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M Tremoulet

Publications and source records attributed to M Tremoulet.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Percutaneous treatment of lumber disk herniation. Radiological criteria of therapeutic decision].

Invasive diagnostic imaging methods such as discography, discomanometry, C.T.-discography are generally not required to accurately depict herniated lumbar disks. On the contrary they should be implemented in specific clinical situations in order to confirm the choice of a percutaneous treatment: nucleolysis or nucleotomy. The major role is devoted to discography. Discomanometry and C.T.-discography are second order methods that will help in difficult cases in choosing therapeutic strategy.

Adult↗
PubMed1993

[Foraminal and latero-foraminal hernia. Mid-term results of percutaneous techniques nucleolysis-nucleotomy].

Forty cases of foraminal (28) and lateroforaminal (12) herniated discs treated either by nucleolysis (N.L.) or percutaneous automated nucleotomy (P.A.N.) were investigated over a period of 12 months or more. The group of patients treated with P.A.N. (15 males, 5 females) with a mean age of 41.8 years, had severe radicular pain in 25% of cases, caused by foraminal (15 cases) and lateroforaminal (5 cases) herniated discs which were predominantly located at the L4-L5 level (12 cases). The group of patients treated with N.L. (13 M, 7 F) with a mean age of 50.3 years complained of severe radicular pain in 65% of cases, caused by foraminal (13 cases) and lateroforaminal (7 cases) disc herniations evenly distributed over the last three mobile segments. The overall results obtained with N.L and P.A.N. showed a 67.5% success rate. The best results were obtained in cases of cruralgia with severe radicular pain caused by foraminal herniated disc at the L3-L4 or L4-L5 levels. A significantly better result was obtained in the group of patients treated by N.L. (80% success rate) than in the group of patients treated by P.A.N. (p < 0.04).

Adult↗
PubMed1991

Fractionated radiotherapy of small inoperable lesions of the brain using a non-invasive stereotactic frame.

Arteriovenous malformations (AVMs) and benign or low grade, small malignant tumors can be treated by stereotactic radiotherapy in a single fraction. This report describes a technique for stereotactic treatment of small lesions using conventional, fractionated, photon beam irradiation. The Laitinen's stereoadapter, non-invasive head frame was used. This device was tested for accuracy by serial mountings and found to be accurate within 1 mm. The accuracy of the dose delivered was within 2%. Adaptation of this device to the linear accelerator required the design of secondary circular collimators which decreased the penumbra from 3-4 mm to 2-3 mm. The dose fall off outside the target volume is steep enough when using two non-coplanar arcs (90 to 10% within 1 cm). Thermoluminescent dosimetry (TLD) in a humanoid phantom showed good correlation with the calculated dose. This system permits delivery of fractionated radiation therapy to small volumes, easily and accurately, under stereotactic conditions.

Adolescent↗
PubMed1988

Therapeutic trial of intravenous nimodipine in patients with established cerebral vasospasm after rupture of intracranial aneurysms.

The therapeutic efficacy of intravenous nimodipine to treat the syndrome of delayed ischemic deterioration or vasospasm after subarachnoid hemorrhage caused by a ruptured aneurysm was investigated in a randomized, double-blind, placebo-controlled multicenter study. A total of 188 patients (nimodipine (N) = 102, placebo (P) = 86) were enrolled in the study, both pre- and postoperatively, within 24 hours of clinical deterioration connected with vasospasm or within 24 hours of arteriography that identified vasospasm. After 61 patients were excluded for not meeting study criteria or for protocol violation, the results were supported by 127 validated case reports: 73 patients received intravenous treatment with nimodipine, and 54 were given placebo. Analysis of the main criterion of efficacy, the number of deaths and of patients with severe deficit related to vasospasm alone, showed a significant statistical difference (N = 8 (19%), P = 17 (49%), P = 0.01). The risk of death or disability was reduced by 66% in the treated group. Analysis of this criterion by type of inclusion (clinical or angiographic) also showed a significant reduction in the clinical group (P = 0.05), but there was no difference in the angiographic group. The risk of mortality connected with vasospasm was reduced by 82%, but analysis by group showed that there was no significant difference for those patients included on clinical criteria, whereas mortality was reduced to a much greater extent in the angiographic group. These results demonstrate the therapeutic efficacy of nimodipine in reducing secondary ischemic brain damage in patients already suffering from angiographic vasospasm or delayed ischemic deterioration.

