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Biomedical subjects

J D Born

Publications and source records attributed to J D Born.

At least 19 recordsLinked to original sources
PubMed2005

[Spontaneous ossification of the cervical spine after subtotal surgery spondylotic myelopathy].

Subtotal corporectomy without fusion (SCWF) is a misunderstood surgical procedure used in the treatment of spondylotic myelopathy. This clinical study was performed to evaluate the efficiency of the SCWF. Long term neurological status and cervical spine ossification were specially studied. Sixty-four patients, operated between 1990 and 2003, were evaluated. The average follow-up period was five years. To assess the severity of neurological symptoms, a functional seven-point classification scale was used. Discriminant analysis was applied as statistic. There was a significant correlation between outcome, functional preoperative score, age, duration of the compression and intramedullary lesion in NMR. After SCWF, no secondary cervical instability was observed. Conversely, we show, for the first time in the literature, that on the twenty-one patients who were the subject of late 3D CT scan, there exists a true rebuilding of the cervical bone with spontaneous fusion and respect of cervical cord decompression. We conclude that the SCWF is a safe and efficient treatment for cervical spondylotic myelopathy. No fusion is required regardless of the number of levels, providing there is no preoperative instability. This surgical procedure which does not require any cervical immobilization considerably decreases surgical risks and costs imposed by the society.

Cervical Vertebrae↗
PubMed2003

The emperor's clothes description of a new epidemic related to diagnostic imaging.

In 1835, Hans Christian Andersen published "The Emperor's New Clothes", one of the 164 fairy tales that earned him worldwide fame. A little more than 25 years ago, drawing inspiration from that tale, F. Gross reported the existence of an ailment capable of affecting multiple systems, "the Emperor's clothes syndrome". This syndrome primarily affects students and physicians for whom career success is of paramount importance. Based on actual experience, we are describing a new epidemic of this ailment, for which the radiological image is the principal vector. We wish to draw attention to the danger of basing a diagnosis solely on diagnostic testing. In an age dominated by technology, we would like to emphasize that anamnesis and clinical examination are still the cornerstones of diagnosis. Any clinical or radiological information, any laboratory phenomenon is subject to variable interpretation by different observers. We also suggest that there are statistical methods for evaluating the reliability of a clinical test.

Adult↗
PubMed2002

[Perioperative management of blood loss during surgical treatment for craniosynostosis].

Blood saving is the major challenge during the surgical repair of craniofacial deformities. Treated patients have a low reserve volume and the techniques available to lower homologous blood transfusions are limited or insufficiently evaluated in this particular case. The most important factor determining blood loss is the quality of the surgical haemostasis. Blood saving begins with early preoperative evaluation of the patient's bleeding risk, which is a function of the type of surgery, of the surgical technique, of the number of sutures involved, of the length of surgery, and of the patients age, weight and physical status. Elaborated blood saving techniques such as preoperative autologous blood donation, erythropoietin administration, normovolaemic haemodilution, and peroperative autologous blood saving and reinfusion have revealed disappointing where used alone. These techniques require a heavy setup and still need to be evaluated extensively. They should be used in selected cases such as in patients with a very high risk of bleeding or face to Jehovah Witnesses. Monitoring during surgery should include precise evaluation of blood losses and haematocrit measurements at regular intervals. The haematocrit threshold allowing homologous blood transfusion should be set at 21%, provided that any other source of autologous blood is exhausted. Postoperative monitoring should also include precise evaluation of blood losses and haematocrit measurements. The 21% threshold should remain the reference during that period.

Blood Loss, Surgical↗
PubMed2002

[How I treat ... facial paralysis by hypoglosso-facial anastomosis].

