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Biomedical subjects

M Bénichou

Publications and source records attributed to M Bénichou.

At least 19 recordsLinked to original sources
PubMed1993

[Forum: reconstruction of the traumatic thumb. Reconstruction of the thumb in a child by double transfer. Apropos of a clinical case].

The authors present a case of atypical thumb reconstruction in children, using a combined vascularized joint transfer and a free partial big toe transfer. They describe a burned hand with first metacarpal amputation and transproximal phalanx amputation of the index. According to the "bank finger" principle the metacarpophalangeal joint was transferred on the top of the first metacarpal, vascularized by the two collateral pedicles. The second metacarpal shaft was removed to create the first web and kept for bone grafting. A "wrap-around" flap (Morrison) with an intercalated bone graft completed this reconstruction. A first web orthesis was used to prevent retraction. Result at six months was functionally and cosmetically good, but the normal growth of the reconstructed thumb must be demonstrated by the future. Finally, the other procedures are considered.

Amputation, Traumatic↗
PubMed1990

[Amyloid arthropathy of the hand in patients on chronic hemodialysis].

Among 70 patients treated by hemodialysis for renal failure and operated for carpal tunnel syndromes, 17 presented with bone and joint lesions. Seven of them had destructive arthropathies of the distal interphalangeal joint, bilateral in 6 cases. Two radiological stages are described. Radiolucent lesions of the carpal bones were present in all the patients ("carpal amyloidosis"). The most frequent sites were around the radius-scaphoid-lunate and scaphoid-lunate joint spaces. Scaphoid-trapezoid-trapezium arthropathy was frequent with dynamic instability in one case. One patient had a pathological fracture of the lunate and scaphoid. Carpal tunnel syndrome was associated in all cases and dorsal wrist tenosynovitis in three cases. Amyloid arthropathy is more frequent in old patients on long-term hemodialysis. Amyloid deposits were shown in tendinous and joint synovial biopsy. The pathogenesis of amyloidosis is discussed.

Aged↗
PubMed1990

[Contribution of Doppler echocardiography to the evaluation and monitoring of normal and pathologic mitral valve prostheses].

Doppler echocardiographic examinations were performed in 146 patients with normal and 42 patients with pathological (31 regurgitations and 11 obstructions) mitral valve prostheses confirmed by catheterisation and/or surgery. The maximum and mean transprosthetic gradients and pressure half times (PHT) were calculated from continuous wave Doppler recordings and regurgitant signals were searched for by continuous and pulsed wave Doppler. In the group of normal mitral valve prostheses, the mean gradients and PHT were very variable even within the subgroups of the same type and size of prosthesis. The best haemodynamic profile was observed with the St Jude prosthesis (mean gradient = 5 +/- 2 mmHg, PHT = 90 +/- 22 ms, p less than 0.05 vs other prostheses). Minimal mitral regurgitation was detected in 12 per cent of bioprostheses and 20 per cent of mechanical prostheses. No correlations were found between the mean pressure gradient or PHT and the size of the prostheses. Regular Doppler echocardiographic follow-up over 2.4 years was obtained in 25 patients and showed a remarkable stability of the Doppler parameters in 17 patients whereas prosthetic valve dysfunction was diagnosed in the other 8 cases. In the group of pathological mitral valve prostheses, regurgitation (N = 31) was associated with a high early diastolic pressure gradient (20.2 +/- 8 mmHg) and a normal or shortened PHT (84 +/- 28 ms). Obstructed prostheses (N = 11) had high mean pressure gradients (17 +/- 5 mmHg) and increased PHT (195 +/- 53 ms). All cases of obstruction were correctly identified by the Doppler but 4 prosthetic valve regurgitations were missed or underestimated (4 mechanical prostheses).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Contribution of Doppler echocardiography in the evaluation of normal and pathologic aortic valve prosthesis].

