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Biomedical subjects

E Melon

Publications and source records attributed to E Melon.

At least 19 recordsLinked to original sources
PubMed1996

[Pharmacological treatment of vasospasm in subarachnoid hemorrhage].

Pharmacological treatment of vasospasm in subarachnoid haemorrhage (SAH) is founded on prevention and treatment of arterial narrowing and delayed ischaemic deficits. Safety and efficacy of different agents have been studied and trials classified according to the level of evidence proposed by the "Stroke Council" of the American Heart Association. Early intracisternal fibrinolysis can prevent vasospasm (level III to V of evidence, grade C). Pharmacological treatment is based on few drugs. Nimodipine reduces poor outcome related to vasospasm, but does not affect angiographic vessel caliber (level of evidence I and II, grade A). Its use is strongly recommended. Nicardipine decreases symptomatic and angiographic vasospasm, but does not affect outcome (level of evidence I to V, grade B). Tirilazad associated with nimodipine prevents delayed ischaemic deficits due to vasospasm and improves outcome in male patients. Intra-arterial infusion of papaverine associated with transluminal angioplasty can improve symptomatic vasospasm, resistant to conventional therapy (level of evidence IV to V, grade C). Pharmacological treatment of vasospasm associated with specific management founded on pathophysiology of SAH has improved patients outcome.

Antioxidants↗
PubMed1996

Ruptured fusiform aneurysm of the superior third of the basilar artery associated with the absence of the midbasilar artery. Case report.

A case involving the absence of the midthird portion of the basilar artery (BA) associated with a ruptured fusiform aneurysm of the superior third of the basilar artery discovered after a subarachnoid hemorrhage is reported. Surgical clipping was precluded by the anatomical conditions. The aneurysm was treated by occlusion (surgical clipping and balloon occlusion) of both posterior communicating arteries to decrease the hemodynamic stress on the aneurysm wall. The pericerebellar arterial network was allowed to supply the distal BA and its collateral vessels indirectly. This treatment proved to be efficient; angiography and magnetic resonance imaging demonstrated shrinkage of the aneurysm cavity. The absence of the midthird of the BA is usually associated with a persisting trigeminal artery (nonexistent in this case) or disclosed in cases of acute BA occlusion in dramatic clinical conditions. A similar anatomical feature has been described only once before. There may be a segmental maldevelopment of the longitudinal neural arteries during embryogenesis or a defect in fusion of these paired structures during the development of the BA itself.

Adult↗
PubMed1992

A technique for stereotactic aspiration of deep intracerebral hematomas under computed tomographic control using a new device.

A new device, modified from the Nucleotome (Surgical Dynamics, Alameda, CA), was used for stereotactic aspiration of deep brain hematomas. Real-time monitoring by computed tomography allows a very safe procedure, and the risk of aspirating the surrounding brain is avoided. The technique was applied in 13 cases of deep brain hematomas. The intraoperative computed tomographic scan demonstrated that the mass effect was always immediately improved. Aspiration was stopped when the midline shift disappeared or was dramatically reduced. For most of the cases, a total aspiration of the hematoma was not needed (mean value of the aspiration rate of 71, 5%). No rebleeding and no complication related to the technique was observed. This technique was easily performed in emergency conditions.

Activities of Daily Living↗
PubMed1991

[Anesthesia for thalamic stimulations: value of flumazenil].

Five cases are reported of peroperative awakening in order to obtain patient cooperation during stereotaxic procedures. General anaesthesia was induced with 0.25 mg.kg-1 midazolam, 1.5 to 2 micrograms.kg-1 fentanyl, and 0.1 mg.kg-1 vecuronium. Maintenance was obtained with isoflurane, nitrous oxide, and small doses of fentanyl. Isoflurane inhalation was discontinued 30 to 40 min before the time of awakening required by surgery. Once expiratory isoflurane concentration reached a level less than or equal to 0.1%, nitrous oxide administration was stopped, and 0.5 mg flumazenil administered. After surgical checking, on the fully awake patient of the efficiency of thalamic stimulation and the lack of any motor deficit, anaesthesia was deepened again, with either isoflurane or a non benzodiazepine intravenous agent. All five patients recovered rapidly and calmly.

Adult↗
PubMed1991

[Nitrous oxide in neurosurgery].