Thirteen patients underwent a hypoglosso- or a spino-facial nerve anastomosis between 1990 and 1996. Facial palsy was the result of surgery in 12 cases and of radiosurgery in 1 case. The mean interval between facial palsy and anastomosis was 12 months. Facial nerve function is determined on the basis of clinical examination according to the classification of House-Brackmann and our own evaluation. According to House, 10 patients are classified grade III and 3 grade IV. Our evaluation defines in 10 grade III, 7 good results and 3 fair results. As far as the good results are concerned, the mean interval between palsy and anastomosis is short (< 3 months). The permanent eating and swallowing dysfunctions are consecutive to multiple cranial nerve deficits. The post-paralysis hemifacial spasm is facilitated by prolongated electric stimulations.

Adult↗
PubMed2002

[Arterial aneurysm within a tumor in a pediatric patient].

A middle cerebral artery aneurysm, completely enclosed in a large frontotemporal anaplastic astrocytoma, is demonstrated in a 11-month-old girl admitted for intracranial hypertension. Clipping of the aneurysm along with radical resection was successfully performed. Five years later, follow-up neurological examination is normal, aneurysm occlusion and no evidence of tumor recurrence are demonstrated by angiogram and MRI. The association of brain tumor and aneurysm is discussed, and documented with the only two cases of a neoplasm surrounding on aneurysm reported in the literature.

Astrocytoma↗
PubMed2002

[Trigeminal neuralgia and hemifacial spasm. Vessel-nerve antagonism].

In the last 30 years, the concept of microvascular compression has achieved widespread acceptance. Still, some remain unconvinced. A review of our 182 operations, 104 trigeminal neuralgia and 78 hemifacial spasms, shows that microvascular decompression of the trigeminal and facial nerves is effective in alleviating trigeminal neuralgia and hemifacial spasm, because it removes the actual cause of the disorder rather than simply causing local injury to the nerve. Our neurophysiological investigations, the so-called abnormal muscle response, performed intraoperatively in twenty patients with hemifacial spasm, confirm that compression of the facial nerve at the root exit zone, by a blood vessel, causes pathological and clinical responses. Microvascular decompression is an extremely safe and effective treatment, even for the older patients without severe disabilities.

Adult↗
PubMed2000

Target-controlled infusion of propofol and remifentanil combined with bispectral index monitoring for awake craniotomy.

We describe the target-controlled administration of propofol and remifentanil, combined with monitoring of the bispectral index, during an awake craniotomy for removal of a left temporo-parietal tumour near the motor speech centre. Target concentrations of the two drugs were adjusted according to the patient's responses to painful stimuli and surgical events, and the need for speech testing. Allowing the effect-site concentrations of propofol and remifentanil to decrease during surgery allowed the performance of cortical speech mapping and the testing of the patient's ability to speak. Although the bispectral index was not used as a guide for the administration of the drugs, its value correlated better with the patient's responsiveness than did the predicted effect-site concentrations of propofol. Side-effects, comprising hypotension, respiratory depression and airway obstruction, were related to rapid increases in drug infusion rates and were easily managed.

Analgesia↗
PubMed2000

Evaluation of acute normovolemic hemodilution for surgical repair of craniosynostosis.

This clinical report investigated the potential benefit of acute normovolemic hemodilution (ANH) as a blood-saving technique in the surgical repair of craniosynostosis. Over a 4-year period, 34 healthy children undergoing surgical repair of scaphocephaly or pachycephaly were randomly assigned to two groups of 17 patients each. Patients of the first group (ANH group) were submitted to ANH (target Ht: 25%) immediately before surgery and patients of the second group (Control group) were not. During surgery, estimated blood loss was compensated with a 5% albumin solution and no autologous or homologous blood was transfused. At the end of surgery, intraoperative blood loss (mean +/- SD) calculated on the basis of the Ht value and the children weight was 21.3+/-8% of the estimated blood volume (EBV) in the ANH group and 24+/-6.6% in the Control group. Children of the ANH group received their autologous blood (18.9+/-3.3% of EBV) systematically at the end of surgery. In the postoperative period, homologous blood was transfused when the Ht value was equal or less than 21%. Both groups were comparable regarding age, weight, type of craniosynostosis, duration of surgery, EBV, and preoperative Ht value. No difference was observed between ANH and Control groups in the number of patients who received homologous blood (15/17 and 14/17, respectively), in the amount of homologous blood transfused (17+/-4.7% and 19.6+/-6.3% of the EBV, respectively), and in the Ht value before hospital discharge (29.4+/-5.0% and 30.7+/-4.9%, respectively). In conclusion, this report suggests that ANH reduces neither the incidence of homologous transfusion nor the amount of homologous blood transfused in this series of children undergoing surgical repair of craniosynostosis.

