Les états de conscience altérée représentent un réel problème au niveau social, économique et éthique et constituent un défi au niveau diagnostique et thérapeutique. Nos résultats ont permis de montrer que lutilisation dune échelle comportementale standardisée reste indispensable pour éviter lerreur diagnostique et que la Coma Recovery Scale-Revised (Giacino et al, 2004) réprésente loutil diagnostique le plus efficace pour détecter des signes de conscience et donc, distinguer les patients végétatifs des patients en état de conscience minimale. Nos résultats suggérent également que lutilisation de paradigmes actifs électrophysiologiques permet dévaluer les capacités cognitives résiduelles de patients sévèrement cérébro-lésés et de détecter une activité cérébrale consciente, même en présence, au niveau de lévaluation comportementale, de comportements peu complexes tels quune fixation et/ou une poursuite visuelle. Enfin, au niveau du traitement, nous avons pu démontrer, à laide de limagerie fonctionnelle, lefficacité de lamantadine sur la récupération de la conscience chez un patient anoxique chronique en état de conscience minimale. Ainsi, nous pensons que lutilisation combinée de techniques comportementales et de techniques objectives telles que lélectrophysiologie et la neuro-imagerie est primordiale et permettra à lavenir, dune part, de clarifier ce quest un comportement conscient et donc, de mieux caractériser les états de conscience altérée et, dautre part, dinvestiguer lefficacité de thérapeutiques invasives ou non et donc, de mieux traiter les patients sévèrement cérébro-lésés récupérant du coma.

Molecular spectroscopy at radio wavelengths is a tool well suited for studying the composition and outgassing kinematics of cometary comae. This is particularly true for distant comets, i.e. comets at heliocentric distances greater than a few AU, where the excitation of molecules is inefficient other than for rotational energy levels. At these distances, water sublimation is inefficient, and cometary activity is dominated by outgassing of carbon monoxide. An observing campaign is presented, where the millimeter-wave emission from CO in comet 29P/Schwassmann-Wachmann 1 has been studied in detail using the Swedish-ESO Submillimetre Telescope (SEST). Coma models have been used to analyse the spectra. The production of CO is found to have two separate sources, one releasing CO gas on the nuclear dayside, and one extended source, where CO is produced from coma material, proposed to be icy dust grains. Radio observations of many molecules in comet C/1995 O1 (Hale-Bopp) have been carried out in a long-term international effort using several radio telescopes. An overview of the results is presented, describing the evolution of the gas production as the comet passed through the inner Solar system. Spectra recorded using the SEST, primarily of CO, for heliocentric distances from 3 to 11 AU are analysed in detail, also using coma models. The concept of icy grains constituting the extended source discovered in comet 29P/Schwassmann-Wachmann 1 is examined by theoretical modelling of micrometre-sized ice/dust particles at 6 AU from the Sun. It is shown that that such grains can release their content of volatiles on timescales similar to that found for the extended source.

This imaginative work of fiction depicts the lives of the Foley family. After a brutal car accident, Kate Foley has lived for the past fourteen years at Gregg Catastrophic Care Center in a persistent vegetative state, leaving her daughter Grace and husband Tom to reconstruct their lives around her. Aside from her mother’s condition, life is relatively normal for Grace; she worries about school, boys, her friends. Then her mother slowly regains consciousness. The family gathers around Kate’s bedside. Grandmother Helen arrives along with Aunt Liz, family that Grace cannot remember, and their stories of her mother’s past are vastly different from the ones her father has told her. Over the next emotional months, secrets are revealed, new alliances forged and others broken as each member of the family grapples with their own issues of memory, self and what it means to be fully present.

Thèse (Ph. D.)--Université Laval, 2008. / Titre de l'écran-titre (visionné le 25 mars 2009). Bibliogr.

Thèse (M.Ps.)--Université Laval, 2003. / Bibliogr. Publié aussi en version électronique.

