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Biomedical subjects

E Cuny

Publications and source records attributed to E Cuny.

At least 19 recordsLinked to original sources
PubMed2006

Side-effects of subthalamic stimulation in Parkinson's disease: clinical evolution and predictive factors.

Chronic bilateral high-frequency stimulation of the subthalamic nucleus (STN) is an alternative treatment for disabling forms of Parkinson's disease when on-off fluctuations and levodopa-induced dyskinesias compromise patients' quality of life. The aim of this study was to assess the evolution of side-effects during the first year of follow-up and search for clinical predictive factors accounting for their occurrence. We compared the frequency of side-effects at 3 and 12 months after surgery in a cohort of 44 patients. The off-medication scores of Unified Parkinson's Disease Rating Scale (UPDRS) II, III, axial symptoms, disease duration and age at surgery were retained for correlation analysis. Dysarthria/hypophonia, weight gain and postural instability were the most frequent chronic side-effects. Whereas dysarthria/hypophonia remained stable over time, weight gain and postural instability increased during the first year post-op. High axial and UPDRS II scores at surgery were predictive of dysarthria/hypophonia. Age and axial score at surgery were positively correlated with postural instability. Despite the occurrence of side-effects, the benefit/side-effects ratio of STN stimulation was largely positive during the first year of follow-up. Age, intensity of axial symptoms and UDPRS II off-medication score before surgery are predictive factors of dysarthria/hypophonia and postural instability after surgery.

Aged↗
PubMed2005

Evolution of postural stability after subthalamic nucleus stimulation in Parkinson's disease: a combined clinical and posturometric study.

OBJECTIVES: The occurrence of postural and balance disorders is a frequent feature in advanced forms of Parkinson's disease (PD). However, the pathological substrate of these disturbances is poorly understood. METHODS: In the present work, we investigated the evolution of posturometric parameters [center of pressure (CoP) displacement and CoP area] and axial scores between the pre-operative period and 3 months post-operative in seven PD patients who underwent bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN). RESULTS: After surgery, the patients leaned backwards much more regardless of the STN stimulation, suggesting that surgery could have a deleterious effect on postural adaptation. During the post-operative period, the improvement in axial and postural scores was similar under levodopatherapy and DBS. On the other hand, DBS of the STN significantly reduced the CoP displacement and the CoP area, whereas levodopatherapy tended only to reduce the CoP displacement and to increase the CoP area significantly. CONCLUSIONS: These data suggest that DBS of the STN and levodopa do not act on the same neurological systems involved in posture regulation. DBS of the STN could improve posture via a direct effect on the pedunculopontine nucleus, which is known to be involved in posture regulation.

Adult↗
PubMed2003

[Botulinum toxin and traumatic brain injury].

Botulinum toxin is a successful focal spasticity therapy. The aim of this article is to study the data of the literature concerning its utilisation in traumatic brain injured patients, whom motor and tonus disturbances are polymorphic, in their clinical presentation as well as in their evolution. Although there are few studies concerning its utilisation in such patients, none of them being controlled, its use seems interesting in focal spasticity treatment. It can contribute to improve functional abilities and comfort for these patients.

Anti-Dyskinesia Agents↗
PubMed2003

[Intrathecal baclofen and traumatic brain injury. A review].

Severe head injury can induce hypertonia. There are two kinds of hypertonia related to severe injury. The most common one is a spasticity that occurs a long time after the head injury; the second is hypertonia that occurs during the early stage of the post-trauma recovery. Hypertonia is associated with other symptoms and defines post-trauma dysautonomia. Intrathecal baclofen can alleviate spasticity in severe head injury with improvement of the Ashworth score, spasm score or reflex score. But it also improves the number of paroxymal dysautonomic episodes. Real functional improvement is more difficult to show. To be effective, intrathecal baclofen therapy in brain injured patients needs high doses per day, through a spinal catheter in the mediothoracic region, and delivered at least continuously for a few hours to achieve a functional improvement.

Baclofen↗
PubMed2002

Minimal tissue damage after stimulation of the motor thalamus in a case of chorea-acanthocytosis.

Autopsy findings are reported from a patient with chorea-acanthocytosis treated for 2 years by deep brain stimulation (DBS) of the motor thalamus. Postoperative testing showed a progressive improvement in axial truncal spasms. Although relatively high currents were used for 2 years in this patient, postmortem analysis showed minimal tissue damage in the vicinity of the electrode tip. It is concluded that DBS has little impact on the surrounding tissues.

Adult↗
PubMed2002

Improvement of severe trunk spasms by bilateral high-frequency stimulation of the motor thalamus in a patient with chorea-acanthocytosis.

