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Biomedical subjects

J Cophignon

Publications and source records attributed to J Cophignon.

At least 55 records · Page 3Linked to original sources
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

[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

A new radionuclide method for the diagnosis of posttraumatic cerebrospinal fistulas. A study of 308 cases.

The authors describe their technique for identifying and localizing posttraumatic cerebrospinal fluid fistulas. The method entails injection of radionuclide tracer into the subarachnoid frontal space with the patient in a sitting position followed by gamma camera scintigraphic recordings. The results in 308 patients are presented; these are compared with those of suboccipital radionuclide cisternography in 40 cases and metrizamide computerized tomography cisternography in nine cases. Transient complications occurred in only three patients.

Cerebrospinal Fluid Rhinorrhea↗
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

[Treatment of tumors in relation to the transverse portion of the vertebral artery].

Among 28 lesions, 22 tumors and 6 anteriovenous malformations, operated with control of the vertebral artery, 15 are located close to the transverse canal. Analysis of arteriographic datas from 20 cases of tumors related to the vertebral artery, points out the interest of the surgical control of this vessel, in the treatment of these tumors. This control is mainly indicated in case of hypervascularized tumors, or compression of the vertebral artery, especially if it is the dominant vessel or if it gives a radiculo-medullary branch. For this control, the lateral retro-jugular approach is used, and sometimes associated with other techniques: embolization, posterior approach, or anastomosis between carotid and vertebral artery about the lesion.

Arteriovenous Malformations↗
PubMed1981

[Night sleep disorders during recovery of severe head injuries (author's transl)].

In 16 young (15 to 25 years) patients, sleep recordings have been performed one month (group T1, 10 cases) or 6 months (group T6,6 cases) after recovery of consciousness following severe head injury. Group T1 can be divided in two subgroups according to clinical and EEG datas: T1A (4 cases) with long duration of coma (15 to 40 days) and low level of brain stem dysfunction (diencephalic). In group T6 every duration of coma and level of dysfunction are present. Percentage of intrasleep wakefulness and number of awakenings are very increased in group T1A (31,5% and 24); these datas are less increased in group T1B (10,1% and 19) and T6 (11.8% and 19). Percentage of REM sleep is very low in group T1A (9,57%) and T1B (12,65%) because of short duration of each phase. In group T6 REM sleep is close to control subjects (16,15% and 20,52%). These results are compared to those reported in normal or insomniac subjects of same age or much older. They are very similar to sleep perturbations observed in elderly (70 years) but normal people. This may evoke an early ageing of brain stem structures involved in organization of wakefulness-sleep rhythm and REM sleep.

Adolescent↗
PubMed1981

[C.T. scan and traumatic intracranial haematoma without clinical signs (author's transl)].

Patients having sustained head injuries were investigated by computerized axial tomography, a few hours after trauma. 24 conscious patients had large traumatic lesions: epidural haematoma, acute subdural haematoma and cerebral attrition. 12 had no focal sign and were well conscious or very slightly drowsy. 12 were slightly drowsy and/or had focal signs but these signs were very discrete in contrast with the huge lesions seen on the CT Scan. This seems to confirm that an epidural haematoma expands very early after the head injury, and, in any case, that it does exist during the free interval. From a practical view point, computerized tomography may greatly improve the treatment of patients who, other-wise, would have been operated upon in comatose state. This study is not a prospective one, it does not lead to any statistical value. But it points out the usefulness of CT Scan after severe head injury especially of conscious patients, above all if there is a skull fracture.

Adolescent↗
PubMed1980

[Significance and prognostic value of Parinaud's syndrome in hydrocephalus (author's transl)].

Eleven out of 260 cases of chronic hydrocephalus in adults were associated with mesencephalic symptoms, in particular Parinaud's ophthalmoplegia. Investigations aimed at detecting intracranial growth consistently gave negative results. In most cases, the midbrain symptoms were accompanied by intracranial hypertension and therefore reflected an aggravation of the hydrocephalus. They regressed when manoeuvres tending to reduce intracranial pressure were applied on time. On three occasions, they were followed by pontobulbar symptoms and treatment was ineffective. When brain stem symptoms (especially Parinaud's syndrome) occur in the course of hydrocephalus, one should always look for tumoral lesions, but they may also point to deterioration of the disease, which should be treated before it becomes irreversible. The mechanism of brain stem involvement in hydrocephalus is discussed in the light of electrophysiological recordings during experimentally-induced intracranial hypertension in the cat.

Adolescent↗
PubMed1980

[Cerebral infections due to anaerobic organisms (author's transl)].

Most of intracranial suppurations, especially those from E.N.T. origin, are secondary to anaerobic germs, which can be cocci Gram (+) or Gram (-), in association or not with aerobic bacteria. 97 cases have been observed between 1968 and 1979 at Lariboisière Hospital. When the bacteriological study was realised in correct conditions, anaerobic germs were found in more than 60% of cases, and less than 10 % of cultures were negative. A lower mortality (11 %) and morbidity (34 %) rates follow an improvement in bacteriological diagnosis. Anaerobic bacteria stay very susceptible to antibiotics, such as the association Penicilline-Metronidazole; now, we prescribe immediately such a therapeutic, and eventually modify it after having received the antibiogram. As a conclusion, the treatment of brain abscesses could be simplified: CT scan and a rigourous bacteriology make possible an accurate control and follow-up of the suppuration after simple punction.

Anti-Bacterial Agents↗
PubMed1978

[Fronto-cranial remodeling for craniostenosis with mobilisation of the supra-orbital barr (author's transl)].

33 cases of fronto-cranial remodeling by osteotomies are reported by the authors. Since 1973, 19 oxycephalies have been operated according to an original technique based on two principles:--rocking and advancement of the supra-orbital barr, with an easy lateral retention by a Z-bony cut.--transposition of free bone flaps to rebuild a forehead of the appropriate curvature. The good results obtained have encouraged the authors to operate on young children or even babies in order to solve simultaneously the functionnal and the aesthetic problems. Three plagiocephalies, two trigonocephalies have thus been treated, as well as 5 facio-craniostenosis for whom a 2 cm forehead advancement has been done, the following results being very encouraging.

Child↗