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Biomedical subjects

C Adam

Publications and source records attributed to C Adam.

At least 73 records · Page 4Linked to original sources
PubMed1998

Is the underlying cause of epilepsy a major prognostic factor for recurrence?

BACKGROUND: We investigated the prognostic value of the type of epilepsies and epileptic syndromes for seizure recurrence. In patients with partial epilepsy, we focused on the prognostic value of any structural brain abnormality and of the location of the epileptogenic region. METHODS: A total of 2,200 adult outpatients were included in a hospital-based observational survey, with a follow-up of 1 to 7 years. Twenty-two percent of the patients exhibited generalized epilepsy, 62% partial epilepsy, and 16% undetermined epilepsy. RESULTS: Seizure control (>1 year without seizure) was achieved in 82% of patients who had idiopathic generalized epilepsy, 35% of those with symptomatic partial epilepsy, 45% of those with cryptogenic partial epilepsy, and 11% of those with partial epilepsy associated with hippocampal sclerosis (HS). Temporal lobe epilepsy (TLE) was the most refractory partial epilepsy, with only 20% of such patients remaining seizure free, compared with 36% of extra-TLE patients. In partial epilepsy, HS, cerebral dysgenesis, and dual pathology (HS and another lesion) were associated with a low rate of seizure-free patients (11%, 24%, and 3%, respectively). No significant difference in seizure control was found between patients with extra-TLE and those with TLE and no HS. CONCLUSIONS: In adults, partial epilepsy is more difficult to treat than idiopathic generalized epilepsy. In patients who have partial epilepsy, the location of the epileptogenic zone does not seem to be a determining factor. Brain abnormalities--especially HS, either alone or associated with another lesion--are a major prognostic factor.

Adolescent↗
PubMed1998

[Therapy outcome in stage III (FIGO) ovarian carcinomas at the Leipzig University Gynecologic Clinic 1976-1982 and 1985-1991].

This retrospective study compares treatment results (median survival time, 5-year survival rate) of 153 patients diagnosed with FIGO stage III ovarian cancer treated between 1976 to 1982 (n = 73) and 1985 to 1991 (n = 80) respectively. Between 1976 to 1982, the median survival time was 12.3 months, while it increased up to 17.0 months during the period of 1985-1991. The 5-year survival rate increased from 14.0% to 28.0%. This improvement may be due to a more radical surgical approach and the use of platinum-based first-line chemotherapy. However, the difference between the two groups was not statistically significant.

Adult↗
PubMed1997

Temporal patterns in human epileptic activity are modulated by perceptual discriminations.

We studied subdural recordings from a patient with an unusually focal and stable occipito-temporal epileptic discharge under four experimental conditions. The series of time intervals between successive spike discharges displayed a few (3-5) clusters of periodic values representing statistically significant short-term periodicities when tested against surrogate data. This short-term predictability was modulated during the different experimental conditions by periodicity shifts of the order of 15-30 ms. Correspondingly, there was an increased gamma-band (30-70 Hz) coherence between the epileptic focus and surrounding recording sites. We conclude that the focal epileptic activity is part of an extended network of neural activities which exert a fast modulation reflected in changes of transiently periodic activities.

Adult↗
PubMed1997

Dipole modelling and intracranial EEG recording: correlation between dipole and ictal onset zone.

This study includes 11 patients (3 males, 8 females) with mean age of 29 years (range: 15-42 years) who underwent a presurgical evaluation for refractory complex partial seizures (CPS). In all patients, neuroimaging (1.5 T optimum-MR) demonstrated intracranial structural abnormalities (space-occupying: n = 2; atrophic: n = 8; dysplastic: n = 1) and video-EEG monitoring showed CPS, because of discrepancies in the non-invasive examinations, all underwent additional intracranial EEG monitoring. After tailored resective procedures, all but one patient became seizure free. Mean follow-up was 30 months (range: 12-52 months). Results of intracranial EEG recording were compared with spatiotemporal dipole mapping of interictal and ictal epileptic discharges. Interictal dipole modelling revealed two distinct dipole patterns. Patients with lesions located in the medial temporal lobe uniformly presented a combined dipole that consisted of a radial and a tangential component with a high degree of elevation relative to the axial plane. Patients with extrahippocampal lesions had a less stable dipole with a predominant radial component. Dipole modelling of early ictal discharges revealed a striking correspondence with the interictal findings in individual patients. Elevation of ictal dipoles was always congruent with localisation based on intracranial EEG recordings. Interictal and ictal dipole mapping of medial temporal lobe sources may limit the number of surgical candidates for refractory CPS that need intracranial EEG recording. Whether ictal dipole modelling can be equally useful in extratemporal epilepsy remains to be proven.

