Biomedical subjects

A Rey

Publications and source records attributed to A Rey.

At least 109 records · Page 6Linked to original sources

PubMed1997

The endovascular approach in the management of patients with multiple intracranial aneurysms.

To investigate the role of endovascular treatment we performed a retrospective study of our patients with multiple intracranial aneurysms seen in our institution between October 1992 and March 1995. This period was chosen to study a homogeneous group of patients since the appearance of controlled detachable coils, and to obtain the largest number of patients with angiographic follow-up of the aneurysms treated. We studied 53 patients with a total of 128 aneurysms, in 46 of whom we treated 67 aneurysms by the endovascular approach. Of these, 5 aneurysms in 3 patients were treated by occlusion of the parent vessel and 62 aneurysms in 43 patients with coils, 52 with Guglielmi detachable coils and 10 with mechanically detachable spirals. Complete occlusion was obtained in 58 aneurysms, and partial occlusion in 9. The therapy caused permanent neurological deficit in 3 cases (6.5%), and there was 1 case of rebleeding (incomplete occlusion of the aneurysm). No deaths occurred. All aneurysms were treated in 29 of the 53 patients. Endovascular procedures were used for 16 patients (30%), surgery was performed in 1 patient (2%) and the two were combined in 12 (23%). In 23 of 53 cases (43%), unruptured aneurysms were left untreated, usually because of their small size. In 1 patient with unruptured aneurysms, the endovascular approach failed and the patient refused surgery.

Adult↗

PubMed1997

Intracranial aneurysms: endovascular treatment with mechanical detachable spirals in 60 aneurysms.

PURPOSE: To evaluate preliminary results with endovascular treatment (EVT) of intracranial aneurysms with mechanical detachable spirals. MATERIALS AND METHODS: EVT with spirals was attempted in 57 patients with 60 aneurysms (47 berry, nine large, and four giant aneurysms). Thirty-seven patients had subarachnoid hemorrhage (three of whom were also treated for associated aneurysm), nine were asymptomatic, six had headache, three had mass effect, and two had neurologic deficits. RESULTS: EVT with the spirals was achieved in 55 (92%) of the 60 aneurysms. Of 42 treated berry aneurysms and 13 treated large and giant aneurysms, 33 berry and nine large and giant aneurysms underwent 3-month angiographic follow-up. Complete occlusion was attained in 23 berry and four large and giant aneurysms, subtotal occlusion (doubtful or obvious small neck remnant) was obtained in eight berry and four large and giant aneurysms, and incomplete occlusion was obtained in two berry aneurysms and one giant aneurysm. These results were obtained after one procedure in 21 patients, after two procedures in 19 patients, and after three procedures in two patients. Seven patients had complications that necessitated infusion of urokinase. Permanent neurologic deficits were found in three. There were no deaths. CONCLUSION: Good results were obtained with EVT of intracranial aneurysms with mechanical detachable spirals. These spirals are characterized by rapid detachment and low cost.

Adult↗

PubMed1997

Extensive cytoreductive surgery in advanced ovarian carcinoma.

From June 1985 to June 1993, 152 patients with advanced ovarian cancer were treated with maximum cytoreductive surgery, and six to nine cycles of platinum-based chemotherapy. Six patients had stage IIIA-B disease, 101 stage IIIC, and 45 stage IV. Twenty-two tumors were grade 1. 58, grade 2. and 72, grade 3. Eighty-four patients (55%) presented with bulky tumors (> 10 cm in diameter). Optimal cytoreductive surgery (diameter of largest residual mass < 2 cm) was performed in 138 patients (91%). Fifty patients (33%) developed postoperative complications; 38 patients (25%) required a second laparotomy within a few days. Two postoperative deaths occurred. Overall 2-year and 4-year survival rates were 56% and 28%, respectively. There was a clear relationship between residual tumor and survival: the 2-year survival rate was 80% in the absence of residual tumor vs. 22% when the residuum exceeded 2 cm in diameter. The 2-year survival rate was 49% for tumor nodules < 2 cm in diameter. In a multivariate analysis of various risk factors (grade, stage, lymph node metastases, residual tumor, and age), the one that correlated most with survival was residual tumor. Despite a high morbidity rate, this modality of treatment, with the presence of optimal and aggressive perioperative measures in terms of intensive care unit and post-operative follow-up, offers an encouraging if not promising strategy for increased chances of survival in advanced ovarian cancer.

