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1.
BMC Geriatr ; 24(1): 353, 2024 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-38641801

RESUMO

BACKGROUND: Transfers of nursing home (NH) residents to the emergency department (ED) is frequent. Our main objective was to assess the cost of care pathways 6 months before and after the transfer to the emergency department among NH residents, according to the type of transfer (i.e. appropriate or inappropriate). METHODS: This was a part of an observational, multicenter, case-control study: the Factors associated with INappropriate transfer to the Emergency department among nursing home residents (FINE) study. Sixteen public hospitals of the former Midi-Pyrénées region participated in recruitment, in 2016. During the inclusion period, all NH residents arriving at the ED were included. A pluri-disciplinary team categorized each transfer to the ED into 2 groups: appropriate or inappropriate. Direct medical and nonmedical costs were assessed from the French Health Insurance (FHI) perspective. Healthcare resources were retrospectively gathered from the FHI database and valued using the tariffs reimbursed by the FHI. Costs were recorded over a 6-month period before and after transfer to the ED. Other variables were used for analysis: sex, age, Charlson score, season, death and presence inside the NH of a coordinating physician or a geriatric nursing assistant. RESULTS: Among the 1037 patients initially included in the FINE study, 616 who were listed in the FHI database were included in this economic study. Among them, 132 (21.4%) had an inappropriate transfer to the ED. In the 6 months before ED transfer, total direct costs on average amounted to 8,145€ vs. 6,493€ in the inappropriate and appropriate transfer groups, respectively. In the 6 months after ED transfer, they amounted on average to 9,050€ vs. 12,094€. CONCLUSIONS: Total costs on average are higher after transfer to the ED, but there is no significant increase in healthcare expenditure with inappropriate ED transfer. Support for NH staff and better pathways of care could be necessary to reduce healthcare expenditures in NH residents. TRIAL REGISTRATION: clinicaltrials.gov, NCT02677272.


Assuntos
Procedimentos Clínicos , Casas de Saúde , Idoso , Humanos , Estudos de Casos e Controles , Serviço Hospitalar de Emergência , Transferência de Pacientes/métodos , Estudos Retrospectivos
2.
J Neurosurg ; 89(4): 519-25, 1998 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-9761043

RESUMO

OBJECT: The authors prospectively studied the efficacy of tirilazad mesylate, a novel aminosteroid, in humans with head injuries. METHODS: A cohort of 1120 head-injured patients received at least one dose of study medication (tirilazad or placebo). Eighty-five percent (957) of the patients had suffered a severe head injury (Glasgow Coma Scale [GCS] score 4-8) and 15% (163) had sustained a moderate head injury (GCS score 9-12). Six-month outcomes for the tirilazad- and placebo-treated groups for the Glasgow Outcome Scale categories of both good recovery and death showed no significant difference (good recovery in the tirilazad-treated group was 39% compared with the placebo group in which it was 42% [p=0.461]; death in the tirilazad-treated group occurred in 26% of patients compared with the placebo group, in which it occurred in 25% [p=0.750]). Subgroup analysis suggested that tirilazad mesylate may be effective in reducing mortality rates in males suffering from severe head injury with accompanying traumatic subarachnoid hemorrhage (death in the tirilazad-treated group occurred in 34% of patients; in the placebo group it occurred in 43% [p=0.026]). No significant differences in frequency or types of serious adverse events were shown between the treatment and placebo groups. CONCLUSIONS: Striking problems with imbalance concerning basic prognostic variables were observed in spite of the large population studied. These imbalances concerned pretreatment hypotension, pretreatment hypoxia, and the incidence of epidural hematomas. In future trials of pharmacological therapy for severe head injury, serious consideration must be given to alternative randomization strategies. Given the heterogeneous nature of head injury and the identification of populations that do relatively well with standard therapy, target populations with a higher risk for mortality and morbidity may be more suitable for clinical trials of such agents.