Adolescent↗
PubMed1997

60Co transfer from water to the rainbow trout (Oncorhynchus mikiss Walbaum).

60Co uptake from natural water, release and tissue distribution were investigated in the rainbow trout (Oncorhynchus mikiss), which is representative of the third order consumers of the freshwater trophic chains. The experiments were carried out on two groups of fingerling trout placed in 0.45 microm filtered river water, maintained at 12 +/- 0.5 degrees C, contaminated with about 30 Bq ml-1 of 60Co and renewed three times a week. After a 8-week exposure phase, the fish of one group were dissected to determine the contamination of the tissues and organs and the distribution of the accumulated 60Co. The fish of the other group were placed in non-contaminated water, renewed daily, to monitor radionuclide release. After a 42-day depuration phase, the specimens were dissected to study the tissue distribution of the residual 60Co.60Co accumulation from water by trout can be described by a one-compartment exponential model. The concentration factor, calculated from the ratio of the radionuclide concentration in filtered water and in the fish, reached a maximum value of 4.6 (w.w.) after 30 days exposure. After the 42-day depuration phase, the fish retained about 29% of the accumulated radionuclide. A single-compartment exponential model was fitted to the 60Co elimination data, and the corresponding radionuclide half-life was 21 days. At the end of the exposure phase, tissue contamination study showed 60Co accumulation by the gills, viscera (air bladder, heart and spleen) and kidneys, to be the highest. At the end of the depuration phase, the kidney was the most contaminated organ, followed by the viscera, head, gills, and liver. In both cases, 60Co concentration was by far the lowest in the muscle, which accounted for about 45% of the total body weight and only 20% of the total radionuclide body load.

Animals↗
PubMed1997

Non-invasive determination of cartilage thickness throughout joint surfaces using magnetic resonance imaging.

Data on articular cartilage thickness in the living are important for the design for computer models, aimed at preoperatively assessing the effect of surgical procedures on joint contact and load transmission, and for the calculation of cartilage material properties from its deformational behavior as determined during arthroscopy. A non-invasive method for measuring cartilage thickness in living subjects is, however, not available. A technique based on magnetic resonance imaging has therefore been tested for assessing articular cartilage thickness throughout joint surfaces. The accuracy is determined by comparing cartilage thickness maps obtained from three patellar specimens with a fat-suppressed three-dimensional gradient-echo sequence (resolution 2 x 0.31 x 0.31 mm) to those obtained with CT arthrography, A-mode ultrasound and anatomical sections. The distribution patterns are quantitatively compared using image analysis. The highest agreement was obtained for MRI and the sections (50% identical pixels), but all techniques yielded very similar results. On average, MR slightly underestimated the cartilage thickness compared with CT and the sections, and overestimated it compared with ultrasound. No evidence of differences in the degree of similarity could be detected in areas of thin and thick cartilage. We conclude that, if the resolution and accuracy of the method presented are considered acceptable, MRI is available for repeatable determination of topographical maps of articular cartilage thickness in living subjects. These data can be used to determine joint contact and stress in computer models and to calculate cartilage material properties in vivo.

Adult↗
PubMed1997

Uptake from water, release and tissue distribution of 54Mn in the Rainbow trout (Oncorhynchus mikiss Walbaum).

