Biomedical subjects
T Boyer
Publications and source records attributed to T Boyer.
Contribution of arthroscopy and magnetic resonance imaging to the evaluation of painful knee osteoarthritis.
In knee osteoarthritis, arthroscopy provides valuable information that suggests an original approach to the disease. In combination with recent imaging study data, this information can be used to develop a novel concept of the evaluation of knee osteoarthritis. The main mechanisms responsible for flares of the disease seem to be synovitis, degenerative meniscal disease, and subchondral bone lesions. Treatments targeted at each of these mechanisms can be used as appropriate. Determination of the exact nature of the lesions can be difficult and relies at present on sophisticated investigations not readily available in everyday practice. Further work is needed to determine how a finer analysis of symptoms and signs in combination with simple investigations can differentiate between the various pathological patterns of knee osteoarthritis.
[Meniscectomy in arthritis of the knee].
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[Exercise and osteoarthritis].
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Hip arthroscopy utilizing the supine position.
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[Gleno-humeral arthroscopic arthrolysis for shoulder stiffness. Apropos of 26 cases. Société Française d'Arthroscopie].
UNLABELLED: Shoulder stiffness is a problem which covers many different conditions. In fact there is still a semantic and pathogenetic confusion. The words: capsulite retractile, frozen shoulder, adhesive capsulitis, stiff shoulder contracture have been successively used and this ambiguity renders the literature difficult to interpret. Moreover the cause of the stiffness which depends on the aetiology, is not always clearly known: capsular contraction, capsular adhesion, capsular scarring following trauma or surgery, extra capsular phenomenons in the subacromial bursa, muscles or tendons. MATERIALS AND METHODS: 26 shoulders (25 patients) were reviewed with a follow up of 21 months using the Constant's scoring system. Patients had an average duration of symptoms for 13 months (1 to 27). Pre op passive motion was: abduction: 74 degrees, external rotation: 6 degrees, forward flexion: 84 degrees. The average motion core was 12.9/40. We distinguished three groups: primary frozen shoulder (13 cases) ; bipolar stiffness (3 cases) due to rotator cuff disease ; acquired "surgical" stiffness, (10 cases). The capsular release was performed, at the anterior rim of the glenoid fossa, purely anterior or anterior and inferior, followed by gentle manipulation. If external rotation was not improved the coraco-humeral ligament was detached from its coracoid attachment. Additional procedures were performed:acromioplasty (5 cases), bursectomy (3 cases), SLAP lesion debridement (1 case). Only 2 out 13 primary shoulders required an additional procedure. RESULTS: 1-There were no intra-operative complications (vascular or neural). 2-Range of Motion: the average gain under anesthesia was: abduction: 72 degrees, external rotation: 34 degrees, forward flexion: 86 degrees. Final result was obtained with a mean duration of seven months. There was no difference according to the aetiology. Gain was more important in the primary group (9.69 to 34.9 vs 15.8 to 30.6). 3-Subjective results were better in the primary group. 4-Objective results demonstrated an absolute Constant's score of 70.3, that is to say 83.4 per cent of the contralateral supposed healthy shoulder. There were 3 excellent, 5 very good, 7 good, but 11 fair or poor results. The relative Constant's score was 91 per cent in the primary group and only 76 per cent in the acquired group. The difference was due to the pain and strength which were greatly improved in the primary group. DISCUSSION: Arthroscopic release of shoulder contracture is feasible, safe and effective. For primary frozen shoulder, there is usually spontaneous recovery. Indications for surgery are very few. There is no evidence that arthroscopic release shortens spontaneous evolution. Therefore, we propose it in very selected cases of dramatically limited motion. One year of evolution is an acceptable time. For bipolar stiffnesses, arthroscopy allows one to recognize the exact cause of the stiffness and to treat it, especially the subacromial pathology. In this occurrence, buroscopy must be performed and cuff pathology treated. For acquired surgical stiffnesses, gain of motion is significant. Subjective and objective results are less satisfactory than those of primary frozen shoulder, due to persistance of pain and lack of strength. The alternative is open release, but arthroscopic release has less morbidity. It can be proposed early as soon as capsular tissue has healed (for instance 6 months).
[Developing services for patients who need long-term care].
Attempts at regional planning in the Outaouais have shown that it is difficult to open up mental health services for underprivileged clienteles that are more vulnerable. Nonetheless, services can be offered by developing partnerships between institutions and community groups, while ensuring that individual expertise and local differences are respected. However, the healthcare and social services network must learn how to build intersectorial mechanisms that can change the socio-economic conditions which explain the conditions of patients and their exclusion. With budget cuts in the background, the participation of citizens could make all the difference.
