Search PubMed⌕ Search

Biomedical subjects

J Godard

Publications and source records attributed to J Godard.

At least 37 records · Page 2Linked to original sources
PubMed1994

Arterial diastolic pressure augmentation by intra-aortic balloon counterpulsation enhances the onset of coronary artery reperfusion by thrombolytic therapy.

BACKGROUND: The early establishment of infarct artery reperfusion by intravenous thrombolytic therapy has improved survival after acute myocardial infarction. Investigations of reperfusion have focused on the effects of specific thrombolytic agents, anticoagulation, and platelet inhibition. However, little attention has been given to the relation of arterial blood pressure to thrombolysis, a factor that probably affects thrombolytic agent delivery to the obstructing thrombus. METHODS AND RESULTS: The effect of arterial diastolic pressure augmentation by intra-aortic balloon counterpulsation (IABP) on reperfusion after intravenous thrombolytic therapy was studied in a canine model. A critical left anterior descending coronary artery stenosis was created by an occluder. Acute thrombosis immediately proximal to the occluder was formed by local injection of a blood and thrombin mixture into a segment of the artery that had intimal damage (groups 1 through 3). Continuous coronary blood flow velocity was measured by an epicardial Doppler probe. Group 1 (n = 7) served as control. Group 2 (n = 6) received an intravenous, front-loaded recombinant tissue-type plasminogen activator (rTPA) regimen (1.25 mg/kg total dose, 15% as bolus, 50% in the first 30 minutes, and 35% for the following 60 minutes). Group 3 (n = 6) received the same rTPA regimen with IABP beginning at the start of rTPA administration. Coronary blood flow velocity, arterial pressure, and heart rate were observed for 150 minutes after the start of thrombolytic therapy. Five animals did not undergo coronary thrombosis (group 4) and had coronary blood flow velocity determined before and after IABP at baseline and after creation of critical stenosis. Mean systolic arterial blood pressure and heart rate were not statistically different between groups. Peak augmented diastolic pressure by IABP was 97.9 +/- 1.3% of systolic pressure in group 3 dogs. Spontaneous reperfusion did not occur in any group 1 dogs. All animals treated with rTPA reperfused. Reperfusion occurred in group 3 (13.1 +/- 2.1 minutes) earlier than in group 2 (39.2 +/- 9.4 minutes, P = .02). Overall duration of arterial patency did not differ between group 2 (81.4 +/- 16.6 minutes) and group 3 (94.9 +/- 15.3 minutes, P = .52). Reocclusions occurred with similar frequency (P = .85) in groups 2 and 3. In group 4, IABP did not increase baseline coronary blood flow velocity. CONCLUSIONS: This study demonstrates that augmentation of diastolic arterial pressure by IABP enhances thrombolysis, leading to faster reperfusion. This effect appears to be unrelated to an increase in coronary blood flow and may be due to an effect of the augmented diastolic blood pressure wave on the obstructing thrombus. These findings suggest that the time to reperfusion by rTPA may be blood pressure dependent. The relation of arterial blood pressure to successful thrombolysis may have important implications for future treatment strategies for myocardial infarction.

Animals↗
PubMed1994

[Lymphocytic adenohypophysitis. Apropos of a new case].

A new case of lymphocytic adenohypophysitis in a five months pregnant woman is related. The sudden appearance of visual symptoms required a surgical procedure. MRI does not enable a precise preoperative diagnosis. Three months after delivery clinical data as hormonal functions returned to normal and also the CT Scan aspect. Eighteen months later the patient remains totally normal. In our case we don't find any argument in favor of an autoimmune disease.

Adult↗
PubMed1994

[Remodeling the cranial vault in anterior craniosynostoses. Our therapeutic experience of trigonocephaly and plagiocephaly].

The authors propose two simple techniques to improve the adaptation of the frontal vault after remodeling the orbito-naso-frontal flap in anterior craniostenosis. In trigonocephaly: the metopic suturectomy is enlarged by lateral translation of the two half frontal bones, then to fall the place the coronal suture is used. The temporal plates are moved forward and turned to fill the failure of fronto-temporal junction due to valgisation of orbito-naso-frontal band. In plagiocephaly: the frontal flattened flap is cut with oblique radial osteotomies starting at bregma so called "Daisy petal". The first internal petal is sacrificed. The others are rotated axially in a medial direction. Internal table corticotomies must be performed at two levels to recurve the flattening and to obtain a curve in the coronal plane. In this two techniques the pericranium and dura-mater must be carefully teated to obtain a better adaptation of the new bone shape and to permit the spontaneous reossification.

Craniosynostoses↗
PubMed1994

[Cranial asymmetries. Reflexions on plagiocephalies. Premature sutural synostosis or extracranial origin?].

