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Biomedical subjects

A Pierre-Kahn

Publications and source records attributed to A Pierre-Kahn.

At least 109 records · Page 6Linked to original sources
PubMed1979

Medulloblastoma in childhood. Survival and functional results.

The authors report on a series of 57 medulloblastomas in children operated upon -etween 1964 and 1976. Among these children, 44 completed the treatment with radiotherapy to the whole central nervous system. The postoperative mortality rate in 10.5%. Postoperative deaths occurred mainly in infants or when a tumour involved the brain stem. The five-year survival rate is 54% in the whole series. It rose to 71% in the patients who completed the treatment with radiotherapy. The study shows that the life of survivals is frequently impaired by mental or behavioural disturbances. IQ varies from 70 to 90 in 58% of the children; it is below 70 in 31%. Behavioural disturbances are found in 93% of cases. 82% have defective spatial orientation, dysphasia, or dysgraphia. In order to evaluate the responsibility of X-ray therapy for the development of these sequelae, the results have been compared to those of a series of cerebellar astrocytomas surgically removed, but not irradiated. The comparison shows that radiotherapy is at least partially responsible for the mental and behavioural disturbances. No relation was found between these disturbances and a persistent ventricular dilatation or an endocrine dysfunction. However the endocrine assessment showed growth hromone deficiency in 65% of the children, short stature in 55%, and compensated hypothyroidism in 58%.

Adolescent↗
PubMed1979

A new surgical approach to the third ventricle with interruption of the striothalamic vein.

In the removal of tumours that develop within the third ventricle, most approaches are not entirely satisfactory. Therefore, a new approach has been devised: transfrontal exposure of the anterior portion of the frontal horn; coagulation and section of the striothalamic vein in order to open up the roof of the third ventricle; use of a blunt spatula introduced in the foramen of Monro and pushed backwards under the choroïd plexus. This approach has been used in ten cases. Postoperative mortality has been nil; the surgical approach has not apparently been responsible for any sequelae. It is simple and gives a good view of the third ventricle.

Adolescent↗
PubMed1978

Influence of the use of a surgical isolator on the rate of infection in the treatment of hydrocephalus.

Two series of patients treated for hydrocephalus (101 original shunt insertions, 81 revisions and 35 reinsertions after infections) have been operated on in the same location, 146 with a surgical isolator (SI), 71 without a SI. Due to temporary poor technical conditions, the use of a SI was decided because, the overall rate of acute postoperative infections had suddenly increased from 9 to 19.7%. Then, although these technical conditions remained unchanged, the use of the SI immediately reduced the overall rate of acute postoperative infections from 19.7 to 7.4%. In original shunt insertions, this rate decreased from 24.9 to 5.8% and in revisions from 10.7 to 5.5%. In reinsertions after infection, it only fell from 27.2 to 16.6%. With the SI, the rate of peroperative contamination is almost nil. If postoperative contaminations due to wound disruption or scalp necrosis, and shunt reinsertions after infection are not taken into account, the rate of acute postoperative infection is 0.8%. The data presented indicate the efficiency of the SI. This results from elimination by the SI of airborne contamination and errors in aseptic technique. These two factors are probably the main sources of infection in shunt insertions for hydrocephalus.

Cerebrospinal Fluid Shunts↗
PubMed1978

[Study of the relationship between intracrânial pressure and paradoxal sleep in the cat (author's transl].

The present study reports on the modification of the intracranial pressure (ICP) during rapid eye movements (REM) sleep in seven chronic cats. 1. REM sleep episodes were characterized by a succession of short lasting (9 +/- 4 seconds) oscillations of the ICP. Peaks amplitude represented a hundred percent increase of the pressure as compared to its resting level. 2. These oscillations either arose from an ICP level similar to that recorded during the preceding slow wave sleep period or were seen to overide a wave of raised ICP that lasted throughout the REM period. 3. Eighty eight percent of the phasic oscillation coincided with a burt of eye movement characteristic of REM sleep. 4. Cerebral pulse wave amplitude can vary for identical ICP mean value in the course of a same REM period.

Animals↗
PubMed1978

[Measuring intracranial pressure with a fontanelle palpation transducer (author's transl)].

