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Biomedical subjects

V Travers

Publications and source records attributed to V Travers.

At least 19 recordsLinked to original sources
PubMed1995

[Uncemented knee prosthesis. Results apropos of 58 cases with a minimum of 5-year follow-up].

PURPOSE OF THE STUDY: The aim of this study was to evaluate, after at least 5 year's follow-up, the results of 64 PCA (TM) cementless total knee prostheses. MATERIAL: From 1984 to 1988, 13 male and 45 female patients (a total of 64 prostheses including 6 bilateral) received PCA Primary prostheses. Both femoral and tibial components were implanted without cement. Mean age of patients was 68.9 years (range: 35-81); mean patient height was 164.41 cm and mean weight 76.74 Kg. The most frequent pathology was gonarthrosis: 43 cases of medial gonarthrosis and 15 of lateral gonarthrosis. There were 4 cases of rheumatoid arthritis and two post-traumatic degenerative arthritis. 52 knees were free of any previous surgical procedure. Of the 64 prostheses and the 58 patients: 6 died and 2 were lost to follow-up; 56 knees were reviewed. The longest follow-up is 9 years for an average of 6.8 years. METHODS: Prosthetic review included clinical evaluation (Hungerford score based on 100 points, ISK rate based on 200 points) and complete radiological evaluation enabling the postoperative position of the implants to be examined. Radiolucencies were examined according to Ewald. X-ray study of polyethylene wear was performed based on the distance between the prosthetic condyle to the height of the metal tibial plateau. All patients were operated on by the same surgeon using the same procedure, and the same postoperative outcome. RESULTS: There were no local postoperative complications or any early reoperations. PHlebitis occurred in 12 per cent of cases. With the exception of 8 patients who were reoperated due to mechanical complications, the Hungerford score raised from 37.5 preoperatively to 88.3 postoperatively. The results of 43 of the 48 patients were rated good or excellent. The 200 point score rating gave 91 per cent of good and excellent results for knee examination, and 69 per cent of good and excellent results for knee function. Mean flexion angle was 107.8 degrees mean pain scored 45/50. Radiologically 75 per cent of operated patients had postoperative varus or valgus in the range 0-5 degrees as against 24 per cent preoperatively. The study of edge defects revealed the absence of any radiological abnormality on the femoral lateral projection in 85 per cent of cases, and the absence of abnormality on the tibial anteroposterior and lateral projections in more than 60 per cent of cases. X-ray study of polyethylene wear was conducted on 49 cases: polyethylene wear was observed radiologically in 1 of 4 cases. There was no correlation between polyethylene wear and polyethylene thickness, postoperative axes, body weight or clinical results. 8 patients had to be reoperated due to mechanical complications: 2 because of a tilting tibial plateau (due to a technical fault), 4 because of polyethylene wear and 2 because of patellar loosening (uncemented metal-back patellar implant). DISCUSSION: The implantation of femoral and tibial components of cementless PCA Primary fitted seems very satisfactory. With longer follow-up, we noted no tibial or femoral osteolysis signs such as those described by Engh, Peters or Berry in the USA. Stability of mid term radiographical results was commonly observed throughout our study. Only 5 very slight lateral displacements were noted: 3 cases of secondary LCP insufficiency with tibial posterior subluxation; in 2 cases the cause was R.A. CONCLUSION: The implantation of uncemented PCA Primary prosthesis caused non complications with respect to the femur. Regarding the tibia, only two reoperations were required because of tibial fixation failure due to a technical fault. The use of a hybrid prosthesis is not required. The microbeads used in PCA are effective but current availability of other materials promoting better bone growth (such as hydroxyapatite, titanium mesh) allows safe implantation of uncemented prostheses. PCA Primary polyethylene wear seems to develop steadily. This is why it should be replaced by the less

Adult↗
PubMed1993

[Reoperation after failure of unicompartmental knee prosthesis. Therapeutic strategy and results based on 40 cases].

