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Biomedical subjects

J Metzger

Publications and source records attributed to J Metzger.

At least 145 records · Page 8Linked to original sources
PubMed1982

[Simplified technic for stereotaxic biopsy of hemispheric tumors].

Stereotaxic biopsy of cerebral tumors has been considerably facilitated by the use of CT scanner. A new method is described using the CT section in the horizontal or oblique plan of biopsy. When this has been determined, it is possible to define a trajectory, calculated by the CT scan computer, with external landmarks marked on the skin. This method is possible with any kind of CT apparatus; the surgical biopsy is performed in the operating room with a simple stereotaxic frame square-shaped and fixed in the plan of the CT section. The biopsy needle may be oriented in an antero-posterior or medio-lateral direction. This method has been used in 33 patients, leading to as precise histological diagnosis in 30 cases. No complications have been noted, except for transient neurological deterioration in two cases, due to local edema. Hemorrhage have not been observed. The topographical precision of the method was verified by the injection of lcc of air followed by a post-biopsy CT scan. This technique seems particularly valuable for the diagnosis of deep or wide spread hemispheric tumors, non indicated for open surgery.

Biopsy, Needle↗
PubMed1982

[Wallenberg's syndrome due to a dissecting aneurysm of the vertebral artery].

A 54 year old man without pathologic past history but mild hypertension, obesity and gastric ulcer, presented with a syndrome of Wallenberg. He had complained for five days of progressive and diffuse headache. The neurological condition improved initially, but the patient died suddenly two weeks later. Pathological examination showed no significant alteration except for left ventricular enlargement and mild arteriosclerosis. There was a hemodissection (dissecting aneurysm) of the left vertebral artery next to the inferior oliva. It induced a lateral infarct and a limited dorsal infarct at the middle third level of medulla oblongata. Although the location of the arterial changes is usual, their nature is exceptional. The cause of the arterial hemodissection could not be ascertained: fibrous arterial dysplasia, atherosclerosis or congenital abnormalities of internal elastic layer may be discussed. But no definite conclusion can be reached.

Aortic Dissection↗
PubMed1982

[Non-lethal brain stem hematomas in hypertensive patients].

Brain stem hemorrhages (peduncular, pontine, medullary) were demonstrated by CT scan in hypertensive patients, the outcome being favorable without surgical intervention. Such lesions are considered as being usually massive and fatal. A review of the literature show that hemorrhages in the brain stem represent 5 to 9 p. cent of intraparenchymatous hemorrhages, and are usually located in the pons. A favorable course was known to occur before the use of computed tomography: the rare cases described were often related to subacute hematomas in young normotensive subjects which could be treated by surgery with or without ventricular shunting. Clinical diagnosis is based on the rapid progressive course of the disorder and the location of the lesion. Computed tomography provides an immediate correlation between anatomical and clinical findings, and allows a better evaluation of semiological and prognostic features that were previously considered well established. A major element appears to be the degree to which the hematoma is tolerated. As far as possible neurosurgical procedures should be avoided in hypertensive patients.

Aged↗
PubMed1981

[Diagnosis of brain lesions and of early complications by CAT scan in traumatic patients in coma. Series of 265 cases (author's transl)].

In every patient admitted with a traumatic coma a CAT scan was performed immediately (less than 6 hours after the accident). As a routine procedure another scan was performed 48 hours later; further scans were done depending upon the clinical and ICP conditions. The patients were operated upon or given a medical treatment from the CAT scan analysis only. Until now the brainstem lesions have not been seen on the first day CAT scan images. The CAT scan performed on the second day will show a stabilization or an expansion of the previous lesions: haemorrhage or oedema. Any change in the patient condition or in the IPC monitoring must lead to a new CAT scan revealing epidural or subdural haematomas, hydrocephalus, subdural hygroma, persistent oedema. Therefore the CAT scanner used by a neurosurgical team must be able to work day and night.

Brain Injuries↗
PubMed1981

CT analysis of intrasellar pituitary adenomas with emphasis on patterns of contrast enhancement.

Analysis of the computed tomograms of 85 purely intrasellar pituitary adenomas documents a highly variable pattern of response to contrast enhancement. Twenty-eight of 85 adenomas exhibited homogeneously increased density. Twenty exhibited heterogeneously increased, patchy or ringlike density; 16, hypodensity; and 8, isodensity with normal pituitary tissue. In 13 patients the predominant CT finding was an empty sella with variable enhancement of the adenoma and residual pituitary tissue. Pathological specimens demonstrated that the hypodense zones observed within pituitary microadenomas may represent pituitary necrosis, cyst, hemorrhage, intratumoral abscess, relatively less intense enhancement than the normal surrounding pituitary tissue.

Adenoma↗
PubMed1981

[Treatment of severe head injuries by external ventricular drainage and barbiturate therapy. Mortality and morbidity in 57 cases (author's transl)].

After severe head injury the majority of deaths, during the early period, is due to acute intracranial hypertension. We report a series of 57 severe head injuries with early signs of brainstem involvement. CT Scan performed within 6 hours after injury and repeated at 48 hours showed hemispheric lesions and edema, without shift of the middle line. Treatment consisted of controlled ventilation, water and sodium restriction and barbiturates. A ventricular catheter was inserted in 52 patients allowing intracranial pressure (I.C.P.) monitoring, and permanent subtraction of cerebrospinal fluid (C.S.F.). This treatment allowed the control of a normal I.C.P. in 80% of the patients. In 6 patients a secondary surgical treatment was performed. In this series the mortality rate was 31,5% the good results and moderate disability 54,3%, the severe disability and vegetatives states 14,2%.

