Biomedical subjects
J Pecker
Publications and source records attributed to J Pecker.
[Treatment of vasospasm in aneurysmal meningeal hemorrhage using intravenous nimodipine. Multicenter cooperative study].
We present a multicentric randomized double-blind study of the curative effect of intravenous Nimodipine on the post hemorrhagic vasospasm after aneurysmal rupture. On 122 validated cases out of 188 analyzed patients, the study demonstrates a significative effect on the mortality and severe morbidity related to vasospasm: the reduction of the risk is appreciated to 72%. The major effect is obtained on the mortality risk. A selective effect can be demonstrate on the isolated vasospasm.
Neurosurgical treatment for brain tumours.
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[Spontaneous subarachnoid hemorrhage. Limits of repeated cerebral angiography].
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[The place of arteriography in the etiologic diagnosis of spontaneous intracerebral hematomas].
456 cases of spontaneous cerebral hemorrhage have been referred at the Neurosurgical Department of the University of Rennes since the CT scan is available, i.e. from 1979 till 1984. Sixteen passed away at the time of admission itself. Among the remaining 440 cases a diagnosis of cerebro-vascular malformation was suspected in 189 according to some atypical features in clinical and/or scanographic presentation, but only 101 patients were actually submitted to an angiographic evaluation, 88 others presenting with a very deep comatose state leading to death in a few hours. We found 14 vascular anomalies (14 p. cent) amongst them eight arterial aneurysms, five arteriovenous malformations and one combining cerebellar AVM and arterial aneurysm of the basilar artery. We couldn't perform an autopsy in all lethal cases but the necropsy findings lead to discover eight additional cases (4 aneurysms and 4 AVM). Statistically it means that a gross vascular lesion is responsible of 5% of cases of cerebral hematomas (22 out of 440). We didn't take in account the cavernomas discovered at the pathological examination of the walls of several hematomas. We may conclude that a careful angiographic study is justified in following cases: young age of the patient (under 65); lack of risk factors, especially cardio-vascular or hematologic; relatively satisfactory clinical status of the patient; topographic criteria related to the CT scan (hematomas located in the fronto-basal area and near sylvian fissure).
[Secondary hematoma of the brain stem. Apropos of 5 cases].
Five cases of brain-stem hematoma are described. The cause of these hematomas was identified as "cryptic angioma" (1 cavernous angioma, 1 telangiectasia, 3 arteriovenous malformations). So, they are so-called "secondary hematoma", as opposed to brain-stem hematoma in relation with hypertension. Such secondary hematomas are reported in the literature: 37 operated on cases and 22 untreated cases were found. The clinical picture does not seem to be typical. The presentation appears to be either with the acute onset of a stroke, or with a subacute onset including relapsing symptoms. A progressive deterioration suggesting a pontine glioma or mimicking demyelination is not rare. The CT scanner appearance is often characteristic showing a high density area in the brain-stem which enhanced after injection of contrast medium with an aspect of "halo". Angiography is usually negative. The natural history of brain-stem hematoma due to rupture of a cryptic angioma is not well documented, but it seems that prognosis is very poor. So, the authors insist on surgical evacuation which is effective and safe allowing the diagnosis of brain-stem hematoma and in some cases the identification of the malformation.
Extracorporeal circulation with deep hypothermia and circulatory arrest in the treatment of intracranial arterial aneurysms.
Extracorporeal circulation with circulatory arrest and deep hypothermia in surgery on certain giant intracranial arterial aneurysms or on aneurysms difficult to access is described. The series includes a giant left carotid aneurysm, an aneurysm of the basilar artery bifurcation, a patient with two aneurysms, one on the right middle cerebral artery and the other at the end of the basilar artery, and a fourth patient with two aneurysms, one on the right middle cerebral and the other on the right carotid. Closed-thorax extracorporeal circulation with femoral cannulation was performed on all the patients. Surgical procedure is described and the advantages and disadvantages discussed. Results are encouraging. The authors suggest that the technique be used during surgical treatment of certain intracranial aneurysms that are in awkward positions or are very large in size. They emphasize that the procedure should be confined to exceptional cases.
[The neurosurgeon and imaging].
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[Benign intracranial hypertension in polycythemia which had caused a lateral sinus thrombosis].
Report of a case of so called "benign" intracranial hypertension whose main characteristics are: the etiology attributed to a thrombosis of the venous transverse sinus in the course of a polycythemia; the clinical signs with a reinforcement during the course of the illness of a previous epilepsy; the prognosis with specially heavy visual impairment questioning the prefix "benign" applied to this condition.
[Syringo-peritoneal shunt].
The pathogenesis of syringomyelia is still under discussion. The authors advocate the role of the pressure of the spinal C.S.F. whose flow can be directed from the perimedullary space into the cavity. This force is responsible for an hydrodynamic dissection of the cord, even in cases of foraminal syringomyelia. Therefore it is not efficient to draw the fluid from the syrinx towards the subarachnoïd space. The authors suggest a syringoperitoneal shunt. The present report is only a technical note, according to the poor number of cases operated by this way (4 patients) and to a too-short follow-up (2 years for the first case).
Spinal cord compression by extradural fat after prolonged corticosteroid therapy.
This young man was operated on twice for thoracic spinal cord compression. He had been on corticosteroid therapy for the last 2 years subsequent to a renal transplant. The only anomaly discovered during the operation was a large quantity of extradural fat that did not present the characteristics of lipoma. The remarkable postoperative clinical improvement suggested that the fat deposit was responsible for the spinal cord compression.
[Pituitary suppression interstitial stereogammatherapy and diabetic retinopathy. A critical study of the ophthalmic results based on 28 cases].
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Extra-intracranial anastomosis using a venous graft.
The authors describe a patient with ischaemic neurological incidents due to bilateral hypoplasia of the carotids. Because the use of the superficial temporal artery or the occipital artery was impossible, the extra-intracranial anastomosis was performed by a direct venous graft between the external carotid artery and the posterior temporal artery. The authors describe and illustrate the operation, emphasizing the particular difficulties due to differences in diameter of the arteries and the graft. Because postoperative control angiography demonstrated perfect permeability of the anastomosis, this technique is suggested for when a normal branch of sufficient diameter of the external carotid artery cannot be used.
[Development of stereotaxic methods and their applications to the study of brain neoplasms].
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[The place of surgery in the treatment of supra-tentorial malignant gliomas (author's transl)].
The natural history of malignant gliomas is compared to the mean survival duration after surgery alone and/or surgery associated with radiotherapy and chemotherapy. In the state of the art a combined treatment by surgery and roentgentherapy offers the best prognosis but does not allow for more than 35% of expectation of life at the end of the first year. According to the severity of the general prognosis the present authors advocate a strict care for the functional integrity. An improved knowledge in the biology of cerebral gliomas justifies further consideration in the surgical treatment preparing the expected effects of radiotherapy and chemotherapy.