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Biomedical subjects

J D Born

Publications and source records attributed to J D Born.

At least 55 records · Page 3Linked to original sources
PubMed1986

[Skull injury. Arteriovenous shunt. Limitations of cerebral x-ray computed tomography].

The authors report the case of a patient suffering from a head trauma after dizziness followed by a loss of consciousness. In the hours following the admission, he developed drowsiness and a left hemiparesis. CT scanner showed an intracerebral haematoma. Due to the dizziness a carotid angiography has been realized and has demonstrated an intracerebral avascular mass, an arteriovenous shunt and an epidural haematoma at the vertex. Two aspects of the case seem to be important: the first one is the limit of CT scanner; the second one is the relationship between the three lesions.

Adult↗
PubMed1986

[Ablation by the anterior transcorporeal approach of an ante-spinal cord cervical meningioma. Apropos of a case].

The authors report a case of an intradural spinal meningioma ventrally located just rear to the 5th cervical body. The patient (a 46-year-old woman) suffered from a spasmodic quadriplegia, walking was nearly impossible. Because of the strictly median and ventral localization the authors have chosen an anterior approach passing through the body of C5 after discectomy of C4-C5 and C5-C6 discs. The tumor and its dural attachment was totally removed with respect to the spinal cord and all rootlets. Reconstruction of cervical spine was performed with an iliac bone graft. The neurological recuperation was complete and quickly achieved. Bone fusion was obtained within 3 months with a good result. The authors emphasize the rarity of ventrally located meningiomas in the cervical spine and the advantages of anterior route which alone enables a total surgical removal of such lesions.

Cervical Vertebrae↗
PubMed1985

Derivation of a bioclinical prognostic index in severe head injury.

We investigated the problem of outcome prediction from seven risk factors in 40 severely head injured patients - 13 favorable and 27 unfavorable outcomes. By applying stepwise logistic discriminant analysis to the patients' data, we selected three significant risk variables: cerebrospinal fluid (CSF) CK-BB isoenzyme activity recorded on admission, severely raised intracranial pressure (more than 40 mmHg) and age, respectively. CSF CK-BB activity, which quantifies the initial neurological damage, proved to be the best prognostic factor. The presence of severe intracranial hypertension was always associated with a bad outcome, whereas its absence was not necessarily indicative of good prognosis. Finally, we combined the three selected variables into a single risk index, which allowed correct predictions in 92% of patients with favorable outcome and in 85% of patients with unfavorable outcome (total predictive efficiency 88%).

Adolescent↗
PubMed1985

Syndrome of inappropriate secretion of antidiuretic hormone after severe head injury.

This study is based on 109 patients with severe head injury who had a Glasgow coma score equal to or less than 7 and a Liège coma score equal to or less than 12 in the first 24 hours. The syndrome of inappropriate secretion of antidiuretic hormone seems to us to be a frequent complication of severe craniocerebral trauma. It has been discovered in 33% of our patients. On the other hand, diabetes insipidus was rarely diagnosed (2.8%). We propose, in cranial trauma, to subdivide the syndrome of inappropriate secretion of antidiuretic hormone into two clinical forms: an early syndrome (5%) that becomes apparent towards the second day and is significantly associated with lesions at the base of the skull; and a delayed syndrome that occurs at the end of the first week and is related to different factors inherent in intensive care procedures. Surgical intervention, in the case of acute craniocerebral trauma, does not result in a higher frequency of inappropriate secretion of antidiuretic hormone.

Adolescent↗
PubMed1985

Relative prognostic value of best motor response and brain stem reflexes in patients with severe head injury.

The object of this study was to determine whether the addition of information on brain stem reflexes improves the prognostic precision of the Glasgow coma scale for patients with severe head trauma. The study is based on 109 patients with a Glasgow coma score of 7 or less during the first 24 hours after injury. The average age was 23 years. The patients were classified into three groups according to their actual outcome after 6 months: dead, 44 patients; persistent vegetative state and severe disability, 13 patients; moderate disability and good recovery, 52 patients. We then compared, by means of multiple group logistic regression, the prognostic ability of motor responses alone using the Glasgow criteria and of brain stem reflexes via an original approach. We showed that the predictive capabilities of brain stem reflexes were greater than those of motor responses. Although closely related (r = 0.68), the use of these two parameters in a single scale, the Glasgow-Liege scale, improves the precision of prognosis, especially for those head trauma patients with initial and complete loss of consciousness. Age was also revealed to be an important factor for outcome prediction.