Doppler echocardiography was performed in 112 patients with normal aortic valve prostheses and 13 patients with dysfunction (3 obstructions, 10 regurgitations) confirmed at catheterisation and/or surgery. The maximum and mean transprosthetic pressure gradients were measured in all patients by continuous wave Doppler. The prosthetic valve surface area was calculated by applying the continuity equation in the last 67 patients and compared with the effective surface area deduced from hemodynamic studies in the literature: --There was a great variability in the values of mean pressure gradient and prosthetic valve area within each group and with each size of prosthesis in patients with normal valves. No significant difference was observed between the gradients of different prostheses. However, for a given size, the St Jude Medical prosthesis had larger calculated surface areas than the other prostheses. The Doppler valve surface area did not differ significantly from the area measured invasively for the different categories of prostheses, and it increased with the size of the prosthesis. Mild aortic regurgitation was observed in 16 per cent of bioprostheses and 30 per cent of mechanical prostheses. The three cases of obstruction were characterised by a high mean pressure gradient (59 +/- 16 mmHg, p less than 0.01 vs normal prostheses) and a reduced Doppler surface area (0.7 +/- 0.2 cm2, p less than 0.005 vs normal prostheses) and were correctly diagnosed by Doppler echocardiography. Eight of the ten prosthetic regurgitations were correctly quantified by Doppler. Cardiac Doppler coupled with echocardiography is a very valuable method of non-invasive assessment of aortic valve prostheses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Respiratory mechanics for assessment of histamine bronchopulmonary reactivity in guinea pigs.

In the course of bronchial challenge, bronchopulmonary response assessment requires pleural pressure measurement. This measurement, mostly obtained in guinea pigs by a pleural catheter, is difficult to perform in anaesthetized paralysed ventilated animals needing periodical large inflations. The aim of this study was to demonstrate that the pulmonary response to intravenous histamine can be correctly appreciated from the respiratory response. In twelve anaesthetized paralysed mechanically ventilated guinea pigs, pulmonary and respiratory compliances (CL and Crs), were measured together with pulmonary and respiratory conductances (GL and Grs), using the method proposed by Rossi et al. (J. Appl. Physiol. 58: 1849-1858, 1985). Pulmonary and total respiratory mechanics were compared in the basal state, and at the end of a 5 min histamine infusion (100 ng.kg-1.sec-1). Pulmonary and respiratory compliances under histamine (HCL and HCrs), as well as pulmonary and respiratory conductances under histamine (HGL and HGrs), were expressed as a percentage of the corresponding basal values. Highly significant correlations were found between HCL and HCrs on the one hand (r = 0.98, P less than 0.001), and HGL and HGrs on the other (r = 0.97, P less than 0.001). We conclude that, in guinea pigs, the response of the total respiratory system to histamine infusion provides a simple and accurate assessment of the pulmonary response.

Animals↗
PubMed1988

[Automated monitoring of respiratory parameters in the anesthetized patient in mechanical respiration].

The constant monitoring of respiratory elastance and resistance can be of interest in patients who present a high risk of peroperative bronchospasm. The constant inspiratory flow method, proposed by Bates et al. (J Appl Physiol, 58: 1840, 1985) was chosen and automated. The inspiratory flow rate and pressure were measured respectively by a pneumotachograph linked to a differential pressure, and by a differential pressure transducer, both placed at the outlet of the inspiratory circuit. The pressure and flow signals were low-pass filtered, sampled, and then processed by an Apple II microcomputer, in order to obtain respiratory elastance and resistance. New results were displayed on the screen about every minute. The automated method was first tested in a series of 18 guinea-pigs; the respiratory parameters were compared with those obtained by the occlusion method proposed by Rossi et al. (J Appl Physiol, 58: 1849, 1985). They were found not significantly different and very strongly correlated (p less than 0.001). The ability of the constant flow method to detect changes in respiratory mechanics was then tested in a series of nine patients, after anaesthetic induction. The results obtained were in accordance with those previously published: a rise in both respiratory elastance and resistance. After giving 1 mg atropine intravenously, the respiratory resistance fell rapidly over a 5 min period, and then reached a plateau. The constant flow method, which avoids interruption in the mechanical ventilation and is sensitive to small changes in respiratory parameters, appears particularly convenient for the peroperative monitoring of patients.

Airway Resistance↗
PubMed1987

[Detection by echocardiography of a thrombus of the right cavities in acute pulmonary embolism].

