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Biomedical subjects

P A Joseph

Publications and source records attributed to P A Joseph.

13 recordsLinked to original sources
PubMed1994

Effect of subclavian syndrome on the basilar artery.

Fifty-five patients with a permanent or intermittent subclavian steal syndrome demonstrated by continuous wave Doppler were included in a prospective study: 25 patients without vertebro-basilar symptoms, 8 symptomatic patients with defined vertebro-basilar symptoms and 22 with hemodynamic vertebro-basilar occurrences. The basilar artery velocity was recorded by Transcranial Doppler Sonography in baseline conditions, and after a hyperaemia test to the upper limb. A spontaneous, incomplete basilar steal was diagnosed in seven patients, and a complete basilar steal in one patient, (14.5% of the cases). After hyperaemia test, 18 other incomplete basilar steal were observed. The occurrence of a basilar steal was higher in the vertebro-basilar group (57% of the cases) especially in 7 of the 8 cases with defined vertebro-basilar symptoms; it was lower in the patients without vertebro-basilar occurrences (36% of the cases). This basilar steal was also seen in five of the six symptomatic patients with opposite vertebral artery stenosis above a 50% diameter. Transcranial Doppler Sonography could help to define a subgroup of subclavian steal syndrome with a high risk of strokes.

Adult↗
PubMed1994

[Doppler transcranial ultrasonography in carotid and vertebral dissections: 36 cases involving angiography].

The aim of this prospective study was to investigate the additional information provided by transcranial pulsed Doppler for the determination of the upper part of dissections of the carotid and vertebral arteries and following-up. Earlier results concerning the role of ultrasound investigations for this indication have been presented elsewhere. Twenty-nine patients were examined (17 females, 12 males; mean age 43 years). All had arterial dissections confirmed by arteriography. There were 24 carotid dissections and 12 vertebral dissections. Investigations were performed during the acute phase and 2 months later. Most of the severe endocranial stenoses were identified by transcranial Doppler: 5 out of 6 severe stenoses of the carotid siphon and 6 out of 7 vertebral stenoses. The haemodynamic effect as measured by sylvian flow was significantly greater (p < 0.01) after a permanent ischaemic event than after temporary events and improved significantly with time (p < 0.008). There was no significant variation in the pulsatility transmission index (PTI), but this index requires a reference artery and is not particularly adapted in cases with bilateral dissection. Collateral perfusion, observed during the acute phase in all cases of occlusion and in 6 of the 8 carotid stenosis, was insufficient in half of the cases. Transcranial pulsed Doppler can be used to guide arteriography and helps determine the length of the dissection. It provides an easy way to assess the haemodynamic consequences of the dissection and is quite useful during follow-up.

Adult↗
PubMed1991

[Traumatic amnesias. Memory disorders consecutive to head injuries].

Traumatic amnesia is a good index predictive of the disablement due sequelae of cranial injuries. The residual memory deficit, correlated with the return to work, mainly affects long-term memory, learning, verbal memory and sensitivity to interferences. The most relevant tests are Rey's 15 words--and particularly their retrieval at 30 minutes--and the verbal fluency test, but the changes in memory observed in the patient's daily life must also be evaluated. Rehabilitation tends to rely on the overall management of intellectual and behavioural disorders, as part of programmes that are specific to subjects with cranial injury.

Amnesia↗
PubMed1991

[Value of the neuropsychological evaluation in cerebral arterial aneurysms surgically treated].

Early examination (3 months) of 81 patients, operated on for ruptured cerebral aneurysms, by neurosurgeons and neuropsychologists show significant differences between them both; the neuropsychological evaluation has the best predictive value as far as the outcome is concerned especially regarding the return to their initial job (69% after a year in this series). The outcome also depends on the age, the preoperative grade, and the professional qualification. The aneurysm location and the date of the operation are not so important. Early neuropsychological evaluation enable us to start a rehabilitation program for socio professional reinsertion and to improve the quality of life.

Adolescent↗
PubMed1990

Total hemolytic complement (CH50) and its fractions (C3 and C4) in the sera of diabetic patients with periodontitis.

The total hemolytic complement activity (CH50) and its fractions C3 and C4 were determined in 50 patients with Type II or non-insulin dependent diabetes mellitus (NIDDM) and 50 nondiabetic patients with periodontitis. The values were compared with those of 50 age and sex matched controls. An elevation of CH50 was observed in both the diabetic and nondiabetic patients, compared to controls. The diabetic patients with periodontitis showed a significantly higher complement activity compared to nondiabetic patients with periodontitis. The C3 and C4 values were significantly elevated in both diabetic and nondiabetic patients when compared with the control group. The elevation being more pronounced in diabetic groups.

