Search PubMed⌕ Search

Biomedical subjects

J Philippon

Publications and source records attributed to J Philippon.

At least 73 records · Page 4Linked to original sources
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

Use of nitroglycerine to produce controlled decreases in mean arterial pressure to less than 50 mm Hg.

The cardiovascular effects of nitroglycerine (TNG) were studied in 30 patients requiring controlled hypotension for intracranial aneurysm surgery. In patients "resistant" to TNG (n = 9), sodium nitroprusside (SNP) was used to supplement the TNG. With TNG alone at a total dose of 31 mg and a mean hypotension duration of 28 min, mean arterial pressure (MAP) decreased by 43%, from 78.3 to 44.4 mm Hg as a result of decreases in cardiac index (Cl) (18%) and systemic vascular resistances (SVR) (21%). Simultaneously, a moderate increase in (Cao2 - Cvo2) (21%), and a significant increase in plasma renin activity (90%) were observed. In patients "sensitive" to TNG, the MAP decreased by 54%, Cl by 27% and SVR by 35%; HR remained stable. In patients "resistant" to TNG, the decreases in Cl and SVR were less marked: 2% and 22% respectively; the observed increase in HR was 12%. When non-toxic doses of SNP were used (less than 2 micrograms kg-1 min-1), hypotension was caused by decreased SVR (31%) and increased Cl (8%). TNG alone can be used to produce controlled decreases in MAP to around 50 mm Hg, and in patients "resistant" to TNG, SNP can be added to increase the hypotensive effect.

Adult↗
PubMed1985

[Late syringomyelobulbia complicating spinal cord injury. Improvement after syringoperitoneal shunt].

A patient suffered from paraplegia of T-10 level at age 29, and he complained of new symptoms in the upper limbs at age 42. Gradual ascending worsening occurred, and the diagnosis of post-traumatic syringomyelobulbia was made 23 years after the initial accident. CT scan with metrizamide transit at the medulla level confirmed the diagnosis. Definite clinical improvement was seen after syringo-peritoneal shunting. Clinical, radiological and therapeutic aspects are briefly discussed.

Adult↗
PubMed1984

Prediction of cerebral vasospasm value of fibrinogen degradation products (FDP) in the cerebro-spinal fluid (CSF) for prediction of vasospasm following subarachnoid haemorrhage due to a ruptured aneurysm.

In a new treatment regimen with antifibrinolytic drugs in patients with aneurysmal subarachnoid haemorrhages, we have systematically controlled the level of fibrinogen degradation products (FDP) in the cerebrospinal fluid (CSF). The frequency of severe vasospasm with clinical ischaemia has been compared with the patient's initial level of FDP. Fifty patients have been included in this study. (All in Hunt and Hess's grades I or II on their arrival.) Patients with a secondary deterioration unrelated to vasospasm were excluded. The FDP levels were measured in the first three days following the bleeding and we were informed of them at the end of the study. The diagnosis of severe vasospasm was confirmed by arteriography and computed tomography (CT) and it was named "severe" when accompanied with signs of clinical ischaemia. Twenty patients developed a severe vasospasm with clinical ischaemia. In these patients, the mean value of the initial FDP level was between 80 and 320 mcg/ml compared with 20 to 80 mcg/ml for those who had not developed clinical ischaemia (p = 0.0009). Furthermore, two different groups may be discriminated by their initial FDP level: FDP greater than 80 mcg/ml; n = 23, 65% severe vasospasm; FDP less than 80 mcg/ml; n = 27.8% no severe vasospasm (p less than 0.001). These results do not imply a direct role of FDP in pathophysiological mechanisms of vasospasm, but they suggest a relationship between the clot lysis and the appearance of vasospasm with clinical ischaemia. To our knowledge this is the first time that such a predictive role can be attributed to the initial FDP level in the prognosis of vasospasm.

Female↗
PubMed1984

Cytosolic and nuclear sex steroid receptors in meningioma.

To determine the nature of the hormone dependency of meningioma, particularly whether progestin receptor (PR) and tumor growth are estrogen-dependent, we measured the cytosol estrogen receptor (ER) and PR separately by an exchange assay with [3H]R 2858 (for ER) and [3H]RU 27987 (for PR) in 21 meningiomas. We correlated these receptors with age, plasma estradiol and progesterone concentrations, histological subtypes, clinical data such as uterine fibromas, and finally preoperative glucocorticoid therapy. ER was detected at low levels in the cytosol and in the nucleus of a few tumors whereas PR was found in 20 of 21 cases at moderate to high levels, usually with higher concentrations in the cytosol than in the nucleus. No clear relation could be drawn between either cytosol or nuclear ER and PR levels and estradiol and progesterone plasma concentrations, or with the other parameters. On the contrary, a clear correlation could be drawn between cytosolic PR and androgen receptor (AR) concentrations (measured with [3H]R 1881 in the presence of triamcinolone acetonide), leading to several hypotheses of hormonal regulation in meningioma.