Adult↗

PubMed1997

Expression of cell adhesion molecules by microvascular endothelial cells in the cortical and subcortical regions of the normal human brain: an immunohistochemical analysis.

We studied the repertoire of junctional, cell-matrix and leucocyte-endothelial adhesion molecules normally expressed by cortical and subcortical brain microvessels, as compared with large intracranial vessels. An indirect immunoperoxidase method was applied to acetone-fixed cryostat sections of normal brain tissue obtained from 10 adult patients during surgical resections for intracranial aneurysms or at autopsy. Like large intracranial vessels, brain microvessels expressed the two endothelial-specific junctional cell adhesion molecules VE-cadherin and platelet-cell adhesion molecule-1. We verified that they also expressed the molecular components of adherens-type junctions, including catenins, plakoglobin, vinculin and alpha-actinin. Brain microvessels expressed a large repertoire of integrin molecules of the beta 1, beta 3 and beta 4 subfamilies. However, they displayed apparently lower levels of alpha 2, alpha 5, alpha V and beta 3 integrin chains than large intracranial vessels. Brain microvessels constitutively expressed large amounts of the leucocyte-endothelial adhesion molecules, intercellular adhesion molecule (ICAM)-2 and CD34 and very low amounts of ICAM-1 and lymphocyte function-associated antigen-3. In contrast to large intracranial vessels, brain microvessels presented no constitutive expression of P-selectin. Our study shows that, in contrast to their highly specific structural and functional characteristics, brain microvascular endothelial cells present a repertoire of cell adhesion molecules very similar to that of most other capillary vessels in the body.

Adult↗

PubMed1997

[Negative second-look laparatomy in ovarian cancers. Survival analysis and prognostic factors from 64 cases treated at the Gustave Roussy Institute].

This study describes 64 cases of ovarian adenocarcinoma seen in the Gustave-Roussy Institut between 1978 and 1988 and who had a negative second-look laparotomy. The median age was 51 years (30-74). FIGO stages were: I: 7 (11%); II: 3 (5%); III: 39 (61%); IV: 3 (5%); and undetermined: 12 (19%). There were 53% of serous type, 14% of endometrioid type, 13% of undifferencied type, 8% of clear cells type, 3% of mucinous type, and 9% of mixed type tumors. There were 50% of grade 3 tumors. Initial debulking surgery was as complete as possible in 59 patients, with a residual tumor after surgery superior or equal to 2 cm in 25 patients. Post second-look surgery treatment (n = 57) consisted of chemotherapy (CT) alone in 22 patients (34%), radiotherapy (RT) alone in 31 patients (49%), and CT associated with RT in 4 patients (6%). Median follow-up is 100 months. The overall survival rates at 3 and 5 years were respectively 86 and 81%, and disease free survival rates 70 and 61%. Among the 64 patients, 26 relapsed (39%). Median time to relapse was 96 months. There is a statistical difference in the survival between patients who had no or inferior to 2 cm residual tumor and others. Residual tumor was the only factor to be significant in univariate and multivariate analysis of survival.

Adenocarcinoma↗

PubMed1997

[Reconstruction technic in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results. Apropos of 56 cases].

PURPOSE: The main factor limiting endovascular treatment of intracranial aneurysms is the shape of the aneurysmal sac, particularly the width of the neck. In this study we present a new technique to occlude wide neck aneurysms that involves the temporary inflation of a non-detachable balloon in front of the aneurysm neck during each coil placement. The aim of the study is to present the feasibility, efficacy and safety of this "remodeling technique" (RT) as compared to that of "normal" GDC treatment. MATERIAL AND METHOD: 56 aneurysms in 54 patients were selected for treatment with the RT. Thirty-seven (70%) of the patients presented with subarachnoid hemorrhage. Twenty-five (45%) of the aneurysms were located at the vertebrobasilar artery, 24 (43%) at the internal carotid artery, and seven at the level of smaller arteries. RESULTS: Treatment was achieved in 52 aneurysms in 50 patients. Two aneurysms which were initially not completely occluded underwent a second treatment using the RT. Final results (i.e. the last follow-up angiography or results at the end of the treatment for the cases that have not yet had follow-up) consisted of total occlusion in 40 cases (77%), sub-total occlusion in nine cases (17%), and incomplete occlusion in three cases (6%). Angiographic evidence of clotting was observed during the procedure in three cases, resulting in one permanent deficit (quadranopia). Rupture of the aneurysmal sac occurred during the procedure in three cases, all of which were asymptomatic in the follow-up. Thus, morbidity due to the technique was 1/52 (0.5%) and mortality was 0/56 patients. CONCLUSION: The remodeling technique allowed the treatment of 52 wide neck or badly shaped aneurysms that were not treatable without this technique. The results of occlusion with the RT seem better than those in our series of normal GDC treatment, and complications related to the technique are fewer. This technique thereby extends the spectrum of treatable aneurysms without increasing the risk incurred by treatment.

