh muscles, nerve blocks are performed via a combined approach using fluoroscopy and nerve stimulation to identify the obturator nerve. No complications occurred and minor side effects are transient painful phenomena during injection. These approaches proved to be accurate, fast, simple, highly successful and reproducible. Percutaneous neurolytic procedures should be done as early as possible, as soon as spasticity becomes painful and disabling in patients with neurological sequelae of stroke, head trauma or any lesion of the motor neuron.

Animals↗
PubMed2005

[Incidence, circumstances and consequences of falls in patients undergoing rehabilitation after a first stroke].

OBJECTIVES: To describe the incidence, circumstances, and consequences of falls in patients admitted in a rehabilitation ward after a stroke. METHODS: Prospective monitoring of falls over four years in a neurological rehabilitation unit. Use of fall registry. INCLUSION CRITERIA: age < 75 years, admission < 45 days after stroke onset, single stroke of 1 cerebral hemisphere (nonlacunar) or of the brain stem. Only falls due to loss of balance were considered; falls caused by a seizure or syncope were not considered. RESULTS: Of 217 consecutive patients with the inclusion criteria, 34 had fallen at least once (15.7%) and 10 twice (4.1%). Fall incidence, defined as the number of falls per patient per day was 2.2 per thousand. Half of the patients fell the first three weeks after admission. Most falls involved getting to or from the wheelchair or the bed; 1 patient had recovered minimal postural abilities at the gym but was not independent. Traumatic lesions were noted in 13 patients: they were minor in nine and severe in four, including three fractures. CONCLUSION: Falls due to loss of balance are a major problem in patients undergoing rehabilitation after a stroke. Getting to and from wheelchairs in the bedroom and bathroom by patients who are not allowed to do so play a key role in many falls. Prevention programs should consider this information.

Accidental Falls↗
PubMed2005

[What is the place of diphosphonates in the treatment of complex regional pain syndrome I?].

OBJECTIVES: To evaluate the efficacy of biphosphonates (BPs) in complex regional pain syndrome I or reflex sympathetic dystrophy and to specify their place in this chronic painful syndrome. METHODS: A literature review of Medline and Embase with use of a combination of 3 key words: biphosphonates therapy, reflex sympathetic dystrophy, complex regional pain syndrome I, controlled study. Each article was classified by 2 independent reviewers according to Aguilar's method into high, middle or low quality. RESULTS: Three second-generation BPs were tested in the treatment of reflex sympathetic dystrophy: pamidronate, alendronate and clodronate. Many open studies investigated pamidronate, but only 2 were randomised and controlled: a low-quality trial comparing pamidronate with placebo and a middle-quality trial comparing pamidronate with calcitonine. Two high-quality trials were performed, 1 with alendronate and 1 with clodronate. Middle-quality trial and high-quality trials reported positive effects on pain with BPs in recent reflex sympathetic dystrophy (disease duration less than eight months). Side effects (fever, asymptomatic hypocalcemia) were observed frequently but disappeared quickly. CONCLUSION: BPs can be used in recent reflex sympathetic dystrophy when calcitonin is inefficient or when calcitonin injections are not well tolerated.

Complex Regional Pain Syndromes↗
PubMed2003

[Strength training with elastic bands: measure of its effects in cardiac rehabilitation after coronary diseases].

OBJECTIVES: To compare high intensity strength training with weightlifting exercises or with elastic bands. SETTING: Outpatient unit of cardiac rehabilitation. TYPE: Prospective randomised clinical trial. POPULATION: Inclusion of coronary patients in phase II after medical or surgical treatment of a myocardiac infarction, without cardiac insufficiency; beta-blockers were accepted. METHOD: Evaluation of coronary patients at beginning and at the end of a 4 week cardiac rehabilitation program. It included progressive aerobic training according to Karvonen method for all the patients, associated with weightlifting exercises (Koch press) in the control group, or use of elastic bands in the experimental group. Cardiac rate, oxygen consumption at rest and at maximum power were the main criteria with also muscle strength of quadriceps, hamstrings, biceps brachii, latissimus dorsi and triceps brachii, body mass indexes, quality of life with SF-36, anxiety (stay T test) and perceived exertion with the Borg 10-point category-ratio scale, myotendinous injuries (Shaw scale). RESULTS: Twenty-six coronary patients, all male from 45 to 65 years old, all receiving beta-blockers, were included, 13 in each group. Control and experimental groups were initially similar. At the end of the 4 week program, all the two groups improved significantly their strength and power and there were no differences between the two groups. Perceived exertion was lower in the group using elastic bands and there were no myotendinous lesions. CONCLUSION: Strength training with elastic bands is a low-cost, attractive, playful technique, proposed to a group of coronary patients, which appears as effective in cardiac rehabilitation as individual weightlifting training.

