Biomedical subjects
Y Lazorthes
Publications and source records attributed to Y Lazorthes.
Spinal versus intraventricular chronic opiate administration with implantable drug delivery devices for cancer pain.
Early publications have separately reported the efficacy, specificity and conservative character of direct spinal and intraventricular morphine analgesia in the treatment of intractable cancer pain. The objectives of this study are to compare efficacy and safety of these sites of local administration in order to determine the indication for each, the clinical effects of different opiates and the choice of various drug administration devices.
[Thermopolymerizable acrylic cranioplasties. Technic and results apropos of 37 cases].
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[Chemonucleolysis in the treatment of surgical sciatica].
Enzymatic dissolution of nucleus pulposus by percutaneous injection of a papain preparation is now used frequently to treat lumbosacral disc hernias responsible for resistant sciatica. Mechanisms of action and techniques are reviewed, and the importance of applying strict criteria for indications for use emphasized. The method should be reserved for nerve root sciatica resistant to medical treatment or physiotherapy, and it constitutes the last stage of conservative treatment. Exclusion criteria are mainly "excluded" disc lesions, major dysfunction or associated spinal vertebral canal stenosis. The optimal indication is represented by the subacute disc hernia in the young. This alternative to open surgery in no way compromises the results in case of failure. Results obtained in a personal series of 150 cases are analyzed comparatively with those reported in the literature.
[Contribution of computer tomography in recent traumatology of the spine. Apropos of 31 cases].
The authors report 31 cases of recent spinal injury (14 cervical, 17 thoraco-lumbar) which have been investigated using computerized tomography. After a critical appreciation of the conventional approach to such lesions, the authors consider the advantages and limitations of computerized tomography. Analysis of the data from 31 cases studies confirms that this technique has considerable applications in the assessment of corporeo-discal and pediculo-lamar lesions and, in particular in the determination of the degree of spinal canal stenosis and in the detection of actual potential neuroaggressive factors which are important for the choice of therapy. Computerized tomography provides information which is essential in choosing the surgical strategy to be adopted in each case, and in particular allows determination of the best approach and of the time scale for successive operations in the case of a double approach. On the other hand, computerized tomography alone does not permit precise determination, either of the degree of instability of spinal lesions or of the magnitude of static deformations.
[Peroperative auditory evoked potentials in surgery of the posterior fossa].
Intraoperative brainstem audiometry electric responses were measured in 22 operations of the posterior fossa, including 11 acoustic neurinomas. The first observation shows the recordings obtained during the exeresis of a voluminous tumor of the cerebellopontine angle and wave V disappearance for 90 minutes. At the end of the operation we noted a better plotting synchronization and the wave V form reappeared. The wave preservation was confirmed by an electrocochleography carried out few days after intervention. The second observation enables the visualization of modifications on ipsi- and contralateral plottings of the cerebellum retraction and brainstem mobilization during a cerebellum medulloblastoma operation. The third observation shows the immediate and considerable extension of wave V latency during mobilization of the antero-inferior cerebellar artery during an acoustic neurinoma operation. The authors discuss the various operative times leading to significant variations in the latency of waves I, V and I-V delays and the advantages of such a monitoring for the brainstem vital functions and hearing preservation.
[Functional neurosurgery of cerebral palsy].
In 1983, approximately 40 000 patients in France and 5 760 patients in Switzerland suffered from cerebral palsy, representing more than 0.1% of their respective populations. The functional disability of these patients is particularly impressive and emphasizes the medical, social and economic importance of this problem. The term cerebral palsy is restricted to non-progressive disorders of motor function, already observed at an early age and due to cerebral lesions. These motor disorders can be of paretic, dystonic and dyskinetic nature. Their epidemiology, classification, etiology, pathology, early diagnosis and evolution are extensively reviewed by Th. Deonna. The difficulty in evaluation of treatment is the absence of a generally accepted rating scale. G. Broggi has proposed one on the basis of a large experience which could serve in the future for more objective evaluation. This monograph is devoted to the functional neurosurgical treatment of cerebral palsy. Physiotherapy and rehabilitation are part of the basic treatment of cerebral palsy, and must be continued after any neurosurgical treatment. Various conservative methods of treatment and their neurophysiological rationale are mentioned by P. Claverie. Some technical devices which improve the neurological deficits and facilitate rehabilitation are presented. Radiculotomies and neurotomies are probably the oldest neurosurgical operations for the treatment of spasticity. The neurophysiological and neuroanatomical basis of this therapeutic approach are treated in the review of the material from the neurosurgical department of Montpellier. Sixty cases were collected and the results analysed according to the type of operation (posterior radiculotomy, anterior radiculotomy, mixed) performed. Stereotactic thalamotomies and subthalamotomies are believed to be the best neurosurgical method to treat the tremor and improve other dyskinesias and hyperkinesias. The technique and a personal review of 49 cases of cerebral palsy are presented. The long-term follow-up in this study demonstrates that this type of operation markedly improves the functional disability of patients with moderate hyperkinesias, moderately improves patients severely affected, but also demonstrates that possible side effects cannot be ignored. Review of the literature indicates the difficulty in interpretation of results due to a lack of objective evaluation. Nevertheless, stereotactic thalamotomy can still be recommended when tremor and rigidity are the most prominent symptoms. Stereotactic dentatotomies in the treatment of spasticity were very popular 20 years ago, but have been largely forgotten for nearly a decade.(ABSTRACT TRUNCATED AT 400 WORDS)
[Effects of cranioplasty on neurological function and cerebral blood flow].
