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Biomedical subjects

M Merle

Publications and source records attributed to M Merle.

At least 109 records · Page 6Linked to original sources

Joint reconstruction following trauma: comparison of microsurgical transfer and conventional methods: a report of 61 cases.

Joint reconstruction at the metacarpophalangeal or proximal interphalangeal levels remains a difficult problem in hand surgery. The authors reviewed sixty-one joints reconstructed acutely or electively allowing to compare Swanson spacer (30 joints), interpositional arthroplasty (4), non vascularized joint transfer (5) and vascularized joint transfer (21). Among these, two different techniques have been used: island compound transfer from a finger bank (10) and free vascularized transfer from the second toe (10) or from a non replantable finger (1). It is not worth while comparing different techniques applied to different indications. The only point which can be stressed is the better average range of movement of metacarpophalangeal reconstruction compared to that obtained at the proximal interphalangeal level.

Arthroplasty

Sarcoid tenosynovitis in the hand. A case report and literature review.

We report a case of involvement of a finger flexor tendon by sarcoidosis. A review of twelve cases suggests that this is a rare manifestation of the illness that most often affects the finger extensors at the wrist. It tends to present in established sarcoidosis and is associated with a higher than usual incidence of polyarthritis. The main differential diagnosis would be tuberculous tenosynovitis. We suggest that a histological spectrum exists running from a predominantly cellular picture to one of fibrotic nodules, perhaps explaining previously described instances of pseudo-tumour. We would recommend tenosynovectomy in conjunction with corticosteroid therapy as the treatment of choice.

Female

[Revascularization of digital avulsion injuries caused by rings].

The authors describe an original technique of ring fingers revascularization, avoiding two chief dangers met in the double vein grafts: the one of the joint and tendinous devascularization with its risks of stiffness, and the other one of the devascularization of the skin sheath with secondary necrosis or trophic trouble. The worse artery is resected and the defect is bridged by a long venous graft, the skin of the distal fingers being provided by the backflow.

Finger Injuries

[Sympathectomy of the digital arteries in acro-syndromes].

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).

Adult

Tryptophanamide formation by Escherichia coli tryptophanyl-tRNA synthetase.

When tryptophanyl-tRNA synthetase from Escherichia coli is allowed to react with L-tryptophan and ATP-Mg in the presence of inorganic pyrophosphatase, the fluorescence change of the reaction mixture reveals three or four sequential processes, depending on the buffer used. Quenched-flow and stopped-flow experiments show that the first two processes, which occur in the 0.001-1.0-s time scale, can be correlated to the formation of two moles of tryptophanyl-adenylate per mole of dimeric enzyme. These two processes are reversible by adding PPi, as seen in the fluorimeter. The third process leads to a reaction product that can no longer reform ATP after addition of PPi and that represents tryptophanyl-ATP ester, as demonstrated by thin-layer chromatography. This compound has been previously shown to be formed by tryptophanyl-tRNA synthetase from E. coli [K. H. Muench (1969) Biochemistry 8, 4872-4879]. Its formation is accompanied by a fluorescence decrease which reaches a minimum in about 30 min. The nature of the fourth process depends on the reaction conditions employed. In sodium bicarbonate or potassium phosphate buffer, the fourth process corresponds to the non-enzymatic hydrolysis of tryptophanyl-ATP ester. This spontaneous hydrolysis competes with formation of the ester and limits its concentration. Eventually, the progressive exhaustion of ATP brings the fluorescence intensity of the reaction mixture back to its initial value. In contrast, in ammonium bicarbonate buffer the previous third process is no longer visible, as evidenced by the absence of a fluorescence decrease beyond the fast initial quenching linked to the formation of tryptophanyl-adenylate. Instead, a fluorescence increase is observed. However, unlike the fourth process seen in sodium bicarbonate buffer, the fluorescence increase in ammonium bicarbonate is much larger than the initial fluorescence decrease linked to adenylate formation, the final fluorescence greatly surpassing the starting fluorescence signal. The reaction product of this process is tryptophanamide, as evidenced by high-performance liquid chromatography. Tryptophanamide formation is faster than that of tryptophanyl-ATP ester and is enzyme-catalyzed with a Km of 1 mM for ammonia and a rate constant of 5.7 min-1 at pH 8.3, 25 degrees C. The affinity of tryptophanamide for the protein is too weak to allow the formation of a significant concentration of enzyme-product complex. Tryptophanamide is therefore released in the reaction medium and its concentration reaches that of the limiting substrate.