Assuntos
Lesões Encefálicas/tratamento farmacológico , Traumatismos Craniocerebrais/tratamento farmacológico , Fármacos Neuroprotetores/uso terapêutico , Pregnatrienos/uso terapêutico , Adulto , Estudos de Coortes , Feminino , Seguimentos , Escala de Coma de Glasgow , Hematoma Epidural Craniano/complicações , Humanos , Hipotensão/complicações , Hipóxia/complicações , Masculino , Fármacos Neuroprotetores/efeitos adversos , Placebos , Pregnatrienos/efeitos adversos , Prognóstico , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Hemorragia Subaracnóidea/tratamento farmacológico , Taxa de Sobrevida , Resultado do Tratamento
3.
Spine (Phila Pa 1976) ; 20(9): 1011-6, 1995 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-7631230

RESUMO

STUDY DESIGN: This study analyzed computed tomographic scans, magnetic resonance images, and biopsies of the paravertebral muscles of patients with camptocormia and age-matched patients with lumbar interapophyseal osteoarthritis or lumbar vertebral stenosis. OBJECTIVES: To define the muscular lesions and clarify their nature in this particular disorder. SUMMARY OF BACKGROUND DATA: Progressive lumbar kyphosis or camptocormia, a rare disease of the elderly characterized by inability to immobilize the lumbar spine in relation to the pelvis appears to be a result of weakness of the paraspinal muscles. The features presented by these patients do not correspond to any myopathy previously described. METHODS: Twenty-seven patients (5 men and 22 women) mean age 69 years, with camptocormia were compared to fifteen age-matched patients without camptocormia but with posterior interapophyseal osteoarthritis and to nine elderly patients operated for narrowing of lumbar canal. Computed tomographic scans, magnetic resonance images, light microscopy, histochemistry, and electron microscopy of paraspinal muscles were obtained in both groups. RESULTS: In patients with camptocormia, computed tomographic scans and magnetic resonance imaging showed heterogeneous appearance of the spinal muscles with areas of low density. These features were distinct from those of patients with interapophyseal osteoarthritis and were similar to the features described in primary muscular dystrophies. The main microscopic change in camptocormia was the increase of fibrous tissue, frequently with a lobular pattern, not seen in osteoarthritic patients. Familial history of the disorder was frequent (20 out of the 27 patients). CONCLUSION: Camptocormia, disappearing in the recumbent position, is thus very probably linked to muscle involvement. That there is often a family history of such disorder is in favor of a genetically transmitted condition. Magnetic resonance images and computed tomographic scan appearance seems to be in favor of primary muscular disease, restricted to the spinal muscles.


Assuntos
Cifose/patologia , Vértebras Lombares , Músculo Esquelético/patologia , Doenças Musculares/patologia , Doenças da Coluna Vertebral/patologia , Idoso , Eletromiografia , Feminino , Fibrose , Humanos , Cifose/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças Musculares/diagnóstico por imagem , Osteoartrite/diagnóstico por imagem , Osteoartrite/patologia , Doenças da Coluna Vertebral/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/patologia , Tomografia Computadorizada por Raios X
4.
Acta Neurol Belg ; 92(1): 16-23, 1992.
Artigo em Francês | MEDLINE | ID: mdl-1546521

RESUMO

The authors describe a surgical technique of total ethmoidectomy by mixed frontal and paralateronasal duct for excision of the ethmoidal bloc tumors. This technique requires a surgical team aware of neurosurgical and ORL problems. The authors report their experience on a series of six patients, surgically managed from 1983 to 1990.