The authors relate a clinical and radiological (X Ray and TDM tridimensional) study with an anthropological (dry skulls) study of plagiocephaly. The aim is to find with the aid of a physical examination, some anatomic parameters which permit to differentiate cranial asymmetry with coronal premature synostotic suture from functional deformation with extracranial outset. The term plagiocephaly is used to define forehead asymmetry. It is necessary to study orbital rim, nasal root, malar eminence, ear and chin mid point position. The morphology of the skull is important to look: frontal flattering and also occipital flattering or bulging, contra-lateral frontal and pterional aera bulging. The authors conclude that a single parameter is necessary to differentiate the two kinds of plagiocephaly: the petrous bone position on the flattened frontal side: sagittalisation: fonctionnal plagiocephaly; frontalisation: synostotic plagiocephaly.

Cephalometry↗
PubMed1994

[Torticollis and C1-C2 rotation subluxation. Apropos of a case. The value of a dynamic scanner and of a 3-dimensional scanner].

The authors report the rare and complex case of a girl who had been followed since the age of 3 years for hydrocephalus the cause of which was found only when she was 6-year old. The causative agent was a pilocytic astrocytoma of the cerebellum. On April 10, 1990, she underwent subtotal excision of the tumour, associated with radiotherapy. Four months later she developed an increasingly painful and irreducible torticollis which did not respond to tractions. Dynamic CT scans and 3-dimensional CT scans were performed in the fourth month and provided a diagnosis of right C1-C2 rotatory subluxation. There was no history of injury and no sign of inflammatory process. Rotatory subluxation is a very rare lesion difficult to diagnose, and few cases have been published, although the signs are those of classical torticollis in children. When medical treatment fails, often due to belated diagnosis, the only surgical treatment is uni- or bilateral C1-C2 arthrodesis. If the diagnosis can be made at an early stage, reduction of the rotatory luxation is usually easy and without consequences to the child. It is therefore recommended to perform a dynamic CT scan and a 3D CT scan as soon as possible in all children with lasting painful torticollis.

Astrocytoma↗
PubMed1993

[Treatment of peritumoral cerebral edema with tetracosactide].

Tetracosactide is known to be used in brain tumours, but its action is difficult to evaluate clearly. Tetracosactide exerts analgesic, anti-emetic and anti-inflammatory effects and it reduces the oedema surrounding brain tumours. It is this latter effect which we have studied. We used a technetium-labelled cerebral marker, 99mTc HMPAO (Ceretec), and found that this functional exploration not only detects the presence of a brain tumour, but also measures regional cerebral blood flow. This marker is mainly used in intracerebral vascular diseases. Since february 1990, eighteen patients suffering from malignant brain tumour with pronounced perilesional oedema were selected and treated with tetracosactide for two days. With the help of 99mTc HMPAO scintigraphy the oedema was quantified, and the results obtained were interpreted. The initial results of this clinical experiment indicate that the phenomena observed were due to improved vascularization of the healthy peritumoral areas with resorption of oedema. This was a consequence of the direct tetracosactide action, and the higher the dose of this compound, the clearer its action.

Adult↗
PubMed1993

[Early somatosensory (SEP) and auditory (AEP) evoked potentials in anoxic coma: prognostic value].

Early somatosensory (SEP) and auditory (BAEP) evoked potentials, when recorded within the first seven days of the course of anoxic coma, appear to be reliable to evaluate anoxic ischemic cortical or under-cortical lesions. Prognosis depends especially on cortical SEP (N20-P25): the lack of SEP is a good outcome predictor of death (abnormal BAEP) or of vegetative status (normal BAEP); the presence of normal and bilateral cortical SEP (with normal BAEP) allows to predict awakening, without prejudging of neurologic sequelae, even if they are severe.

Acoustic Stimulation↗
PubMed1993

[Peroperative echography in neurosurgery. Its value and applications 10 years later].

Intraoperative ultrasound imaging has many advantages over other imaging methods. The authors present their experience from hundred patients over ultrasound scanning. A large iconography is exposed. Not only the intracerebral lesions such as gliomas or metastases but also abscess or cysts can be controlled or biopsied directly. Per-operative ultrasonography is interesting for spinal cord lesions and spinal traumas. Ten years from the first utilisation in neurosurgery, the method is always used, its cost is low and its practice is very easy.

Biopsy, Needle↗
PubMed1992

[Intramedullary neurinoma. Apropos of a case. Review of the literature].

The authors present a case of intramedullary neurinoma. A 44 years old patient was admitted for lumbar pain and bilateral sciatica. Neurological examination was normal except for dysuria and diminution of Achilles tendon reflexes. Lumbar spine X-rays and spinal cord angiogram were normal, but myelogram and myelo-scan revealed a fusiform enlargement of the conus medullaris. MRI confirmed this aspect. Total removal of an intramedullary tumor was done, using ultrasonography, operating microscope and ultrasonic aspiration. The post-operative course was uneventful, with, as sequelae a perineal hypoesthesia. Histological examination of the excised tumor revealed a neurinoma. The epidemiology, clinical features, radiology, and surgical treatment of such rare intramedullary tumors are discussed.

Adult↗
PubMed1992

[Cerebral alveolar echinococcosis. Apropos of a surgically-treated case. Review of the literature].

