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Biomedical subjects

J Brotchi

Publications and source records attributed to J Brotchi.

At least 91 records · Page 5Linked to original sources
PubMed1996

Prognostic value positron emission tomography with [18F]fluoro-2-deoxy-D-glucose in the low-grade glioma.

OBJECTIVE: The natural history of the supratentorial low-grade glioma (LGG) of the adult is variable, and its malignant transformation is hardly predictable. Because positron emission tomography with [18F]fluoro-2-deoxy-D-glucose (FDG) has prognostic value in high-grade gliomas, this study was designed to search for a possible relationship between glucose metabolism and risk of malignant evolution in LGGs. METHODS: Positron emission tomography with FDG was performed in 28 patients with LGGs (22 at the time of diagnosis and 6 after the diagnosis). A metabolic grading system based on the visual inspection of the positron emission tomographic images was used. RESULTS: In 19 patients, no area of FDG uptake higher than in the white matter was detected (metabolic Grade 1). All of those patients were alive at the end of the follow-up period. Only one of the patients presented a histological modification 7 months after the diagnosis. Nine patients presented areas of increased FDG uptake (metabolic Grade 2 or 3). Those areas were found in the tumor area in eight patients and in an area of radionecrosis in one. Of the nine patients with FDG "hot spots," six died, two had recurrence but were alive at the end of the follow-up period, and the patient with radionecrosis had no signs of recurrence. CONCLUSIONS: The presence of areas of increased FDG uptake in a histologically proven LGG predicts, in most cases, a deleterious evolution. This metabolic feature, detectable with a noninvasive procedure, may provide a clue to cellular changes, announcing malignant transformation in a tumor that retains the histological features of an LGG. Protocols with aggressive therapeutic strategies in this situation should be considered for evaluation.

Adolescent↗
PubMed1996

Lectin histochemistry, ploidy level and proliferation indices in meningioma subtypes.

The glycohistochemical expression of binding sites for eight lectins is characterized in a series of 15 meningothelial, 10 fibroblastic and 15 transitional meningiomas. The correlation between lectin staining and either the proliferation index or ploidy level has also been investigated. The data show that the cytochemical binding of some lectins is of value in distinguishing between the different meningioma subgroups. For example, fibroblastic meningiomas express significantly higher amounts of wheat germ agglutinin (WGA) and Ulex europaeus agglutinin (UEA-I) than the meningothelial sub-type. Diploid tumours express a higher glycine maximus (SBA), Arachis hypogaea (PNA) and Phaseolus vulgaris leukoagglutinin (PHA-L) binding than aneuploid tumours. These differences are probably due to the modification of post-transcriptional glycosylation events linked to tumour ageing. The data also reveal that the increased binding of PHA-L is inversely correlated with the proliferation indices of the tumours.

Histocytochemistry↗
PubMed1996

[Cerebral metastases of gynecological origin].

BACKGROUND: A few cases of brain metastasis from gynecological cancer have been reported. This tumor usually dissaminates via the blood stream, normally through surface implantation or lymphatic spread. PURPOSE: We report four cases of brain metastases from gynecological cancer (2 from ovarian cancer and 2 from endometrial cancer). RESULTS: Several months later, three patients developed brain metastases without any other location elsewhere. For the other patient, brain metastasis was the first sign of her malignant disease. CONCLUSIONS: In brain metastases from gynecological cancer, treatment should consist in surgical resection, radiation therapy and chemotherapy.

Adult↗
PubMed1995

Relationship between DNA ploidy level and tumor sociology behavior in 12 nervous cell lines.

