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Biomedical subjects

F Lapierre

Publications and source records attributed to F Lapierre.

At least 55 records · Page 3Linked to original sources
PubMed1985

[Ultrasonic, arteriographic and anatomopathological correlation in 59 cases of carotid atherosclerosis].

This study was carried out on 49 patients who underwent an ultrasound study by continuous Doppler and echotomography B real-time, an angiography of supra-aortic arteries, and a carotid endarterectomy. Thirteen had had transient ischemic attacks and 20 a stroke. A quantification of the carotid stenosis in 4 stages was established for each method. For detection of lesion an excellent correlation was observed between the results of echotomography and pathology. For the quantification of lesion the correlation between echotomography and pathology was excellent also in 79,7 p. 100 of the cases, discordant in 20,3 p. 100. It was similar to the correlation between arteriography and pathology (excellent in 83 p. 100 of the cases). The correlation with pathology enabled to distinguish for stages of atherosclerotic lesions, to clarify their type of complications, and to evaluate their functional significance, particularly those with a high risk of embolism.

Adult↗
PubMed1985

[Functional evaluation of temporo-sylvian anastomoses by ultrasonic transcutaneous flow measurement].

The intra-extracranial bypass using the superficial temporal artery remains a matter of controversy about its usefulness and indications. The improvement in ultrasonic technics allows henceforward to measure the blood flow inside this anastomosis with a good precision. In that purpose, we use a duplex Doppler system and a vascular echotomograph. This system brings us the necessary informations to calculate the blood flow: the Doppler frequency shift, the internal diameter of the vessel, and the incidence of the Doppler beam. The spectral analysis of the Doppler signals not only gives us informations concerning the local circulation but also the distal circulatory resistance. An intra-extracranial operation and this examination have been performed in thirty seven patients. The blood flow inside this anastomosis ranges between ten and 360 ml/minute. Patients presenting a blood flow superior to 40 ml/minute seem to improve more frequently. Otherwise there is also an excellent correlation between the blood flow inside the anastomosed temporal artery and its diameter. The evaluation of the cerebral circulatory index of resistance is a good criteria to predict the becoming of the anastomosis and the expected clinical improvement. The functional study of the temporo to middle cerebral artery anastomosis using the duplex echography-Doppler provides essential data to test their efficacy. The expected progress in ultrasonic technics will allow to know, the value of the cerebral circulatory resistances before the operation and so to predict the possible gain for the patient.

Cerebral Revascularization↗
PubMed1985

[Antibiotic therapy of pneumopathies in intensive care and protected distal bronchial samples].

Bacteriology was performed on 57 specimens collected by the Wimberley protected catheter bronchoscopy technique (PCB) from 42 ventilated patients with severe head trauma hospitalized in the neurosurgical intensive care unit to determine the etiology of their pneumopathy. All patients had a nasotracheal tube upon arrival at the intensive care unit. For each sample, smears were examined and cultures under aerobic and anaerobic conditions as well as with CO2 were performed. In 34 (59%) of the 57 cases, examination of smears allowed rapid diagnosis and appropriate chemotherapy. In 47 (82%) cases, culture was positive, with a single pathogen being recovered in half of cases. The most prevalent organisms among the 75 species isolated were S. aureus (38%), P. aeruginosa (15%), Klebsiella (12%), Haemophilus (8%), and Pneumococcus (9%). Consistency with positive cultures of blood or pleural effusion samples was recorded in 92% of cases. Narrow spectrum antibiotic therapy can be chosen according to the results of PCB bacteriology and rapid automated antibiotic sensitivity testing obtained within 24 hours. PCB is therefore recommended in pulmonary infections in intensive care units.

Adolescent↗
PubMed1984

[Echotomography and spectral analysis of the Doppler signal in the assessment of carotid lesions].