Adolescent↗
PubMed1981

[Computed tomography in schizophrenic patients. Results from 15 patients. Review of the literature (author's transl)].

The authors analyzed the scans of 15 chronic schizophrenic patients, apparently deteriorated, all of whom were long standing in-patients. They found 11 pathological cases (6 cortical atrophies and ventricular enlargement, 3 ventricular enlargement, 1 cortical atrophy, 1 cerebellar atrophy). With one exception all these atrophies were slight. The authors findings are comparable with those already reported in other studies. The article also summarizes the results of earlier studies of schizophrenics, by pneumoencephalography which are similar. Although no firm conclusions can be drawn, for such a limited sample, in particular due to the lack of any visible correlation between the pictures obtained and clinical diagnosis or prognosis, the consistent appearance of tomographic anomalies justifies continued research on these lines.

Adult↗
PubMed1981

Sulindac (Clinoril) hepatitis.

A patient with Sulindac-induced hepatitis is presented. Sulindac was confirmed as the cause of the patient's liver disease when hepatic dysfunction abruptly recurred after an inadvertent reexposure to Sulindac and quickly resolved when the drug was withdrawn. The prompt reappearance of fever, chills, pruritus, rash, tender hepatomegaly, and abnormal liver tests after only two doses of Sulindac suggested a hypersensitivity reaction.

Adult↗
PubMed1980

[Metrizamide radiculography with simplified dynamic test (author's transl)].

The development of metrizamide, a recent hydrosoluble contrast medium, has opened up the possibility of dynamic lumbosacral radicolugraphy, but in the opinion of the authors only the upright position is adequate to accentuate or reveal new pathological appearances. This was the case in 68 out of 100 consecutive radiculographies performed.

Back Pain↗
PubMed1980

Pharmacokinetics of contrast media: experimental results in dog and man with CT implications.

The pharmacokinetics of contrast media such as sodium iocarmate, sodium ioxithalamate, metrizamide, sodium/meglumine diatrizoate, and sodium ioxaglate (a recently introduced medium: a hexaiodinated monoacid dimer) was compared in 25 dogs. A biphasic phenomenon was observed due to the rapid diffusion of contrast media from plasma into tissue (interstitium) followed by slow urinary excretion. A bicompartmental analysis was performed in dogs for each agent, showing that the tissue distribution of ioxithalamate is higher than that of other media. Sodium/meglumine ioxithalamate, sodium iocarmate, and sodium/meglumine ioxaglate were also compared in 20 human subjects. The diffusion and excretion phases observed in man appear to be slower than in the dog. Significant variations of iodine plasma concentration from one patient to another were recorded for the same medium and at the same interval after injection. Significant differences were observed between ioxithalamate and iocarmate or ioxaglate plasma concentrations due to the greater tissue diffusibility of ioxithalamate. The mechanisms affecting contrast media diffusibility are discussed: osmolarity, liposolubility, protein binding, and molecular size. Variations in contrast medium concentration in plasma noted in different patients with the same medium are explained by variations in tissue distribution, contrast medium volume, patient age, and patient hydration. Some computed tomographic (CT) implications of these pharmacokinetic studies are discussed. The need for highly diffusible media in routine CT and for less diffusible media in CT angiography is emphasized.

Adult↗
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

[Recurrency of intracranial tumors operated. Diagnosis (author's transl)].

The records of 123 patients who had previously be operated upon for intra-cranial tumors are studied to find symptoms of recurrency. 82 of these patients underwent a second operation. The value of CT Scan, cinegammagraphy and angiography are compared. CT Scan yields the best results to detect recurrency and its place. Using both CT Scan and cinegammagraphy increases reliability for difficult cases, mainly in the cases of multiple lesions. Angiography is no longer used to detect recurrencies but only just before operation.

Angiography↗
PubMed1979

Malignant gliomas treated after surgery by combination chemotherapy and delayed irradiation. Part I: Analysis of results.

Forty-six patients with gliomas were introduced after surgery into a therapeutic programme of six cycles of combination chemotherapy with VM26 and CCNU, followed by delayed irradiation six months after surgery with an average dose of 5,800 rads. After irradiation the same preradiation chemotherapy was readministered for an average of four cycles. The results were compared to those from another group of 28 patients treated only by the same chemotherapy (CRC and C groups sucessively). Twelve patients (26%) died before irradiation in the CRC group, six patients (13%) had recurrences at the time of irradiation, and 28 patients (61%) had no clinical or radiological signs of recurrence at the time of irradiation. For the total of treated patients the median survival after surgery was 17 months, and 46% of the patients were surviving at 18 months. The percentage of survivors at 18 months was significantly more elevated in the group treated by combination chemotherapy and delayed irradiation than in a control group treated by the same combination chemotherapy alone. This result suggests that in approximately 50% of cases combination chemotherapy after surgery, and delayed irradiation six months after surgery, cumulated their effects on survival time.

Adolescent↗