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Biomedical subjects

J F Mathé

Publications and source records attributed to J F Mathé.

At least 19 recordsLinked to original sources
PubMed2003

[Pharmacological treatment of post-traumatic behavioural disorders].

OBJECTIVE: Literature review of the data concerning pharmacologic treatment of post-traumatic behavioural disorders. This review is limited to the treatment of agitation, excitation, mood lability, hostility and agressivity as defined by the NRS and excludes pharmacologic treatment of mental slowness, cognitive disorders and depression. METHODS: Medline interrogation using keywords Traumatic Brain Injury, Agitation, Agressivity, Behaviour, Pharmacology, Neuroleptics, Benzodiazepines, Carbamazepine, Valproate, Buspirone, SSRI, Propanolol, Methylphenidate and review of recent contents. The data finally includes 29 original studies. RESULTS: The overall level of evidence is quite low as the data mainly consist in open studies and case reports. These data and data from reviews or didactic articles suggest the efficiency of a variety of treatments. Mood-stabilizing antiepileptics, and specially carbamazepine constitute together with SSRI antidepressants the first choices. Some data suggest efficiency of buspirone, methylphenidate and atypic neuroleptics. Lithium requires close monitoring but is probably efficient. It is difficult to conclude concerning propanolol. CONCLUSION: The available data is in favour of the use of CBZ and SSRI antidepressants. Further studies are required. It is necessary to establish clear evidence of the efficiency of CBZ and assess the effects of methylphenidate, which is almost not prescribed in France.

Adrenergic beta-Antagonists↗
PubMed2001

[Post-traumatic endocrine deficits : analysis of a series of 93 severe traumatic brain injuries].

OBJECTIVE: The aim of the study is to measure the incidence in severe traumatic brain injury of endocrine deficits with special consideration for hypotestosteronemia in male patients. PATIENTS AND METHODS: Retrospective analysis of a series of 115 TBIs consecutively admitted to our brain injury unit. Endocrine screening is routinely performed at admission and includes radioimmunological assays for T3, T4, TSH, testosterone or oestradiol and progesterone, FSH, LH and cortisol. Twenty-two records were incomplete and excluded from further analysis. The analysis relies on 93 records among which those of 75 males. RESULTS: One partial hypothyroidism of pituitary origin (low T3, T4 and TSH and no raise of TSH after stimulation by TRH) and one posthypophyseal deficit were found. The incidence of hypotestosteronemia is 28%. All are of central origin (low testosterone and low or normal LH). In one case the hypothalamic origin is demonstrated by the considerable increase of LH after injection of GnRH. We found no correlation between the occurrence of endocrine deficit and either the Glasgow Coma Scale or the existence of basal skull fracture. DISCUSSION - CONCLUSION: These results show that endocrine deficits are not exceptional in TBIs and that isolated hypotestosteronemia is frequent. These deficits are not necessarily all of functional origin, but further studies including longitudinal follow up are required to conclude on this point. Further studies addressing the opportunity of substitution in some patients should also be conducted.

Adult↗
PubMed1999

[Post-traumatic syringomyelia].

Clinical and neuroradiological data were recorded in a series of 73 spinal cord injured patients (33 in Nantes, 40 in Paris-Bicêtre) in whom a post traumatic syringomyelia (PTS) developed. These findings and a review of the literature allow to point out some of the main characteristics in such a pathology. Clinical symptoms are frequent, the commonest of them are pain and sensory loss but any alteration of the neurological status after spinal cord injury has to be considered. Magnetic resonance imaging (MRI), sagittal and axial T1 and T2 weighted images, confirms the diagnosis of syrinx (area with the same signal intensity as CSF extending beyond the site of the initial lesion at least on 2 vertebral segments). MRI allows the diagnosis when it is performed in the follow up of asymptomatic patients. So PTS is not infrequent in spinal cord injured patients, for some of them in the first year after the trauma. The highest incidence is found in patients with complete thoracic lesions. Pathophysiology and surgical management have to take into account post traumatic residual stenosis of the vertebral canal.

Adult↗
PubMed1998

Ischaemic myelopathy following aortic surgery or traumatic laceration of the aorta.

Paraplegia is one of the major complications following repair of aortic aneurysms or congenital malformations and from trauma of the aorta. In a series of 12 surviving patients we describe the clinical features as well as the evolution and pathophysiology of ischaemic lesions of the spinal cord. The clinical characteristics: loss of tendon reflexes, preservation of light touch sensation and bladder function, and the special topography of pin prick impairment, suggest involvement of the central grey matter. This lesion of the grey matter is incomplete in most of the patients and tends to extend for 2-10 segments. In some cases it can extend downward to the conus resulting in complete flaccid paraplegia. On follow-up we have observed limited improvement in most cases. No patient has recovered fully. Except in cases of traumatic laceration, where symptoms existed before surgery, paraplegia followed surgical repair in all other cases. Ischaemia can be related to the duration and the site of crossclamping of the aorta. Clamping above the left subclavian artery and/or a ligation of the intercostal arteries without previous visualisation of the spinal cord arteries can be dangerous. Other factors such as the phenomena of revascularisation and the presence of free radicals are discussed. These could explain delayed postischaemic spinal cord hypoperfusion.

