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Biomedical subjects

P Pere

Publications and source records attributed to P Pere.

At least 19 recordsLinked to original sources
PubMed1992

Topical application of 5% eutectic mixture of lignocaine and prilocaine (EMLA) before removal of arch bars.

The analgesic effect of topical application of a 5% eutectic mixture of lignocaine and prilocaine (EMLA) was studied in 45 patients undergoing removal of oral arch bars used for the treatment of mandibular fractures. Employing a double-blind technique, either 4 g of the eutectic mixture (EMLA group, n = 15) or 4 g of a similar emulsion containing no local anaesthetic (placebo group, n = 15) was applied to the gingivae using a toothbrush and a standardised technique. In the control group (n = 15), infiltration anaesthesia with lignocaine was used only if requested by the patient during the removal of the arch bars. The patients in the EMLA group had significantly better analgesia (P less than 0.005) of the gingivae just before removal of the arch bars than patients in the placebo group, but by the end of the procedure the difference in analgesia was not significant. The number of patients who found the procedure pain-free was significantly higher in the EMLA group (7/14) than in the placebo group (2/15) (P less than 0.005). The plasma concentrations of both lignocaine and prilocaine were well below the toxic levels. Topical application of EMLA can be recommended for short procedures as an alternative to infiltration.

Administration, Oral↗
PubMed1992

Dialysis-associated arthropathy: a multicentre survey of 171 patients receiving haemodialysis for over 10 years. The Co-operative Group on Dialysis-associated Arthropathy.

In order to determine the prevalence of dialysis-associated arthropathy (DAA) and what factors favour its development, we conducted a survey in 19 centres in northeastern France, of all patients receiving haemodialysis for over 10 years (171). A diagnosis of DAA was made in 84 patients (49%) by two investigators, using as criteria single or combined presence of carpal tunnel syndrome (32%), erosions and bone cysts of the large limb joints (33%) and destructive spondylarthropathy (14%). The 84 patients with DAA were compared with the 87 dialysis patients free of these clinical or radiological abnormalities. The affected patients were significantly older at the start of dialysis than unaffected patients. The risk of developing carpal tunnel syndrome increased with the duration of dialysis. Amyloid deposits were found in carpal tunnel tissue obtained from 24 of the 39 operated patients (62%) during surgery. Destructive spondylarthropathy was significantly associated with the presence of disc calcifications and more frequent in AN 69-treated patients in whom secondary hyperparathyroidism appeared to be more severe. The use of an AN 69 membrane for at least 90% of the dialysis period (in 15 patients) was not associated with a lower prevalence of DAA. We found that after 10 years of haemodialysis DAA occurred whatever type of membrane was used and the prevalence increased with the patient's age and the duration of dialysis.

Adolescent↗
PubMed1992

Effect of continuous interscalene brachial plexus block on diaphragm motion and on ventilatory function.

Interscalene block may cause phrenic nerve block and decreased diaphragmatic motion. We evaluated the effect of continuous interscalene block on ventilatory function and diaphragmatic motion. We studied ten patients scheduled for surgery or manipulation of the shoulder. Preoperatively, the patients underwent spirometry and double-exposure chest radiography. They received an interscalene block with 0.75% bupivacaine. Thereafter, 0.25% bupivacaine was infused into the interscalene space for 24 h. Spirometry was repeated three times and double-exposure radiography twice. The maximal inspiratory and expiratory pressures were measured repeatedly. Haemoglobin oxygen saturation (SPO2) was monitored with pulse oximetry. The block provided adequate anaesthesia for surgery or manipulation. All patients had a marked ipsilateral paresis of the diaphragm in the radiographs 3 h after the initial block. Twenty-one hours later five patients had diaphragmatic motility comparable to the situation before the block. In the other five patients, the amplitude of diaphragmatic motility on the side of the block was only 4-37% of the values before the block. All patients had a clear reduction in forced vital capacity (FVC), forced expiratory volume in 1s (FEV1) and peak expiratory flow (PEF) 3 and 8 h after the block without signs of dyspnoea. In conclusion, in all our patients interscalene block caused an ipsilateral hemidiaphragm paresis, which in five of ten patients persisted until the end of the continuous block.

Adult↗
PubMed1991

Autosomal dominant arthropathy in a French family.

We studied a French family in which 18 adult members had destructive arthropathy and enthesopathic changes. In 16 patients, the diagnosis was verified radiologically, and in the 2 other patients, the clinical history was consistent with familial arthropathy. The disease predominantly affects the wrists, fingers, shoulders, and peripheral entheses, and its onset occurs after age 18. Genetic transmission is autosomal dominant, with 100% penetrance, and is not related to the HLA system. The clinical and radiologic features are strikingly similar in all patients in successive generations and different branches of the genealogic tree, and this suggests monogenic transmission.

Age Factors↗
PubMed1991

Plasma concentrations of bupivacaine and two of its metabolites during continuous interscalene brachial plexus block.

