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M H Bernard

Publications and source records attributed to M H Bernard.

At least 37 records · Page 2Linked to original sources
PubMed1987

[Is it necessary to operate on asymptomatic aneurysms? Apropos of 114 surgically treated asymptomatic aneurysms].

A six years retrospective analysis of asymptomatic aneurysms (A.A.) was done in 4 neurosurgical departments: 114 AA were clipped in 99 patients. In 44 patients (48 asymptomatic aneurysms) the surgical procedure was achieved in one step for both symptomatic and asymptomatic aneurysms. In 59 patients (66 asymptomatic aneurysms) the surgical procedure was delayed as it necessitated a second and elective craniotomy. As regard the treatment of asymptomatic aneurysms, there was no morbidity, and one death due to a massive pulmonary embolism. These surgical results are undoubtebly better than the risk of hemorrhage from unruptured aneurysm as emphasized in the literature.

Adult↗
PubMed1985

[Diagnostic strategy for a thyroid nodule].

Solitary thyroid nodules present as localized tumefactions of the thyroid gland readily detectable clinically. They are frequent (2-5% of the general population) and due to a variety of causes, each requiring a specific treatment; hence the need for a systematized diagnostic approach. On scintigraphic grounds, one can distinguish between "warm" or "extinctive" nodules (10% and 20% of the cases respectively), which are a priori benign, and "cold" nodules (70%), which in 1 out of 10 cases correspond to a differentiated epithelioma with excellent post-operative prognosis. Three methodological data call for comments: (1) the images supplied by technetium may differ from those supplied by radioactive iodine, which remains the reference radioisotope; (2) there is no clinical criterion of malignancy, but fluid-containing nodules are almost invariably benign; (3) needle cytology is the best means of selecting nodules for surgery and histology which is the only reliable diagnostic examination. We therefore propose, albeit with due caution, a diagnostic approach based on the sequence scintigraphy-needle exploration and cytology and aimed at limiting surgery to purely therapeutic purposes.

Biopsy, Needle↗
PubMed1985

Immunohistochemical localisation of macromolecules of the basement membrane and extracellular matrix of human gliomas and meningiomas.

The distribution of type I, III, IV and V collagen in 35 gliomas and 20 meningiomas was studied by indirect immunofluorescence staining. In addition, the presence of fibronectin (FN) and laminin (LN) is also reported. In gliomas expression of type IV collagen and LN was found in the vessel walls and associated with the endothelial glomerulus-like proliferations. FN and type V collagens were located in proliferating vessel walls in a pattern corresponding both to the basement membrane and the perivascular matrix around the vessels. In the extracellular matrix of grade III and IV gliomas occasional faint intercellular fluorescence was also observed with both FN and type V collagen. Type I and III collagens were localised in the vessel walls and in the perivascular connective sheet. Glioma cells did not express any of the antigens investigated. In meningiomas, type IV and V collagens, LN and FN were found in vessel walls, whorls formations and psammoma bodies. These stainings support the hypothesis of a vascular origin of these psammoma bodies which were only found in syncytial and transitional meningiomas. Both type I and III collagens were detected in the perivascular connective tissue. In general, meningioma cells and extracellular matrix did not express any of these molecules, except in transitional meningiomas where occasional fluorescence was observed in extracellular matrix with type V collagen and FN.

Basement Membrane↗
PubMed1985

[Extramedullary arteriovenous fistula of the spinal canal with spinal cord venous drainage. Apropos of 2 cases].

