Biomedical subjects
Publications and source records attributed to P Frerebeau.
Since February 1981, eight patients with neoplastic intractable pain have been treated by intracerebroventricular administration of small doses of morphine. Morphine was injected into the cerebrospinal fluid through a ventricular reservoir either by direct puncture or by self-administration. Clinical results were very good, and there were no deleterious effects.
Explore the source record for details and available documents.
The authors report the results of their biomechanical experimental study on the fixation of various lesions of the spine, using Roy Camille metal plates, and the results of Fischer -- Gonon (using Harrington rods) and Kempf -- Jaeger (using Kempf rods). They conclude to: the efficiency of the posterior techniques of fixation, the necessity, in the thoraco-lumbar and lumbar segments to associate an anterior graft (fibula), in order to reinforce the late stability, the best functional results achieved by a "short" fixation in association with an anterior graft (double approach technique). According to their experience, the authors advocate for the use of Roy Camille metal plates screwed in the pedicles, the Harrington or Kempf rods helping in the per operative course to gain further reduction, namely in cases of disymetrical displacements.
We studied 21 cases of diastematomyelia associated with myelo-meningocele (3 cases) or congenital spine deformities (18 cases). Analysis of bone and neuraxis abnormalities with special reference to the spinal canal, related to operative findings demonstrate in all cases an embarrassed cord by localized compression or global narrowing of the malformed spinal canal (11 cases), bone spur fixation (13 cases) and tethered cord associated lesions (5 cases). Mechanisms of neural damage and prophylactic value of laminectomy before the orthopedic treatment of the curve during the same operation is discussed.
The authors report their own experience of microsurgery for surgical treatment of lumbar disc herniation. Series include 30 cases with a one year of mean follow up. Comparative studies are discussed according to others microsurgical series already published. Good care of peridural fat and gently retraction of the root seem to be main factors for good functional result.
Three cases of complex pelvic fractures associated with lumbo sacral roots lesions are reported. The authors stress this possible association should be suspected through clinical and conventional radiological findings. The contrast sacco-radiculography brings up confirmation. However the so called pseudo-meningocele is by far of less topographical value than the same myelographic findings at cervical level (for brachial plexus avulsion injuries). Direct and concise evaluation is performed by surgical approach of roots during a homolateral hemi-laminectomy. This procedure allows to appreciate the anatomical lesions and to clarify the anatomo-radiological discrepancies. Moreover endodural closure and reduction of volume of meningoceles and removal of arachnoidal adhesions is to pain relief value and may prevent delayed complications of neighboring roots compression related to increase in volume of meningocele. According to the literature and our findings, in future, the aim should be microsurgical repair of such roots lesions as they ar not avulsed from the conus but merely more distally ruptured on the cauda equina. We could not so far achieve this procedure, because of difficulties to identify the distal part of root, often retracted far away from its spinae foramen.
Explore the source record for details and available documents.
The patient is lying on his left side. Paravertebral muscles of the right side are separated from the spinous processes and from the right laminae. Spinous processes are then cut at their base, and hold with a strong retractor Laminectomies are then feasible, as wide as necessary. Reconstruction is particularly strong. Our 3 years experiences of 200 cases, with clinical and radiologically very good late results, is underlined.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The authors suggest a one-stage treatment for craniofaciostenosis, using two surgical teams, to try to correct both the functional problems and morphological disorders.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The particular value of clinical, radiological and electromyographical features is compared in 42 patients with motor deficit related to cervicarthrosic myelopathy or amyotrophic lateral sclerosis. The initial onset of the disease was identical (motor deficit and long tracts pathways involvement). Three different groups were identifyed according to the evolution: -- Group I: (13 cases): true lateral amyotrophic sclerosis which were not operated on. -- Group II (10 cases): myelopathy called "cervicarthrosic" because of radiological findings which were operated on but had the same steady worsened course as a lateral amyotrophic sclerosis. -- Group III (19 cases): cervical myelopathy which had surgery. The operation brought about stabilization or fairly good recovery over the 18 months following at least. From a clinical aspect, the "Lhermitte sign" or objective sensitive deficit are strongly significant for cervical myelopathy. On the contrary, diffuse fasciculations specially in the tongue seem to be mostly found in lateral amyotrophic sclerosis, whereas they are restricted into the paralysed area in cervical myelopathy. Electromyographic examination is decisive: simple activity with high frequency motor units (increased amplitude and polyphasic waves) or "preponderant potentials" into a cranial nerve territory or three segments of the lower limbs are frequently found in lateral amyotrophic sclerosis. These electromyographic features are less significant in the upper limbs. The neuroradiological findings lonely cannot assert definitely the cervicarthrosic origin of the myelopathy but visualize the conflicting situation between the spinal cord and the cervical canal and allow to choose the surgical procedure.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Radial nerve compression palsies at the elbow and forearm result in a lower radial nerve palsy whose clinical data are generally a hardly diagnosed dissociated radial palsy, or a rough paresis in the range of epicondylalgia. Apparently spontaneous non traumatic compressions are rare. They are essentially due to lipomas, to fibromas, or sometimes to synovial cysts of the elbow. In the course of rheumatoid arthritis, palsies must be isolated. Besides, there is an actual inflammatory canal syndrome of epicondylalgias range, in which radial nerve paresis must be investigated. Traumatic compressions are essentially due to Mongeggia fractures. Radial nerve injury at the elbow is explained by a real radial canal being, in which the nerve is entrapped and where it is especially fixed on a level of its entering the supinator brevis. Any addition of a pathological element in that area (traumatic or not, tumoral or inflammatory) will be able to involve a compression and a nerve stretching, on a level of the arch of Frohse, essentially. Surgical treatment in non traumatic compressions enables to give the etiological diagnosis and to warrant healing by opening the radial canal excising the added pathological element. To achieve a total surgical operation, in epicondylalgias, the surgeons will have to open this radial canal, as well. Traumatic compressions will be explored only in cases of non spontaneous recovery, after treating the osteoarticular injury.