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Biomedical subjects

J Metzger

Publications and source records attributed to J Metzger.

At least 127 records · Page 7Linked to original sources
PubMed1986

Examination of epidural tumors of the spinal canal. Comparative study with magnetic resonance imaging, computed tomography and tomo-myelography.

To delimit the vertical extension of epidural tumors of the spinal canal, tomo-myelography and magnetic resonance imaging (MRI) are the most accurate examinations, MRI appearing to us to be even superior to tomo-myelography. To evaluate precisely the bone extension of tumor growth as compared with the epidural lesions, computed tomography (CT) is more accurate than the other methods mentioned. The choice between these three techniques is of great importance as an aid in selection the best therapeutic method in each particular case.

Adult↗
PubMed1986

[Computed tomographic examination in orbitofacial injuries].

Eighty patients with craniofacial injuries were investigated using a CT scan apparatus of the second generation. The advantages of this examination over conventional methods of exploration are discussed and details provided of projections used. Conventional tomography imaging has now been completely abandoned.

Facial Injuries↗
PubMed1986

[Pregnancy and hyperprolactinemia. Review of therapeutic measures apropos of a series of 35 patients].

Forty-eight pregnancies were observed in 35 patients with hyperprolactinaemia divided into 3 groups according to their initial radiological appearances: normal sella turcica (Group I, n = 11), microadenoma (Group II, n = 12) or macroadenoma without suprasellar expansion, visual defect or pituitary deficiency (Group III, n = 12). Twenty-seven patients were treated with Bromocriptine (Br) from the outs six by adenomectomy + Br, one by adenomectomy alone complicated by meningitis and by corticotropic and thyrotropic hormone deficiencies, followed by amenorrhea despite normalisation of the hyperprolactinaemia requiring induction of a first pregnancy with Clomid. As regards the pregnancies induced by Br (43/48), Br was withdrawn at an early stage in Group I and in the majority of cases in Groups II and III. In all, 37 pregnancies came to term; after Br therapy we observed 5 spontaneous abortions and 3 premature deliveries; 2 caesarian sections were performed before term (one case of hypertension and one adenomatous expansion); one early termination was performed for a tumoral complication. One congenital abnormality (oesophageal atresis) was detected. These observations support the results of extensive studies showing no effects of Br on the outcome of pregnancy and no detectable teratogenic effects with this drug. Five pituitary complications occurred during pregnancy after withdrawal of Br; 1 case of headaches with expansion of a macroadenoma cured by adenometry after prophylactic caesarian section before term; 1 case of optic chiasma compression (Group III) which responded to emergency surgery and 2 cases of pituitary apoplexy (Groups II and III) which responded favourably to Br and in which pregnancy continued normally.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗
PubMed1986

[Primary hypothalamic tumors (excluding craniopharyngioma). Endocrine and post-radiotherapy development study. Apropos of 17 cases].

The authors underline a number of features of primary hypothalamic tumours (except craniopharyngioma) based on a study of 17 cases: The vital prognosis is satisfactory; only one death was observed with an average follow-up period of 80 months (range 1 to 17 years). This raises the question of the necessity for systematic biopsy to confirm the tumour histology (although when performed in conditions of stereotaxis there are no serious risks). The site of the tumour makes surgery difficult and complete ablation impossible. As many hypothalamic tumours, including the pilocytic astrocytoma which is the commonest type, are sensitive to radiotherapy, this would seem to be the treatment of choice. Total regression is observed in the majority of cases. From the endocrine point of view, the mediocre prognosis is aggravated by high energy radiotherapy. However, with the present therapeutic methods, it is relatively easy to compensate complete or dissociated deficits. There is an endocrine syndrome suggestive of hypothalamic tumour which consists of anterior pituitary deficiency, diabetes insipidus and moderate hyperprolactinaemia (20 to 100 ng/ml). Close medical surveillance is essential, both of the local (visual field and frontal CT scanning) and endocrine effects. Hormonal deficits may occur as a late complication up to 5 years after radiotherapy. The problems inherent to hypothalamic tumours: neurogenic hypernatraemia which is luckily uncommon, with an unexplained weight gain occurring during substitute therapy for adrenal insufficiency with physiological doses of hydrocortisone. Finally, the overall prognosis is good with a minimum of complications due to radiotherapy, excepting endocrine deficiency, providing a dose of 60 grays in 6 weeks at 2 grays per session is not exceeded.

Adolescent↗
PubMed1985

Operability of intracranial meningiomas. Personal series of 353 cases.

