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J C Baron

Publications and source records attributed to J C Baron.

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

[Positron emission tomography in the physiopathological study of cerebral ischemia in man].

The development of positron emission tomography now allows the local study of cerebral blood flow, oxygen consumption and glucose utilization in ischemic stroke patients. In recent cerebral infarction, a disruption of the normal couple between flow and metabolism is almost constantly observed: in the first few days cerebral blood flow is either inadequate (persistent ischemia) or over-abundant ("luxury perfusion"), whereas a late "luxury perfusion" is almost constant within the necrotic area between the 10th and the 40th day. Threshold values for cerebral blood flow and oxygen consumption that are ultimately associated with necrosis or tissue integrity have been determined. A metabolic depression without C.T. Scan counterpart has been observed in various brain structures remote from the infarcted area per se. Lastly, the hemodynamic and metabolic effects the superficial-temporal-middle-cerebral-artery anastomosis have been studied.

Brain Ischemia↗
PubMed1983

Coupling between regional blood flow and oxygen utilization in the normal human brain. A study with positron tomography and oxygen 15.

Using the oxygen 15 continuous-inhalation technique and positron emission tomography (PET), the regional cerebral blood flow (rCBF), oxygen extraction fraction (rOEF) and oxygen utilization (rCMRO2) were measured in 19 control subjects. The rCBF and rCMRO2 values, computed for small regions of interest (ROI), were within accepted normal ranges. Larger, more convenient ROI provided values for gray and white matter regions that were, respectively, lower and higher than those found using small ROI. The rOEF values were not affected by the ROI size, but seemed to slightly overestimate real OEF. These findings may be explained by (1) the partial volume effect, and (2) some limitations of the 15O steady state model. The 15O-PET technique therefore provides representative but clinically useful physiological indexes. In addition, our study demonstrated the normal coupling between local oxygen supply and demand.

Adult↗
PubMed1983

Tissue acid-base balance and oxygen metabolism in human cerebral infarction studied with positron emission tomography.

Nine patients who had suffered strokes were examined between 10 and 34 days after onset using positron emission tomography. DMO labeled with carbon 11 was used to evaluate brain acid-base balance, and the oxygen-15 inhalation technique was used to measure regional cerebral blood flow, the oxygen extraction fraction, and cerebral metabolic rate for oxygen. [11C]DMO concentration and oxygen metabolism variables were measured in the infarcted area and in the symmetrical region in the contralateral cerebral hemisphere. [11C]DMO concentration was found to be unchanged or slightly increased in five cases and markedly increased in four cases. The apparent increase in tissue pH can be explained by the presence of a large extracellular fluid space with a pH nearly identical to that of brain plasma, or by an increase in intracellular pH, or by both phenomena. The change in [11C]DMO concentration in the infarcted area relative to that in the normal tissue was independent of the change in blood flow. Cerebral metabolic rate for oxygen was decreased in all cases. The increase in [11C]DMO concentration in the infarcted area was linearly correlated with the decrease in the oxygen extraction fraction in the same region; that is, it was correlated with the occurrence of perfusion in excess of metabolic demand. The overabundant local perfusion could play a role in the decreased H+ content.

Acid-Base Equilibrium↗
PubMed1983

[Water diffusion and measurement of cerebral blood flow by C15O2 inhalation].

Measurement of local Cerebral Blood Flow (CBF) using the C15O2 continuous inhalation technique coupled with Position Emission Tomography (PET) rests on the assumption that the in vivo labelled water (H215O) of blood diffuses freely within the brain water pool. This requirement however, may be disputed: in the rhesus monkey, Eichling et al (1974) showed a linear relationship between the single-pass extraction of water (E) and CBF after intra-carotid H215O injection, such that E decreases as CBF increases. Such a limitation in water transport across the blood brain barrier has also been suggested to exist in man (Paulson, 1977). In order to verify its possible effects on measured CBF in baboons, simple computer analysis was performed comparing the data obtained with CBF values reported in similar experiments, but using a freely diffusible inert gas (133Xe). This allowed calculation of a water extraction index (IE), which was shown to decline as CBF increased. This result may be considered as a presumption of the part played by the limited water diffusibility on the final CBF values, but other factors must also be considered, such as the inescapable admixture of grey and white matter (partial volume effect), a limitation of present day PET technology.