Adult↗
PubMed1984

Cerebral edema associated with meningiomas: possible role of a secretory-excretory phenomenon.

A retrospective study of cerebral edema in 40 patients with intracranial meningiomas seems to demonstrate that the extent of edema is not related to anatomical factors such as location. Histological type is more significant; cerebral edema is usually observed with meningothelial forms. Furthermore, the study of tumor cells by electron microscopic methods indicates that secretory-excretory activity is closely associated with with the production of peritumoral edema. The ultrastructural aspects of this secreted material are described, but further biochemical studies are necessary to determine its exact nature. The possible role of tumoral steroid receptors in the secretory-excretory phenomenon is discussed.

Brain Edema↗
PubMed1984

[Pure spinal cysticercosis. Note on the cerebrospinal fluid].

A patient from Benin experienced bilateral sciatic pain, followed by a progressive sensori-motor defect of the lower limbs. Five years after, he displayed symptoms and signs of a thoracic spinal cord compression, but no definite level could be determined. Myelography showed numerous intrathecal cysts from the cauda equina to the cervical cord. The diagnosis of cysticercosis was made by examination of the cysts removed after lumbar laminectomy. The search for another localisation of the parasite was negative. Repeated examination of cerebrospinal fluid (CSF) showed the presence of eosinophils, a high protein concentration, and a local synthesis of immunoglobulin G with an oligoclonal profile on electrophoresis. An accidental cyst punction revealed a fluid with protein migration in the alpha, beta and gamma ranges and a local synthesis of immunoglobulin A. Treatment with Praziquantel was uneffective.

Cysticercosis↗
PubMed1984

[Contribution of the electroencephalogram to the diagnosis of vasospasm after rupture of intracranial aneurysms].

This study concerns 74 patients with subarachnoid haemorrhage from ruptured supratentorial aneurysm--Serial electroencephalographic recordings (EEG) have been made with precise chronology. The first EEG (Day 1 or 2) had a prognostic value, good if it was normal, alarming if axial bursts or comatose patterns were recorded. Associated with CT scan and dosage of Fibrin degradation products in C.S.F. (F.D.P.), initial EEG gave a strong probability in predicting the occurrence of secondary ischemia. The second EEG, between Day 4 and Day 7, had a diagnostic value. When a vasospasm occurred, confirmed by further angiography, focal or unilateralized slow waves were recorded in more than 85% or these EEG. Further EEG gave the opportunity of controlling the evolution of ischemic electrical patterns.

Electroencephalography↗
PubMed1983

[Primary lymphoma of the central nervous system. Apropos of 8 cases].

Eight cases of intracranial primary lymphoma are reported. This condition accounts for 1.6% of all lymphomas. Although diagnosis is only confirmed by cerebral biopsy or surgical excision, it may be suggested by CT scan in multifocal forms. No localizations were demonstrated outside the CNS upon thorough clinical and radiological investigations or postmortem examination. Prognosis is poor: 5 patients died within four months. Tumor size and meningeal invasion are of more prognostic significance than the histological type. The authors advocate conventional radiotherapy delivering 45 000 grays over 5 weeks. Chemotherapy must be added in huge tumors or when meningeal invasion is present.

Adult↗
PubMed1983

Steroid hormone receptors in human meningiomas, gliomas and brain metastases.

Progestin, estrogen, androgen, glucocorticoid as well as mineralocorticoid receptors (PR, ER, AR, GR and MR, respectively) were all evaluated with specific synthetic radioligands (biochemical assays) in 25 meningiomas, 9 gliomas and 4 brain metastases. In meningiomas the main steroid hormone receptors appeared to be the progestin receptor, present in 24/25 cases (mean level: 7 105 fmol/gT) and the androgen receptor, present in 23/25 cases (mean level: 2 265 fmol/gT). Progestin receptor levels were found to be significantly lower in meningiomas of the fibroblastic subtype whereas none of the steroid hormone receptors were detected in the anaplastic case. On the other hand, glucocorticoid receptor levels were related to the preoperative glucocorticoid therapy. In gliomas only estrogen receptors (2/9 cases) and especially androgen receptors (8/9 cases) were noticeable: the latter seemed to be related to the histological types and to the sex of patients. No receptors were found in any of the four studied metastases, including one from breast cancer. The biochemical characterization of the receptors as well as their relevance to tumor biology and to the physiology of the normal tissues where tumors arise, were discussed, and biochemical data were compared with those previously reported.

