Biomedical subjects
Publications and source records attributed to F Alvarez.
Two cases of Hodgkin's disease are described; one was intracerebrally located and the other one extended to bone, dura mater and cerebral parenchyma. The classification of the different types of intracranial Hodgkin's disease is reviewed, and the role of Computed Tomography and surgery in the management of this pathology is emphasized.
A case of cerebral gumma is reported. The appearance of this kind of lesion is exceptional at the present time. Gummas are the expression of localized meningovascular forms of neurosyphilis and their clinical symptoms and signs are similar to those of any other space-occupying intracranial lesion. Computed tomography scan showed a ring-enhancing lesion with intense cerebral edema. A criticism of computed tomography features of the reported cases in the literature is carried out. Surgical excision, whenever possible, is the treatment of choice since it achieves the removal of the mass and its histologic verification.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The paper reports two cases of supratentorial neuroepithelial cysts, also called ependymal cysts. One of them was extracerebral and the other intracerebral. The preoperative diagnosis was made by determination of attenuation values of consecutive sections of cyst on computed tomography. The ultrastructure of the cyst wall was studied in one case. Other problems dealing with these rare lesions are discussed.
A group of 112 patients affected by cerebral arteriovenous malformations is reviewed. Sixty-six per cent of the cases presented with subarachnoid hemorrhage. Epilepsy was the main clinical feature in 20% of the cases. In 45 cases an intracerebral or intraventricular hematoma was diagnosed by CT-scan, angiography or was found during surgery. Seventy cases (62.5%) were operated upon and 42 cases were treated conservatively. In 57 operated cases, total excision of the AVM was confirmed by postoperative angiography. In this group there was no rebleeding during the follow-up period. Other 13 cases were submitted to partial excision of the AVM or clipping of the feeding vessels. In this latter group, 2 patients had later subarachnoidal rebleeding. Operative mortality was 11% in this series. Mortality caused by the AVM in the non-operated group was 20%. Comparing the morbidity in both groups, the operated group had a much better clinical evolution than the non-operated one. Regarding the final clinically results, an abnormal state of consciousness before surgery, a large size of the AVM and the presence of intracerebral hematoma appear to have a bad prognosis significance.
The retrospective analysis of 201 children who presented with portal hypertension and were investigated by esophageal endoscopy provides the following results : 1) esophageal varices were present in 90% of the children examined; 2) the hemorrhagic risk is much higher in children with extra hepatic portal obstruction (gastrointestinal bleeding occurred in 80% of these children) than in children with intrahepatic or postsinusoidal portal hypertension (29%); 3) endoscopic signs of major portal hypertension such as tension of varices and/or congestion of the esophageal mucosa were present in virtually all children who experienced one or more episodes of gastrointestinal bleeding; 4) esophageal or gastric lesions not related to varices were responsible for bleeding in 6 children; 5) gastric varices were present in 21 of 105 children in whom a thorough gastric endoscopy was carried out; 6) partial or complete regression of varices occurred in 11 of 27 children in whom several endoscopies were performed with a follow-up of 9 months to 6 years; complete regression occurred only when varices were of small size; 7) measures used to prevent gastrointestinal bleeding in children with varices often failed when endoscopic signs of major portal hypertension were present. These results confirm the major importance of eso-gastric endoscopy in the investigation of children with portal hypertension and suggest that porto-systemic surgical shunts should be considered in children who experience at least one spontaneous episode of gastrointestinal bleeding provided the responsibility of varices is ascertained by endoscopy.
From the retrospective study of 47 children who presented with portal hypertension and gastro-intestinal bleeding before 3 years of age, the following conclusions can be drawn: 1) The cause of portal hypertension was extrahepatic portal obstruction in 35 children, cirrhosis in 10 and congenital hepatic fibrosis in 2. 2) Endoscopic signs of major portal hypertension were present in 26 of 27 children in whom a thorough endoscopic examination was carried out. 3) Most children experienced several episodes of bleeding. One or several hematemeses occurred in 36 children, one or several episodes of melaena in 23, one or several proctorrhagia in 5 and anemia alone in 2. Two children with liver failure died during a gastrointestinal bleeding episode. 4) Transthoracic direct ligation of esophageal varices was performed in 8 children ; all but one experienced one or more episodes of bleeding within one year after surgery. One child died during one of these episodes. 5) A surgical portosystemic shunt was carried out in 37 rated on before the age of 3. Shunts were successful in 7 of 11 children who were ope children. Patency of the shunt was demonstrated in 32. These results show that early shunt surgery can provide a permanent solution to the life-threatening problems of gastrointestinal bleeding in young children with portal hypertensions.
The retrospective study of 115 children in whom a successful portosystemic shunt was carried out for portal hypertension, provides the following conclusions: 1) Patency of the shunt must be checked by esophageal endoscopy, six months postoperatively. A patent shunt can be expected when the size of the spleen and/or thrombocytopenia improve in the early post-operative period. Early ultrasound examination is also very useful in that respect. 2) None of the children with extrahepatic portal vein obstruction or congenital hepatic fibrosis presented with clinical signs of portal systemic encephalopathy (PSE). 3) Eight of 30 children with cirrhosis presented with one or more clinical episodes of PSE. Some were transient allowing for a normal diet to be resumed later on. 4) It is thus advisable to give children with cirrhosis a low protein diet in the months after surgery. Protein content of the diet can usually be increased progressively over a period of one to two years. 5) Whenever splenectomy is necessary, it is mandatory to prevent pneumococcal infections with the pneumococcal vaccine and daily treatment with oral penicillin.
Explore the source record for details and available documents.
We describe a 12 year-old patient that relapsed into fulminant non A, non B, non C (NANBNC) hepatitis 10 weeks post-clinical recovery. A complete clinical and pathological evaluation, including an ultra-structural examination of a liver biopsy was consistent with the diagnosis of NANBNC hepatitis. The patient relapsed into hepatic failure and required transplantation. NANBNC hepatitis may have a relapsing form that can lead to hepatic failure requiring transplantation. Consultants in hepatology should have a high degree of clinical awareness and maintain prolonged patient follow-up.