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Biomedical subjects

J Berney

Publications and source records attributed to J Berney.

At least 19 recordsLinked to original sources
PubMed1997

Appropriateness of indications for surgery of lumbar disc hernia and spinal stenosis.

STUDY DESIGN: This prospective study examines the appropriateness of indications for surgery of herniated intervertebral disc and spinal stenosis in patients undergoing surgery in a university hospital setting. OBJECTIVE: To evaluate the appropriateness of surgery using explicit criteria developed by an expert panel in the United States. SUMMARY OF BACKGROUND DATA: The use of surgery for herniated intervertebral disc and spinal stenosis varies widely within and among countries. It has been postulated that the main reason for treatment failure is poor selection of candidates for the procedure. METHODS: The authors prospectively evaluated appropriateness of surgical indications for herniated lumbar intervertebral disc or spinal stenosis in 328 consecutive patients undergoing the operation in two university neurosurgery departments. Outcome was measured 1 year after surgery by a standardized interview. RESULTS: Indications for surgery were considered to be appropriate or equivocal in 202 (62%) patients and inappropriate in 126 (38%). Among the 126 inappropriate procedures, 66 were so rated because of insufficient activity restriction before the procedure. One year after surgery, 74% of the patients perceived the results of the operation as good or very good. CONCLUSIONS: Appropriateness as measured by the criteria established by the American panel identified a large percentage of day-to-day practice in the two surgical units as inappropriate. However, use of criteria that include new findings about lack of efficacy of bed rest probably would lower this percentage. Criteria of appropriateness of medical and surgical procedures, developed through the panel process, need to be updated regularly.

Adolescent↗
PubMed1996

[Pituitary adenoma secreting prolactin. Results of their surgical treatment].

A retrospective study of 75 patients operated for pituitary prolactin-secreting adenomas between 1972 and 1992 is presented. 57 were women, 18 males. The major symptom was amenorrhea for women and impotence for men. Prolactinemia is correlated to the size of adenoma and thus permits a prediction of surgical results. Most of the patients with a prolactinemia under 300 ng/ml were cured by surgery alone. Surgical treatment alone at the-term follow-up cure 87% of the micro-adenomas, 17% of the enclosed adenomas, and none of the invasive adenomas. In this study there is only 7% of true recurrence. According to the high cure rate and low frequency recurrence after transphenoidal surgery for micro-adenomas we suggest this approach as the first choice treatment. On the other hand the best treatment for macro-prolactinomas is medicamentous.

Adult↗
PubMed1995

Head injuries in children: a chronicle of a quarter of a century.

Children aged 0-15 years hospitalized in Geneva for head trauma during the last quarter of a century are reviewed. More than half of the severely injured children were not from Geneva area. New methods of management have been introduced progressively. The cases are divided in four successive time periods and classified according to their pathology. A continuous improvement in mortality is obvious, decreasing from 29.4% to 2.2%, but climbing again to 15.2% in the last period, probably due to more severe pathologies. For the Geneva area the mortality decreased progressively from 10.4/100,000 to 3.5/100,000 annually, due to better organization and management, but also to a drop in the incidence of severe cases from 35.5-13.5/100,000 per year. A decrease in the number of traffic accidents is responsible for this. However, the number of handicapped children has not changed.

Accidents, Traffic↗
PubMed1994

Paediatric head trauma: influence of age and sex. I. Epidemiology.

A consecutive unselected series of 1812 children (up to 15 years old) admitted for head injuries over a period of 8.5 years was studied. The cases were divided up according to five categories of pathology: benign injury, extradural haematoma, subdural haematoma, open brain laceration and brain contusion in a broad sense. All cases of benign injury were from the Geneva area (57000 children) and 52% of the cases of severe injury were referred from other places. To these 1812 cases were added those of 23 children who died before admission recorded by the police. In the Geneva area the mortality was 6.8/100,000 per year. Patients were divided into three age groups: I (0-3 years), II (3-9 years), and III (9-15 years); group I was further subdivided into subgroups I a (0-1 year) and I b (1-3 years). The incidence of each type of accident was calculated for each age group, separately for girls and boys. Each type of pathology was correlated, sex by sex and for different ages, with the type of accident. Overall, two boys were injured for each girl. Road accidents were responsible for 15% of head injuries in group I girls, 17% in group I boys, 43% in group II girls, 45% in group II boys, 50% in group III boys and 61% in group III girls. They were responsible for 94% of all deaths and 85% of deaths of hospitalized patients. Falling was the most frequent cause of injury. Benign injuries were more frequent in group I. Only 1 of 25 patients with extradural haematomas died, and there were only 8 patients with subdural haematomas, 4 in subgroup I a (babies aged less than 1 year).

