Search PubMed⌕ Search

Biomedical subjects

B George

Publications and source records attributed to B George.

At least 235 records · Page 13Linked to original sources
PubMed1983

[Current therapeutic orientation in intracranial suppuration].

Changes in diagnosis and management of intracranial infections have been studied on a continuous series of 102 cases 1968 through 1980. Use of CT scan has not increased the number of patients diagnosed in acute phase (before the fifteenth day) but has increased the rate of case observed before the second day (37 p. cent with and 27 p. cent without the CT scan). However the neurological status and specially the state of consciousness has not changed. Four specific data of abscess diagnosis have been defined on 56 cases suspected to have an intracranial infection; 16 out of these cases have proven by surgery not to be infectious lesion. Evolution under treatment is best followed by CT. Final aspect on CT are not different after puncture or after excision. Average delay of disappearance of edema is 20 days and of abscess is 44 days. Importance of bacteriological study in the choice of antibiotics is underlined by comparison of bacteriological and clinical results. Since the introduction of a laboratory of bacteriology in the hospital in 1976, we observed a decrease of sterile cultures (11.5 p. cent and 56 p. cent before 1976), an increase of the number of germs identified in each case and specially anaerobic germs (40 p. cent after and 10 p. cent before 1976) and a decrease in mortality and sequelae (respectively 8,3 p. cent and 19.4 p. cent before 1976 and 11,5 p. cent and 33 p. cent before 1976). Use of CT scan and progress in bacteriological study have led us to simplify our surgical attitude in case of intracranial abscess: puncture as soon as the diagnosis is done on CT; antibiotics according to the bacteriological study and survey by CT in neurosurgical unit.

Adult↗
PubMed1983

[Analysis of infectious sequelae of 1000 neurosurgical operations. Effects of prophylactic antibiotherapy].

Postoperative infections: cellulitis at the site of skin incision and/or meningitis, were reported in 5.1 p. cent of 1 000 cases treated by neurosurgery in Pr R. Houdart's department between december 1980 and march 1982. Statistically significant factors predisposing to infection were: emergency surgery, opening of the sinus, presence of a foreign body, and operation lasting more than 5 hours. The age of the patient, diabetes, or previous corticoid therapy did not significantly alter the risk of infection. Prophylactic antibiotic therapy had been administered to 37 p. cent of patients, but this had not affected the incidence of general infection, a statistically significant effect being observed only after operations lasting for more than 5 hours. The risk of infection was high after craniotomies and major after external ventricular shunts (valves). For the latter type of operation it was not possible to determine factors favorable for infection: neither duration of surgery, nor age of patient, nor absence of antibiotic therapy. The risk of postoperative infection was low (less than 1 p. cent) in the absence of factors favorable for its development, but its frequency increased considerably in patients presenting one or more other intercurrent infections. It is therefore possible to recognize surgical and general factors influencing infection, but prophylactic antibiotic therapy has only a weak effect on morbidity modification.

Anti-Bacterial Agents↗
PubMed1983

[Enlarged transbasal approach by mobilization of the medial fronto-orbital ridge].

Tumors involving the base of the skull are best approached by the transbasal route as described by Derome. However this approach can be improved by mobilization of the medial part of the supra-orbital ridge according to the technical principles used in treatment of craniosynostosis. This allows a wide exposure of the ethmoido-sphenoidal area with minimal retraction of the frontal lobes. The axis of working becomes parallel and even inferior to the plane of the cribriform plate and gives a better access to the upper part of the clivus. Rhinologic complementary approach (rhinoseptal or transfacial) can be associated with this technique. However a more anterior part of the nasal mucosae is exposed by this procedure: one can control the mucosae in front of the tumor and avoid a complementary rhinoseptal route. This simple technical trick has been used in seven cases with satisfactory results.

Humans↗
PubMed1983

[Use of real time ultrasonography in neurosurgery. Peroperative value in adults].