We report on a patient with a severe form of chorea-acanthocytosis, intractable to medical treatment, who benefited from bilateral high-frequency stimulation (HFS) of the posterior ventral oral nucleus of the thalamus. The frequency of trunk spasms dramatically decreased after surgery and the clinical benefit remained stable 1 year later. However, no clear effect was observed on dysarthria nor on hypotonia, which always impaired gait. We propose that HFS of the motor thalamus is a potential treatment for choreic or truncal dystonic symptoms whenever hypotonia is not the main feature of the syndrome.

Adult↗
PubMed2002

Nodular intracerebral lesions can reveal an asymptomatic systemic lymphoma.

OBJECT: To investigate whether a systemic workup is useful to assess the primary or secondary nature of brain lymphoma in immunocompetent patients suffering from nodular intracerebral lesions. METHODS: We retrospectively studied a consecutive series of 62 immunocompetent patients suffering from non-Hodgkin's brain lymphoma and analyzed two parameters: (1) the results of a partial systemic workup and (2) the pattern of relapse for all patients who are currently followed up or were so until death. RESULTS: The workup was conducted with chest X-ray and blood analysis in all cases, total body CT scan in 31 cases, bone marrow biopsy in 30 and serum lactate dehydrogenase in 29. Asymptomatic systemic lymphomatous lesions were found in 9.6% of the cases (n=6/62). Two were nodal lymphomas and four were extranodal (maxillary sinus, testis, cutaneous and osseous). No systemic localization was observed during the follow-up of patients in whom the primary nature of the lymphoma was assessed after their initial negative workup (56/62). In this group, all relapses occurred within the central nervous system, even in those exclusively treated with cerebral radiotherapy (29/56). CONCLUSIONS: Our results indicate that nodular intracerebral lesions can reveal asymptomatic systemic lymphoma. When brain lymphoma is suspected or diagnosed, systemic workup including clinical, biological and radiological examinations is mandatory before assessing the primary or secondary nature of the disease. Node areas, skin, testis, Waldeyer's ring and adjacent structures are of special interest and should be carefully explored.

Adult↗
PubMed2002

[How can we define the modalities and clinical levels of coma to wakefulness?].

OBJECTIVE: The starting point of the French conference of consensus concerning arousal after coma was to answer the following question: "How can we define the ways of going from coma to arousal and their clinical levels? MATERIALS AND METHOD: A team of readers have picked up in the literature one hundred and fifty papers, out of which fifty six have been analysed. RESULTS: From this analysis, three points emerged: The concepts of coma and arousal; The conditions of evolution from coma to arousal; Various groups of patients depending on their expressing arousal. One could not find any consensual model concerning the different ways of going from coma to arousal. The variability of the technics and the changing validity of all scores did not allow the conditions of arousal to reach a satisfactory level of proof. The Glasgow Coma Scale (GCS) is the recognised standard for severe wakefulness' impairment, but it is not sensitive enough while patients' arousing. The Glasgow Outcome Scale (GOS) takes into account the patients' situations far later and does not include situations such as Minimally Conscious States (MCS). That's why we face multiple scores, either ordinal, or categorial, all tending to evaluate the slow levels of arousal. CONCLUSION: Clinical findings concerning arousal are to be completed by non-clinical data. This would be greatly helpful to define appropriate management concerning individualized groups of patients. At this stage, another challenge for clinicians is to make the difference between emerging wakefulness and growing conscious activity.

Coma↗
PubMed2001

Dysautonomia syndrome in the acute recovery phase after traumatic brain injury: relief with intrathecal Baclofen therapy.

In the initial phase of severe head injury, dysautonomic abnormalities are frequent. Within the framework of a prospective study, evaluating the efficacy of continuous intrathecal Baclofen therapy (CIBT) on hypertonia during the initial recovery phase of severe head injury, the authors report on the preliminary results of this treatment on paroxysmal dysautonomia about four patients. Continuous intrathecal Baclofen infusion was first delivered, for a test period, continuously for 6 days. If a relapse of dysautonomia occurred at the end of the test period, an implantation of a continuous intrathecal infusion pump delivering Baclofen was performed. Results were assessed with four continuous variables; duration (days), dose of Baclofen per day (microg/d), number of dysautonomic paroxysmal episodes per day, and initial recovery evaluated by a scale of the first initial stages of head injury coma recovery. For three patients: (1) the number of dysautonomic paroxysmal episodes per day and the doses of Baclofen during the follow-up period were correlated (p = 0.02, p < 0.001, p = 0.008, respectively, distribution-free test of Spearman), (2) during the test period and the relapse after the test period, the number of paroxysmal episodes and the Baclofen dose are correlated to p < 0.05, p = 0.03, p = 0.04, respectively (distribution-free test of Spearman). The second statistical test was used to prove that Baclofen doses and number of paroxysmal dysautonomic episodes are correlated independently of the duration of follow-up. The fourth patient improved with CIBT without any recurrence at the end of the treatment test period. For the four patients, recovery score increased during the overall follow-up. In the authors' experience CIBT is very efficient to control paroxysmal dysautonomia during the initial recovery phase in severe head injury, and seems to facilitate recovery.

