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F Artru

Publications and source records attributed to F Artru.

At least 19 recordsLinked to original sources
PubMed1993

[Evaluation of the clinical benefit of decompression hemicraniectomy in intracranial hypertension not controlled by medical treatment].

Through the findings in the literature on the basis of 9 personal cases, we review the indications and value of decompressive hemicraniectomy with plasty of the dura mater in cases of medically uncontrolled and decompensated intracranial hypertension. Seven patients had a pseudo-tumoral brain infarction. Five patients survived and their functional recovery is consistent with an autonomous daily life. Another patient with acute traumatic sub-dural haemorrhage died. The ninth patient had presuppurative encephalitis and recovered with no disability. At the time of surgery, all the patients were comatose with herniation of the mesencephalon (n = 3), uncal transtentorial herniation which was either unilateral (n = 4) or bilateral (n = 2). ICP was between 25 and 60 mmHg before the operation. After flap removal, ICP decreased by 15% and, after opening of the dura, it fell a further 70%. In 6 patients we were able to carry out continued post-operative monitoring of ICP, which stayed below 50% of initial values. Decompressive hemicraniectomy is an effective means of treating ICH caused by carotid cerebrovascular accidents with a high degree of edema, where mortality rises to 70-85% when only medical treatment is administered. No haemorrhagic complications, which can occur during hemispherectomies, were observed during decompression.

Adolescent↗
PubMed1992

[Monitoring of intracranial pressure with intraparenchymal fiberoptic transducer. Technical aspects and clinical reliability].

A fiberoptic intracranial pressure transducer (Camino) was assessed prospectively in 100 patients. In all, 122 sensors were inserted intraparenchymally at the bedside, without the help of a neurosurgeon. Before the procedure, patients were given 2 to 4 mg of phenoperidine. The scalp was opened over a few millimeters in the frontal paramedian area. A burr holc was made with a 2 mm bit. The dura mater was opened and a hollow screw inserted in the diploë. When the zero of the transducer had been obtained, a 5 cm length was inserted within the screw. The transducer was then about 5 mm deep within cerebral parenchyma. The procedure took an average of about 15 min. An intracerebral haematoma around the transducer occurred five times. One had to be drained surgically. There were no infectious complications. The daily baseline drift was about 0.3 mmHg. The system seemed to be reliable: there was close agreement between the intracranial pressure (ICP), neurological status and CT scan findings. In trauma cases, there was also good correlation between mean ICP and the basal cistern obliteration score, finally, ICP became equivalent to mean arterial blood pressure in all brain dead patients. It is concluded that this system may be used in all cases where ICP requires to be monitored, even when the lateral ventricles are no longer visible, or when craniotomy has been performed. This will most probably result in a more extended use of ICP monitoring in neurosurgical intensive care.

Adolescent↗
PubMed1992

The combined monitoring of brain stem auditory evoked potentials and intracranial pressure in coma. A study of 57 patients.

Continuous monitoring of brainstem auditory evoked potentials (BAEPs) was carried out in 57 comatose patients for periods ranging from 5 hours to 13 days. In 53 cases intracranial pressure (ICP) was also simultaneously monitored. The study of relative changes of evoked potentials over time proved more relevant to prognosis than the mere consideration of "statistical normality" of waveforms; thus progressive degradation of the BAEPs was associated with a bad outcome even if the responses remained within normal limits. Contrary to previous reports, a normal BAEP obtained during the second week of coma did not necessarily indicate a good vital outcome; it could, however, do so in cases with a low probability of secondary insults. The simultaneous study of BAEPs and ICP showed that apparently significant (greater than 40 mm Hg) acute rises in ICP were not always followed by BAEP changes. The stability of BAEP's despite "significant" ICP rises was associated in our patients with a high probability of survival, while prolongation of central latency of BAEPs in response to ICP modifications was almost invariably followed by brain death. Continuous monitoring of brainstem responses provided a useful physiological counterpart to physical parameters such as ICP. Serial recording of cortical EPs should be added to BAEP monitoring to permit the early detection of rostrocaudal deterioration.

Adolescent↗
PubMed1992

[Monitoring of intracranial pressure in children. Prospective fiber optic study of an intraparenchymatous system].

The authors studied the reliability and tolerance of a new intra-parenchymatous fiberoptic device for intracranial pressure monitoring in 20 neurosurgical children. The system proved to be reliable, and the measures were well correlated with clinical evolution, CT scan lesions, and the abolition of the cerebral perfusion pressure in the case of brain death. There was a minimal shift of the electric 0 after 15 days of monitoring. The tolerance was good and no hemorrhagic, infectious or epileptic complications were observed.

Adolescent↗
PubMed1992

[Unilateral hydrocephalus caused by abscess of the choroid plexus].

A case of unilateral hydrocephalus due to an abscess in the ipsilateral choroid plexuses, and revealed by intracranial hypertension is reported. Treatment with ceftriaxone, metronidazol and thiophenicol was clinically and radiographically successful, without surgery 3 weeks later. Management and mechanisms are discussed.

