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Biomedical subjects

E Melon

Publications and source records attributed to E Melon.

30 records · Page 2Linked to original sources
PubMed1988

[Value of a fraction of low molecular weight heparin, enoxaparine, in patients at high risk of hemorrhage and thrombosis].

Treatment of patients with both thromboembolic manifestations and acute bleeding episodes is poorly defined. The use of low molecular weight heparin fractions has been shown to provide prophylactic antithrombotic activity in humans, with the possibility of fewer hemorrhagic complications because of their low anticoagulant activity and weaker action on platelets. An open trial was carried out in 50 patients. 47 of whom had a recent history of thromboembolic accident (34 venous thrombosis, including 13 with pulmonary embolism, 9 systemic arterial episodes, 4 cardiac emboli) and 3 who required prophylaxis. Conventional heparin therapy was contraindicated in all patients: 30 because of major digestive or muscle hemorrhage and 20 with high hemorrhagic risk (neurosurgery, deep thrombocytopenia). Enoxaparine (Laboratoire Pharmuka, Gennevilliers) was administered as 1 mg/kg/24 hours as 2 divided injections with adjustment to maintain an anti-Xa activity of 0.1 to 0.4 IU/ml. Antithrombotic efficacy as function of type of pathology was rated excellent in all patients, while tolerance, evaluated similarly by tests chosen as a function of type of hemorrhage, was good: one patient had moderate bleeding after accidental overdose and 4 patients minor bleeding. Enoxaparine by subcutaneous injection could represent a new therapeutic approach by improving the efficacy/risk ratio in this type of patients.

Blood Coagulation Tests↗
PubMed1987

[Cranial traumatology. Recent statistical data].

The authors describe a one-year prospective study carried out in Créteil from October, 1983 to October, 1984 in 155 selected patients admitted for at least 24 hours with traumatic head injury. Patients with gunshot wounds of the head were excluded from the study. 30% of the patients were infants, 60% were adults aged between 15 and 60, and 5% were over 60; 48% were not comatose (initial Glasgow symptomatic score [GSC] greater than or equal to 8) and 36% were free of any neurological symptom. Prognosis was related to the initial neurological status, to the patient's age and to underlying diseases, such as alcoholism. 10 out of 11 patients with an initial GSC of 4 or less died, against 12 out of 144 with a GSC above 5. At the first CT scan, 10% were found to have an extradural haematoma, but the examination was normal in 20% of patients with neurological symptoms and/or coma; 22% of the CT scans were abnormal without any clinical symptom, as was the case, in particular, with 4 extradural haematomas. Surgery was performed in 24% of all patients and in 17.4% of infants, whereas the percentage reached 30% in alcoholic patients, due to the frequency of intracerebral haematomas in this population. In 16% of the 155 cases, barbiturates were used to treat uncontrolled intracranial pressure higher than 20 mmHg. 15% of the 155 patients deteriorated; a second operation was necessary in 9 cases. The final outcome on discharge was: 112/155 patients with good recovery or moderate disability, 22 with severe disability, 5 with persistent vegetative state and 21 deaths.

Adolescent↗
PubMed1985

Altered capillary permeability in neurogenic pulmonary oedema.

Two cases of fatal neurogenic pulmonary oedema are depicted. The hemodynamic study failed to document any hypertensive crisis or pulmonary hypertension. By contrast, the low values of pulmonary capillary wedge pressures and the high protein concentration in tracheal fluid suggest a pulmonary capillary wall lesion.

Adult↗
PubMed1983

[96 cases of spontaneous medical cerebral hemorrhage. Diagnostic and therapeutic experience].