Nitrous oxide (N2O) is far from inert in terms of its cerebral effects. It can increase the cerebral blood flow (CBF) and the cerebral metabolic rate for oxygen in animals and in man. In poor risks patients, the N2O may increase the intracranial pressure (ICP) but these effects are blocked by hyperventilation, benzodiazepines, barbiturates and narcotics. N2O is not epileptogenic but modifies evoked potentials. Because of its greater solubility than Nitrogen it can increase ICP, in case of pneumoencephalus and the size and consequences of gazous embolism. In neurosurgical patients, nitrous oxide should be used cautiously in regards of its neurological effects.

Anesthesia, Inhalation↗
PubMed1990

[Physiopathology of meningeal hemorrhage caused by aneurysmal rupture: extracerebral aspects].

Subarachnoid hemorrhage induces a lot of extracerebral disturbances such as: systemic hypertension, electrocardiographic abnormalities both morphological, rhythmic and subendocardial damages; those events have been interpreted as overactivity of the sympathetic nervous system. In biochemical changes, hyponatremia early recognized was referred during a long time to a syndrome of inappropriate secretion of antidiuretic hormone. Hyponatremia is now referred to a cerebral salt-wasting. Hypovolemia often observed supports the use of volemic expansion in the prevention and treatment of ischemic complications associated with ruptured intracranial aneurysms. The hypothalamus which lies in close anatomical proximity to the circle of Willis may be directly influenced by the rupture of a cerebral aneurysm. So, hypothalamic dysfunction may affect pituitary adrenal function sympathetic and parasympathetic activities. The knowledge of all these disturbances, and their mechanisms supports the current strategies for the management of aneurysmal subarachnoid hemorrhage.

Arrhythmias, Cardiac↗
PubMed1990

[Correlations between anatomy and computerized tomography findings in transtentorial cerebral herniation].

The diagnosis of transtentorial brain herniation has long relied on encephalography, then arteriography. Computerized tomography (CT) is a safer method which permits a more precise and earlier visualization of temporal and central herniations and herniation of the culmen cerebelli, which are the three varieties of transtentorial herniation. In an attempt to evaluate the reliability of CT images of herniation, the authors have conducted a study of anatomy-CT correlations, using autopsy specimens of brains with these three types of transtentorial herniation. Temporal herniation was well studied, irrespective of the CT reference plane. Direct visualization of temporal uncus herniation and filling of the homolateral perimesencephalic cistern was regularly obtained. Central herniation was better visualized when the occipito-temporal was used as reference. The disappearance of perimesencephalic cisterns on CT sections through the widest part of the tentorial incisura is the best element of diagnosis. Herniation of the culmen is easily studied on the conventional orbito-meatal plane. Provided CT scans are performed with the technique they recommend, the authors consider that this examination is reliable for the diagnosis of transtentorial herniation. Some variations in the anatomy of the incisura may explain why the clinical consequences of herniation are varied. CT perfectly shows the configuration of this notch and therefore may be helpful in predicting the prognosis.

Brain↗
PubMed1989

Anatomy-computerized tomography correlations in transtentorial brain herniation.

The diagnosis of transtentorial brain herniation has long relied on encephalography, then arteriography. Computerized tomography (CT) is a safer method which permits a more precise and earlier visualization of temporal and central herniations and herniation of the culmen cerebelli, which are the three varieties of transtentorial herniation. In an attempt to evaluate the reliability of CT images of herniation, the authors have conducted a study of anatomy-CT correlations, using autopsy specimens of brains with these three types of transtentorial herniation. Temporal herniation was well studied, irrespective of the CT reference plane. Direct visualization of temporal uncus herniation and filling of the homolateral perimesencephalic cistern was regularly obtained. Central herniation was better visualized when the occipito-temporal plane was used as reference. The disappearance of perimesencephalic cisterns on CT sections through the widest part of the tentorial incisura is the best element of diagnosis. Herniation of the culmen is easily studied on the conventional orbito-meatal plane. Provided CT scans are performed with the technique they recommend, the authors consider that this examination is reliable for the diagnosis of transtentorial herniation. Some variations in the anatomy of the incisura may explain why the clinical consequences of herniation are varied. CT perfectly shows the configuration of this notch and therefore may be helpful in predicting the prognosis.

Autopsy↗
PubMed1988

[Value of a fraction of low molecular weight heparin, enoxaparine, in patients at high risk of hemorrhage and thrombosis].

