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Biomedical subjects

B George

Publications and source records attributed to B George.

At least 145 records · Page 8Linked to original sources
PubMed1992

[Intra- and extracranial nasopharyngeal fibroma. Contribution of imaging and study of local failure. Report on 34 patients].

Thirty-four patients with nasopharyngeal angiofibroma were treated between 1975 and 1990. Lesions were classed according to Sessions' classification. 17 showed intracranial extension. Treatment always associated embolization and surgical excision using a transfacial approach and, if necessary, neurosurgical techniques. A total of 13 patients (38.2%) developed recurrent lesions; these included 3 (17.6%) patients in the extracranial group and 10 (58.8%) patients in the intracranial group. Erosion of the clivus and displacement of the cavernous sinus seem to be 2 factors significantly associated with the development of recurrent lesions. Symptomatic recurrences were managed by surgery. Close clinical and radiological follow-up of patients with asymptomatic recurrent tumor made it possible to observe the stabilization, or even, the regression of the tumor. This study also underlines the importance of modern diagnostic and interventional imaging, which makes it possible to better determine tumor extension and to perform highly selective embolizations. Modern imaging also detects recurrences which once would have remained unknown because of their small size and the absence of symptoms. The techniques of embolization of the tumor branches from the internal and external carotid arteries are explained. Finally, our results are compared to those published in the literature.

Adolescent↗
PubMed1992

[Multiple intracranial aneurysms. Endovascular treatment by coils].

The authors report the case of a 30 years-old man presenting with 3 intracranial aneurysms, which were treated by endovascular techniques. The aneurysm responsible for two previous subarachnoid hemorrhages was a giant supracavernous left internal carotid artery aneurysm. Endovascular therapy using coils caused intraoperative rupture which was successfully managed by balloon occlusion of the internal carotid artery. The two other aneurysms (basilar top, and right middle cerebral artery) were small and asymptomatic; complete obliteration of both aneurysms was achieved by selective coils embolization. Persistent occlusion of the three aneurysms was documented ad six months angiographic follow up.

Adult↗
PubMed1992

[Value and control possibilities of the vertebral artery in tumor surgery at the base of the skull].

Following anatomical description of the third segment of the vertebral artery (from C2 to the foramen magnum), the surgical techniques which permit to expose and control this artery at this level are presented. Choice is between the posterior approach in sitting or procubitus position and the lateral approach in supine position. The former is mainly applied on intradural tumors or prolongments and the latter on extradural tumors. These techniques were utilized on more than 60 cases including for the most frequent types meningiomas, neurinomas, paragangliomas and osseous tumors and were associated with a very low morbidity and mortality.

Humans↗
PubMed1992

[Cerebral blood flow in the determination of vasospasm and surgical decision].

The interest of C.B.F. studies performed on patients with subarachnoid haemorrhage is discussed on the basis of the literature and of our experience of 142 cases. C.B.F. results in basic condition are influenced by many factors which make its use very limited and especially during the first days after haemorrhage (J0-J3). However, the analysis of the evolution of C.B.F. values in the same patient and moreover the C.B.F. reactivity to acetazolamide are good indicators of the occurrence of a vasospasm; progressive drop of the C.B.F. or poor reactivity are generally observed before clinical signs of vasospasm. Our policy is therefore to decide the date of surgery according to C.B.F. values but only for patients planned for delayed surgery (after the 3rd day).

Acetazolamide↗
PubMed1992

[Giant intracranial aneurysm. Elective endovascular treatment using metallic coils].

The authors present nine cases of giant aneurysm treated endovascularly by obliteration of the aneurysm lumen using platinum coils. Three aneurysms were located on the anterior circulation and six on the vertebrobasilar system. Presenting symptoms were mass effect in five cases and subarachnoid hemorrhage in four. Total occlusion of the aneurysms was achieved in four patients and partial occlusion in five. On follow-up (15 months), there was one repermeation and one neo-aneurysm. Both of these cases were retreated with placement of additional coils. All patients who presented with a mass effect had improvement of their symptoms (two after transient aggravation). Two patients died: one partially treated from hemorrhage, and the other from M.C.A. infarct after surgical clipping of the aneurysm. One technical complication included a lost coil which did not result in any angiographic or clinical change. One year follow-up angiographies show a permanent stable occlusion induced by coils. This technique should be considered as an option when treating giant non surgical aneurysm.

Adult↗
PubMed1992

[Cisternal cysticercosis of the cerebellopontine angle. A surgically-treated case and review of the literature].