Adolescent↗
PubMed1985

One-stage excision of high-flow arteriovenous malformations.

The authors describe two cases of high-flow arteriovenous malformations which illustrate a new technique to reduce the risk of brain swelling and diffuse hemorrhage during or after operation. This technique, used in the latter of the two cases, includes occlusion of the shunt, followed by the progressive tightening of a Selverstone clamp placed on the cervical internal carotid artery, lowering of the systemic arterial pressure, and the use of barbiturate anesthesia. Clamping and anesthesia are maintained for a 24-hour period after surgery.

Cerebrovascular Circulation↗
PubMed1984

[Intracranial pressure in severe brain injuries. 1st Part: X-ray computed tomography of cerebrospinal fluids and manometry].

In a series of 40 patients with severe head injury (L.C.S. less than or equal to 12), we simultaneously studied the variations of intracranial pressure (I.C.P.) and cerebrospinal fluid (C.S.F.) spaces (ventricular and subarachnoidal) on C.T.-scan. At the time of C.T.-scan, normal C.S.F. spaces mean a normal I.C.P. (less than 15 torr) but cannot preclude a secondary intracranial hypertension. With a collapse of the C.S.F. spaces, it is to be geared that a severe hypertension occurs (greater than 40 torr).

Adolescent↗
PubMed1984

Changes in cerebrospinal fluid enzyme activity after severe head injury. Diagnostic and prognostic values.

We studied CSF CK and LDH isoenzyme activities in 27 patients with severe head injury and in 10 patients with chronic hydrocephalus not related to trauma. CSF enzymes showed an increased activity immediately after trauma, contrasting with the low values measured in the patients with hydrocephalus. In severe head injury, we found a correlation between enzyme release and brain dysfunction assessed according to two methods: the Glasgow coma scale (GCS), and the Liège coma scale (LCS) which uses elements of the GCS and the study of 5 brain stem reflexes. The correlation between enzyme activity and the Liège coma scores is better than that observed with the Glasgow coma scores. High enzyme activity is associated with a bad outcome at six months. It has a prognostic value on so far as it reflects the severity of traumatic structural brain damage.

Adolescent↗
PubMed1984

[Correlation between the Liège scale and a biomechanical marker of the cerebral lesion].

Brain type creatine kinase isoenzyme (CK.-1) was measured in the ventricular cerebrospinal fluid in a series of 42 patients within 7 +/- 3,4 hours following severe head injury (GCS less than or equal to 7, LCS less than or equal to 12). The presence of the CK.-1 isoenzyme correlated with the degree of head injury as indexed by the Glasgow coma scale and the Liege coma scale. There was a significant logarithmic correlation between CK.-1 activity in the C.S.F. and the coma scores. However, the correlation with the Liege coma scale score (r = -0,84) is significantly better (Z = 1,97; p less than 0,05) than with the Glasgow coma scale score (r = -0,65). Thus, the Liege coma scale is a better index of neurological trauma.

Adolescent↗
PubMed1984

[Intracranial pressure in severe brain injuries. 2nd Part: Therapeutic interests and prognosis].

Sixty-seven patients with severe head injury underwent intracranial pressure (ICP) monitoring (10 extradural and 57 intraventricular). All patients had Liege coma scale (LCS) score of 12 or less. Ventriculitis (E. Coli) occurred in one patient (1,8%). The intraventricular method allows C.S.F. drainage with lowering of I.C.P. even with slit ventricles. After 8 days, if an intracranial hypertension persists, we perform a ventriculo-atrial drainage. Pressure recording is a useful way of following the patient's evolution and a guide for prognosis of survival. If I.C.P. is constantly below 5 torr, then the probability of a bad outcome is great. The study also confirms the high mortality rate (93%) if I.C.P. is greater than 40 torr.

Adolescent↗
PubMed1983

Creatine kinase isoenzymes in severe head injury.

Brain-type creatine kinase (CK) isoenzyme (CK-BB) was found in the ventricular cerebrospinal fluid (CSF) and the serum in a series of 35 patients within 13 hours following severe head injury. There was a good correlation between total CK and CK-BB activities in CSF only. The values found in the CSF appear to be a quantitative index of brain dysfunction at admission, and did not correlate with intracranial pressure activity. High levels of CK-BB in the CSF correlated with a poor outcome, and thus offer a reliable criterion for the assessment of the severity of head injury.

Adolescent↗