Assuntos
Seio Etmoidal/cirurgia , Neoplasias dos Seios Paranasais/cirurgia , Equipe de Assistência ao Paciente , Adolescente , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Neurocirurgia , Otolaringologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Operatórios/métodos
5.
Rev Neurol (Paris) ; 134(3): 183-95, 1978 Mar.
Artigo em Francês | MEDLINE | ID: mdl-705167

RESUMO

The author establish an onerall picture of cerebellar infarction with brain stem compression after reviewing 63 cases published in the literature and 4 personal observations. The frequency of this affection can be compared with that of cerebellar hematomas. Diagnosis is based on its predominance in males, the early age at which it appears, its rapid and typical onset, and the delayed signs of brain stem compression. Conventional neuroradiological procedures show an expanded cerebellar volume, and the scanner can specify the ischaemic nature of the lesion. As soon as changes in consciousness occur surgical decompression is necessary, first by external drainage of C.S.F. and later, if necessary, by direct access to the postdrior fossa.


Assuntos
Doenças Cerebelares/diagnóstico , Encefalomalacia/diagnóstico , Adulto , Edema Encefálico/diagnóstico , Edema Encefálico/patologia , Tronco Encefálico/patologia , Doenças Cerebelares/patologia , Infarto Cerebral/patologia , Diagnóstico Diferencial , Encefalomalacia/patologia , Feminino , Hematoma/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Pseudotumor Cerebral/diagnóstico , Fatores Sexuais
6.
J Neuroradiol ; 26(2): 79-86, 1999 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10444931

RESUMO

PURPOSE: To describe the MR imaging findings in eight patients with cavernous hemangioma of the orbit. METHODS: CT, MR imaging and echographic studies of eight patients with cavernous hemangioma localized in the orbit were reviewed. All patients presented with a progressive symptomatology: in seven cases with a painless proptosis, in one case with a failing of visual acuity of the concerned eye. The patients were examined with T2- and T1-weighted spin echo sequences, before and after intravenous administration of Gadolinium*, in axial, coronal and sagittal planes. In seven patients, a fat saturation prepulse was given after the Gd-enhanced study. Two patients were also examined with CT scan, with and without intravenous contrast administration. Three patients underwent a Doppler color-coded transorbital sonography. The analyzed criteria were: location, form, margins, size, signal or density. Seven patients underwent surgery with pathologically proved cavernous hemangioma. In one patient, therapy was conservative, because of the absence of significant clinical complaints. RESULTS: In all cases, MRI showed a well-defined intraconal mass. The lesions were homogeneous, isointense to muscle on the T1-weighted sequence and hyperintense to muscle on the T2-weighted sequences. In five cases, a peripheral rim, hypointense to the mass on the T1- and T2-weighted sequences could be observed. After Gadolinium*, six lesions showed initial central patchy enhancement. On the three following T1-Gadolinium* sequences, these lesions showed total and homogeneous filling. In two patients, the lesions showed immediate homogeneous enhancement. On CT, the orbital masses were spontaneously hyperdense, with associated focus of microcalcifications. On echography, the lesions appeared hyperechogenic, heterogeneous, with individualization of small areas of very slow flow. CONCLUSION: From the analysis of the MR appearance of an intraconal, well-defined mass, associating homogeneous signal, isointense to muscle on T1-weighted sequence, hyperintense on T2-weighted sequence, and especially progressive filling on Gd-enhanced sequences, the diagnosis of cavernous hemangioma may be highly suggestive, in a patient presenting a painless progressive proptosis.


Assuntos
Hemangioma Cavernoso/diagnóstico , Imageamento por Ressonância Magnética , Neoplasias Orbitárias/diagnóstico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Arch Pediatr ; 8(6): 608-10, 2001 Jun.
Artigo em Francês | MEDLINE | ID: mdl-11446182

RESUMO

CASE REPORT: We report the case of a nine-year-old child with a cervical medullary arteriovenous malformation (AVM), revealed by total paraplegia, whose regression started during steroid therapy, before embolization. CONCLUSION: The frequency of AVM's spontaneous favorable outcome is unknown but should not be underestimated. It might be improved by steroids.