The authors present a case of a cerebral echinococcosis in a male farmer operated upon 9 and 6 years ago for pulmonary and hepatic localisations of Alveolar Echinococcosis. Cerebral lesions were diagnosed by CT scan and MRI and were totally removed. The follow-up was uneventful. A review of the literature revealed only eighteen previously reported surgical cases. The authors comment the epidemiology of this endemic parasitic disease, and the particular aspects of its cerebral localisation.

Brain Diseases↗
PubMed1992

[Cervical osteoid osteoma. Report of a case and review of the literature].

One case of a cervical osteoid osteoma is presented and compared with infrequent similar cases from the literature. The authors recall the diagnosis difficulties, facing a long standing not explained neck pain due to poor neurological and current radiological informations. The interest of the bone scintigraphy, CT scan and M.R.I. are emphasized. Like in other cases, the pain disappeared after surgical removal of the tumor. The eventually associated scoliosis often rectify too.

Adult↗
PubMed1991

Spinal subdural hematoma.

The authors report a case of spinal subdural hematoma in a 51-year-old man who experienced a sudden onset of back pain accompanied by vomiting and headache without paralysis or paraparesis. CT Scan, myelography and MRI revealed a subdural hematoma at the levels of 6th, 7th and 8th thoracic vertebrales. Laminectomy allowed the removal of an encapsulated cyst formation filled with xanthochromic fluid and some blood clots. The follow-up was uneventful.

Diagnosis, Differential↗
PubMed1991

[Intervertebral biopolymer implant for arthrodesis. A study of 45 cases].

The B.O.P. biocopolymer is a bioresorbable, biocompatible product which can ossify. It has been used in 45 spinal arthrodesis, 42 times in cervical region but three in lumbar spine. The authors report their results after a follow-up period of 8 to 28 months. Persistent cervical pain has been noted in 9 cases. This was the most important postoperative complaint. Graft ossification has nevertheless been observed only in 40% of cases, as proved by simple X rays or/and scanner examination over a 26 months period. An osseous overproduction with posterior osteophytes could otherwise be observed. The authors remains cautious about using moreover this kind of graft, at least in its actual presentation, though the clinical results can be compared with these obtained with osseous autograft.

Biocompatible Materials↗
PubMed1991

[Cauda equina syndrome complicating cutaneous T-cell lymphoma (mycosis fungoides)].

Authors present a case of a cutaneous T. cell lymphoma (mycosis fungoides) complicated by a cauda equina syndrome. Crural and sciatic radicular pain were due to epidural lumbar involvement by tumoral process. After surgical decompression completed by chemotherapy the evolution was uneventful. This case is the second one reported in the literature.

Cauda Equina↗
PubMed1991

[The value of C-reactive protein in the detection of chorioamnionitis in cases of premature rupture of membranes].

In a context of premature rupture of the membranes, the authors compare the sensitivity and ability to predict the onset of chorio-amnionitis of the conventional clinical signs (hyperthermia, fetal tachycardia, discolored amniotic fluid) and paraclinical signs (hyperleukocytosis and bacteriology of the amniotic fluid) with those of the assay of C reacting protein in the maternal plasma. The latter test is apparently more sensitive and of greater positive predictive value in this disorder.

C-Reactive Protein↗
PubMed1991

[Solitary plasmacytoma simulating pituitary adenoma].

A case of solitary plasmocytoma of the sphenoid is reported, masquerading as pituitary adenoma. At the time of surgery, the patient had no findings of multiple myeloma. The tumor was removed by trans-sphenoidal route and radiotherapy delivered. The post-operative course was uneventful, and two years later, there is no sign of recurrency or extension of multiple myeloma.

Adenoma↗
PubMed1990

Intestinal decontamination in a polyvalent ICU. A double-blind study.

A double blind, placebo-controlled trial was performed to test the efficacy of prevention of nosocomial infections by selective digestive decontamination. Placebo or tobramycin (80 mg) and colistin (100 mg) was given four times daily via the gastric tube. Amphotericin B (500 mg/6 h) was administered to all patients. As our ICU is divided into two separate subunits, intestinal decontamination or placebo was administered alternatively to patients of the two subunits during two 3-month periods, separated by a 2-month period without prevention. The decontamination (n = 97) and placebo groups (n = 84) were similar with respect to age, sex, severity score and diagnostic categories on admission. Intestinal decontamination alone failed to significantly reduce the number of infected patients (26% vs 34.5%, p = 0.20), but was effective on ICU-acquired infections (0.33 vs 0.60, p = 0.02) especially gram-negative infection rates (0.17 vs 0.43, p = 0.01). The onset of the first ICU-acquired infection was delayed (9 vs 13 days, p less than 0.001) and incidence of pneumonia (2 vs 13 cases, p less than 0.01) including bacterial pneumonia (0 vs 8 cases, p less than 0.01) was significantly decreased. However, mean ICU stay and mortality were not significantly modified by intestinal decontamination.

Amphotericin B↗