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Biomedical subjects

J Chiras

Publications and source records attributed to J Chiras.

At least 109 records · Page 6Linked to original sources
PubMed1992

MRI in neurosarcoidosis.

Nine patients with neurological manifestations of sarcoidosis were explored by MRI and, in some cases, CT. The MRI examinations were performed in T1- and T2-weighted spin-echo sequences in all patients, with gadolinium injection in seven. Several non-specific lesions were demonstrated, the most frequent of them showing on T2-weighted sequences as high-intensity signals in the periventricular white matter and the semi-oval centres. Other abnormalities, such as infiltrations of the hypothalamo-pituitary region, granulomatous masses within the brain tissue and meningeal infiltrations, were observed. These findings were in agreement with those found in the literature. Gadolinium injection seems to be important in this pathology, as it demonstrates lesions that are not visible on conventional T1- and T2-weighted spin-echo sequences.

Adult↗
PubMed1991

Treatment of recurrent malignant supratentorial gliomas with carboplatin (CBDCA).

Twenty patients with malignant supratentorial gliomas progressing after radiation therapy and chemotherapy with nitrosoureas received intravenous carboplatin, 450 mg/m2. Courses of therapy were repeated every four weeks. Therapeutic evaluation was performed monthly using neurologic examination and CT scan of the brain. Of 19 patients evaluable for response, 2 (10%) responded to therapy and 6 (30%) had stable disease. The estimated median time to tumor progression for responding and stable patients was 6 months. Median duration of survival was 6 months for all patients. Of 20 patients evaluable for toxicity, none had renal or auditory toxicity. Side effects consisted of hematologic toxicity in 4 patients (20%): one patient had grade 4 toxicity requiring discontinuation of carboplatin and 3 patients had grade 2-3 toxicity.

Adult↗
PubMed1991

Visual toxicity following intra-arterial chemotherapy with hydroxyethyl-CNU in patients with malignant gliomas. A prospective study with statistical analysis.

We studied the effects of intra-arterial chemotherapy (IAC) with a new nitrosourea (hydroxyethyl-chloroethyl nitrosourea: HeCNU) on the visual system of 68 patients with malignant gliomas. The intra-arterial chemotherapy was given as a complementary treatment of glioma after surgery (19 patients), after tumor recurrence (28 patients) and as the preliminary treatment before radiotherapy (21 patients). Eleven patients (16%) suffered a visual complication after two or more courses of chemotherapy. The main visual symptoms included mild to major decrease of visual acuity and in some cases ocular pain, palpebral edema and conjunctival injection. The delay in onset of ocular symptoms from the last course of IAC varied from 1 week to 9 months. From ophthalmoscopic findings, visual field testing and fluorescein angiography, the visual symptoms presented by our patients could be related to ischemic optic neuropathy or retinal vasculopathy. None of the patients had hypertension, diabetes, cardiopathy or hematological disease. Statistical analysis failed to demonstrate a relationship between the occurrence of visual toxicity and patient age, number of courses of HeCNU, the vascular axis treated, total systemic dose or dose by carotid artery, suggesting a possible specific sensitivity of some patients to chemotherapy. The pathophysiology and the therapeutic implications of this visual toxicity are discussed.

Adult↗
PubMed1991

Intracerebral stenosing arteriopathies. Contribution of three radiological techniques to the diagnosis.

Fifty-one patients with intracerebral stenosing arteriopathy were studied by computerized tomography (CT), magnetic resonance imaging (MRI) and cerebral arteriography. Clinical symptoms were varied, included impaired cognitive functions, progressive neurological deficit, headache and vomiting, and were sometimes not suggestives of the diagnosis. CT scans of the brain were normal in 25 percent of the cases or they were not probative because of various and non-specific abnormalities (hypodensity of various types or haemorrhagic hyperdensity). MRI always showed abnormalities but in many cases the lesions observed on T2-weighted images consisted of non-specific focal areas of high-intensity signal in the white matter. High-intensity signals in both white matter and cortex seemed to be more suggestive of the diagnosis. In this as in other studies, arteriography therefore remains the reference examination for stenosing arteriopathies. Inflammatory, infectious and atheromatous processes are the main causes of these arterial lesions. The aetiological value of radiological examinations is poor, and in most cases the morphology and distribution of the lesions does not point to any specific origin. However, herpes zoster arteritis usually affects the proximal segments of the anterior and middle cerebral arteries and spares the carotid siphon.

Adult↗
PubMed1991

[Vertebro-dural arteriovenous fistulae of the foramen magnum with perimedullary venous drainage].

