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Biomedical subjects

Y Lazorthes

Publications and source records attributed to Y Lazorthes.

At least 55 records · Page 3Linked to original sources
PubMed1991

CSF baclofen levels after intrathecal administration in severe spasticity.

The pharmacokinetic parameters in the CSF of baclofen given to 4 patients as an intrathecal bolus are reported. Considerable inter-individual variability in the parameters was observed. The elimination half-life ranged from 0.9 to 5 h and the clearance from 0.013 to 0.08 l.h-1. In order to optimize treatment, it is suggested that CSF baclofen levels be matched to changes in Hoffman's monosynaptic reflex (H reflex).

Adult↗
PubMed1991

[Analysis of the results of surgery and nucleolysis using papain in 1085 cases of lumbar disk hernias].

1,085 patients have been treated for intervertebral disc herniation with lombo-sciatica: in 751 cases surgical discectomy without laminectomy has been performed with or without microscope; 334 underwent papain nucleolysis. The two clinical groups were separated on clinical and radiographic backgrounds: nucleolysis was performed in patients with no motor disturbance, no stenosis of the lumbar canal, no displaced fragment; the other patients received surgical treatment. The results were evaluated according to MacNab's criteria with a follow-up of 12 to 84 months (mean 17.2 months). The results after surgical treatment were excellent in 53.8% and good in 36.8% of the cases. For papain treatment they were excellent in 32.7% and good in 38.8% of the cases. Papain nucleolysis therefore appears to be an efficient method for the treatment of intervertebral disc herniations associated with lombo-sciatica but, overall, gives poorer results than surgery in spite of a strict selection procedure. In this study, complications due to papain nucleolysis were restricted to chemical spondylodiscitis (5 cases) and to 2 benign allergic syndromes. Statistical analysis of all the cases and multifactorial correlation research pointed out the importance of "workmen's compensation" as prognostic factor. Since this study, 90% of the patients presenting with disc herniation associated with lombo-sciatica recalcitrant to medical treatment undergo surgical discectomy; papain nucleolysis is reserved for sub-ligamentary and non-displaced forms without stenosis of the lumbar canal and represent 10% of our current population.

Adolescent↗
PubMed1990

Chronic intrathecal baclofen administration for control of severe spasticity.

Baclofen, the most effective drug for treating spasticity, is a specific agonist of gamma-aminobutyric acid-B receptors, and is very abundant in the superficial layers of the spinal cord. Given orally, baclofen does not easily penetrate the blood-brain barrier, and is distributed equally to the brain and spinal cord. Direct intrathecal administration was given in order to change the distribution of the drug by preferentially perfusing the spinal cord. Eighteen patients presenting a severe spastic syndrome were treated with chronic intrathecal infusion of baclofen in the lumbar cerebrospinal fluid. After clinical preselection, 38 patients were implanted with a lumbar access port allowing long-term trials in order to determine the efficacy of baclofen therapy and the effective 12-hour dose. The 18 patients selected for chronic administration were implanted with a programmable pump. The pathology in these cases was: multiple sclerosis (6 cases), posttrauma spastic syndrome (eight cases), and (one case each) cerebral palsy, ischemic cerebral lesion, spinal ischemia, and transverse myelitis. The mean follow-up period was 18 months (range 4 to 43 months). The clinical results were evaluated according to muscular hypertony on Ashworth's scale (changed for occurrence of painful spasms) and functional improvement. Results were better for spastic syndrome secondary to traumatic medullary lesion than for demyelinating disease. Hypertonia was improved in all cases as confirmed by the registration of the Hoffman (H) reflex. Painful muscular spasms disappeared in 14 of the 16 affected patients. Significant functional improvement was noted in nine patients and was considerable in three. The risk of side effects secondary to overdose (such as excessive hypotonia or central depression) and the absence of a specific baclofen antagonist stresses the necessity for accurate determination of the efficient dose. After an initial titration period and adjustment of the therapeutic dose, the individual doses were from 21 to 500 micrograms/24 hrs (mean 160 micrograms/24 hrs). This new conservative method is very effective, perfectly reversible, and safe when administered in conditions favorable to its use.

Baclofen↗
PubMed1990

[Monitoring management of nosocomial infections in a neurosurgical department].

