Search PubMed⌕ Search

Biomedical subjects

J Benezech

Publications and source records attributed to J Benezech.

At least 37 records · Page 2Linked to original sources
PubMed1986

[Panmedullary ependymoma with complete excision in several stages. Apropos of a case].

Treatment of a panmedullary ependymoma involved a three-stage operation with total excision under microscopic control and the use of the Cavitron. The patient, a 22 year old woman, presented with a three-year history, with clinical onset of staged spinal pain and cervicobrachial neuralgia, of spasmodic paraparesis with sensory and sphincter disturbances. The extent of the lesion from C3 to L2 was determined from data from conventional myelography with Iopamiron, a CT scan with intrathecal contrast and nuclear magnetic resonance imaging of sagittal and frontal sections. The tumor, a grade I ependymoma, was treated by three-stage laminectomies (L2-T12, T12-T3, T3-C3), total excision being obtained by ultrasound fragmentation (Cavitron). Gross pathology showed a heterogeneous appearance with two cysts, one capping the tumor from the bulbospinal junction to C3, the other attached to the medullary cone. Hemorrhagic cavities were noted at cervicothoracic region and multiple microcysts in the dorsal expansion. The postoperative course was uneventful with recovery of walking wearing a bivalve acrylic corset, the most disturbing functional complication being the posterior cord syndrome responsible for an ataxia.

Adult↗
PubMed1985

Intraventricular tumors in tuberous sclerosis.

Eleven of our own cases of tuberous sclerosis with intraventricular tumor and 34 cases from the literature are reviewed. Initial symptoms and identification of tuberous sclerosis and tumor are reviewed. Results of surgical treatment, including direct radical excision and shunting are given. On gross examination, the tumor was most often loosely connected to ependyma near the foramen of Monro, causing hydrocephalus. Giant cell subependymal astrocytoma was frequently found on microscopic examination. The glial origin of the tumor is discussed and direct surgical approach of the tumor is proposed as the best treatment of these lesions.

Adolescent↗
PubMed1985

[Lumbar cord potentials evoked by stimulation of the nerves of the lower limb in man].

Lumbar cord potentials evoked by electrical stimulation of the posterior tibial and sural nerves at the ankle were recorded with monopolar epidural electrodes, at T11-T12 level in 20 subjects and were compared with surface recorded potentials. Two quadriplegic patients with spinal section were included in this group. Curare was given in two cases. Xylocaine block of peripheral nerve was carried out in 4 cases. Double shock study was done in 5 cases. The lumbar cord evoked potentials show two successive components: a 'primary' negative-positive spike response with a latency of 19-35 msec, and the 'secondary' waves with latencies up to 200 msec. The 'primary' response is mainly produced by the afferent volley in the fibres of the dorsal roots and of their intramedullary prolongations. There is no evidence which suggests that it is correlated with presynaptic inhibition. The secondary components may be divided into the early and the late waves. The early waves (40-90 msec) are related to the polysynaptic activities from the afferent fibres of small diameters. The late waves are under the influence of supraspinal mechanism and may be related to long-loop reflexes. The clinical implications of these evoked potentials are discussed.

Adult↗
PubMed1985

[Osteosynthesis of the low lumbar spine and spondylolisthesis. Modification of the Scholner plate and pedicular screwing].

A modification of Roy Camille's Technic for better screw location into the pedicle of vertebra of the low lumbar column and lumbo-sacral junction is reported. A small 5 millimeters resection of the inferior articular process allows a more cranial drill-hole which is more steadily in the pedicle of the vertebra as confirmed by X rays controls and anatomic specimens. A 10 degree slope to a caudal direction is needed at the L5 level and a 30 degree slope to a caudal direction is required at S1 level. 50 millimeters length screw can be used for adult patients. Some modification of Scholner's plate are proposed in spondylolisthesis surgery.

Bone Plates↗
PubMed1985

[Functional neurosurgery of cerebral palsy].