Assuntos
Malformações Arteriovenosas/complicações , Paraplegia/etiologia , Medula Espinal/irrigação sanguínea , Corticosteroides/uso terapêutico , Malformações Arteriovenosas/patologia , Malformações Arteriovenosas/cirurgia , Criança , Embolização Terapêutica , Humanos , Imageamento por Ressonância Magnética , Masculino , Medula Espinal/patologia , Resultado do Tratamento
8.
Neurochirurgie ; 40(2): 116-20, 1994.
Artigo em Francês | MEDLINE | ID: mdl-7870244

RESUMO

The authors report a randomized prospective study of 80 patients operated for lumbar disc herniation. In one group of patients, the operator used a microscopic discectomy, in the other group, the surgery was performed through an interlaminar approach without microscopic magnification. All patients were operated on by the same surgeon. The results have been evaluated by a blind neurosurgeon after 12 to 18 months. 90% patients of the two groups have an excellent or a good outcome following the criteria of Mac Nab. There is no difference, regarding the outcome, between microscopic and non-microscopic removal of disc herniation. Using the microscope does not influence the operating time, the post operative inpatient stay and the time off-work. The authors conclude that the use of the microscope, can facilitate the operation and give a better visual comfort, but does not improve the final results.


Assuntos
Discotomia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Microcirurgia , Pessoa de Meia-Idade , Estudos Prospectivos , Distribuição Aleatória
9.
Neurochirurgie ; 26(2): 109-21, 1980.
Artigo em Francês | MEDLINE | ID: mdl-7412977

RESUMO

The authors analyse the detailed clinical course in an homogenous review of 17 cases reports of traumatic injury affecting the extracranial portion of internal carotid artery. Only cases in which there were neither cervical perforating wound nor atheromatous predisposing lesion were considered. As in cases reported in the literature, the young age of these patients, with prevalence in the second decade and in men, was attributable to the etiology. Circumstances in which diagnosis was established induce to discern two unequal groups, according as there was either a coma or immediate focal signs, or a delayed symptomatology : it occured most frequently after a free interval shorter than 48 hours, and reaching in the extrema (one instance) 40 days. Brachiofacial hemiparesis was the most frequent clinical picture. Doppler investigation was able to detect, with a rather satisfying reliability, anomalies in the carotid flow before angiography ; angiogram showed lesions nearly always facing first or second cervical vertebra and bilateral lesions in four instances. Injuries consisted in dissecting aneurysm with stenosis aspect much more often than in thrombosis. In a third of cases distal ischemic lesions below dissecting aneurysm were noted. Prognosis in these cases is very poor since eight patients in our series died without any possibility of expectation according to clinical or angiographical data. Medical therapeutics were disappointing, and this induced to consider an extension in preventive realization of extra-intracranial by pass, each time diagnosis is established and patient is lucid. Etiopathogenical aspect is the originaler part of this study, since we could precisely approach incriminated mechanisms in a methodic analysis of impacts and their results. In our review cranial or facial shock was constantly noted, always frontal and often mild. In II cases association to a frontal and upper thoracic traumatism was found ; safety belt may have been responsible in part, in the mechanism of fixation of upper thoracic orifice, in most cases where this thoracic impact seemed to be missing. Thwarted stretching of carotid artery seems to be the necessary condition for occurring of an intimal tear. Other mechanisms like direct cervical shock may certainly be found, but we did not observe any instance in this review.