Animals↗
PubMed1983

Brain uptake and organ distribution of 11C from 11C-labeled glucose.

The time course of the distribution of carbon-11 (11C, t1/2 = 20.4 min) in brain after the i.v. administration of 11C-labeled glucose [( 11C]glucose) was studied in an effort to understand and explore its behavior in relation to the known factors concerning the catabolic fate of glucose carbon in the brain. The biodistribution of 11C from [11C]glucose was studied in rats using organ dissection. Human radiation doses were estimated from rat biodistribution data. All the rat organs except the brain cleared with a half time of 30-60 min. The brain showed delayed uptake that plateaued from 20 to 60 min. The 11C distribution in normal, non-ischemic, brain 30 min after intravenously administered [11C]glucose is due to labeled carbon incorporation into amino acids associated with tricarboxylic acid cycle intermediates. External imaging with the Massachusetts General Hospital positron camera, PC I, was performed in dogs and humans and the time course of 11C incorporation was similar to the rat brain results. Regional uptake paralleled known metabolic differences between grey and white matter in normal human volunteers. A patient with progressive dementia had less uptake in an area of decreased perfusion as demonstrated angiographically, suggesting that the image obtained 20 min after tracer administration could be used to detect abnormalities in cerebral metabolism due to pathology.

Adult↗
PubMed1983

Brain regional pharmacokinetics of 11C-labeled diphenylhydantoin: positron emission tomography in humans.

We used positron emission tomography to study the regional cerebral pharmacokinetics of 11C-labeled diphenylhydantoin (11C-DPH), which was given intravenously to 10 patients (8 intractable partial epileptics and 2 nonepileptics). In the nonaffected hemisphere, 11C-DPH concentration in gray matter reached equilibrium with blood within 20 minutes but was still rising at 60 minutes in white matter, where equilibrium was too slow to be detected owing to the fast physical decay of 11C. Brain-blood concentration ratios at 50 minutes were 1.37 and 1.06 in gray and white matter, respectively, similar but less variable than steady-state DPH ratios reported in human brain surgical samples. There was no indication that normal brain regions of medically resistant epileptics bind DPH less effectively than in nonepileptic patients. Brain and blood 11C-DPH concentrations were well correlated, confirming that the latter gives a reliable estimate of the former in unaffected brain regions.

Adolescent↗
PubMed1983

[Cerebral blood flow and oxygen extraction in lacunar hemiplegia. Semi-quantitative study using oxygen 15 and emission tomography].

The oxygen 15 non invasive continuous inhalation technique coupled with positron emission tomography (P.E.T.) allows the local study of cerebral blood flow and oxygen metabolism. Recent P.E.T. studies have demonstrated the frequent occurrence of widespread metabolic depression remote from the site of middle cerebral artery territory infarct per se, especially over the cortical mantle and thalamus ipsilaterally, and over the cerebellar hemisphere contralaterally. These phenomena have been taken as indicative of transneural depression (i.e. diaschisis). We thought it interesting to study the possible occurrence of such abnormalities in patients with lacunar syndromes. We have applied the (15)0 technique to six patients (2 with pure motor hemiplegia, 4 with ataxic hemiparesis) for whom no large causal ischemic lesion could be demonstrated on CT scans; in only one patient was a lacunar lesion, presumably responsible for the clinical deficit demonstrated. Compared to a set of 19 patients without brain disease, the semi-quantitative results (analyzed in terms of asymmetry indices between homologous brain regions) in our patients did not disclose any pathophysiologically significant abnormality. More specifically, no evidence of physiological dysfunction similar to that reported in internal carotid artery territory infarcts, was detected over the cerebral or cerebellar cortices. These findings are commented upon in view of the presumably small size and the uncertain topography of the causal lesion.