Accidental Falls↗
PubMed1994

Paediatric head trauma: influence of age and sex. II. Biomechanical and anatomo-clinical correlations.

A consecutive, unselected series of 1812 cases of head trauma in children less than 15 years of age and admitted hospital over a period of 8.5 years was studied. Data concerning the grade of energy involved, the ages of the victims, the types of pathologies caused and the clinical features noted were collected and statistically analysed. Babies and toddlers (0-3 years) were shown to sustain rather low-energy trauma and suffer more skull fractures, more subdural haematomas and more benign injuries. They lost consciousness less frequently and were less frequently in coma than the other children. By contrast, they had more frequent signs of lateralization, and early seizures were much more frequent in babies than in other children. Young children (3-9 years) had rather higher-energy accidents, frequently lost consciousness, were more frequently in coma and have more frequently had a free interval associated with the development of brain swelling. They did not suffer subdural effusion or contrecoup lesions. Schoolchildren (9-15 years) were statistically more or less like young adults: the clinical sequences of trauma were more severe than in the other children, mortality was a little bit higher, the risk of extradural haematoma was higher, and they rarely suffered subdural haematomas or contrecoup lesions. Traffic accidents, with higher energy involved, were more severe.

Accidents, Traffic↗
PubMed1994

Chronic subdural haematomas. Results of a closed drainage method in adults.

This paper concerns 106 consecutive subdural haematomas in adults, 94 of whom were chronic and 12 subacute. Among these, 78 subdural haematomas were operated upon according to a new protocol--two burr holes, irrigation and closed drainage of the haematoma for 48 hours in the supine position. The others were treated by decompressive craniectomy according to the clinical judgement of the surgeon. The results are presented.

Adult↗
PubMed1994

[Epidemiology of narrow spinal canal].

During a period of 4.5 years, 199 patients have been operated on by laminectomy because of narrow lumbar canal. The incidence in Geneva is about 11.5 case/100000/year and the ratio between male and female is 1.28. The disease is strongly related to aging, but men are affected earlier in their life than women. Heavy work, particularly for men, has a part to play in the genesis, like the body mass calculated by BMI (Body Mass Index). A comparison between the epidemiology of lumbar disc prolapse and lumbar stenosis shows the differences.

Adult↗
PubMed1994

[Prevention of infections of cerebrospinal fluid shunts for hydrocephalus].

Two consecutive series of patients operated for insertion or revision of a shunt for hydrocephalus have been followed for at least 18 months. The series are comparable. The first series (84 cases) did not receive antibiotic prophylaxis, whereas the second series (59 cases) received a unique dose of intravenous Vancomycin immediately before the operation. In the first series (168 operations), there were 18 infections, 8 in the group of 34 children and 10 in the group of 50 adults. In the second series, only one infection happened in the group of 27 adults (41 operations) and none among the 22 children (44 operations). The difference was significative. Bacteriological samples were taken during these operations. The positive cultures, mostly for sta. epidermidis, were as frequent among the cases of the first series than among those of the second series. The antibiotics are considered effective in protecting the shunting device against contamination during the surgical procedure by germs from the skin of the patient.

Adolescent↗
PubMed1993

[Intramedullary meningeal melanocytoma].

A primary benign melanotic tumour was resected twice in the thoracic spinal cord of a 49-year-old woman. The patient had complained of low back pains, obstipation and mictional urgency for two years. She developed a partial Brown-Sequard's syndrome at th10-th12 level. The tumour showed the histological and immunohistochemical features of a meningeal melanocytoma. The following up was marked by tumoral seeding in the lumbosacral region and later in the cerebral hemispheres, which lead to death 4 years after the diagnosis. This is a survey of the clinical and morphological characteristics of meningeal melanocytoma and demonstrates the risk of secondary dissemination of this primary benign tumour.

Brain Neoplasms↗
PubMed1992

Pathogenesis of diastematomyelia: can a surgical model in the chick embryo give some clues about the human malformation?