Transcription of circular and noncircular forms of Sry in mouse testes.
Although its expression in adult testis was immediately apparent, the role for Sry (sex determining region, Y) in testicular function remains elusive. We have performed transcriptional studies in an effort to elucidate potential roles of Sry by studying the time and location of its transcription in mouse testes. Northern analyses and more sensitive nuclease protection assays detected transcripts in 28-day-old testes and beyond. The highly sensitive technique of reverse transcription polymerase chain reaction (RTPCR) could not detect Sry expression in 14-day testes when primers for the most conserved portion of the gene, the high mobility group (HMG) box, were used, but primers for the circular form detected Sry transcription at all postnatal stages studied. The same HMG box primers were able to detect expression of Sry in XX, Sxra or Sxrb testes. This suggested that Sry is expressed in cells other than germ cells, which was confirmed with studies on fractionated cells--RTPCR detected transcription of Sry in the highly pure interstitial cell fraction. However, Leydig cells and a Leydig cell tumor were negative for Sry expression. We performed in situ studies in an attempt to localize the expression of Sry in the testes. Abundant expression of an Sry cross-hybridizing transcript was found in spermatogonia, in early spermatocytes, and in some interstitial cells with antisense probes to the HMG box or a more specific, 3' region, whereas the sense probe gave little or no hybridization. It is probable that the circular transcripts, which are seen in reverse transcriptase positive (RT+) and RT- reactions by PCR because of the RT activity of Taq polymerase, are responsible for the hybridization seen in spermatogonia and spermatocytes, whereas linear and circular forms are detected later. Thus Sry is expressed in pre- and postmeiotic germ cells and in somatic cells of the testes.
The SFA system for assessing articular cartilage lesions at arthroscopy of the knee.
We proposed to establish a system of assessing severity of chondropathy taking into account localization, size, and depth of cartilage lesions. The design of the study was prospective and multicenter. The subjects were 755 patients who had undergone arthroscopy of the knee. Criteria for assessment of severity of chondropathy were as follows: (a) Physician's overall assessment using a 100-mm-long Visual Analogue Scale, and (b) size, grade, and localization of cartilage lesions recorded on a diagram. We used multivariate parametric and nonparametric analyses. The analyses resulted in two systems of assessing severity of chondropathy: SFA scoring for the three compartments of the knee, which is a continuous variable, and SFA grading, which is a semiquantitative variable. These systems seem to be of clinical relevance. However, more studies are required to further validate them and their capacity to detect changes in severity of chondropathy.
[Proposal of a simplified arthroscopic score of cartilage lesions of the knee (simplified SFA score)].
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[Proposal for a classification of cartilagenous lesions of the knee by the French Society of Arthroscopy].
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Transcription of the sex-determining region genes Sry and Zfy in the mouse preimplantation embryo.
We have confirmed the faster growth of male preimplantation mouse embryos. We have also studied the transcription of Y chromosomal genes postulated to have a role in sex determination, using the highly sensitive technique of reverse-transcription polymerase chain reaction at these early stages. We find that two sex-determining region genes, Sry and Zfy, are transcribed during mouse preimplantation development, while the Zfy homologs Zfx and Zfa and a sex-determining region gene originally called A1s9 (now called Ube1y-1) are not. We also show that the anti-Müllerian hormone gene, which contains a Sry consensus binding element in its 5' promoter region, is not transcribed at this time. Developmental curves show that Sry and Zfy are expressed commencing at the two-cell stage. These results suggest that mammalian sex determination starts prior to gonad differentiation.
[Arthroscopy of the hip. Methods and values].
The authors report on their experience with 225 arthroscopies of the hip (performed in 241 patients from January 1983 through September, 1991). Only 15 arthroscopies were performed using traction. For 228 procedures they used their simplified method without traction which does not visualize the congruent cartilage surfaces or acetabular fossa. To determine whether this method ensures a satisfactory diagnostic and therapeutic approach to the hip, 100 patients belonging to three groups (normal arthroscopy, indeterminate diagnosis, and chondromatosis) were sent a questionnaire on one to three occasions. Follow-up at the time of the first questionnaire was at least six months. Mean follow-up was 3 years (range 8 to 83 months). Arthroscopic diagnosis was based on direct evidence for the peripheral part of the joint and indirect evidence for lesions of the congruent joint surfaces and acetabular fossa. Sixty four responses were obtained, rates of error were only 5% for patients with normal arthroscopies and 22% for those with indeterminate arthroscopies (i.e., the group with the highest potential for error). Therapeutic results with the simplified method were satisfactory in 40% (15/35) of patients with chondromatosis; however, 7 of 44 patients (16%) had a repeat arthroscopy which was unsuccessful in more than half the cases (4/7). No complications or technical failures occurred in this series. In conclusion, simplified arthroscopy without traction is advocated as the routine arthroscopy procedure for investigating and treating hip disorders. The conventional technique with traction remains necessary when imaging procedures (especially the CT scan or arthroscan) demonstrate lesions of the congruent articular surfaces or acetabular fossa.