Echocardiography evaluates the severity of acute pulmonary embolism from its repercussions on haemodynamics. However, many authors have reported the discovery of thrombosis in the right heart cavities of patients with acute pulmonary embolism. In order to assess the frequency of intracavitary thrombosis and to evaluate the practical problems it raises, we have systematically examined by echocardiography 84 patients hospitalized for severe, acute pulmonary embolism (mean Miller's score: 21). In this series of 39 men and 45 women (mean age 62 years), 9 thrombi were detected, i.e. an incidence of 11%. Depending on the ultrasonographic images they presented, these patients were divided into two groups: 1. Six patients with low mobility thrombi attached to the cardiac wall. All benefited from a medical treatment consisting of heparin in 4 cases and a thrombolytic drug in 2 cases. There was no clinical evidence of recurrent embolism. Echocardiography showed complete disappearance of the thrombi in 5 of these 6 patients and partial regression under heparin therapy in one. 2. Three patients with a large and mobile thrombus threatening to prolapse through the tricuspid valve during atrial systole. It seemed rational to regard such thrombi as carrying a high risk of embolism with recurrences, especially since they had formed in patients already with severe pulmonary embolism. This view was confirmed by a search in the literature which yielded a 40% death rate figure when these thrombi were associated with pulmonary embolism. This high mortality, however, can be reduced by diagnostic and therapeutic measures.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1986

[Detection of arterial thrombi using blood platelets labeled with indium-111].

Scintigraphy with Indium 111-labelled platelets was carried out in 62 patients (37 transient cerebral ischaemic accidents, 21 lower limb ischaemic episodes and 4 aortic aneurysms) to detect arterial thrombi. The results of this investigation were compared with the surgical findings and showed this to be a satisfactory method of detecting haematologically active thrombi.

Blood Platelets↗
PubMed1985

[Repeated coronarographies in 122 medically treated patients].

122 patients treated medically 115 men and 7 women aged 51.9 +/- 8.51 years (range 32 to 79 years) underwent repeat coronary angiography 34 +/- 26 months (1 month-11 years) after the initial investigation Patients with normal coronary arteries were excluded. The repeat investigation was performed for aggravation and persistance of symptoms in 74 cases, myocardial infarction in 14 cases, with a view to aortocoronary bypass in 23 cases, for cardiac failure in 8 cases and for ventricular arrhythmias in 3 cases. Three groups of patients could be distinguished: Group I: the coronary angiography was unchanged (41 patients, 33.6 p. 100). The interval between the two investigations was 30.7 +/- 24.8 months. Group II: the coronary lesions had regressed in 12 patients (9.8 p. 100). The interval between the two investigations was 29.4 +/- 23 months. The degree of stenosis was reduced in 6 cases; recanalisation of an occluded artery was demonstrated in 3 cases; coronary spasm was diagnosed in 3 cases. Paradoxically, 4 patients had developed lesions on other coronary segments. Group III: the coronary lesions had progressed in 69 patients (56.6 p. 100). The interval between the two investigations was 36.8 +/- 26.9 months. The progression was observed on a pre-existing stenosis in 51 cases and on an initially normal segment in 34 cases. Left ventricular function had worsened in 21.7 p. 100 of patients compared to only 5.6 p. 100 of patients in groups I and II (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Antihypertensive effect of a new form of nifedipine compared to a beta-blocker during chronic administration].

The aim of this study was to test the efficacy of a 20 mg tablet preparation of nifedipine alone in twice daily dosage, in the treatment of moderate hypertension (95 greater than or equal to DBP less than or equal to 115 mmHg). Efficacy was defined as the ability to maintain treatment for 6 months with a fall in DBP of a least 5 mmHg after the first month, and with a DBP 100 mmHg from the second month. One hundred and seventy seven patients were recruited from november 1981 to december 1982, 55% during the first three months of the trial. There were 95 men (54%) and 82 women, with a mean age of 55.6 +/- 10 years. The DBP ranged from 96 to 111 mmHg in 80% of cases. The patients were randomly allocated in lots of 6, to three groups: placebo (58 patients), nifedipine (57 patients) and acebutolol (61 patients). The comparability of 21 parameters amongst these 3 groups was verified. After 1 month of placebo, 25 patients did not meet the criteria of inclusion and were excluded from the study. During this phase, 19 patients (10.5%) complained of at least one side effect. Of the 152 patients who received active treatment, 34 (22.4%) were "wrongly included", 17 did not complete the test period for undefined reasons and were considered to have been "lost to follow-up", and 6 patients "deviated" from the protocol. These 3 groups were taken into account in the statistical analysis of the graphs of non-failure.

Acebutolol↗
PubMed1984

[Genesis of myocardial infarction].