Cell population sociology was studied in two medulloblastomas and 10 astrocytic human tumor cell lines by means of the characterization of the structure of neoplastic cell colonies growing on histological slides. This was carried out via digital cell image analysis of Feulgen-stained nuclei, to which the Delaunay triangulation and Voronoi paving mathematical techniques were applied. Such assessments were compared to the DNA polidy level (assessed by means of DNA histogram typing). The results show that the cell colony architecture characteristics differed markedly according to whether the cell lines were euploid (diploid or tetraploid) or aneuploid (hyperdiploid, triploid, hypertriploid, or polymorphic). In fact, the cell colonies from the euploid cell nuclei populations were larger and more dense than those from the aneuploid ones. Furthermore, for an identical period of culture, the cell lines from high-grade malignant astrocytic tumors (glioblastomas) exhibited cell colonies that were larger and more dense than those in cell lines from low-grade astrocytic tumors (astrocytomas). In each of these two groups, the diploid cell nuclei populations exhibited cell colonies larger and more dense than the nondiploid colonies. The present methodology is now being applied in vivo to histological sections of surgically removed human brain tumors in order to distinguish between high-risk clinical subgroups and medium-risk subgroups in clearly circumscribed histopathological groups.

Aneuploidy↗
PubMed1995

Use of positron emission tomography (PET) in stereotactic conditions for brain biopsy.

In order to take advantage of the metabolic information provided by positron emission tomography (PET) in cases of brain tumour, we have developed a technique to integrate PET images routinely in the planning of stereotactic brain biopsy. We used stereotactic PET with [18F]-labelled fluorodeoxyglucose (PET-FDG) in 38 patients undergoing brain biopsy. To evaluate the contribution of PET-FDG in guiding brain biopsy, we analyzed the diagnosis provided by the 78 stereotactic trajectories obtained in these patients. We found that stereotactic PET-FDG seemed to provide more information in cases of anaplastic astrocytomas and glioblastomas than in low-grade gliomas. Our results also show that biopsy trajectories performed in areas where increased FDG uptake is found within the lesion boundaries always provide interpretable specimens; this was not the case for trajectories guided by CT only. Therefore, the routine integration PET-FDG in the planning of stereotactic brain biopsy may lead to a reduction in sampling. Recently, we also tested consecutive stereotactic PET with [11C]-labelled methionine (PET-Met) and PET-FDG. This technique allowed us to compare accurately the tumoural glucose metabolism and protein synthesis. Our results suggest that stereotactic PET may increase the diagnostic yield of brain biopsy and may improve the understanding of PET in neuro-oncology.

Adult↗
PubMed1995

Evaluation of endoscopy in the treatment of rare meningoceles: preliminary results.

BACKGROUND: Endoscopy is used on different occasions-for instance, to open the floor of the third ventricule in triventricular hydrocephalus, to open a cyst into the cerebrospinal fluid circulation, for biopsy or for partial resection of some tumors, or to insert a shunt in hydrocephalus or syringohydromyelia. However, the use of endoscopes for evaluating and treating meningoceles remains to be assessed. METHODS: Five different kinds of rare meningoceles are presented. In each, neuroendoscopy was used as the main tool for exploration and treatment. RESULTS: Two sacral meningoceles and one oral cephalocele were cured through a keyhole opening under endoscopic control. One posterior sacral meningocele was explored and no communication with normal subarachnoid spaces was observed, allowing a simple suture of the posterior to the anterior walls. And, last, a complex case with three intrasacral meningocles was explored and partially treated. CONCLUSIONS: Meningocles with very small communication within the normal subarachnoid spaces appeared the most suitable to be cured by an endoscopic procedure. In case of a larger communication, the meningocele could be treated, or at least the morphology can be better understood, by using a keyhole procedure under endoscopic control. In all cases the surgery was of short duration (less than 1 hour) and very well tolerated.

Adolescent↗
PubMed1995

Identification of high versus lower risk clinical subgroups in a group of adult patients with supratentorial anaplastic astrocytomas.