Arthroscopic treatment of synovial chondromatosis of the knee.
Between 1971 and 1987, arthroscopy was performed in 39 patients with synovial chondromatosis of the knee; 29 of these patients (32 knees) were followed an average of 3.5 years. A good result was obtained in 78% of the cases. Removal of loose bodies was the only treatment in 31 of the 32 knees. A synovectomy was performed in one case. No synovectomies were performed secondarily. Only three patients required a second arthroscopic procedure. The essential prognostic factor for a good functional result is the condition of the femorotibial cartilage. We concluded that simple arthroscopic removal of cartilaginous bodies without synovectomy is the treatment of choice for synovial chondromatosis of the knee.
[Arthroscopy of the hip].
In reference to 50 arthroscopies performed since january 1983, we describe a simplified approach to the hip. This joint may be divided, from the standpoint of arthroscopic anatomy, into a coxo-femoral area per se and a peripheral area. The latter represents the most interesting part from a rheumatologist's standpoint. This is the area that our method enables to study quite easily. With the macroscopic study and the possibility of controlled biopsy or biopsy under direct vision, arthroscopy realizes an additional diagnostic approach to questionable hips. It represents already a new therapeutic approach in hip chondromatosis.
[Arthroscopy of degenerative lesions of the internal meniscus. Classification and treatment].
In reference to 310 degenerative meniscal lesions (DML), we are proposing to classify these lesions into five types. They must be differentiated from arthrosis to which they are not automatically associated, even if the presence of cartilaginous lesions appears to be an important prognostic factor. Likewise, studies by age groups mix pure traumatic lesions and properly so called DMLs (which, by definition, do not involve a true initial trauma); the role of micro-traumas seems however probable. In reference to 87 type IV lesions, we remind of the difficulty of the radio-clinical diagnosis, insisting on the readily progressive nature of the troubles (49.4 p. cent of the cases), the lack of specificity of the symptoms, dominated by subjective pain (93 p. cent of the cases) and the pain induced by pressure on the medial joint space (70.1 p. cent of the cases). 87 patients underwent a partial meniscectomy. 72 were followed over a period of 32.4 months. In the entire group, the results are good or very good in 83.3 p. cent of the cases. In case of a considerable cartilaginous lesion visualized on arthroscopy (25 out of 87 patients), there are still 73.7 p. cent of good and very good results.
[Incidence of previous engagement in sports among patients with symptomatic arthrosis. Controlled study].
The authors investigated sports-related precedents in two groups of male subjects, aged 40 years and over, of French nationality. One group had consulted for a degenerative, chronic rheumatic disorder, and the control group showed no signs of this type of disorder. Care was taken to verify that the two groups did not differ in terms of profession, means of commuting from home to work, and non-sporting leisure physical activities. The authors observed that the subjects of the first group (chronic degenerative rheumatic disease) more frequently engaged in a sports activity, and in a significant manner, than did the control subjects. A separate study of the certain kinds of sports and the various arthritic localisations also revealed significant correlations. Although this involved a retrospective enquiry, the authors feel that the results provide arguments in favor of the pathogenic role of sports activity, with regard to peripheral joints and the spine. However, this role of sports is probably only partial and irregular. The risks of sports activity must be put in perspective and balanced with the various advantages afforded by the practice of sports.
Double-blind controlled trial of prednisolone therapy in patients with severe acute alcoholic hepatitis and spontaneous encephalopathy.
Twenty-eight patients entered a double-blind controlled trial to evaluate the efficacy of prednisolone treatment in severe acute alcoholic hepatitis accompanied by encephalopathy. Fifty-three percent (8 of 15) given prednisolone and 54% (7 of 13) given placebo died during the study. The mean duration of hospitalization was 66 days for the prednisolone-treated group and 56 days for those treated with placebo. Prednisolone treatment produced no important beneficial effect on any of the hepatic biochemical tests. The outcome in any particular case was directly related to the development of specific lethal complications (renal failure, injection, and gastrointestinal bleeding) rather than to the treatment employed. We were unable to show any beneficial effect of prednisolone treatment on morbidity or mortality in patients with severe acute alcoholic hepatitis and encephalopathy.