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Biomedical subjects

J Berthomieu

Publications and source records attributed to J Berthomieu.

4 recordsLinked to original sources
PubMed1994

[Fatigue, drowsiness and sleep].

Vigilance is a critical output of adaptative processes related to sleep/wake continuity and circadian rhythms. Since vigilance is highly stressed in the modern technic society, its sudden failures, expressed as fatigue, drowsiness and/or sleepiness, may be dramatically involved in accident's incidence, as observed in work accidents, manufacturing and transport sectors and private life. There is a detectable human factor involved in 70% of cases. Even if there are multifactorial circumstances, human factor such as fatigue, overwork or errors in decision are generally reported. Two main cases may be described: on one hand sleepiness and fatigue occur as sleep deprivation builds up, with an excessive duration of wakefulness (that suggests that it may be prevented by information and hygienic precautions), on the other hand sleepiness is the expression of a sleep illness or disease (and it must be detected early by a clinical biological survey). Three levels are reviewed and discussed for a comprehensive view of abnormal fatigue and sleepiness: what is the prevalence as evaluated by epidemiologic, biologic and psychologic methods? is there any specificity of cognitive disturbances associated with intrinsic or rhythmic dyssomnic illness and how can one evaluate or measures them? on the basis of some experimental reports in normal subjects by changing wake and sleep schedules it is assumed that the recovery which follows a sleep deprivation may be quite different when there is an early or a late night sleep deprivation. Possibilities for self-sleep training are discussed. The actual great interest in abnormal sleepiness is supported by its human and socio-economic consequences. If new pharmacological or physiological treatments have recently be suggested, information and cooperation are required in healthy subjects and in patients. Self-detection in the course of sleepiness is a critical factor: it may be learned and taught by medical preventive projects.

Accidents, Traffic↗
PubMed1993

[Electrophysiological development under thalamic stimulation of post-traumatic persistent vegetative states. Apropos of 25 cases].

We have studied the electrophysiological evolution, with the aid of long-term, quantitative E.E.G. (Holter method) and sensory evoked potentials (visual, auditory and somatosensory) on 25 severe traumatic head injury patients (initial Glasgow scale--between 3 and 5) aged from 5 to 42 years having evolved towards a persistent vegetative state and being object of a protocol of thalamic stimulation. Electrophysiological exploration was practised before placement of the stimulation, then at 2 weeks, 1 month, 2 months and finally 3 months after. The electrophysiological parameters appear to have no predictive value on the clinical evolution after stimulation. However, changes such as long-term quantitative EEG as well as evoked potentials mostly precede clinical progress when present. Cortical evoked potentials are the first to change significantly (J15) followed by long-term quantitative EEG and brain stem evoked potentials (J30); the latter improving more completely. Also the consideration of the chronobiological aspects of the recordings of the long term EEG allow the proposal of "waking targeted" stimulations at the most favorable moments of the nyctohemeral period.

Adolescent↗
PubMed1992

[Research and surgical treatment of epilepsy].

The currently available surgical procedures for the treatment of epilepsy, from fundamental data to therapeutic results, including various means of investigation are reported. The work is based on a review of the literature and on the cases studied by the two teams from the Universities of Montreal and Bordeaux who share the same concept of epilepsy surgery. The patient groups of the two teams include 316 S.E.E.G., 214 cortectomies, 39 callosotomies and 2 multiple sub-pial transsections. In the first part, the authors attempt to demonstrate that the epileptic focus corresponds to the region where the seizures arise, that this focus is not directly comparable to the region where inter-ictal spikes are recorded and sometimes becomes autonomous from the causal lesion. The epileptic phenomenon has a definite harmful effect on cerebral functions and a probable self-aggravating potential. The second chapter summarizes the clinical data on which the indications and contraindications are based. These obviously depend on whether the intervention is intended to be curative or palliative. Various non-invasive and invasive investigations are then reviewed, according to their relative importance and the experience of each team. The main points developed are: the electroclinical correlations during seizures, the symptomatological data for differentiating between temporal and frontal lobe seizures, the contribution of M.R.I. in demonstrating the epileptogenic and epileptic lesions, the electrophysiological information suggesting that S.E.E.G. remains the most informative mean of investigation. The various methods of investigation of assessing electrical, functional (cerebral blood flow, metabolism) and morphological aspects of epilepsy, supply non-redondant findings about the localisation of the epileptic focus. The chapter on surgical techniques mainly discusses the various modes of implantation of subdural and intracerebral electrodes and reports the same rate of morbidity in both cases. Orthogonal teleradiography is still perfectly suited to the implantation of intracerebral electrodes. S.E.E.G. is still the most anatomically precise technique. However, in certain conditions, extraoperative E.Co.G. is more adequate. New surgical modalities have recently appeared such as the multiple subpial transsections which allow treatment of epileptic foci unapproachable by cortectomy and such as modified techniques of hemispherectomy, which by decreasing morbidity, renew interest in them. In the chapter on surgical results, the authors emphasize the methodological problems of evaluation that partly account for their wide variability. The results obtained with the various surgical modalities are reviewed. The outcome in cortectomies is discussed at length in terms of the data from the literature as well as the results reported by both teams.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