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Biomedical subjects

J F Hirsch

Publications and source records attributed to J F Hirsch.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Percutaneous endoscopic gastrostomy. 174 cases].

Nutritional assistance was given by percutaneous endoscopic gastrostomy to 174 patients with neurological diseases (80 cases), tumours of the ear, nose and throat (ENT) region (70 cases) or malnutrition (24 elderly people). These patients had either deglutition disorders with inhalation or severe malnutrition, or could not tolerate a nasogastric tube. The endoscopic catheter (Bioser) was installed by the pull technique under general anaesthesia (26 percent), neuroleptanalgesia (16 percent), premedication (14 percent) or without sedation (44 percent). Installation was possible in 98 percent of the cases. Twenty-nine percent of the patients were treated in an outpatient clinic. The problems encountered (21 percent) were mainly due to blockade of the flange and rupture of the thread. Transoperative accidents, such as dyspnoea, bleeding or cardiac arrest, all without sequelae, were noted in 5 percent of the cases. The catheter remained in situ for a mean period of 3.9 +/- 0.3 months (range: 0.1 to 20 months). The following complications were observed: short-term (15 percent), hyperthermia (5), local infection (6), abscess of the abdominal wall (3), meteorism (9), pneumoperitoneum (1), subocclusion (2); long-term (25 percent), inflammatory reactions (13), leakage (19), catheter displacement (8) and catheter rupture (3). Local infections were more frequent in patients with ENT tumours than in the others. Percutaneous endoscopic gastrostomy is a fast and reliable technique preferable to surgical gastrostomy. Complications are frequent (46 percent) but usually minor (42 percent). Contra-indications must be respected, and the catheter must be introduced with the utmost care.

Administration, Cutaneous↗
PubMed1990

Neurosurgery with craniotomy and CT stereotactic guidance in the treatment of intracerebral space-occupying lesions.

When intracerebral space-occupying lesions are small or located deeply within the brain parenchyma, it is sometimes difficult to localize them at surgery or to design the most direct and least hazardous surgical approach. Therefore, we have developed a method that combines conventional neurosurgical techniques with craniotomy using stereotactic guidance. We have used the Brown-Roberts-Wells (BRW) stereotactic system, which allows for computed tomography (CT) or magnetic resonance imaging (MRI) guidance and does not interfere with the absolute sterility mandatory each time a flap is created. Eleven patients were operated on using this method. The deep tumors were approached through a linear incision of the cerebral cortex. Then a needle, fixed in the right position on the arc system of the BRW, was inserted toward the surface of the lesion; the exposure was finally widened by inflation of a rubber balloon set on the stereotactic needle. This technique allows the two lips of the cortical incision to be glued at the end of the operation. Gluing with a fibrin glue avoids the postoperative subdural collections that often develop when the ventricle has been opened. Except for one case, the postoperative course was uncomplicated in these patients. No permanent postoperative neurological worsening was observed even after the removal of an intrathalamic tumor.

Brain Diseases↗
PubMed1990

Medulloblastoma in childhood: progressive intellectual deterioration.

A series of 120 medulloblastomas in children operated on between 1967 and 1987 at the Hôpital des Enfants-Malades has been reviewed in order to check whether the conclusions of our study published 10 years ago have remained valid and, in particular, to verify whether the quality of life of these patients, which had been found to be poor at the time, had improved or worsened over the years. The postoperative mortality for the whole series was 6.5%; there have been no deaths in the 35 patients operated on after 1980. The overall survival rate for the 120 children was 60% at 5 years and 53% at 10 years; for the patients who completed radiotherapy, the survival rate was 73% at 5 years and 64% at 10 years. Survival rates were surprisingly better in patients treated when under 6 years of age than in older children. They were also better in girls than in boys, and in desmoplastic compared with other medulloblastomas; however, the differences were not significant. When comparing the groups after total or subtotal resection of tumors, survival rates were not significantly different, but were lower in the small group of partial resections. Cell differentiation did not influence the prognosis. Psychological sequelae were significant and worsened over the years. Five years after treatment 58% of the children showed an IQ above 80; 5 years later this group included only 15% of the patients. These psychological sequelae were related to age at the time of radiotherapy: the younger the child, the lower the final IQ.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Presentation and management of suprasellar arachnoid cysts. Review of 20 cases.

The clinical presentation and treatment of suprasellar arachnoid cysts remain controversial. The authors review 20 cases treated at their institution and 86 cases from the literature reported in sufficient detail for analysis. The high frequency of endocrinological disorders, which not only persist following treatment but may also develop years later despite the satisfactory decrease in volume of the cyst, are emphasized and documented. The difficulties of management are discussed, including; subfrontal approaches to these cysts; removal and/or marsupialization of the cysts, procedures that are frequently dangerous and ineffective; and ventricular shunting which often leads to a paradoxical increase in the size of the cysts. The authors emphasize the advantages of percutaneous ventriculocystostomy, which is a simple, benign, and efficacious procedure.

