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Biomedical subjects

C Plets

Publications and source records attributed to C Plets.

At least 37 records · Page 2Linked to original sources
PubMed1997

Use of external drainage for posthemorrhagic hydrocephalus in very low birth weight premature infants.

To treat progressive posthemorrhagic hydrocephalus we used early external ventricular drainage (EVD) in 14 premature infants. We think it is important that the catheters in these critically ill infants be inserted in the neonatal intensive care unit, allowing us to keep the infants in an extremely stable environment. Only after prolonged external ventricular drainage (on average 38.4 days) is a ventriculoperitoneal shunt considered, preferably when the child has reached a body weight of 2000 g. There were no infections or other severe drainage-related problems. We report mean daily EVD volumes (which are related to body weight) and EVD duration. The 14 patients included 9 who required permanent shunting. Comparing the mortality, morbidity and follow-up data to at least 3 months of age in this group with similar data for an earlier cohort treated with lumbar punctures and late permanent shunting, we demonstrate the safety of the policy we have recently adopted.

Cerebral Hemorrhage↗
PubMed1996

Juvenile fibrosarcoma of the temporal bone.

A case of juvenile fibrosarcoma arising from the head and neck region is described. This type of tumour should be considered as a separate entity different from the fibrosarcoma in adults because of the different clinical behaviour. The symptomatology, the radiographic features and the literature data are reviewed.

Child, Preschool↗
PubMed1996

Use of a ventriculosubgaleal shunt in the management of hydrocephalus in children with posterior fossa tumors.

We present our experience with the use of ventriculosubgaleal shunting (VSGS) for the management of hydrocephalus associated with posterior fossa tumors in a consecutive series of 63 children. In 42 children, a temporary VSGS was inserted. There were no complications associated with the procedure, and it gave a period of several days in which to improve the general condition of the child, and to perform the necessary imaging studies, without an encumbering external drainage device. In most cases the VSGS could be removed after the posterior fossa surgery, without new general anesthesia. Other advantages and drawbacks of this technique are discussed.

Brain Neoplasms↗
PubMed1996

Lymphocytic infundibulohypophysitis presenting in the postpartum period: case report.

BACKGROUND: Lymphocytic adenohypophysitis is a well-known autoimmune disorder affecting the anterior pituitary gland. Posterior pituitary gland function can be impaired by a similar autoimmune disorder called lymphocytic infundibulohypophysitis. Only very few cases have been reported. CLINICAL PRESENTATION: We present a patient with central diabetes insipidus in the postpartum period. On radiologic and endocrine evidence lymphocytic involvement of the pituitary stalk and infundibulum was suspected. INTERVENTION: A diagnostic pterional craniotomy was performed. The diagnosis of lymphocytic infundibulohypophysitis was confirmed by biopsy. CONCLUSION: We present a case of lymphocytic infundibulohypophysitis. In view of its autoimmune pathophysiology the occurrence of this disorder in the postpartum period is not surprising, even though it has not been reported before. This rare disorder should be distinguished from the more common lymphocytic adenohypophysitis.

Adult↗
PubMed1996

Outcome of chronic subdural haematoma: analysis of prognostic factors.

Prognostic factors for the outcome of patients with a chronic subdural haematoma were analysed in a consecutive study of 260 patients, regardless of the method of neurosurgical treatment. CT findings such as haematoma volume, midline shift and residual subdural collections had no influence on the outcome. The only statistically significant factor of importance for the outcome of patients with chronic subdural haematoma was the neurological condition at the time of treatment. Early diagnosis is therefore of major importance.

Adolescent↗
PubMed1996

Aggressive pituitary macroadenoma: CT and MR appearances.

Two cases of aggressive pituitary macroadenoma (prolactinoma) with diffuse invasion of the skull base are described. Clinical signs usually appear late. CT shows the bone destruction, whereas MRI accurately delineates the extension of the tumor and involvement of the surrounding neurovascular structures. Histopathology and immunohistochemical staining are necessary for a definitive diagnosis differentiating prolactimonas from a wide range of skull base tumours and for deciding on additional therapy and prognosis. Aggressive pituitary macroadenoma is a large and diffuse tumor which is difficult to treat; therapy usually consists of extensive surgery, radiotherapy and pharmacotherapy with dopaminergic agents.

