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Biomedical subjects

J Richaud

Publications and source records attributed to J Richaud.

At least 37 records · Page 2Linked to original sources
PubMed1986

Posterolateral approach and anterior spinal canal recalibration in severe spinal injury affecting T-12, L-1: a study of seven cases.

The authors present seven cases of spinal trauma at the T-12--L-1 level with severe spinal canal stenosis secondary to compressive, anterior discocorporeal lesions. Associated neurological disorders were of varying severity. Six cases were investigated by computed tomography, which enabled the degree of thoracolumbar spinal canal stenosis to be determined. In all cases, the surgical procedure involved rectification of spinal deformity, with an initial unilateral posterolateral approach permitting anterior spinal canal recalibration, either by impaction of protrusive fragments or ablation of ejected disc fragments. The stabilization was in all cases achieved by complimentary bilateral plates using Roy-Camille material, associated with posterolateral arthrodesis by grafting with reconstruction of the articulopedicular structure. The functional spinal result was excellent in all cases, and recalibration was verified by tomography. In those cases showing neurological deficiency, good and early recovery was attributable to the suppression of spinal canal stenosis. The application of this posterolateral approach for severe lesions of the thoracolumbar junction seems to represent, in all cases of recent lesions, an alternative to the anterior or combined methods, which present widely recognized difficulties at the thoracoabdominal junction.

Adult↗
PubMed1985

[Chemonucleolysis in the treatment of surgical sciatica].

Enzymatic dissolution of nucleus pulposus by percutaneous injection of a papain preparation is now used frequently to treat lumbosacral disc hernias responsible for resistant sciatica. Mechanisms of action and techniques are reviewed, and the importance of applying strict criteria for indications for use emphasized. The method should be reserved for nerve root sciatica resistant to medical treatment or physiotherapy, and it constitutes the last stage of conservative treatment. Exclusion criteria are mainly "excluded" disc lesions, major dysfunction or associated spinal vertebral canal stenosis. The optimal indication is represented by the subacute disc hernia in the young. This alternative to open surgery in no way compromises the results in case of failure. Results obtained in a personal series of 150 cases are analyzed comparatively with those reported in the literature.

Adolescent↗
PubMed1985

[Contribution of computer tomography in recent traumatology of the spine. Apropos of 31 cases].

The authors report 31 cases of recent spinal injury (14 cervical, 17 thoraco-lumbar) which have been investigated using computerized tomography. After a critical appreciation of the conventional approach to such lesions, the authors consider the advantages and limitations of computerized tomography. Analysis of the data from 31 cases studies confirms that this technique has considerable applications in the assessment of corporeo-discal and pediculo-lamar lesions and, in particular in the determination of the degree of spinal canal stenosis and in the detection of actual potential neuroaggressive factors which are important for the choice of therapy. Computerized tomography provides information which is essential in choosing the surgical strategy to be adopted in each case, and in particular allows determination of the best approach and of the time scale for successive operations in the case of a double approach. On the other hand, computerized tomography alone does not permit precise determination, either of the degree of instability of spinal lesions or of the magnitude of static deformations.

Adult↗
PubMed1985

[Effects of cranioplasty on neurological function and cerebral blood flow].

The authors present a review of their experience of cranioplasty in cases showing of skull defects. Forty recent case reports were retained out of a total of 125 cases and of these, 15 showed neurological deficiency prior to cranioplasty. In 7 out of these 15 cases cranioplasty appeared to have no effect, but in the 8 remaining cases, an improvement in the neurological condition was observed. In connection with these clinical observations, a recent study of a small group of patients with skull defects used the Xenon 133 inhalation method to investigate cerebral blood flow. In all cases these was a significant postoperative improvement in cerebral blood flow. The rate varying from 15 to 30% and this improvement was even observable in the case of small skull defects of the order of 10 cm2. The mechanism giving rise to such improvements is discussed; it may be related to cerebral hemodynamic normalization after skull restoration. The improvement in cerebral blood flow brought about by cranioplasty in all the cases studied suggests that this technique may be important not only for simple skull repair but also to improve neurological function.

Cerebrovascular Circulation↗
PubMed1980

[Traumatic injury affecting the extracranial portion of internal carotid artery (17 case reports) (author's transl)].

The authors analyse the detailed clinical course in an homogenous review of 17 cases reports of traumatic injury affecting the extracranial portion of internal carotid artery. Only cases in which there were neither cervical perforating wound nor atheromatous predisposing lesion were considered. As in cases reported in the literature, the young age of these patients, with prevalence in the second decade and in men, was attributable to the etiology. Circumstances in which diagnosis was established induce to discern two unequal groups, according as there was either a coma or immediate focal signs, or a delayed symptomatology : it occured most frequently after a free interval shorter than 48 hours, and reaching in the extrema (one instance) 40 days. Brachiofacial hemiparesis was the most frequent clinical picture. Doppler investigation was able to detect, with a rather satisfying reliability, anomalies in the carotid flow before angiography ; angiogram showed lesions nearly always facing first or second cervical vertebra and bilateral lesions in four instances. Injuries consisted in dissecting aneurysm with stenosis aspect much more often than in thrombosis. In a third of cases distal ischemic lesions below dissecting aneurysm were noted. Prognosis in these cases is very poor since eight patients in our series died without any possibility of expectation according to clinical or angiographical data. Medical therapeutics were disappointing, and this induced to consider an extension in preventive realization of extra-intracranial by pass, each time diagnosis is established and patient is lucid. Etiopathogenical aspect is the originaler part of this study, since we could precisely approach incriminated mechanisms in a methodic analysis of impacts and their results. In our review cranial or facial shock was constantly noted, always frontal and often mild. In II cases association to a frontal and upper thoracic traumatism was found ; safety belt may have been responsible in part, in the mechanism of fixation of upper thoracic orifice, in most cases where this thoracic impact seemed to be missing. Thwarted stretching of carotid artery seems to be the necessary condition for occurring of an intimal tear. Other mechanisms like direct cervical shock may certainly be found, but we did not observe any instance in this review.

Adult↗