Adult↗
PubMed1983

[Cerebellar hemorrhage. Clinico-topographic correlations and therapeutic indications].

Spontaneous cerebellar hemorrhages are more easily recognized since the large use of CT scanner. In this series of 28 cases, they represent 9% of all spontaneous intra-cranial hemorrhages. Three main categories may be described. Small hematomas (less than 3 cm) are located in the postero-medial part of the cerebellum (9 cases): they are difficult to recognize, due to their limited clinical signs; their evolution is spontaneously favorable. Larger hematomas (more than 3 cm) represent two thirds of our clinical cases. When situated near the midline (7 cases) stupor or coma are quite constant, as neurovegetative signs; differentiating this type of case from brain-stem hemorrhages is difficult; prognosis is severe as even with surgery; there is a high mortality rate. When located more laterally (12 cases), their evolution is less acute: consciousness disturbances do not generally occur at the onset, whereas cerebellar disfunction is quite obvious; contrary to midline cases, these, when operated upon at an early stage, show a high success rate. If operation is delayed, the prognosis is much more serious due to the mass effect of this lesion in the posterior fossa. This is clearly demonstrated by CT scan which consistently shows displacement of the 4th ventricle with hydrocephalus of the lateral ventricles.

Adult↗
PubMed1983

[Prognostic value of cerebrospinal fluid fibrinolytic activity in meningeal hemorrhages as a result of aneurysm rupture].

26 patients with subarachnoid hemorrhage from ruptured cerebral aneurysms have been reviewed. Fibrinolytic activity of the C.S.F. has been evaluated by the dosage of Fibrin/Fibrinogen degradation products (F.D.P.). When patients have developed clinical signs of ischemia, F.D.P. levels were significantly higher than in those without neurological deficit. Even, if the detection of F.D.P. seems directly correlated to the presence of blood in the C.S.F., there is no direct relation between their level and the importance of S.A.H. as shown by C.T. scan. However when F.D.P. levels are greater than 80 mcg/ml, there is a high risk of vasospasm with clinical signs.

Adult↗
PubMed1982

Progestin and oestrogen receptors in meningiomas. Biochemical characterization, clinical and pathological correlations in 42 cases.

Progestin receptors (PR) were evaluated in 40 intracranial and 2 spinal meningiomas. PR measured with radiolabelled R 5020 were found in 93% of cases (39/42). PR levels were significantly higher (p = 0.05) in females (mean: 5,720 fmol/gmT) than in males (mean: 3,120 fmol/gmT). Biochemical characterization of the R 5020 saturable binding sites showed that they were mainly cytosolic, had a high affinity constant (Kd approximately equal to 1 nM) and were progestin specific. Correlation with sex suggested some biological activity of PR in meningiomas. Oestrogen receptors (OR) were evaluated in 36 intracranial and 2 spinal meningiomas. OR measured with radiolabelled R 2858 were present in 79% of cases (30/38). OR mean levels were equal in females (mean: 285 fmol/gmT) and in males (mean: 330 fmol/gmT). The relevance of PR and possibly OR in the biology of meningiomas and of leptomeninges was suggested by the presence of receptors in a sample of normal leptomeninges.

Adult↗
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↗
PubMed1981

[The use of electrical transcutaneous nerve stimulations in chronic pain. Method and preliminary results in 28 cases (author's transl)].

The analgesic effect of conventional transcutaneous nerve stimulation has been studied in 29 patients, all having a chronic pain caused by peripheral neurological disease. As already reported in the literature half of patients were improved on a short-term basis. Long-term improvement was observed mainly in patients with traumatic nerve lesions; such cases, thus appear to be the best indication for this method. It should be emphasized that whatever the etiology, the delay between the onset of pain and the beginning of transcutaneous stimulations was a critical factor. Nine out of ten patients suffering for less than one year were satisfactorily improved. This suggests that transcutaneous stimulations should be used as early as possible after the onset of neurological pain.

Adult↗
PubMed1981

[Hypoglosso-facial anastomosis. Results in 10 cases (author's transl)].

The authors present the results of 10 hypoglosso-facial anastomoses performed according to the technique of J.M. Sterkers and J.M. Pelisse. In 9 cases regularly followed up: - Muscle tone reappeared between 4 and 5 months and was symmetrical in all cases. - Motility of the half of the face was visible between 4 and 7 months after the anastomosis. In 8 cases out of 9 the definitive result was good with muscle testing varying between 17 and 23/30. In one case palpebral occlusion was incomplete with testing at 13/30. Paralysis of one half of the tongue was invariably well tolerated. Hypoglosso-facial anastomosis has the value of reliability superior to other techniques, in particular facio-facial anastomosis.

Facial Muscles↗