Albumins↗
PubMed2000

[Anterior and antero-lateral surgery for degenerative cervical spine diseases. Role of graft and osteosynthesis. Analysis of practices of the French-speaking european neurosurgeons].

The neurological complications of cervical spondylosis depend on the direct or indirect effects of the mechanical compression of the spinal cord and roots. Nobody questions the interest of a surgical decompression, when the medical treatment is ineffective, but there is no consensus on the choice of the surgical approach and on the necessity of performing a graft with or without osteosynthesis after an anterior decompression. On the initiative of the French Speaking Neurosurgical Society (SNLF), we have analyzed the practices of its European members in 1998 and report here the results of this study which collects 3 645 surgical procedures for degenerative pathology of the lower cervical spine responsible for radiculopathy or myelopathy. An anterolateral approach was used in 85.3 % of all cases, among which 87.9 % of extensive discectomy (Smith Robinson or Cloward technique) and 12.1 % of median somatotomy. In case of discectomy, no grafting was performed in 34.7 % of cases, grafting without fixation in 25.7 %, grafting with plating in 14.9 %, interbody cages in 21.9 %, other techniques in 2.8 %. In case of somatotomy, no grafting was performed in 17.8 % of cases, grafting without fixation in 15.5 %, and grafting with plating in all other cases. When a graft was performed, an autograft was used in 59.5 % of cases, hydroxyapatite in 24.4 %, and many other bone substitutes in rare cases every time. For the fixation, monocortical screwing was used in 75 % of all cases, and bicortical in 25 %. The reasons for these practices are equivocal and not based on scientific attitude. The reasons given are : to avoid discal plucking, to prevent or treat kyphosis and postoperative spinal instability, to prevent cervical postoperative pain, to help eliminate osteophytes and hypertrophy of the ligamentum flavum.

Belgium↗
PubMed2000

[Evaluation and treatment of cervical spondylotic myelopathy by subtotal corporectomy without grafting].

These experimental and clinical studies were performed to evaluate the efficiency of a new surgical procedure in the treatment of spondylotic myelopathy, the subtotal corpectomy without fusion. In a first step, the biomechanic analysis of eleven human cadaveric cervical spines, before and after corpectomy without grafting, demonstrated that this procedure does not reduce significantly the cervical stiffness. In a second step, we prospectively evaluate 77 patients operated between 1990 and 1998. The average follow-up period was 53 months (range: 10 to 111 mo). We conclude that this procedure is a safe and efficient treatment for cervical spondylotic myelopathy. No fusion is required regardless of the number of levels, providing there is no preoperative instability. We showed that clinical myelopathy severity and age are significant predictors of the outcome.

Activities of Daily Living↗
PubMed1999

Effects of two calculated plasma sufentanil concentrations on the hemodynamic and bispectral index responses to Mayfield head holder application.