The present work investigates whether computer-assisted techniques can contribute any significant information to the characterization of astrocytic tumor aggressiveness. Two complementary computer-assisted methods were used. The first method made use of the digital image analysis of Feulgen-stained nuclei, making it possible to compute 15 morphonuclear and 8 nuclear DNA content-related (ploidy level) parameters. The second method enabled the most discriminatory parameters to be determined. This second method is the Decision Tree technique, which forms part of the Supervised Learning Algorithms. These two techniques were applied to a series of 250 supratentorial astrocytic tumors of the adult. This series included 39 low-grade (astrocytomas, AST) and 211 high-grade (47 anaplastic astrocytomas, ANA, and 164 glioblastomas, GBM) astrocytic tumors. The results show that some AST, ANA and GBM did not fit within simple logical rules. These "complex" cases were labeled NC-AST, NC-ANA and NC-GBM because they were "non-classical" (NC) with respect to their cytological features. An analysis of survival data revealed that the patients with NC-GBM had the same survival period as patients with GBM. In sharp contrast, patients with ANA survived significantly longer than patients with NC-ANA. In fact, the patients with ANA had the same survival period as patients who died from AST, while the patients with NC-ANA had a survival period similar to those with GBM. All these data show that the computer-assisted techniques used in this study can actually provide the pathologist with significant information on the characterization of astrocytic tumor aggressiveness.

Adolescent↗
PubMed1995

Diagnostic yield of stereotactic brain biopsy guided by positron emission tomography with [18F]fluorodeoxyglucose.

The aim of the present study was to determine whether routine integration of positron emission tomography (PET) with 18F-labeled fluorodeoxyglucose (FDG) in the planning of stereotactic brain biopsy increases the technique's diagnostic yield. Forty-three patients underwent combined FDG-PET- and computerized tomography (CT)-guided stereotactic biopsy of intracranial lesions according to a previously described technique. In 36 patients, an area of abnormal FDG uptake was used to guide at least one stereotactic biopsy trajectory. A total of 90 stereotactic trajectories were performed; among them, 55 were based on FDG-PET-defined targets and 35 were based on CT-defined targets. Histological diagnosis was obtained in all patients, but six of the 90 trajectories were nondiagnostic; all six were based on targets defined by CT only. Differences between the diagnostic yield of trajectories based on FDG-PET-defined targets and those based on CT-defined targets were statistically significant in patients with contrast-enhanced lesions, but not in patients with nonenhancing lesions. These results support the view the FDG-PET may contribute to the successful management of brain tumor patients requiring stereotactic biopsy. Because no significant increase in discomfort or morbidity related to the technique was found, it is suggested that the development of similar techniques integrating PET data in the planning of stereotactic biopsy should be considered by centers performing stereotactic surgery and having access to PET technology.

Adolescent↗
PubMed1995

[Subarachnoid hemorrhage in patients over 65 years of age. Retrospective study of 72 patients including 65 cases of aneurysmal origin].

For this study, we reviewed a series of 564 consecutive SAH among which 72 cases (12.7%) were older than 65 years. Etiology of SAH was: arterial aneurysms (65), arteriovenous malformations (1), unknown origin (6). Among the 65 aneurysms, 28 operated cases were between 65-69 years old. One year after surgery, the results are: GOS 1 and 2: 22 cases (57%); GOS 3: 4 cases; GOS 5: 13 cases. In the non operated group, 19 cases died (73%) and among the alive patients, one was GOS 2 (4%), 5 GOS 3 and 1 GOS 4. In the operated group, mortality is similar to other published series. In the non operated group, mortality is unsurprisingly higher (73%) than in the operated group, but also than in the literature. An explanation could be found with analyses of the income of our patient whose many are not referred cases from other hospital. Our analysis confirmed that the severity of SAH after 65 years is increasing. The raise of anterior communicating aneurysms location is demonstrated. Operative indication and timing are dependent of neurological grading, general condition and secondarily of the location and anatomy of the aneurysm.

Age Factors↗
PubMed1995

Stereotactic biopsies from astrocytic tumors. Diagnostic information contributed by the quantitative chromatin pattern description.