Assuntos
Lesões das Artérias Carótidas , Adulto , Traumatismos Faciais/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Crânio/lesões , Traumatismos Torácicos/complicações
10.
Neurochirurgie ; 38(6): 333-46, 1992.
Artigo em Francês | MEDLINE | ID: mdl-1306888

RESUMO

Per-operative use of S.E.P.s for vascular disease is based on: 1. The relationship between electrical cortical responses and cerebral blood flow. 2. The existence of a reversible threshold of cerebral ischemia. Intra-operative monitoring S.E.P.s were used during 30 procedures for aneurysms of the middle cerebral artery (M.C.A.). In 18 cases, a temporary occlusion of M.C.A. was necessary. Occlusion times ranged from 1 to 30 minutes. The central conduction time delay (C.C.T.), i.e. the delay N14-N20 and the cortical peak (N20) amplitude, elicited by median nerve stimulation was bilaterally monitored. A prolongation of the C.C.T. by 1 millisecond (compared with the baseline induction value) and a progressive decrease or a disappearance of the N20 peak were considered as "significant" changes. In response to these changes, immediate corrective actions (interruption of temporary M.C.A. occlusion (T.O.), repositioning of brain retractors, reapplication of aneurysm clips ...) were implemented. The reversibility of the S.E.P.s alterations during surgery was correlated with the post-operative outcome. Significant changes were found in 20 cases (including 13 T.O.). They were totally reversible in 11 cases: 5 of them developed a new but transient immediate post-operative deficit, none had a definitive deficit, and 6 patients had no new deficit. In 9 cases, the per-operative S.E.P.s alterations were not reversible: 3 cases (including 1 T.O.) had a transient deficit, 4 a permanent deficit, and 1 died (aneurysm rupture during craniotomy). An irreversible N20 peak disappearance predicted a permanent post-operative deficit in 4 of 4 patients (100%), whereas an isolated irreversible C.C.T. increase was only followed by a transitory deficit. Only 1 of 9 patients with no change in S.E.P.s (during a 15 min. T.O.), had a transient hemiparesis: this "false-negative" case will be discussed. This study confirms that S.E.P.s monitoring provides useful warning during aneurysm surgery. Median nerve S.E.P.s reflect the functional integrity of cortical M.C.A. territory; it is the pathway a risk during M.C.A. aneurysm surgery. S.E.P.s changes are not real-time information (an average of 500 responses need about 2 min), but these delays allow the surgeon to reverse the situation by immediate intra-operative adjustment, especially during temporary M.C.A. occlusion.


Assuntos
Aneurisma Roto/cirurgia , Potenciais Somatossensoriais Evocados , Aneurisma Intracraniano/cirurgia , Monitorização Intraoperatória , Adulto , Idoso , Aneurisma Roto/complicações , Isquemia Encefálica/diagnóstico , Feminino , Seguimentos , Humanos , Aneurisma Intracraniano/complicações , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Hemorragia Subaracnóidea/etiologia
11.
Neurochirurgie ; 22(5): 445-53, 1976.
Artigo em Francês | MEDLINE | ID: mdl-1018720

RESUMO

The authors present percutaneous technic treatment of some pain syndrom by thermocoagulation of rachidian nerves with radiofrequency generator. This method had been employed on 60 patients in various indications (cervico-occipital neuralgias, low back pain, stage syndrom, painful scar etc...). After anatomic justification one literature analysis precede personal results of this therapeutic method. This one is easy to realise and seems to deserve a good place in the actual possibility of functional neurosurgery.


Assuntos
Eletrocoagulação/métodos , Dor Intratável/cirurgia , Nervos Espinhais/cirurgia , Seguimentos , Humanos , Fusão Vertebral/métodos
12.
Neurochirurgie ; 40(1): 31-66, 1994.
Artigo em Francês | MEDLINE | ID: mdl-7997316

