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Biomedical subjects

M Bonnin

Publications and source records attributed to M Bonnin.

At least 19 recordsLinked to original sources
PubMed2004

[Current status of valgus angle, tibial head closing wedge osteotomy in media gonarthrosis].

In young and active patients, closing-wedge high tibial osteotomies are reliable procedures in the treatment of osteoarthritis of the medial compartment of the knee. This has been consistently shown throughout the last 2 decades. The present study analyzes the long-term results of 217 patients after an average of 9 years and compares them to the results in the literature. Besides correction of the alignment, other prognostic factors such as the patients' age, overweight, the preoperative degree of osteoarthritis, but also a newer prognostic factor described by the Lyon knee school have been evaluated. The authors found that the "tibial bone varus angle" might be helpful to differentiate between a bony deformity of the proximal tibia, amenable to correction by osteotomy, and a secondary bony erosion of the medial tibial plateau, with a worse prognosis.

Adult↗
PubMed2004

[Prolonged motor blockade after combined epidural and general anaesthesia for oncologic gynaecological surgery].

The case described is a patient submitted to an oncologic gynaecological surgery under combined epidural and general anaesthesia. The anaesthesia involved complications, a prolonged motor blockade for up to 9 h whereas recommended doses had been respected. A few later after a magnetic resonance imaging that did not showed any extradural haematoma, full recovery occurred. The combined epidural and general anaesthesia was approved as an interesting technique for both per and postoperative analgesia, but also for postoperative rehabilitation. Nevertheless, for older patients, inhalational anaesthetics and opioids have to be decreased during the intervention, moreover local anaesthetics doses for epidural anaesthesia have to be reduced too, in order to control motor blockade duration.

Anesthesia, Epidural↗
PubMed2004

Midterm results of the Salto Total Ankle Prosthesis.

The Salto Total Ankle Prosthesis is noncemented with mobile bearings and is characterized by an anatomic design and a dual Ti-HA coating. Between 1997 and 2000, 98 consecutive Salto prostheses were implanted. At last followup, two patients were deceased, one patient was lost to followup, and two prostheses were removed in two patients. Ninety-three implants in 91 patients were available with a mean followup of 35 months (range, 24-68 months). Survivorship at 68 months, with the end point implant removal, then was 98% (favorable scenario) to 94.9% (unfavorable scenario). The American Orthopaedic Foot and Ankle Society score was 32.3 points preoperatively and 83.1 points at followup. Seventy-two patients are pain-free, 54 patients walk unlimited distances, and 25 patients have limitation but walk more than 1 km. Sixty-seven patients have no limp but seven need walking aids. Fifty-eight patients can walk on tiptoes, 49 patients can walk on uneven ground, 14 patients can run, 76 patients ascend stairs normally, and 63 patients descend stairs normally. Range of motion as measured on stress radiographs improved from 15.2 degrees preoperatively to 28.3 degrees at followup. Preliminary results of the Salto prosthesis are encouraging and validate the concept of anatomic replacement.

Adult↗
PubMed2004

[Development of health care networks: ethical and political contexts].

The operation of our health care system is in the midst of a major crisis. There is a significantly unacceptable level of health inequities and access to care, high premature mortality rates, lack of a coherent health policy, a weakness in the professional demographic projections, increasing financial deficits, quasi-revolt of professionals, complete disregard for the law (Parliament's vote on the National Insurance's budget)--these are just a few of the symptoms of chaos which have embedded themselves right before our very eyes. This article aims to offer a glimmer of light on this gloomy horizon. It is the first outcome of a new working group which was originally referred to as "les Vignerons d'Uzès", a title which could be seen as lacking substance and has therefore become "The Transdisciplinary Working Group on the Organisation of Health and Care". The group's purpose and objective is to reflect upon the values, practices, regulations, evaluation and what is at stake in the context of our health care system.

Community Networks↗
PubMed2001

Fgf8 transcripts are located in tendons during embryonic chick limb development.