OBJECTIVE: To reduce the problem of heterogeneity in astrocytic tumors by means of computer-assisted microscope analysis of Feulgen-stained nuclei. STUDY DESIGN: Thirty-eight glial tumors for which we obtained 227 stereotactic biopsies were subjected to digital cell image analysis of Feulgen-stained nuclei. This series of 38 glial tumors included 36 supratentorial astrocytic tumors (13 astrocytomas, 7 anaplastic astrocytomas and 16 glioblastoma multiformes) and 2 grade 3 astrocytic tumors of the cerebellum. RESULTS: The results suggest a new methodology, enabling the biologic characteristics of the brain parenchymal area surrounding a given glial tumor to be characterized. This methodology relies on the performance of three successive steps. The first is quantitative characterization of nuclear morphology and its chromatin pattern by means of 15 morphonuclear variables. This characterization is carried out by means of the computer-assisted microscope analysis of Feulgen-stained nuclei. The second step consists of setting up morphonuclear data banks, with each process giving the precise portrait of a given cell nuclear population. This process is carried out by means of multivariate analysis, taking into account the 15 variables mentioned above. Multivariate analysis includes principal components analysis followed by the canonical transformation of the data. The third step consists of testing unknown cases against these morphonuclear data banks. This is carried out by means of linear discriminant analysis, which enables the various cell nuclear types in the stereotactic biopsy to be quantified. CONCLUSION: The present methodology makes it possible to investigate whether infiltrating tumor cells are present in or absent from the parenchymal brain area surrounding a glial tumor. It can therefore contribute additional information to that contributed by computed tomography and/or magnetic resonance imaging with respect to the precise delineation of the volume of a brain tumor. This delineation must be as precise as possible to allow total surgical resection of the tumor and prevention of its recurrence.

Astrocytoma↗
PubMed1995

Chronic intrathecal baclofen in severely disabling spasticity: selection, clinical assessment and long-term benefit.

Flexor and extensor spasms associated with severe spasticity frequently cause pain and suffering in neurologically impaired patients, and greatly interfere with comfort and activities. When high doses of oral medications are necessary to keep the symptoms under control and are poorly tolerated, the long-term spinal-selective intrathecal infusion of baclofen by means of implanted drug pump and catheter is a safe, efficient and reversible alternative to destructive surgical procedures. Between September 1991 and March 1995, intrathecal baclofen was infused in 18 selected patients out of a series of 42 severely disabled spastic cases. We report here our preliminary experience with the criteria of selection, the initial intrathecal bolus test and the long-term benefit of the selected patients. Our results confirm the dramatic immediate and long-term benefit reported in other series. After a period of treatment of 1 to 42 months, 13 patients had a complete disappearance of their spastic symptoms without any oral treatment, one patient kept unchanged clonus despite the use of low-dose oral treatment and another one a severe, not improved dysuria although in both of them hypertonia and spasms were abolished. Finally, 2 patients had important joint stiffness slightly impairing the benefit from the treatment. None of the 18 patients had central side-effects related to baclofen. With time, a slight increase in daily dose (inferior to 10%) was necessary in most patients.

Adult↗
PubMed1995

[Association of traumatic cortical aneurysm of the middle cerebral artery and spontaneous aneurysm of the trifurcation of the same cerebral artery].

Traumatic aneurysms constitute a very small percentage of all intracranial aneurysms. A high mortality results of a catastrophic rupture and they run an unpredictable course. Traumatic aneurysms usually involve the large basal arteries or the middle meningeal arteries. We report a case of an association of a traumatic aneurysm with a congenital aneurysm located on the same middle cerebral artery. At our knowledge, it is the first described case of the literature.

Adult↗
PubMed1994

Presence of calcitonin gene-related peptide receptors coupled to adenylate cyclase in human gliomas.

Eleven surgical samples of gliomas (1 of grade II, 3 of grade III and 7 of grade IV) were analyzed. Calcitonin gene-related peptide (CGRP) receptors were identified by 125I-alpha h-CGRP binding in 9 cases and the presence of a CGRP-stimulated adenylate cyclase in all the 11 cases. Tracer binding was inhibited by unlabelled alpha h-CGRP (Kd of 0.3 nM), by (8-37) alpha h-CGRP (Kd of 30 nM), by (12-37) alpha h-CGRP (Kd of 3.000 nM) but not by human calcitonin. The mean density of CGRP receptors (120 fmol/mg membrane protein) was comparable to that of beta-adrenergic receptors. CGRP stimulated 1.4 to 4.7-fold (mean 2.7) the adenylate cyclase activity with a K(act) of 2.0 nM. The CGRP fragments had no intrinsic activity but inhibited the CGRP effect. The (8-37)CGRP fragment had a Ki of 30 nM. Thus, at variance with previous reports on rat and human brain membranes, that showed the presence of CGRP receptors not coupled to adenylate cyclase, we observed in human gliomas the presence of CGRP receptors that, when occupied, stimulated efficiently the adenylate cyclase activity.