Amino Acyl-tRNA Synthetases

Immediate and prolonged effects of dihydroergocryptine after experimental vascular microsurgery.

An animal model of limb replantation has been utilized in order to evaluate the effects of dihydroergocryptine (DHEC, 0.1 mg/kg I.V.) on arterial and peripheral tissular blood flows after reperfusion. DHEC is a partial agonist of adrenergic receptors and is therefore liable to exert an action on arteriovenous shunts that remain abnormally opened after ischaemia. DHEC showed important efficacy in this model, increasing, in low doses, blood flow in sutured artery and peripheral tissue.

Animals

Free vascularized nerve grafts: an experimental study in the rabbit.

An experimental animal model of a vascularized graft is presented as an alternative to recover faster function. The technique is described and the model compared to a conventional graft in the sciatic nerve of a rabbit. Results are evaluated with histological studies and quantified using a computer to measure the thickness of the myelin sheath as a correspondence factor of regeneration. Results showed a more favorable regeneration when a vascularized graft was used.

Animals

Fractures of the hook of the hamate.

Fractures of the hook of the hamate are rare injuries. Six new cases are presented; the most usual mechanism is probably a direct blow to the area of the hook. The diagnosis, which can only be made by special roentgenographic techniques is usually missed at the acute phase. Most of the cases are diagnosed when painful non-union, fraying tendinitis of the flexor tendons to the ulnar fingers, ulnar or median nerve deficits appear. The adequate treatment is usually excision of the hook fragment.

Adult

[Hueston's flap for reconstruction of loss of distal thumb substance].

The classical rotation flap described by J. Hueston involves the advancement of a denervated skin area on the distal stump. In distal amputations of the thumb, this flap should only be used on the lateral side in order to avoid creating a blind medial pulp. Furthermore, this leaves a proximal skin defect thereby exposing the neurovascular bundles. This secondary defect is best covered by a lateral triangular rotation flap.

Humans

Homodigital neurovascular island flaps in hand surgery. A study of sixty cases.

The homodigital island flap is a useful technique in problem cases such as distal amputation of the pulp, atrophic or insensative pulp on the index finger or thumb and painful neuromas. In a series of 60 operations preformed by one surgeon with the SOS Main in Strasbourg, we describe the indications for, and results of, several different techniques: unipedical flaps either advanced or "exchanged" and bipedical flaps either advanced or retreated.

Adolescent

Technique and indications of the forearm flap in hand surgery. A report of thirty-three cases.

The Chinese forearm flap is vascularized by the radial artery and may be used as an island or a free flap. Used as an island flap, the pitfalls of the microsurgical procedures required for a free flap, may be avoided. Vascular anastomosis is easily performed owing to the large diameter of the vessel. The possibility of using it as a composite flap with fascia, tendons, muscle, bone or nerve makes this flap a "must" in reconstructive surgery of the hand. A series of 33 cases was reviewed in an attempt to summarize their indications and contraindications respectively.

Adolescent

Thumb reconstruction pollicisation or toe-to-hand transfers. A comparative study of functional results.

A statistical study of thumb reconstruction after traumatic amputation, based on the records of 33 pollicisations and 21 microsurgical toe-to-hand transfers was made. A precise method of evaluation of results is presented. The types of lesions are divided into 4 groups; 1: amputation of the thumb without injuries of the other fingers; 2: amputation of the thumb associated with amputations or mutilation of other fingers; 3: metacarpal hand; 4: amputation of the thumb distal to the metacarpophalangeal joint. The aim of this study was to determine the respective indications of the two methods. It may be concluded that: in group 1, the results of pollicisation and of toe-to-hand transfers are similar. The former is superior as far as the discriminative sensory and fine motor results are concerned, while toe transfer reestablishes better strength. In group 2, the more the other fingers are mutilated, the more toe transfers should be preferred to pollicisation which weakens the performance of the long fingers, especially when they are injured. In group 3 (metacarpal hand), the transfer of one or more toes is a revolution. It is the only technique capable of returning function and, if technique is correct, a cosmetically satisfactory aspect as well. In distal amputations of the thumb (group 4), the only indications for pollicisation are cases of a proximally injured finger with a healthy distal segment, transferable on healthy pedicles, which is relatively rare. Partial toe-to-hand transfers, is a new solution to this challenge.

Amputation, Traumatic