Biomedical subjects
Publications and source records attributed to J Bories.
A series of 26 cases of injury to the extracranial carotid artery included 3 patients with false aneurysms, 21 dissecting aneurysms, and 3 aneurysms following direct trauma. Clinical and angiographic findings, and clinical course in the 26 patients are described, together with changes observed on angiography in the 11 cases where this was repeated. Prognosis in this series appeared to be better than that usually described.
Brain stem hemorrhages (peduncular, pontine, medullary) were demonstrated by CT scan in hypertensive patients, the outcome being favorable without surgical intervention. Such lesions are considered as being usually massive and fatal. A review of the literature show that hemorrhages in the brain stem represent 5 to 9 p. cent of intraparenchymatous hemorrhages, and are usually located in the pons. A favorable course was known to occur before the use of computed tomography: the rare cases described were often related to subacute hematomas in young normotensive subjects which could be treated by surgery with or without ventricular shunting. Clinical diagnosis is based on the rapid progressive course of the disorder and the location of the lesion. Computed tomography provides an immediate correlation between anatomical and clinical findings, and allows a better evaluation of semiological and prognostic features that were previously considered well established. A major element appears to be the degree to which the hematoma is tolerated. As far as possible neurosurgical procedures should be avoided in hypertensive patients.
This report summarizes the extraordinary development of the neuroradiological entrance into the treatment of massive vascular malformations of the head and spine, also highly vascularized tumors, by embolization accomplished with the appropriate type of catheter and highly refined technique, in collaboration with the surgeons of neurology, ophthalmology, otolaryngology, and of the vascular system.
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The results obtained in 145 cases of space-occupying lesions in the sellar and suprasellar structures, after exploration with computer assisted tomography, were used to assess the technical and diagnostic value of this procedure. Precise details of the localization and extent of the lesion can be obtained, but not the nature of the lesion in many cases.
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The authors report a case of traumatic arteriovenous fistula between the vertebral artery and the internal jugular vein at the level of the atlas, treated successfully by a direct surgical approach which permitted exclusion after simple dissection. The relative ease of the surgical approach of the suboccipital segment of the vertebral artery may permit one to extend this technique to other more common indications, in particular due to atheroma.
A propos 24 cases of gastro-intestinal tract's embolization of which eleven were performed in emergency for bleeding, the principle indications are described and illustrated. In some cases embolization gracefully replaces the ligation by a rapid and simple procedure at the time of diagnostic arteriography, preparing with safety the operative cure. In other cases embolization alone is curative: arteriovenous fistulas, telangiectases in 'Osler-'s disease, radiotherapic bleeding lesions, inoperable cancers. This implies the presence of trained radiologic teams and a tight collaboration with intensive care, endoscopy and surgery in large medical center. In this view the existence of radio-surgical rooms is useful.
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Observation of the four cases reported and a review of the published literature suggest that spinal column lipomas can produce two entirely unrelated types of radiological image. 1. An image of cord-like appearance and variable width which joins the filum terminale to the sacrum, and is usually associated with enlargement of the spinal cord at the same level. This image can be demonstrated by both gas myelography and opaque myelography, and is produced by a lipoma of the filum terminale. The cord image is either that of an ectopic spinal cord or that of the lipomatous tumor itself, which joins the filum terminale to the sacrum. A spina bifida is often associated with these tumors, which can be intradural alone, which is very rare, or both intradural and epidural, and are often associated with enlargement of the spinal canal. 2. A fairly specific blocking-type of image which can be seen by opaque myelography, and consists of fringed bands which become progressively shorter from above downwards until being completely blocked. This appearance, which is extremely rare, is peculiar to intramedullary lipomas, the image probably corresponding to the dissociation of the medullary fiber bundles by the tumoral cords.