In situ fibrinolysis in supra-aortic main vessels. A preliminary study.
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Biomedical subjects
Publications and source records attributed to J M Derlon.
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The authors report experience of intravascular angioplasty of atheromatous ostial strictures of the vertebral artery in 24 patients. After reviewing the technique, they outline the indications provided through Doppler velocimetric data. The results seem to be encouraging as symptoms disappeared completely in 21 patients.
Cerebral Blood Flow (CBF), Oxygen Extraction Fraction, and Oxygen utilization (CMRO2) have been studied in 15 patients before and After Extra-Intracranial Arterial bypass (EIAB), using PET and 150 steady-State Inhalation technique. Fourteen patients had carotid artery obstructive lesions and the last one a middle cerebral artery occlusion. In the whole group of patients, both CBF and CMRO2 increased significantly on both cerebral hemispheres after the EIAB. This effect was more marked in patients with extensive occlusive disease of neck vessels. This metabolic improvement afforded by EIAB in our patients suggests that long-standing hemodynamic failure may induce a metabolic depression that's still potentially reversible by surgical revascularization. On the other hand, improvement of focal CBF abnormalities depends, in our patients, upon the preoperative coupling of CBF-CMRO2 (mainly misery perfusion syndrome) as reported earlier.
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The authors are reporting their experience about percutaneous transluminal angioplasty in atheromatous stenosis of proximal supra-aortic arteries. In this series of 12 patients, with an 6 months follow-up, vertigo was the main clinical symptom (6 cases), and it must be pointed out that 5 of these 6 patients also underwent a proximal angioplasty of one or the two of their vertebral arteries at the same time. Two subclavian steal syndromes, one arterial insufficiency of an upper limb, one transient cerebral ischaemia, and two asymptomatic cases were also treated by the same procedure. For diagnosis as well as for follow-up, the authors are emphasizing the value of hemodynamic results of Doppler recording. As for the technics itself, it mainly derives from the PTA of the lower limbs arteries. The results in this series appear to be good from an hemodynamic point of view, with neither morbidity, nor mortality.
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A 19 years' old white male presented with a stuporous state, initially suspected to be of a toxic origin. It appeared soon that the patient had a left oedematous cerebellar infarction with obstructive hydrocephalus. The angiographic study has shown an occlusion of the left vertebral artery at the level of C2. After reviewing the literature about the different etiologies of vertebral occlusions in the young people, it appeared likewise that, in this case, it was the result of a traumatic compression due to an alcoholic coma. Despite an external ventricular drainage, the neurological state worsened. After a left suboccipital craniotomy and resection of the external part of the cerebellar hemisphere, the state of the patient improved quickly, and he was discharged from hospital with a light cerebellar syndrome.
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On the tenth anniversary of the Bone Tumor Study Group (BTSG) the authors report on their overall experience of the surgical management of osteogenic osteosarcomas. Current data from the medical literature is analyzed. The authors believe that every time a resection-reconstruction procedure is possible it should be preferred to systematic amputation. This policy is warranted by the continuing advances in medical management, particularly in chemotherapy. However, when dealing with osteosarcomas, the therapist's fore-most concern is the danger to life rather than functional considerations. Attention is drawn to recent technical developments enabling total excision of vertebral and costovertebral osteosarcomas, that should lead to considerable improvement of the prognosis of such tumors which was hopeless until now.
Description of a cervical intradural extramedullary neurenteric cyst in a fifty eight years old female. After a sudden onset of right brachial paresis, spinal hemiplegia during the following few days. The tumor was situated at C6 and C7 in front of the spinal cord. It could be completely removed by means of laminectomy.
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A 27 year old man developed a pyramidal syndrome with hypoesthesia up to the level of D8, over a period of two months. Radiographic examination revealed the presence of an angioma of D8. Selective angiography demonstrated that there was epidural invasion as well as an angioma of the vertebral body, and enabled embolization of the 2 pedicles of the lesion to be performed. This produced only a partial, temporary improvement, and a posterior epidural tumor was found and removed by operation. The histological appearance of the tumor was that of a cavernoma, and rapid and permanent recovery of normal neurological function was obtained after the operation. The authors discuss the pathogenicity of the neurological disorders associated with single bone angiomas, and the problems raised by their treatment.
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Angiography of the spinal cord after trauma to the spine is reported in 14 new cases with neurological signs. Three types of angiographic signs are demonstrated: (1) arterial interruption of the anterior spinal artery, the ascending branch of the radiculomedullary arteries or the extravertebral arteries; (2) displacement of the anterior spinal artery without interruption; (3) hyperemia. The mechanism and significance of these signs are discussed.
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Twenty-three dogs underwent a complete transection of the spinal cord at L 1 level. Section was followed in eighteen animals by reconstruction effected through suture of the arachnoide with the aid of monofilament 10 X 0 thread. The operation was in all cases concluded by an osteosynthesis with metallic material in order to prevent any movements in the operated site, and a tight dural closure was achieved in order to prevent propagation of any epidural hematoma or secondary granuloma. This technique did not prevent an unfavorable evolution of the suture, which demonstrated three different morphological features:--necrosis of the spinal cord cut ends with secondary formation of a transverse cyst;--secondary infiltration of the operated focus by a fibrous scar growing from the inner aspect of the dura;--failure of axon regeneration through this fibrous block in spite of noteworthy proliferation of axons coming from the dorsal roots. A critical analysis of those results led to a comparaison with various previous works on the same subject. The most recent of these works have led to promising prospects which need confirmation.
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