Biomedical subjects
Publications and source records attributed to B Bataille.
The authors report a case of a 5 year old child suffering from isolated sacral tuberculosis which presented as sudden and total loss of function of the left leg. The rarity of this bony site, and the recurrence at nine months of a presacral abscess after 9 months of anti-tuberculous treatment in an HIV negative child, vaccinated with BCG, justify the presentation of this observation.
We report 6 cases of corticotroph macroadenomas which show heterogeneity of clinical and biological features (from Cushing's syndrome to silent adenoma) and heterogeneity of immunocytochemical staining. One patient reported on had skin hyperpigmentation and ACTH hypersecretion without clear abnormal adrenocortical function; we believe that this patient's plasma contained ACTH with very low bioactivity.
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A retrospective study of thromboembolic complications after lumbar disc surgery has been performed. It included 16,656 patients from fifty neurosurgical units, operated on over the year 1989. The average number of operations was 333 +/- 19.5 in each unit, their average duration 55.2 +/- 20 minutes, and the hospital care 6.2 +/- 1.7 days. Surgery was performed using the genupectoral position in 64% of the cases, the supine position in 28%, and the lateral position in 8%. Two groups of patients have been individualized: a first group of patients with no preventive antithrombic treatment (46% of the units) including 10,351 patients, a second group (54% of the units) including 6,305 patients and receiving a systematic treatment with low molecular weight heparin (4,304 patients) or calciparin (1,001 patients) or antiplatelet agents or pentosane polysulfate (1,000 patients). 0.63% of the patients (105) had a thromboembolic accident: 0.65% in the first group (68 cases) and 0.58% in the second (37 cases). No statistically significant difference was noticed between the two groups concerning pulmonary embolism and/or lower-limb thrombophlebitis. Nevertheless, a prospective randomized study would be usefull to corroborate this first data.
Spheroids are prepared from microcrystalline cellulose in binary and compound combination with lactose and theophylline, in certain fixed conditions of extrusion and of spheronisation. The present work envisages the influence of combinated raw materials upon the physical-technique characteristic of the made spheroids. Besides a variation in the granulometric distribution a statical study through analysis of variance brings to the fore that the parameters of formulation contribute to modify the properties of hardness and of friability of the minigranules.
This report based on a series of 8 cases deals with the appearance of cerebral venous angiomas with computed tomography (CT), arteriography and magnetic resonance imaging (MRI). The CT data are not conclusive, and venous involvement is demonstrated by arteriography, as well as the site of involvement. Magnetic resonance imaging seems to be useful owing to the morphological information and data on flow phenomena it provides.
Brainstem auditory evoked responses were recorded in a neurosurgical intensive care unit in 38 patients who had all the clinical criteria for brain death. Of the brain-dead patients, 65.8% never showed a response. 3.42% showed a type I wave, which was unilateral in 26.3% and bilateral in the other 7.9%. Types II to VII waves were never seen. An increase in latency of type I waves (2.25 +/- 0.24 ms) was noted. The interest and the limits of this non invasive electrophysiologic technique for the diagnosis of brain death are discussed.
The authors report a case of L4-L5 foraminal disc herniation revealed by symptoms of bi-radicular and medullary lesions. Anatomical study allows to understand such association of symptoms.
The authors report the case of an isolated supratentorial hemangioblastoma occurring in a woman operated on for a cerebellar hemangioblastoma twenty years before. The data furnished by immunohistochemical technics don't seem to be deciding and don't work out the problem of hemangioblastoma histogenesis.
The authors report on the case of a young woman, seven months gone, with an history of sudden onset of successive lobar intracerebral hematomas. They revealed a Rendu-Osler-Weber disease. The mechanism is discussed.
A mixed ENT and neurosurgical approach is employed widely at present for exeresis of malignant ethmoidal tumors. The stability of the reconstruction of the anterior stage by bone graft is satisfactory in the long term even after radiotherapy. The transfacial approach, with or without conservation of the maxillonasal bone flap, procures a remarkable opening allowing in most cases a monobloc excision.