In 1983, approximately 40 000 patients in France and 5 760 patients in Switzerland suffered from cerebral palsy, representing more than 0.1% of their respective populations. The functional disability of these patients is particularly impressive and emphasizes the medical, social and economic importance of this problem. The term cerebral palsy is restricted to non-progressive disorders of motor function, already observed at an early age and due to cerebral lesions. These motor disorders can be of paretic, dystonic and dyskinetic nature. Their epidemiology, classification, etiology, pathology, early diagnosis and evolution are extensively reviewed by Th. Deonna. The difficulty in evaluation of treatment is the absence of a generally accepted rating scale. G. Broggi has proposed one on the basis of a large experience which could serve in the future for more objective evaluation. This monograph is devoted to the functional neurosurgical treatment of cerebral palsy. Physiotherapy and rehabilitation are part of the basic treatment of cerebral palsy, and must be continued after any neurosurgical treatment. Various conservative methods of treatment and their neurophysiological rationale are mentioned by P. Claverie. Some technical devices which improve the neurological deficits and facilitate rehabilitation are presented. Radiculotomies and neurotomies are probably the oldest neurosurgical operations for the treatment of spasticity. The neurophysiological and neuroanatomical basis of this therapeutic approach are treated in the review of the material from the neurosurgical department of Montpellier. Sixty cases were collected and the results analysed according to the type of operation (posterior radiculotomy, anterior radiculotomy, mixed) performed. Stereotactic thalamotomies and subthalamotomies are believed to be the best neurosurgical method to treat the tremor and improve other dyskinesias and hyperkinesias. The technique and a personal review of 49 cases of cerebral palsy are presented. The long-term follow-up in this study demonstrates that this type of operation markedly improves the functional disability of patients with moderate hyperkinesias, moderately improves patients severely affected, but also demonstrates that possible side effects cannot be ignored. Review of the literature indicates the difficulty in interpretation of results due to a lack of objective evaluation. Nevertheless, stereotactic thalamotomy can still be recommended when tremor and rigidity are the most prominent symptoms. Stereotactic dentatotomies in the treatment of spasticity were very popular 20 years ago, but have been largely forgotten for nearly a decade.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1985

[Iatrogenic carotid-cavernous fistulas, complications of carotid thrombectomy].

The authors report four cases of carotid cavernous fistula at the C5 segment of the internal carotid artery following embolectomy by a 3F Fogarty Catheter. All patients were operated on a carotid bifurcation stenosis (pre-occlusive) and a thrombectomy with a 3F Fogarty Catheter was carried out in the same time in 3 patients and during re-operation in 1 patient who had post operative thrombosis. The carotid-cavernous fistula occurred the day after surgery in 2 cases, 1 week after in 1 case, and 2 months later in 1 case. Spontaneous recovery occurred in two patients (1 occlusion--1 re-stenosis), 1 patient died from controlateral carotid occlusion, and 1 patient was lost for investigation. There were no relationship between the number of "repeated passages" of the Fogarty Catheter and the interval time where the fistula occurred. However the location of fistula was constant. Overtension on the internal wall of the artery by the balloon could be advocated rather than a collateral torn of the intra cavernous internal carotid. Endoluminal treatment of various vascular lesion is increasingly used and iatrogenic problems as reported here should be kept in mind. Age and atheromatous lesion of carotid siphon appear to be the main risk factors.

Aged↗
PubMed1984

Intraventricular administration of morphine in patients with neoplastic intractable pain.

Since February 1981, eight patients with neoplastic intractable pain have been treated by intracerebroventricular administration of small doses of morphine. Morphine was injected into the cerebrospinal fluid through a ventricular reservoir either by direct puncture or by self-administration. Clinical results were very good, and there were no deleterious effects.

Adult↗
PubMed1984

[Intracranial hypertension and ependymoma of the end of the spinal cord].

A 42 year-old woman was admitted with a subacute intracranial hypertension which improved under medical treatment. Angiographic data and CT scan showed enlarged ventricles. CSF showed 1.95 g/l of proteins. Five months later, a relapsing acute intracranial hypertension led to a ventricular derivation. CT scans, angiographies and ventriculography showed progressively enlarged ventricles but failed to disclose any intracranial tumor. A thoraco-lumbar tumor of the spinal cord was incidentally discovered and removed. Histopathology concluded to an ependymoma. No sign of recurrence has occurred after an eighteen month follow up. The pathogenesis of intracranial hypertension occurring in spinal cord tumors is discussed.