Aged↗
PubMed1982

Production of 18F-labelled 2-deoxy-2-fluoro-D-glucose and preliminary imaging results.

To allow an additional approach to the study of brain metabolism in our laboratory, the synthesis of 18F-2-deoxy-2-fluoro-D-glucose (18FDG) has been adapted by the development of simple, reliable control techniques for routine use. By positron emission computed tomography, it has been established, in the baboon Papio papio, that there was a correlation between an epileptic focus and an increase in glucose incorporation. On the other hand, in man, a comparison between the local glucose utilization, cerebral blood flow and oxygen consumption has showed, in patients with ischaemic strokes, a disruption in the normal flow-metabolism couple.

Animals↗
PubMed1982

[Controlled therapeutic trials in migraine: methodology and results].

This review first brings justification to performing controlled therapeutic trials in migraine. It then describes the organisation of a prophylactic trial; the criteria for inclusion and exclusion, the various possible protocols, and the data analysis are discussed, while the many difficulties and pitfalls brought about by the natural characteristics of the disease are stressed. Some limitations inherent to prophylactic trials and to migraine when interpreting the results are emphasized. The findings of the prophylactic trials published to date are briefly summarized in three tables; the results indicate both the usefulness and the validity of this methodological approach in migraine. The main features and specific difficulties of the controlled trials of drugs the treatment of migraine attacks are briefly commented, and the literature review is broadly tabulated. Lastly, a brief account of the problems involved in controlled trials of non-chemical migraine therapy is given. Despite their numerous limitations, the controlled trials have considerably clarified the therapeutic approach of migraine.

Clinical Trials as Topic↗
PubMed1982

Noninvasive measurement of blood flow, oxygen consumption, and glucose utilization in the same brain regions in man by positron emission tomography: concise communication.

Local cerebral blood flow (CBF), oxygen consumption (CMRO2), and glucose utilization (CMR-Glc) have been measured in three patients by positron emission tomography (PET), together with continuous inhalation of oxygen-15-labeled gases and i.v. injection of [18F]fluoro-2-deoxy-D-glucose. In normal brain, the close local coupling between CBF and CMR-Glc, and that between CMRO2 and CMR-Glc, were well demonstrated. The coupling held for the asymptomatic areas and for parts of the affected hemispheres in two patients with cerebral ischemia. In one patient the CBF/CMR-Glc couple, but not the CMRO2/CMR-Glc couple, was disrupted in the acute ischemic core. This preliminary work demonstrates the local quantification of these important functional parameters, and indicates the potential usefulness of studying their pathophysiological interrelationship in brain disease.

Aged↗
PubMed1982

[A 15oxygen positron study of relative local perfusion and oxygen extraction of the brain in lacunar hemiparesis (author's transl)].

The oxygen-15 non-invasive continuous inhalation technique coupled with positron emission tomography (PET) allows the local study of cerebral blood flow and oxygen metabolism. Recent PET studied have demonstrated the frequent occurrence of widespread metabolic depression remote from the site of middle cerebral artery territory infarct per se, especially over the cortical mantle and thalamus ipsilaterally, and over the cerebellar hemisphere contralaterally. These phenomena have been taken as indicative of a transneural depression (i.e. diaschisis). We thought interesting to study the possible occurrence of such abnormalities in patients with lacunar syndromes. We have applied the 15O technique to seven patients (2 with pure motor hemiplegia, 5 with ataxic hemiparesis) in whom no large causal ischemic lesion could be demonstrated on CT Scans; in only one patient was a lacunar lesion, presumably responsible for the clinical deficit, evidenced. Compared to a set of 19 patients without brain disease, the semi-quantitative results (analyzed in terms of asymmetry indices between homologous brain regions) in our patients did not disclose any pathophysiologically significant abnormality. More specifically, no evidence of physiological dysfunction similar to that reported in internal carotid artery territory infarcts, was detected over the cerebral or the cerebellar cortices. These original findings are commented upon in view of the presumably small size and the uncertain topography of the causal lesion.