The senior author's experience has been reviewed in 353 operated meningiomas; so called "malignant meningiomas" have been discarded. The whole series has been split into two groups: the first (A) includes 273 cases operated before the CT era, the second (B) consists of 80 cases the operability of which was based mainly on the CT. In addition, during the time elapsed to constitute the second series surgery has been refused to 15 patients which were considered for CT and clinical reasons as surgically incurable when one wants to reduce the risk of mortality and morbidity. Therefore, we have reviewed in series B indisputable, questionable and incurable cases with respect to operability in the present condition of our technical possibilities including arterial hypotension, the operative microscope and the CUSA. Considering localization, we have made technical observations with respect to the principles on which operations have been based since 1958 when general anaesthesia became available in La Pitié. Among the patients of the whole series, 14 were admitted for a recurrence. The time interval between surgery and readmission has been given as well as the primary location of the meningiomas. The mortality rate has been 26 out of 353 (7%), and the main causes have been reviewed especially in series B. With regard to series B, we have been able to get in touch with 53 patients out of 80; 90% of them returned to work or family without sequelae. Intracranial meningiomas remain the most curable tumours, nevertheless some of them must be considered incurable like in meningiomatosis or when the dural attachment is extensive. For those cases surgery is not the final answer and we must accept the fact that in the future other kinds of treatment will develop.

Adult↗
PubMed1985

[Results of bromocriptine treatment of giant or invasive prolactin adenomas. Apropos of 20 cases].

The therapeutic results of twenty patients with giant expansive prolactinomas were studied under bromocriptine as treatment of first intent (Group I, n = 10) or of second intent after surgery with or without radiotherapy (Group II, n = 10). Patients in Group I (PRL: 350-17 000 ng/ml) were given bromocriptine alone (10 to 20 mg/day) for a period of 21 days to 22 months. The visual fields and acuity returned to normal in 8 days to 3 months in 4 out of 7 patients and significantly improved in 2 out of 7 patients. A reduction in tumour size was demonstrated on CT scanning in 7 out of 10 patients mainly in the suprasellar region (6/9) with appearances of a partially empty sella in 4 cases. Normalisation of the PRL (7 out of 10 cases) was accompanied by a correction of one or more other hypophyseal deficits in 3 patients. Bromocriptine was continued in 5 out of 10 cases with a good result after 12 to 22 months follow-up. Five patients were referred secondarily for surgery for spontaneous rhinorrhea in 1 patient or because Bromocriptine was only partially effective in 4 patients; a postoperative visual improvement with reduced serum prolactin levels was observed in these 4 cases. In Group II (PRL: 200-11 600 ng/ml after surgery), bromocriptine therapy (5 to 30 mg/day for 1.5 to 72 months) was associated with normalisation or a significant improvement in visual symptoms in 6 out of 9 cases and a reduction in tumour size in 8 out of 10 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗
PubMed1984

Computed tomography in primary lymphoma of the brain.

C.T. scans of 19 patients with histologically proved primary lymphoma of the brain were reviewed and divided into three groups: solitary tumors (58%), multifocal tumors (31,5%), diffuse involvement of the brain (10,5%). The C.T. differential diagnosis are manifold, including meningioma, glioma, metastases, progressive multifocal leukoencephalopathy. Arteriography is not specific, but, correlation with C.T. results may suggest the correct diagnosis and encourage biopsy. The radiosensitivity of primary lymphoma of the brain emphasizes, the importance of an early diagnosis.

Adult↗
PubMed1984

[X-ray computed tomography (CT scanner) in schizophrenia. Comparison of its results with other studies].

This paper concerns the tomodensitometric (TDM) study, with the same clinical and radiological criteria, of 78 schizophrenic patients (age: less than 60 years) from psychiatric hospitals in Madrid and from Sainte-Anne hospital (Paris). The length of evolution and the severity of disturbances seemed to be the most important causal elements of cerebral atrophy. Some TDM peculiarities appeared correlated with some clinical forms (paranoid or hebephrenic). The review of previous works illustrates the importance of some etiological conditions for the production of cerebral atrophy: age, length of evolution and, more particularly, the severity of the disease. The confrontation of the anatomo-pathological and pneumoencephalographic studies with the TDM results suggests that, if the TDM is a good indicator of ventricular dilatation, appreciation of the widening of the cerebral sulci remains difficult.

Adult↗
PubMed1983

[Myelographic diagnosis of radiculomeningeal metastases of carcinomas. Apropos of 10 cases].

The authors report ten cases of intra-arachnoid metastases affecting the spinal cord and its roots. These cases illustrate all the myelographic appearances seen: multiple nodular appearances, striated appearance related to thickening of the roots, failure to visualise one or more root sheaths, filling defect of varying regularity preferentially seen in the dural cul-de-sac, but also in the terminal part of the cord associated with varying degrees of block. Myelographic technique is essential of they are to be visualised: water soluble opaque agents and tomography, if possible by complex scanning alone ensure accurate analysis of the roots. This type of involvement raises a pathogenic problem regarding the exact mechanism of such metastases. The prognosis is very poor despite treatment based upon radiotherapy and chemotherapy.

Arachnoid↗
PubMed1982

[Computed tomography of the head in gunshot wounds. Thirty-three cases (author's transl)].

The authors report a series of 33 cases of craniocerebral lesions secondary to projectiles injuries studied by means of CT scan. Ct scans demonstrate the path of the missile, destructions of deep cerebral parenchyma, dissections of with matter (intra-cerebral bubble) and reactive oedema. Prognostic incidence of CT is discussed. CT scan helps to choose the best therapeutic approach as regards each particular case.

Adolescent↗