RESUMO

This text summarizes the course organized for residents and trainees by the Société de Neurochirurgie de Langue Française. It was presented by the authors during the annual winter meeting held in Paris in December 1992. The aim of this course was to discuss all the technical points needed to achieve safely a microsurgical clipping of an intracranial aneurysm of the anterior circulation. Although many of these technical points discussed can apply to any kind of intracranial aneurysm, the very specific difficulties of the treatment of giant aneurysms or posterior circulation aneurysms were not mentioned. The usual pterional approach is described. The need of having a slack brain to perform easily the dissection of the aneurysm is stressed. Standards of hemodynamic control during surgery are described either with the use of a total or a proximal temporary clipping under the electrophysiologic control of the somesthetic evoked potential. Prevention of peroperative cerebral ischemia and brain protection are discussed. Dissection of the aneurysm is presented step by step until clipping. Different ways of clipping are discussed after a short description of the characteristics and composition of various available clips. How to deal with a premature intra-operative rupture of the aneurysm is also discussed. The last chapter describes step by step the approach and clipping of the four most frequent aneurysm locations i.e. at the posterior face of the intracranial internal carotid artery, the intracranial carotid bifurcation, the middle cerebral artery, and the anterior communicating artery.


Assuntos
Aneurisma Roto/cirurgia , Aneurisma Intracraniano/cirurgia , Grampeadores Cirúrgicos , Circulação Cerebrovascular , Craniotomia/métodos , Potenciais Somatossensoriais Evocados , Humanos , Hipotensão Controlada , Microcirurgia , Monitorização Intraoperatória , Fatores de Risco
13.
Neurochirurgie ; 37(2): 96-104; discussion 104-5, 1991.
Artigo em Francês | MEDLINE | ID: mdl-1830132

RESUMO

1,085 patients have been treated for intervertebral disc herniation with lombo-sciatica: in 751 cases surgical discectomy without laminectomy has been performed with or without microscope; 334 underwent papain nucleolysis. The two clinical groups were separated on clinical and radiographic backgrounds: nucleolysis was performed in patients with no motor disturbance, no stenosis of the lumbar canal, no displaced fragment; the other patients received surgical treatment. The results were evaluated according to MacNab's criteria with a follow-up of 12 to 84 months (mean 17.2 months). The results after surgical treatment were excellent in 53.8% and good in 36.8% of the cases. For papain treatment they were excellent in 32.7% and good in 38.8% of the cases. Papain nucleolysis therefore appears to be an efficient method for the treatment of intervertebral disc herniations associated with lombo-sciatica but, overall, gives poorer results than surgery in spite of a strict selection procedure. In this study, complications due to papain nucleolysis were restricted to chemical spondylodiscitis (5 cases) and to 2 benign allergic syndromes. Statistical analysis of all the cases and multifactorial correlation research pointed out the importance of "workmen's compensation" as prognostic factor. Since this study, 90% of the patients presenting with disc herniation associated with lombo-sciatica recalcitrant to medical treatment undergo surgical discectomy; papain nucleolysis is reserved for sub-ligamentary and non-displaced forms without stenosis of the lumbar canal and represent 10% of our current population.


Assuntos
Quimiólise do Disco Intervertebral , Deslocamento do Disco Intervertebral/terapia , Vértebras Lombares , Papaína/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/cirurgia , Dor nas Costas/terapia , Feminino , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ciática/cirurgia , Ciática/terapia
14.
Neurochirurgie ; 48(2-3 Pt 1): 75-9, 2002 May.
Artigo em Francês | MEDLINE | ID: mdl-12053160

RESUMO

BACKGROUND AND PURPOSE: The direct transnasal approach is a less invasive approach to the sella turcica and represents an alternative to the sublabial transsphenoidal approach with minor oro-nasal complications. In this study, we describe this approach with emphasis on post-operative course. METHODS: We studied retrospectively 60 patients operated on consecutively by a transnasal approach between January 1996 and December 2000. RESULTS: There were 47 macroadenomas, 9 microadenomas and 4 non-adenomatous pathologies. Despite its narrowness, the transnasal approach was possible in all cases and allowed tumor removal as satisfactory as with the sublabial approach. Eight patients had complications not directly related to the approach: 1 death (meningitis with brain stem ischemia), 3 pituitary fossa hematomas, 4 rhinorrheas and 2 meningitis. Seven patients had complications related to the approach: 2 nasal obstructions, 1 nasal dryness, 2 sinusitises and 2 hyposmias. All these local complications were transitory and disappeared within 3 months. CONCLUSIONS: In our experience, the direct transnasal approach is safe, quick and less invasive than the sublabial approach.