As part of a research programme on the transfer of several radionuclides along a pelagic trophic chain, two groups of 12 trout were kept for 8 weeks in water contaminated with 30 Bq ml(-1) of (54)Mn. In order to simulate chronic contamination and limit alterations in the physical and chemical characteristics of the medium, the water was renewed every 2 days. The kinetics of the accumulation and elimination of the radionuclide were monitored in one group of fish. The second group was used to study the contamination of the main organs and tissues at the end of the accumulation phase. The dynamics of contamination can be described by a bi-compartmental model, taking into account the fluctuations in the concentration of (54)Mn in the water, as well as the biological dilution resulting from the growth of the fish. The theoretical value of the steady-state concentration factor for zero growth is 13 (w.w.) and the radionuclide release is characterised by two biological half-lives of 6 and 97 days. At the end of the accumulation phase, the (54)Mn is preferentially fixed in the bone, gills, skin and brain. The data obtained at the end of the depuration phase allow one to classify the organs in two groups with different elimination kinetics. The first group consists of organs of penetration or transit, such as the skin, gills, kidneys, liver, primary and secondary gut and viscera, whereas the second group is made up of the receptor and storage organs and tissues such as the bone, head, fins and muscle.

Journal Article↗
PubMed1997

Dipole modeling in epilepsy surgery candidates.

PURPOSE: The validity and clinical significance of dipole modeling in epilepsy surgery candidates is not fully established. PATIENTS AND METHODS: Interictal and ictal dipole modeling was performed in 43 patients with refractory complex partial seizures (CPS) and intracranial structural abnormalities demonstrated with optimum magnetic resonance imaging (MRI: space-occupying, n = 15; atrophic, n = 26; dysplastic, n = 2). Video-EEG monitoring showed CPS in all patients. In 12 patients, additional intracranial EEG monitoring demonstrated hippocampal seizure onset in 11 patients and medial occipital ictal onset in 1. RESULTS: Spatiotemporal dipole mapping of averaged interictal spikes and epochs of early ictal discharges revealed two distinct dipole patterns. Patients with lesions located in the medial (+/-lateral) temporal lobe (n = 34) and medial occipital lobe (n = 1) uniformly presented a combined interictal dipole that consisted of a radial and a tangential component with a high degree of elevation relative to the axial plane. Eight of 9 patients with extratemporal lesions had a less stable dipole with a predominant radial component. Ictal dipole modeling identified the ictal onset zone correctly as compared with intracranial EEG recordings from bilateral hippocampal depth electrodes. Ictal dipoles showed a striking correspondence with the interictal dipoles in individual patients. CONCLUSIONS: Interictal and ictal dipole mapping provided additional, reliable, and relevant localizing information in surgical candidates for refractory CPS. Ictal dipole analysis may limit the number of patients who require intracranial electrodes.

Adolescent↗
PubMed1997

Quantitative analysis of incongruity, contact areas and cartilage thickness in the human hip joint.

Joint incongruity and cartilage thickness have been shown to determine the contact stresses and the load partitioning between the solid and fluid phases of articular cartilage. Matrix stresses, which are relevant in the development of osteoarthrosis, can, however, not be determined experimentally but must be calculated using numerical methods. The aim of the present study was to quantify the incongruity and cartilage thickness of the human hip, in order to allow for the construction of morphologically accurate finite element models. Twelve cadaveric specimens (34-86 years), two fresh and ten fixed, were investigated. The loading configuration was based on in vivo measurements of hip joint forces during midstance. The incongruity and contact areas were determined using a polyether casting technique, in the minimally and the fully loaded state. The cartilage thickness was measured at identical coordinate points with an A-mode ultrasonic system. Generally, the contact started at lower loads at the edge of the lunate surface, and the joint space increased towards its central aspects. In some specimens the contact started in the acetabular roof, leaving a joint space of up to 2 mm in the horns of the lunate surface. In others, the initial contact was observed in the anterior and posterior horns of the lunate surface with a joint space width of up to 0.75 mm in the acetabular roof. The size of the contact areas increased from about 20% of the lunate surface to 98% at higher loads. The articular cartilage thickness ranged from 0.7 to 3.6 mm, the maxima being located in the ventral aspects of the femoral head and acetabulum. These quantitative data on joint space width, contact, and cartilage thickness in the human hip joint may be used to construct and validate finite element models which are required to elucidate the mechanical factors involved in osteoarthrosis.