Real-time echography and C.W. Doppler examination with spectrum analysis are the two methods most widely used for the study of the circulation. Echography allows the detection and the localization of the atheromatous defects whereas Doppler examination provides information on the blood flow. With the help of the frequency analysis of the Doppler signal it is possible to study much more accurately the local haemodynamic conditions. Spectrum analysis is one of the possible display mode for the Doppler signal. It provides in comparison with the zero crossing mode, much more haemodynamic parameters on the blood flow, such as velocity spectrum, density of red cells on each velocity... In this study, we tried to demonstrate that a relationship exists between the amplitude of the spectrum disturbances, recorded just after a stenosis and the degree of this stenosis. For that we propose a classification of the spectrum disturbances in five grades, each of them being related to an interval of possible values for the stenosis degree (grade I----stenosis less than 40% in area, grade II----40-60% stenosis, grade III----60-75% stenosis (extended defects) grade IV----70-90% (extended defects) and 60-90% short stenosis. Grade V: stenosis greater than 90%. The results provided by this classification were compared to those obtained by measurements of the stenosis degree on the piece of endarterectomy (72 cases). The results were in agreement in 94% of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Arteriosclerosis↗
PubMed1984

[Validation of quantitative and qualitative data of real-time carotid echotomography in comparison with standard Doppler tests, arteriography and anatomopathology. On 59 carotid endarterectomies].

Findings on ultrasound, arteriography and pathology examinations were compared in 49 patients undergoing 59 carotid endarterectomies between December 1981 and April 1983. Carotid artery lesions were investigated routinely by cervical Doppler, high resolution rapid ultrasound and either direct or more usually venous arteriography (with photographic subtractions). Postoperative endarterectomy specimens were examined to determine the exact degree of stenosis, and also qualitatively (gross pathology and histology of ulcerations and thromboses, the biochemical nature of the plaques, etc.). With respect to detection, that is demonstration of the existence or not of an atheromatous lesion, the ultrasonographic findings could always (100% of cases) be correlated with pathology data. Qualitative analysis of atheromatous lesions showed certain to be diagnosed with ease: calcified, fibrous or chondroid and lipidic plaques, while those complicated by hemorrhage, ulceration or mural thrombosis were less constantly diagnosed by ultrasound imaging. Occlusive plaques were easily detected, while recent intraluminal thrombosis was more difficult to diagnose by ultrasound alone. In this case the combined use of Doppler is a valuable aid, and is a routine procedure, in fact, in the department. Results of quantitative analysis showed good correlation between ultrasound and pathology findings in 79.7% of cases (insufficient in 20.3%). However, if ultrasonography is combined with other ultrasound methods of examination (standard Doppler and spectral analysis of Doppler) correlation is of the order of 95%, close to morphological data supplied by arteriography, with in addition a functional and qualitative approach not possible with arteriography alone.

Aged↗
PubMed1984

[Evaluation of the degree of carotid stenosis by spectral analysis of the Doppler signal. Comparison of the results of spectral analysis, angiography and anatomo-pathology].

With the single Doppler spectrum analysis, one can appreciate the degree of the carotid stenosis according to the importance of the haemodynamic disturbances induced by the stenosis. The purpose of our study is to show the possibilities and the limitations of this method. Spectrum disturbances were classified in 5 grades, each of them being related to the importance of the stenosis. The degree of stenosis has been evaluated by the C.W. Doppler spectrum analysis, the angiographies and the anatomical study of the endarteriectomies. We considered that we had a perfect concordance between the results of the different methods when the degree of stenosis measured on the angiographies or on the endarteriectomies was compatible with the spectrum analysis classification: grade I: stenosis inferior to 40% (in area), 23% (in diameter); grade II: stenosis ranging between 40 and 60% in area (23 and 40 in diameter); grade III: stenosis of 60 to 75% in area (40 to 50% in diameter) and of particular shape (extended plaque); grade IV: stenosis ranging between 60 and 90% in area (40 to 70% in diameter); grade V: stenosis higher than 90% in area (70% in diameter). The confrontation of spectrum analysis and angiographic date concerns 58 bifurcations. We got a perfect correlation in 93% of the cases. The confrontation of the spectrum analysis method and the anatomical study of the endarteriectomies concerns 38 bifurcations. We got a perfect correlation in 92% of the cases. The appreciation of the carotid stenosis degree is now performed in routine at the Hospital. For some patients, the endarteriectomy has been decided from the clinical and the spectrum analysis data, and an electro-encephalogram with compression. However these date are generally completed with an angiography with venous punction.

Carotid Arteries↗
PubMed1984

[Ultrasound and atheromatous disease : current contribution of Doppler spectrum analysis in carotid stenoses].

