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Biomedical subjects

B Irthum

Publications and source records attributed to B Irthum.

32 records · Page 2Linked to original sources
PubMed1990

[Evaluation of the treatment of aneurysmal meningeal hemorrhage with antifibrinolytic agents, calcium inhibitors and maintenance of effective blood volume].

To prevent and treat the ischemic complications due to the vasospasm, this report suggest the management of aneurysmal subarachnoid haemorrhage by the association of antifibrinolytics (tranexamic acid) to lower the risk of rebleeding, calcium channel blockers (nimodipine), and the keeping of an effective total blood volume (thanks to volume expansion and dopamine). From 88 patients aged from 4 to 73, two thirds were admitted at latest 48 h after the aneurysmal rupture Emergency surgery was carried out in the case of a compressive hematoma, early surgery (between the first and the third day) on the grades I, II and III of Hunt and Hess without any signs of angiographic vasospasms (40% of this series), delayed surgery for the others (27.5%), 10% didn't undergo any surgery. Only three patients (3.4%) presented rebleeding leading to death. The features of the whole series are: 51% recovered without any after effects, 22% had mild neurological deficiency, 10% had severe neurological deficiency and 17% died after their release from hospital. This protocol allowed a decrease in the ischemic complications due to the vasospasm and in the rate of rebleeding during the waiting interval when an angiographic or a clinical vasospasm allowed no surgery.

Adolescent↗
PubMed1989

[Ventricular subarachnoidal hydrocephalus of arachnoid villi origin].

In 102 infants (0.5 to 22 months), the C.T. scan performed for various neurological symptoms, was systematically reviewed with analysis of ventricular size, pericerebral space and interhemispheric fissure. In 70% of the cases, an increase of the intracranial volume of C.S.F. was noted, with a good correlation between the ventricular and pericerebral volume. The authors discuss the pathophysiological mechanism of this condition an evoke the possibility of an idiopathic disturbance of the C.S.F. reabsorption. In two cases, suffering from severe axial hypotonus, this fact was explored by four methods: continuous monitoring of intracranial pressure, intraventricular infusion test, isotopic cisternography through ventricular injection and venous phase of angiography. From these investigations showing no venous anomaly, and because of the lack of any pathological event able to induce a C.S.F. obstruction, we suggest a delay in the maturation of arachnoïd villi (normally ended at 18 months) to explain this condition.

Arachnoid↗
PubMed1986

[Prospective trial of treating aneurysmal meningeal hemorrhage by delayed operation under cover of antifibrinolytic therapy].

Seventy patients with subarachnoid haemorrhage due to ruptured intracranial aneurysms were managed by delayed intervention (third week) along with the prescription of antifibrinolytic drugs (tranexamic acid 6 g/daily). During the pre-operative period, 41 patients stayed in the same clinical status as on admission or improved, whereas 29 deteriorated due to rebleeding (4 cases), vasospasm (18 cases), large hematoma (4 cases), hydrocephalus (2 cases) and postarteriographic accident (1 case). Clipping the aneurysm was finally achieved in 42 patients only; with 3 deaths, 3 severe sequellae, 8 light handicaps, and 28 patients considered as cured with returning to previous occupations. As far as the whole series is concerned, these results yield a 38.5% rate of mortality, 20% morbidity, and 41.5% recovery. It is concluded that 1) Tranexamic acid was effective in reducing the risk or rebleeding, 2) Third week delayed intervention associated with this drug significantly reduced the operative mortality, but probably favoured vasospasm, and finally had no beneficial effect on the overall results concerning the entire series of patients.

Adult↗
PubMed1985

Dilatation of the subarachnoid pericerebral space and absorption of cerebrospinal fluid in the infant.

The authors investigated intracranial pressure, resistance to cerebrospinal fluid (CSF) absorption following ventricular infusion and radiopharmaceutical absorption of radionuclide injected into the ventricles in two infants with dilatation of the subarachnoid pericerebral space. The results of this study showed an increased resistance to CSF absorption. Intraspinal CSF absorption was seen to predominate, as shown by isotopic cisternography.

Cerebrospinal Fluid↗
PubMed1984

[Plateau wave, unexpected cause of anoxo-ischemic syncope. Reflections on the pathogenesis of the plateau wave apropos of a case].