Aged↗
PubMed2003

[A French questionnaire to assess quality of life of the aphasic patient: the SIP-65].

OBJECTIVES: To develop and demonstrate validity and reliability of a aphasic-adapted version of the Sickness Impact Profile (SIP-136), a generic widespread questionnaire used to measure quality of life (QoL). DESIGN: Survey, outpatient oral interviews. POPULATION: Aphasic people from 20 to 80 years old, with a time from stroke or trauma of more than 12 months, living at home for more than six months, able to understand the questions with a Z-score profile at Boston Diagnostic Aphasia Examination above average for oral comprehension. METHOD: 1. Developments of the short version of the SIP-136, from a first sample of aphasic people; 35 patients were included with a mean time from stroke or trauma of 17 months. This first step consisted in excluding the least relevant items and/or subscales, rewriting some items to make them easier to understand, studying redundancy by multiple components analysis (MCA) and deleting some redundant items. 2. Validity compared with initial SIP-136 and reliability (inter-rater and test-retest) from a second sample of 55 aphasic people (mean time from stroke or trauma = 23 months). RESULTS: - 1. The first step of development led to a short version with eight subscales and 65 items (SIP-65) exploring physical, psychological and social components of QoL; it took about 16 min to fill it, less than half of the time necessary for the SIP-136. 2. Linear correlation of the responses between SIP-65 and SIP-136 was good: r = 0.97; p < 10(-6). SIP-65 demonstrated a good test-retest (r = 0.97; p < 10(-6)) and inter-rater (r = 0.92; p < 10(-6)) reliability. DISCUSSION AND CONCLUSION: SIP-65, a short version of SIP-136, is feasible and clinically sound and must be recommended to assess health-related functional status of French aphasic people.

Adult↗
PubMed2002

[Treatment of neurogenic heterotopic ossifications (NHO) in brain injured patients: review of literature].

This article is a review of the literature about treatment of neurogenic heterotopic ossifications (NHO) in brain injured patients, from analysis of the main data bases (Medline, Embase, Reedoc). In spite of the hope they arouse in the seventies, biphosphonates, including etidronate, have not demonstrated their efficiency to inhibit NHO in clinical practice. In fact a very early diagnosis, with the scintigraphic overactivity of the joint area and the increase of serum alkaline phosphatases, must lead to begin passive motion and postures, and may contribute to save functional range of motion. Yet, when joint stiffness or even ankylosis have led to severe functional disorders, surgery with NHO resection is the only way; it looks more reliable to manage it when NHO is mature, after a delay of more than 12 months after the first signs, but earlier operations have been reported without an enhanced risk of recurrence; this surgery must be associated with continuous passive motion for several weeks; radiation therapy and/or non-steroid anti-inflammatory drugs have been proposed in the immediate after-surgery period, but their role is still discussed.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2002

[Is it necessary to rehabilitate coronary artery disease patients based on ventilatory threshold?].