Adolescent↗
PubMed1990

[Treatment of suprasellar arachnoid cysts by percutaneous transfrontal ventriculocystostomy. Apropos of a series of 17 cases].

The treatment of suprasellar cysts is controversial and most often disappointing: on the one hand, subfrontal approaches to the cysts, in view of removal or fenestration, are frequently dangerous and ineffective; on the other hand, ventricular shunting frequently leads to the paradoxical increase in the size of the cyst. Because of these difficulties, the authors have treated 17 consecutive cases by the means of a percutaneous transfrontal ventriculocystostomy. In 11 cases, the cyst was perforated by a leukotome which was guided radiologically in 10 cases and by ultrasounds in 1 case. In the remaining 6 patients, the cystostomy was achieved by a monopolar coagulation under ventriculoscopic control. The results were as follows: in 3 cases, it was not possible to achieve the fenestration of the cyst with the leukotome due to the resistance of the membrane; in 1 case, the ventriculocystostomy was complicated by a poor control of the trocar progression under ultrasounds; the other 14 procedures were successful: signs of increased I.C.P. disappeared; the neurological symptoms regressed; the cysts diminished in size. However, the preoperative endocrine troubles did not decrease. The persistence of a post operative ventriculomegaly apparently did not affect the level of the intellectual development of the patients. The authors emphasize the interest of the percutaneous ventriculocystostomy, this procedure being simple, benign and efficacious. The fenestration of the cyst by coagulation appeared more suitable than by the leukotome.

Adolescent↗
PubMed1989

[Prognosis of antenatal hydrocephalus].

One hundred and eight children born with hydrocephalus were reviewed in order to evaluate their neuropsychological development. Premature children and children with spina bifida were excluded. The most frequent types of hydrocephalus were the communicating type (39 cases) and that where the condition is due to stenosis of the aqueduct of Sylvius (32 cases, not counting 6 cases of Bickers-Adams syndrome and 4 cases of toxoplasmosis); 84 per cent of the children were operated upon before the age of 3 months. The mean follow-up period was 7 years (range: 1 to 14 years). The actuarial survival rate at 10 years was 62 per cent. Among the 75 survivors, 28 per cent had an IQ of at least 80 and 50 per cent and IQ lower than 60; 29 per cent of the 52 children who reached school age had normal education. Forty-six per cent of the children showed little or no disorder of behaviour. The head circumference at birth, the size of the cerebral ventricles and the child's age at the time of surgery had no influence on the neuropsychological development. However, the prognosis seemed to be better in cases without associated malformation or infected valve, in those where the hydrocephalus was due to stenosis of the aqueduct of Sylvius (except when related to sex or toxoplasmosis) and when the first IQ evaluated at the age of about 6 months was higher than 80.

Abnormalities, Multiple↗
PubMed1989

Benign astrocytic and oligodendrocytic tumors of the cerebral hemispheres in children.

The authors review 42 consecutive cases of benign astrocytic and oligodendrocytic tumors of the cerebral hemispheres in children undergoing surgery in the pediatric service of the Hôpital des Enfants Malades between 1975 and 1987. Epilepsy was the presenting sign in 76% of the children and remained the only clinical sign at diagnosis in 62%. Partial or complex partial seizures were observed in half of the cases, but other seizure types were also frequent. Diagnosis of the tumor as the etiological agent rested upon the results of computerized tomography or magnetic resonance imaging. Postoperative mortality (5%) and morbidity (16%) rates were low. The postoperative intelligence quotient was above 80 in 71% of the patients, and 77% of the children had no major problem in school. Although only two of the 42 patients were given postoperative radiotherapy, there were no recurrences in 82% of the survivors. The actuarial probability of nonrecurrence of the tumor was 95% at 5 years. Three patients with recurrent tumor underwent further surgery and are, at the present time, recurrence-free. The incidence of epilepsy fell from 76% before surgery to 19% after removal of the tumor alone; therefore, intraoperative electrocorticography and resection of the electrically abnormal cortex at the time of the first surgical procedure do not appear necessary. It is possible that tumor removal restores a mechanism that limits the spread of seizures and, thus, the clinical manifestations of epilepsy. Benign astrocytic and oligodendrocytic tumors of the cerebral hemispheres in children should not be treated with adjuvant radiotherapy, at least initially.

Adolescent↗
PubMed1989

[Hydrocephalus of venous origin].

