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Biomedical subjects

P Frèrebeau

Publications and source records attributed to P Frèrebeau.

At least 19 recordsLinked to original sources
PubMed2003

[Percutaneous sacral thermorhizotomy to treat equinism of spastic cerebral palsy children].

We propose to evaluate the effect of sacral percutaneous thermorhizotomy on cerebral palsy children. A prospective study including 29 children followed by a multidisciplinary team was conducted from 1990 to 2000. A thermal radiofrequency lesion of the first sacral root was obtained by percutaneous puncture of the posterior intervertebral foramen with evaluation by stimulation of the best motor response for the minimal threshold (<0.5 volts). The efficacy of the lesion was evaluated by testing and modification of the stimulation threshold obtained (x 2). The results on spasticity was evaluated using the Held score and the functional effect on walking, and classified as "good" (9 cases), "efficacy" (6 cases) and "nil" (4 cases). Indications of the procedure are discussed during the walking acquisition period and growing period of the cerebral palsy child.

Adult↗
PubMed1996

[Arachnoid cysts and subdural hematomas].

Arachnoid cysts of the middle cerebral fossa is a not uncommon lesion which can occur in young subjects, sometimes after minimal head trauma. Subdural hematomas and sometimes intracystic hemorrhage may develop. We report a personal series of seven cases seen in young subjects (6-24 years). Clinical presentation was not specific, the complication usually being revealed by signs of intracranial hypertension. The pathogenesis of subdural hematoma is discussed. Magnetic resonance imaging is the most useful diagnostic tool, providing excellent tissue specificity, although CT scan is often used to visualize a subdural hematoma and subsequent arachnoid cyst. Treatment relies on surgery to empty the subdural hematoma and remove compression. There has been no real consensus on treatment modalities. Long-term prognosis is good in most cases.

Adolescent↗
PubMed1995

Early restructuration of consciousness after traumatic coma.

Recovery of consciousness after acute brain injury is a remarkable phenomenon, yet, not completely understood. We describe the early clinical stages of recovery of consciousness in 48 selected patients by means of different items of the Glasgow Coma and Liege Coma Scales. Arousal, expressed by the stimulated opening of the eyes (E2) was correlated with the appearance of the localizing pain response (M5), with the capacity to obey commands (M6), with the opening of the eyes (E4) and with the blink reflex (R5). This study confirms the classical clinical sequence of arousal and recovery of consciousness characterized by the consecutive appearance of E2, R5, E4, M5 and M6. When the appearance of E2 and R5 are considered separately, we noticed a significant difference, suggesting different structural and functional brain recovery processes.

Adolescent↗
PubMed1994

Clinical recovery of consciousness after traumatic coma.

OBJECTIVE: To describe early clinical stages in the recovery of consciousness, using selected items from the Glasgow Coma Scale and the Liège Coma Scale. DESIGN: Validation cohort study, conducted in a tertiary care center. SETTING: Neurosurgical intensive therapy unit in a university teaching hospital. PATIENTS: Patients (n = 137) with traumatic coma who were selected according to the following criteria: a) coma due to blunt head trauma with an initial Glasgow Coma Score of < or = 7; b) admission to the neurosurgical intensive therapy unit within the first 24 hrs after trauma; c) patients > 14 yrs of age; requiring endotracheal intubation, mechanical ventilation, and the administration of drugs; and d) survival period allowing analysis of the recovery of consciousness. MEASUREMENTS AND MAIN RESULTS: Arousal, as expressed by stimulated opening of the eyes and recorded as a delay in days, was correlated with the appearance of the localized pain response, capacity to obey commands, blink reflex, and the cessation of drugs in three groups of patients. These groups were defined according to the time in which there was an appearance of the stimulated opening of the eyes: < 8 days (group 1); between 8 and 15 days (group 2); and after 15 days (group 3). When the three groups of patients were compared, significant differences existed between the mean delays of appearance of stimulated eye opening and the appearance of the blink reflex. Extubation coincided with the appearance of spontaneous eye opening, with a mean delay of 13.5 days. CONCLUSIONS: This study confirms the classical clinical sequence of arousal and recovery of consciousness, with the appearance of stimulated eye opening and the blink reflex first, followed by spontaneous eye opening, and the capacity to obey commands in intubated, traumatized, coma patients. A direct correlation existed between the delay of arousal and the complete recovery of consciousness. When groups of patients with various mean delays for the appearance of stimulated eye opening are considered, reappearance of the blink reflex did not always coincide with stimulated eye opening, suggesting differing structural and functional brain recovery processes.

Acute Disease↗
PubMed1994

Disco-computed tomography in extraforaminal and foraminal lumbar disc herniation: influence on surgical approaches.

Between January 1990 and February 1992, a total of 301 patients underwent discectomy for lumbar disc herniation; 29 had an extreme lateral herniation, i.e., foraminal or extraforaminal. The intervertebral foramen is a three-dimensional area demarcated primarily by the pedicles; we call it the lateral interpedicular compartment. The extraforaminal zone is the space outside the lateral border of the pedicles. All patients were evaluated by computed tomography (CT), water soluble myelography, postmyelographic CT scanning, or magnetic resonance imaging. Fifteen patients consecutively underwent disco-enhanced CT to adjust a correct diagnosis and to distinguish extraforaminal from foraminal herniation. In 10 cases of extraforaminal herniation, a selective radicular decompression with good-to-excellent clinical results was achieved by an extra-axial lateral decompression of the interpedicular compartment, with preservation of the facet joint. The operative target was the lateral aspect of the pars interarticularis and not the intertransverse space, as previously described. In two cases of both foraminal and extraforaminal herniation, the same technique was used. Fourteen patients with foraminal disc herniation and three patients with both foraminal and extraforaminal herniation underwent a standard intervertebral foraminotomy. An accurate preoperative diagnosis established by disco-CT is crucial in order to select the most suitable surgical approach.

Adult↗
PubMed1985

Intraventricular tumors in tuberous sclerosis.

Eleven of our own cases of tuberous sclerosis with intraventricular tumor and 34 cases from the literature are reviewed. Initial symptoms and identification of tuberous sclerosis and tumor are reviewed. Results of surgical treatment, including direct radical excision and shunting are given. On gross examination, the tumor was most often loosely connected to ependyma near the foramen of Monro, causing hydrocephalus. Giant cell subependymal astrocytoma was frequently found on microscopic examination. The glial origin of the tumor is discussed and direct surgical approach of the tumor is proposed as the best treatment of these lesions.

Adolescent↗
PubMed1976

[Prolonged traumatic and vascular coma: prognostic and therapeutic indications based on hemodynamic and metabolic studies].

From haemodynamic and metabolic investigation of 65 comatose subjects following cranial traumatism or cerebral vascular accident, the following prognostic and therapeutic indications emerged: The isolated increase in oxygen pressure in the jugular vein to above 50 mm Hg, the simultaneous decrease in circulation of the brain to below of 30 ml/100g/min., and of the brain consumption of oxygen to below 1.5 ml/100g/min., combined with a loss of autoregulation and a decrease in carbon dioxide reactivity indicate that prognosis is very poor. Induced arterial hypertension, associated with hyperventilation, partially corrects brain hypoperfusion in coma from bulbo-pontine lesions. Sodium penthiobarbital and sodium gamma hydroxybutyrate and have the effect of reducing oxygen metabolism which might have some therapeutic value during the acute phase of coma. Clomipramine which has a stimulating effect on oxygen metabolism should be kept in reserve for the chronic phase of prolonged coma.

Blood Gas Analysis↗