Adult↗
PubMed1997

[Strategy of evaluation and surgical results in medial temporal lobe epilepsy].

To analyse the presurgical evaluation process of mediotemporal lobe epilepsy (MTLE) in relation to electroclinical characteristics of the patients, we reviewed the presurgical data (clinical, EEG, neuropsychological, MRI, FDG-PET and sometimes intracranial EEG) and the post-operative results of 53 consecutive cases treated by antero-medial temporal resection for MTLE (without lesion other than mediotemporal sclerosis). Forty one patients (77 p. 100) had a typical and well-lateralised presentation and were operated without invasive procedure. Twelve patients (23 p. 100) presented less pure data: unusual or absent auras, divergent scalp EEG features (bitemporal, widespread or extratemporal) or absence of MRI-based hippocampal sclerosis or FDG-PET hypometabolism. They were explored by invasive monitoring which confirmed the medial temporal origin of seizures. Outcome (follow-up: 30 months) was excellent in 88 p. 100 of the pure cases (Engel's class I) and less favorable in the more difficult ones (50 p. 100 of class I). In conclusion, the diagnosis and surgical treatment of MTLE can be performed without invasive investigations in the majority of cases owing to the strong contribution of brain imaging and video EEG monitoring. Some patients however present a less pure presentation suggesting more complex epileptogenic networks and associated to relatively less favorable postsurgical results.

Adult↗
PubMed1996

Inhibition of neutrophil elastase by the alpha1-proteinase inhibitor-immunoglobulin A complex.

Neutrophil elastase is thought to be involved in cartilage destruction occurring in rheumatoid arthritis despite the local presence of alpha1-proteinase inhibitor. Part of synovial fluid alpha1-proteinase inhibitor forms a mixed disulfide with immunoglobulin A, which has been postulated to lack inhibitory activity. We show here that the immunoglobulin-inhibitor complex tightly inhibits neutrophil elastase and cathepsin G, bovine pancreatic trypsin and chymotrypsin, and porcine pancreatic elastase. Although the rate constant of inhibition of neutrophil elastase by immunoglobulin A-bound alpha1-proteinase inhibitor (k(ass) = 9.2 X 10(5) M(-1) x s(-1)) is about 10-fold lower than that measured with the free inhibitor, it is high enough to enable efficient inhibition of elastase in vivo.

Blotting, Western↗
PubMed1996

Variability of presentation in medial temporal lobe epilepsy: a study of 30 operated cases.

INTRODUCTION: To evaluate the homogeneity of patients operated on for MTLE. MATERIAL AND METHODS: 30 consecutive patients prospectively investigated with clinical, EEG, neuropsychology, MRI, FDG-PET criteria and eventually intracranial EEG, who underwent antero-medial temporal resection (follow-up: 24 months). RESULTS: Clear and well-lateralised MTLE was non-invasively ascertained in 22 patients (73%). Eight patients (27%) had a less pure presentation due to divergent scalp EEG features (bitemporal, widespread or extratemporal), unusual auras or absence of MRI-based hippocampal sclerosis or FDG-PET hypometabolism. They were explored by invasive monitoring which confirmed medial temporal origin of seizures. Outcome was excellent in 95% of the pure cases (Engel's class I) and less favorable in the more difficult ones (65% of class I). CONCLUSIONS: MTLE criteria, including the strong contribution of brain imaging, permit to select accurately a large percentage of patients. However a consistant number of patients present a less pure presentation suggesting more complex epileptogenic networks.

Adolescent↗
PubMed1994

Value of magnetic resonance imaging-based measurements of hippocampal formations in patients with partial epilepsy.