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A 31-year old primigravida was admitted at 31 week gestation for subarachnoid haemorrhage. Cerebral angiography revealed an aneurysm on the left middle cerebral artery. Eleven days later, the aneurysm was clipped off. General anaesthesia was induced with thiopentone, pancuronium and fentanyl, and maintained with fentanyl (40 micrograms.kg-1) and isoflurane in air/O2 with a non-rebreathing circuit. The patient was mechanically ventilated to maintain mild hypocapnia. Arterial hypotension was induced by increasing the inspired isoflurane concentration from 1 to 3 vol%. The response was immediate and a mean arterial pressure of 60 mmHg was maintained for 80 min with an inspired isoflurane concentration of 2.5 vol%. Foetal heart rate was monitored before, during and after general anaesthesia. Loss of beat to beat variation was observed after induction, and foetal heart rate slowly decreased from 150 to 115 b.min-1 at the end of the operation. Postoperative state was good, except for transitory aphasia. At 35 week gestation, the patient went into premature labour, with hypothermia of 39.5 degrees C; an emergency caesarean section was performed. The 2,340 g female infant had a 10 min Apgar score of 8. One month later, clinical examination of the mother and daughter was quite normal. The precautions and anaesthetic management of patients suffering from ruptured cerebral aneurysm during the end of pregnancy are reviewed. Hypotensive agents are discussed.
Three cases of spinal cord tumor, revealed by hydrocephalus, are reported. Two patients showed symptoms of increased intracranial pressure and the third one presented himself with ataxic gait without intellectual impairment nor incontinence. In two cases ventriculo atrial shunt was initially inserted and the correct diagnosis was made only later on myelogram because lombosciatalgia or syndrome of the cauda equina. Clinical outcome was satisfying after surgical removal of the tumor. The nature of which was a neurinoma of the cauda equina; a lumbar intradural granuloma and an ependymoma of the cauda equina. The mechanism by which spinal cord tumors raised intracranial hypertension is discussed.
A case of a surgically verified neurinoma of the oculomotor nerve is presented. The diagnostic difficulties due to the parasellar localisation are discussed. Computed tomography scan data rarely allow to distinguish the nature of the tumor and in all cases are insufficient to distinguish a trigeminal nerve neurinoma of the oculomotor nerves.
The stability of anaesthesia and the quality of recovery obtained with low doses of enflurane were studied. Two groups of 20 patients operated for lumbar slipped disc were compared. The mean age and weight distribution of the two groups were not statistically different. Induction was the same in the two groups (diazepam, fentanyl, pancuronium and nitrous oxide). In one group, enflurane (0.4%) was added with controlled ventilation. Thiopentone was added if some spontaneous movements were observed, if arterial pressure and heart rate increased, and if the digital plethysmograph curve decreased. The quality of recovery was assessed by number-connection tests 1 and 2 h after the end of anaesthesia. Thiopentone was required five times in the group without enflurane, whilst it was never used in the group with enflurane. This difference was statistically significant (p less than 0.01) and showed a more important stability of anaesthesia when enflurane (0.4%) was used. No statistically significant difference was found in the recovery scores between the two groups 1 and 2 h after the end of anaesthesia. It was proposed that low doses of enflurane were sufficient to increase the effects of the other anaesthetic drugs without any residual effect on recovery. Low doses of enflurane could be used during anaesthesia induced with fentanyl and diazepam, giving better stability during anaesthesia without any pernicious effects on recovery.
A 22 year old woman had a seizure, and the skull X-ray showed an intracranial arched calcification. CT scan permitted diagnosis of dermoid cyst. Rupture of the cyst was testified by low density areas disseminated on the cortical surface and intra-ventricular fat level. Surgical removal confirmed dermoid cyst with rupture and fat fluid inside. Authors underline infrequency of such intra-ventricular fat level. CT scan, with low density of lipidic origin promote considerably such diagnosis both of the real nature of the cyst and of its rupture.
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