Adult↗
PubMed1991

[A prospective study of 180 percutaneous catheterizations of the axillary vein during resuscitation].

Central venous catheterization via the axillary vein was performed in 180 comatose patients with a success rate of 91%. The scarcity of serious nervous (none), thrombotic (6%), hemorrhagic (9.4%), infectious (1.8%), or thoracic (none) complications, the preservation of cerebral venous drainage, a longer distance between puncture site and tracheostomy or intubation tube make this safe and easy procedure perfectly convenient for comatose patients.

Adolescent↗
PubMed1991

[Use of intravenous lidocaine in neuro-anesthesia and neuro-resuscitation].

Bolus injections of lidocaine are commonly used during neuroanesthesia to prevent or treat ICP elevations caused by tracheal or painful stimuli. Lidocaine can also be employed in case of hard intracranial hypertension, when the usual therapy fails. With continuous perfusion, at high doses, of this agent, a state of lidocaine anesthesia can be induced which is more readily reversible than barbiturate anesthesia. A simultaneous anticonvulsant therapy is mandatory because of the well-known epileptogenicity of lidocaine. Closed cardiovascular monitoring is also needed to detect early signs of cardiotoxicity. Experimental works point to the effectiveness of i.v. lidocaine to prevent ischemic lesions secondary to a cerebral artery occlusion. This protective effect may result from some properties exhibited by lidocaine and not by thiopental: stabilisation of transmembrane ionic fluxes, inhibition of leucocytes intravascular sticking and tissular migration. So, i.v. lidocaine seems help to preserve or improve cerebral perfusion pressure and in cases when the latter decrease below the critical threshold, to protect against cerebral ischemia.

Anesthesia, Intravenous↗
PubMed1991

[Clinical and pharmacokinetic comparative study of sufentanil and fentanyl in supratentorial neurosurgery].

The pharmacokinetic and the effects of sufentanil (S) and fentanyl (F) on cardiovascular stability, brain swelling, respiratory depression and post operative status were studied in 30 neurosurgical patients (group S, n = 15; group F, n = 15). Anesthesia was induced with sufentanil and fentanyl given intravenously (bolus injection 2.5 micrograms.kg-1 vs 25 micrograms.kg-1) followed by a constant rate infusion (0.25 vs 2.5 micrograms.kg-1 x h-1) and a sleep dose of thiopental (3 mg.kg-1) and pancuronium (0.1 mg.kg-1). If necessary, patients could receive more narcotic and, for sudden arousal, a dose of thiopental. Plasma concentrations of sufentanil and fentanyl were measured during and up to 12 hours after infusion. After induction bolus, mean arterial pressure decreased significantly (-30%) with sufentanil. In the group 5, the baseline heart rate and arterial pressure were lower and more stable than in the group F. Brain relaxation always seemed satisfactory. For all but 12 patients with sever neurological status, recovery and extubation times were less than 2 hours and allowed early neurological evaluation. Respiratory depression required naloxone for 2 patients with fentanyl. The plasma clearance of sufentanil and fentanyl (902 vs 914 ml.min-1) are similar. The volumes of distribution are respectively 4.9 and 11.3 l.kg-1, and the half-life 250 and 562 min. The wider volume of distribution and the great half-life compared with previous studies are attributed to corticoïd, osmotic and diuretic preoperative treatment.

Adult↗
PubMed1990

[Treatment of ischemic cerebral edema with intracranial hypertension after neurosurgery of intracranial aneurysms].

Ischemic cerebral edema frequently develops after aneurysm surgery and may lead to severe intracranial hypertension. Of prime importance are reducing the level of ICP and preserving oligemic areas from becoming infarcted. Besides correction of factors known to worsen intracranial hypertension, several therapeutics may be of value: external CSF drainage, perfusion of mannitol, induced arterial hypertension and use of anesthetic agents with cerebral vasoconstricting capability. Hyperventilation is not recommended. Arterial hypotension and hypovolemia certainly contribute to aggravate cerebral ischemia and must be corrected. Cerebral ischemia may be reduced by two specific approaches: by improving cerebral oxygen transport in ischemic areas using arterial hypertension and calcium blockers rather than hemodilution or hypervolemia; by reducing cerebral metabolic rates with heavy anesthesia under the cover of a complete cardiovascular monitoring. In view of the large heterogenicity in cerebral lesions and physiopathological stages, a therapeutical trial appears suitable in each individual case. Criteria allowing to know if any therapeutic, used alone or in association, is beneficial include increase in blood flow in ischemic areas, reduction of ICP level and normalizing of indices like CSF or venous jugular blood lactate.

Blood Pressure↗
PubMed1990

[Hyperthermia in meningeal hemorrhage. Contribution of daily determination of inflammation proteins].