Adult↗
PubMed1996

[Spontaneous hematomas of the cerebellum over the age of 60 years].

We present a retrospective analysis of a consecutive series of 50 patients, over 60 years of age, with spontaneous cerebellar hematomas. Treatment was chosen on an individual basis : conservative treatment in 8 "benign" cases, craniotomy and/or ventricular drainage in the majority of cases (37), depending on the clinical presentation and the degree of hydrocephalus on CT scan, and surgical abstention in 5 moribund patients. The outcome at one month was studied and compared for different possible prognostic factors. Seventeen patients (34%) died, and three were in a vegetative state; they later died as a direct result of their initial cerebellar hemorrhage. At the latest follow-up, five other patients had also died, one due to cancer, and the others from cardiac causes. The obliteration of the basal cisterns, the volume of the hematoma, the absence of brain stem reflexes and the presence of coma were highly significant factors determining early mortality. The age of the patients, their estimated premorbid health and the degree of hydrocephalus were not significantly associated with fatal outcome. Intensive treatment for cerebellar hematomas, including suboccipital craniotomy, may be justified even in aged patients after careful selection.

Aged↗
PubMed1995

Magnetic resonance angiography of supratentorial tumours: comparison with selective digital subtraction angiography.

We compared magnetic resonance angiography (MRA) and intra-arterial digital subtraction angiography (IADSA) in the study of brain tumours and assessed the utility of gadolinium-enhanced MRA. We studied 17 patients with supratentorial brain tumors. The entire brain was imaged with multiple overlapping thin volume acquisitions. After IV injection of gadolinium-DTPA, a single thick-slab MRA acquisition was performed. Standard three-dimensional (3D-TOF) acquisitions (in six patients) and 3D-TOF with magnetization transfer prepulse and tilted optimisation nonsaturing radiofrequency excitation pulses (in 11 patients) were used. Displacement of the anterior cerebral artery, main stem and insular branches of the middle cerebral artery was seen well on unenhanced and contrast-enhanced MRA. Displacement of the lenticulostriate and anterior choroidal arteries was seen only once, after Gadolinium. Tumour encasement of the middle cerebral artery was demonstrated in one patient. Tumour vessels were seen in 2 of 8 cases before and 3 of 8 after gadolinium; Tumour hypervascularity was seen only after gadolinium, in 3 of 8 cases. Study of the veins was possible only on gadolinium-enhanced MRA. Displacement of the venous angle was seen in 4 of 7 patients in the frontal, and in all of 8 patients on the lateral projections. Early venous drainage was not seen. Patency of the dural venous sinuses was demonstrated in all patients, but in one neoplastic occlusion of a cortical vein was recognized.

Adult↗
PubMed1995

Coating of intracranial aneurysms: a long-term follow-up study of 34 cases.

We performed a retrospective follow-up study of 33 patients, with 34 ruptured aneurysms, treated by coating using bio-adhesive polymers. The rebleeding rate after a mean follow-up of 10 years was 18% (6 patients), with 4 cases of early haemorrhage and 2 late rebleedings (late rebleeding rate of 0.7% per year). All rebleedings proved fatal. Coating of the aneurysmal wall provides some protection in patients with "unclippable" aneurysms, but is obviously inferior to clipping, and should be used only in very selected cases.

Adolescent↗
PubMed1995

Chordoma of the lower cervical spine.

Vertebral chordomas are rather rare tumours, especially in the lower cervical region. We present a patient with a C7 vertebral body chordoma and a discussion of pertinent literature is given. Only three C7 chordomas have been reported previously. Diagnosis is sometimes difficult to establish and is based on radiological examinations. Once the histological diagnosis is available, one should aim at a total resection. If this is not possible, adjuvant radiotherapy should be given. For limited cervical lesions, we advise a corporectomy with fusion by an iliac crest graft and osteosynthetic plate stabilisation.

Cervical Vertebrae↗
PubMed1995

Transient cerebellar mutism after posterior fossa surgery in children.