Adult↗
PubMed1989

[Long-term study of 20 cases of proximal stenosis of the middle cerebral artery. Role of transcranial Doppler ultrasound].

The validity of transcranial Doppler (tD) was evaluated for the identification of stenoses of the middle cerebral artery (MCA). Twenty patients with atheromatous stenosis of the proximal MCA of more than 30% (3 of these cases with stenosis of more that 75%) had repeated transcranial Doppler between 1975 and 1987 and conventional angiography. No patient had carotid stenosis nor embolus-producing cardiopathy. Ten patients had had infarcts or transient ischemic attacks (symptomatic group). Ten patients were asymptomatic (asymptomatic group). Cerebral infarcts in the MCA territory occurred in 1 patient of each group and 1 additional patient in each group had an infarct in another territory. Follow-up was possible in 15 patients. The stenosis remained unchanged in 14, occlusion occurred in 1. The results of transcranial Doppler were compared to those of angiograms in this series and in an additional series of 40 patients who had had a normal angiogram. Sensitivity of transcranial Doppler was 60% (75% when stenosis was over 50%). Specificity was 95%. Comparison with angiography findings showed, among causes of failure of tD, analysis of the artery over too short a segment or kinked artery of very long stenoses, or too decreased blood flow. The failure rate of tD due to failure of bone penetration by ultrasounds was 5%. This new reproducible, non-invasive method appears to be able to detect MCA stenoses of 50% or more and help in follow-up.

Adult↗
PubMed1989

[Ultrasonic study of 22 cases of carotid artery dissection].

The purpose of this study was to assess the value of duplex scanning and continuous wave Doppler velocimetry in the diagnosis and follow-up of ICA dissections. Between 1975 and 1988, 20 patients (11 women and 9 men; mean age 45 years) were admitted to the University Hospital of Angers for dissection of the ICA confirmed by angiography. The dissections were unrelated to direct cervical injury and were unilateral in 18 cases and bilateral in 2 cases. Six patients experienced transient cerebral ischaemic accidents (later completed in 2 cases) and 2 patients merely complained of ocular disorders of sympathetic origin. Fourteen patients were treated with heparin. All patients were examined by continuous wave Doppler ultrasound followed by duplex scanning. These examinations were performed 10 days on average before angiography. Continuous wave Doppler revealed signs of obstruction of the ICA in 95% of the cases: occlusion in 4 cases, tight stenosis in 13 cases and marked slowing of blood flow in the carotid and ophthalmic arteries in 4 cases. The acoustic signs of high or extensive ICA stenosis with reduced or retrograde ophthalmic artery blood flow were fairly suggestive of dissection. These results were completed by mode B which showed signs of dissection in 61% of the cases (tapering stenosis or occlusion, tubular ICA, separation of the vascular walls on rare occasions) and excluded atheromatous lesions in 81% of the patients. The tubular ICA image being non-specific was interpreted in relation to the clinical context and haemodynamic data, after discussion and exclusion of fibromuscular dysplasia, intracranial carotid stenosis causing severe reduction of blood flow and the exceptional hypoplasia of the ICA.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Transcranial Doppler evaluation of middle cerebral artery stenosis.

Symptomatic stenoses of the middle cerebral artery (MCA) are not uncommon, although Corston observed the occurrence of stroke in 24% of patients with MCA stenoses during a 6-year follow-up study. We tried to use transcranial Doppler (TCD) sonography for the detection and evaluation of MCA stenoses. Intra-arterial angiography demonstrated 16 MCA stenoses of more than 30% diameter reduction in 15 patients (14 atheromatous stenoses, 2 dysplasias). Severe associated lesions were present in 2 cases (more than 75% internal carotid artery stenosis). These 15 patients with MCA stenosis were examined with TCD in a blind study. A Doppler signal from the MCA was obtained through the temporal bone and was recognized on the result of common carotid artery compression test. We ascertained MCA stenosis when TCD demonstrated 1) segmental flow acceleration with peak systolic frequency of more than 3 KHz with or without high energy low frequency direct or reverse components; or 2) segmental increase in systolic peak frequency of more than 20%. Using these criteria, we confirmed through TCD the presence of MCA stenosis in nine out of 12 cases with diameter reduction of at least 50%, and one among four cases with less than 50% diameter reduction. Although our results are consistent with Aaslid and von Reutern's figures, methodological problems and diagnostic criteria have to be improved. Nevertheless, TCD seems to be a useful tool for the detection of stenosis with at least 50% diameter reduction, where it proved to offer a 75% sensitivity. Further studies are necessary to improve sensitivity and specificity.