The authors present their beginning experience in the use of a new technique applied to neurosurgery: that is real-time echography. A preliminary non operative experience has first been carried on. It concerned five adults who have been studied through surgical defects. Then, eight patients, were explored intra-operatively: concerning three cerebral abscesses, one intra-cerebral haematoma, two subcortical tumors and two biopsies. In these cases, the ultrasonographic study was performed through a 3 centimeters diameter craniotomy--in case of abscess or haematoma aspiration or of biopsy--or through a classic bone flap--in case of tumor extirpation. Echography allowed an easy study of intracerebral structures and lesions. Its permits to visualize subcortical neoplasms and thus to aim them with accuracy. In the treatment of brain abscess, real time echography gives the possibility of guiding and following the progression of the probe. It, also, allows to appreciate the reduction of the suppurated cavity and thus assures a more reliable efficacity. Such a procedure indeed facilitates brain tumor biopsy; but we think that such a technique should be used only if a classic stereotactic procedure is not considered as necessary and if the mass lesion is large enough (over 1.5 cm) and not too profondly seated.

Adult↗
PubMed1982

Vertebro-basilar ischaemia. Its relation to stenosis and occlusion of the vertebral artery.

Bilateral vertebral angiography has been performed on 44 cases of vertebrobasilar ischaemia (VB I), excluding transient ischaemic attacks, and on 20 cases of carotid ischaemia with lesions of the vertebral artery (VA). Significant lesions (stenosis of more than 50% of the lumen and occlusion) of the VA were found in 72% of VB I and 70% of carotid ischaemia cases. In the VB I group, occlusions are as frequent as stenosis (17 occlusions and 15 stenosis); on the contrary, occlusions are half as frequent as stenosis in the carotid ischaemia group. Bilateral lesions are also more often discovered after VB I than after carotid ischaemia. Topographically, the lesions are mainly at the ostium and in the third portion of the VA. The possibility that vertebro-basilar strokes are related to significant lesions of the VA in its cervical part is emphasized. Haemodynamic disorder can explain infarcts related to bilateral lesions and some of those reported after unilateral lesions. Embolism may be suggested in cases of significant stenosis and of certain unilateral occlusions.

Angiography↗
PubMed1982

Vertebro-basilar ischaemia with thrombosis of the vertebral artery: report of two cases with embolism.

Two cases with vertebro-basilar infarcts associated with severe stenosis of the vertebral artery in its cervical part is reported. Complete thrombosis of the vertebral artery was observed after a short delay in both cases. As the carotid arteries were normal and the controlateral vertebral artery was dominant, an embolic mechanism was suspected. No new event occurred in the following one and three years respectively after the stroke. These two cases demonstrate the possibility of embolism from severe stenosis of the cervical vertebral artery. This mechanism could explain some of the infarcts related to vertebral artery occlusion.

Cerebral Infarction↗
PubMed1982

[Lumbosciatica and nerve root anomalies].

The authors report 3 cases of lumbar pain and sciatica where operation revealed the existence of abnormalities in the distribution of L5 and S1 roots. In one case, the L5 root was not recognised within fibrous tissue also surrounding S1 and S2 and histological examination of this "fibrosis" led to the identification of nerve structures. Development of postoperative L5 paralysis showed that the L5 root was contained within the tissue non-individualised, consisting of multiple rootlets. In the other two cases the L5 and S1 roots arose from a common trunk. There was an associated herniated disc in all three cases. A review of the literature revealed the rarity of such abnormalities, as well as the fact that they were not recognised before surgery. They are difficult to recognise, even at the time of operation. The prognosis is less good than in typical lumbar pain and sciatica, essentially because of surgical difficulties of the disc curettage.

Adult↗
PubMed1982

[Intraspinal dracunculosis. Apropos of a case of epidural medullary compression].

The authors report on a case of spinal cord compression due to Dracunculiasis. They study the nine others cases of the literature. In all these cases, the worm was epidural. The extradural guinea worm granuloma was localised at the level of the cervical region or in the upper part of the thoracic region of the spinal canal. Before operation the diagnosis is almost always impossible. It could be evocated if the guinea worm is calcified and, then, visible on the spinal tomograms.