Adult↗
PubMed1985

Hormonal steroid receptors in intracranial tumours and their relevance in hormone therapy.

Determination of cytosolic estradiol and progesterone receptors was carried out in 30 intracranial tumors: 12 meningiomas, 13 metastases, two angioreticulomas, two gliomas and one sarcoma. The hormonal fraction found with the receptor and the dissociation constant (Kd) were determined by the Scatchard method. Values higher than 10 fmol/mg of protein were considered as positive. Ten of the 12 meningiomas (83%) showed progesterone receptors (RP), while estrogen receptors (RE) were not found in any of the cases; six of the 13 metastases showed the two types of receptors; the other tumors did not present detectable receptor levels. There was no correlation between the receptor level and patient age, sex or hormonal status. Thee results suggest the possible use of endocrine therapy for example in cases of high-risk patients or incomplete surgical resection.

Adult↗
PubMed1985

[Use of barbiturates in posttraumatic comas at the mesencephalic level. Apropos of 38 cases].

Thirty-eight patients with brain injury and mesencephalic coma, or a Glasgow score of less than 5, were treated routinely with Thiopental administered by electric syringe for a mean duration of 4 days. Follow up review criteria were based on clinical computed tomography and electroencephalographic data, as well as results of monitoring of intracranial pressure and assay of blood barbiturate levels. Global results indicated a mortality of 55.3% and reintegration of 34.2% of the patients. Results as a function of the different parameters of surveillance are discussed.

Adult↗
PubMed1985

[Cerebral blood flow and meningeal hemorrhage. An aid to the surgical decision].

One hundred and eleven measurements of cerebral blood flow (C.B.F.) were performed using the Xenon 133 inhalation method in 80 cases of spontaneous subarachnoid hemorrhage of which 59 were due to ruptured aneurysms. This method is non-traumatic, reproducible and dependable. A correlation was found between clinical condition and C.B.F. values, but in a number of cases which cannot be dismissed, very low mean C.B.F. values or ischemic foci were revealed where clinical state gave no indication. A poor correlation appeared between vasospasm seen by angiography and ischemic foci detected by isotopic technique. Patients' age influenced C.B.F. values but not clinical evolution. No correlation was found between C.B.F. values and cisternal blood seen on CT scan. C.B.F. values, measured in the first two weeks of illness, were significantly higher in those patients having favorable outcome, whatever their clinical state at the time of C.B.F. measurement (comas excluded). The figure of 60 ml/100 g/min for mean cortical flow seemed to be a critical level below which the risk of complication was greater. Below this level or in cases or ischemic foci, surgery was delayed. Thus, C.B.F. measurement promises to be a valuable prognostic tool, playing an important role in the therapeutic strategy for this type of patients.

Adult↗
PubMed1978

[Levels of axial lesion in severe head injuries (author's transl)].

Over the past few years considerable amount of clinical syndromes describing brain stem levels of lesion were reported. This work was undertaken to establish, if possible, a simplification of criterions of axial lesions in head injuries. 125 patients with severe head injuries were strictly selected. Statistical analysis of careful examination of clinical pattern was performed and correlated, when possible, with anatomical lesions. Only four homogeneous groups were isolated:--group I represents the cortico-sub-cortical level,--group II représents the diencéphalie level,--group III represents the upper brain stem level with two subdivisions dependent upon the mechanism of herniation : central or uncus,--group IV represents the lower brain stem level.

Brain Stem↗
PubMed1975

[The surgical approach to spontaneous intracerebral hematomas (author's transl)].

Following a recent statistical survey of 56 cases over a period of 3 years the authors considered the choice between the frontal or the parieto-temporal approaches to intracerebral haematomas. From their anatomical studies they considered that the frontal route is the better for approach to haematomas of the external capsule, whereas the parieto-temporal approach is preferred for haematomas of the internal capsule.

Cerebral Hemorrhage↗