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Biomedical subjects

C Thurel

Publications and source records attributed to C Thurel.

At least 19 recordsLinked to original sources

Cerebral vasodilation after the thermocoagulation of the trigeminal ganglion in humans.

The resulting changes in the regional cerebral blood flow of 18 patients suffering from idiopathic trigeminal neuralgia and treated by selective thermocoagulation of the trigeminal ganglion were measured by xenon-133 emission tomography. One hour after thermal stimulation, there was an asymmetric increase (P < 0.05) in cerebral blood flow, with a 14.7% mean increase in the ipsilateral cerebral hemisphere (P < 0.001) and a 12.7% mean increase in the contralateral side (P < 0.01). The increase in regional cerebral blood flow was not uniform but was most marked in the ipsilateral middle cerebral artery territory (P < 0.001). There was a slight decrease in cerebellar blood flow, but the reduction in the ipsilateral cerebellar lobe was less than that in the contralateral lobe (P < 0.01). The topography of the most significant changes coincided with that of the innervation of the cerebral vessels by the trigeminal nerve. Several mechanisms are involved in the increase in regional cerebral blood flow, including overall nonspecific activation of the central nervous system and local mechanisms associated with the trigeminal-vascular system.

Adult

Levels of morphine and metabolites in CSF during respiratory depression after intraventricular morphine injection.

We report a case of respiratory depression after intracerebroventricular morphine administration of a dose inadvertently 10 times greater than the typical daily dose. At the time of the respiratory dysfunction, the concentrations of morphine and its metabolites in cerebrospinal fluid (CSF) and plasma samples were determined. On comparison of these results with previous clinical studies in which there was no respiratory depression, no relationship was found between the occurrence of respiratory depression and the concentration of morphine or its metabolites in the CSF. The occurrence and characteristics of respiratory depression may be related to the concentrations of morphine and its metabolites in bulbar tissue.

Adenocarcinoma

Primary lymphoma of the central nervous system. An unresolved therapeutic problem.

From January 1979 to December 1987, 35 cases of primary central nervous system lymphoma (CNS-L) were treated. We recently reviewed these cases focusing on treatment results, treatment modalities, and radiotherapy (RT) or chemotherapy-radiotherapy (CT-RT). Variables such as age, risk factors, presenting symptoms, and histologic condition (all were high-grade or intermediate-grade non-Hodgkin's lymphomas [NHL]) and radiologic data were similar to those of series reported previously. The median survival time was 36 months (+/- 0.2 months) and the disease-free survival (DFS) time was 16 months (+/- 0.12 months). Twelve of 32 patients evaluable for treatment results experienced a recurrence (all but one occurred in the CNS). The DFS rate was 70% for the CT-RT group and 50% for the RT group (median follow-up time, 24 months). Therapeutic results in CNS-L are discussed with special emphasis on a putative role of CT in the management of this rare type of tumor.

Adolescent

Stereotactic biopsy diagnosis of primary non-Hodgkin's lymphoma of the central nervous system. A histological and immunohistochemical study.

We report 29 cases of primary non-Hodgkin lymphomas (NHL) of the Central Nervous System (CNS), 26 of which were diagnosed by stereotactic biopsy and 3 by autopsy. In seven cases the patients were affected by AIDS. Histological examination of this series revealed 15 cases of immunoblastic lymphoma, 12 cases of centroblastic lymphoma, 1 case of lymphoplasmacytic immunocytoma and 1 case of unclassified high grade lymphoma. By immunohistochemistry the B-cell origin of lymphoma cells was demonstrated in 28/29 cases. Eight cases were assigned to the B-cell lineage by demonstration of monotypic surface or cytoplasmic immunoglobulin or of the B-cell phenotype CD22+, CD2-, CD3-, CD5-. In twenty cases the B-cell nature of lymphoma was identified by positivity with two or more anti-B monoclonal antibodies (LN1LN2MB2) and negativity by the anti-T monoclonal antibody UCHL1. The histologically unclassified case was a peripheral T-NHL (CD1-, CD2+, CD3-, CD5+, CD22-). We conclude that histological and immunohistological evaluation of stereotactic biopsy specimens provides sufficient information for diagnosis and phenotypic characterization of primary NHL of the CNS. These lymphomas exhibit important predominance of high-grade malignancy histological types and are nearly always B-cell derived. In addition, we provide further evidence that the panel of monoclonal antibodies LN1, LN2, MB2, and UCHL1 is useful for immunophenotypic characterization of brain lymphomas when only paraffin embedded stereotactic biopsy tissue is available.