The effects of two calculated plasma sufentanil (SUF) concentrations on the hemodynamic and bispectral index (BIS) responses to Mayfield head holder (MH) application were studied in 20 patients scheduled for intracranial surgery. Premedication consisted of hydroxyzine, alprazolam, and atropine given orally 1 hour before surgery. Anesthesia was provided with propofol (PPF) and SUF using a target-controlled infusion device. Patients were randomly assigned to one of two groups according to calculated plasma concentrations: 3 microg/mL(-1) of PPF and 0.5 ng/mL(-1) of SUF in group I (GI) and 3 microg/mL(-1) of PPF and 1 ng/mL(-1) of SUF in group II (GII). The MH was fixed 33.0+/-6.6 minutes (mean +/- SD) after induction. Systolic (SAP), diastolic (DAP), and mean arterial pressure (MAP) as well as heart rate (HR) and BIS were recorded 1 minute before pinning (baseline) as well as 1 minute (P1), 2 minutes (P2), and 3 minutes (P3) after pinning. Multivariate repeat-measured analyses of variance were applied to the baseline-subtracted measurements of hemodynamic and BIS values. Groups were compared using the Student's t test, and P < .05 was considered to be statistically significant. Patients' characteristics, baseline hemodynamic values, and BIS values were similar in both groups. A significant overall time effect was observed for all variables, but no significant overall SUF effect was detected. Increases in SAP, MAP, DAP, and HR did not differ significantly between groups. The increase in hemodynamic variables did not exceed 20% of baseline value in either group. In contrast, at P1, the increase in BIS over the baseline value was significantly higher in GI (15.0+/-7.9) than in GII (6.7+/-6.5). In conclusion, MH application was associated with a significant, although not clinically relevant, increase in hemodynamic variables whatever the calculated plasma SUF concentration (0.5 or 1.0 ng/mL(-1)). In contrast, the increase in BIS observed at pinning was significantly higher in patients with the lowest calculated plasma SUF concentrations. This suggests that the BIS response to noxious stimulation is modulated by the analgesic regimen.

Alprazolam↗
PubMed1998

Motor and somatosensory evoked potentials in cervical spondylotic myelopathy.

We recorded upper and lower limb MEPs and SEPs in 55 patients with clinically suggestive and myelography-documented cervical cord compression due to spondylotic changes. MEPs were abnormal in biceps brachii of 21 patients (38%), in first dorsal interosseous muscle of the hand of 49 patients (89%) and in tibialis anterior of 47 patients (85%). Overall, MEP abnormalities were present in at least one muscle of 51/55 patients (93%). Median SEPs were abnormal in 20 cases (36%), ulnar SEPs in 24 (44%) and posterior tibial SEPs in 40 (73%). Overall incidence of SEP alterations was 73% (40/55) and SEPs detected clinically silent sensory dysfunction in 10 patients (18%). Among the 43 patients who underwent surgical decompression, first dorsal interosseous (FDI) MEPs and tibial SEPs remained abnormal in most cases 1 year after surgery, independently of clinical outcome. On the other hand, serial EP studies seemed useful to confirm and monitor the clinical evolution of unoperated patients.

Adult↗
PubMed1998

[The Emperor's New Clothes syndrome. Description of a new epidemic].

In 1971, F. Gross, inspired by "The Emperor's new clothes" (H.C. Andersen--1835), published in the New England Journal of Medicine, a report of an endemic polysystem disease: the emperor's clothes syndrome. In the first place, it touches students or physicians who fear losing their prestige. From personal observations, we describe a new epidemic of this disease whose radiological image is the main vector. By this comment, we wish to attract the attention to the danger of giving a diagnosis uniquely on the basis of the complementary examinations. We want to underline the importance of the medical history and physical examination. All clinical or radiological data, all biological phenomenons are subject to variable interpretation. There exist statistical methods to estimate the sensitivity, the specificity and the clinical value of a test.

Attitude of Health Personnel↗
PubMed1997

Elevated plasma alpha 1-acid glycoprotein levels: lack of connection to resistance to vecuronium blockade induced by anticonvulsant therapy.