Most neurocysticercosis (N.C.C.) cases reported occur in undeveloped countries where contaminated food by Taenia solium gives rise to human infection. People of developed countries are exposed by migrations and travels. We report a case of a 36 years old french woman living at La Reunion. Her symptomatology consisted of left unilateral hypoacusis progressing over a two years period accompagnied by intermittent headaches. CT scan showed a hypodense mass with a ring enhancement in the left cerebello pontine angle (C.P.A.). M.R.I. showed multicystic arrangement of vesicles in a racemous fashion that spread out to peduncular and carotid cisterns. Parenchymatous or ventricular involvement was not observed. A lateral suboccipital craniectomy was carried up in the sitting position. After division of a thickened arachnoid in the C.P.A., the vesicles were dissected an pulled out easily because the membranes had not any adhesions. Progressive improvement of hearing was observed in the next week. Primary cisternal involvement of N.C.C. is rare and, in literature, there is not any other reported case in the C.P.A. Different mechanisms of invasion to the C.N.S. are discussed.

Adult↗
PubMed1991

Anterior skull base tumour. The choice between cranial and facial approaches, single and combined procedure. From a series of 78 cases.

In order to define the most adequate surgical procedure to apply on anterior skull base lesions, we reviewed 78 cases of either benign (43 cases) or malignant (35 cases) tumours; they were treated either by a single surgical approach including transfacial approach (TF) in 9 cases, transbasal approach (TB) in 15 cases and fronto-orbital ridge deposition (FORD) in 16 cases or by a combined procedure: TB + TF (28 cases), TB + FORD (10 cases). In 7 cases, a pterional approach was associated to one of these combined procedures. A classification is proposed, based on the tumour extension along the anteroposterior axis: I) anterior to the crista galli; II) anterior to the anterior clinoïd process; III) posterior to the anterior clinoïd process; and along the vertical axis A: below the bone level; B: below the dura level; C: at and above the dura level. This classification appears very useful to choose among the surgical procedures which one is the more appropriate. In type A tumour (N = 8), TF is sufficient while in type B (N = 38) and C (N = 32) a cranial route is always necessary; among the latter, a combined procedure is frequently asked for posterior tumours type II (N = 29) and III (N = 24). However, others parameters such as tumour consistency, vascularization and need for en-bloc removal are also relevant in this choice.

Adolescent↗
PubMed1991

MRI in spontaneous dissection of vertebral and carotid arteries. 15 cases studied at 0.5 tesla.

Fifteen patients were observed between 1987 and 1990: there were six with angiographically confirmed vertebral artery dissection, and 9 with carotid artery dissection. Results showed concordance of MRI and angiographic findings, in all cases but one. The dissected portion consistently showed a semilunar hyperintensity narrowing the residual eccentric signal void of the lumen when the artery was not completely occluded. In one angiographically occluded vessel, MR detected a small signal void within the hyperintensity, indicating that the artery was not completely occluded. The length of the dissected portion was clearly demonstrated by MR. Follow up MR and angiographic studies confirmed the regression of the dissection, and also allowed examination of the cerebral parenchyma.

Aortic Dissection↗
PubMed1991

MRI in multiple vascular lesions: identification of the ruptured malformation.

4 patients were recently admitted for subarachnoid haemorrhage with multiple vascular lesions. 3 of them presented with multiple aneurysms, and one with an aneurysm associated with an arteriovenous malformation. In these 4 cases identification of the ruptured lesion was difficult in spite of clinical examination, CT scan, and complete panangiography; on magnetic resonance imaging (MRI) was found a signal hyperintensity, mainly on T2 weighted views, corresponding to blood clots around the ruptured aneurysm. This signal hyperintensity was completely absent in the vicinity of the associated vascular lesion, which appeared only as a signal void corresponding to the blood flow inside the unruptured lesion. Therefore MRI can be used in such cases to identify the ruptured lesion, so permitting the choice of the best approach and strategy of treatment.

Adult↗
PubMed1991

Repair of truncus arteriosus in infancy.