Adolescent↗
PubMed1998

Post-traumatic syringomyelia and post-traumatic spinal canal stenosis: a direct relationship: review of 75 patients with a spinal cord injury.

This study aims to demonstrate predictive factors for post traumatic syringomyelia (PTS), and in particular to correlate the role of insufficiency of reduction of a spinal fracture with the occurrence of syringomyelia. One hundred and twenty-eight spinal cord injured patients (SCI) were studied during the years 1992 and 1993. Among them, 75 underwent a complete and reliable evaluation including: review of the initial vertebral lesion, and of the surgery report, and a radiological study of the lesion site with standard X-rays, a CT scan, and an MRI. The CT Scan included slices in sagittal reconstructions and in the axial plane at the site of injury with the calculation of a percentage of canal stenosis in the two planes of the space. An MRI was carried out with T1 and T2 weighted images, including sagittal entire cord images in addition to sagittal and axial slices centred on the site of injury. A syrinx was diagnosed in 28% of the patients. The occurrence of a syrinx is significantly correlated with spinal canal stenosis in the sagittal plane (delta D) with a P < 0.001 and in the axial plane (delta S) (P < 0.05). This present study demonstrates the major role of the insufficiency of reduction of the vertebral lesion in the genesis of a syrinx. The quality of the initial treatment of the vertebral injury is the first step in the prevention of a syrinx. The treatment of a syrinx, besides techniques of drainage, must also take into account the spinal realignment.

Adolescent↗
PubMed1997

Load compensation tasks evoke tremor in cerebellar patients: the possible role of long latency stretch reflexes.

'Tremor' is one of the clinical signs of cerebellar dysfunction. Its nature remains subject to debate, one hypothesis being that of a predominant role of peripheral afferences in its genesis. This study was designed to study whether load compensating tasks, evoking sudden stretch, and thus stimulation of peripheral afferences induced tremor in cerebellar patients. We study the kinematics and EMG pattern of a load compensating task which consists of maintaining a constant elbow position despite the onset and cessation of a 2 Nm torque loading the elbow flexors in eight cerebellar patients and six controls. Angular position and velocity, and EMG of the biceps and triceps are recorded at a sampling rate of 1 kHz. In normal subjects, trajectories are simple with little overshoot of the aimed position. EMG analysis shows a long latency stretch response (LLSR) which initiates a phasic and then tonic voluntary activity. In cerebellar patients, the two prominent cinematic features are hypermetria and tremor. The stretch response is of the same latency, but the EMG pattern is modified with bursts of activity related to the tremor. These results show severe perturbations of load compensating tasks in cerebellar patients. We discuss the possible role of the exaggeration of LLSR in both hypermetria and tremor.

Case-Control Studies↗
PubMed1996

Laryngotracheal stenosis after intubation or tracheostomy in patients with neurological disease.

OBJECTIVE: This retrospective study evaluated the incidence of airway complications in neurological patients following translaryngeal intubation, tracheostomy, or both. DESIGN: The medical records of 315 consecutive patients (200 with traumatic brain injuries, 31 traumatic tetraplegics, and 84 with other neurological disorders) were reviewed. The type of artificial airway, duration of intubation, and use of nocturnal ventilation were recorded. Eighty-six percent of the patients underwent some combination of tracheal tomograms, flow-volume loop analysis, and fiberoptic tracheolaryngoscopy. Stenosis was classified as severe if it required surgery, if it required maintaining the tracheostomy, or was lethal. It was classified as benign if it was successfully treated by medical or local means. RESULTS: Fifty-five percent of the patients were intubated translaryngeally only (mean = 17 days). Three percent underwent tracheostomy only, and 42% underwent tracheostomy after intubation for a mean of 13 days. The overall incidence of airway stenosis was 20%, 1/4 of which was severe. Fifteen percent of these patients died as a result of tracheal complications. The incidence of stenosis was higher following tracheostomy than following intubation only (29% vs 13%, p < .01). The incidence of severe stenosis in intubated-only patients was low (1%) compared with that following tracheostomy (10%, p < .01). No significant relationship was found between the length of intubation or the timing of tracheostomy. CONCLUSION: Fewer complications are associated with transtracheal intubation than with tracheostomy. The data suggest that longer periods of intubation be used when attempting ventilator weaning before restoring to tracheostomy if weaning fails.

Adolescent↗
PubMed1995

[Bladder-sphincter disorders in patients with spinal cord injuries].

Improvement in the management of neuropathic bladders in spinal cord injury has considerably increased the life expectancy of these patients. The classical classification in central or peripheric neuropathic bladders, now leave place to a functional, clinical, and urodynamic classification. Three periods define the evolution of the neuropathic bladders: the initial period (drainage), the reeducation phase, and the stabilized period. Urodynamic investigations detect situations of risk (high intravesical pressures) and allow therapeutic adjustment. Intermittent catheterization has transformed neuro-urology and allowed deliberate choice of retention. Long term follow up is imperative (urodynamic study, echography, intravenous urography) to avoid secondary degradation.