Adult

Esthesioneuroblastoma with intracranial extension.

The authors present five cases of olfactory neuroblastoma with intracranial extension operated on in the Department of Neurosurgery in collaboration with otorhinolaryngologists. This tumor is most frequently reported as growing inside the nasal cavities, and it can extend to the paranasal sinuses. Cases presenting initially as intracranial tumors have been infrequently reported. At present, histological diagnosis of this tumor is aided by the use of electron microscopy and immunocytochemistry. Total resection combined with radiation therapy remains the most satisfactory treatment.

Adolescent

[Treatment of intractable pain in ORL cancer].

Numerous effective treatments are available to relieve the intractable pain of terminal E.N.T. cancers when aetiological therapies are no longer of any use. These treatments must be prescribed as a progressive therapeutic scale ranging from analgesics, and notably morphine which remains the basic drug, to the classical or stereotactic surgical operations. To these must now be added other routes of administration of morphine (e.g. intraventricularly) which in some cases give unexpected results.

Humans

[A neurosurgeon's point of view on lumbago].

Low back pain is an important health and economic problem which plagues a large segment of the population of industrialized countries. Etiologic theories based upon tissue damage, and therapeutic measures aimed at eliminating a presumed noxious stimulus are often not efficacious. There is considerable evidence that social and psychological factors play a major role in the symptom complex known as "Low Back pain".

Adult

[Effects of delayed-action tetracosactide on chronic pain].

Beta 1-24 corticotrophin was the object of an open trial in the "acute" treatment of chronic pain in 22 patients. The analgesic effect of the drug was assessed before and after two weeks of treatment by means of 3 subjective tests: visual analogue scale, numeric scale and Mac Gill pain questionnaire. The results were statistically significant (P less than 0.01). They confirmed that slow-release tetracosactide exerts a beneficial effect on the sensory-discriminative and affective-emotional components of pain. The drug may be prescribed for short periods (1 to 2 weeks) to patients with chronic pain refractory to the usual treatments. Its analgesic effect is immediate and enables a conventional treatment to be instituted.

Chronic Disease

Pre-operative embolization of naso-pharyngeal angiofibromas. Report of 58 cases.

58 patients with a juvenile nasopharyngeal angiofibroma have been treated by a combined neuroradiological-surgical method. In the cases with smaller tumor extension, fed only by the external carotid arteries or with only slight participation of the internal carotid arteries, the external carotid arteries alone have been embolized using particles. In the cases with marked participation of the internal carotid arteries these vessels were also embolized. In the first group there have been no complications and no recurrences. In the latter (31 cases) there have been three temporary minor complications and 11 recurrences.

Adolescent

[Tympanic and jugular paragangliomas. I. Clinical symptomatology and evaluation of extension. Apropos of 25 cases].

Based on a review of 25 cases of tympanic and jugular paragangliomas treated and followed up in the Lariboisière hospital, Paris between 1978 and 1986, clinical aspects and extension of these tumors are studied. The often long delay in making the diagnosis is related to lack of knowledge of presenting symptomatology, frequent discordance between functional and physical symptomatology exists, but remarkable progress has been made in assessment of extension of tumors using new imaging techniques, particularly angiography, which can also guide the preoperative embolization and surgical procedures.

Adult

[Tympanic and jugular paragangliomas. II. Angiographic, surgical and irradiation treatment. Results. Indications. Apropos of 25 cases].

Results of treatment are reviewed in 25 cases of tympanic and jugular paragangliomas treated and followed up in the Lariboisière hospital, Paris between 1978 and 1986. Therapy has been transformed by the use of embolization but its non-negligible neurologic accident risks, whatever the carotid artery territory involved, justify prior weighing of indications for its application. New surgical technics allow more extensive exeresis, but intrapetrous extension to the nerve compartment of the jugular foramen and the anterior pericarotid region still raises difficult surgical problems and appears to be the principal reason for failure of treatment. Radiotherapy is very effective and applicable for inoperable forms, as a complement to incomplete surgical removal and for recurrences.

Cerebral Angiography