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Biomedical subjects

J F Hirsch

Publications and source records attributed to J F Hirsch.

At least 91 records · Page 5Linked to original sources
PubMed1980

[Meningioma of infants and children (author's transl)].

The authors report 11 meningiomas observed on infants and children. They point out four items: --In children the diagnosis of intraspinal meningiomas is impossible before surgery while diagnosis of intracranial meningiomas should be possible since in this case the neuroradiological investigations are most often characteristic. --The total removal of intraspinal meningiomas less than (en plaque) is not always possible. --In intracranial meningiomas detected on children less than five years-old, asymmetric macrocrania is very frequent. --Since infants' intracranial meningiomas are sometimes very large, it is likely that the tumor is congenital.

Adolescent↗
PubMed1980

Hydrocephalus and achondroplasia. A study of 25 observations.

Two series of achondroplastic patients were studied. The first series included 5 patients referred to our neurosurgical department for macrocranium and/or mental retardation. The second series was composed of 20 patients arbitrarily chosen from a medical group. Macrocranium was observed in 60% of the patients and was related to hydrocephalus in all but 2 cases. Radiological studies demonstrated that the posterior fossa was deformed and narrowed in its 3 planes, while its volume was conserved because of an abnormal ascension of the tentorium. The conflict between normal brain development and the craniostenosis at the base of the skull is responsible for an upward tilt of the petrous pyramids, a lowering of the mastoid process, and the illusion of a basilar invagination. Ventriculographies, pneumoencephalographies and isotopic transits demonstrated normal CSF circulation. The study suggests that hydrocephalus is related to the stenosis of the sigmoid sinus at the level of narrowed jugular foramina with a resulting raise in intracranial venous pressure. The majority of patients with macrocranium stabilizes spontaneously. Thus, a surgical indication should be extremely limited.

Achondroplasia↗
PubMed1980

[Neurological complications of hemophilia in children (author's transl)].

Although the treatment of hemophilia has greatly improved, the disease is still sometimes responsible for neurological or neurosurgical disorders. Such disorders were observed in the department of Neurosurgery at the "Hopital des ENFANTS MALADES' in twelve hemophiliacs, five of them having antifactor antibodies. Four main points results from this study: 1) A traumatic etiology was found only in one third of the cases. 2) CT Scan is the main investigation since it allows to find out what cases should be operated upon. The ratio of neurosurgical cases varies from one statistic to another from 40% to 70%. 3) The frequency of neurological disorders is correlated with the importance of the deficit in antihemophilic factors, which is usually less than 1%. 4) The death rate in this series was nil. Hemophiliacs without antifactor antibodies should receive a substitutive treatment as soon as possible. However, in hemophiliacs with antifactor antibodies, this treatment should only be given when surgery is required.

Brain Diseases↗
PubMed1979

Medulloblastoma in childhood. Survival and functional results.

The authors report on a series of 57 medulloblastomas in children operated upon -etween 1964 and 1976. Among these children, 44 completed the treatment with radiotherapy to the whole central nervous system. The postoperative mortality rate in 10.5%. Postoperative deaths occurred mainly in infants or when a tumour involved the brain stem. The five-year survival rate is 54% in the whole series. It rose to 71% in the patients who completed the treatment with radiotherapy. The study shows that the life of survivals is frequently impaired by mental or behavioural disturbances. IQ varies from 70 to 90 in 58% of the children; it is below 70 in 31%. Behavioural disturbances are found in 93% of cases. 82% have defective spatial orientation, dysphasia, or dysgraphia. In order to evaluate the responsibility of X-ray therapy for the development of these sequelae, the results have been compared to those of a series of cerebellar astrocytomas surgically removed, but not irradiated. The comparison shows that radiotherapy is at least partially responsible for the mental and behavioural disturbances. No relation was found between these disturbances and a persistent ventricular dilatation or an endocrine dysfunction. However the endocrine assessment showed growth hromone deficiency in 65% of the children, short stature in 55%, and compensated hypothyroidism in 58%.

Adolescent↗
PubMed1979

A new surgical approach to the third ventricle with interruption of the striothalamic vein.

In the removal of tumours that develop within the third ventricle, most approaches are not entirely satisfactory. Therefore, a new approach has been devised: transfrontal exposure of the anterior portion of the frontal horn; coagulation and section of the striothalamic vein in order to open up the roof of the third ventricle; use of a blunt spatula introduced in the foramen of Monro and pushed backwards under the choroïd plexus. This approach has been used in ten cases. Postoperative mortality has been nil; the surgical approach has not apparently been responsible for any sequelae. It is simple and gives a good view of the third ventricle.

Adolescent↗
PubMed1979

[Regressive dysautonomia associating orthostatic hypotension with an invariable pulse and choleriform diarrhea (author's transl)].

The authors describe a case of very severe orthostatic hypotension with an invariable pulse arising during the course of considerable motor diarrhea. The diagnosis of primary dysautonomia was made only after eliminating the many organic causes of diarrhea: microbial, toxic, tumoral endocrine including diabetes. Shy and Drager's syndrome was rejected because of the spontaneously regressive course after a period of 4 years, the patient having had no further signs of orthostatic hypotension.

Cholera↗
PubMed1978

Influence of the use of a surgical isolator on the rate of infection in the treatment of hydrocephalus.

