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Biomedical subjects

M Djindjian

Publications and source records attributed to M Djindjian.

At least 55 records · Page 3Linked to original sources
PubMed1988

The normal vascularization of the intradural filum terminale in man.

The arterial and venous blood-supply of the intradural filum terminale was studied microscopically in 18 fresh cadavers after removing the dorsolumbar spinal cord in one piece, with the roots and the filum in their dural sheath. The arteries were examined after manual injection of the artery of the lumbar enlargement, while study of the veins was made without injection since their bluish-black color made them easily identifiable. After gross examination, each specimen was fixed and then sectioned at 12 different levels from the medullary conus to the bottom of the dural sac for histologic study. The distribution of the vascularization of the filum terminale appeared constant. A single artery, the artery of the filum, arises from the termination of the anterior spinal axis, either by trifurcation or from the proximal part of one of the 2 branches of the anastomotic ansa of the conus. The artery travels in front of the filum, with rapidly diminishing caliber; rarely, it can be followed into the sacral canal. The vein of the filum travels in front of that structure but behind the artery, as in the cord; its caliber is uniform but varies from subject to subject. It traverses the dura below and is continuous with the anterior spinal vein above. No vessels were found on the dorsal aspect of the filum. While the artery of the filum is of a caliber proportional to that of the filum and appears to be a nutrient vessel, the vein has a caliber unrelated to that of the filum and appears rather as an intradural drainage route continuous with the anterior spinal vein.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1987

[Cranial traumatology. Recent statistical data].

The authors describe a one-year prospective study carried out in Créteil from October, 1983 to October, 1984 in 155 selected patients admitted for at least 24 hours with traumatic head injury. Patients with gunshot wounds of the head were excluded from the study. 30% of the patients were infants, 60% were adults aged between 15 and 60, and 5% were over 60; 48% were not comatose (initial Glasgow symptomatic score [GSC] greater than or equal to 8) and 36% were free of any neurological symptom. Prognosis was related to the initial neurological status, to the patient's age and to underlying diseases, such as alcoholism. 10 out of 11 patients with an initial GSC of 4 or less died, against 12 out of 144 with a GSC above 5. At the first CT scan, 10% were found to have an extradural haematoma, but the examination was normal in 20% of patients with neurological symptoms and/or coma; 22% of the CT scans were abnormal without any clinical symptom, as was the case, in particular, with 4 extradural haematomas. Surgery was performed in 24% of all patients and in 17.4% of infants, whereas the percentage reached 30% in alcoholic patients, due to the frequency of intracerebral haematomas in this population. In 16% of the 155 cases, barbiturates were used to treat uncontrolled intracranial pressure higher than 20 mmHg. 15% of the 155 patients deteriorated; a second operation was necessary in 9 cases. The final outcome on discharge was: 112/155 patients with good recovery or moderate disability, 22 with severe disability, 5 with persistent vegetative state and 21 deaths.

Adolescent↗
PubMed1987

Post-operative intracranial foreign body granuloma: a case report.

The authors report and discuss some clinical, radiological, histological and ultrastructural aspects of an intracranial foreign body granuloma. This granuloma, which simulated a cavernoma, was due to a surgical swab forgotten during a previous neurosurgical evacuation of an intracerebral hematoma.

Adult↗
PubMed1987

Vertebral hemangiomas presenting with neurologic symptoms.

Six cases of spinal hemangiomas with neurologic symptoms are reported. In three of them the diagnosis was obtained before surgery using plain x-rays and spinal computed tomography scan or biopsy. In the other cases the diagnosis was not done before surgery. In two cases preoperative embolization had minimized blood loss during surgery. Laminectomy was performed in three cases. Large removal and/or vertebrectomy was carried out in the other cases. Our results and a review of the literature about the investigations and treatment of vertebral hemangiomas led us to propose a stereotypical management of spinal hemangiomas with neurologic symptoms.

Adolescent↗
PubMed1987

[Occipital intraosseous epidermoid cyst producing a clinical picture simulating benign intracranial hypertension. A clinical case].

The authors describes a 17 years old woman with a small occipital intradiploic epidermoid cyst simulating a benign intracranial hypertension on an initial CT scanner. Digital angiography showed torcular compression by the tumor. Intracranial pressure and sagittal sinus pressure were analysed and implicated the epidermoid cyst as the cause of the intracranial hypertension.

Adolescent↗
PubMed1986

Successful removal of a brainstem hemangioblastoma.

This is the report of the surgical removal of a solitary hemangioblastoma that had developed in the left nucleus cuneatus of the medulla oblongata. The surgical intervention was simple and no technical or anesthetic problems were encountered. In spite of the patient's extremely serious neurological state before the operation, his nervous functions reverted virtually to normal.

Brain Neoplasms↗
PubMed1986

Oxacillin prophylaxis in cerebrospinal fluid shunt procedures: results of a randomized open study in 60 hydrocephalic patients.

A 27-month open randomized trial (October 1981-January 1984) was carried out to study the prophylactic efficacy of antibiotics in 60 hydrocephalic patients being shunted for the first time. The treatment group received oxacillin at a dosage of 200 mg/kg/day by six bolus intravenous injections, beginning with anesthetic induction and continuing for 24 hours after the operations. The minimum postoperative observation was 6 months. Six patients in the control group developed cerebrospinal fluid infections (20%) as compared with only a single patient in the oxacillin group (3.3%); this difference was statistically significant (p less than 0.05). Time of development of cerebrospinal fluid infection was brief (86% at 6 weeks), and as usual staphylococci were the pathogens most frequently implicated. This study would appear to confirm the choice of oxacillin for prevention of meningitis. Nevertheless, the frequency of methicillin-resistant staphylococci, which account for 20% of nosocomial staphylococcal infections, constitutes a limiting factor for such prevention.

