Current trends in the combined radiological and surgical management of vascular malformations, tumours and dysplasias involving the vertebral artery.
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Biomedical subjects
Publications and source records attributed to B George.
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The authors report a case of traumatic arteriovenous fistula between the vertebral artery and the internal jugular vein at the level of the atlas, treated successfully by a direct surgical approach which permitted exclusion after simple dissection. The relative ease of the surgical approach of the suboccipital segment of the vertebral artery may permit one to extend this technique to other more common indications, in particular due to atheroma.
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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.
A correlative study is done between observation of cases of shunted hydrocephalus with mesencephalic signs such as Parinaud's syndrome and a multiunitary recording of mesencephalic and bulbar reticular formation activities during acute and chronic intracranial hypertension in cats. Clinical and experimental data are first separately analysed and then superimposed. This results in analysing the evolution of such intracranial hypertension in three stages: first stage of "tolerance" with minimal clinical signs and no change of reticular activity; second stage of "uncompensation" when mesencephalic signs appear and with increased mesencephalic activity and unchanged bulbar activity; third stage of "exhaustion" where can be noted disorders of consciousness, decerebration fits, and cardiorespiratory disorders; mesencephalic activity falls down to lower levels than basal ones, bulbar activity increases first and then also decreases rapidly. This suggests a mechanism of exhausting stocks of monoamines but also of change of the local cerebral blood flow. Increase and then fall of the reticular activity may be the general way, even without any herniation, of evolution of any intracranial hypertension of traumatic or tumoral origin.
Modifications of mesencephalic and bulbar reticular formation activity were studied with microelectrodes during acute and chronic intracranial hypertension. In both cases, the mesencephalic reticular activity increased progressively until a pressure level of 70 to 90 cm of CSF was reached and then fell irreversibly to less than the base value. The bulbar reticular activity followed the same pattern but more slowly. Different hypotheses are advanced to explain these modifications and their meanings.
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This study using the dapsone/creatinine (D/C) ratio was undertaken to find out how many of the patients attending the Village Clinics were actually taking the DDS tablets. The Urine D/C ratio was estimated in 35 patients who were receiving a supervised daily dosage of either 50 or 100 mgs of DDS. The D/C ratio was also estimated in 100 out patients who were on either 50 or 100 mgs of dapsone. It was determined that 72% of this group had taken DDS in the previous 24 hours. It was also seen that the 55 patients who were receiving 100 mgs of DDS had taken 79.3% of their dapsone dosage, and the 45 patients receiving 50 mgs of DDS had taken 96% of their dosage.
The major changes in clinical condition during and after encephalography may be explained by intracranial pressure variations. If neither intracranial hypertension nor CSF dynamic perturbations exist, minimal complications may be predicted, but in intracranial hypertension immediate deterioration may occur. Despite an apparently good level of tolerance, complications may develop if the compensation phenomena cannot occur: normal pressure hydrocephalus, craniosynostosis. In the cases with good clinical tolerance, minimal changes occur when air injection is administered at a slow rate and with a small volume.
A fast-moving hemoglobin variant was detected in a screen for abnormal hemoglobins. Structural analysis shows that there is a substitution of glycine by aspartic acid at position in 136 in the beta chain.