Biomedical subjects
Publications and source records attributed to J C Marchal.
The authors report two cases of low back pains with sciatica caused by a synovial cyst of the interapophyseal joint of the lumbar spine. Analysis of only 23 cases found in the literature, point to their rarity, the lack of specific clinical signs, the importance of the CT scan for the diagnosis and the excellent results of surgical treatment.
The authors report a recent case of massive and immediate epistaxis resulting from a rupture of the internal intracavernous carotid artery caused by closed head injury. The point out the unusualness and the extreme severity of such lesions. The pathogenesis of these epistaxis can be explained by an immediate arterial rupture proceeding from a sphenoidal fracture. The emergency bilateral carotid angiography states precisely the diagnosis and the level of the rupture, allowing in the same time the intravascular treatment by detachable balloon.
Seven patients with unilateral arterial carotid occlusion and contralateral arterial carotid stenosis in the neck are reported. Authors perform an extra-cranial to intra-cranial anastomosis on the occluded side prior to realize endarterectomy on the stenosed side. This policy obviates the need of an internal vascular shunt during temporary occlusion of I.C.A.
The authors compare the results of carotid artery back pressure and EEG monitoring in 100 carotid endarterectomies. They point out that EEG, especially during operative carotid occlusion, is more reliable to detect cerebral ischemia. EEG monitoring permits also to avoid using shunt more frequently.
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The authors report a recent series of 12 intra-cranial epidermoid and dermoid cysts. After they had reminded the main classical radiological and clinical signs which are rarely specific, they study C.T. scan semiology which at present and in most cases permits to base an undoubted diagnosis.
Authors point out three observations of spontaneous dissection of cervical internal carotid artery (I.C.A.) with various evolution. They emphasize on evolutivity of residual aneurysms and necessity to purpose a preventive treatment of secondary projections.
Authors describe their own experience of Sundaresan anterior approach and exposure of the upper thoracic vertebrae (T1-T2) including resection of the internal third of the clavicle and manubrium sterni. They point out technical details of that surgical approach and its indications.
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The main difficulty in diagnosis and treatment of fronto-basal skull fractures can be said in two propositions: --On the one hand owing to the fact that diagnosis of cerebro-spinal fistula is sometimes difficult; --on the other hand because therapeutic require intervention of several surgical teams. An anatomo-pathological classification should take into considerations the point of frontal impact which is: medio-facial, medio-cranio-facial, latero-cranio-facial and it sagittal outcome which is: frontal, ethmoïdal, sphénoïdal. Surgical indication whether meet urgent character or respond to clinical and radiological facts (rhinorrhea, pneumocephalus, meningitis, radiological suspicion of osteo-meningeal break). Surgical treatment will envisage primary and complete repair of neuro-surgical and maxillo-facial injuries.
Thanks to analysis of 46 observations and the review of the literature, the authors enumerate the main physiopathological mechanisms of this uncommon entity with its ambiguous clinical aspects and it too often severe evolution. They bring some new elements of the prognosis and emphasize the necessity of a rational utilization of neuroradiological investigations in order to avoid some diagnostic traps and purpose the better treatment of which indications are analysed and censured. Extra-intracranial by-pass represents a new therapeutic advance which will perhaps improve the prognosis of this condition.
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