Forty revisions for failure of unicompartmental knee prostheses were assessed. Twenty-eight women and twelve men (mean age: 67 years) were reoperated. Failure of an medial single-compartment prosthesis was involved in 35 cases, of a lateral prosthesis in 5 cases. The initial prostheses had been cemented in 19 cases and uncemented in 21 cases. Preoperative functional conditions were assessed by Hungerford's functional score and a 200-points score. The radiological study before revision showed 35 cases of varus distortion; in 12 of these, the varus distortion exceeded 10 degrees. Rather than studying the causes for failure of the single-compartment prosthesis, it seemed more useful to try to define the adequate reoperation procedure strategy and analyze its results. Our procedure aimed at solving the following difficulties: surgical approach: the same incision as in the initial operation was performed, the primary prosthesis was removed and a two-stage treatment was justified in cases of infection, metallosis involved complete removal of debris, the problem of bone-recutting and, chiefly, the problem of residual bone defect requiring bone-graft. Bone-recutting was performed with the tibial and femoral elements of the primary prosthesis still in place and using the ancillary equipment of the new prosthesis. Bone defects involved the femur as often (14 cases) as the tibia (12 cases); tibial bone defects occurred more frequently with cemented prostheses (9 cases) than with uncemented prostheses (3 cases). Femoral graft being relatively easier to perform one of the two major difficulties in our strategy was the achievement of a tibial graft.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Experimental irradiation of femoral arteries by carbon dioxide (CO2) laser: morphologic changes under transmission electron microscope (T.E.M.) examination.

In order to study the morphologic changes after CO2 laser irradiation, 42 rat femoral arteries were irradiated under various conditions at different time intervals from zero to three weeks. The arteries were examined under transmission electron microscope (T.E.M.), and 30 mW power and 0.3 to 0.5 mm/sec velocity were considered to be the most suitable for a CO2 anastomosis of small femoral arteries.

Animals↗
PubMed1990

A comparative experimental study of vascularized and nonvascularized nerve grafts.

In order to compare vascularized and nonvascularized nerve grafts in a normal bed, 96 median nerve grafts were performed in rabbits. The median nerves were grafted in situ bilaterally, whether vascularized or nonvascularized. The length of the grafts was 2 cm, 4 cm, or 6 cm. A morphometric study was performed eight weeks and 24 weeks after the operation. No significant differences were found between vascularized and nonvascularized grafts at the same levels of nerve grafts. However, significant differences between vascularized and nonvascularized grafts were found for 4-cm and 6-cm grafts at eight weeks, and for 6-cm grafts at 24 weeks postoperatively, comparing the proximal normal nerve segments with the nerve segments distal to the nerve grafts.

Animals↗
PubMed1989

[Results of surgery of nerve trunks in the treatment of post-traumatic brachial plexus paralysis].

Between 1972 and 1985, 256 patients with a brachial plexus injury were operated on in our institution. One hundred fifty-nine post-traumatic injuries, with a minimal follow-up of 2 years for partial palsies and 3 years for complete palsies were reviewed. Clinical examination is particularly important, and CT scan combined with myelography and more recently Magnetic Resonance Imaging ensures exact assessment of the lesions. The operative procedure is described, depending on the level and the number of injured nerve roots. Eighty-six fascicular grafts, 9 trunk grafts and 35 nerve transfers were performed. In 40 cases a neurolysis only was performed. Results were analyzed: at follow-up a motor and sensory recovery was observed in 70% of cases allowing to relieve the pain and to improve the function of the limb. The operation must therefore be performed at the appropriate time according to the most appropriate procedure depending on the number of usable roots. Secondary palliative transfers also help to improve function.

Adolescent↗
PubMed1989

[Magnetic resonance imaging in paralysis of the upper limb of traumatic origin].

We have used magnetic resonance imaging in addition to the other imaging techniques for the examination of 31 patients with traumatic upper limb paralysis. The therapeutic indications of traumatic brachial plexus paralysis depend on the early and precise assessment of the lesions. Computed tomography with a contrast injection at a lumbar level opacifying the subarachnoid spaces provides a morphological study of the canal, spine and nerve roots and of container-contents relationships. In our experience, the diagnostic reliability for the detection of intraspinal radicular lesions is 86%. A study in all 3 spatial planes is possible with MRI with T1- and T2-weighted or gradient echo sequences. The reliability of the technique for the diagnosis of meningoceles in the detection of nerve root avulsion is similar to that of CT (85%). The excellent spatial resolution and natural high contrast allow following the nerve roots in their extraspinal course and determining the site of nerve trunk rupture (50%). The use of oblique and double-obliquity sections should yet improve these results. These first results lead us to proposing magnetic resonance imaging for the exploration of traumatic lesions of the brachial plexus. This nonagressive, more precise and more complete assessment of the lesions certainly has a significant influence on therapeutic choice.

Adolescent↗
PubMed1988

Experimental microvascular anastomoses with a CO2 laser. A series of 240 anastomoses.

