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Biomedical subjects

B Roquefeuil

Publications and source records attributed to B Roquefeuil.

At least 73 records · Page 4Linked to original sources
PubMed1979

[Resuscitation of the elderly brain].

The little poses the question of the usefulness of resuscitation of elderly individuals, victims of cerebral damage or aggression. The author reviews the difficulties inherent in the definition of the "elderly patient" and the "elderly brain". The results obtained in 195 patients aged 60 or over are reported. In a 12 month period, this accounted for 32.77 p. 100 of "resuscitated" patients in a department of neurosurgery. Resuscitation implied a state of coma with artificial ventilation for varying periods. It thus differed from simple surveillance, even specialised. Survival rates are analysed in terms of neurological state, aetiology, whether or not there was surgery under general anaesthesia, past history, complications and the gravity of the resuscitation methods employed. The overall rate of 32.31 p. 100 was already lower than that in the elderly in a general intensive care unit. The picture in geriatric neurological resuscitation worsens further if only good quality survivals are noted: approximately 21.03 p. 100. Nevertheless, all the indications are that these figures are likely to improve in this recent field of resuscitation.

Aged↗
PubMed1979

[Monitoring of intracranial pression in acute neurotrauma by extra-dural screw (author's transl)].

These data emphasize the interest of the study, in acute traumatic comatose, of the brain-stem reflexes and level of coma (Plum, Posner, Perez-Dominguez, Barge, Espagno) and the monitoring of the intracranial pression (ICP) by extra-dural screw (Vries, de Rougemont, J. Brunon). It is possible to describe: 1)The bilateral hemispherical contusions: with cortico-subcortical level and bilateral decorticate comatose. The normal brain-stem reflexes (N.B.S.R.) are presents. The monitoring of ICP allows to separate the reversible bilateral hemispherical contusions (ICP can present unstable recording during 3 days with pressure-waves--B waves--or to be stable (between 10--15 mm Hg)), from the severe bilateral contusions with rostro-caudal evolution and "plateau-waves". 2) The brain-stem contusions: the clinical level is often a mesencephalic level with decerebrate rigidity and N.B.S.R. +/- (Automatic Eye Movements). In severe injury the ICP is increased and unstable with A waves. In reversible brain-stem contusions the ICP is often stable and low with arteriography and ventriculography insignificant. 3) The associated contusions: In general, the head injuries of this group are alternatively decorticate or on decerebrate rigidity ("ambiguous reaction"). In the severe associated contusions the ICP shows A waves. In reversible contusions ICP is stable with normal supratentorial angiogramm and ventriculography.

Brain Injuries↗
PubMed1978

[Anesthetic evidence of pheochromocytoma].

The authors report the clinical case of a patients who underwent four anaesthetic inductions during a period of 3 months. Two were associated with severe acute hypertension making the intended operation impossible at that time. Thorough investigations led to a diagnosis of phaeochromocytoma. Reviewing the protocol of the four anaesthetic inductions, the authors discuss the mechanism of provocation of paroxysmal hypertension which was seen on two occasions.

Adrenal Gland Neoplasms↗
PubMed1978

[Hemodynamic and metabolic effects of barbiturates on the human central nervous system].

Anoxic cerebral ischemia results in an almost instantaneous stoppage of the EEG, and a depletion of the cerebral energy reserves with anaerobic orientation. The experimental work, especially of Safar and Michenfelder, have proven the significant cerebral protection under barbituric hypometabolism. The cerebral impacts of barbiturates in the animal, in vitro and in vivo, are multiple: decrease in glycolysis, energetic stabilisation, a blocking of the adenylcyclase activity, membrane stabilisation by trapping of the free radicals or by an increase of the cerebral osmolarity, ect... In man, the metabolic and the hemodynamic data, of which there is little, have only confirmed the reports of metabolic and circulatory depression made by Himwich as early as 1947. The use of barbiturates in postischemic protection poses a problem of their specificity. For an equivalent cerebral metabolic depression a protective effect could not be proven with the tilisation of halogens nor with the morphines... Other narcotics (Alfatésine, Gamma OE) also depress the CNS, but their protective effects are unknown. MICHENFELDER attributes the barbituric protection to the "functional neuron" block without interference at the metabolic level of cellular life. The specificity of barbiturates in this block has yet to be proven. In the post-ischemic resuscitation, Safar insists, and rightly so, on the urgency to correct the cerebral hypoperfusion with a parallel barbituric induction. If there is no "specificity" in the narcotic hypometabolism, it would be logically imperative to use that which provides the best protection, in the shortest, delay, and with the least systemic depression.

Adenine Nucleotides↗
PubMed1977

[Action of dibencozide on nitrogen metabolism in immediate and long-term postoperative resuscitation].

The catabolic orientation of the immediate post-aggression phase is aggravated in neurosurgery by the almost routine prescription of corticosteroids. This emphasises the value of any treatment which might limit this orientation. The authors report their experience with the use of dibencozide, with its known facilitating action upon nitrogen assimilation, in the absence of any side effects.

Adult↗
PubMed1977

[Value of brain metabolic studies in post-traumatic coma].

