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Biomedical subjects

E Emery

Publications and source records attributed to E Emery.

34 records · Page 2Linked to original sources
PubMed1998

[Correlations between clinical deficits, motor and sensory evoked potentials and radiologic aspects of MRI in malformative syringomyelia. 27 Cases].

Twenty-seven patients (15 males, 12 females, age range: 16-66 years) were admitted for malformative syringomyelia diagnosed on MRI with measures of syrinx extending and transverse diameter. Posterior tibial somatosensory evoked potentials (PT SEP), median (M SEP), trigeminal (V3 SEP), brain stem auditory evoked potentials (BEAP), cortical and cervical motor evoked potentials (MEP) were correlated with clinical and radiological findings. SEP abnormalities were not correlated with the duration of symptoms. PT SEP proved to be more sensitive than M SEP. MEP abnormalities were very frequent (87% of the cases), even without clinical motor deficits. Trigeminal SEP were more sensitive than BEAP which were not related to the presence of associated cranio-vertebral abnormalities. We found no significative relationship between clinical and radiological results. Moreover, there was a positive relationship between electrophysiological and radiological results: abnormal trigeminal SEP were detected in 85% of the patients with high cervical syringomyelia. In all cases, trigeminal SEP and MEP should be done in association with M and PT SEP as both of them detect subclinical evidence of spinal cord dysfunction in syringomyelia.

Adolescent↗
PubMed1998

Apoptosis after traumatic human spinal cord injury.

OBJECT: Apoptosis is a form of programmed cell death seen in a variety of developmental and disease states, including traumatic injuries. The main objective of this study was to determine whether apoptosis is observed after human spinal cord injury (SCI). The spatial and temporal expression of apoptotic cells as well as the nature of the cells involved in programmed cell death were also investigated. METHODS: The authors examined the spinal cords of 15 patients who died between 3 hours and 2 months after a traumatic SCI. Apoptotic cells were found at the edges of the lesion epicenter and in the adjacent white matter, particularly in the ascending tracts, by using histological (cresyl violet, hematoxylin and eosin) and nuclear staining (Hoechst 33342). The presence of apoptotic cells was supported by staining with the terminal deoxynucleotidyl transferase-mediated deoxyuridinetriphosphate nick-end labeling technique and confirmed by immunostaining for the processed form of caspase-3 (CPP-32), a member of the interleukin-1beta-converting enzyme/Caenorhabditis elegans D 3 (ICE/CED-3) family of proteases that plays an essential role in programmed cell death. Apoptosis in this series of human SCIs was a prominent pathological finding in 14 of the 15 spinal cords examined when compared with five uninjured control spinal cords. To determine the type of cells undergoing apoptosis, the authors immunostained specimens with a variety of antibodies, including glial fibrillary acidic protein, 2',3'-cyclic nucleotide 3'-phosphohydrolase (CNPase), and CD45/68. Oligodendrocytes stained with CNPase and a number of apoptotic nuclei colocalized with positive staining for this antibody. CONCLUSIONS: These results support the hypothesis that apoptosis occurs in human SCIs and is accompanied by the activation of caspase-3 of the cysteine protease family. This mechanism of cell death contributes to the secondary injury processes seen after human SCI and may have important clinical implications for the further development of protease inhibitors to prevent programmed cell death.

Adolescent↗
PubMed1997

Syringomyelia and Arnold Chiari in scoliosis initially classified as idiopathic: experience with 25 patients.

The authors analysed the clinical and radiological findings and the surgical management of 25 patients admitted for scoliosis classified as idiopathic at first presentation, but in fact associated with spinal cord and/or brain stem anomalies. Twenty patients had syringomyelia, 19 had Chiari malformation. Scoliosis was the only presenting symptom when all these patients were referred to the orthopaedic surgeon. On examination, five patients had normal neurological findings, while the others showed very mild neurological deficits. The diagnosis of syringomyelia and Chiari malformation was established by MRI, which is the best form of neuroradiological examination for discovering spinal abnormalities. Neurosurgical treatment is strongly recommended as the first step in the management of "pseudo" idiopathic scoliosis.

Adult↗
PubMed1997

Microsurgical DREZotomy for pain due to brachial plexus avulsion: long-term results in a series of 37 patients.

The authors analyzed the postoperative and long-term results of the microsurgical DREZotomy procedure performed in 37 patients suffering from chronic pain due to brachial plexus avulsion. The evaluation was based on clinical parameters. The immediate results consisted of good pain relief (pain relief > 75%) in 79% of the patients. A long-lasting good pain relief has been achieved in 66.5% of the patients with a mean follow-up of 60 months (range 12-120). The morbidity rate was 5%.