Adolescent↗

PubMed1997

[Trans-petrous surgery in acoustic neuroma. Value of preoperative audiovestibular and facial investigation in the risk evaluation of facial nerve function].

Between 1987 and february 1994, 162 consecutive patients with acoustic neuroma were operated on by an otoneurosurgery team, using transpetrous approaches (89% translabyrinthine, 8% middle fossa and 3% retrosigmoid). The relationship between the clinical, audiometric and vestibulographic characteristics and the post-operative facial nerve function were evaluated. In acoustic neuromas with cerebello-pontine component inferior to 3 cm without central neurologic signs (ic: central controlateral auditory and/or ipsilateral vestibular pathway alteration), good post-operative facial nerve function was achieved in 80% of cases. In acoustic neuromas superior to 3 cm with alteration of the central vestibular and auditory pathways, a good result was obtained in only 30% of cases which correlated negatively with preoperative facial dysfunction. These results underline the value of preoperative facial and audiovestibular examinations in predicting the postoperative facial nerve function following surgery for acoustic neuroma.

Adolescent↗

PubMed1996

Endovascular treatment of anterior communicating artery aneurysms using Guglielmi detachable coils.

The aim of this study was to evaluate endovascular treatment of anterior communicating artery aneurysms using Guglielmi detachable coils GDC. To obtain long-term follow-up, we selected patients treated between October 1992 and March 1994. Among the 251 berry aneurysms treated by detachable coils at our institution, 36 were located at the anterior communicating artery and treated with GDC. The most frequent clinical presentation in this group (86%) was subarachnoid haemorrhage (30 cases). There were 23 aneurysms which were completely and 6 were partially occluded. We did not treat 7 aneurysms. In 3 cases, no endovascular treatment was attempted either because the aneurysmal neck was not clearly distinct from the adjacent, or parent vessels (2 cases), or because the aneurysm sac was too small (1 case). In 4 cases, treatment failed because of atheroma of the cervical and intracranial vessels. Complications were, in the majority of cases, related to clotting (3 cases) with a good outcome in 2 cases and neurological sequelae in 1. In 1 case rupture of the aneurysm occurred during treatment. Endovascular packing was continued until complete occlusion of the aneurysm was achieved and no clinical complication was observed after the treatment. Two patients died as a result of complications of subarachnoid haemorrhage (vasospasm in one case, pulmonary complications in the other). Endovascular treatment using GDC is an efficient technique for treating anterior communicating artery aneurysms even in the acute phase of bleeding.

Adult↗

PubMed1996

Endovascular treatment of pericallosal artery aneurysms.

Recent technical developments have made endovascular treatment using controlled-detachable coils suitable for intracranial aneurysms. However, endovascular approach of the aneurysms of the pericallosal artery remains difficult because of their usual small size and their anatomical situation.

Adult↗

PubMed1996

Selective occlusion of basilar artery aneurysms using controlled detachable coils: report of 35 cases.