Fulfilling a nosocomial infection watch program in a neurosurgery department lead to assess the basic situation i.e. the same characteristics related to both surgery and I.C.U. (incidence rate of wound infections 3%, of bronchopulmonary tract infections 20.8% and of urinary tract infections 9.1%). To ensure feasibility of data collection and data accuracy, strategy was based on weekly passive epidemiological data collection, laboratory data and monthly confrontation with neurosurgery's practitioners.

Bacteriological Techniques↗
PubMed1990

[Recalibration via a postero-lateral approach in recent traumatic stenosis of the dorsal and lumbar spine. Modalities and results apropos of 31 cases].

The authors present 31 cases of spinal trauma affecting thoraco lumbar level with severe spinal canal stenosis secondary to compressive trauma of the anterior disco-corpereal region. Associated neurological disorders were of varying severity. 23 cases were investigated by computed tomography. In all cases, the surgical procedure involved rectification of spinal deformities, with initially a unilateral postero-lateral approach permitting anterior spinal canal recalibration, either by impaction of protrusive fragments or ablation of free disc fragments. The stabilization was usually achieved by complementary bilateral plates using Roy-Camille or Privat material in 22 cases, associated with postero-lateral arthrodesis by grafting with reconstruction of the articulo-pedicular structure in 19 cases. Emergency operation was done in 14 cases; in 5 cases operation was done on the 2nd or 3rd day and in 11 cases after the 3rd day. The functional spinal result was excellent, and recalibration was verified by tomography in all cases. In those cases showing neurological deficiency, good and early recovery was attributable to the suppression of spinal canal stenosis, and a consequently neurological improvement was always obtained, even for the most serious of lesions except those at the thoracis level superior to T10. The application of this postero-lateral approach for severe spinal trauma seems to represent, in all cases of recent lesions, an alternative to the anterior or combined methods. We do not share the opinion that delay in decompression does not influence the neurological prognosis and emergency operation is advisable.

Adolescent↗
PubMed1989

Human brain and spinal cord scan after intracerebroventricular administration of iodine-123 morphine.

[123I]iodomorphine (IMPH) was administered intracerebroventriculary (i.c.v.) in eight patients treated by i.c.v. morphinotherapy (i.c.v.m.). Scans obtained by gamma-scintigraphy over 1 h post-injection showed only a slight diffusion of IMPH beyond the ventricular system, particular attention being paid to the spinal cord. These data agree well with induced i.c.v.m. analgesia (mean latency 20 min) and biological results such as HPLC assay of morphine in the lumbar cerebrospinal fluid, supporting the action of morphine only on the central opiate receptors.

Brain↗
PubMed1989

Biostim 1988.

Explore the source record for details and available documents.

Electric Stimulation Therapy↗
PubMed1988

[Acupuncture meridians demythified. Contribution of radiotracer methodology].

Radioactive trajectories can be visualized by injecting a radioactive tracer, technetium 99 m, at the site of acupuncture points. To determine the exact nature of these trajectories we performed several experiments on healthy volunteers, and our results may be summarized as follows. The target organs of technetium 99 m, and notably the thyroid gland, were always visualized. The circulating radioactivity, visible on scintiscans and confirmed by venous blood counts, was not negligible. The radioactive trajectories we observed were often divided at their starting point and did not extend along the whole length of the acupuncture meridians they might have made visible. The radioactive trajectories disappeared after venous blockade to reappear when the blockade was lifted. Finally, the radioactive trajectories obtained were very similar after injection at the acupuncture point and at a control point. These findings indicate a lymphatic and venous drainage of the radioactive tracer at the site of injection followed by transportation through the veins, rather than visualization of acupuncture meridians as suggested by some authors.

Acupuncture Therapy↗
PubMed1988

Chemonucleolysis for herniated cervical disc.

The authors treated 38 cases with cervical disc prolapse and discoradicular pain by percutaneous chemonucleolysis. Material and procedure are described and the results of 31 cases with a follow-up between 3 and 52 months analysed. The global results were excellent. In detail the results are analysed according to symptomatology, aetiology, findings of discography and the dose of enzyme used.

Adult↗
PubMed1988

CSF morphine levels after lumbar intrathecal administration of isobaric and hyperbaric solutions for cancer pain.