Acinetobacter Infections↗
PubMed1986

[Unilateral traumatic temporal lesions and secondary involvement of the 3d cranial nerve. Role of medical treatment].

Four cases of unilateral traumatic cerebral lesion with secondary third nerve palsy are reported. These four cases were observed over the course of one year and represent 5% of all unilateral traumatic cerebral lesion observed in our department during that period. The clinical situation presumptive of tentorial herniation included: partial (2 patients) or total (2 patients) secondary third nerve palsy, homolateral to the cerebral lesion; noncomatose state with initial Glasgow verbal score of 3 or greater; slight or no contralateral deficit. The anatomic lesions are unilateral and included 2 cases of temporal hematoma, one case of hemispheric swelling with acute subdural hematoma, and one case of general brain edema with temporal hematoma; In all 4 cases the clinical course was favorable with medical treatment alone. Based on the clinical information (non comatose state) and CT-scans (basal cisterns present or slight compressed in 3 of 4 cases), the authors believe that there was no tentorial herniation; third nerve palsy occurred without axial compression. The authors analysed several of the accepted criteria for severe head injuries (GCS, CT-scan, and ICP) and referred to the literature in order to determine optimal patient management in such reversible situations that posed a danger of tentorial herniation. Repeated clinical examination and CT-scan for visualization of basal cisterns appeared to be the best criteria for therapeutic decision.

Adult↗
PubMed1986

[Non-traumatic vertebro-epidural radiculo-spinal cord compressions: value of x-ray computed tomography coupled with myelography for lesion evaluation and therapeutic indications].

About 37 cases of non-traumatic spinal cord and cauda-equina compression, the authors emphasize the value of CT-scan study after intra-thecal injection of water-soluble contrast-medium. This exploration gives accurate informations about the involvement of both spinal and para-spinal spaces. These data are helpful diagnosis purpose and for the choice of therapeutic especially when surgical procedure is decided.

Adult↗
PubMed1985

Altered capillary permeability in neurogenic pulmonary oedema.

Two cases of fatal neurogenic pulmonary oedema are depicted. The hemodynamic study failed to document any hypertensive crisis or pulmonary hypertension. By contrast, the low values of pulmonary capillary wedge pressures and the high protein concentration in tracheal fluid suggest a pulmonary capillary wall lesion.

Adult↗
PubMed1984

[Giant intra-extracranial meningioma of the calvaria].

A 30 year old woman presented with a tumor of calvaria which had grown slowly over a period of 10 years. There was no history of symptoms other than an isolated episode of seizure. Infiltration of the scalp noted at physical examination and radiologic findings suggested the diagnosis slowly progressive sarcoma but the diagnosis of meningioma was established by histologic examination which also showed the important vascularization of the tumor (estimated blood loss was 300cm3). Taking into consideration the histologic benignity of the tumor and the complete thrombosis of the longitudinal sinus, removal of the lesion was planned after complete embolization of the vessels branching from the external carotid artery to supply the tumor. A two stage procedure was performed. During the first operative stage portion of the meningioma infiltrating the bone (800 g; 15 X 12 X 2 cm) and scalp was removed. In as second stage the intracranial "en plaque" meningioma was removed with no significant bleeding. The resected dura was replaced by combining a pericranial graft with a dermal graft. The cranial valt was restored with a bone homograft. The patient tolerated the procedure well and is in good health 18 months following surgery.

Adult↗
PubMed1983

[Treatment of malignant glioma. Apropos of 39 cases].

Thirty-nine patients with malignant gliomas (36 glioblastomas, 3 astrocytomas grade III; age median 52.5) were treated after surgery by combination chemotherapy followed by irradiation. The median survival on the actuarial curve is 7 months. An attempt is made to evaluate each therapeutic modality by analysis of clinical and CT parameters.

Adult↗
PubMed1982

Arteriovenous malformations (AVM) of the spinal cord in children. A review of 38 cases.

The cases of 38 children with AVM seen at the Lariboisière Hospital since 1962 are reviewed. The clinical picture was often of sudden onset with impairment of motor function and/or subarachnoid hemorrhage. The diagnosis was usually made by myelography, but spinal arteriography is the key examination, since it confirms the diagnosis and is essential to determine the exact location of the angioma: whether it is extramedullary, intramedullary, or mixed. Angiotomography and angiomyelography with magnification are necessary to determine if the lesion is median, compact, and if it has long sulco-commissural arteries, details which have an important bearing on the prognosis. Operation should be performed as soon as possible after its feasibility has been demonstrated angiographically. But embolization with new materials has also been effective, either associated with operation or as an alternative.

Adolescent↗
PubMed1981

[Removal of kidneys for transplantation. Experience in a French general teaching hospital (author's transl)].

A law issued on december 22, 1976 and aimed at increasing the number of kidney transplantations in France authorizes the removal of kidneys from deceased persons of full age provided they had not expressed refusal while still alive; for decreased persons under age, removal is subject to written consent of the legal representative. In a general teaching hospital of whose than 1 000 beds, 21 kidneys donors were operated upon between January 1, 1971 and December 31, 1975 (an average of 4.2 per year). A kidney transplantation team was developed in 1976. Between January 1, 1976 and August 31, 1979, 83 kidneys donors were operated, an average of 22.6 per year. Ninety-five per cent (59/62) of the kidneys removed and transplanted in the hospital began to function (diuresis greater than 2 ml/min) within minutes of releasing the clamp, no matter how long cold ischaemia had lasted. The increase in kidney removal and transplantation may be attributed to the fact that motivation was maintained among the various units concerned (anaesthesia and intensive care, neurosurgery, neuroradiology) by sustained information and teaching.

Cadaver↗