Adult↗
PubMed1983

[Microsurgery of common discal sciatica. Technics and results].

The authors report their own experience of microsurgery for surgical treatment of lumbar disc herniation. Series include 30 cases with a one year of mean follow up. Comparative studies are discussed according to others microsurgical series already published. Good care of peridural fat and gently retraction of the root seem to be main factors for good functional result.

Follow-Up Studies↗
PubMed1983

[Traumatic elongation-traction lesions of the roots of the sciatic nerve, secondary to fractures of the pelvis].

Three cases of complex pelvic fractures associated with lumbo sacral roots lesions are reported. The authors stress this possible association should be suspected through clinical and conventional radiological findings. The contrast sacco-radiculography brings up confirmation. However the so called pseudo-meningocele is by far of less topographical value than the same myelographic findings at cervical level (for brachial plexus avulsion injuries). Direct and concise evaluation is performed by surgical approach of roots during a homolateral hemi-laminectomy. This procedure allows to appreciate the anatomical lesions and to clarify the anatomo-radiological discrepancies. Moreover endodural closure and reduction of volume of meningoceles and removal of arachnoidal adhesions is to pain relief value and may prevent delayed complications of neighboring roots compression related to increase in volume of meningocele. According to the literature and our findings, in future, the aim should be microsurgical repair of such roots lesions as they ar not avulsed from the conus but merely more distally ruptured on the cauda equina. We could not so far achieve this procedure, because of difficulties to identify the distal part of root, often retracted far away from its spinae foramen.

Adolescent↗
PubMed1983

[Value of intraventricular morphine analgesia in intractable neoplasm pain. Apropos of 8 cases with self-administration in 4].

Intractable pain in 4 patients having disseminated cancer was treated by intraventricular morphine. For all these patients, previous efficiency of opiates therapy was assessed by a positive trial of epidural injections of morphine. The latter method had to be stopped and a switch to intraventricular morphine was motivated, in 3 cases, by a local non-tolérance to the subarachnoid catheter. In one case, an intraventricular system was inserted at the first onset. In all cases, the intraventricular system consisted of a "Holter" type device, using a reservoir implanted subcutaneously in the frontal scalp and connected at right-angle with a catheter inserted in the lateral ventricle. Trial times were respectively of 8 days, one month, two months and six months (this latter case still under trial). In comparison with the epidural and lumbar intrathecal administration of morphine, the authors insisted upon the quality of analgesia obtained, the absence of respiratory depression, the comfort and minimal daily quantities of morphine injected (inferior to one mg daily in three cases). Enlightened by these 4 cases, the authors also discussed the relative importance of the spinal and brain mechanisms involved in morphinic analgesia.

Adult↗
PubMed1983

[Conservative lumbar laminectomies. Technic and results].

The patient is lying on his left side. Paravertebral muscles of the right side are separated from the spinous processes and from the right laminae. Spinous processes are then cut at their base, and hold with a strong retractor Laminectomies are then feasible, as wide as necessary. Reconstruction is particularly strong. Our 3 years experiences of 200 cases, with clinical and radiologically very good late results, is underlined.

Humans↗
PubMed1982

[Intraventricular morphine analgesia. Apropos of 4 cases, 1 with self-administration].

Intractable pain in four patients enduring disseminated cancer was treated by intraventricular morphine. For all these patients, previous efficiency of opiates therapy had been assessed by a positive trial of epidural injections of morphine. The latter method had to be stopped and a switch to intraventricular morphine was motivated in three cases by a local non-tolerance to the subarachnoid catheter. In one case, an intraventricular system was inserted at the first onset. In all cases, the intraventricular system consisted of a Holter type device, using a reservoir subcutaneously implanted in the frontal scalp and connected at right-angle with a catheter inserted in the lateral ventricle. Trial times were respectively of eight days, one month, two months and seven months, with a self administration system in one case. In comparison with the epidural and lumbar intrathecal administration of morphine, the authors insist upon the quality of analgesia obtained, the absence of respiratory depression, the comfort and minimal daily quantities of morphine injected (inferior to one mg daily in three cases). Enlightened by these four cases, the authors also discuss of relative importance of the spinal and brain mechanisms involved in morphine analgesia.

Aged↗