Adenylyl Cyclases↗
PubMed1994

Total recuperation in a case of sudden total paraplegia due to an aneurysmal bone cyst of the thoracic spine.

A 3-year-old girl developed sudden complete paraplegia because of an aneurysmal bone cyst of the fourth thoracic vertebra. We performed a two-step surgical procedure resulting in complete neurological recuperation and no cyst recurrence within 2.5-year follow-up. Although the literature shows the prognosis of such a condition to be poor, this case reveals the positive effect of rapid surgical decompression and of postponing assessment by magnetic resonance imaging until before the second surgical stage. Furthermore, this case is an example of cure with neither interbody fusion nor postoperative radiotherapy, despite the total involvement of the vertebrae by the lesion.

Bone Cysts, Aneurysmal↗
PubMed1994

Expression of pituitary adenylate cyclase activating polypeptide (PACAP) receptors in human glial cell tumors.

Twenty-three human gliomas were analyzed: 13 astroglial neoplasms including three grade II, four grade III, and six grade IV tumors; seven ependymomas; and three oligodendrogliomas. A crude membrane fraction was prepared within 30 min after surgical removal of the tumors and was immediately tested for the presence of pituitary adenylate cyclase activating polypeptide (PACAP) receptors. PACAP stimulated adenylate cyclase activity in 23 tumors, but a specific binding of [125I-acetyl-His1]PACAP-27 was detected in only 16 tumors. In all cases, PACAP-27 and -38 were equipotent (Kd or Kact of 1-3 nM) and were 100- to 1000-fold more potent than VIP. PACAP stimulated threefold the adenylate cyclase activity in the presence of GTP. The results were compatible with an interaction of PACAP with a highly selective type I PACAP receptor and not with a high-affinity VIP/PACAP type II receptor. The presence of PACAP receptors on glial neoplasic opens the possibility of a control of the tumor growth by this family of peptides.

Adenylyl Cyclases↗
PubMed1994

Quantitative assessment of quinolinic acid-induced striatal toxicity in rats using radioligand binding assays.

To validate specific, sensitive and quantitative markers of the rat model of Huntington's disease produced by the intrastriatal injection of quinolinic acid, we used striatal homogenate binding assays for [3H]MK-801-labelled N-methyl-D-aspartate receptors, [3H]SCH 23390-labelled D1 and [3H]sulpiride-labelled D2 dopamine receptors, [3H]CGS 21680-labelled adenosine A2 receptors, [3H]GBR 12935-labelled dopamine uptake sites, [3H]hemicholinium-3-labelled high affinity choline uptake sites and [3H]PK 11195-labelled glial cells, in 3 groups of rats: 1) lesioned only, 2) pretreated with MK-801, an antagonist of the N-methyl-D-aspartate receptor, to assess the non-N-methyl-D-aspartate-mediated toxicity of quinolinic acid, and 3) pretreated with MK-801 plus scopolamine, an anticholinergic drug that prevents MK-801 neuronal toxicity. [3H]MK-801 and [3H]PK 11195 are sensitive markers of quinolinic acid toxicity. In addition, [3H]SCH 23390, [3H]CGS 21680 and [3H]hemicholinium-3, are found to be specific markers of quinolinic acid-induced toxicity on striatonigral and striatopallidal projecting neurons, and on large interneurons, respectively. MK-801 pretreatment prevented the quinolinic acid-induced reduction in binding of [3H]MK-801, [3H]SCH 23390 and [3H]CGS 21680 but failed to do so for [3H]sulpride and [3H]hemicholinium-3, suggesting that quinolinic acid may act by mechanisms other than direct activation of N-methyl-D-aspartate receptors. Combined pretreatment with MK-801 and scopolamine increased the protection against quinolinic acid, suggesting an involvement of the cholinergic system.

Animals↗