Two cases of dural arteriovenous fistulae of the foramen magnum with perimedullary venous drainage are reported. Their arterial component was a dural branch of a vertebral artery. The localization and the origin of these fistulae appeared very uncommon but could be explained by the embryogenesis of the vertebral arteries, of which the third portion corresponds to the first cervical radicular artery. The first patient had signs and symptoms usually described in this disease, but the second presented a subarachnoid haemorrhage with neither motor and sensory deficit not sphincter disturbance. Myelographic findings, M.R.I. abnormalities and treatment of these rare dural arteriovenous malformations are discussed.

Arteriovenous Fistula↗
PubMed1991

[Spinal infarction in the anterior spinal territory with possible relation with bilharziasis].

We report a case of spinal cord infarction in the anterior spinal artery territory with selective involvement of the anterior horns. A 35-year-old Mauritanian woman was hospitalized because of an acute and severe flaccid paraplegia without any sphincter dysfunction or sensory disturbance. MRI abnormalities (hypersignal on T2-weighted sequences) were restricted to the anterior horns of the lower thoracic spinal cord and conus medullaris. Adamkiewicz's artery appeared abnormally thin at arteriography. The infarction was probably related to vasculitis of schistosomal origin.

Adult↗
PubMed1990

Treatment of malignant recurrent glioma by intra-arterial, infra-ophthalmic infusion of HECNU 1-(2-chloroethyl)-1-nitroso-3-(2-hydroxyethyl) urea. A phase II study.

53 patients suffering from malignant recurrent glioma were treated with iterative arterial infusions of HECNU. The intra-carotid injections were performed below the ophthalmic artery. The response rate was 49% and the median survival was 8.5 months. The results differ substantially according to the histological subtype. The response rate was 33% for glioblastomas, 50% for anaplastic astrocytomas and 92% for malignant recurrences of low grade astrocytomas. The median survival was 4.5 months for glioblastomas and 18 months for anaplastic astrocytomas and malignant recurrences of low grade astrocytomas. Serious complications were a monocular blindness in 3 cases and a leucoencephalopathy in 6 cases.

Adult↗
PubMed1990

Treatment of malignant gliomas with surgery, intra-arterial infusions of 1-(2-hydroxyethyl)chloroethylnitrosourea, and radiation therapy: a phase II study.

Forty patients with malignant supratentorial gliomas were treated with surgery, intra-arterial infusions of 1-(2-hydroxyethyl)chloroethylnitrosourea, and radiation therapy. The median duration of survival was 12 months; it differed according to the histological subtype (over 30 months for patients with anaplastic astrocytomas or anaplastic oligodendroglioma and 10.5 months for glioblastoma; P = 0.0025). Serious complications of monocular blindness and leukoencephalopathy were observed in four patients (10%).

Adolescent↗
PubMed1990

[Post-traumatic enophthalmos].

Based on 8 cases, the authors study the mechanisms involved in post-traumatic enophthalmos and demonstrate that they result from an increase in orbital volume. There are no grounds to suggest that the disappearance of orbital fat is involved.

Edema↗
PubMed1989

Preoperative spinal cord arteriography in aneurysmal disease of the descending thoracic and thoracoabdominal aorta: preliminary results in 45 patients.

Between 1985 and 1988 45 patients with descending thoracic or thoracoabdominal aortic aneurysms underwent selective arteriography of the intercostal and lumbar arteries to delineate preoperatively the artery of Adamkiewicz and the thoracic radicular artery. Identification of these vessels failed in five patients (11%), was considered complete in 31 patients (69%) and incomplete in nine (20%). Selective arteriography classified these patients into four groups: groups A and B--the artery of Adamkiewicz arose respectively above and below the zone of operation; group C--the artery arose directly from the segment to be operated; and group D--origin could not be determined. All 30 patients in group C underwent a spinal cord revascularization procedure (complete in 20 cases, incomplete in 10). Spinal cord complications occurred in 9/45 patients (20%). No spinal cord complications occurred in groups A and B; their incidence was 5% in group C when revascularization was complete, and 50% when revascularization was incomplete; and 60% had complications in group D (p less than 0.01). Spinal cord complications were more frequent (p less than 0.05) when the artery of Adamkiewicz arose from an intercostal or lumbar artery obliterated at its aortic origin but filled through collaterals or when spinal cord circulation was interrupted for more than 45 minutes. This study confirms the importance of preserving arterial supply to the spinal cord during repair of descending thoracic and thoracoabdominal aneurysms. The information obtained from spinal cord arteriography allows the prediction of complications and informs the choice of the appropriate surgical technique.