The development of new devices, especially controlled detachable coils, has made the endovascular approach one of the modalities for the treatment of intracranial aneurysms. We describe the treatment and present the results of 35 patients treated by selective occlusion of basilar artery aneurysms in our department during a period of 2 years (November 1992-November 1994). This period of time was chosen to analyze a homogeneous population treated since the introduction of controlled detachable coils and also to be able to have as many follow-up angiographic controls of the treated aneurysms as possible. The clinical presentation was subarachnoid hemorrhage in 32 patients and transient ischemic attack in 1 patient. In another two patients, the aneurysms were incidentally discovered. The majority of the aneurysms were berry aneurysms. The aneurysms were located at the basilar bifurcation (23 patients), at the basilar tip between the posterior cerebral artery and the superior cerebellar artery (5 patients), on the basilar trunk (3 patients), and at the vertebrobasilar junction (4 patients). Endovascular treatment using coils was achieved in 34 patients, using Guglielmi detachable coils (Target Therapeutics, San Jose, CA) in 29 patients and mechanical detachable spirals (Balt, Montmorency, France) in 5 patients. One patient died during the positioning of the first coil into the aneurysmal sac. Twenty-five of 35 aneurysms (73.5%) were completely occluded. Nine aneurysms (26.5%) were only partially (> 90%) occluded. No subsequent bleeding occurred during the follow-up period. Two patients treated in the acute phase of subarachnoid hemorrhage died days or weeks after endovascular treatment because of complications related to the natural history of subarachnoid hemorrhage (vasospasm in one patient and pulmonary complications in the other). In three patients, clotting occurred during the endovascular procedure. In all three patients, occlusion of the aneurysmal sac was achieved despite clotting. Urokinase was administered to two of the three patients. In the remaining patient, no fibrinolytic therapy was initiated. The clinical outcomes were excellent for all three patients. In this study, the morbidity-mortality rate of the endovascular technique is low (3%). If we include complications related to the subarachnoid bleeding, the morbidity-mortality rate remains low (8.8%) Regarding basilar artery aneurysms, endovascular treatment (selective occlusion by controlled detachable coils) is now useful for some patients, especially those with small aneurysms. However, long-term anatomic follow-up is needed to accurately evaluate the role of this treatment modality in the management of basilar aneurysms.

Adolescent↗

PubMed1996

Comparison of bronchoscopic diagnostic techniques with histological findings in brain dead organ donors without suspected pneumonia.

BACKGROUND: The techniques for recognising pneumonia in mechanically ventilated patients were evaluated as no "gold standard" is available to establish the diagnosis in these patients. METHODS: A prospective study was performed on nine brain dead organ donors not suspected of having pneumonia to assess the specificity of bacteriological results from different samples by comparing them with the histological findings from an open pulmonary biopsy specimen taken immediately after death through a mini-thoracotomy. RESULTS: Seven of the nine organ donors without clinical evidence of pulmonary infection and not on antibiotic therapy showed histological features of bronchopneumonia. There was no association between the histological findings and quantitative cultures of the lung biopsy specimen. CONCLUSIONS: Histological evidence of pneumonia was common in this group of ventilated patients who had no clinical signs of the disease.

Adult↗

PubMed1996

Pericardial cyst. Surgical resection in two symptomatic cases.

Two cases of surgical resection of symptomatic pericardial cysts are reported. Pathological aspects, diagnostic methods and alternatives of management in these benign lesions are discussed. Other excised cases are also mentioned. The authors recommend excision of these cysts in all patients with a low risk in order to: 1) eliminate the tumour mass, 2) relieve symptoms and 3) allow histological examination.

Adolescent↗

PubMed1996

[Antiaggregant treatment for cerebral ischemia: ticlopidine versus aspirin].

INTRODUCTION: There at present exists marked controversy as to the possible greater efficacy of ticlopidine as opposed to aspirin in brain ischaemia secondary prophylaxis. In our study we compare the efficacy and safety of antiaggregant treatment with ticlopidine as opposed to aspirin in a group of 310 patients admitted to the 'Hospital Mutua de Terrassa' between the years 1990 and 1994. RESULTS: In the group of patients treated with ticlopidine we found a larger number of new cerebrovascular incidents (p = 0.02) and peripheral vascular incidents (p = 0.01). New cerebrovascular incidents were more frequent in males (p = 0.03), in those patients with substantiated infarct (p = 0.02) and in patients with ischaemia in the carotidal region (p = 0.04). On the other hand, the group of patients treated with ticlopidine presented more secondary effects than the group treated with aspirin at the digestive (p < 0.001) and haematologic (p < 0.001) levels. The most frequent digestive secondary effects were diarrhoea (p < 0.001) and hepatopathy (p = 0.02); abnormalities in the leucocyte count were more frequent in patients treated with ticlopidine (p < 0.001), neutropenia being found in 0.8% of cases. CONCLUSION: In the patients we studied ticlopidine was less efficacious than aspirin in the secondary prophylaxis of new vascular incidents (both cerebrovascular and peripheral vascular) and also presented a greater incidence of secondary (digestive and haematological) effects.