Improvements in myocardial protection, surgical technique, and postoperative care have decreased operative mortality for neonatal repair of truncus arteriosus. Primary repair of truncus arteriosus in infancy without prior pulmonary artery banding is currently the preferred approach. During the period from 1982 to December 1990, 32 patients under the age of 12 months underwent surgical correction of truncus arteriosus at UCLA. The average age was 3.5 months (range, 12 days to 12 months). Three patients had interrupted aortic arch. Early mortality for the entire group was 15.6% (5/32); for those older than 1 month early mortality was 7% (2/28). In the past 4 years, early mortality has decreased to 8.3% (2/24); both of these patients had interrupted aortic arch. Excluding patients with interrupted aortic arch, there were no early deaths in the last 22 patients (1986 to 1990). Late mortality overall was 7.4% (2/27). In a mean follow-up of 73 months (range, 40 to 110 months), 71% (5/7) of the survivors with Dacron porcine-valved conduits required conduit replacement secondary to obstruction. In a mean follow-up of 36 months (range, 1 to 89 months), only 14% (3/21) of the patients with homografts required replacement secondary to obstruction.

Age Factors↗
PubMed1991

Endovascular occlusion of vertebral arteries in the treatment of unclippable vertebrobasilar aneurysms.

Twenty-one patients with aneurysms of the vertebrobasilar circulation underwent unilateral or bilateral endovascular occlusion of the vertebral artery. Six patients presented with subarachnoid hemorrhage (SAH), 10 with mass effect, four with mass effect and SAH, and one with ischemic symptoms. Thirteen patients had good outcomes with complete clinical and angiographic cure. Six patients had partial thrombosis of their aneurysms. There was one death and one treatment failure. One patient suffered transient stroke. It is concluded that endovascular occlusion of the vertebral artery following test occlusion is a safe and effective treatment for proximal aneurysms of the vertebrobasilar circulation.

Adolescent↗
PubMed1991

Thrombomodulin in the central nervous system.

Thrombomodulin (TM), a thrombin receptor, present on the endothelial surface of blood vessels is a major anticoagulant proteoglycan. In this work the presence of TM antigen in the human brain and in the whole central nervous system of calves was investigated by immunocytochemistry using specific antibodies against human and bovine TM. When TM antigen was well preserved by immediate fixation on frozen tissues, TM was found present in the brain vessels of all human surgical specimens examined as well as in the whole vasculature of the calf central nervous system (CNS), from the medulla to the cortex. Moreover, even without immediate fixation, TM antigen was always found on the surface of the cerebrospinal fluid (CSF) cavity: on the arachnoid and on the inner aspect of the dura mater in humans and in calves. This suggests that the proteolytic enzymes responsible for the cleavage of TM from the endothelium are not present in the CSF and in the meningeal cells. The results reported here emphasize the importance of TM in the CNS as protecting, by its antithrombogenicity, a free circulation of blood and CSF in normal and even more, in pathological situations in which the permeability of the meningeal barrier increases.

Animals↗
PubMed1991

Trivandrum Developmental Screening Chart.

The Trivandrum Developmental Screening Chart (TDSC) was designed by selecting 17 test items from BSID (Baroda Norms). It was validated both at the hospital and community level against the standard DDST. TDSC had a sensitivity of 66.7% and specificity of 78.8%, which makes it an acceptable simple screening tool even for the community level worker.

Child, Preschool↗
PubMed1991

[Value of the measurement of cerebral blood flow before and after diamox injection in predicting clinical vasospasm and final outcome in aneurysmal subarachnoid hemorrhage].

The timing for surgery on ruptured intracranial aneurysms remains a difficult question and the choice of the day of operation depends greatly from the occurrence of a vasospasm. On a previous paper, the value of the cerebral blood flow (CBF) measurement by intravenous injection of Xenon 133 was demonstrated to be efficient for the prediction of vasospasm only when done between day 4 and day 8 after bleeding. Moreover the efficiency of the measurement was much greater if the evolution of the CBF values between D0 and D8 was considered, but this method was incompatible with early surgery. It suggested the interest of a dynamic study of the CBF by the same method. On a series of 43 patients, the comparison between basal CBF values and reactivity of CBF values to intravenous injection of 1 gram of acetazolamide for the prediction of clinical vasospasm is presented. The series comprises 32 early admitted patients (74%) and 31 operated patients (16 of them between D0 and D3 after bleeding, 15 others after D4). The efficiency of the CBF reactivity study for the prediction of the clinical vasospasm appears much greater than that of the basal CBF value, even during the first three days after bleeding, but not for the prediction of the final clinical outcome. The method is immediate and compatible with early surgery. What precisely is evaluated by this method on the physiopathology of the vasospasm remains disputable, but the operability of the patients seems to be explored.

Acetazolamide↗