The reduction in visual performance typically found in keratoconic patients is believed to be associated with large magnitudes of uncorrected irregular astigmatism and higher-order aberrations (HOAs). Previous studies indicate that correcting HOAs in keratoconus patients may result in an improvement in visual performance. This thesis explores the correction of HOAs using standard sphero-cylindrical and customised aberration-controlling soft contact lenses in 22 patients with keratoconus. The findings of this work may be useful from a clinical perspective, as some keratoconic patients cannot tolerate rigid gas-permeable (RGP) contact lenses and have few alternatives, excluding surgical intervention, for vision correction. This thesis firstly describes a series of preliminary studies conducted to improve our current understanding of the HOAs manifested in keratoconus. The results of these investigations suggested that alterations in aberrations, due to changes in accommodation or variations in the pre-corneal tear film post-blink, were unlikely to hinder the correction of HOAs for keratoconic patients. Equally, it was ascertained that subjective refraction data provided significantly better visual acuity compared to objective, aberrometry-derived refractions for patients with keratoconus. The findings also show that both lower-order aberrations (LOAs) and HOAs displayed a larger degree of variability in keratoconic eyes compared to those previously reported for visually-normal subjects. Furthermore, significant increases in 3rd-order coma root mean square aberrations were found after temporarily suspending RGP contact lens wear for 16 keratoconic patients. The results of two clinical studies suggested that standard sphero-cylindrical soft lenses can, to some extent, mask HOAs in keratoconic patients; however, the visual performances achieved were found to be poorer compared to RGP lenses. Equally, the results showed that RGP lenses provide superior visual performances compared to customised, aberration-controlling lenses, in spite of the customised lenses providing comparable reductions in uncorrected HOAs. The inducement of superfluous HOAs and LOAs, through customised contact lens translations and rotations, were modelled using MatLab (version 7.6.0.324; The Mathworks, Natick, MA, US). The results confirmed that minimising the decentration of aberration-controlling contact lenses, to less than 5 degrees of rotation and less than 0.50 mm of translation, will help to achieve an optimal correction of HOAs. However, more stringent criteria were required for LOAs, where rotational displacements should be reduced to less than 3 degrees and translational displacements should be limited to less than 0.10 mm. In conclusion, the correction of HOAs for patients with keratoconus is possible using customised, aberration-controlling soft contact lenses; however, several factors will govern their success, including the repeatability and accuracy of HOA measurements for these irregular corneas, and the stability of the customised lenses on-eye.

OBJECTIVES: The S100B protein subgroup is a thermolabile acidic calcium-binding protein. S100B protein was first described in the central nervous system. Destruction of the nerve tissue results in S100B protein release from astrocytic glial cells and elevation of its levels in the cerebrospinal fluid. If the blood-brain barrier is also damaged, S100B gets into the systemic circulation and elevated blood levels of S100B are detected. Higher S100B serum levels in patients with head injury are predictive of possible development of secondary brain injury and the extent of permanent injury to the CNS. MATHERIAL AND METHODS: The authors present their results obtained in the group of 39 children aged 0 (newborns) to 17 years with isolated craniocerebral injury. RESULTS: Our group included 39 children aged 0-17 years. Excellent results (GOS - Glasgow outcome scale 4-5) were observed in 33 patients already at the time of transfer from our ICU to the neurological department. There was no death and the poor outcome group included only 6 children. Second GOS evaluation was performed 6 months later, when 36 children were in the GOS 4-5 group and only 3 children in the GOS 2-3 group. CONCLUSIONS: Due to high variability in S100B protein serum levels in children depending on age and gender, no correlation between...

Animated color film with images of water, birds, winged humans, a man in a hooded sweatshirt, doors, the sea, a woman on a stool wearing a red scarf, marching soldiers, a gun, a knife, blood on hands, a dancing couple, a crowd of dancers, a seed, plants growing, clouds, a flying winged person, a figure playing an instrument. The images transform into each other in ever-changing sequences. Notes Music by The Coma Lilies, a musical group from Santa Rosa, California, 2001-present; Memento Mori is the name of the album, and the track used for this film. http://www.thecomalilies.net/ 'Memento mori' is a Latin phrase reminding us of our own mortality.

