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Biomedical subjects

R Chacornac

Publications and source records attributed to R Chacornac.

52 records · Page 3Linked to original sources

Hyperbaric oxygenation for severe head injuries. Preliminary results of a controlled study.

60 patients were included in a prospective study to evaluate the effectiveness of hyperbaric oxygenation (OHP) as a treatment of head injury coma. They were assigned to nine subgroups according to age, level of consciousness and eventual neurosurgical procedure, and then selected randomly for OHP or standard therapy. OHP was administered in one or several series of daily exposure at 2.5 ATA. However, the OHP therapy protocol was to be interrupted in 11 cases developing pulmonary, hyperoxic, or infectious complications. Overall mortality and mean duration of coma in survivors were not different in both groups, indicating that OHP was either ineffective or too intermittently applicated. Analysis of results in subgroups revealed that, in one subgroup (18 patients), the rate of recovered consciousness at 1 month was significantly higher when OHP was used. These patients were under 30 and had a brain stem contusion without supratentorial mass lesion. The view is defended that, besides its toxic action on the normal nervous tissue, OHP can counteract edema and ischemia in the zones of brain injuries.

Adolescent↗

[General anesthesia during neurosurgery in sitting position].

Sitting position during surgery of the posterior fossa is very convenient for the neurosurgeon but can be dangerous, specially concerning the risk of air-embolism. We discuss the major problems of this special position, and the modifications of respiratory and hemodynamic functions from our experience on 84 cases. We study the monitoring of these patients during surgery, with special emphasis on prevention and detection of air-embolism with the capnograph. With the protocol suggested we can avoid major risk in this position.

Adolescent↗

[Place of neuroleptics in neurosurgical anesthesia-resuscitation].

The interest of neuroleptics in neurosurgery should be examined in the light of physiopathological and pharmacological data concerning cerebral circulatory autoregulation and intracranial pressure. The fairly favourable conclusions permit one to consider their wide use justified, especially, by the feeble hypnogenic effects, without any marked disturbance of the E.E.G., associated with an anticatecholaminergic and stabilizing effect on the autonomic nervous system. They therefore occupy a place of choice, in particular during induction of anesthesia in high risk patients, during operations requiring neurological or continuous E.E.G. investigations, in surgery of intracranial aneurysm and, finally, to obtain sedation and post-operative autonomic control.

Anesthesia↗

[Hyperbaric oxygen therapy in cerebral circulatory insufficiency].

From a study bearing upon 26 patients suffering from a cerebral circulatory insufficiency induced by a stenosis or a thrombosis, the writers analyse the part played by Hyperbare Oxygen in the neurologic evolution. The defining of the efficacy criteria enabled them to determine whenever this part was prevalent and obvious (that's to say in 20 p. 100 of the cases). However, in the other cases it was hard to decide whether Hyperbare Oxygen played any part. Only functional lesions are liable to benefit from this therapy which seems mainly useful to cover the period of circulatory adaptation at a time when supply circulations may come into play. The difficulty to appreciate the importance of supply circulations urges on to treat this type of patients early enough in a systematic way and all the more so as they are young.

Adult↗

[Treatment of facial neuralgias: retrogasserian thermocoagulation under iterative discontinuous narcosis with propanidid].

Coagulation of the Gasserian ganglian is currently recommended in the treatment of trigeminal neuralgia due to the slight risks that it presents. It is accompanied by brief but intense periods of pain which necessitate the need of an Anaesthetist. As well as we have been able to verify in the course of sixty-two of these procedures, a discontinuous narcosis obtained by reiterated injections of propanidid presents a satisfying solution. It permits the neurological examinations, which need absolute cooperation of the patient, before each new coagulation to be accomplished in good conditions.

Aged↗

[Reliability of the results of the ultrasonic hemodynamic recording (Doppler effect) in the diagnosis of cerebral ishemic ischemia of carotid origin].

The Doppler ultrasound diagnosis of carotid artery stenosis (asymetrical systolic and diastolic flows; elevated resistance index: ratio of flow pulse amplitude to systolic and diastolic values; flow reversal in the ophtalmic artery) is compared, in 52 patients, to the clinical, angiographic (40 patients) an surgical findings and to the peroperative measure of intra-arterial pressure and flow (30 patients). Its reliability is proved as a guide for angiographic exploration and for postoperative watching, but it is restricted to great vessels (cervical carotid artery) and is unable to detect ulcerated plate without stenosis.

Angiography↗