Two series of patients treated for hydrocephalus (101 original shunt insertions, 81 revisions and 35 reinsertions after infections) have been operated on in the same location, 146 with a surgical isolator (SI), 71 without a SI. Due to temporary poor technical conditions, the use of a SI was decided because, the overall rate of acute postoperative infections had suddenly increased from 9 to 19.7%. Then, although these technical conditions remained unchanged, the use of the SI immediately reduced the overall rate of acute postoperative infections from 19.7 to 7.4%. In original shunt insertions, this rate decreased from 24.9 to 5.8% and in revisions from 10.7 to 5.5%. In reinsertions after infection, it only fell from 27.2 to 16.6%. With the SI, the rate of peroperative contamination is almost nil. If postoperative contaminations due to wound disruption or scalp necrosis, and shunt reinsertions after infection are not taken into account, the rate of acute postoperative infection is 0.8%. The data presented indicate the efficiency of the SI. This results from elimination by the SI of airborne contamination and errors in aseptic technique. These two factors are probably the main sources of infection in shunt insertions for hydrocephalus.

Cerebrospinal Fluid Shunts↗
PubMed1978

[Nondiscal sciatica without organic lesion].

Among 1 800 patients operated on for hernia of the disc, 2% were completely negative on surgical exploration. Since a psychiatric aetiology might be involved, these patients were again given physical examination, clinical psychiatric examination and a personality test (minimult). This psychometric examination yelded pathological results in 68% of these patients. A comparison with two control groups operated on for hernia of the disc permitted a distinction of statistically significant differences. The results are compared with similar studies by other authors on patients with lumbalgia and dorsalgia. A practical approach is defined.

Adult↗
PubMed1978

[Study of the relationship between intracrânial pressure and paradoxal sleep in the cat (author's transl].

The present study reports on the modification of the intracranial pressure (ICP) during rapid eye movements (REM) sleep in seven chronic cats. 1. REM sleep episodes were characterized by a succession of short lasting (9 +/- 4 seconds) oscillations of the ICP. Peaks amplitude represented a hundred percent increase of the pressure as compared to its resting level. 2. These oscillations either arose from an ICP level similar to that recorded during the preceding slow wave sleep period or were seen to overide a wave of raised ICP that lasted throughout the REM period. 3. Eighty eight percent of the phasic oscillation coincided with a burt of eye movement characteristic of REM sleep. 4. Cerebral pulse wave amplitude can vary for identical ICP mean value in the course of a same REM period.

Animals↗
PubMed1978

[Fronto-cranial remodeling for craniostenosis with mobilisation of the supra-orbital barr (author's transl)].

33 cases of fronto-cranial remodeling by osteotomies are reported by the authors. Since 1973, 19 oxycephalies have been operated according to an original technique based on two principles:--rocking and advancement of the supra-orbital barr, with an easy lateral retention by a Z-bony cut.--transposition of free bone flaps to rebuild a forehead of the appropriate curvature. The good results obtained have encouraged the authors to operate on young children or even babies in order to solve simultaneously the functionnal and the aesthetic problems. Three plagiocephalies, two trigonocephalies have thus been treated, as well as 5 facio-craniostenosis for whom a 2 cm forehead advancement has been done, the following results being very encouraging.

Child↗
PubMed1978

[Measuring intracranial pressure with a fontanelle palpation transducer (author's transl)].

The accuracy and reliability of a non-invasive method for the measurement of intracranial pressure through the fontanelle without puncture was tested during 12 or even 24 hours recordings. Wealthall and Smallwood modified aplanation transducer was first used. A metal frame had to be developed in order to secure the transducer rigidly over the fontanelle so that the recording could take place with the infant in any position and completely free of its movements. Simultaneous recordings of extradural or intraventricular pressure have shown the measurements were accurate to about 1 or 2 cm H2O in a neurosurgical environnement (i.e large fontanelles with pressure over 10 cm H2O). For smaller fontanelles or low or even negative intracranial pressure, a smaller transducer seems to be needed. The preliminary test of a plane strain gauge transducer that partially fills this need is shown.

Circadian Rhythm↗
PubMed1978

[Medulloblastoma in childhood. Survival rates and functional results (author's transl)].

The authors report on a series of 57 medulloblastomas operated upon in children from 1964 ot 1976. Among these children, 44 completed the treatment with radiotherapy of the whole central nervous system. The post-operative mortality rate in 10,5%. Postoperative death occurred mainly in infants or when the tumor involved the brain stem. The five years survival rate is 46,6% in the whole series. It raises up to 50% in the series of the patients who completed the treatment with radiotherapy. The study shows that the life of survivals is frequently impaired by mental or behavioural disturbances. I.Q. varies from 70 to 90 in 66% of the children; it is below 70 in 20%. Behavioural disturbances are found in 91% of cases, wrong space orientation, speech or writing disabilities in 87%. In order to evaluate the responsibility of ray therapy in the development of these sequelae, the results have been compared to those of a series of cerebellar astrocytomas surgically removed, but not irradiated. The comparison shows that radiotherapy is at least partially responsible for the mental and behavioural disturbances.

Adolescent↗
PubMed1977

[Angioventriculography in the study of deep arteriovenous aneurysms].

The authors discuss the value of angioventriculotomography before surgery in deep arteriovenous malformations. This new procedure was performed in 2 infants and 3 children. In all cases, it was possible to know the precise relations of the lesions to deep structures of the central nervous system. Surgery was then contra indicated in two patients. In the remaining three patients, it not only proved to be of great value before deciding surgery, but it also determined the entire surgical procedure. The only incident encountered in this series was a rapidly regressive convulsive seizure in an infant of 3 months.

Adolescent↗
PubMed1977

[Transitory dyslexia related to hematoma of the left temporal lobe in a 14-year-old adolescent].

A hematoma limited to the median region of the second left temporal convolution was the factor of an involvement of written language which rapidly set in in a 14 years old adolescent. The type of disorders observed are quite superimposable on dyslexia in children. After evacuation of the hematoma, the reading disorders disappeared, as was proved by normalization of the leximetric test.

Adolescent↗