An interscalene brachial plexus block was performed via a catheter with 20-28 ml of 0.75% bupivacaine plus adrenaline for surgery of the shoulder region in 12 patients. Constant infusion of 0.25% bupivacaine 0.25 mg kg-1 h-1 was continued for 24 h. During surgery light general anaesthesia, without analgesics, was maintained. Plasma concentrations of total and unbound (free fraction) bupivacaine, desbutylbupivacaine (DBB), 4-hydroxybupivacaine (4-OHB) and alpha 1-acid glycoprotein (AAG) were measured at predetermined intervals during the continuous block. The greatest mean plasma concentrations of bupivacaine were measured at 30 min (1.63 (SD 0.55) micrograms ml-1) and 60 min (1.38 (0.48) micrograms ml-1). There was a small but statistically significant increase in the plasma concentration of bupivacaine between 12 and 24 h of infusion. The mean unbound concentration of bupivacaine in plasma decreased from 0.044 (0.015) microgram ml-1 (3.6 (1.1)% of total bupivacaine concentration) at 3 h to 0.023 (0.011) micrograms ml-1 (2.1 (1.0)%) at 24 h. The AAG concentration in plasma increased by 38% in 24 h. The metabolites DBB and 4-OHB were detectable in plasma from 30 min, with a gradual increase during infusion. At 24 h the mean concentrations of DBB and 4-OHB were 0.33 (0.22) micrograms ml-1 and 0.13 (0.04) micrograms ml-1, respectively. There were no toxic reactions during the blocks.

Adult↗
PubMed1991

Cumulation of bupivacaine, desbutylbupivacaine and 4-hydroxybupivacaine during and after continuous interscalene brachial plexus block.

Desbutylbupivacaine (DBB) and 4-hydroxybupivacaine (4-OHB) are major metabolites of bupivacaine. They may cumulate during continuous infusion blocks. In the present study, all patients received an interscalene brachial plexus block with 20-28 ml of 0.75% bupivacaine plus adrenaline. A catheter was introduced into the interscalene space, and an infusion of 0.25% bupivacaine (5-9 ml/h) was started and continued with ten patients for 24 h and with another ten for 48 h. An infiltration block of the suprascapular and intercostobrachial nerves was performed using 0.5% bupivacaine. Before surgery, light general anaesthesia was induced. For measurement of plasma concentrations of bupivacaine, DBB and 4-OHB blood samples were taken before the block and 30 min, 3 h, 24 h and 48 h after the blocks as well as 30 min, 1 h, 2 h, 4 h and 6 h after the termination of the infusions. The highest plasma concentrations of bupivacaine, mean 1.84 micrograms/ml, were measured 30 min after the block. There was a slight but statistically significant rise in the bupivacaine concentrations between 24 and 48 h. The bupivacaine concentration decreased by 54% and 45%, on average, during the first 6 h following the 24- and 48-h infusions, respectively. On average, the highest DBB concentrations were measured 2 h after the 24-h infusion (0.31 +/- 0.18 micrograms/ml) and 30 min after the 48-h infusion (0.33 +/- 0.13 micrograms/ml). The highest 4-OHB concentrations were measured 1 h (0.18 +/- 0.09 micrograms/ml) and 30 min (0.20 +/- 0.05 micrograms/ml) after the 24- and 48-h infusions, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Osteo-articular manifestations in dialysis of patients over 70 years].

A clinical, biological and radiological prospective study was carried out in 21 patients over 70 years of age and treated by hemodialysis or chronic ambulatory peritoneal dialysis (CAPD) to evaluate the frequency and specificity of rheumatic diseases observed in aged chronic renal failure patients. Some are caused or favored by old age and are not in any way related to renal failure and its replacement therapy. Such was the case with arthrosis which was present in 85% of patients, ankylosing vertebral hyperostosis (14%), Paget's disease (5%) and gouty arthritis (10%). Elsewhere there is an implication between abnormalities due to aging and those linked to renal failure and/or dialysis, some of which can worsen or accelerate others. Secondary hyperparathyroidism seems less frequent in the elderly than in the young patients. Common vitamin dependent osteomalacia should not be neglected because it can be either prevented or efficiently treated. Osteoporosis is another important factor in osteopenia. Extra-skeletal calcifications are frequent: periarticular calcifications (38%), chondrocalcinosis (14%) and disc calcifications (24%). Dialysis arthropathy comprising: carpal tunnel syndrome, erosive lesions of large and intermediate limb joint articulations and destructive spondylarthropathy is observed in 43% of patients after an average dialysis period of 44 months. The advent of this complication seems to be quite early in the elderly, as compared to the young population, which confirms the role played by age as a favoring factor.

Aged↗
PubMed1990

[Fractures caused by bone insufficiency of the proximal femoral epiphysis. Contribution of MRI].

The fractures by bony insufficiency are particularly well seen on MRI. On T1 weighted images they are detected as a very hypointense line surrounded by a hypointense area. On T2 weighted images, the hypointense line is also recognized and represents the fracture surrounded by a hyperintense area due to oedema or hemorrhage. Five cases of bony insufficiency fracture of the femoral head are reported. The features of the superior subchondral locations of these fractures and some primary and limited epiphyseal osteonecrosis are similar and consistent with a common pathogeny.

Aged↗
PubMed1988

[Joint complications in patients with chronic renal failure hemodialyzed for over 10 years. 40 cases].

A retrospective study of 40 patients with chronic renal failure who underwent haemodialysis for more than 10 years (mean: 153 months) showed that 18 patients (45 p. 100) had arthralgia in the shoulders, hands, wrists and knees, 13 (32 p. 100) had carpal tunnel syndrome requiring surgery, and 20 (50 p. 100) were found to have bone cavities in the humeral head, external supra-acetabular region, carpus and patella. Aluminium overload was present in 47 p. 100 of the patients, and amyloid deposits were found in 10 of the 12 patient operated upon for carpal tunnel syndrome. This study confirms the frequency in patients under long-term haemodialysis of an articular pathological entity consisting of arthralgia, carpal tunnel syndrome, juxta-articular bone cavities and amyloid deposits which are now known to be made of beta 2-microglobulin. The initial lesion seems to affect the synovial membrane; it appears to be facilitated by age and is often associated with aluminium overload. The mechanism(s) responsible for amyloid deposits remain (s) to be elucidated.

Adolescent↗