OBJECTIVE: To determine the occurrence of magnetic resonance imaging-detected hippocampal atrophy (HA) in patients with partial epilepsy (temporal and extratemporal, cryptogenic, or symptomatic). Magnetic resonance imaging-detected HA has been demonstrated to be both sensitive and specific for hippocampal sclerosis in cryptogenic temporal lobe epilepsy. DESIGN: Patients' hippocampal formations were measured on a computerized system using T1-weighted, 5-mm contiguous magnetic resonance coronal images made perpendicular to the hippocampus long axis. Hippocampal atrophy was defined on the basis of a normative asymmetry index and correlated with the epileptogenic focus defined by clinical, electroencephalographic, and magnetic resonance imaging (apart from HA) localizing data. PATIENTS AND CONTROL SUBJECTS: Seventy patients with intractable complex partial seizures of temporal, extratemporal, or undefined origin and 21 healthy control subjects. RESULTS: Hippocampal atrophy was present in 70% of patients with cryptogenic temporal lobe epilepsy (TLE) (n = 40), 44% of patients with symptomatic TLE (n = 9), 29% of patients with extratemporal epilepsy (n = 14), and 6% of unclassified patients (n = 16). In the cryptogenic TLE category, HA was marked and usually concordant (93%) with electroencephalographic lateralization. Hippocampal atrophy was often mild in the extratemporal epilepsy category. With the use of a wider confidence interval (+/- 3.1 SD instead of +/- 2.2 SD), HA specificity for TLE increased to 93%, HA specificity for lateralizing cryptogenic TLE reached 96%, and HA sensitivity for cryptogenic TLE stood almost unchanged (68%). We found a link between early convulsions and HA occurrence. CONCLUSIONS: Hippocampal atrophy is a marker for TLE. Dual pathologic findings are detected in 44% of symptomatic TLE cases. Mild HA is rarely associated with extratemporal epilepsy. Magnetic resonance imaging-based hippocampal volumetric analysis is a useful method to localize the origin of partial complex seizures.

Adult↗
PubMed1991

Twin delivery: influence of the presentation and method of delivery on the second twin.

To ascertain the perinatal mortality and morbidity in the second twin as related to its presentation and method of delivery, we reviewed the data on 578 sets of twins delivered from 1980 to 1987 and included 397 sets in whom both twins were greater than or equal to 1000 gm, without lethal anomalies, and in whom the first twin presented as a vertex. The perinatal outcome comparing twin A (all vertex) with twin B (vertex or nonvertex) with cesarean section or vaginal delivery was analyzed. No statistically significant difference in perinatal mortality or morbidity was found in comparing the nonvertex second twin delivered vaginally or by cesarean section. The one perinatal death and significant perinatal morbidity occurred in infants weighing less than 1500 gm or at less than 32 weeks' gestational age. It is concluded that vaginal delivery, irrespective of the position of the second twin, is valid in selected cases as long as fetal weight is greater than 1500 gm and the gestational age is greater than or equal to 32 weeks.

Birth Order↗
PubMed1990

[Clinical application of grafts of cultured epidermis in burn patients. Apropos of 16 patients].

The authors report a series of 16 patients with extensive burns partially treated by epidermal culture between May 1985 and July 1988. This series consisted of 9 males and 7 females between the ages of 6 and 88 years (mean age: 34 years). The mean surface area of the burns was 66% (range: 30% to 92%). The technique of epidermis culture used was derived from that developed by Green and Rheinwald. A fragment of full-thickness skin taken from the patient was subjected to the action of trypsin. The keratinocytes were cultured on nutrient layers of 3T3 cells. After 10 days, the secondary cultures corresponded to stratified squamous epithelium with a differentiation similar to that of normal human epithelium. This cultured epithelium was used for autografts as well as allografts. Three deaths were related to septic or metabolic complications of the burn. The take rate of the initial graft was greater than 50% in 9 patients. In 3 patients the graft take rate was less than 50% and in 4 patients it was nil. The long-term evaluation of 12 patients revealed partial lysis of the grafts in 3 patients, a stable result in 6 patients and a healed surface greater than the grafted surface in three cases. The best results were obtained with autografts. The initial evaluation of taking of the graft is difficult, as the fine and shiny texture of the grafts is sometimes difficult to distinguish from non-covered zones. The good tolerance of cultured epidermis allografts is due to the fact that they are devoid of Langerhans cells. Although controversial, the reality of the taking of these allografts opens the way to establishing epidermis culture banks.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