Prognosis in a homogeneous series of 96 cases of non-traumatic cerebral hemorrhage admitted to a neurosurgical department within 6 to 24 hours of onset was assessed by studying possible correlations between clinical condition (grade I: conscious; grade II: somnolent; grade III: comatose; grade IV: comatose with signs of brain stem involvement) and computed tomography findings (site, extension, size of hemorrhage; degree of edema and of mass effect; presence of hydrocephalus or ventricular hemorrhage). It was possible to distinguish effects due to destruction and/or compression of functional cerebral regions for a given clinical picture, and to apply these data to determine types of therapy and surveillance according to 3 time-periods. During the first 48 hours there was almost perfect agreement between the severity of the clinical picture and the degree of cerebral destruction (62,6 p. 100 of grade IV, 27,7 p. cent of grade III died). Only patients in grade III with temporal hemorrhage directly menacing the brain stem were operated upon. From the 3rd to the 7th day surveillance was based on clinical findings and computed tomography, repeated in principle on the 3rd and 7th days. Patients operated upon during this period were those in whom clinical signs and/or effects due to mass effect as seen on the CTscan were becoming worse. The third period, lasting from the 8th to the 21st day, was that during which the vital prognosis was generally no longer affected, and indications for surgery were functional in nature. The prognostic value of measurements of intracranial pressure is discussed.

Adult↗
PubMed1983

[Functional prognosis in skull injuries with signs of axial damage. Value of the quality of the arousal phase (series of 80 cases)].

In a series of 80 diffuse brain injuries with early clinical signs of brainstem dysfunction without shift of the midline on the first CT SCAN investigation; the authors have studied the time course of recovery. Among several neurological parameters, they have choosen two steps: first one the spontaneous opening of the eyes, which marks a restoration of vigilance, second one the capacity to execute simple commands which marks the end of unconsciousness). The duration of the period of recovery (delta) (between the eyes opening and the obays commands) was variable from 0 to 173 days. But it was a good statistic correlation (p less than 0,001) between the length of this period and the functional outcome at one year.

Adolescent↗
PubMed1981

[Diagnosis of brain lesions and of early complications by CAT scan in traumatic patients in coma. Series of 265 cases (author's transl)].

In every patient admitted with a traumatic coma a CAT scan was performed immediately (less than 6 hours after the accident). As a routine procedure another scan was performed 48 hours later; further scans were done depending upon the clinical and ICP conditions. The patients were operated upon or given a medical treatment from the CAT scan analysis only. Until now the brainstem lesions have not been seen on the first day CAT scan images. The CAT scan performed on the second day will show a stabilization or an expansion of the previous lesions: haemorrhage or oedema. Any change in the patient condition or in the IPC monitoring must lead to a new CAT scan revealing epidural or subdural haematomas, hydrocephalus, subdural hygroma, persistent oedema. Therefore the CAT scanner used by a neurosurgical team must be able to work day and night.

Brain Injuries↗
PubMed1981

[Treatment of severe head injuries by external ventricular drainage and barbiturate therapy. Mortality and morbidity in 57 cases (author's transl)].

After severe head injury the majority of deaths, during the early period, is due to acute intracranial hypertension. We report a series of 57 severe head injuries with early signs of brainstem involvement. CT Scan performed within 6 hours after injury and repeated at 48 hours showed hemispheric lesions and edema, without shift of the middle line. Treatment consisted of controlled ventilation, water and sodium restriction and barbiturates. A ventricular catheter was inserted in 52 patients allowing intracranial pressure (I.C.P.) monitoring, and permanent subtraction of cerebrospinal fluid (C.S.F.). This treatment allowed the control of a normal I.C.P. in 80% of the patients. In 6 patients a secondary surgical treatment was performed. In this series the mortality rate was 31,5% the good results and moderate disability 54,3%, the severe disability and vegetatives states 14,2%.

Adolescent↗
PubMed1980

[Buprenorphine. Haemodynamic study (author's transl)].

Haemodynamic effects of intravenous buprenorphine 3 microgram/kg were studied on nine subjects. Subjects were under controlled ventilation, and had a radial cannula and a Swan-Ganz catheter. Heart rate slowed up, from 109 +/- 23 to 96 +/- 18 at the 90th minute (p less than 0.02), and remained slightly depressed at the 4th hour. Mean arterial blood pressure fell from 91 +/- 17 to 82 +/- 18 mm Hg (p less than 0.001): the difference remained statistically significant until the 3th hour. Cardiac index fell from 4.16 +/- 0.67 to 3.55 +/- 0.63 l/mn/m2 at the 60th minute (p less than 0.001). Thus the haemodynamic effects of buprenorphine exist but are light.

Adolescent↗