Aged↗
PubMed1981

[Migraine].

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Adolescent↗
PubMed1981

Positron imaging in ischemic stroke disease using compounds labeled with oxygen 15. Initial results of clinicophysiologic correlations.

Initial results in over 50 patients with stroke suggest that positron images made during continuous inhalation of carbon dioxide labeled with oxygen 15 and molecular oxygen labeled with oxygen 15 provide data on tissue function that may be relevant to acute stroke management. Five cases illustrate the following findings: 15O-activity patterns observed in areas of ischemic injury or infarction are what one would expect if the 15O distributions represented physiologic functions, such as cerebral blood flow and metabolism. Areas of abnormal 15O activity correlate with the clinical or computed tomographic (CT) localization of the deficit. In studies performed acutely, changes in 15O distributions anticipate alterations in CT scans and may be predictive of outcome. Data related to oxygen metabolism correlate better with tissue viability than do those reflecting cerebral blood flow.

Aged↗
PubMed1981

Noninvasive tomographic study of cerebral blood flow and oxygen metabolism in vivo. Potentials, limitations, and clinical applications in cerebral ischemic disorders.

The non-invasive continuous inhalation technique of C15O2 and 15O2 coupled with positron emission tomography (PET) provides brain images that are thought to represent local cerebral blood flow (CBF) and oxygen extraction fraction (OEF). Experimental studies in baboons have confirmed that C15O2 inhalation allows tomographic measurement of CBF. The numerous difficulties involved in PET absolute quantitation are stressed, as well as some limitations inherent to the 15O inhalation model. However, the values for local CBF, OEF and CMRO2 obtained in normal young subjects are satisfactory in view of the above-mentioned limitations. The clinical application to recent cerebral infarction has allowed two opposite types of flow-metabolism uncoupling to be identified, which appear to be often predictive if tissue prognosis. The time course of spontaneous changes in CBF and OEF within the infarct is also described. Our studies have, in addition, revealed the previously unknown phenomenon of "crossed cerebellar diaschisis" in supratentorial infarction. Lastly, a state of chronic watershed ischemia, potentially reversible by surgical revascularization, has been identified as presumably involved in the progression of watershed necrosis. The clinical potentials of this method appear considerable.

Adolescent↗
PubMed1978

[Tomographic study in humans of blood flow and oxygen consumption of the brain by continuous inhalation of oxygen 15. Preliminary findings in cerebral ischemic accidents].

Transverse axial tomographic imaging of regional cerebral blood flow (rCBF) and regional oxygen extraction fraction (rOEF) were obtained in 13 patients hospitalizedfor ischemic strokes (eleven middle cerebral artery territory infarcts, one capsular or pontine lacune, one transient hemispheric attack) by continuous inhalation of 15O2 and C15O2 to equilibrium and exclusive detection of the gamma rays emitted in coincidence by means of a tomograph for positron emitting agents. In the transient ischemic attack and in the case of lacune the rCBF and the rOEF images were found to be normal, and they were abnormal in all cases of middle cerebral artery territory infarcts. In recent infarcts, rOEF was always strikingly decreased in the clinically suspected area, whilst the rCBF was either decreased, normal or increased. In infarcts older than 30 days rCBF was always clearly decreased over the clinically suspected area whilst rOEF was in most cases normal or only slightly decreased. These results are briefly discussed. Some practical and theoretical limitations of this method are mentioned. The potential of the present technique appears great however, since it is possible to simultaneously visualize in tomographic fashion the blood flow and the oxygen metabolism in areas of the brain that are of small volume, and however deep they are. A quantification of these parameters is presently under investigation, as well as the verification of the theoretical model on which such method is based. The non-invasiveness of the present method, the feasibility of repeating it at regular intervals of time, and the possibility of measuring the immediate effects of a given therapeutic mode on the regional metabolism of brain all constitute further advantages whose action apply preeminently in the field of the cerebral ischemic diseases.

Aged↗