Fibroblast growth factor 8 (Fgf8) is a secreted growth factor involved in the initiation, outgrowth and patterning of vertebrate limbs (Genes Dev. 12 (1998) 1571). In this paper, we present a new site of expression of Fgf8 in the chick limb. Fgf8 transcripts are localised close to the muscle fibres, at the same level as the tendon-associated molecules, tenascin and scleraxis. Fgf8 is expressed in a sub-region of the tendons during limb development; its location being restricted to the area near the muscle. In addition, the restricted Fgf8 expression in the tendons allowed us to observe that the myogenic determination factor (MyoD) is not detected at the myotendinous junction.

Animals↗
PubMed2000

[Revision in non-infected total knee arthroplasty: an analysis of 69 consecutive cases].

PURPOSE OF THE STUDY: We reviewed 69 consecutive cases of total knee arthroplasty revisions to analyze the causes of failure. MATERIAL AND METHODS: Sixty-nine total knee arthroplasty revisions were required between 1990 and 1997 for non-septic failure. Five categories of failures were identified: 30 loosenings including 11 with an initial malposition (varus position of the tibial component in 8 cases), 14 laxities (medial in 5, lateral in 5 and anteroposterior in 4), 11 stiff knees with no other clinical or radiological anomaly, 6 patellar failures (2 dislocations, 2 cases of excessive wear, 2 painful knees with a Freeman prosthesis), and 8 cases of painful knees with no other detectable anomaly. RESULTS: A three-phase reconstruction procedure was used after removing the failing TKA: 1) reconstruction of the tibia with replacement of lost bone, 2) reconstruction of the femur with balanced flexion determining the size of the implant, 3) balanced extension determining the distal/proximal position of the femoral component. A "simple" sliding prosthesis was used in 16 cases, a modular reconstruction prosthesis in 40 cases and a hinge prosthesis in 13 cases. Mean follow-up for functional and radiographic assessment after revision surgery was 37 months (59 cases) with a minimum follow-up of 1 year. The best outcome was observed in the "loosening", "laxity", and "stiffness" patients. Outcome was less favorable for the group "isolated pain" with IKS functional scores of 35.5 +/- 16 and 52.5 +/- 21. DISCUSSION: In 36 p. 100 of cases, TKA failure was related to a technical mistake (component malposition, poor ligament alignment). In 33 p. 100, failure was patient related (multiple procedures, congenital hip dysplasia, rheumatoid arthritis.). Outcome after revision TKA was less favorable than after primary TKA, particularly in case of painful knees with no other detectable anomaly. CONCLUSION: Surgical revision of TKA must follow a rigorous procedure with a detailed preoperative work-up. The decision for revision must not be made unless a precise anomaly has been identified.

Adult↗
PubMed1999

Information systems evaluation and subjectivity.

This paper claims that, when evaluation of information systems is at stake, it is impossible in most cases to discard human subjectivity in the same way that one cannot discard quality of life when a therapeutic strategy is to be evaluated.

Attitude to Computers↗
PubMed1999

Arthroscopy of the ankle: analysis of results and indications on a series of 75 cases.

The purpose of this study was to evaluate the results of arthroscopy of the ankle. Of the 114 arthroscopies of the ankle that we performed between 1991 and 1996, 13 were for diagnosis, 6 were associated with open surgery, and 10 were ankle arthrodeses. We report the results of the remaining 85 therapeutic arthroscopies. We identified five groups according to preoperative indications: (1) anterolateral synovitis after a sprained ankle (33 cases), (2) sequelae of fractured ankles (17 cases), (3) anterior impingement as a result of osteophytes (12 cases), (4) loose foreign bodies as a result of avulsion of fragments of bone (6 cases), and (5) osteochondral lesions of the talar dome (17 cases). In anterolateral synovitis, results were better when the pain followed a single sprain than when after chronic instability. In osteochondral lesions of the talar dome, results were better in anterolateral lesions than in posteromedial lesions.

Adolescent↗
PubMed1997

[Longitudinal splitting syndrome of the short fibular tendon. . Imaging and classification by MRI].