This paper studies the causes of hyperthermias occurring after a subarachnoid hemorrhage by ruptured aneurysm in 54 patients, totalizing 66 febrils episodes. Only 29 episodes bacteriologically proved infections. The profile of thermic curve, the hemodynamical profile, and clinical examination are not convincing. The most convincing elements for the diagnosis of infection are the increasing number of the leucocytes counts, the increasing curve of CRP, and simultaneous decreasing curve of C4. The evolution of these parameters permit to follow the efficiency of antibiotics.

Adult↗
PubMed1990

[Neurogenic pulmonary edema, complication of meningeal hemorrhage: report of 4 cases].

Neurogenic pulmonary edema (NPE) observed in 4 patients admitted in Neurosurgical Intensive Care au SAH by ruptured a vascular malformation. This complication is unusual (1.9%) and has been observed in comatose patients. For 3 patients, NEP resorption was rapid, from 12 to 72 hours with a treatment by CCPV with a P.E.E.P. and with restoring the hemodynamical parameter. The drug must be discussed according to eventual deleterous side effects on cardiac output and systemic resistances. The early hemodynamical study argues for an essentially hemodynamical mechanism due to the brutal symphatic discharge created by cerebral lesions and increasing. ICP, more than a toxic lesionnal edema, as the Weidner's study shows it in ultrastructural analysis of sheep lungs.

Adolescent↗
PubMed1990

[Blood coagulation disorders in intracerebral hematoma caused by rupture of intracranial angioma. Incidences on hemorrhagic recurrence].

In 34 patients admitted in Neurological Intensive Care Unit, for a cerebral hematoma by ruptured arterio-venous malformation, are present in 26 patients, on the first day. In many cases, the APTT is increased and this can be respected. These disorders do not seem to modify the incidence of delayed hemorrhage, except for the severe perturbances, related to a DIC or an hepatic deficiency. In these cases, the delayed hemorrhage must be prevented by transfusions of platelets and/or freeze fresh plasma.

Adolescent↗
PubMed1990

[A rare and severe complication of meningeal hemorrhage: spinal arachnoiditis with paraplegia].

This observation relates a case of spinal arachnoiditis with paraplegia, for a 56 year old patient hospitalized for a S.A.H. by a ruptured aneurysm of the P.I.C.A. This patient present some complications, requiring a prolonged ventilatory support with a tracheostomy, a ventricular shunt for hydrocephalus. The treatment is only surgical, and the corticosteroids delay the evolution, but without successful outcome.

Arachnoiditis↗
PubMed1990

[Intracerebral hematoma caused by rupture of intracranial angioma. Analysis, prognosis and clinical course of 35 comatose patients admitted to intensive care units].

The outcome of 35 patients in deep coma (GSS less than 7) due to an intracerebral hematoma following ruptured arteriovenous malformation (AVM) and admitted to a neurosurgical intensive care unit is reviewed. Eighty percent of these patients had a cerebral AVM and 20% had an AVM in the posterior fossa. All had a medical treatment of increase intracranial pressure (ICP). Twenty-four patients or 68.6% had an early surgical treatment or some days further and 13 had a good outcome, six had a persistent coma or a residual neurological deficit and five died. Four patients or 11.4% had an endovascular embolisation therapy and three had no satisfactory results and one died; all had a new intracranial hemorrhage with hematoma. Seven patients were not treated: four died before 48 hours of hospitalisation, one is in persistent coma and two are waiting an endovascular embolisation, alive but with a neurological deficit. The results suggest that neurosurgical treatment are a safe and effective means for treatment of these AVM with compressive intracranial hematoma.

Adolescent↗
PubMed1989

A controlled study of Dextran 40: effect on cerebral blood flow and metabolic rates in acute head trauma.

A controlled double-blind evaluation of the effects of Dextran 40 at different concentrations on cerebral blood flow (CBF), cerebral oxygen consumption (CMRO2) and cerebral lactate production (CMRLact) was carried out. We studied 40 patients in coma due to recent head injury. Concentrations of Dextran solution were not significantly related to variations in CBF and metabolic rate over the period of infusion. The lack of effect of the Dextran infusion may be explained by the absence of global brain ischemia in these patients at the time of the study. The very low initial CBF values were a consequence of brain metabolic depression and not a sign of global ischaemia. The rheological benefits of treatment with Dextran 40 in head injured patients should preferably be investigated using techniques which permit detection of local changes in CBF and metabolism.

Adolescent↗
PubMed1988

Transient drug-induced abolition of BAEPs in coma.

Combined infusion of high doses of lidocaine and thiopental in a comatose patient induced major latency and amplitude BAEP changes, which progressed to complete BAEP abolition. Responses returned to normal after drugs were discontinued. EEGs during the episodes showed long-lasting periods of activity suppression, but were never isoelectric. BAEPs are resistant to hypothermia and barbiturates, but must be interpreted cautiously in patients treated with a combination of anesthetic drugs that includes lidocaine.

Adult↗