The case of a 56 year old female suffering from a carcinomatous meningitis with recurrent attacks of unconciousness is presented. The ischemic nature of the attacks was substantiated through a simultaneous recording of ICP, systemic arterial blood pressure, and EEG. Every syncope was clearly accompanied by 1) a typical ICP plateau-wave, 2) a systemic blood pressure wave of lower amplitude, 3) a considerable correlative diminution of the cerebral perfusion pressure and 4) a slowing down of the EEG. These phenomenons could be provoked by intraventricular injections of a few milliliters of artificial CSF, whereas a ventriculo-peritoneal shunting made them disappeared. The role played by the disturbances of the CSF flow in the production of the plateau waves is discussed.

Blood Pressure↗
PubMed1984

[Fractures of the posterior arch of C2. Apropos of 34 cases].

The authors preferred the term of "fracture of the posterior arch of the axis", rather than the restrictive terms of bipedicular or bi-isthmic fractures commonly referred to in the literature. It was possible, from 34 cases to joint out 4 different figures of fractures of the posterior arch of axis: isthmus, body and articular process, pedicle and lamina. From this classification it is possible to get indications for surgical treatment, as some of those fractures need internal fixation and others not. On completing Xrays study with research of instability between C2-C3 it's possible to fix a standard management for those fractures. --at first reduction for many patients, then --immobilisation by a minerva cart in mostly cases --or surgical approach and internal fixation in case of diastasis or of bad reduction --anterior arthrodesis if needed (anterior instability) --or both posterior fixation and anterior arthrodesis.

Adult↗
PubMed1983

[Slit-ventricle. Apropos of 2 cases].

The so called slit-ventricle syndrome appears as a potential complication of the CSF derivations, whatever their types. It consists of repetitive episodes of elevated intracranial pressure, associated with collapsed ventricles as demonstrated by CT scan. Clinical symptoms happen after several months or years during which the derivation worked well, and then get more and more frequent. Between the episodes, the only statement one can do is the slow re-filling of the pump after it has been depressed with finger. The valveless lumbo-peritoneal derivations, and the ventriculo-atrial or ventriculo-peritoneal derivations using a low-pressure valve, are most often found in patients with the slit-ventricle syndrome. This suggests that overdrainage of the CSF is likely to be the main cause of this syndrome. Possible managements comprise: changing the valve, for an other one with a higher opening pressure,--adding to the derivation an antisyphon device, and making a subtemporal decompression.

Cerebral Ventriculography↗
PubMed1981

Benign intracranial hypertension and disorders of CSF absorption.

Sixteen patients suffering from benign intracranial hypertension were studied by a continuous measurement of intraventricular pressure, a simultaneous recording of intraventricular and sagittal sinus pressures, and a measurement of the cerebrospinal fluid (CSF) resistance to drainage. Isotope cisternography was performed and the patency of the dural sinuses verified by direct sinography or phlebography or both. The same procedure was used to study 6 other patients suffering from disorders leading to the same type of intracranial hypertension. In 16, our results confirm a defect in CSF absorption mechanisms linked to an abolition of the pressure gradient between CSF and sagittal sinus in 6 patients, as well as an important increase in CSF resistance to drainage in 10 others. Despite this defect, the CSF circulation was normal in most patients (10 of 12) as demonstrated by isotope cisternography.

Absorption↗
PubMed1981

[Comparative trial of a new epidural transducer for intracranial pressure monitoring (author's translation)].

The measurement of intracranial pressure using a new epidural pressure transducer has been compared with the classical method of measuring intraventricular pressure. Comparative measures in vitro have been carried out with acid of an enclosure in which the hydrostatic pressure can be varied. Four positions of the epidural transducer with the respect to the dura mater have been studied; of these, only one, coplanarity between the epidural transducer and the dura, gives an excellent correlation between values of epidural pressure and hydrostatic pressure. Twenty-nine prolonged recordings have been carried out in vivo. Fifteen of these have given comparable recordings for E.D.P. and I.V.P. In the other fourteen cases the recordings were considered non comparable, either because of a significant difference between the average values of E.D.P. and P.I.V. or because the two curves were not parallel. It is considered that these differences are due to the problems of correctly positioning the epidural pressure transducer and hence an inability to achieve the condition of coplanarity. These problems should be resolved by a modification of the method of positioning the epidural pressure transducer. The use of this type of materiel is of interest for the monitoring of the I.C.P. of neurosurgical patients, as the epidural pressure follows the variations of I.C.P. and indicates pressures waves when they exist.

Epidural Space↗