Humans↗
PubMed1994

[Environments and handicaps].

Chronic deficiencies have been known ever since man left traces of his own existence but have increased since the 19th century. The number of people with chronic deficiencies in France is close to five millions, of which 1,2 million are very severe. This figure does not include occasional deficiencies due to age or "normal" transitory situations of life. These deficiencies engender disabilities which themselves create a handicap. Particular attention to environmental conditions is required to cope with such situation and try and equalize opportunities and reduce exclusion. This is a part of the scope of medicine if the aim is, as Pr. B. Glorion reminded us recently "to treat and cure but also maintain the patients physical and moral equilibrium". Reeducation is concerned with the person, rehabilitation with the adaptation of the individual and collective environment. It is in intervening in this area, that it becomes possible to reduce otherwise overwhelming inequalities. "What constitutes real democracy is not to recognise equals but to make them equal" (Gambetta). While it remains necessary to answer to the requirements of individual situations, it is on the wider and collective front that solutions must be found in order to deal with the greater situational difficulties of collective life. To be efficient, the principles of action must leave behind conventional classifications and attempt to solve the functional difficulties: daily life activities, transportation, work, education, access to social life. Given pressure from individuals, often grouped in associations, and from medical practitioners sensitive to these problems, laws have been passed and local authorities have adapted infrastructures.(ABSTRACT TRUNCATED AT 250 WORDS)

Persons with Disabilities↗
PubMed1982

[Rigid-spine syndrome in a female patient (author's transl)].

A case of rigid spine syndrome in a woman is reported. There were a diffuse myopathic process, with atrophy and mild weakness not involving the face and a major rigidity of the spine. Contractures were present as well as a pure restrictive respiratory failure. Heart-rythm disorders and prolapse of the mitral valve were present. Histological features of a deltoid muscle biopsy were slight necrosis, lack of fibrosis and major disproportion in fiber-types. There were a high rate of fiber I and absence of fiber IIB. This case was similar to others described as Dubowitz's rigid spine syndrome. The histological features belonged to the second neuropathological group of cases, with disproportion in fiber-types. The rigid spine syndrome may be considered as a clinically definite disease and distinguished from other myopathies with orthopedic deformations. It should not be confused with arthrogryposis multiplex. The disease is probably autosomic recessive.

Adult↗
PubMed1982

[Detrusor inactivity in central spinal cord lesions. Hypothesis of inhibitory hyperreflexia of sympathetic origin].

In connection with two observations of suprasacral complete spinal cord patients showing a clear sublesional spasticity and paradoxically and inactive and unreactive detrusor, the authors discuss the mechanisms that are usually considered: vesical distension, sacral peripheric neurogenic lesion, reflex inhibition of the detrusor of somatic origin. They express the hypothesis of an inhibition hyper-reflex of sympathetic origin, reversible under phenoxybenzamine treatment, consider the urodynamic evaluation and the therapeutic treatment and compare this type of neurogenic vesical dysfunction to that of the spinal shock.

Adolescent↗
PubMed1980

[Unusual involvement of the CNS in a case of neuro-sarcoidosis (author's transl)].

A peculiar case of neuro-sarcoidosis is reported. Clinical symptoms associated ocular dysfunction, hypopituitarism due to hypothalamic disorders, hypersomnia and alveolar hypoventilation. Dynamic tests have proved hypothalamic involvement. The patient died swiftly and suddenly. Neuropathological examination showed typical granuloma consistent with sarcoidosis mainly distributed to the area of the third ventricle and spread hyperplastic gliosis of pons and medulla.

Adult↗
PubMed1980

[Cerebral radionecrosis discovered 32 years after conventional irradiation therapy for a pituitary adenoma (author's transl)].

A case of late radiation lesions of the brain was discovered 32 years after conventional X Ray therapy for pituitary adenoma. The major clinical picture was made of dementia and slight hypothalamic and pituitary dysfunction. Extensive bone-necrosis of the skull was observed. A defect of the sella led to recurrent meningitis. Segmental atheromatous lesions of cortical arteries are supposed to be induced by the photonic radiations. Intra parenchymatous lesions were slightly of the necrotic type and mainly of the degenerative one. Severe hyalin and calcic degeneration of small vessels was observed as well as extensive demyelination. The role of vascular and metabolic effects in the genesis of these late radiation lesions is discussed.

Adenoma↗
PubMed1978

[Therapeutic use of tiapride in movement disorders].

Tiapridal was given to twenty-four patients suffering from dyskinesias. Therapeutic efficacity seems to the etiology. Not any fonctitonal improvement was observed in parkinsonism with dyskinesia consecutive to Dopa therapy. On the other hand a good efficacity was found in the treatment of choreas with a quite good tolerance; the functional result will depend of the evolutive state of the disease.

Benzamides↗