The carotid bifurcation plaque is a common pathology. Specific pathologic atheromatous findings have been studied in three hundred patients-carotid bifurcations. This study was carried with the Doppler technics and especially the spectral analysis of the Doppler. From that study it appeared that the most frequent disturbances could be classified according five grades, corresponding to the importance of the stenosis. The first grade corresponds to a stenosis responsible of an obstruction less than 40% of the vessel. The second one is a stenosis from 40% to 60% of the lumen. The third grade is the witness of a extended plaque and a stenosis between 60% to 75%. The fourth grade corresponds to a stenosis between 60% and 90%. The fifth grade is a stenosis superior to 90% of the surface of the artery, also called pre-occlusive grade. This ultrasonic method has been compared to the data provided by the angiography, the echotomography and the anatomopathology. The correlation is excellent in the three cases, and is of 95%. The authors emphasize that this method is the most accurate among the non invasive investigations and let hope that it might replace the traumatic ones in the future.

Arteriosclerosis↗
PubMed1983

Ocular bobbing: abnormal eye movement or eye movement's abnormality?

Ocular bobbing is classified as an abnormal eye movement, resulting from pathological neuronal activity of the brain stem after bilateral pontine lesions. Clinical oculographic study of 5 patients suffering from ocular bobbing shows that upwards voluntary eye movements are abnormal. We suggest that ocular bobbing should not to be regarded as an abnormal eye movement, but, rather, as the only residual movement of patients which are totally deprived of both horizontal and upward movements.

Arterial Occlusive Diseases↗
PubMed1983

[Postarteriographic vertebral arteriovenous fistula].

The vertebral artetio-venous fistulas are seldom reported as a complication of the carotid angiography. As emphasized in this case report it's difficult to identify the place of the communication between the vein and the artery. It explains that two operations were necessary before the total exclusion of the fistula. The study of the literature recalls the main clinical features in that sort of fistula, constituted by the subjective and objective perception of a hum. The more often related complications consist in vertebro-basilar insufficiency, symptoms of root or spinal-cord squeezing, ischemic brain pathology, or cervical tumor. It's often difficult to read the angiograms because of the presence of a lot of enlarged veins. The therapy of that kind of fistula may consist in: --trapping of the fistula, but the symptoms may reappear after a few days due to the local anastomosis, --direct surgery with occlusion of the fistula which is difficult and also presents risks of recurrence (cf our case), --embolisation which looks interesting and could become the best mean of treatment in the future.

Arteriovenous Fistula↗
PubMed1982

[Meningeal hemorrhage disclosed by the initiation of Prinzmetal's angina].

The association of a cardiac disturbance and a subarachnoïd hemorrhage is well known but the cardiac signs seldom look the most important. When studying a case which was very particular because the cardiac signs consisted in a Prinzmetal's variant angina, it finality appears that the Prinzmetal's angina is not so rare as could be thought in such circumstances. Therefore a neurological pathology hidden by a cardiac one has been rarely reported such as it was seen in that case. In the literature, the influence of the parasympathetic and especially the sympathetic nervous system is emphasized as a probable cause of the most frequent cardiac abnormalities. All the authors think the medical cardiac treatment and the surgical treatment of the subarachnoïd hemorrhage have to be done at once.

Angina Pectoris, Variant↗
PubMed1979

[Primary intra-cerebral hemorrhage in the new born, nursling and child (author's transl)].

The authors report 6 cases of intracerebral hemorrhages in 6 children, of what appears to be, of primary origin. 3 cases concern children between the ages of 4 and 14 years; the 3 others are situated shortly after birth or during the first months of life. A review of the literature emphasizes the sporadic nature of these cases and the persistance of diagnostic and etiological problems as to the cause of these hemorrhages. In the course of reviewing articles as well as our own personal series, it is evident that the cat scanner has demonstrated its qualifications as a diagnostic tool in the early detection of the lesions, permitting a better adapted treatment, thus improving their prognosis. The prognosis appears to be linked : --to an early diagnosis --to whether or not the hemorrhage is of massive nature or not --to the precise location of the hematoma --to the neurological state of the patient at the time of treatment --to the absence of an associated pathologie (severe prematurity, coagulation pathology). The long distance prognosis in the case of these apparently primary hemorrhages remains uncertain, due to the high rate of recidivism at a later unpredictable date (one month or several years later); to the occurence or not of a hydrocephalus especially in the case of young infants; and frequent sequels affecting superior functions. This long distance prognosis seems, however, to be little affected by the recent acquisitions in diagnostic testing.

Adolescent↗