The relationship between intracranial pressure and superior sagittal venous pressure has been often debated. On one side, the observation of patients with achondroplasia or hydrocephalus associated with craniostenosis suggest that the venous hyperpressure could be the cause of the enlarged ventricles; on the other side, reports have demonstrated that an increased superior sagittal venous pressure could be the consequence of increased intracranial pressure. Therefore, the authors undertook a study to determine if there was a test that could distinguish between rare instances of increased superior sagittal venous pressure caused by structural and irreversible narrowing of the sinus, and those caused by increased intraranial pressure. This test is based on the study of venous pressure variation during cerebrospinal fluid withdrawal as compared to simultaneous intracranial pressure variations. The relationship between a sinus venous hyperpressure and an enlargement of the ventricles, the pathology of pericerebral collection occurring in such cases of hydrocephalus are discussed.

Blood Pressure Monitors↗
PubMed1989

[Treatment of chronic subdural collection in infants by subdural peritoneostomy].

Between 1980 and 1987, 50 chronics bilateral subdural collections in infants were treated by means of a subdural peritoneal shunt (unilateral in 48 cases, bilateral in 2 cases). In 2 patients with huge macrocranium the drains were left in situ. In the 48 others, the drains were removed after an average of 10 months. In these 48 cases, the drainages either bilateral (2 cases) or unilateral (46 cases) led to the disappearance of the collections; however, in 1 of these 48, a drain had to be reinserted due to the reproduction of the collection following the removal of the initial drainage. High level of C.S.F. protein content did not alter the peritoneal resorption. Obstruction of the catheter by a clot occurred in 3 cases with grossly bloody collections. Unilateral subdural peritoneal drainage for bilateral pericerebral collection is an efficient and safe treatment. The authors should advocate temporary external drainage only in the cases where the collection is grossly bloody.

Chronic Disease↗
PubMed1989

Epilepsy and brain tumours in children.

Although epilepsy is one of the clinical manifestations of brain tumour in one out of three children, such tumours are only found in 1 to 2% of epileptic children explored. When epilepsy reveals the tumour, the latter is benign in 9 out of 10 cases: usually an astrocytoma, an oligodendroglioma or a mixed oligoastrocytic tumour. These tumours accounted for 84% of benign tumours of the cerebral hemispheres among children treated by surgery in our department at the Enfants Malades hospital, Paris; 76% of them had been revealed by epileptic seizures. Among other lesions responsible for epilepsy were 2 cavernous angiomas and 6 thrombotic angiomas. Brain tumours were located in the temporal lobe in almost one half of the cases. The type of epileptic attack was variable, but complex partial seizures were the majority (47%). Several types were associated in 30% of the cases. Surgery was the only treatment in view of the very low recurrence rate. In 80% of the case, removal of the tumour was sufficient to suppress epilepsy. 71% of the children operated upon have an IQ of more than 80; 77% have normal schooling.

Adolescent↗
PubMed1989

[Stereotaxic technics with an open skull in the treatment of space-occupying brain lesions].

When intra-cerebral space-occupying lesions are small or when they are deeply located in the brain parenchyma, it is sometimes difficult to localize them at surgery or to design the most direct and least hazardous surgical approach. Therefore we have developed a method which combines conventional neurosurgical techniques with craniotomy using stereotaxic guidance. We have used the Brown-Roberts-Wells (B.R.W.) stereotaxic system which allows for CT scan or MRI guidance and does not interfere with the absolute sterility mandatory every time a flap is created. Eleven patients were operated on using this method. The deep tumors were approached through a linear incision of the cerebral cortex; then a needle fixed in the right position on the arc system of the B.R.W. was inserted toward the surface of the lesion; the exposure was finally widened by the inflation of a rubber balloon set on the stereotaxic needle. The post-operative course was very uncomplicated in all these patients. No permanent post-operative neurological worsening was observed, even after the removal of an intra-thalamic tumor.

Brain Neoplasms↗
PubMed1988

Lumbosacral lipomas with spina bifida.

The pathological and metabolic characteristics, as well as the anatomical and functional evolution of lumbosacral lipomas, were studied in a series of 73 patients operated on between 1970 and 1983. The pathological study showed that they are mainly composed of adipocytes, but that they also possess fibrous tissue, vessels, and nerve fibers. Innervated muscle fibers, contracting under proper nerve stimulation, were found in several cases. Lipogenesis and lipolysis are the same in lumbosacral lipomas and in normal fat tissue. However, these lipomas can grow with the rest of the fatty pool. Moreover, spontaneous progressive worsening of the clinical status has been observed in 36% of the cases. Surgery is efficient and not harmful to the patient. Postoperative mortality was nil. Early postoperative worsening occurred in 2.7% of the cases. The 6% rate of late postsurgical deteriorations should be compared to the 36% to 56% rate found when patients are not operated on. Three different mechanisms are responsible for clinical worsening: compression or stretching of the cord, and cord injury on the posterior upper limit of the spinal defect. In each case, one mechanism is prevalent. Three different types of lumbosacral lipomas can thus be individualized. The surgical implications of these data are discussed. The necessity for early and systematic surgical treatment is pointed out.

Adult↗