Adult↗
PubMed1989

[Medical treatment of inoperable malignant glioma. Non-superselective intra-arterial chemotherapy with HECNU followed by conventional radiotherapy].

Forty-six cases of non-surgical malignant glioma were treated by several repeated infusion of non-superselective intra-arterial chemotherapy using HECNU, followed by conventional radiotherapy. Chemotherapy was well tolerated immediately. Good responses rate was 46% for the whole group, but was higher in anaplastic astrocytomas (71%) than in glioblastomas (43%). The median survival for responders was 17 months, and clinical improvement was observed in a large majority of them. Later, neurological or ophthalmological ipsilateral complications of varying severity were observed in 8.7% and 15% of the cases respectively. Despite these complications the treatment was generally well tolerated and gave in responders a longer survival with better comfort.

Adult↗
PubMed1989

Intraarterial infusion of carboplatin in the treatment of malignant gliomas: a phase II study.

Twenty-three previously treated patients with malignant gliomas were included in this phase II study of carboplatin (400 mg/m2) given as an intraarterial infusion every 4 weeks. Five patients (26% of 19 evaluable) achieved a partial response for 3 to 10 months and 5 patients presented a stabilization for 2 to 7 months. Toxicity was mild in most patients, with nausea, vomiting and myelosuppression being the most frequent side-effects. No renal or auditory toxicity was observed. One patient developed central nervous toxicity and another one a reversible fall in visual acuity. Finally, carboplatin infused by the intraarterial route seems to be an active drug, less toxic than cisplatin, in malignant gliomas, and further trials are warranted.

Adult↗
PubMed1989

[Role of surgical resection in the treatment of vertebral hemangioma].

Resection (total or subtotal excision of vertebra) of vertebral hemangiomas appears to be the logical course when there are neurological signs. This is a rather complicated surgery with the aim of reduction of recurrence rate. We report two such cases with surgical technique and results at 2 and 4 years post-operatively.

Adolescent↗
PubMed1989

[Pseudotumoral spinal cord dilatation during multiple sclerosis. 2 cases with magnetic resonance imaging].

We report 2 patients presenting with signs and symptoms of a medullary lesion. Spinal magnetic resonance imaging (MRI) using surface coils showed a volume increase of the spinal cord. Multiple sclerosis (MS) was suspected on the clinical evolution, the cerebrospinal fluid oligoclonal pattern in one case and the return of the cervical cord to an almost normal calibre on successive MRI. This diagnosis was further supported by the results of encephalic MRI. Such a pseudotumoral aspect of the spinal cord in MS has rarely been reported, and probably has been underestimated. MS should be considered in the differential diagnosis of localised enlargement of the spinal cord.

Adult↗
PubMed1988

MR imaging of spinal cord arteriovenous malformations at 0.5 T: study of 34 cases.

Thirty-four patients with angiographically proved arteriovenous malformations of the spinal cord were studied between May 1986 and July 1987. Examinations were performed on a CGR 5000 Magniscan 0.5-T scanner with a surface coil in all cases, and multislices in both T1- and T2-weighted sequences were obtained in sagittal and axial planes. The results showed that MR can accurately diagnose all cases of intramedullary arteriovenous malformations, since transverse images were able to precisely locate the nidus within the spinal cord. Other types of spinal cord arteriovenous malformations were also studied (perimedullary fistulae and dural arteriovenous fistula), and the findings confirmed the value of MR in the characterization of these lesions as well.

Adult↗
PubMed1988

[Spinal dural arteriovenous fistulae: exacerbation after myelography with metrizamide].

Metrizamide dorsal myelography was performed in two patients with minor to moderate sensorimotor paraparesis. Direct and indirect myelographic signs of spinal arteriovenous aneurysm were seen and spinal cord angiography showed thoracic dural arteriovenous fistulae (AVF) in both cases. Within 24 hours following myelography, clear neurological worsening occurred, associated with cephalalgia, nausea and transient diplopia in one case, leading to paraplegia in a few days. Paraplegia was complete six months after surgery in one case, and had resolved after embolization of fistula in the other patient. The mechanism of neurological worsening may include: substraction of cerebrospinal fluid, sitting position during and after myelography and local increase of metrizamide concentration secondary to impaired resorption caused by the fistula. Water-soluble myelography is of invaluable aid in the diagnosis of dural AVF and must be followed by early angiography, thus allowing prompt therapeutic embolization.

Adult↗