To reproduce diastematomyelia, a sagittal incision was carried out at the level of the rhomboidal sinus of 36- to 40-h-old chick embryos. A small piece of membrane shell, a small agar screen, or a piece of quail isochronous isotopic notochord was inserted into the gap. The embryos were killed and fixed after 9 days' incubation. Diastematomyelia was obtained in several embryos treated with interposition of a membrane screen or a piece of quail notochord. Microscopic examination revealed two hemicords, each containing its own central canal; in some cases one of the cords showed hydromyelia. Absence of the rump was seen in association with experimental diastematomyelia. The interposition of a resorbable agar screen did not succeed in reproducing diastematomyelia. The results of these surgical manipulations suggest that diastematomyelia cannot be explained by a primary disorder of neurulation. It supports the theory of noninvolution of a firm midline structure (probably the neurenteric canal, rapidly surrounded by mesodermal cells originating from the notochord), which prevents the fusion of the separated parts.

Animals↗
PubMed1992

The future of neurosurgery.

Many factors influence the future of neurosurgery, among them the general growth of the world population with an increasing number of older persons and the political-economical development which differs markedly from region to region. Another important factor will be the biological and molecular revolution which has just begun and makes it likely, that some of the pathologies, which needed neurosurgical management, become accessible to conservative treatment in the future. Finally the neurosurgical sphere of activity is endangered by take-over tendencies of neighbouring medical specialties. Those of us who are in charge of neurosurgical organization and planning should take these and additional factors into consideration early enough, in order to give neurosurgery and neurosurgeons a chance to adapt to the future.

Developing Countries↗
PubMed1992

Diagnosis of cerebellopontine angle tumors.

Between 1980 and 1990, 9,176 patients suffering from otoneurological disorders were investigated in our clinic. Sixty-six (0.72%) internal auditory canal or other cerebellopontine angle tumors (CPAT) were diagnosed. Brainstem auditory evoked potentials (BAEP), interaural time discrimination, and magnetic resonance imaging (MRI) revealed to be the most sensitive and efficient tests for the detection of CPAT. However, the investigation of otoneurological symptoms cannot be limited to BAEP and MRI on the a priori of a hypothetical CPAT. Electrophysiologic tests such as impedancemetry, and electronystagmographic testing are also needed to elucidate the many causes of otoneurological symptoms.

Adolescent↗
PubMed1992

[Cervical meningocele and meningomyelocystocele. Apropos of 4 cases].

Published cases of cervical dysraphic lesions are rare. Their estimated proportion is about 5% of the entire group of spinal dysraphism. Four cases are reported, representing 2 types of lesion: 2 meningoceles with a simple fibrous band fixing the posterior aspect of the cord to the skin and 2 meningomyelocystoceles with other associated anomalies (hydromyelia, hydrocephalus, Chiari II, Peter's ocular anomaly). The clinical presentation is that of a soft posterior cervical mass without marked neurological impairement. The surgical treatment is simple, consisting in the resection of the lesion, intradural exploration to untighten the cord if fixed by a fibrous band, and drainage of the hydrocephalus. Neurological outcome is generally good immediately but may need sometimes secondary surgical exploration.

Abnormalities, Multiple↗
PubMed1991

Anterior-sacral meningocele; value of magnetic resonance imaging and abdominal sonography. A case report.

With the presentation of a case of giant anterior sacral meningocele, the evident superiority of magnetic resonance imaging over any other methods for the diagnosis of this rare condition is demonstrated. Ultrasound as a screening tool is often the first to reveal the presence of the intrabdominal cystic abnormality and furthermore is an excellent means for checking the post-operative course. In addition this particular case is interesting because the dural stalk linking the meningocele to the dural abdominal sac was not entirely free from nervous structures inspite of macroscopic appearances to the contrary.

Adult↗
PubMed1991

[Acute subdural hematoma of arteriolar origin. Traumatic or spontaneous?].

Acute subdural hematomas are usually related to the rupture of a bridging vein with or without tearing of brain matter. In some instances the origin of the hemorrhage is due to the shearing of a cortical arteriole bleeding directly into the subdural space, generally after a minor head trauma. Ten cases were reviewed at Geneva's Neurosurgical clinic over a period of thirteen years (1973-1986). They represent less than 5% of all acute and subacute subdural hematomas treated during that period. Subdural hematomas of venous origin are usually encountered on previously normal brain whereas those of arteriolar origin are thought to result from the disruption of a small arteriolar knuckle adhering to the arachnoid and dura. While the majority of arteriolar hematomas reported here and in the literature are of traumatic origin, some are undoubtedly spontaneous. The clinical features of these hematomas are characterized by a high incidence of falsely localising motor signs, presumably due to the so called Kernohan's phenomenon. Their treatment requires a wide exposure, allowing identification and coagulation of the bleeding source located in most instances around the Sylvian fissure. Although a rare entity, the existence of arteriolar subdural hematomas must be emphasized, since any delay in their treatment may result in a dramatic outcome.

Adult↗