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Submitted by Cristina Afonso (cac@lisboa.ucp.pt) on 2018-12-10T14:18:40Z No. of bitstreams: 1 PELIKAN_IEP_OSTALGIE.pdf: 20876581 bytes, checksum: dfb3dcce9c27554de1540d001f477eac (MD5) Approved for entry into archive by Cristina Afonso (cac@lisboa.ucp.pt) on 2018-12-10T14:18:52Z (GMT) No. of bitstreams: 1 PELIKAN_IEP_OSTALGIE.pdf: 20876581 bytes, checksum: dfb3dcce9c27554de1540d001f477eac (MD5) Made available in DSpace on 2018-12-10T14:18:52Z (GMT). No. of bitstreams: 1 PELIKAN_IEP_OSTALGIE.pdf: 20876581 bytes, checksum: dfb3dcce9c27554de1540d001f477eac (MD5) Previous issue date: 2017-06-21

This report concern a series of 100 consecutive patients operated by direct attack for intracranial ruptured aneurysms (mortality: 14%, complete removal: 70%). 35% of this patients have been early operated before the 96e hour. In this series, only one case of spasm was observed. But we have observed other neurosurgical complications, analysed and compared to the postoperative course of the patients who had delayed operations.

Computerised axial tomography requires total immobility, which must be obtained by a simple and safe technique of anaesthesia. Three anaesthesia techniques were used and analysed in 54 children aged less than 5 years: the technique of the feeding bottle, sedation with pentobarbital or diazepam and general anaesthesia with ketamine hydrochloride. The technique of the feeding bottle can be proposed in selected patients. Sedation can be also used but judiciously, not to deep. The systematic use of an depression immobilizing mattress with these two techniques gives better results. Intramuscular ketamine hydrochloride, when not contrindicate (intracranial hypertension or acute hydrocephaly), has been used always successfully.

Five cases of intracranial aneurysms with polycystic kidneys are reported: --15% of polycystic kidneys have an intracranial aneurysm, and about 4% - 5% of intracranial aneurysms are joined with polycystic kidneys; --the surgical treatment of intracranial aneurysm with this association doesn't present more risk than an intracranial aneurysm, and the surgical prognosis isn't bad; --the pathogeny isn't clear. This association is perhaps a congenital elastic system disease.

In 22 months, about 2 000 patients were hospitalized for head injury and 410 of these had computerized tomography to determine the presence and extent of intracranial pathology. 165 patients had normal C.T. scan, and in 245 cases the scan showed an intracranial pathology: 132 brain contusions, 45 epidural hematomas, 36 subdural hygromas, 32 chronic subdural hematomas, 8 intracerebral hematomas, 2 pneumocephalus. The C.T. scan is a very useful technique for evaluation of the head injured patient in emergency. For epidural hematomas, mortality rate which was 16% before C.T. scan period decreased to 8% after C.T. scan period. The C.T. scan has a definite advantage over angiography in brain contusions. Instead of seeing only mass effect, one can tell on C.T. scans whether the abnormality is a small hematoma, an area of contused swollen brain, an hemorrhagic contusion, or a brain oedema. The surgical decisions are more precise with this information. In the management of head injury, we think that C.T. scan must be repeat because many patients developed new lesions and delayed hematomas: intracerebral, subdural, epidural.

The authors report 106 intracranial aneurysms operated on during the first 7 days post S.A.H. The résults according to grade and operative day are compared to the results of litterature, operative indications according to grades and spasms are given.

The authors reported the late results of a serie of fifteen intracranial aneurysm treated by plastic coating. These fifteen patients belong to a group of twenty cases operated with this technic. Four patients were pre-operatively in stade V. One patient died massive pre-frontal infract probably to retractor. In the same period, seventy-two others patients were operated for intracranial aneurysm by usual clip. The fifteen patients with plastic coating have been from two years to seven years observed. One case of minor epilepsy, one case of meningitis good imprevoded were noted. In this serie, no relapsing meningeal hemorrhage, is noted.