Assuntos
Adenoma/cirurgia , Cavidade Nasal/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/cirurgia , Sela Túrcica/cirurgia , Adenoma/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/anatomia & histologia , Procedimentos Neurocirúrgicos/efeitos adversos , Neoplasias Hipofisárias/patologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos , Instrumentos Cirúrgicos
15.
Neurochirurgie ; 48(2-3 Pt 1): 92-6, 2002 May.
Artigo em Francês | MEDLINE | ID: mdl-12053163

RESUMO

BACKGROUND AND PURPOSE: By definition, image-guided neuroendoscopy is a connection between a neuroendoscope and a neuronavigational system creating a computer-guided instrument. Our objective was to adapt our rigid endoscope with our neuronavigation system to perform computer-guided endoscopy. METHODS AND RESULTS: The rigid neuroendoscope, equipped with light emitting diodes, was connected to the work station. We report our early results with this device in 17 patients: 8 ventriculocisternostomies, 5 ventriculocisternostomies with biopsies of tumors of the posterior part of the third ventricule, 4 biopsies or tumor removal like colloid cysts. No technical complications were encountered. CONCLUSIONS: The development of image-guided neuroendoscopy has modified our approach to neuroendoscopy because the surgical procedure is facilitated. The use of fluoroscopy becomes unnecessary. The surgeon can choose, independent of the preestablish surgical technique, the entry point, the target and, of course, the optimal trajectory. The technique is adaptable to the individual anatomy of each patient, the location and the nature of the target. It is an undeniably useful teaching tool and represents a real progress in minimally invasive neurosurgery.


Assuntos
Encéfalo/patologia , Endoscopia/métodos , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Cistos/cirurgia , Endoscópios , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/instrumentação , Estudos Retrospectivos
16.
Neurochirurgie ; 25(2): 91-5, 1979.
Artigo em Francês | MEDLINE | ID: mdl-492442

RESUMO

Following spinal cord lesions, signs of spasticity may be observed on bladder with decreased capacity and urinary leaks. We have attempted to associate the inocuity of anesthetic blocks and the selective precision of microsurgical rhizotomies by percutaneous thermocoagulation of sacral roots. Bilateral 53 root coagulation, under Rx control, vesical pressure monitoring and stimulation tests, is ususally efficient. Authors report the technic and the results of this simple method about the first nine cases with more than one year of follow up.


Assuntos
Eletrocoagulação/métodos , Raízes Nervosas Espinhais/cirurgia , Bexiga Urinaria Neurogênica/cirurgia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
Neurochirurgie ; 45(5): 417-21, 1999 Dec.
Artigo em Francês | MEDLINE | ID: mdl-10717594

RESUMO

A case of cervical spine infection due to Streptococcus anginosus is reported. Streptococcus milleri is encountered in the mouth, gastro-intestinal tract, vagina and nasopharynx. It is an uncommon pathogen responsible of suppurative infections such as brain liver or spleen abscesses, intra-abdominal or soft tissue abscesses and pleural empyema. In rare cases it can cause spondylodiscitis and osteomyelitis. Based on the review of eight cases of spondylodiscitis or osteomyelitis, diagnosis and treatment are discussed.