In 34 comatose patients in the acute phase, the mean hemispheric CBF is lowered as well as the CMRO2, with a quite good relation between these values and the coma level and prognostic so. The cerebral response to a PaCO2 range indicates a quite good relation with the coma level (the lowest value in the most severe comas). The cerebral autoregulation study, using Aramine induced hypertension, can separate the cases with a present autoregulation and the cases with a loss of autoregulation (the most severe and the poorest prognosis). In dynamic conditions (variation of the PaCO2 or Aramine induced hypertension), the change in CMRO2 is interesting : rather good prognosis among the patients with a normal metabolic autoregulation - poor prognosis among those whose metabolic autoregulation is lost.

Brain↗
PubMed1976

[Prolonged traumatic and vascular coma: prognostic and therapeutic indications based on hemodynamic and metabolic studies].

From haemodynamic and metabolic investigation of 65 comatose subjects following cranial traumatism or cerebral vascular accident, the following prognostic and therapeutic indications emerged: The isolated increase in oxygen pressure in the jugular vein to above 50 mm Hg, the simultaneous decrease in circulation of the brain to below of 30 ml/100g/min., and of the brain consumption of oxygen to below 1.5 ml/100g/min., combined with a loss of autoregulation and a decrease in carbon dioxide reactivity indicate that prognosis is very poor. Induced arterial hypertension, associated with hyperventilation, partially corrects brain hypoperfusion in coma from bulbo-pontine lesions. Sodium penthiobarbital and sodium gamma hydroxybutyrate and have the effect of reducing oxygen metabolism which might have some therapeutic value during the acute phase of coma. Clomipramine which has a stimulating effect on oxygen metabolism should be kept in reserve for the chronic phase of prolonged coma.

Blood Gas Analysis↗
PubMed1976

[Value of cerebral metabolic exploration in post-traumatic coma states in the acute phase].

The authors report the values of mean hemispheric blood-flow and cerebral arterial consumption they found in 34 neurosurgical comatous cases in acute state. In basal conditions, mean values of mean hemispheric bloodflow and oxygen consumption are lowered. There seems to be a relation between the values found and the comatous stage on one hand, the prognosis on the other hand. The cerebral response to hypercapnia (16 assays) allows to separate 2 groups, one with a noticeable improvement of cerebral bloodflow, the other with only a minimal response. There was no significant variation of cerebral oxygen consumption in both group. Cerebral response to CO2 seems to be clearly related to the stage of coma (low in the most severe cases) but pronostic incidence remained uncertain. A hypertensive test by means of Aramine (18 assays) allows to separate 3 groups : 1 group (8 cases) where the mean hemispheric bloodflow remained stable during hypertension as did the cerebral oxygen consumption -(autoregulation remained unchanged), 1 group (4 cases) where mean hemispheric bloodflow and cerebral oxygen consumption were lowered (excessive autoregulation), 1 group (6 cases) where mean hemispheric bloodflow increases clearly while under Aramine perfusion (loss of autoregulation). Those dynamic tests, either hypercapnic or hypertensive, allow, in comparing oxygen consumption variations with cerebral bloodflow variations, the distinction between : patients where metabolic autoregulation seems maintained (good prognosis) - (10 cases), patients where metabolic regulation is lost with either "luxury perfusion" (14 cases) - poor prognosis, or "insufficient perfusion" (10 cases). The authors are discussing the treatment concerning those last mentioned patients.

Brain↗
PubMed1976

[Study of carbohydrate tolerance without and with corticotherapy].

Using the glucose tolerance test by the intravenous route, from which the coefficients K (CONARD) of carbohydrate assimilation and (BERNIER) of fasting glycogenolysis, are deduced, the authors study the carbohydrate tolerance of neuro-surgical patients in acute and chronic phases, under corticosteroid therapy and without corticosteroid therapy. The role of corticosteroid therapy in the decrease in carbohydrate tolerance reported is discussed ; for comparative purposes, the authors present the study of carbohydrate assimilation in irreversible coma and in patients with advanced neuroplegia.

Adrenal Cortex Hormones↗
PubMed1976

[Plasma cortisol in neurosurgical resuscitation].

The authors study the values of spontaneous cortisonemia in neuro-surgical patients. They analysed the correlations between this parameter and certain clinical criteria (age, etiology, level of consciousness), the duration and nyctohemeral changes in spontaneous hypercortisonism. Furthermore, they presented the values of iatrogenic cortisonemias as a function of increasing doses of hydrocortisone and discussed the possible mechanisms for the disapperance of injected cortisone.

Adolescent↗
PubMed1975

[Acute neurogenic pulmonary edema].

Neurogenic edema, in the strict sense of the term, has at the present time practically not benefitted from precise hemodynamic investigations in human clinical practice, and owing to this fact, authors still classify them under the heading "mixed edema or of unknown pathogenesis". In contrast with this lack of information in man, animal experimental works are surprising by their coherence and the experimental facility of producing neurogenic edema (cranial hypertension by a small inflatable balloon and cisternal infection of fibrin). If one excludes the now ancient vagal theories (CAMERON 1949; CAMPBELL, 1949) which were never confirmed, all of the most recent experimental works (SARNOFF, 1952; DUCKER, 1968; LUISADA, 1967; MORITZ, 1974) confirm the adrenergic disorder of central origin during neurogenic A.P.E. which from the hemodynamic standpoint is like an authentic hemodynamic A.P.E. with raised left atrial pressure, pulmonary venous pressure and pulmonary capillary pressure.

Animals↗