Biomedical subjects
P Bourrel
Publications and source records attributed to P Bourrel.
[Mycetoma of the hand. Apropos of 10 cases].
Mycetomas of the hand are a rare site of an uncommon disease, particularly in temperate climates. They are non-purulent inflammatory pseudotumours of mycotic origin. They are generally seen in Tropical Africa with a slow course progressing towards a phase of cutaneous fistula formation producing black, white or red grains depending on the fungus responsible. Ten cases are reported together with a review of the literature. Treatment must often be radical to prevent recurrence in the actinomycotic forms and this raises difficult problems of mutilating surgery of the hand for a benign and painless disease. However, ketoconazole has revolutionised the treatment of fungal varieties by allowing partial resections compatible with preservation of hand function.
[Surgical treatment of neurotrophic lesions in leprosy. Application in other neuropathies].
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[Palliative operations for correction of claw fingers].
Palliative treatment of palsy of intrinsic muscles of the four fingers classically aims at suppressing claw. But functional restoration is mainly ensured in setting up again the volar flexion, the stage preparing prehension. Three hundred and thirty seven hands have been operated. Each one of the utilized interventions has advantages and drawbacks that have to be known in order to select the best adapted technics, the more or less important stiffness of fingers being the most important criteria. Finally a simple choice is easy and possible, particularly for inexperienced surgeons in the treatment of those paralysis (that become rarer and rarer in the West on account of the success of nervous sutures facing a large number of leprotic hands to operate in endemic countries); it is the metacarpophalangeal stabilization test: the active interphalangeal extension obtained after passive manual stabilization, of metacarpophalangeal joint indicates the degree of proximal interphalangeal residual stiffness, and the indications come in function of these various types of stiffness. Loose PIP joint: residual flexion from 0 degree to 20 degrees: MP capsular shortening, H shaped, and flexor pulley advancement; "Lasso" operation: a single slip of FDS by finger or one FDS for two fingers; Bunnell-Litter's operation: one FDS for 4 fingers; Giraudeau's operation: FCR + fascia lata; Brand's operation: 1st (ECRL) or 2nd (ECRB) + tendon graft; Palande's operation: ECRB + many tailed fascia lata graft fixed at the muscle tendon junction. Stiff PIP Joint: residual flexions from 20 degrees to 60 degrees: modified Bunnell's operation: one FDS for 2 fingers, the FDS of the third used to restaure the opposition; "lasso" operation: one FDS for each finger, or for two fingers. Very stiff PIP joint: residual flexion superior to 90 degrees: proximal interphalangeal joint arthrodesis.
The metacarpophalangeal stabilization test beevor or bouvier?
In a claw hand by ulnar and median nerve palsy if the digits are stabilized in order to prevent overextension of the metacarpophalangeal joints, the long extensor alone can fully extend all phalanges. Based on the proximal interphalangeal stiffness evaluated by this test (in more than 200 claw hands I have had the opportunity to operate in over 20 years), I would like to propose a simple therapeutic plan for palliative surgery. Some have recognized Beevor as the author of this test in 1903, but, it seems as though it was Bouvier who first described it in 1851. In any case, rather than using a name, why not just call it "the metacarpophalangeal stabilization test"?
[Volar flexion of the fingers. Its value in the diagnosis of paralysis of the intrinsic muscles of the fingers, in leprosy particularly, and the study of the results of palliative operations].
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[Surgical decompression of leprous neuritis].
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[Epidemiologic concept of the prevention of leprous mutilations and surgery].
The frequency of mutilations reaches about 20% to 30% of the tuberculoid or borderline forms owing to the evolution of leprosy neuritis and their aggravation when leprosy reactions occur. In fact, the determinant cause is the loss of sensitivity of the extremities, as a result of internal compression of nervous bundles, which is increased by traumas in articular movements, and mainly by the external compression in the bony canals, in hypertrophic neuritis. There are many propitious causes: exposure of the extremities to traumas which are related either to crafts or to walk, or to occupational traumas, and which are worsened by deformations and subacute infection. In intractable neuritis, hygiene, protection from traumas of the extremities (especially of the feet), treatment of paralyses, resection of bony prominences, in order to distribute pressions more equally, in spite of such care, only will be able to delay supervening of mutilations. The best technique of prevention is represented by early diagnosis and early treatment of leprosy and neuritis, for which retrospective epidemiological investigations should be carried out, in order to apply identifying the risk factors.