Adult↗
PubMed1987

[Diagnostic contribution of ultrasonic diagnosis coupled with pulsed Doppler combined with continuous Doppler to the exploration of the vertebral arteries of atherosclerotic patients. Preliminary report].

Velocimetric exploration by continuous emission Doppler is still essential for non-invasive evaluation of vertebral circulation but it does not provide morphologic data. Results were compared of exploration with combined continuous emission Doppler and a Duplex examination (sectorial scanning ultrasound imaging coupled with pulsed emission Doppler) and data from arteriography of 186 vertebral arteries in patients, mean age 57 years, admitted for exploration of a cerebral ischemic accident or a cervical murmur. The Duplex examination allowed identification of proximal segment (VI) in 98% of permeable vertebral arteries. The ostium of the vertebral artery was more difficult to visualize because of possible tortuosities, of sometimes a too posterior or intrathoracic localization or of a short neck. Nevertheless the vertebral ostium was identified in 78% of cases on the right and 48% on the left. The Duplex examination demonstrated sensitivity of 72% and specificity of 98% for detection of proximal stenosis of vertebral artery, and its sensitivity was therefore twice as sensitive as continuous emission Doppler for detection of stenoses of less than 50%. The Duplex examination should complete data from continuous emission Doppler by providing an evaluation of vertebral artery diameter and information on presence and characters of an elongation or stenosis. In this way, 9 atheromatous plaques not identified on arteriography were detected by ultrasound imaging. Similarly, the Duplex examination is particularly useful for identification of a hypoplastic vertebral artery, to distinguish the specific lesions of the subclavian artery from those extending onto vertebral ostium, and to characterize ostial lesions when these are accessible to examination.(ABSTRACT TRUNCATED AT 250 WORDS)

Basilar Artery↗
PubMed1987

[Transcranial Doppler study of sylvian vascular reactivity as affected by a calcium inhibitor. Preliminary results apropos of 28 cases].

The transcranial Doppler 2 MHz test, a new non-invasive investigatory method, allows direct instantaneous recording from middle cerebral artery in 96% of healthy subjects and, in contrast to classical means of measuring cerebral blood flow, the possibility of continuous monitoring of middle cerebral artery in bedridden patients or during operation. This transcranial pulsed Doppler (T.P.D.) test was used to study the effect of a calcium inhibitor, Nifedipine, on middle cerebral artery smooth muscle and its cerebrovascular effects in 28 subjects: 8 cases of hypertension, 9 of sylvian artery stenosis confirmed by arteriography (5 approximately equal to 30% and 4 greater than or equal to 50%) and 11 healthy volunteers. Recording of middle cerebral artery flow by T.P.D. was preceded by cervicocephalic continuous emission Doppler exploration (DMS, MIRA 4 MHz) and vascular echotomography (Duplex Sonedap 10 MHz). Recordings from the first segment of middle cerebral artery were obtained from a low frequency (2 MHz) and high power (maximum 350 mW) probe introduced facing squamous portion of temporal bone. Identification of this artery is dependent on its depth of access--average 5 cm--its response to homolateral carotid artery compression and the convergence of its flux towards the probe. After sublingual absorption of 2 to 3 capsules of Nifedipine, systolic and diastolic blood pressure and systolic and diastolic frequencies of middle cerebral activity were recorded regularly over 20 minutes with the patient at rest in dorsal decubitus. Variations in these parameters were considered significant when 10% or more. Criteria proposed for identification of middle cerebral artery stenosis were segmental acceleration of 3 kHz or more with or without associated turbulence (fig. 2).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Transcranial Doppler sonography for blood flow velocity measurement during pharmacological tests.

Transcranial Doppler sonography, using a 2 MHz pulsed Doppler system, is suitable for non-invasive continuous monitoring of middle cerebral artery blood flow velocity during pharmacological studies. Methodological problems, and factors affecting cerebral blood flow have to be discussed (vasomotor spontaneous changes, intracranial blood pressure, blood viscosity, heart rate, vascular risk factors, etc.). Arguing from a previous study in 28 subjects (11 healthy volunteers, 8 hypertensive patients, 9 patients with middle cerebral artery stenosis), showing the hypotensive action of Nifedipine, without significant decrease of cerebral blood flow in 83% of cases, we emphasize the advantages and limits of this new non-invasive method for cerebral blood flow monitoring.

Aged↗