Adolescent↗
PubMed1997

[Motor reconnection between the damaged cervical cord and the denervated biceps muscle using an autologous peripheral nerve segment in the adult marmoset].

Our research group is studying, in the primate (marmoset), the conditions of an anatomical and functional reconstruction of the spinal cord and of its motor connections, following a focal spinal lesion. In this attempt to repair the damaged neuronal circuitry, we used long segments of autologous peripheral nerves joining the injured cervical spinal cord to an aneural region of the denervated biceps brachialis muscle (7 marmosets) or to the musculocutaneous nerve (6 marmosets). After retrograde tracing (HRP) and histochemical studies of the muscle, we found that a great number of neurons, located mostly in the ventral part of the grey matter extended axons into the peripheral nerve graft. Some of these labelled neurons were motoneurons, which could established functionnal neuromuscular junctions. The muscle regeneration was effective but slower than already known in rat studies.

Animals↗
PubMed1997

[Post-traumatic reconnection of the cervical spinal cord with skeletal striated muscles. Study in adult rats and marmosets].

In an attempt at repairing the injured spinal cord of adult mammals (rat, dog and marmoset) and its damaged muscular connections, we are currently using: 1) peripheral nerve autografts (PNG), containing Schwann cells, to trigger and direct axonal regrowth from host and/or transplanted motoneurons towards denervated muscular targets; 2) foetal spinal cord transplants to replace lost neurons. In adult rats and marmosets, a PNG bridge was used to joint the injured cervical spinal cord to a denervated skeletal muscle (longissimus atlantis [rat] or biceps brachii [rat and marmoset]). The spinal lesion was obtained by the implantation procedure of the PNG. After a post-operative delay ranging from 2 to 22 months, the animals were checked electrophysiologically for functional muscular reconnection and processed for a morphological study including retrograde axonal tracing (HRP, Fast Blue, True Blue), histochemistry (AChE, ATPase), immunocytochemistry (ChAT) and EM. It was thus demonstrated that host motoneurons of the cervical enlargement could extend axons all the way through the PNG bridge as: a) in anaesthetized animals, contraction of the reconnected muscle could be obtained by electrical stimulation of the grafted nerve; b) the retrograde axonal tracing studies indicated that a great number of host cervical neurons extended axons into the PNG bridge up to the muscle; c) many of them were assumed to be motoneurons (double labelling with True Blue and an antibody against ChAT); and even alpha-motoneurons (type C axosomatic synapses in HRP labelled neurons seen in EM in the rat); d) numerous ectopic endplates were seen around the intramuscular tip of the PNG. In larger (cavitation) spinal lesions (rat), foetal motoneurons contained in E14 spinal cord transplants could similarly grow axons through PNG bridges up to the reconnected muscle. Taking all these data into account, it can be concluded that neural transplants are interesting tools for evaluating both the plasticity and the repair capacities of the mammalian spinal cord and of its muscular connections.

Animals↗
PubMed1996

[Neurosurgical aspects of Rendu-Osler disease. Apropos of 6 recent cases and review of the literature].

Six patients with neurological complications in Rendu-Osler-Weber disease were reviewed. There were 4 patients (3 int the same family) with a brain abscess, one patient with a brain abscess and a spinal cord subarachnoid hemorrhage, one patient with a recurrent intracerebral hemorrhage due to a vascular malformation. The infectious complications are related to the presence of pulmonary arterio-venous fistula, which should be treated, whenever diagnosed. Because of the potentially severe outcome of these neurological complications of the Rendu-Osler-Weber disease, screening of the patient's relatives is highly recommended.

Adult↗
PubMed1995

Fracture of the occipital condyle: case report and review of the literature.

Fracture of the occipital condyle is a rare injury that can be easily overlooked. We report a patient with an occipital condyle fracture who presented with pyramidal syndrome and normal plain radiographs. The diagnosis was made by high-resolution computed tomographic scanning with sagittal and coronal reconstructions and magnetic resonance imaging. Surgical treatment was deferred because of spontaneous recovery. This fracture should be considered whenever a trauma patient presents neck pain and plain cervical spine radiographs show no abnormalities.

Adult↗
PubMed1994

[Respective indications of orbital and/or zygomatic arch removal combined with fronto-pteriono-temporal approaches. 58 cases].

