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Biomedical subjects

F X Roux

Publications and source records attributed to F X Roux.

At least 109 records · Page 6Linked to original sources
PubMed1984

[Arguments for early intervention in intracranial aneurysms. From a series of 33 aneurysms with hematoma].

33 cases of intra-cerebral hematomas after rupture of intra-cranial aneurysm are reported: 12 were operated on emergency (before 24 hours); surgery was delayed in 13 cases, and 8 died before surgery. Mortality in operated cases is not as high as usually considered (28%). Results of patients with late surgery (day 3 to day 30) are similar to those patients with early surgery in spite of better neurological state. These poor results are related to worsening because of spasm development during time elapsed before surgery. Early surgery may prevent spasm development by release of blood clots out of basal cisterns. This attitude can be extended in cases with large amount of blood clots in subarachnoid spaces. Out of 23 cases with unoperated aneurysm, 8 cases had an hematoma and 6 died, and 11 cases had an important subarachnoid haemorrhage and 9 died. Except in one case, death was related to spasm development.

Cerebral Hemorrhage↗
PubMed1984

[Intramedullary astrocytoma and ependymoma in the adult. Do therapeutic tactics influence the long-term results? Evaluation of 23 surgically treated cases and discussion of the literature].

The authors tried to determine the best treatment of intramedullary tumors nowadays. They studied a personal series of 23 intraspinal ependymomas and astrocytomas. 15 patients had a mean long term follow-up of 5 1/2 years. Among these, only patients with ependymomas were clinically cured or dramatically improved (30%). On the contrary, no patients operated on an astrocytoma received benefit of the surgical procedure. This study was compared to most of the recent series of the literature , the results of which are superimposable . Concerning an intraspinal ependymoma, a logical attitude is to proceed, under optic magnification, to the most complete excision as possible, as long as a well individualized plan of cleavage is visible. Radiotherapy is indicated only in case of incomplete excision or recidive. Concerning an astrocytoma, a total excision is almost always impossible since it is an infiltrating tumor. It appears more dangerous than advantageous to try to take off as much tumor as possible. Radiotherapy appears inefficient.

Adolescent↗
PubMed1983

[Prevention of headache following lumbar puncture. A controlled double blind trial of the effectiveness of intravenous tiapride].

To evaluate the effectiveness of intravenous tiapride in preventing cephalalgia following rachiocentesis, two groups of patients were studied in a double blind trial. In group I (tiapride), two 100 mg vials of tiapride given in a slow intravenous injection were effective in 86.7% of patients. In group II (placebo), only 46.6% of patients did not experience cephalalgia. These results were shown to be statistically significant by the Hypothesis Zo test (Zo = 2,33 for p less than 1%).

Adolescent↗
PubMed1983

Intracranial ependymomas in childhood. Survival and functional results of 47 cases.

A pediatric series of 47 intracranial ependymomas (15 supra- and 32 infratentorial) is presented. All children were operated upon between 1969 and 1979. Among these children, 35 completed the treatment with radiotherapy. The irradiation was usually limited to the intracranial content but in 7 patients, it was extended to the spinal axis as well. Malignant ependymomas represented 69% of the whole series (86% of the supratentorial and 53% of the infratentorial ependymomas). The operative mortality rate was 17%. The 5-year survival rate was 39% in the whole series and 51% when excluding postoperative mortality. Recurrences developed in 41% of cases and metastases in 20%. The study of this series and of the literature points out that: (1) metastases from supratentorial ependymomas are not frequent, almost always supratentorial and secondary to a malignant ependymoma, and (2) metastases from infratentorial ependymomas are almost always intraspinal and occur in one third of these tumors. The rate of seeding is especially high in the case of malignant infratentorial ependymomas (50%) but is also 15% in the case of benign tumors. These data lead the authors to propose a craniospinal irradiation in the case of infratentorial ependymomas whether benign or malignant, an irradiation of only the brain in the case of malignant supratentorial ependymoma, an irradiation of only the tumoral bed when ependymomas are benign and supratentorial.

Brain Neoplasms↗
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

[Acute interhemispheric subdural hematomas].

Three cases of acute interhemispheric subdural hematomas, one of which bilateral, are reported. These are secondary to cranial traumatism and/or to treatment by anticoagulants and have stereotyped clinical signs. Following a lucid period, intracranial hypertension appears, then a sudden predominantly crural hemiparesis or even paraplegia. The aspects shown by computerized tomography are characteristic. The literature and our experience suggest that the best treatment is complete evacuation of the hematoma by craniotomy performed before alteration of consciousness.

Aged↗
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

[Intracranial ependymoma in children. Prognosis and therapeutic perspectives].

The authors report 47 cases of intracranial ependymomas occurring in children less than 15 years of age, who were operated on from 1969 to 1979. The aim of the study was to study the incidence of intraspinal metastases and to suggest a logical protocol for postoperative radiotherapy. The operative mortality rate was 17%. The 5 year survival rate, after exclusion of postoperative mortality, was 51%. Recurrences developed in 41% of cases and metastases in 20%. Among these, intraspinal metastases occurred in 14.5% and were found only in infratentorial ependymomas, whether benign or malignant. The results and those in the literature suggest that a protocol of irradiation adapted to the site and the histological grading of these tumors should be discussed with the teams of radiotherapy; in infratentorial ependymomas, the irradiation should include the whole craniospinal axis.

Adolescent↗
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↗
PubMed1983

Brain abscess in childhood. A study of 34 cases treated by puncture and antibiotics.

During the last 15 years, 34 children were treated for a brain abscess. 13 (38%) had cyanotic heart disease; 12 (35%) had an ENT infection. The standardized treatment protocol included puncture of the abscess and administration of antibiotic and antiedematous drugs. Postoperative permanent epidural monitoring of intracranial pressure and, in the last 5 years, repeated CT scans indicated if retapping the abscess or reinforcing the antiedematous treatment was necessary. In 7 out of these 34 cases the abscess had to be excised. Postoperative mortality rate was 6%. Overall mortality rate was 12%. Neurological sequelae were slight. Epilepsy frequency was 10%. Mental retardation (18%) was found only in cyanotic congenital heart disease to which it is related. Repeated CT scans demonstrated the progressive disappearance of the capsule within a few months. This study shows an improvement in the results when brain abscesses in children are punctured rather than excised.

Adolescent↗
PubMed1982

[Spinal subdural hematoma. An unusual complication of lumbar puncture (author's transl)].

Spinal subdural hematoma following lumbar puncture occurred in a patient with embolic hemiplegia. The authors discuss the possible responsibility of heparin administered immediately after the tap. Physiological mechanisms of spinal subdural hematoma are reviewed. The authors emphasize the poor prognosis associated with this rare complication. They suggest that anticoagulant therapy be discontinued during and after a spinal tap. The first signs of medullary and radicular compression should be promptly recognized and an emergency neurosurgical procedure undertaken in order to forestall definitive paraplegia.

Female↗
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

[Extrapyramidal rigidity with dystonia, optic atrophy and bilateral putaminal lesions in an adolescent. Juvenile form of Leigh's disease (author's transl)].

A 19-year-old man presented with an apparently non-familial neurological disorder that had progressed from the age of 6 years. Dystonia of the trunk and limbs with extrapyramidal rigidity, dysarthria, a pyramidal syndrome with spasticity of the lower limbs, bilateral optic atrophy, and nystagmiform ocular movements were present. CT scan demonstrated symmetrical putaminal lesions. The different aetiologies of bilateral striatal lesions are considered, the final diagnosis being a juvenile form of Leigh's disease.

Adult↗