In order to compare conventional microvascular suture anastomoses with CO2 laser-assisted anastomoses, 240 anastomoses were performed in Wistar albino rats. Average time required for anastomosis was 8.30 minutes in the laser group and 14.30 minutes using the conventional technique. Patency rate was the same in both groups for arterial anastomosis but in femoral veinous anastomoses, the patency rate was of 89% using laser and 75% when done by hand. Secondary vein thromboses amounted respectively to 2% with laser and 18% with conventional sutures. Scanning electron microscope examination revealed a better endothelialization in the laser group. T.E.M. examination showed an important inflammatory reaction around the threads in the conventional suture group, even at the end of the first month. In the laser group, a partial and transient necrosis of the media appeared between the second and fourth day. Laser assisted microvascular anastomosis seems to be a promising technique with potential clinical applications.

Anastomosis, Surgical↗
PubMed1988

A ten years follow-up of the results of surgery for Dupuytren's disease. A study of fifty-eight cases.

Fifty-eight patients (52 males and 6 females) operated on for Dupuytren contracture were examined by the same author with a more than ten year follow-up. At time of surgery the average was 55 years old. 69 hands (169 fingers) rated 4.33 according to the simplified Tubiana's score were treated by the same operative procedure: Mac Indoe's incision, digital Z plasty (if needed), subtotal fasciectomy and physiotherapy beginning 8 days postoperatively. At long term, recurrence appears for 49 hands (71%) one every two in the two first postoperative years, one out of five after five years. 24 of them were graded stage I. The recurrence appeared 14 times associated with an extension of the disease and the earlier, the higher was the initial stage. Some factors seem to be of a bad prognosis regarding recurrence: age (93% of recurrence under 50 years old) Ledderhose or Lapeyronie (100%) other associated diseases (Alcoholism, diabetes mellitus, epilepsy) and severe preoperative stage. Subjective results are good: 45 patients are satisfied and only 3 underwent a second operation.

Adult↗
PubMed1988

[Arthroscopy in the treatment of primary acute pyogenic arthritis of the knee in adults. Apropos of 12 cases].

Twelve arthroscopies have been performed in the treatment of acute septic arthritis of the knee. This gave an early visualisation of the cartilaginous and synovial lesions and treatment by lavage, drainage and irrigation of the joint. Using this technique, all the patients were cured of the infection and only one patient showed ultimate limitation of movement of the knee. Arthroscopy made it possible to confirm the diagnosis and to treat the arthritis effectively at an early state and to reduce the mortality and poor functional results of arthrotomy.

Acute Disease↗
PubMed1988

Occurrence and treatment of pain after brachial plexus injury.

The occurrence of pain was investigated in 118 patients with posttraumatic brachial plexus injuries (BPI). Ninety-five patients were operated upon by the same surgeon. Three to 14 years after BPI and reconstructive surgery, 91% of the patients experienced permanent pain that was severe in 40% and mild in 51% of cases. When early reconstructive surgery was successful, a significant decrease in pain occurred more frequently. For 57% of patients with pain, a plurimodal medical treatment with tricyclic antidepressants, antiepileptic drugs, and behavioral therapy efficiently reduced pain. For the patients with unbearable paroxystic pain, when medical treatment failed, the destruction of deafferented dorsal horns at the level of avulsion (Nashold procedure) could produce pain relief. In all cases psychosocial management produced early rehabilitation.

Adult↗
PubMed1988

Imaging of posttraumatic brachial plexus injury.

After reviewing a series of 220 patients operated upon between 1975 and 1985 for traumatic brachial plexus injuries, the authors present the results of 103 myelographies, 48 computed tomographies (CT scans) combined with standard myelography, and 25 series of images obtained by magnetic resonance imaging (MRI). To evaluate precisely the type and level of injury, the accuracy of these three techniques was compared with clinical and operative findings. The accuracy of myelography was considered good in 84% of the cases, but 4% were evaluated as false positive results and 12% as false negative or doubtful results. The combined CT scan and myelography reduced the number of doubtful results and accuracy reached 94.25%, but they did not visualize the roots distal to the spinal foramina. MRI correlated well with CT scan images and, in addition, offered visualization of distal radicular injuries. MRI seems a promising diagnostic procedure and should also help to situate nerve grafts and check their viability.

Adult↗
PubMed1987

Resin corrosion cast in experimental evaluation of femoral microanastomosis.

In order to obtain more information about the site of microvascular anastomosis, the authors used the methylmethacrylate resin corrosion casts. 80 microvascular anastomoses were performed in Wistar albino rats and divided into two groups: in the Group 1 (40 anastomoses), the resin was injected into the vessel whereas in Group 2, the tissues were prepared without injecting resin. Both groups were compared under the scanning electron microscope (SEM). The SEM preparation was easier in the Group 1 and the artefacts were significantly reduced. The anastomotic site was better appreciated in Group 1 in three-dimensional views. The resin corrosion cast is a promising technique for the evaluation of the microvascular anastomosis.

Anastomosis, Surgical↗