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Biomedical subjects

P Denys

Publications and source records attributed to P Denys.

At least 19 recordsLinked to original sources
PubMed1996

Intrathecal baclofen administration for control of severe spinal spasticity: functional improvement and long-term follow-up.

OBJECTIVES: To assess long-term efficacy and functional benefits of intrathecal baclofen for severe spinal spasticity. DESIGN: A prospective before-after trial. SETTING: A neurological rehabilitation department of a university hospital. Pump implantation was realized in neurosurgery; follow-up was carried out mostly on an outpatient basis. PATIENTS: Eighteen patients with severe and disabling spinal spasticity received intrathecal baclofen by an implantable pump; average follow-up was 37.4 months (range, 9 to 72). MAIN OUTCOME MEASURES: Spasticity (Ashworth and spasms frequency scores); disability (Functional Independence Measure [FIM]). RESULTS: A significant decrease in tone and spasms was observed in all patients. Tolerance appeared during the first 6 to 9 months. Later on, efficacy remained stable, except in cases of mechanical problems of the pump or catheter. Functional assessment found a highly significant (p < .001) increase of FIM score (particularly for bathing, dressing lower body, transfers, and in some cases, locomotion). This was particularly marked in patients with thoracic spinal cord lesion. In cases of severe upper limb dysfunction, FIM was only improved for wheelchair displacements, due to a better sitting position, but nursing became easier and life comfort was enhanced. Severe side effects (overdose) were observed in two cases. CONCLUSION: Efficacy remained stable after 6 to 9 months. Marked improvement of functional independence was observed in paraplegic patients. Improvement was less spectacular in patients with severe upper limb dysfunction, but nevertheless appreciable in terms of life comfort and use of attendants.

Activities of Daily Living↗
PubMed1996

Late cognitive and behavioural improvement following treatment of disabling orthopaedic complications of a severe closed head injury.

Interactions of physical, emotional, cognitive and behavioural impairments after severe closed head injury (CHI) remain poorly understood. A 47-year-old man was referred to our department 13 months after a severe CHI. He demonstrated severe left hemiplegia and disabling orthopaedic complications (left hip infectious arthritis, after surgical treatment for heterotopic ossification). His hip was blocked and extremely painful. He was totally dependent for daily-life activities (Functional Independence Measure (FIM) score = 18). Moreover he exhibited severe cognitive and behavioural troubles, which had been stable for many months beforehand, e.g. complete disorientation for time and place, major memory disorders, agitation, anxiety, depression, irritability, disinhibition, aggressiveness and lack of initiative. Pain disappeared within a few weeks after treatment. Progressively, functional improvement occurred (sitting position, transfers, walking between parallel bars). The FIM score increased to 63. Aggressiveness, irritability and agitation disappeared. Surprisingly, neuropsychological assessment demonstrated parallel improvement of cognitive functions, especially in regard to orientation, and to a lesser degree attention and memory. Such an observation should encourage use of active treatment of physical disabilities, even in patients presenting with an apparently poor cognitive prognosis at a late stage of severe CHI.

Cognition Disorders↗
PubMed1995

[Bladder and sphincter disorders in multiple sclerosis. Clinical, urodynamic and neurophysiological study of 225 cases].

Two hundred and twenty-five patients with multiple sclerosis and bladder dysfunction were evaluated. 72% had urinary incontinence, 46% dysuria and 24% urinary retention. Detrusor hyperreflexia was the most common finding on cystometry (70%) and 9% of patients had areflexia. Coaxial needle electromyography was performed on all patients and 82% had detrusor-sphincter dyssynergia. Cortical evoked potentials following stimulation of the pudendal nerve were delayed in 72% and sacral evoked latency in 16% especially in patients with incontinence secondary to overactive bladder (25%), suggesting a conus medullaris lesion in these cases. Urologic complications were noted in 40%, with benign lesions in 24% (diverticula, urinary infections) and serious lesions in 16% (hydronephrosis, pyelonephritis, renal reflux). The most common treatment was anticholinergic drugs (efficacy in 92%), alphablockers agents (efficacy in 60%) and autocatheterism in 28%.

Adult↗
PubMed1994

[Persistence of the bulbocavernosus reflex during micturition in bladder hyperactivity of central neurological origin].

The bulbocavernosus reflex (BCR) was evaluated before, during and after micturition in 35 patients. All the 19 patients with upper motor neuron lesions had a positive BCR during micturition. By comparison, 11/16 of the patients with a lower motor neuron lesion or with urogynecologic diseases did not have a BCR during micturition. The persistence of BCR during voiding seems to be a loss of central inhibition and maybe represent a good sign of upper motor neuron bladder dysfunction.

Adult↗
PubMed1994

[Stretch neuropathy of the internal pudendal nerve. Its relationship to urinary incontinence, anorectal, and genito-sexual disorders in women].