We herewith report 400 cases of forceps delivery under local regional block anesthesia of the internal pudental nerves. They were carried out together with routine episiotomy. The indications were the purely classical ones and the results were good. There were very few fetal complications and these were in all instances mild. There were very few maternal complications. So long as some precautious are taken we have in our hands an excellent method for extracting a baby with instruments and it should not have come into disrepute as it has (in comparison with the vacuum extractor).

A case of adult woman surgically treated for hepatic alveolaris ecchinococcosis on 1975 is presented. On 1976, a hypertensive intracranial syndrome is treated by removal of a right temporal kystic localisation. On 1977, a new localisation is successfully raised. The authors, in a short review of the literature note that these cerebral localisations are not always terminal. The alveolaris ecchinococcosis is now autochthonous in France.

During four years, 80 patients with intracranial aneurysms were examined by a CT scanner. The CT was helpful for: The rapid and easy diagnosis of subarachnoid hemorrhage. Direct visualization of intracranial aneurysms. Detecting intracerebral or intraventricular hematoma and distribution of subarachnoid clots. The limitations and pitfalls of CT were: No abnormality was seen on 16 scans (20%). The identification of the source of bleeding in multiple intracranial aneurysms.

This work has for main goal to study and set suitable techniques to deal with the two aspects of transient signals detection and localization in power distribution cable networks. Thus, the proposed methods are related to the problems issued from signal propagation in cables, the physical aspects being considered to set these methods. For detection aspect, we introduce the specific criteria of whole transients detection from the received signal. This is a very important point in so far as the signal measurement may be composed of the direct propagated pulse but also of reflections and other sort of transients. For analysis and localization, it is essential to detect all the transients, regardless of their energy. First, the well known methods of – spectrogram, wavelets and higher order statistics – are studied. These methods are shown to be suitable and robust in the context of electrical transitory signals, but they cannot easily detect low amplitude transients. The complex time distribution is then proposed as a concept able to detect transients via the signal phase derivation. We show that this technique succeeds in good detection results of whole transients thanks to the consideration of the instantaneous phase which is a very distinctive tool in so far as it is regardless of the amplitude. The localization step is based on the consideration of two major difficulties. The first one is the pulse propagation complexity and its physical modelling; the second one is the problematic and restricting need of measurements synchronization for multi-sensor on-line diagnostic. We propose a localization technique which measures the pulses distortion, issued from their propagation, in function of their propagation time. This low cost technique interest is proved by tests in simulated and real context.; Cette thèse a pour objectif principal d'étudier et de proposer des techniques adéquates aux problématiques de détection et de localisation des sources de signaux transitoires dans un réseau de câbles de transport d'énergie. Ainsi, les méthodes proposées tiennent compte de l'ensemble des problématiques liées à la propagation des signaux dans les câbles, les aspects physiques étant pris en compte lors de la mise en place de ces méthodes. Nous proposons pour la détection, d'introduire un critère spécifique de détection de l'ensemble des transitoires du signal reçu. Ce point est très important car un enregistrement peut contenir le transitoire propagé par le trajet direct mais également des réflexions ainsi que d'autre type de transitoires. Pour l'étape d'analyse et de localisation, il est donc très important de pouvoir détecter tous les transitoires, indépendamment de leur énergie. Nous étudions, dans un premier temps, les méthodes les plus connues – la détection à partir du spectrogramme, des ondelettes et des statistiques d'ordre supérieur. Nous prouvons la robustesse de ces méthodes dans le contexte des transitoires électriques mais également leur difficulté à détecter les transitoires de faible amplitude. Nous proposons ainsi l'utilisation du concept de distribution à temps complexe qui effectue la détection des transitoires via la dérivation de la phase du signal. Nous montrons que cette technique fournit de bonnes performances de détection de l'ensemble des transitoires, grâce à l'étude de la phase instantanée qui constitue un très bon élément pertinent en raison de son invariance par rapport à l'amplitude. La phase de localisation repose sur la prise en compte de deux difficultés majeures. La première étant la complexité de propagation d'une impulsion dans un câble et la modélisation physique de cette propagation, la seconde étant la nécessité contraignante d'acquisition synchrone pour un diagnostique on-line multi-capteur. Notre contribution consiste à proposer une technique de localisation qui quantifie la déformation relative subie par les transitoires propagés, en fonction de leur durée de propagation. L'intérêt de cette technique peu coûteuse est prouvé par des tests en configuration simulée ainsi que réelle.