PURPOSE: To compare the efficiency of two programs of exercise-based rehabilitation that are different for heart rate (HR) training in patients with coronary artery disease: heart rate (HR) according to Karvonen formula (HR training =70% (max HR -rest HR) +rest HR) or HR recorded at the gas exchange ventilatory threshold (VT). TYPE: Controlled randomised clinical trial. SETTING: Cardiovascular rehabilitation unit. METHOD: Twenty-four male patients (54 +/-9.5 years old) with coronary artery disease were allocated at random to one of the two groups: KHR group (n =13) according to Karvonen formula (n =11), and VTHR group according to VT determined by exertion test (n =13). The exercised-based program was similar for all the patients, differing only in HR training (five daily sessions a week for four weeks). Assessment tests were performed at D1 and D28 and included: - an exercise test with measure of HR and double product (HR x blood pressure) at rest, submaximal and maximal intensity, with measure of oxygen consumption and gas exchanges at rest and at maximum exercise; - specific functional tests based on daily life activities; - dyspnea assessment at maximal intensity; - quality of life measurement by SF36. It was taken notice of the drugs taken by the patients, specially betablockers. RESULTS: At inclusion, the two groups were not different for parametric (age, body mass index) and non parametric values (medical or surgical treatment, comorbidity). Even though HR training was significantly different (p <10(-6)), at the end of the program there was a significant increase of power and oxygen consumption at VT (+42.6%, p <10(-6); +18.6%, p <10(-5)) and at maximal intensity (+18.7 %, p <10(-6); 14.2 %, p <10(-5)), but differences between the two groups were not significant; double product was significantly lower at rest (-13.9 %, p <10(-5)) and at submaximal exertion (-10.6 %, p < 10(-3)). Yet, the two groups differed in HR, and HR increased in VTHR group and decreased in KHR, the difference being significant at VT (p =0.05), at submaximal (p =0.037) and maximal exercise (p = 0.05). Dyspnea at maximal intensity was higher in VTHR but SF36 values were not different. DISCUSSION AND CONCLUSION: These results confirm the efficiency of cardiac training program according to Karvonen formula as to ventilatory threshold. However, there is a negative chronotropic effect of cardiac training according to Karvonen formula with a higher intensity, which corresponds to a less cardiac work for a same activity.

Anaerobic Threshold↗
PubMed2001

[Physical therapy of frozen shoulder: literature review].

OBJECTIVE: To determine the efficacy of physical treatments in adhesive capsulitis of the shoulder by a systematic review of literature, attempting to perform a meta-analysis from randomised clinical trials. METHOD: A systematic literature search was conducted to retrieve all randomised controlled trials of physical therapy such as physiotherapy and manipulation, but also arthrographic distension, mobilisation under general anaesthesia or nerve block, arthroscopic distension or arthrolysis, and intra-articular corticoid injections. The main outcome for meta-analysis was the restoration of range of movement between the sixth week and the third month. RESULTS: Only 16 articles could be selected, and only three about capsular distension were included in a meta-analysis because of the heterogeneity of the criteria assessing the functional results and of the poor methodological value of most of the articles. DISCUSSION: Some open studies stressed the value of daily manipulations and physiotherapy, intra-articular corticosteroid injections, but their quality was poor or limited. Nothing was written about antalgic drugs to facilitate joint mobilisation, and the use of a thoraco-brachial abduction device between exercises was only quoted. The most refractory cases might need more aggressive interventions: arthrographic distension with local anaesthesia and steroid injection; mobilisation under general or local anaesthesia, specially interscalene brachial plexus block; arthroscopic release. But there was no randomised controlled study comparing these three techniques and it seemed impossible to come to any conclusion about the superiority of one of them. The meta-analysis showed yet that capsular distension with intra-articular corticoid injections was better than corticoid injections alone. CONCLUSION: This demonstrated the need of a consensus about the criteria of assessment, the time of evaluation, before assessing by randomised clinical trials of good quality their therapeutic value.

Adrenal Cortex Hormones↗
PubMed2001

[Locomotor reeducation and multiple sclerosis. A critical analysis of the literature].

