Agressologie: revue internationale de physio-biologie et de pharmacologie appliquees aux effets de l'agression最新文献

Clinical configuration of borderline period of awakening is described based on the triangular relation (Patient, Family, Care Team) beginning during coma. The possible suffering before awakening (regressive attitude, downfall of immune defences, and so on ...) evokes a sort of reply of trauma and the hypothesis that mechanisms of "negative hallucination" play a part in post-traumatic amnesia.

Electrophrenic Respiration (REP) is a technic specially reserved to the patients with a first motoneuron disease but having moreover normal phrenic nerve, diaphragm and lungs. Electrical pulse trains are applied to the phrenic nerve by a surgically implanted electrode. They produce rhythmic inspiratory diaphragm contractions; expiratory time is passive. The energy is delivered by a transcutaneous radiofrequency external pacer. Before to decide to implant a REP device, it should be wait for a sufficient time to avoid either a possible return to a spontaneous breathing or, on the contrary, a peripheral nerve disease initially unrecognized. After regularly repeated external detection exams, surgery must be done gently on a stabilised patient, out of infection and, if possible, without intellectual trouble. The training needs a long time (many months) since to become fatigue-resistant a paced muscle must be trained progressively and durably. In that way the results are generally good, as the 13 patients we have implanted may give an evidence.

Post traumatic ischemia appears to be largely involved for the extension of lesions in acute injury of the spinal cord. The present study evaluate the putative improvement of spinal cord blood flow (S.C.B.F.) by calcium channel blocker after acute spinal cord injury in baboons. S.C.B.F. measured by a scannographic technique with 133Xe were realised each thirty min for 4 hours and seven days later; somatosensory evoked potentials (S.E.P.) magnetic resonance imaging (M.R.I.) and histological study of the spine were realised at different time of the experimentation. Ten monkey were used. Acute trauma was achieved by compression of the cord at T1 by applying a 2.10(2) kPa (2 bar) pressure for 5 s with a balloon catheter inflated with Ringer's solution. Then, five monkeys received saline infusion for seven days and the other five received a nimodipine infusion (0.04 mg.kg-1.h-1) during the same time. Nimodipine improved significantly S.C.B.F. Two monkeys in the treated group showed improvement of axonal function as judged by S.E.P. Conversely no significant difference was noted by R.M.I. although the histological study showed smaller lesions in the treated group. Nimodipine could represent in the next years a new medical treatment in acute spinal cord injury in man.

This article is devoted to ablative neurosurgical procedures used for the treatment of chronic pain. The procedures are classified as those directed to the cranial nerves, the peripheral nerves, the spinal roots, the dorsal root entry zone and the ascending spino-reticulo-thalamic pathways. The rational and neurophysiological effects of these operations are stressed. The actual indications for each procedure are specified.

Several pathophysiological events follow spinal cord trauma. Vascular abnormality and changes in spinal cord blood perfusion occur immediately after injury primarily within the gray matter. Progressive biochemical and histological alterations take place both in gray and white matter subsequently. The significant metabolic and ionic alterations, all of which are interdependent (reduction in energy substrate, enzymes and neurotransmitters release alterations, ionic fluxes changes) result either in loss of functional activity or structural integrity in the injured spinal cord and remains a matter of speculation.