This work has for main goal to study and set suitable techniques to deal with the two aspects of transient signals detection and localization in power distribution cable networks. Thus, the proposed methods are related to the problems issued from signal propagation in cables, the physical aspects being considered to set these methods. For detection aspect, we introduce the specific criteria of whole transients detection from the received signal. This is a very important point in so far as the signal measurement may be composed of the direct propagated pulse but also of reflections and other sort of transients. For analysis and localization, it is essential to detect all the transients, regardless of their energy. First, the well known methods of – spectrogram, wavelets and higher order statistics – are studied. These methods are shown to be suitable and robust in the context of electrical transitory signals, but they cannot easily detect low amplitude transients. The complex time distribution is then proposed as a concept able to detect transients via the signal phase derivation. We show that this technique succeeds in good detection results of whole transients thanks to the consideration of the instantaneous phase which is a very distinctive tool in so far as it is regardless of the amplitude. The localization step is based on the consideration of two major difficulties. The first one is the pulse propagation complexity and its physical modelling; the second one is the problematic and restricting need of measurements synchronization for multi-sensor on-line diagnostic. We propose a localization technique which measures the pulses distortion, issued from their propagation, in function of their propagation time. This low cost technique interest is proved by tests in simulated and real context., Cette thèse a pour objectif principal d'étudier et de proposer des techniques adéquates aux problématiques de détection et de localisation des sources de signaux transitoires dans un réseau de câbles de transport d'énergie. Ainsi, les méthodes proposées tiennent compte de l'ensemble des problématiques liées à la propagation des signaux dans les câbles, les aspects physiques étant pris en compte lors de la mise en place de ces méthodes. Nous proposons pour la détection, d'introduire un critère spécifique de détection de l'ensemble des transitoires du signal reçu. Ce point est très important car un enregistrement peut contenir le transitoire propagé par le trajet direct mais également des réflexions ainsi que d'autre type de transitoires. Pour l'étape d'analyse et de localisation, il est donc très important de pouvoir détecter tous les transitoires, indépendamment de leur énergie. Nous étudions, dans un premier temps, les méthodes les plus connues – la détection à partir du spectrogramme, des ondelettes et des statistiques d'ordre supérieur. Nous prouvons la robustesse de ces méthodes dans le contexte des transitoires électriques mais également leur difficulté à détecter les transitoires de faible amplitude. Nous proposons ainsi l'utilisation du concept de distribution à temps complexe qui effectue la détection des transitoires via la dérivation de la phase du signal. Nous montrons que cette technique fournit de bonnes performances de détection de l'ensemble des transitoires, grâce à l'étude de la phase instantanée qui constitue un très bon élément pertinent en raison de son invariance par rapport à l'amplitude. La phase de localisation repose sur la prise en compte de deux difficultés majeures. La première étant la complexité de propagation d'une impulsion dans un câble et la modélisation physique de cette propagation, la seconde étant la nécessité contraignante d'acquisition synchrone pour un diagnostique on-line multi-capteur. Notre contribution consiste à proposer une technique de localisation qui quantifie la déformation relative subie par les transitoires propagés, en fonction de leur durée de propagation. L'intérêt de cette technique peu coûteuse est prouvé par des tests en configuration simulée ainsi que réelle.