Orbito- and or zygomatic arch removal associated to fronto-pteriono-temporal craniotomy can be useful to minimize brain retraction and achieve optimal exposure with the shortest possible distance and the most adequate view angle, in the approa-ch of difficult lesions located in the vicinity of the skull base via a supratentorial route. Fifty-eight patients admitted for such difficult lesions were operated on by the authors between 1988 and 1993 using orbital and/or zygomatic removal. Mortality rate was 1,7%. Complications due to orbital and/or zygomatic removal amounted at 15%, but were mostly transient. Sequels owned to excessive brain retraction were less than 10%. No bony cosmetic sequel was observed. From this experience, the authors suggest the respective indications orbit-zygomatic: removal for access to the cavernous sinus, supra-sellar region, tentorial notch, inter-peduncular cistern; simple orbital arch removal for access to complex aneurysms of the anterior circulation, to mesio-temporal lesions; simple zygoma arch removal for approaching infra-temporal lesions, the Meckel's cave, the circumpeduncular cistern and aneurysms of the P2 portion of the posterior cerebral artery.

Adult↗
PubMed1994

[Intraspinal hemangioblastoma. Apropos of a recent series of 20 cases].

This report deals with a series of 20 patients admitted for a spinal hemangioblastoma between 1970 and 1993, 18 of whom between 1978 and 1993. There are 8 men and 12 women and the onset of spinal symptoms is before the age of 50 years for 76% of the patients. Nineteen patients have an intra-dural tumor (extramedullary 15.5%, intramedullary 75% with 62.5% close to the dorsal surface, 37.5% partly out, none totally enclosed with spinal cord) and only one patient has an extra-dural tumor. Cysts are present in 70% of our cases. Two cases have been revealed by an hemorrhagic syndrome. Ten cases belong to a von Hippel-Lindau (vHL) disease. Nineteen patients were operated on, one patient died. Total resection of the tumor was performed in 17. Symptoms improved postoperatively in 8 patients, were inchanged in 6, and worsened temporary in 4. MRI with gadolinium is the best procedure for both the diagnosis and the follow-up. After surgery, the prognosis is very good for sporadic cases with a single spinal lesion whereas it is very poor in case of vHl disease. For these patients (50% of our cases), half of them died because of the evolution of multifocal lesions even if they were operated on several times. Thus, each patient should have a precise check-up (SNC and visceral lesions). The gene causing vHL disease located on the short arm of the chromosome 3 has just been characterized. This will help to elaborate a presymptomatic diagnosis and a better screening of the patients with the hope of a specific treatment.

Adolescent↗
PubMed1993

Randomised controlled trial of albumin infusion in ill preterm infants.

We assessed the effect of albumin infusion on weight loss and ventilation requirement in sick premature infants. Thirty infants, median gestational age 29 weeks, were entered into a randomised controlled trial, at a median of 2 days of age. The infants, all with an albumin level < or = 30 g/l, received either 5 ml/kg of 20% albumin or 5 ml/kg of their maintenance fluids (placebo), both given as part of the total daily fluid requirement. The response to the infusion was assessed by comparing two periods; 12 h immediately prior to the infusion and 12-24 h after the infusion. Albumin infusion was associated with a significant increase in albumin level and a significant reduction in weight, but in the placebo group there was a significant increase in weight. There were, however, no significant changes in the peak inspiratory pressure in response to either infusion. There was only a modest reduction (< 15%) in the inspired oxygen concentration, which occurred in both groups, but reached statistical significance only following the albumin infusion. We conclude that our results suggest that albumin infusion in "hypoalbuminaemic" sick preterm infants is unlikely to alter their respiratory status.

Albumins↗
PubMed1993

[Epidermoid cyst of the 4th ventricle. Apropos of a case in a child and review of the literature].

A 6 year-old child was admitted for a recurrent bacterial meningitis at Proteus Morganii. She was treated with antibiotics. The C.T. Scanner showed a midline low-density lesion, with a mild annular contrast uptake in the posterior fossa. M.R.I. showed the lesion and revealed a skin-bone-dura fistula. The surgical resection was complete. It was an epidermoid tumor. Intracranial epidermoid tumors constitute about 1% of brain tumors and are considered to be congenital. Epidermoid tumors of the 4th ventricle are exceedingly rare in childhood. The authors reviewed the literature and discuss the pathogeny, the radiographic diagnosis and the treatment of these tumors.

Brain Diseases↗
PubMedDate not supplied

[Technic of partial splenectomy with linear stapler instrument (TA 90, U.S., Surgical Corps].

Seven patients have been treated by partial splenectomy, performed with TA 90 linear stapler instrument (U.S. Surgical Corp). Three patients had non parasitic cyst of the spleen, two had malignant disease and two were operated for traumatic injuries. The section and the hemostasis of the spleen was performed with the linear stapler instrument. No patient required blood unit transfusion. Postoperative course was uneventful. Partial splenectomy with the TA 90 stapler, which does not supply the complications of total splenectomy, is an easy and safe procedure. It should be more often indicated.

Colonic Neoplasms↗