The authors report two cases of extramedullary arteriovenous fistulas in the spinal canal with venous return into the spinal cord veins. Both patients were middle-aged men who presented with multiple nerve root involvement of the lower extremities for one year and three months respectively. Myelography demonstrated an indentation at the level of the conus medullaris by a dilated vein in both cases. Arteriography of the spinal cord demonstrated an arteriovenous malformation from the dura mater with venous return into the ascending spinal cord veins, located in both cases at T11. Unlike typical angiomas of the spinal cord, these arteriovenous fistulas do not arise from spinal cord arteries. Only the venous return is into the spinal cord system. Initial clinical manifestations are progressive and often misleading, with pseudoradicular pain of the lower extremities or intermittent claudication which was observed in both patients. Only good quality myelography enabled visualization of the dilated vein at the level of the conus medullaris which lead to localization of the arteriovenous malformation and its afferent arteries outside of the spinal cord itself. Treatment is either surgical, or neuroradiological (embolization). Similar results are obtained by both methods, in a condition which would otherwise progress to paraplegia.

Arteriovenous Malformations↗
PubMed1985

[Benign intracranial hypertension (17 cases) and cerebral venous thromboses (49 cases). Comparative study].

A series of 49 cases with cerebral venous thrombosis (CVT) and a series of 17 cases with benign intracranial hypertension (BIH) without CVT, both observed between 1973 and 1983, have been compared. Papilledema has been found in 100% of BIH and 28.5% of CVT, visual acuity loss in 52% of BIH and 6% of CVT, obnubilation in 0% of BIH and 65% of CVT. Cerebrospinal fluid, EEG, cerebral angiography and Scanner were normal in all cases of BIH, while in CVT the same investigations were abnormal in respectively 90%, 100%, 100% and 54% of cases. Prognosis was excellent in BIH with only one residual mild loss of visual acuity. Recurrences occurred in 18% of BIH. Among CVT 18% died, 23% developed neurological sequelae, 59% totally recovered. There was no recurrence. On the basis of this comparative study we emphasize the following points: 6% of CVT only follow a course of BIH from end to end, according to Johnston and Paterson's diagnostic criteria of BIH. These cases concern only thrombosis of lateral sinuses. Other cases of CVT rather deal with patients admitted in neurosurgical units on emergency. Diagnosis of CVT is a difficult one and prognosis is still serious in spite of the use of Heparin. 85% of BIH are irrelevant to CVT. BIH is a "quiet" intracranial hypertension without trouble of vigilance. Prognosis is really good if diagnosis is early made, in spite of possible multiple recurrences. Treatment consists of CSF subtraction, preferably through external lumbar drainage, and Acetazolamide prescription. Head injuries and hormonal imbalance in women are two common etiologies of BIH and CVT.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

[Acute benign cerebral angiopathy. 6 cases].

The 6 cases reported here constitute, with 5 previously published cases, a special nosological entity tentatively called "acute benign cerebral angiopathy" by the authors. These 11 cases have in common certain radiological and clinical features. Arteriography shows segmental, multifocal and assymetrical stenoses involving the cerebral arteries between Willis' circle and the terminal arterioles and looking like "strings of sausages". The lesions disappear within one month and present the radiological characteristics of arteritis of medium caliber vessels. The clinical symptoms are suggestive of meningeal haemorrhage or acute cerebromeningeal oedema, with acute repetitive attacks of severe headache and agitation with obnubilation; epileptic seizures and transient neurological deficit may occur. True meningeal haemorrhage confirmed by lumbar puncture is seen in nearly one half of the cases; it seems to be due to alterations in the blood-brain barrier induced by the angiopathy. Intracerebral haematoma may develop, but the disease is usually benign and regresses spontaneously in a few days. None of the usual causes of cerebral arteritis (intra-cranial infection, collagen disease, allergic or toxic angitis) has been found. Pseudo-arteritis (notably spasm of ruptured arterial aneurysms) has been excluded. No aetiological factor common to the 11 cases reported has been elicited, although 6 of the patients had recently given birth and our 6 patients had benign virus infection before or during the clinical manifestations of the disease. In the authors' opinion, the most rewarding line of research would be the role of short acute attacks of arterial hypertension.

Acute Disease↗
PubMed1983

[Effect of estrogens on the value of serum thyroglobulin].