Adult↗
PubMed1982

[Importance of the bacteriologic study in brain abscess. Comparison of the evolution of bacteriologic and therapeutic results in a series of 102 cases].

Progresses in bacteriological study have been analyzed on 102 cases of intracranial infections between 1968 and 1980: sterile cultures decrease from 56% to 11,5%, rate of isolation of anaerobic and association of aero-anaerobic bacteria increase respectively from 10 to 40% and from 2 to 17,1%. Clinical results progress in close relation; the mortality rate decrease from 11,5% to 8,3% as well as morbidity rate from 33% to 19,4%. Moreover clinical results are worse when the bacteriological study fails to isolate any germ: mortality 15,7% and sequellae 53,5%. The best results are observed in the group of anaerobic infections: mortality 4% and sequellae 26,6%. Lastly, the interest of the systematic research of particular bacteria such as capnophilic or microaerophilic bacteria or mycobacterium tuberculosis (2 cases) is underlined. This work emphasizes the importance of the bacteriological study for the management of intracranial infections and the improvement of the clinical results.

Bacteriological Techniques↗
PubMed1982

[Use of the scanner in diagnosis and therapeutic surveillance of brain abscess].

Comparison from 102 cases of brain infections has been done between 2 periods: before and after 1978. The use of CT scan in routine since 1978 has not changed the number of patients diagnosed in acute phase (less than 15 days); but diagnosis was done before 2 days in 37% after 1978 and in 27% before 1978. However frequency of consciousness disorders is equal in both groups: 55%. By a semi-statistical analysis on 40 cases, 10 CT scan datas have been tested according to their sensibility and specificity to the diagnosis of brain abscess; 4 datas have a satisfying sensibility and specificity and are more accurate than the others: regularity of the shape, regularity of the enhanced ring; enhancement after injection, surrounding edema. Survey of 40 cases by CT scan has permitted to determine the average delay of disappearance of mass effect (20 days), of disappearance of the abscess (44 days) and the cicatricial aspects according to the treatment: puncture or excision.

Brain Abscess↗
PubMed1981

Frequency of primary brain stem lesions after head injuries. A CT scan analysis from 186 cases of severe head trauma.

Analysis of level of brain stem dysfunction, evolution, and CT scan profile was made on 76 cases of head injuries with prolonged unconsciousness and without hemispheric focal lesion and midline shift on CT scan. Eleven cases were considered normal on CT scan. The CT scan aspect of primary brain stem lesion was identified in 31.5% of these series, and in 14.5% of all severe head traumas (186 cases), from which this series is taken. Primary and secondary CT scan profiles were observed whatever the clinical level of dysfunction and its evolution. Pontine lesions were mainly associated with haemorrhage in the brain stem and diffuse brain swelling; but minimal signs (cortical level) and benign outcome can also be related to axial haemorrhage. These results emphasize the frequency of primary brain stem lesions and the value of CT scan in head injuries.

Brain Diseases↗
PubMed1981

[Polygraphic study of nocturnal waking in patients with traumatic brain stem injuries (author's transl)].

The waking periods during sleep of 16 patients, having been in post-traumatic coma for 5-40 days (aged 15-28 years), were studied electroencephalographically 1 month (T1) and 6 months (T6) after regaining consciousness and were compared with control subjects. The amount of waking (frequency and duration) increased appreciably at 1 month (20% of total sleep time and 21 awakenings per night) and was augmented even more in those cases in which the initial damage was more severe caudally and the duration of coma longer. At 6 months, the duration of waking was reduced somewhat (12% vs. 3% controls), but the frequency of awakening had not changed. By this stage the level of initial damage did not seem to produce any effect. These results show that the disturbance in the sleep-waking cycle regresses more rapidly the less severe the degree of initial damage was.

Adolescent↗