The progressive denervation of the striated pelvic sphincter musculature is due to repeated stretch injury of the innervation of these muscles when the pelvic floor diaphragm is weak. Electromyography examination, evoked potentials and perineal nerve motor latency confirmed perineal neurogenic abnormalities. This real "perineal stretch neuropathy" can be determine stress urinary incontinence, fecal incontinence and sexual disorders. Rehabilitation therapy may be tried in the treatment of the neuropathy.

Electromyography↗
PubMed1993

[Disorders of the bladder sphincter. Etiopathogenic approach].

Disorders of the vesico-sphincteral system are due to multiple causes (urological, gynaecological, neurological, psycho-behavioural, iatrogenic) which may be associated. By providing information on the type and evolution of these disorders and on the circumstances in which they developed, questioning is fundamental for the diagnosis. Completed by physical examination, it must precede all exploratory methods, including urodynamic, electrophysiological and radiological examinations. It allows these examinations to be graded and, compared with the results, it gives a better understanding of the physiopathology and aetiology of micturition disorders and therefore ensures their better treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1993

[Bladder-sphincter complications after peridural anesthesia. 8 cases].

Eight cases of vesico-sphincteric disorders (dysuria and chronic retention of urine) observed after spinal anaesthesia are reported. These symptomatic disorders were caused by a peridural haematoma in 3 cases and by lack of bladder contraction due to an "exhausted detrusor muscle" in 5 cases. The mechanism of the disorders (predominant vesical hypoactivity with sensory disorders) is discussed. The usefulness of urodynamic investigation in determining the physiopathological mechanism(s) and that of electrophysiological exploration in the search for a neurogenic disease is emphasized, as is the need for a preventing treatment (intermittent catheterization) in case of forced bladder detected by systematic recording of postoperative micturitions.

Adult↗
PubMed1993

[Active forces of urinary continence and urethral fatigability. Application to stress urinary incontinence in women].

Eighteen women who had urinary stress incontinence were studied to find the existence of urethral fatigue on effort by using a sphincterometric technique. Urethral pressure measurements at rest as compared with after six heavy coughs showed a mean lowering of the urethral pressure of 40% (range 24.5%-90%) in 10 women. Spectral analysis of the electromyographic trace of the striated urethral sphincter at rest and then after coughing confirms that the striated muscle and the periurethral tissues are involved with a marked quantitative lessening of electric sphincter activity. The clinical, physiopathological, prognostic and therapeutic consequences of this new concept are discussed, together with their relationship to other active forces involved in continence.

Adult↗
PubMed1993

[The active forces of continence. Illustration by quantified analysis of the electromyographic signal of the urethral striated sphincter combined with urethral pressure studies].

Continence in women, ensured by a constantly positive urethral closing pressure, is the result of two phenomena: purely passive factors (urethral pressure and compliance, transmission of bladder pressure to the urethra) and active factors mediated by a voluntary and reflex neuromuscular mechanism (contraction, reflexivity, sphincter endurance). In order to define these active forces of continence, we simultaneously studied the quantitative electromyographic activity of the striated sphincter and the bulbocavernosus muscle and variations in the urethral and vesical pressure under various conditions (rest, coughing, stimulation of the pudendal nerve). During coughing, the urethral pressure peak occurred earlier (100 milliseconds) than the vesical peak, associated with hypertransmission of 20%, the bulbocavernosus muscle contracted first, followed by contraction of the striated urethral sphincter (150 ms delay) and this electrical activity preceded the rise in vesical and urethral pressures. Stimulation of the pudendal nerve eliminated the possibility of an artefact related to coughing and induced the same sequence of events.

Adult↗
PubMed1992

[Comparative results of flowmeter studies before and after urodynamic exploration].

Results of flowmeter studies in 145 patients before and then immediately after urodynamic exploration were unchanged in 80% of women and 72% of men. Abnormal results on flowmetric examination, detected in 18% of cases prior to urodynamic studies, were assessed as normal during follow-up urodynamic tests. These findings raise the question of the validity of flowmeter parameters determined during urethrocystometric exploration.

Adolescent↗
PubMed1992

[Neuropathy due to stretching of the internal pudendal nerve and female urinary incontinence].

For many years, perineal neurogenic abnormalities associated with stress urinary incontinence have been described using electromyography examination, evoked potentials or neuromuscular biopsy. It has been suggested that the progressive denervation of the striated pelvic sphincter musculature that occurs in genuine stress incontinence is due to repeated stretch injury of the innervation of these muscles when the pelvic floor diaphragm is weak. New investigations such as perineal nerve motor latency confirmed this hypothesis. A real "perineal stretch neuropathy" may be described. It is very important to know about this neurogenic factor before considering rehabilitation therapy.

Female↗