We present a series of 38 cases of longitudinal splitting of the peroneus brevis tendon revealed by MR imaging (12 lesions were confirmed at surgery). MRI enabled classification in four surgical grades. The frequency of such lesions in chronic ankle instability as observed in our series is often reported in the literature. Bilateral cases are common. Asymptomatic cases do occur, especially in grades I and II. MRI has been shown to be a very effective investigation for demonstrating this tendinous lesion; the proton density weighted sequence in the axial plane is the most adequate sequence.

Adolescent↗
PubMed1996

The weight-bearing knee after anterior cruciate ligament rupture. An in vitro biomechanical study.

Unilateral weight bearing was simulated on 12 cadaver knees to quantitate anterior tibial translation (ATT) after anterior cruciate ligament (ACL) transection and to asses the role of the posteromedial structure and the hamstrings in controlling laxity. With the ACL intact, ATT was 3.5 +/- 2.8 mm in extension and 4.3 +/- 3.6 mm at 60 degrees flexion. After sectioning the ACL, ATT was 6.5 +/- 4.7 mm in extension and 17.5 +/- 10 mm at 60 degrees flexion (P = 0.001). Applying a force in the hamstrings was unable to correct the pathological ATT observed after ACL section. Partial medial meniscectomy did not increase ATT after the ACL section. Disinsertion of the posterior horn of the medial meniscus and total medial meniscectomy increased ATT significantly compared to isolated ACL section. After ACL transection, sectioning the meniscotibial fibers or posteromedial capsule significantly increased ATT (6.5 +/- 0.5 mm in extension). Section of the postero-oblique ligament or popliteus tendon had no effect on ATT.

Aged↗
PubMed1996

[Representations, discourses and practices about drug substitution with opiates. Apropos of a survey conducted in cooperation with 97 French physicians].

In order to analyse the various factors which determine physician's position on the use of opiates in a substitution treatment--as a harm-reducting and heroin dependence treatment tool-, 97 French physicians (i.e. 47 general practioners, 36 psychiatrists, 10 internists, 4 emergency care practioners) answered anonymously 103 closed questions, in presence of a single investigator. Among these 97 physicians, 40 were choosed at random from a list of addiction treatment's practioners, 19 were choosed nominatively for their explicit point of view toward substitution, and 38 were choosed at random from the Herault physicians register. In this latter sample, the survey showed a majority of physicians took an ambivalent position towards substitution, or were favourable without being prescriptors themselves--even though meeting drug users-. General practioners were more favourable to drug substitutes than specialists (50% vs 22%). This practice appeared as legitimate for 70% of physicians; AIDS helped justify this attitude for 26% of the specialists and 5% of the general practioners. Individual or socio-professional factors, the representations of the drug-addict and of his suffering, the perceptions of AIDS contamination risk and the standards of knowledge on the substitution treatments did not differ significatively (p < 0.02) between the groups, determinated according to the expressed practioners point of view toward substitution. Using a method exploring opinion structuration, no description of the typical doctor can be drawn from his position towards substitution. Militant discourses were rare; the main disagreements concerned the status, the negotiation around "the product ... or the medicament" within the drug addict-physician relationship should have. Substitution was considered by some as a mere shift from one object of dependence to another; and to others, as a means of setting up a therapeutic relationship. Ambivalent opinions frequently noticed in the physician's point of view towards substitution appears as a multifactorial phenomenon. Not only does it reveal the physician's difficultie in adapting previous patterns of treatment which are not longer adequate to a critical situation, but it also questions the foundations of the very relationship between the practioner and the drug addict.

Attitude↗
PubMed1995

CT and MRI evaluation of tenosynovitis of the rheumatoid hindfoot.

Thirty-nine patients with rheumatoid arthritis who had presented with tarsitis before, were investigated at the level of the rearfoot. The first 17 patients had CT with previous tenography when it was possible; the following 22 patients had MRI with gadolinium injection. Tendon involvement appeared in 52.9% of the cases on CT, and in 90% of the feet on MRI; therefore, in case of clinical or radiological signs of tarsitis, it appears that tendon involvement must be suspected. With the two procedures the tibialis posterior tendon lesions were very predominant. In the majority of the patients (31/39), there was associated involvement of two or more tendons. If there is a ruptured tendon, the authors think that one must be cautious with surgical tendinous transfer; indeed, the long-term results of this surgical procedure present a strong probability of being compromised in rheumatoid arthritis which is a progressive disease.