The objectives of this study were to compare the pharmacokinetic properties and the duration of analgesia following intrathecal administration (L5-S1) of 2 mg morphine in 2 forms: (1) an isobaric (NaCl 0.9%) and (2) a hyperbaric solution (7% dextrose). The study was carried out on 5 cancer patients with severe, intractable pain in the lower half of the body. Samples of CSF were collected at the level of the 10th thoracic vertebra at regular intervals for 15 h after administration. Morphine concentrations were determined by HPLC. The pharmacokinetic properties of the solutions (I and II) were quite different. Peak levels (I) were reached in 5-15 min (30 and 60 micrograms/ml); they then fell rapidly during the 1st hour (7 and 11 micrograms/ml) with an elimination half-life of 10 and 15 min, followed by a change in slope (elimination half-life of 108 and 140 min). Peak levels (II) were reached in 4-5 h (0.8-3.3 micrograms/ml); they then fell progressively according to a single exponential function (elimination half-life: 144-246 min). The duration of analgesia for a dose of 2 mg was 30 h for solution 2 and 24 h for solution 1. The hyperbaric solution, which produced the same degree of analgesia as the isobaric solution, limited the cephalad diffusion of morphine and reduced or abolished the central depressant effects of the drug.

Chromatography, High Pressure Liquid↗
PubMed1988

The stability of morphine in isobaric and hyperbaric solutions in a drug delivery system.

Intrathecal preparations of morphine for use in intractable pain must contain no preservatives. They are generally formulated in saline (isobaric) or dextrose (hyperbaric) which raises questions of stability. The behaviour of morphine in hyperbaric and isobaric solutions stored in a reservoir for implantation has been examined and the effect of temperature and the time of contact of morphine with the different components of the reservoir as well as the sterilization procedure have been investigated. The best stability was observed with a hyperbaric solution in which there was 15 to 20 times less pseudomorphine than in the isobaric solution, which was found to contain 1% pseudomorphine after 1 month of storage at 37 degrees C in the reservoir. Similar solutions stored in ampoules did not degrade.

Atmospheric Pressure↗
PubMed1988

[The double approach in recent cervical injury. Indications apropos of 15 cases and a review of the literature].

The authors presented 15 cases of recent spinal cervical injuries treated with double approach procedure. Neurological disorders were variable but instability was severe in all cases. In 11 cases with severe neurological disorders the anterior procedure was made immediately, in 4 cases secondary with one or two sequences. In all cases was made discectomy and arthrodesis or removal vertebral body and arthrodesis associated with a posterior stabilization using generally bilateral plates of Roy-Camille. The functional spinal results were excellent with immediate or early mobilisation. In 4 cases with incomplete quadriplegia was observed favorable recovery. In 9 cases with complete quadriplegia two excellent recovery are obtained.

Adult↗
PubMed1987

Chronic stimulation of the Gasserian ganglion for treatment of atypical facial neuralgia.

After a trial of percutaneous stimulation of the Gasserian ganglion in 21 patients with atypical facial pain, five patients were selected for chronic implantation. After a follow-up of two years (18 to 32 months), there is stable and excellent analgesia in three patients. There are various complications and problems associated with the method of implantation, either percutaneous or open. The best indication for this procedure is the presence of trigeminal pain and some sensory loss in the painful area. This new application of neurostimulation for pain was described by Myerson in 1980, and this therapy should be considered for any patient who has atypical facial pain that has been resistant to other forms of treatment.

Electric Stimulation Therapy↗
PubMed1986

Posterolateral approach and anterior spinal canal recalibration in severe spinal injury affecting T-12, L-1: a study of seven cases.

The authors present seven cases of spinal trauma at the T-12--L-1 level with severe spinal canal stenosis secondary to compressive, anterior discocorporeal lesions. Associated neurological disorders were of varying severity. Six cases were investigated by computed tomography, which enabled the degree of thoracolumbar spinal canal stenosis to be determined. In all cases, the surgical procedure involved rectification of spinal deformity, with an initial unilateral posterolateral approach permitting anterior spinal canal recalibration, either by impaction of protrusive fragments or ablation of ejected disc fragments. The stabilization was in all cases achieved by complimentary bilateral plates using Roy-Camille material, associated with posterolateral arthrodesis by grafting with reconstruction of the articulopedicular structure. The functional spinal result was excellent in all cases, and recalibration was verified by tomography. In those cases showing neurological deficiency, good and early recovery was attributable to the suppression of spinal canal stenosis. The application of this posterolateral approach for severe lesions of the thoracolumbar junction seems to represent, in all cases of recent lesions, an alternative to the anterior or combined methods, which present widely recognized difficulties at the thoracoabdominal junction.

Adult↗