Assuntos
Vértebras Cervicais/microbiologia , Cervicalgia/etiologia , Espondilite/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificação , Adulto , Ampicilina/uso terapêutico , Quimioterapia Combinada/uso terapêutico , Humanos , Imageamento por Ressonância Magnética , Masculino , Metronidazol/uso terapêutico , Espondilite/complicações , Espondilite/diagnóstico , Espondilite/tratamento farmacológico , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus/classificação , Streptococcus/patogenicidade , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Vancomicina/uso terapêutico
18.
Neurochirurgie ; 21(3): 191-203, 1975.
Artigo em Francês | MEDLINE | ID: mdl-1219488

RESUMO

UNLABELLED: The author's describe: I. METHODS OF ANALGESIC CUTANEOUS STIMULATION: I) Transcutaneous analgesic stimulation: Stimulations realized by biphasic asymetrical "waves" of 0 to 80 milliamps intensity for a frequency of 10 to 100 cycles/S. -Place of the stimulation: a painful area. -Stimulation length: 15 to 20 minutes, repeated during several days. RESULTS: appreciate patients tolerance to the tingling sensation. Test the analgesic effect, sometimes sufficient to treat the patient. 2) Analgesic percutaneous stimulation: The percutaneous electrode is applicated to the dura, without penetrating it. Same types of results as for transcuteneous stimulation but more precise. II. DEFINITION of the indication of chronic implantation of an analgesic stimulator. Studying results of repeated analgesic transcutaneous stimulations allows to distinguish between several possibilities. I) Intolerance of the sensation of stimulation: Contra-Indication or increasing of the pain. 2) Complete and lasting amelioration leads to: Chronic transcutaneous neurostimulation. 3) Partial amelioration, No amelioration leads to: Acute percutaneous stimulation either successful results after stimulation, : Chronic implantation: -of peripheral nerve -on a peripheric nerve -of dorsal column -on dorsal column, either paraesthesis without Analgesia:? III - EXPERIMENTAL APPROACH TO THE MECHANISM OF ACTION OF THE "ANALGESIANT" ELECTRIC STIMULATION. A cutaneous "analgesiant" stimulation produces, in the cat, the inhibition of evocated potential in C.M. by "nociceptive" stimulation of the sciatic nerve. The inhibition only appears after a 30 minutes latence. This let suppose different mechanisms from the "Gate Control" theory. The authors specify their personal results (Tab. 2.)


Assuntos
Estimulação Elétrica/métodos , Dor Intratável/terapia , Estimulação Elétrica/instrumentação , Humanos
19.
Neurochirurgie ; 31(6): 471-93, 1985.
Artigo em Francês | MEDLINE | ID: mdl-3831771

RESUMO

Enzymatic dissolution of nucleus pulposus by percutaneous injection of a papain preparation is now used frequently to treat lumbosacral disc hernias responsible for resistant sciatica. Mechanisms of action and techniques are reviewed, and the importance of applying strict criteria for indications for use emphasized. The method should be reserved for nerve root sciatica resistant to medical treatment or physiotherapy, and it constitutes the last stage of conservative treatment. Exclusion criteria are mainly "excluded" disc lesions, major dysfunction or associated spinal vertebral canal stenosis. The optimal indication is represented by the subacute disc hernia in the young. This alternative to open surgery in no way compromises the results in case of failure. Results obtained in a personal series of 150 cases are analyzed comparatively with those reported in the literature.


Assuntos
Quimopapaína/uso terapêutico , Deslocamento do Disco Intervertebral/tratamento farmacológico , Ciática/terapia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/cirurgia , Tempo de Internação , Vértebras Lombares , Masculino , Microcirurgia , Pessoa de Meia-Idade , Sacro
20.
Neurochirurgie ; 45(2): 164-9, 1999 May.
Artigo em Francês | MEDLINE | ID: mdl-10448660

RESUMO

Most ruptured cervical discs are operated on by an anterolateral approach. The posterior approach is an older procedure, nowadays underused because it was associated with a high morbidity, especially in terms of medullary complications. However, posterior approach has evolved in posterolateral route, which is not so devastating and has a very low morbidity rate. It gives excellent functional results when surgery is dedicated to monoradiculopathy from soft posterolateral cervical hernias. It seems appropriate to consider this surgical route as an alternative to anterolateral surgery in these very selected cases. The authors describe and comment the technique.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Ruptura Espontânea
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