This study was designed to investigate the relationships among anticonvulsant therapy, plasma alpha 1-acid glycoprotein (AAG) levels, and resistance to vecuronium blockade. Thirty-one patients scheduled for routine neurosurgery were included in the study. The patients were treated (TG; n = 20) with phenytoin (n = 15) and/or carbamazepine (n = 4) and/or phenobarbital (n = 3) for > or = 6 days or were left untreated (UG; n = 11, control group). TG patients were further assigned to one of two subgroups according to the plasma anticonvulsant level measured the day before surgery and found to be within (TGW, n = 10) or below (TGB, n = 10) the therapeutic range. Finally, the 31 patients were divided into two more groups according to their plasma AAG levels: higher than (HAAG, n = 17) or within (NAAG, n = 14) the normal range (25-94 mg dl-1). Anesthesia was induced and maintained with propofol and sufentanil. Muscle relaxation was obtained with vecuronium 0.1 mg kg-1. A train-of-four (TOF) stimulation mode at 2 Hz was applied to the ulnar nerve every 15 s, and neuromuscular transmission was assessed using a TOF-Guard accelograph monitor. Plasma AAG concentrations (means +/- SEM) were 103.7 +/- 7.6 mg dl-1 in TG, 80.7 +/- 6.7 mg dl-1 in UG, 95.9 +/- 13.2 mg dl-1 in TGW, 111.6 +/- 7.6 mg dl-1 in TGB. 114.9 +/- 7.4 mg dl-1 in HAAG, and 71.4 +/- 3.8 mg dl-1 in NAAG groups. The differences in plasma AAG concentrations between UG and TG and between HAAG and NAAG groups were statistically significant. No significant relationship was found between plasma AAG levels and phenytoin concentrations (r = -0.26). The time (mean +/- SEM) to recovery of T1 to 25% of control was significantly shorter in TG (28.2 +/- 1.4 min) than in UG (42.2 +/- 3.1 min) but did not differ significantly according to the plasma anticonvulsant level (27.3 +/- 2.0 min in TGW; 29.1 +/- 1.9 min in TGB) and the plasma AAG level 31.7 +/- 1.9 min in HAAG; 35.3 +/- 3.3 min in NAAG). The time for the TOF ratio to recover to 25% yielded similar profiles and statistical significance levels: TG, 32.9 +/- 2.2 min; UG, 51.2 +/- 4.0 min; TGW, 35.0 +/- 3.9 min; TGB, 30.7 +/- 1.8 min; HAAG, 38.1 +/- 3.1 min; NAAG, 42.0 +/- 4.1 min. We conclude that anticonvulsant therapy induces an increase in plasma AAG independently of the plasma anticonvulsant level. However, duration and recovery of vecuronium blockade do not differ according to plasma AAG levels. Consequently, elevated AAG does not contribute to the resistance to vecuronium blockade induced by anticonvulsants.

Adult↗
PubMed1997

[Surgery of the rolandic region guided by the peroperative localization of the primary motor cortex and neuro-navigation].

Surgery close to the central motor area carries the risk of a new or increased postoperative motor deficit. One reason is the difficulty of localizing the motor cortex when it is displaced by the tumor. Neurosurgeons have long recognised the need for anatomical and functional localisations during any procedure and nowhere is this more important than in and around the central region. For ten years, we have used modern imaging techniques which provide a wealth of information concerning anatomy and pathophysiology and a new method of intraoperative localization of the primary motor cortex based on the application of single anodal electric pulses to the brain surface. In fifty patients, lesions within or adjacent to the motor area were microsurgically resected using a minimally invasive surgical technique.

Adolescent↗
PubMed1996

Intraoperative localisation of the primary motor cortex using single electrical stimuli.

A new method of intraoperative localisation of the primary motor cortex is described, based on the application of single anodal electric pulses to the brain surface. Patients were anaesthetised with propofol infusion, and neuromuscular blockade was temporarily alleviated to allow recording of surface EMG responses (CMAPs) to the stimuli. Primary motor areas could be localised in 18/19 patients studied. In the other patient, no responses were elicited, as the operative field was posterior to the motor cortex. When compared with MEPs elicited in awake patients by magnetic stimuli, responses to intraoperative anodal stimulation were of small amplitude (usually less than 10% of MEPs) and their latency was some 1 to 2 ms longer. One month after the operation, only 1/19 patients was left with a slight muscle weakness, although seven showed preoperative motor deficit. The procedure proved easy and fast, needing no preliminary surgery or time consuming preparation. It did not induce any detectable side effects.

Brain Mapping↗