The accuracy and reliability of a non-invasive method for the measurement of intracranial pressure through the fontanelle without puncture was tested during 12 or even 24 hours recordings. Wealthall and Smallwood modified aplanation transducer was first used. A metal frame had to be developed in order to secure the transducer rigidly over the fontanelle so that the recording could take place with the infant in any position and completely free of its movements. Simultaneous recordings of extradural or intraventricular pressure have shown the measurements were accurate to about 1 or 2 cm H2O in a neurosurgical environnement (i.e large fontanelles with pressure over 10 cm H2O). For smaller fontanelles or low or even negative intracranial pressure, a smaller transducer seems to be needed. The preliminary test of a plane strain gauge transducer that partially fills this need is shown.

Circadian Rhythm↗
PubMed1978

[Medulloblastoma in childhood. Survival rates and functional results (author's transl)].

The authors report on a series of 57 medulloblastomas operated upon in children from 1964 ot 1976. Among these children, 44 completed the treatment with radiotherapy of the whole central nervous system. The post-operative mortality rate in 10,5%. Postoperative death occurred mainly in infants or when the tumor involved the brain stem. The five years survival rate is 46,6% in the whole series. It raises up to 50% in the series of the patients who completed the treatment with radiotherapy. The study shows that the life of survivals is frequently impaired by mental or behavioural disturbances. I.Q. varies from 70 to 90 in 66% of the children; it is below 70 in 20%. Behavioural disturbances are found in 91% of cases, wrong space orientation, speech or writing disabilities in 87%. In order to evaluate the responsibility of ray therapy in the development of these sequelae, the results have been compared to those of a series of cerebellar astrocytomas surgically removed, but not irradiated. The comparison shows that radiotherapy is at least partially responsible for the mental and behavioural disturbances.

Adolescent↗
PubMed1977

[Angioventriculography in the study of deep arteriovenous aneurysms].

The authors discuss the value of angioventriculotomography before surgery in deep arteriovenous malformations. This new procedure was performed in 2 infants and 3 children. In all cases, it was possible to know the precise relations of the lesions to deep structures of the central nervous system. Surgery was then contra indicated in two patients. In the remaining three patients, it not only proved to be of great value before deciding surgery, but it also determined the entire surgical procedure. The only incident encountered in this series was a rapidly regressive convulsive seizure in an infant of 3 months.

Adolescent↗
PubMed1977

[Transitory dyslexia related to hematoma of the left temporal lobe in a 14-year-old adolescent].

A hematoma limited to the median region of the second left temporal convolution was the factor of an involvement of written language which rapidly set in in a 14 years old adolescent. The type of disorders observed are quite superimposable on dyslexia in children. After evacuation of the hematoma, the reading disorders disappeared, as was proved by normalization of the leximetric test.

Adolescent↗
PubMed1976

Intracranial pressure and rapid eye movement sleep in hydrocephalus.

Intracranial pressure (ICP) was monitored for 24 h in 30 hydrocephalic patients (21 infants, 9 children) representing borderline cases. The need for surgery was uncertain because their hydrocephalus seemed to be more or less arrested. In 13 cases an electroencephalogram, an electro-oculogram, an electromyogram and an actogram were simultaneously recorded. During sleep related to a period of rapid eye movement (REM) fairly regular steep-rising waves of raised ICP recurred every 50-75 min, decreasing slowly to previous levels in 25-40 min. No concomitant clinical symptoms were exhibited. The cerebral pulse wave amplitude increase during REM sleep, but might vary during one period of REM sleep. The relationship between these raised ICP waves and an increase in cerebral blood flow occurring during REM sleep is studied.

Child, Preschool↗
PubMed1975

[Role of the ventriculocisternostomy in the treatment of non-communicating hydrocephalus].

44 ventriculo-cisternostomies were carried out on infants and children who manifested non communicating hydrocephalus. They were performed through perforation of the floor of the 3th ventricle with the aid of a leukotomy trochar which was introduced through a frontal ventriculography burr hole, and then guided under X ray control. The study of this group showed that the operation is benign, although the mortality is not null, and is effective except in the case where non communicating hydrocephalus develops after meningeal haemorrhage of meningitis. The late results seem good, but the time lapse is too short for a final conclusion. The preoperative radio-isotopic cisternography does not unable prediction of the cases which will be failures; it does however sometimes make it possible to foresee those which will be successful. The post-operative radio-isotopic cisternography is useful in checking on the permeability of the shunt.

Cerebral Ventricles↗
PubMed1975

[Neurosurgery under strict asepsis. Effect of the surgical isolator on the level of infections after valve shunts for hydrocephalus].

