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Biomedical subjects

P Mertens

Publications and source records attributed to P Mertens.

12 recordsLinked to original sources
PubMed1991

Does microsurgical vascular decompression for trigeminal neuralgia work through a neo-compressive mechanism? Anatomical-surgical evidence for a decompressive effect.

The positive effect of Microsurgical Vascular Decompression (MVD) on idiopathic trigeminal neuralgia still remains controversial between a decompressive mechanism and a "neo-compressive" one. This paper is a summary of a comparative study of the results on pain obtained with two technical modifications of the MVD procedure. The first consisted of interposition of a foreign material between the nerve and the transposed artery after dissection of the trigeminal nerve, whilst in the second the offending vessel(s) was dislodged without using any material touching the nerve. The two series of 60 patients in each were similar concerning the clinical features. Evaluation of results on neuralgia - with one year follow-up-in both series, shows that the technique used in the second group was not followed by a higher rate of recurrence than the technique used in the first group. On the contrary; 4.5% in the 2nd group compared to 10% in the first. This indicates that MVD would not act as a result of "neo-compression" of the nerve, but rather through a real decompressive mechanism.

Arteries↗
PubMed1990

Ablative neurosurgical procedures for the treatment of chronic pain.

This article is devoted to ablative neurosurgical procedures used for the treatment of chronic pain. The authors detail only those procedures that are currently performed. The procedures are classified as those directed to the peripheral nerves, spinal roots and cranial nerves; the dorsal root entry zone; the ascending extra-lemniscal pathways. The authors have analyzed the results of their own series and those published in the literature. They concentrate on the rationale and neurophysiological effects of the operations.

Chronic Disease↗
PubMed1990

Microsurgical ablative procedures in the peripheral nerves and dorsal root entry zone for relief of focal spasticity in the limbs.

When spasticity is harmful and localized in the limb(s), ablative procedures in the peripheral nerves or the dorsal root entry zone (DREZ) can be useful. The authors report on the long-term results of (1) selective tibial neurotomy in a series of 62 spastic feet, and (2) microsurgical DREZ-tomy in a series of 69 patients affected with hyperspasticity in the entire upper or lower limb(s).

Follow-Up Studies↗
PubMed1990

[Microsurgical vascular decompression in trigeminal neuralgia. Comparison of 2 technical modalities and physiopathologic deductions. A study of 120 cases].

Since 1972, 1,000 patients were operated upon for trigeminal neuralgia, 816 percutaneously using thermocoagulation and 184 through a direct approach at the cerebello-pontive angle. This article deals with the microvascular decompression (MVD) procedure, stressing on the influence (on morbidity and results) of different technical modalities. This work compares: 1. a series of 60 patients operated upon in the sitting position, with a wide opening of the cerebellopontine-angle, and using an interposed foreign body to protect the nerve from the conflicting artery (Group I, 1984-1986) and 2. a series of 60 other patients who underwent MVD in the lateral position, with a restricted approach and transposition of the conflicting artery without interposition of synthetic material (Group II, 1986-1988). Both series were fortuitously comparable concerning sex, age and clinical features. Comparison of results in the two series shows that: 1. Duration of the anesthetic induction, surgery and awakening, were all shorter (70 mm, 2 h 47 mn, 1 h 38 mn, respectively) in group II than in group I (110 mn, 3 h 12 mn, 2 h 38 mn). 2. Complications related both to anesthesia and surgery were significantly less frequent in group II than in group I, excepted for rhinorrhea due to C.S.F. leak through the mastoid cells. 3. Trigeminal neuralgia was completely relieved--without any hypoesthesia and/or dysesthesias--in 75% of group I patients (mean follow-up: 41 months) and in 83.3% of group II (mean follow-up: 16 months). Evaluation of results on pain, after one year, in both series shows that the technique used in the second series: transposition of the conflicting vessel without foreign body touching the nerve was not followed by a higher rate of recurrences than in the first series, on the contrary: 4.5% versus 10%. This indicates that MDV would not act by creating a neocompression of the nerve, but in fact by a real decompression mechanism.

Adult↗
PubMed1988

Choroid plexectomy for the treatment of chronic infected hydrocephalus.

Choroid plexectomy was performed for chronic infected hydrocephalus in 17 children via a direct open approach. In 16 cases, the CSF was sterilized soon after the plexectomy. In 37% of cases, the hydrocephalus was arrested without a shunt. The incidence of seizures did not increase after plexectomy. Removal of the choroid plexus was controlled by scintigraphy. Neuropsychological results were not encouraging, probably related to the long history of chronic ventricular infection. Surgical mortality was 6%. Choroid plexectomy should be considered as a possible treatment of chronic infected hydrocephalus in children.