Nerve complications in closed fractures of the lower end of the radius.
Nineteen cases of nerve complications following closed fractures of the lower end of the radius (17 lesions of the median nerve, 4 of which were associated with lesions of the ulnar nerve, and 2 isolated lesions of the ulnar) were observed. A therapeutic approach may be suggested for lesions of the median nerve and/or the ulnar nerve: immediate lesions: immediate reduction, gently if possible and avoiding the position of volar flexion and ulnar deviation. Early secondary lesions associated with immobilization in flexion and ulnar deviation: modify the position and complementary pinning when necessary. Deterioration----neurolysis: no improvement----neurolysis at the 6th month. Early secondary lesions following immobilization in a neutral position: same approach as previous case. Late cases: in absence of malunion or in presence of a minimal malunion: division of the carpal tunnel and/or Guyon's canal. Exceptionally associated fascicular neurolysis. In presence of malunion: corrective osteotomy, completed in serious cases of compression syndrome by a division of the canals.
[Epiperineural nerve sutures and neurilemmatic sutures. Comparative clinical results about 109 cases (author's transl)].
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[Nerve "mixed" suture. A new technique (author's transl)].
A critical evaluation of the various methods of nerve suture, followed by the description of a new personal method of "mixed suture" taking up the neurolemma and the perineurium in the same stitch. It may be used under emergency conditions or not, at all levels of nerve trunk interruption (and in particular in the region of the plexi) without the need for costly optical equipment. The technique is simple and may be used under all circumstances, even by the non-specialised surgeon. Results obtained over more than 10 years, involving the treatment of 109 nerve lesions confirm the value of this type of suture.
[Electromyographic study of the hilus syndrome or cervico-axillary compression syndrome].
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[Transplantation of the extensor indicis proprius for restoration of opposition of the thumb. Apropos of 15 cases].
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[Tarsal tunnel syndrome. Apropos of 15 "pure" cases and 100 cases "combined" with leprosy or diabetes mellitus].
The authors have observed 15 cases of the tarsal canal syndrome: the 14 cases operated on showed compression of the nerve by bone fragments resulting from trauma by local varices, by a muscular anomaly, or as a result of enclosure by post-trauma fibrosis. Surgery resulted in 10 cures and considerable improvement in 2 other cases. In addition to these 15 "pure" cases the authors report their experience of neurolysis of the posterior tibial nerve and of the plantar nerves of the tarsal canal in the treatment of perforating plantar lesions in leprosy (88 cases) and diabetes (12 cases). The good results in these cases indicate the value of extending this therapy to the treatment of perforating plantar lesions in cases of large nerve neuritis.
[Aspects of cutaneous plastic surgery in the tropics].
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[Fatigue fractures of the leg bones. Apropos of 19 cases].
The authors report non-traumatic fracture occurring in healthy bond, fatigue fractures of the leg, much less common than fatigue of the metatarsal bones. The authors report here 19 cases, characterised by periosteal apposition and a limited bony fissure which could only be demonstrated towards the second or third week. Its radiological appearance consisted of peri-osteal apposition and bony fissure, and is quite characteristic. However, it is not always obvious and, in some cases, a misdiagnosis of reticulosarcoma was made. It is treated by plaster immobilisation or simple rest and this leads to a cure without sequelae. Progressive and sufficiently prolonged physiotherapy permits recovery of the normal bony structure submitted to new stresses in intensity and duration and should prevent further fractures.
[The value of second-look explorations of nerve wounds. With 30 case reports (author's transl)].
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[Recurrent shoulder dislocations treated by the Bankart procedure or by coracoid-preglenoid abutment. Apropos of 156 cases].
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