The authors report on two groups of 75 shunts for hydrocephalus. Each group includes both cases in which the shunt was implanted for the first time and cases in which the repair of a former shunt was necessary either for mechanical or infectious complications. The operations within the first group were performed with traditional techniques; those of the second group were carried out during the same period of time and by the same team, but with the use of a surgical isolator. The overall rate of early infections was greatly reduced in the second group. Careful analysis of the infections which still occured with the surgical isolator indicated that they were related to the reappearance of a preoperative infection or to secondary contamination through post-operative cutaneous complication. In this second group using the surgical isolator, no contamination occured during the operation itself.

Antisepsis↗
PubMedDate not supplied

[Sleep polygraphy with recording of intracranial pressure and measure of cerebral blood volume in hydrocephalic infants (author's transl)].

This study was carried with the intention of explaining the causes of modifications in intracranial pressure (ICP) during paradoxical sleep (PS) in normal and hydrocephalic infants, and establishing relationships between these modifications and cerebral blood volume (CBV). All tests (conventional sleep polygraphy, ICP measured by a transducer on the fontanel, CBV measured by isotopic labelling of red blood cells in vivo) were carried out without use of surgical procedures. During paradoxical sleep there was a sustained wave of increased intracranial pressure lasting from 10 to 20 minutes, as well as phase-type variations lasting no longer than 1 minute. Increased ICP was also observed in the normal subjects. Recordings show that there is well-defined correlation between the sustained wave of high intracranial pressure and an increase in CBV.

Blood Volume↗
PubMedDate not supplied

Mechanical complications in shunts.

A retrospective study was conducted on 1,719 hydrocephalic patients, treated between 1974 and 1983 at the Hospital for Sick Children (Toronto) and l'Hôpital des Enfants Malades (Paris), in order to better understand shunt failure. The statistical analysis demonstrates the following: (1) A probability of occurrence of shunt malfunction of 81% at 12 years of follow-up. (2) A high prevalence of shunt obstruction (56.1% of all malfunction) and fracture or disconnection of the tubings (13.6%). (3) A higher risk of proximal occlusion with flanged ventricular catheter. (4) Less malfunction with proximal-non-slit valves as compared to distal-slit valves. (5) The importance of pressure-flow characteristics of the shunt; because of an indirect relation between overdrainage and proximal occlusion. (6) A correlation between connectors and migration or fracture of the shunt. (7) Less distal obstructions when an open-ended distal-catheter was used. These complications were of some clinical, psychological and economical consequences. Their rate could be lowed.

Cerebrospinal Fluid Shunts↗
PubMedDate not supplied

[Neurosurgery in strict asepsis. First trials in an operation isolator during the placement of 10 ventriculoperitoneal derivations].

Authors report on a series of ten ventricular-cardiac or peritoneal derivations performed under operative field isolation, air-tight and sterile enclosure that makes possible to perform surgery under strict aspsis. The first results compared with those mentioned in the medical literature, let foresee a fall in the occurence of post-operative infections. The technique is adaptable to neurosurgery and does not complicate the operative process.

Antisepsis↗
PubMedDate not supplied

[True precocious puberty in non-tumor hydrocephalus. An analysis of 16 cases].

True precocious puberty occurred in 16 children (15 girls and 1 boy) with non tumoral shunted hydrocephalus at a mean age of 6.8 years. They had mild clinical manifestations of precocious puberty, and the other pituitary functions were found to be normal. Except for one child, precocious puberty did not correlate with raised intracranial pressure or lack of cerebral drainage by the shunt. Growth was the main concern in this group as the predicted height fell at a mean value of 1.7 SD below the parental target height, and even more in children with myelomeningocele. This growth retardation is due to an early progression of bone age observed even prior to the appearance of breast or pubic hair. Therefore we suggest that these children might benefit from early treatment by an LHRH analogue as soon as precocious puberty occurs.

Age Factors↗
PubMedDate not supplied

[Precocious puberty caused by a suprasellar arachnoid cyst. Analysis of 6 cases].

The authors report 6 cases (4 girls and 2 boys) with central precocious puberty associated with a suprasellar arachnoid cyst. Precocious puberty is rarely the presenting sign of arachnoid cysts. It was characterized by early onset, patent symptoms and frequent association (3 of 6 cases) with growth hormone deficiency. The latter represents a further risk of short stature. Evolution of precocious puberty varied from one case to another, without any relation with the quality of control of the arachnoid cyst and associated hydrocephalus. Half-yearly follow-up of height and bone age allowed for deciding a suppressive treatment of precocious puberty and a substitutive growth hormone therapy when needed.

Body Height↗