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Patrick Niccola? Lemlih Ouchchane Maurice Libier Fay?ale Beouche Monique Belon Jean-Marc Vedrinne Bilal El Drayi Laurent Vallet Franck Ruiz Céline Biermann Pascal Duchêne Claudine Chirat Sylvie Soule-Sonneville Christian Dualé Claude Dubray Pierre Schoeffler 《Canadian journal of surgery》2015,58(2):114-120
Background
A greater incidence of persistent pain after inguinal herniorrhaphy is suspected with the open mesh procedure than with laparoscopy (transabdominal preperitoneal), but the involvement of neuropathy needs to be clarified.Methods
We examined the cumulative incidence of neuropathic persistent pain, defined as self-report of pain at the surgical site with neuropathic aspects, within 6 months after surgery in 2 prospective subcohorts of a multicentre study. We compared open mesh with laparoscopy using different analysis, including a propensity-matched analysis with the propensity score built from a multivariable analysis using a generalized linear model.Results
Considering the full patient sample (242 open mesh v. 126 laparoscopy), the raw odds ratio for neuropathic persistent pain after inguinal herniorrhaphy was 4.3. It reached 6.8 with the propensity-matched analysis conducted on pooled subgroups of 194 patients undergoing open mesh and 125 undergoing laparoscopy (95% confidence interval 1.5–30.4, p = 0.012). A risk factor analysis of these pooled subgroups revealed that history of peripheral neuropathy was an independent risk factor for persistent neuropathic pain, while older age was protective.Conclusion
We found a greater risk of persistent pain with open mesh than with laparoscopy that may be explained by direct or indirect lesion of nerve terminations. Strategies to identify and preserve nerve terminations with the open mesh procedure are needed. 相似文献2.
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M Ouchchane D Portmann M S Doutre E Brottier-Mancini 《Revue de laryngologie - otologie - rhinologie》1992,113(3):201-204
The authors describe the circumstances for detection of an AIDS lymphomatous complication revealed by an otological picture in one patient. The lymphomatous pathology not related to HIV is reviewed. The particularity of these lymphomas, when they are related to HIV, is their frequent initial extra-ganglionic location, their high grade histological type and their poor prognosis. The authors emphasize the need to perform a biopsy rapidly when confronted with any external otitis resistant to general and local treatments. 相似文献
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Stéphane Chapuis Lemlih Ouchchane Olivier Metz Laurent Gerbaud Franck Durif 《Movement disorders》2005,20(2):224-230
The impact of motor complications of Parkinson's disease (PD), especially levodopa-induced dyskinesias, on quality of life (QL) was studied in 143 patients with PD. All were evaluated on the Hoehn and Yahr (H&Y) scale, and the Motor part of the Unified Parkinson's Disease Rating Scale (UPDRS). Motor complications were analyzed using the UPDRS Parts IV(A) and IV(B) and the Abnormal Involuntary Movement Scale. A specific Parkinson's disease quality of life questionnaire (39-item version, PDQ-39) was used. Motor complications significantly worsened the PDQ-39 Summary Index (PDQ-SI) of patients with PD. The dimensions of Mobility, Activities of Daily Living, Stigma, and Communication were the most strongly affected. "Peak dose" dyskinesia decreased Mobility, Emotional Well-Being, and Cognition, whereas biphasic dyskinesia affected Mobility, Stigma, Communication, and Activities of Daily Living. Morning akinesia, end-of-dose fluctuations, and "unpredictable offs" decreased QL on the dimensions of Mobility, Activities of Daily Living, Stigma, and Communication. Nocturnal akinesia led to a deterioration of all dimensions of the PDQ-39. Thus, motor complications and especially nocturnal akinesia and biphasic dyskinesias worsened the QL of PD patients. 相似文献
5.
Jean-Jacques Lemaire Jérôme Coste Lemlih Ouchchane Simone Hemm Philippe Derost Miguel Ulla Séverine Siadoux Jean Gabrillargues Franck Durif Jean Chazal 《International journal of computer assisted radiology and surgery》2007,2(2):75-85
Object Relationships between clinical effects, anatomy, and electrophysiology are not fully understood in DBS of the subthalamic
region in Parkinson’s disease. We proposed an anatomic study based on direct image-guided stereotactic surgery with a multiple
source data analysis.
Materials and Methods A manual anatomic mapping was realized on coronal 1.5-Tesla MRI of 15 patients. Biological data were collected under local
anesthesia: the spontaneous neuron activities and the clinical efficiency and the appearance of adverse effects. They were
related to relevant current values (mA), the benefit threshold (bt, minimal current leading an clear efficiency), the adverse
effect threshold (at, minimal current leading an adverse effect) and the stimulation margin (sm = at − bt); they were matched
with anatomy.
Results We found consistent relationships between anatomy and biological data. The optimal stimulation parameters (low bt + high
sm) were noted in the dorsolateral STN. The highest spontaneous neuron activity was found in the ventromedial STN. Dorsolateral
(sensorimotor) STN seems the main DBS effector. The highest spontaneous neuron activity seems related to the anterior (rostral)
ventromedial (limbic) STN.
Conclusion 1.5 Tesla images provide sufficiently detailed subthalamic anatomy for image-guided stereotactic surgery and may aid in understanding
DBS mechanisms. 相似文献
6.
Simone Hemm François Caire Jérôme Coste François Vassal Christophe Nuti Philippe Derost Lemlih Ouchchane Laurent Sarry Franck Durif Jean-Jacques Lemaire 《International journal of computer assisted radiology and surgery》2008,3(1-2):69-77
Object
In deep brain stimulation, the anatomic positions of electrode contact centers are used as the basis for analysis. We propose a new semi-quantitative approach (contact membership concept) considering patient’s individual anatomy, contact size, and extent of involvement of STN and neighboring structures.Materials and methods
In ten bilaterally operated and improved Parkinsonian patients, effective contact positions (contacts used for monopolar stimulation) were analyzed. The position of the contact center (classical binary approach: each center assigned, 1, or not, 0, to a given structure) and of the contact in its dimension (contact membership concept: membership degree, ordinal values from 0 to 1, assigned to each anatomic structure according to extent of involvement) were compared for the whole patient group and, individually, for each patient.Results
The membership concept revealed that for 13 out of 20 contacts, more than one structure was involved, where the classical binary approach assigned only one structure. For both approaches lateral STN, zona incerta and H1 (Forel’s Field) were the main structures involved, but their frequencies of appearance differed.Conclusion
The membership concept allows detailed analysis of the anatomic contact position. In the future this approach could assist in correlating anatomy and clinical results for all electrode contacts (effective ones and clinically less efficient ones). 相似文献7.
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Risk factors for recurrence of venous thromboembolism associated with the use of oral contraceptives