Adult↗
PubMed1995

[Arthrodesis of the ankle under arthroscopy. Apropos of 10 cases reviewed after a year].

PURPOSE OF THE STUDY: The technique, results and indications for arthroscopic ankle fusion are detailed and compared with open technics. MATERIAL AND METHODS: 10 arthroscopic ankle fusions were performed between 1991 and 1993. This procedure was used in 4 cases of rheumatoid arthritis, 5 cases of osteoarthritis and 1 case of joint destruction consecutive to hemophilia. All patients were followed until fusion with an average follow-up of 12 months. The quality and position of the fusion were analyzed clinically and on radiograms. RESULTS: 9 patients obtained fusion in a neutral position and were able to walk with normal shoes. The average time to fusion was 14.5 weeks (8 to 40). 1 case failed and required reoperation after 15 months. No local complications were observed. DISCUSSION: Arthroscopic ankle fusion is a safe procedure with good results in cases with relatively little deformities. Its main interest lies in the low rate of complications. The technique does not increase the rate of fusion when compared to open technics. CONCLUSION: Arthroscopic fusion is recommended in cases with little to moderate deformities in the presence of poor wound healing factors.

Adult↗
PubMed1994

Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared.

Anterior tibial translation was measured in both knees using the radiological Lachman test and the lateral monopodal stance tests in 281 patients with unilateral anterior cruciate ligament (ACL) rupture. Measurements of translation in the medial compartment were more useful than those in the lateral compartment. Measurement of anterior tibial translation in the medial compartment using the radiological Lachman test showed ACL rupture in 92% of cases compared with 70% for the lateral monopodal stance test. In normal and in ACL-ruptured knees the monopodal stance test showed that every 10 degrees increase in posterior inclination of the tibial plateau was associated with a 6 mm increase in anterior tibial translation; the radiological Lachman test showed a 3 mm increase for every 10 degrees increase in tibial slope.

Adolescent↗
PubMed1993

Estradiol modulation of GNRH-stimulated LH release in rat anterior pituitary cells: involvement of dihydropyridine-sensitive calcium channels.

Although enhancement of GnRH-stimulated luteinizing hormone (LH) release by estradiol (E2) has been established, it is not known at what stages of the process of transduction E2 acts. We investigated the release of LH in response to GnRH and to Bay K 8644, an activator of L-type calcium channels, in a culture of pituitary cells obtained from ovariectomized females, these cells having being treated or not with E2 (OVX + E2 and OVX). We studied the effects of D600, an antagonist of T- and L-type calcium channels, and PN 200-110, an antagonist of L-type calcium channels. The effects of the latter were studied in protein kinase C-depleted cells in order to investigate the possible phosphorylation of these channels. D600 caused a decrease in GnRH-stimulated LH release in OVX and OVX + E2 cells. However, this decrease was greater in OVX + E2 cells, suggesting that at least one type of calcium channels may be involved as a result of treatment with E2. We confirmed the involvement of L-type calcium channels in the action of GnRH since the GnRH-stimulated LH release was enhanced in the presence of Bay K 8644 in OVX cells. Bay K 8644 alone increased basal LH in a dose-dependent manner only in OVX + E2 cells. PN 200-110 induced a decrease of GnRH-stimulated LH release only in OVX + E2 cells. These results suggest that L-type calcium channels are activated in E2-treated cells. The dose-dependent decrease caused by PN 200-110 in OVX + E2 cells disappeared in the OVX + E2 PKC-depleted cells. This result was confirmed with Bay K 8644 and suggests a phosphorylation of dihydropyridine-sensitive calcium channels by protein kinase C.