Aged↗

PubMed1996

[Latent period before hospital admission in cerebrovascular pathology: determining factors].

OBJECTIVE: Establish the factors determining the latent period before hospital admission of patients with cerebrovascular disorders. MATERIAL AND METHOD: One hundred patients with cerebrovascular disorders admitted to the Hospital de la Santa Creu i Sant Pau, Barcelona were analyzed. All patients were systematically interviewed, evaluating: age, sex, place of residence, initial condition, type of transport to hospital, vascular risk factors, past history of cerebrovascular disorders, time of onset of symptoms, sleeping-wakefulness state, initial symptom, accompanying symptoms, initial course of illness, complications whilst in hospital, clinical condition and functional ability on leaving hospital, and duration of stay in hospital. All these factors were compared according to the latent period before admission (6 hours or less, or more than 6 hours). RESULTS: Patients with a latent period before admission of 6 hours or less more frequently had: changes in the level of consciousness (p = 0.04), motor disorders (p < 0.01), stable course (p = 0.04), systemic complications (p = 0.02) and were severely affected (p > 0.01). Patients with a latent period of more than 6 hours before admission more frequently: were smokers (p > 0.01), had a clinical course in stages (p < 0.01) and no limitation (p = 0.02). The stay in hospital lasted longer in the first group of patients. No differences were found when comparing: age, sex, place of residence, state at onset, type of transport to the hospital, vascular risk factors apart from smoking, past history of cerebrovascular illness, time of onset of symptoms, state of sleeping-wakefulness, initial symptoms and accompanying symptoms apart from changes in level of consciousness and motor defect. CONCLUSIONS: Factors determining delay in the hospital admission of patients with cerebrovascular disorders are: smoking, the clinical picture (alteration of consciousness, motor disorders) and the initial course of symptoms.

Aged↗

PubMed1996

[Contralateral hyperhidrosis secondary to the pontine infarct].

Unilateral hyperhydrosis due to a cerebral infarct is a clinical sign rarely described in the literature, the significance of which is unknown and may be due to a lesion of the crossed sympathetic inhibitory tract. We describe the case of a patient with contralateral hyperhydrosis due to a hemipontine infarct.

Cerebral Infarction↗

PubMed1996

[Subarachnoid hemorrhage and onset of marginal hemosiderosis caused by a spinal cord cavernoma].

An intradural cavernoma of the spinal cord located at T12 was identified in a 39-year-old man presenting with recurrent episodes of lower back pain on the basis of MRI findings. The patient was hospitalized for severe subarachnoid hemorrhage complicated with hydrocephalia requiring ventriculo-peritoneal draining. Marginal asymptomatic hemosiderosis of the spinal cord above the malformation was observed. The cavernoma which did not involve nervous tissue was removed surgically to avoid the risk of recurrent bleeding and further development of marginal hemosiderosis.

Adult↗

PubMed1996

[Neurosurgical aspects of Rendu-Osler disease. Apropos of 6 recent cases and review of the literature].

Six patients with neurological complications in Rendu-Osler-Weber disease were reviewed. There were 4 patients (3 int the same family) with a brain abscess, one patient with a brain abscess and a spinal cord subarachnoid hemorrhage, one patient with a recurrent intracerebral hemorrhage due to a vascular malformation. The infectious complications are related to the presence of pulmonary arterio-venous fistula, which should be treated, whenever diagnosed. Because of the potentially severe outcome of these neurological complications of the Rendu-Osler-Weber disease, screening of the patient's relatives is highly recommended.

Adult↗

PubMed1996

[Sudden deafness disclosing acoustic neuroma. Apropos of 16 cases].

We performed a retrospective review of the audiologic, radiologic and clinical data on 239 patients operated on for acoustic neuroma from 1987 to 1995 at Beaujon Hospital. In 16 patients or 6.6% of the total group, we identified as having experienced sudden hearing loss by history. The 16 tumors involved were 1 stade I; 8 stade II, 5 stade III and 2 stade IV. In 14 cases, the tumor was removed by translabyrinthine approach, 1 case by masto-retrosigmoid approach and 1 case by middle fossa approach. The hearing was preserved in the two latter cases. The purpose of this study is to illustrate and reaffirm the importance of a thorough neurotologic evaluation and to discuss the diagnostic methods in this select patient population.

Adult↗