Treatment of patients with both thromboembolic manifestations and acute bleeding episodes is poorly defined. The use of low molecular weight heparin fractions has been shown to provide prophylactic antithrombotic activity in humans, with the possibility of fewer hemorrhagic complications because of their low anticoagulant activity and weaker action on platelets. An open trial was carried out in 50 patients. 47 of whom had a recent history of thromboembolic accident (34 venous thrombosis, including 13 with pulmonary embolism, 9 systemic arterial episodes, 4 cardiac emboli) and 3 who required prophylaxis. Conventional heparin therapy was contraindicated in all patients: 30 because of major digestive or muscle hemorrhage and 20 with high hemorrhagic risk (neurosurgery, deep thrombocytopenia). Enoxaparine (Laboratoire Pharmuka, Gennevilliers) was administered as 1 mg/kg/24 hours as 2 divided injections with adjustment to maintain an anti-Xa activity of 0.1 to 0.4 IU/ml. Antithrombotic efficacy as function of type of pathology was rated excellent in all patients, while tolerance, evaluated similarly by tests chosen as a function of type of hemorrhage, was good: one patient had moderate bleeding after accidental overdose and 4 patients minor bleeding. Enoxaparine by subcutaneous injection could represent a new therapeutic approach by improving the efficacy/risk ratio in this type of patients.

Blood Coagulation Tests↗
PubMed1987

[Cranial traumatology. Recent statistical data].

The authors describe a one-year prospective study carried out in Créteil from October, 1983 to October, 1984 in 155 selected patients admitted for at least 24 hours with traumatic head injury. Patients with gunshot wounds of the head were excluded from the study. 30% of the patients were infants, 60% were adults aged between 15 and 60, and 5% were over 60; 48% were not comatose (initial Glasgow symptomatic score [GSC] greater than or equal to 8) and 36% were free of any neurological symptom. Prognosis was related to the initial neurological status, to the patient's age and to underlying diseases, such as alcoholism. 10 out of 11 patients with an initial GSC of 4 or less died, against 12 out of 144 with a GSC above 5. At the first CT scan, 10% were found to have an extradural haematoma, but the examination was normal in 20% of patients with neurological symptoms and/or coma; 22% of the CT scans were abnormal without any clinical symptom, as was the case, in particular, with 4 extradural haematomas. Surgery was performed in 24% of all patients and in 17.4% of infants, whereas the percentage reached 30% in alcoholic patients, due to the frequency of intracerebral haematomas in this population. In 16% of the 155 cases, barbiturates were used to treat uncontrolled intracranial pressure higher than 20 mmHg. 15% of the 155 patients deteriorated; a second operation was necessary in 9 cases. The final outcome on discharge was: 112/155 patients with good recovery or moderate disability, 22 with severe disability, 5 with persistent vegetative state and 21 deaths.

Adolescent↗
PubMed1985

Altered capillary permeability in neurogenic pulmonary oedema.

Two cases of fatal neurogenic pulmonary oedema are depicted. The hemodynamic study failed to document any hypertensive crisis or pulmonary hypertension. By contrast, the low values of pulmonary capillary wedge pressures and the high protein concentration in tracheal fluid suggest a pulmonary capillary wall lesion.

Adult↗
PubMed1983

[96 cases of spontaneous medical cerebral hemorrhage. Diagnostic and therapeutic experience].

Prognosis in a homogeneous series of 96 cases of non-traumatic cerebral hemorrhage admitted to a neurosurgical department within 6 to 24 hours of onset was assessed by studying possible correlations between clinical condition (grade I: conscious; grade II: somnolent; grade III: comatose; grade IV: comatose with signs of brain stem involvement) and computed tomography findings (site, extension, size of hemorrhage; degree of edema and of mass effect; presence of hydrocephalus or ventricular hemorrhage). It was possible to distinguish effects due to destruction and/or compression of functional cerebral regions for a given clinical picture, and to apply these data to determine types of therapy and surveillance according to 3 time-periods. During the first 48 hours there was almost perfect agreement between the severity of the clinical picture and the degree of cerebral destruction (62,6 p. 100 of grade IV, 27,7 p. cent of grade III died). Only patients in grade III with temporal hemorrhage directly menacing the brain stem were operated upon. From the 3rd to the 7th day surveillance was based on clinical findings and computed tomography, repeated in principle on the 3rd and 7th days. Patients operated upon during this period were those in whom clinical signs and/or effects due to mass effect as seen on the CTscan were becoming worse. The third period, lasting from the 8th to the 21st day, was that during which the vital prognosis was generally no longer affected, and indications for surgery were functional in nature. The prognostic value of measurements of intracranial pressure is discussed.

Adult↗