Acute Disease↗
PubMed2001

Monitoring external forces that affect the practice of dentistry.

Dealing with the varied and often changing requirements and regulations that affect every dental practice can be a daunting task for the dentist and dental staff. Knowing how and where to access accurate and timely information provides relief for the busy dental professional. This article explores the impact of regulatory mandates and government agency standards on dentistry and provides suggestions for simplifying the search for reliable information.

California↗
PubMed2001

[Physiopathology of chronic subdural hematoma].

Coagulation, fibrinolysis and kinin-kallicrein system disorders could explain chronic subdural hematoma pathophysiology. The marked decrease in antithrombin III in the hematoma suggest that the decreased levels of clotting factors were caused by excessive coagulation resulting in clotting factors consumption. The decrease in alpha 2-antiplasmin with the increase of fibrin degradation products suggest that hyperfibrinolytic activity of the subdural hematoma. Coagulation and fibrinolysis disorders could explain repetitive hemorrhages from the outer membrane, which cause progressive enlargement of the hematoma. Kinin-kallicrein system disorders raise the hemorrhage by its action on the outer membrane. Nowadays, the earliest osmotic theory should reasonably be abandoned.

Blood Coagulation Factors↗
PubMed2000

Dental safety needles' effectiveness: results of a one-year evaluation.

BACKGROUND: Some government agencies and state legislatures recently have passed regulations mandating the use of safety-enhanced devices, including dental anesthetic safety needles. Little information exists, however, on the efficacy and utility of these types of needles currently on the market. METHODS: The authors evaluated four types of dental safety needles and syringes for clinical acceptability. Two of these devices were deemed unacceptable owing to inherent features identified during the bench test. The remaining two devices were clinically evaluated using an 11-statement survey. Senior dental students completed the survey at one, two, four, five, six and eight weeks from introduction of the devices to a dental school clinic. Junior dental students joined the senior students using one of the devices for the last six months of the evaluation and joined the senior students in completion of a final survey at 52 weeks. RESULTS: The survey results indicated increasing user dissatisfaction with nine of the safety device features evaluated over the 52 weeks. At eight weeks, use of one of the two devices was discontinued owing to poor clinical performance. A review of the blood exposure incident reports that routinely are collected following an exposure incident revealed a small increase in exposures involving anesthetic needles. The sample size was too small to determine statistical significance of the change in injury rate, but it did show that needlesticks continue to occur in spite of the use of safety devices. CONCLUSIONS: None of the safety devices tested successfully passed the clinical evaluation. Continued evaluation is necessary to ensure that effective safety devices are available to dental practitioners. CLINICAL IMPLICATIONS: Evaluators had significant concerns about the usability of dental safety needles and their ability to adapt to using them effectively. Results of a review and bench tests indicate that the devices tested are no safer than traditional anesthetic needles.

Accidents, Occupational↗
PubMed2000

OSHA 2000: a review of compliance issues.

The California Occupational Safety and Health Administration is responsible for enforcing worker safety regulations in the state of California. The infection control regulation, while the best known to dentists, is only one of many that affect every dental practice. The past two years have brought significant changes to Cal/OSHA rules. This paper reviews some of the current regulations that apply to dental offices.

Blood-Borne Pathogens↗
PubMed1998

Occupational exposure to blood and body fluids: new postexposure prophylaxis recommendations. United States Occupational Safety and Health Administration.

Dental health care professionals continue to suffer exposure incidents from instruments contaminated with blood and/or body fluids from patients. Each of these cases requires that a rigid protocol be followed for their evaluation. New information regarding the risk factors for HIV-seroconversion following an exposure incident have been identified. Recent data has demonstrated that a 79 percent reduction in disease transmission may be possible with a new combination drug therapy. The anti-retroviral drugs included in this new regimen are now standard in the management of occupational exposure to HIV. Several factors set dentistry apart from other health care occupations, and these differences appear to have an effect on the risks associated with occupational exposures. This article explores these risk factors and the new recommendations for postexposure care.

Anti-HIV Agents↗