Multiple Sclerosis (MS) is a disabling chronic neurological disorder with multiple motor impairments and its progressive course leads to severe disability. The question of the value of exercises program and physiotherapy to reduce these motor disorders and their consequences was raised. This literature overview is based on data from common database: Medline, Embase, Cochrane Library. Were selected articles corresponding to open studies and especially clinical controlled randomised trials. To be analysed, each article should correspond with inclusion criteria: confirmed diagnosis according to Poser's criteria, secondary or primary progressive form of MS without relapse for the study period, randomisation according to severity assessed by the Expanded Disability Status Scale (EDSS), no change in symptomatic drugs along the study period, and a simple blind assessor. Impairment, disabilities, handicap and quality of life had to be measured. Five clinical controlled randomised trials were consistent with these criteria. They demonstrated the effectiveness of comprehensive programs on motor function in the less severe forms of MS, but also their inability to change the course of the most severely affected forms. However, the effects on disability, handicap and quality of life were significant in comparison with control patients. These trials emphasised the value of multidisciplinary programs including physiotherapy and occupational therapy, carried out daily or 3 times a week by specialised staffs. The effects lasted only few weeks or months, requiring to propose them again after this period. Other controlled randomised studies also stressed the value of specific programs: temporary alleviation of spasticity and fatigue with cooling techniques; aerobic endurance training for less severely affected patients to prevent disuse consequences and improve fitness and quality of life; expiratory training to enhance coughing capacity and prevent pulmonary infections in very disabled patients. From this overview study, it seems that multidisciplinary comprehensive programs clearly provide benefits to those patients and contribute to reduce disability and improve quality of life at each stage of MS.

Clinical Trials as Topic↗
PubMed2001

[Management of multidimensional clinical scores: which solutions for items aggregation?].

BACKGROUND: Clinical evaluation is a multifactorial process producing as many clinical scores as there are clinical dimensions. For a medicoeconomical analysis however, a single global score would be most useful. The aim of this work was to examine methods allowing relative quantification of items on multidimensional clinical scores in order to determine an appropriate solution for weighted items aggregation. METHOD: Several techniques for item weighting, developed as part of a multi-criteria decision-making tool (AMCD Aide Multi-Critère à la Décision), were examined. Two methods were applied to multidimensional assessment of disability in order to estimate the weight that should be assigned to each of its six items before aggregation in a unique score. The AHP method was used with an interview of 20 functional rehabilitation specialists. The Diakoulaki method was based on the observation of thirty patients with chronic back pain and in thirty patients with vascular hemiplegia. RESULTS: The three weighting schemes were very different from the uniform weighting and were not correlated with each other. The items best weighted by the AHP method were "physical independence" and "mobility". For the Diakoulaki method, they were "social integration" and "economic independence" for the chronic back pain patients, and "awareness of the outside world" and "economic independence" for the vascular hemiplegia patients. Application of these three weighting schemes to theoretical patients produced very different assessments of global disability. CONCLUSIONS: Weighting schemes are useful to quantify the relative importance of individual clinical items. The choice of the weighting method is determinant and depends on the objective of the investigator. If the objective is a global score, the first step is to estimate the weight of the individual items, either when applying a validation process for a new multidimensional clinical score, or secondarily to adapt a validated score to a particular protocol.

Back Pain↗
PubMed2000

The polymodal sensory cortex is crucial for controlling lateral postural stability: evidence from stroke patients.

In modern literature, internal models are considered as a general neural process for resolving sensory ambiguities, synthesising information from disparate sensory modalities, and combining efferent and afferent information. The polymodal sensory cortex, especially the temporoparietal junction (TPJ), is thought to be a nodal point of the network underlying these properties. According to this view, a pronounced disruption of the TPJ functioning should dramatically impair body balance. Surprisingly, little attention has been paid to this possible relationship, which was the subject of investigation in this study. Twenty-two brain-damaged patients and 14 healthy subjects were subjected to a self-regulated lateral balance task, performed while sitting for 8 s on a rocking platform. Their lateral body balance was analysed both with and without vision (darkness). Support displacements in the frontal plane were recorded by means of an accelerometer. Two criteria were taken into account to evaluate body stability in each trial: the number of aborted trials due to balance loss and the angular dispersion of the supporting surface. Lesions involving the temporoparietal junction were found to markedly increase body instability, both with and without vision. Therefore, the temporoparietal junction plays a pivotal role in lateral body stabilisation, irrespective of the sensory condition in which the task is performed. This suggests that body stability is controlled throughout internal model(s).

Adult↗