Cerebellar mutism has been reported after surgery for posterior fossa tumors in children and, rarely, in adults. The pathogenesis of this syndrome remains unclear, and controversy exists regarding whether it is a purely psychogenic disorder or an organic syndrome. The anatomical substrate for the mutism also remains unknown. We encountered five cases of postoperative transient cerebellar mutism in a consecutive series of 63 children with posterior fossa tumors. These cases were analyzed and compared with the patients without mutism to find predictive factors for the occurrence of mutism, with the hope of elucidating further the pathophysiological mechanism. The most significant finding was the presence in all cases of a period of cerebellar dysarthria after resolution of the muteness. We, therefore, believe that cerebellar mutism is an extreme form of dysarthria, rather than a real cognitive deficit or a psychological disturbance.

Adolescent↗
PubMed1995

Neurocysticercosis: a poorly understood disease.

A 22-year-old male patient of Indian origin presented with generalized seizures. Brain magnetic resonance imaging (MRI) showed two cystic lesions. Extensive screening only revealed positive skin tests for tuberculosis. Immunoassays for cysticerosis were negative in serum and cerebrospinal fluid. Biopsy of the temporal lesion revealed a cysticercus. Although neurocysticercosis is a common cause of seizures in patients from countries where cysticercosis is endemic, the diagnosis can be difficult in a patient with evidence of multiple infections or in whom serological evidence is lacking, as is illustrated by the present case. Furthermore, because the pathogenic factors determining the activity of the disease are poorly understood, its management represents a similar problem as it depends upon the activity of the disease as estimated by clinical, radiological and laboratory tests. The present case report illustrates these difficulties.

Adult↗
PubMed1995

Long-term results after anterior cervical fusion and osteosynthetic stabilization for fractures and/or dislocations of the cervical spine.

This study presents the 5-9-year follow-up after anterior cervical fusion and osteosynthetic stabilization anterior plating for fractures and/or dislocations of the cervical spine in 25 patients. Adequate bony fusion was obtained in all patients within 1 year postoperatively. There were no problems of late screw loosening. Fracture of the osteosynthetic plate occurred in one patient. Late degenerative changes of the cervical spine at the disc levels adjacent to the fusion area were radiologically detected in 15 of the 25 patients (60%) and were related to the following situations: fusion on more than one disc level, fusion on a lower cervical segment, Frankel class A-C at admission, and hyperflexion injuries. However, these late degenerative changes had no subjective or clinical repercussions, at least until now. From a neurological point of view all patients remained stable postoperatively and no patients had late deterioration.

Adolescent↗
PubMed1994

Neurological outcome after surgery for thoracolumbar fractures. A retrospective study of 93 consecutive cases, treated with dorsal instrumentation.

Surgical reconstruction and fusion form the treatment of choice for unstable thoracolumbar fractures. It remains difficult, however, to prove that surgical treatment provides an increased potential for neurological recovery. Also, the role of a decompressive laminectomy is still unclear. To address these issues, 93 consecutive cases of thoracolumbar fractures treated with dorsal instrumentation were reviewed. The neurological status at the time of admission and at a mean of 26 months postinjury was graded according to a modified Frankel scale. By using preoperative radiographs and computed tomography scans, we differentiated between fracture-dislocation lesions, dislocation lesions, flexion-distraction lesions, complete and incomplete burst fractures. Spinal stenosis was classified from grade 0 (no stenosis) to grade 3 (> 66% stenosis). All thoracolumbar fractures were treated with posterior instrumentation, using Dick's fixateur interne and Steffee's VSP plates and screws. During this procedure, laminectomy was performed in 33 patients (35%). In 17 cases (52% of the laminectomies), a surgically treatable lesion (dural tear, trapped nerve root, etc.) was found, especially in patients with a combination of a neurological deficit and a dislocation lesion, a fracture-dislocation lesion or a complete burst fracture with spinal stenosis grade 2 or 3. The neurological and functional outcome was excellent: none of the patients deteriorated, 68% made a complete neurological recovery, and 61% regained their previous level of activity.

Adult↗