Serum thyroglobulin (TG) is considered as a useful index of differentiated thyroid carcinoma evolution. Previous studies have suggested that TG levels might be dependent upon oestrogens. Here TG levels were determined in volunteers , free of any thyroid disease, divided into 5 groups according to estrogen level. Results (mean +/- s.d.) indicated that Tg levels in men group A (n = 9): 6,6 +/- 2,8 ng/ml in women undergoing oestroprogestagen treatment group B (n = 10) 3,7 +/- 1,5 ng/ml; in women free of oestroprogestaten treatment group C (n = 10): 5,9 +/- 4,0 ng/ml; in pregnant women group D (n = 40): 4,6 +/- 2,7 ng/ml, and in parturient women group E (n = 4): 7,2 +/- 2,2 ng/ml; were not correlated to estrogen levels. However, in a group where thyroid gland was not carefully examined i.c. a "blood doners group", a difference (p less than 0,005) was found between women (29 +/- 15) and men (14 +/- 9). Sex and estrogen levels there fore do not influence the TG index which as a result can be used in the monitoring of thyroid carcinoma in pregnant women.

Adult↗
PubMed1982

[Aponeuroplasty after lumbar disk surgery].

To prevent scar tissue formation after lumbar surgery --for cure of disk herniation or laminectomy for narrowing of the spinal lumbar canal--the authors use an aponeurotic graft picked up by cleavage of lumbar aponeurosis and fixed between the laminae and remaining ligamentum flavum, closing posteriorly the lumbar canal and separating hermetically the dura from the anterior face of lumbar muscles. Presentation and discussion of results after four years' utilisation in 680 patients--and only 6 reinterventions which allowed an experimental study of the previously left in place graft.

Cicatrix↗
PubMed1982

[Double spinal cord compression by dorsal meningioma and Paget's disease of a vertebra. A propos of 2 cases treated surgically].

A spinal cord compression due to intradural meningioma appeared in two patients with vertebral X-Rays lesions of foreknown Paget's disease. These lesions were located at the same level that the meningioma in the second case and three vertebra below the meningioma in the first case. In both cases, it took one year between the first clinical symptoms and the surgical decision. We truly think the Paget's disease and its X-Rays vertebral lesions to be responsible for the waist of time in myelography and surgical schedule. No other case of meningioma associated with Paget's disease has been found through literature. Because the treatment of Paget's disease paraplegia is now mostly medical, we thought important to report our experience in order to avoid other delays in this unusual diagnosis.

Aged↗
PubMed1981

[A prospective study of malignancy criteria in 407 surgical patients (author's transl)].

A prospective study of 407 patients with "cold" solitary thyroid nodule seen over 4 1/2 years and systematically operated upon was undertaken with the view of determining the pre-operative criteria of malignancy. Thirty-nine nodules were malignant. Since various methods of multidimensional statistical analysis failed to give satisfactory results, an attempt was made to base rational surgical indications on purely descriptive criteria. Neither the patient's age, morphology, personal or family history of thyroid disorders, nor the size of the nodule, the circumstances in which it was discovered and the presence of calcification made it possible to distinguish between malignant and non-malignant nodules. Cervical lymph node involvement, paralysis of the recurrent nerve, previous irradiation of the neck and site of the nodule equally had no discriminative value. Only two clinical findings, softness of the nodule and liquid content, were clearly associated with the absence of malignancy.

Adolescent↗
PubMed1980

[Value of the estimation of gliofibrillary acid protein in the diagnosis of glial tumours (author's transl)].

Glial Fibrillary Acidic Protein (G.F.A.P.) is characteristic of astrocytes. Its estimation in a tumour fragment removed surgically may be used to confirm whether or not a cerebral tumour is glial in nature. This was confirmed here by study of 6 cases. G.F.A.P. levels were normal only in the 2 patients whose cerebral tumours were not glial. It remains to be determined whether this estimation may be used to define a particular treatment or prognosis.

Adolescent↗