The causes of myocardial infarction (MI) are complex and multiple and may eventually be associated. Two main types of mechanism are thought to be implicated: Functional mechanisms: these are operative in prolonged angina: the difference between MI and angina pectoris is related to the duration of these phenomena and to the resistance of the myocardial cells to anoxia: unsatisfied increase in myocardial oxygen demand, as for example in exercise-induced myocardial infarction; sudden reduction in oxygen supply due to an excessive fall in coronary flow, inadequate vasodilatation, platelet aggregation or coronary spasm. Priviledged cases are presented to demonstrate the reality of these phenomena. These mechanisms can sometimes cause MI by themselves, even when the coronary arteries are normal (5% of cases), and nearly always complicate and aggravate obstruction due to an atheromatous plaque. Organic obstructive lesions: coronary obstruction observed in about 2/3 of cases, sometimes caused by rupture of an atheromatous plaque, is usually the result of coronary thrombosis. The predominance of this mechanism is an argument in favour of it being the principal cause of MI. However, other workers believe that thrombosis is a secondary phenomenon induced by stasis, functional mechanisms or severe stenosis. The clot itself would then cause obstruction even if the primary cause were to regress. Irrespective of the roles of each of these factors it would appear logical to treat the functional mechanisms assumed to be responsible and the coronary thrombosis before the myocardial cells are destroyed by the anoxia.

Coronary Circulation↗
PubMed1984

[Esophageal spasm: a common cause of spontaneous precordial pain].

Fifty-eight consecutive patients were investigated for spontaneous chest pain without symptoms of effort angina, previous myocardial infarction or other signs of cardiac disease, to determine the incidence of oesophageal spasm. The character of the chest pain, its context and the results of resting ECGs were analysed. An ECG recorded during chest pain was available in 23 cases and exercise stress testing was performed in 43 cases. Coronary angiography was carried out in all patients. The coronary arteries were normal or showed little change in 44 patients. Further investigations were ordered: oesophageal manometry (42 cases), echocardiography 44 cases) and ergometrine provocation tests (44 cases). The patients were then divided into 4 groups: 23 patients (40 p. 100) with coronary artery disease; either atheroma (14 cases) or spasm (9 cases); 8 patients (13,5 p. 100) with non-coronary cardiac pathology (myocardial hypertrophy or mitral valve prolapse); 15 patients (26 p. 100) with oesophageal spasm alone; 12 patients (20,5 p. 100) with no obvious organic disease. Often simulating spontaneous angina, clinically and electrocardiographically, oesophageal spasm may sometimes be distinguished (6 out of 15 cases) by the finding of painful dysphagia on swallowing ice-cold liquid. The condition is confirmed by oesophageal manometry which shows abnormalities of oesophageal contraction. In addition, 13 out of 15 patients in our series had hypotonia of the gastro-oesophageal sphincter. Dyskinetic phenomena and this hypotonia should be taken into consideration in the treatment of this condition.

Adult↗
PubMed1983

[Provocation tests for coronary spasm. Methods, value and indications].

Five methods are currently used to demonstrate coronary spasm: they use derivatives of ergotamine, alkalinisation, cold, adenosine triphosphate and exercise stress test. The criteria used to confirm spasm are either direct visualisation at coronary angiography or indirect electrocardiographic changes. The value of these test is beginning to be established: --their specificity is excellent with all methods (a positive test is diagnostic); --their sensitivity is mediocre (a negative test does not exclude the diagnosis). This depends on three factors: the choice of criteria of positivity: angiographic appearances is the most reliable; the timing of the test: it is more likely to be positive when the test is carried out close to episodes of chest pain; the method of provocation: the most sensitive tests use either the ergotamine derivatives or alkalinisation; --reproductibility is satisfactory at short and long term. These tests have diagnostic and therapeutic indications. It is preferable to perform diagnostic tests during coronary angiography in patients with normal coronary arteries and unexplained episodes of chest pain. However, in patients with fixed coronary lesions (except triple vessel and left main stem disease) when coronary bypass surgery is planned, the results of the test can help in the choice of associated therapy, such as plexectomy and calcium antagonist drugs. The repetition of the test is useful in the evaluation of antispastic therapy: when the test becomes negative the drug used is probably effective. In conclusion, with equal patient comfort and MSR, provocation tests using the ergotamine derivatives would seem to be the method of choice: alkalinisation is a good alternative.

Adenosine Triphosphate↗