Anti-Bacterial Agents↗
PubMed1988

Pericallosal aneurysms.

The authors report a series of 19 patients with one (17 cases) or two (2 cases) pericallosal aneurysms referred during the past 10 years. Of the 19 patients, 18 had a ruptured pericallosal aneurysm and one was asymptomatic. On admission two were graded I, four graded II, six graded III, and six graded IV. Of the latter group two patients died from rebleeding, and the asymptomatic patient would not undergo surgery. The 16 operated patients underwent surgery after a delay ranging from 6 to 90 days after hemorrhage (25 days on average). The delayed surgery allowed the patients to be operated on in better neurological status: seven were graded I or Ia, six graded II, three graded III, and none graded IV. The results were excellent (with resumption of their previous activity) in 11 cases (69%), good (autonomous but with a slight deficit) in 4 cases (25%), and bad in 1 case (6%). There was no operative mortality or morbidity.

Adult↗
PubMed1988

Selective neurotomy of the tibial nerve for treatment of the spastic foot.

One of the most frequent neurological sequelae seen by the specialist in rehabilitation is the spastic foot. Spasticity in the foot may be responsible for abnormal posture and painful or trophic disturbances impairing standing and walking. This disability can be corrected by a simple neurosurgical procedure, the selective tibial neurotomy. In this procedure, one sections the tibial nerve branches to the muscles sustaining spasticity, i.e., the soleus and/or the gastrocnemius nerves for equinus and ankle clonus or the posterior tibialis branch for varus and the flexor fascicles for tonic flexion of the toes. After microsurgical dissection of each tibial nerve branch at the lower part of the popliteal region and their identification with bipolar electrostimulation, the selected branches are partially sectioned under the operating microscope. The present series consists of 62 operations performed in 53 patients, 9 bilaterally and 44 unilaterally. Operation obtained complete suppression of the disabling spasticity that had been present for 2 to 17 years (4 on average), total pain relief, and consequently improvement of the residual voluntary movements (by achieving a better balance between agonist and antagonist muscles) in 51 of the 62 spastic feet (i.e., 82% of the cases). For all of these patients, the beneficial effects were long-lasting over the 1- to 10-year follow-up (3 years on average). Selective neurotomy of the tibial nerve should be considered only after failure of intensive prolonged kinestherapy and of all available medical treatment. It must take place, however, before the onset of irreversible articular disturbances and musculotendinous retractions, which require complementary orthopedic corrections.

Adolescent↗
PubMed1988

[Intra-orbital explosion of a rocket].

Orbito-palpebral ballistic wounds are relatively common, most often due to firearms, and raise the problem of their surgical management. Excision of the intra-orbital foreign bodies remains difficult, above all when there is impaction of the anterior portion. The authors report a model case of orbital trauma by rocket splinter, excision of which was possible via the entry orifice.

Eye Foreign Bodies↗
PubMed1983

Improvement in ventilation-perfusion matching by almitrine in COPD.

Almitrine, a peripheral chemoreceptor stimulating drug, was given 100 mg orally to six patients with advanced chronic obstructive pulmonary disease (COPD), and its effects on hemodynamics, blood gases, lung mechanics, and the distribution of ventilation/perfusion ratios (VA/Q), determined by the inert gas elimination technique, were investigated. Arterial Po2 increased from 52 +/- 4 to 59 +/- 3 mm Hg, mean +/- SEM, p less than 0.01, arterial Pco2 decreased from 46 +/- 3 to 43 +/- 3 mm Hg, p less than 0.05, and venous admixture from 30 +/- 6 to 19 +/- 3 percent, p less than 0.02. No change occurred in ventilation, variables of lung mechanics, systemic and pulmonary hemodynamics, except an increase in pulmonary vascular resistance (from 364 +/- 103 to 438 +/- 99 dyne.s.cm-5, p less than 0.05). A reduction in VA/Q inequality could be demonstrated with a redistribution of blood flow into the lungs by a diversion of 15 percent of total blood flow from units with low VA/Q (between 0.08 and 0.4) to units with normal VA/Q (between 0.5 and 1.8). These changes might be explained by an enhancement of hypoxic pulmonary vasoconstriction. Pharmacologic peripheral chemoreceptor stimulation, at an infra-ventilatory analeptic dosage, might be of therapeutic interest to patients with respiratory insufficiency due to VA/Q inequality.

Administration, Oral↗