Submitted by (edna.saturno@ufrpe.br) on 2016-10-20T14:21:22Z No. of bitstreams: 1 Moacir Bezerra de Andrade.pdf: 486371 bytes, checksum: 997bf7f6be2c645f0415215a82b09935 (MD5) / Made available in DSpace on 2016-10-20T14:21:22Z (GMT). No. of bitstreams: 1 Moacir Bezerra de Andrade.pdf: 486371 bytes, checksum: 997bf7f6be2c645f0415215a82b09935 (MD5) Previous issue date: 2008-02-28 / Considering that the consciousness level corresponds to the degree of behavioral alert shown by individuals and that the later is subject to strong variation among neurological patients, the relevance of its evaluation and measurement becomes clear. In that account, several scales were developed and proposed to human medicine, all of them based on the analysis of the patients and consequent scoring regarding their global consciousness level every other moment. The technological development and improved research of the nervous system enhanced the neurological knowledge regarding veterinary medicine. Advances in both scientific production and medical clinic were achieved, as in the philosophical debate about animal well-being and consciousness. Yet, additional research is required in order to develop safer and more accurate clinical instruments and proceedings. The objective of the present work is to modify the Pediatric Glasgow’s Scale of Coma focusing on its application in veterinarian clinical neurology, in order to evaluate and measure the consciousness levels ofcanine patients. Another objective is to test the applicability of the Glasgow’s Scale for Dogs. This study was conducted on 30 adult canine patients, disregarding the gender, race, and weight, which presented pathological processes causing them neurological changes suitable for consciousness level evaluation. Animals were provided by the Department of Clinic Neurology and Psychobiology of the Medical Clinic for Small Animals in the Veterinary Hospital of the Department of Veterinary Medicine (DMV) of the University Federal Rural of Pernambuco (UFRPE). The Glasgow’s Scale of Coma Modified for Dogs was applied in three distinct moments (m0, m1 e m2) with an interval of 48 hours between them, leading to 90 recorded events. Data were submitted to factorial analysis, and results suggested that the Glasgow’s Scale of Coma Modified for Dogs is valid for the evaluation of the consciousness levels of adult dogs in the ambulatory routine. / Considerando-se o conceito de que o nível de consciência é o grau de alerta comportamental que o indivíduo apresenta e também, as possibilidades de variação desse parâmetro em pacientes neurológicos, observa-se a relevância de sua avaliação e mensuração. Neste sentido, várias escalas foram desenvolvidas e propostas à medicina humana e todas elas baseadas na análise do paciente e na atribuição de um escore de pontuação que propicie uma idéia global da condição do nível de consciência, momento a momento. Na medicina veterinária, devido ao desenvolvimento tecnológico e aos estudos mais acurados do sistema nervoso, houve grandes avanços na área neurológica, tanto na produção científica quanto na clínica médica e no debate filosófico sobre o bem-estar animal e a consciência. Contudo, apesar dos incrementos, deve-se ressaltar a necessidade de realização de diversas pesquisas no campo da neurologia clínica veterinária que venham viabilizar o surgimento de instrumentos e procedimentos clínicos mais seguros e eficazes. O presente trabalho teve como objetivo modificar a Escala de Coma de Glasgow Pediátrica visando sua utilização na neurologiaclínica veterinária, a fim de avaliar e mensurar os níveis de consciência de pacientes da espécie canina. Uma outra finalidade do trabalho foi a aplicabilidade da Escala de Glasgow para Cães. No desenvolvimento deste estudo foram utilizados 30 pacientes da espécie canina, adultos, sem distinção de sexo, raça, peso, portadores de processos patológicos que causem alterações neurológicas, passíveis de avaliação do nível de consciência. Os animais foram provenientes do Serviço de Neurologia Clínica e Psicobiologia da Clínica Médica de Pequenos Animais do Hospital Veterinário do Departamento de Medicina Veterinária (DMV) da Universidade Federal Rural de Pernambuco (UFRPE). A Escala de Coma de Glasgow Modificada para Cães foi aplicada nos cães em três momentos distintos (m0, m1 e m2), sendo respeitado um intervalo de 48 horas entre as análises, ocasionando 90 eventos diversos. Os dados obtidos foram tratados estatisticamente através da Análise Fatorial, que permitiu concluir que a Escala de Coma de Gvalidade construída, possuindo a capacidade de avaliar, na rotina ambulatorial, o nível de consciência em cães adultos.

Memoria (licenciado en ciencias jurídicas y sociales) / No autorizada por el autor para ser publicada a texto completo / Hay diferentes problemas que plantea el avance tecnológico en los últimos años, siendo especialmente atrayente la controversia suscitada a raíz del progresivo cambio de mentalidad desde la “santidad” de la vida humana hacia la “calidad” de la vida humana, que trajo el reclamo al “derecho de una muerte digna” y las voces favorables a la aplicación de la eutanasia. Dentro de este contexto es de extraordinario interés la problemática jurídica, médica y ética del llamado estado vegetativo permanente, que recientemente adquirió relevancia mundial con el caso de Terri Schiavo