3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethy↗
PubMed1993

Gonadotropin-releasing hormone-induced changes of intracellular pH in pituitary gonadotrophs: influence of estradiol.

Using the pH indicator, seminaphtorhodafluor, we studied the effects of GnRH on intracellular pH (pHi) in single gonadotroph cells, obtained from 3-week ovariectomized rats, treated or not with estradiol (E2) (OVX + E2, OVX). In a majority of cells (77.7% for OVX cells and 93.7% for OVX + E2 cells), GnRH induced acidification. A biphasic change of pHi, acidification followed by alkalinization, was observed in about 44% of the cells tested. In E2-treated cells, amplitude of acidification and duration of alkalinization were increased. Acidification and Ca2+ mobilization were related in time with a short delay (4-5 sec.). Depolarization with KCl and ionomycin, a Ca2+ ionophore, induced acidification. Taken together these observations suggest that acidification was caused by [Ca2+]i increase. When the Na+/H+ exchanger was blocked by amiloride or in Na(+)-free medium, GnRH-induced alkalinization was inhibited. Alkalinization disappeared completely when the cells were depleted in protein kinase C (PKC). Nevertheless, acute application of phorbol myristate acetate, known to activate PKC, was not sufficient to induce alkalinization. We conclude that PKC is necessary but not sufficient for alkalinization. In contrast, the GnRH response can be mimicked by a simultaneous application of phorbol myristate acetate and KCl. To further explore the putative role of pHi in the secretory process, LH release was studied. Using Na(+)-free medium or amiloride, we show that basal LH was not dependent upon the Na+/H+ exchanger activity. Conversely, GnRH-induced LH release was significantly decreased; this decrease was greater in E2-treated cells but prevented by bicarbonate. These data show that pHi and the Na+/H+ exchanger play an important role in the stimulus secretion coupling process of gonadotrophs. E2, which is an important factor in the regulation of gonadotropic hormone release, participates also in the pHi variations.

Amiloride↗
PubMed1992

Transient but not oscillating component of the calcium mobilizing response to gonadotropin-releasing hormone depends on calcium influx in pituitary gonadotrophs.

Gonadotropin-releasing hormone (GnRH)-stimulated changes in the cytosolic free Ca2+ concentration ([Ca2+]i) were studied in gonadotrophs cultured from 3-week ovariectomized rat pituitaries. One animal was used per cell preparation. [Ca2+]i was monitored in individual gonadotrophs by dual emission microspectrofluorimetry, using Indo-1 as the intracellular fluorescent Ca2+ probe. A short stimulation with GnRH evoked a complex concentration-dependent Ca2+ response in individual gonadotrophs. 0.1-1 nM GnRH triggered a series of sinusoidal-like [Ca2+]i oscillations superimposed upon a modest slow [Ca2+]i rise--the oscillating response mode--while 10-100 nM GnRH caused a biphasic increase in [Ca2+]i consisting of a monophasic transient and oscillations--the transient/oscillating response mode. Despite the consistency of Ca2+ responses, an inter-preparation heterogeneity of [Ca2+]i oscillations frequency was noticed. Moreover, we observed that, within a given cell preparation, the frequency of [Ca2+]i oscillations was independent of GnRH concentration whereas both peak [Ca2+]i and area under the [Ca2+]i versus time curve were concentration-dependent. Thus, in gonadotrophs, the presence of the GnRH signal would lead to [Ca2+]i oscillations, while the amplitude of the [Ca2+]i responses would code for the concentration of agonist. Both transient and oscillating components of GnRH responses depended on releasing activity of Ca(2+)-sequestering pools in as much as GnRH responses were unaffected by brief removal of external Ca2+, but suppressed by chelating intracellular free Ca2+ with BAPTA. However, prolonged exposure to a Ca(2+)-free medium suppressed the transient component while leaving the oscillating component unaffected. We therefore propose that gonadotrophs employ Ca(2+)-sequestering pools, whose maintenance depends on a slow Ca(2+)-entry, to give an amplitude-coded Ca2+ rise in response to a short GnRH stimulation.

Animals↗