The authors present a review of their experience of cranioplasty in cases showing of skull defects. Forty recent case reports were retained out of a total of 125 cases and of these, 15 showed neurological deficiency prior to cranioplasty. In 7 out of these 15 cases cranioplasty appeared to have no effect, but in the 8 remaining cases, an improvement in the neurological condition was observed. In connection with these clinical observations, a recent study of a small group of patients with skull defects used the Xenon 133 inhalation method to investigate cerebral blood flow. In all cases these was a significant postoperative improvement in cerebral blood flow. The rate varying from 15 to 30% and this improvement was even observable in the case of small skull defects of the order of 10 cm2. The mechanism giving rise to such improvements is discussed; it may be related to cerebral hemodynamic normalization after skull restoration. The improvement in cerebral blood flow brought about by cranioplasty in all the cases studied suggests that this technique may be important not only for simple skull repair but also to improve neurological function.
[Chronic electrode implantation in contact with the round window in the treatment of tinnitus].
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[Percutaneous analgesic thermocoagulation of spinal nerve roots. 218 cases (author's transl)].
Between 1974 and 1980 the authors have performed 218 radiofrequency thermocoagulations of spinal nerve roots or posterior branches. The procedure is atraumatic and selective but requires considerable technical accuracy. Its major indications (posterior lumbalgias, spondylolisthesis, staged spinal syndromes, painful thoraco-abdominal scars, etc.) emerge from this detailed review of a large series of patients suffering from pain of spinal or extraspinal origin. Satisfactory results were obtained in 39% to 45% of these patients for whom conventional treatments had failed. This should encourage to try this strictly percutaneous technique (usually performed under local anaesthesia) before open surgery.
Long-term follow-up of dorsal cord stimulation for chronic pain syndrome after multiple lumbar operations.
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[Role of computerized gas meatocisternography in the diagnosis of small acoustic neurinoma].
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Electrical spinal cord stimulation for spastic movement disorders.
Clinical results of electrical stimulation of the spinal cord at three different clinics are reported for 53 patients suffering from different spastic movement disorders out of a series of 164 cases tested transitorily. Two-thirds of the cases were multiple sclerosis patients. The difficulty of objective assessment is emphasized. Motor function was principally evaluated and surprisingly showed a marked improvement 1-5 years after the implantation of an electrical device. Other criteria are analyzed and compared with literature. Dorsal cord stimulation seems to be a valuable method for improving the quality of life in a limited percentage of cases of neurological motor disorders.
[Critical Study of 100 intracranial sustentorial aneurysms operated (authors' translation)].
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Indications and ethical considerations of deep brain stimulation.
Electrical impulses through chronically implanted electrodes in the human brain are used today in the relief of chronic crippling pain, motor movement disorders and behavior disturbances. A great number of reports from animal studies and several descriptions of the results produced by human stimulation seem to suggest that pain can often be adequately controlled. However, the perspectives of such methods raise many ethical problems and ask for caution. Nervous tissue damage after long-term stimulation, biochemical modifications, electrode migration and long-term follow-up of its clinical value are still under study and are the factors which might limit for the time being the indications. A restrictive role for this procedure is advocated for: 1. cases of chronic facial pain, 2. cases of chronic pain in other locations where other neurosurgical operations have failed and where the patient is not too young and is not suffering from pain of benign origin.
[Analgesia by intrathecally applied morphine. Pharmacokinetics study and application to intractable pain (author's transl)].
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[Traumatic injury affecting the extracranial portion of internal carotid artery (17 case reports) (author's transl)].
The authors analyse the detailed clinical course in an homogenous review of 17 cases reports of traumatic injury affecting the extracranial portion of internal carotid artery. Only cases in which there were neither cervical perforating wound nor atheromatous predisposing lesion were considered. As in cases reported in the literature, the young age of these patients, with prevalence in the second decade and in men, was attributable to the etiology. Circumstances in which diagnosis was established induce to discern two unequal groups, according as there was either a coma or immediate focal signs, or a delayed symptomatology : it occured most frequently after a free interval shorter than 48 hours, and reaching in the extrema (one instance) 40 days. Brachiofacial hemiparesis was the most frequent clinical picture. Doppler investigation was able to detect, with a rather satisfying reliability, anomalies in the carotid flow before angiography ; angiogram showed lesions nearly always facing first or second cervical vertebra and bilateral lesions in four instances. Injuries consisted in dissecting aneurysm with stenosis aspect much more often than in thrombosis. In a third of cases distal ischemic lesions below dissecting aneurysm were noted. Prognosis in these cases is very poor since eight patients in our series died without any possibility of expectation according to clinical or angiographical data. Medical therapeutics were disappointing, and this induced to consider an extension in preventive realization of extra-intracranial by pass, each time diagnosis is established and patient is lucid. Etiopathogenical aspect is the originaler part of this study, since we could precisely approach incriminated mechanisms in a methodic analysis of impacts and their results. In our review cranial or facial shock was constantly noted, always frontal and often mild. In II cases association to a frontal and upper thoracic traumatism was found ; safety belt may have been responsible in part, in the mechanism of fixation of upper thoracic orifice, in most cases where this thoracic impact seemed to be missing. Thwarted stretching of carotid artery seems to be the necessary condition for occurring of an intimal tear. Other mechanisms like direct cervical shock may certainly be found, but we did not observe any instance in this review.
Radiofrequency coagulation of the petrous ganglion in glossopharyngeal neuralgia.
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