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Biomedical subjects

M Jan

Publications and source records attributed to M Jan.

At least 73 records · Page 4Linked to original sources
PubMed1989

Colloid cyst of the fourth ventricle: diagnostic problems and pathogenic considerations.

The authors report the case history of a patient with a colloid cyst of the 4th ventricle. The clinical history of slow intracranial hypertension, homogeneous hyperdensity with contrast enhancement on computed tomographic, scan, and the gelatinous aspect of the cyst at surgery are characteristic of colloid cysts. The diagnosis was made, however, only at the time of histological examination. A common neuroepithelial origin with 3rd ventricle cysts would be explained by similar embryological developments of the prosencephalic and the rhombencephalic roofs.

Adult↗
PubMed1989

[Otoneurosurgery in the elderly].

An oto-neuro-surgical experience on patients older than 65 years is reported. 25 patients have been operated: 9 meningiomas, 5 trigeminal neuroglia, 2 vestibular neurectomies, 9 acoustic neuromas. The assessment, the indication, the surgical techniques are discussed. Are also evaluated the anesthetic technique, the patient drugs, position, and the post-operative survey.

Aged↗
PubMed1989

[Spinal osteoid osteomas. Apropos of 4 cases].

Spinal osteoid osteomas constitute a rare but perfectly curable cause of non-disc root pain. In discussing four cases (2 cervical and 2 lumbar), the authors stress that this disorder affects above all males under 30 and presents as vertebral column pain gradually becoming radicular in character; the pain, essentially nocturnal, is spectacularly but transiently relieved by salicylates and is accompanied by often frank stiffness of the spine. The diagnosis is based less on X rays and tomographs, than on isotope bone scanning, which reveals a focus of intense hyperfixation, and CAT scanning which shows a bony lacuna possibly with an opacity in the center producing a rosette shaped image. Block excision of the osteoid osteoma produces immediate relief for the patient and prevents recurrence which only occurs exceptionally.

Adult↗
PubMed1989

[Does nimodipine improve the outcome of perioperative complications of aneurysm rupture? Results of systematic treatment].

Morbidity after aneurysmal subarachnoid hemorrhages is proceeding from many factors; ischemic etiology is underestimated and frequently thought to be vasospasm related only. Other undoubted mechanisms are in the setting of ischemic disorders after ruptured aneurysms. The management of these disorders is relevant of new calcium blockers. Early administration of prophylactically oral nimodipine, with temporary intravenous administration of the therapy after surgery or in the setting of delayed ischemic deterioration, were assigned to 36 patients with aneurysm surgery. Efficacy was judged on prevention and outcome of ischemic disorders at discharge and three months later using the Glasgow Outcome Scale. On all, twenty-nine patients were disabled from any etiology; twenty made full or improved recoveries at discharge; twenty-eight get independent conditions of life at 3 months. Fourteen patients have return to their pre-rupture activity. Twenty-two surgical patients (61%) set an undoubtly ischemic disability during any time of their hospitalization, but many etiologies were identified in majority of cases. Spasm is the main factor of stroke in only 6 patients, and one of the ischemic factors in 15 cases. Among these ischemic deteriorations, twenty improved or made full recovery at discharge and get independent life at 3 months. No death with spasm. These data support the assumption that vasodilatating is not the only mode of nimodipine action. Hypervolemia must be adjunct with nimodipine to prevent regional hypoperfusion.

Adolescent↗
PubMed1988

Therapeutic trial of intravenous nimodipine in patients with established cerebral vasospasm after rupture of intracranial aneurysms.

The therapeutic efficacy of intravenous nimodipine to treat the syndrome of delayed ischemic deterioration or vasospasm after subarachnoid hemorrhage caused by a ruptured aneurysm was investigated in a randomized, double-blind, placebo-controlled multicenter study. A total of 188 patients (nimodipine (N) = 102, placebo (P) = 86) were enrolled in the study, both pre- and postoperatively, within 24 hours of clinical deterioration connected with vasospasm or within 24 hours of arteriography that identified vasospasm. After 61 patients were excluded for not meeting study criteria or for protocol violation, the results were supported by 127 validated case reports: 73 patients received intravenous treatment with nimodipine, and 54 were given placebo. Analysis of the main criterion of efficacy, the number of deaths and of patients with severe deficit related to vasospasm alone, showed a significant statistical difference (N = 8 (19%), P = 17 (49%), P = 0.01). The risk of death or disability was reduced by 66% in the treated group. Analysis of this criterion by type of inclusion (clinical or angiographic) also showed a significant reduction in the clinical group (P = 0.05), but there was no difference in the angiographic group. The risk of mortality connected with vasospasm was reduced by 82%, but analysis by group showed that there was no significant difference for those patients included on clinical criteria, whereas mortality was reduced to a much greater extent in the angiographic group. These results demonstrate the therapeutic efficacy of nimodipine in reducing secondary ischemic brain damage in patients already suffering from angiographic vasospasm or delayed ischemic deterioration.

Adult↗
PubMed1988

[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.

Double-Blind Method↗
PubMed1988

[Surgical approaches of the trigonoseptal region].

Surgical approaches to the trigone and septum are described with the help of dissections of anatomical specimens under operative conditions and using a microscope: the anterior frontal approach which gives access to the anterior pillars and to the body of the trigone; the ventricular junction route which provides an approach to the body of the trigone and to the hippocampal commissure; the anterior transcallosal approach.

Cerebral Veins↗
PubMed1988

[Petrectomy of the point during approach to the clivus: technic, values and limitations. Apropos of a case of meningioma].

A voluminous clivus meningioma was removed by a middle fossa transpetrous approach. We describe the surgical technique, with its advantages and its limits. The petrous bone was burred between the internal auditory canal, the internal carotid artery, the superior petrosal sinus and the inferior petrosal sinus. This approach gives excellent exposure of the clivus, anterior to the brainstem and the cranial nerves. This approach can be used for removal of voluminous intradural tumors arisen anterior to the internal auditory canal, and for clipping of aneurysms of the basilar artery. It appeared that the choice of the side for this approach must only depend on the extension of the tumour and displacements of the brainstem and the basilar artery, without concern on the hemispheric lateralization.

Aged↗
PubMed1987

Spondylitis and osteomyelitis caused by Kingella kingae in children.

Two cases of documented osteoarticular infections caused by Kingella kingae in children are reported. The main bacteriological characteristics and antibiotic susceptibilities of these two isolates are described. The pathology of K. kingae, particularly in bones and joints, is reviewed.

Bacterial Infections↗
PubMed1987

[Rupture of a cerebral aneurysm and pregnancy: apropos of a case of neurosurgical intervention during pregnancy].

The authors report a case of an aneurysm of the posterior cerebral artery that was operated on after 28 weeks of amenorrhoea without any sequelae for the mother or the fetus. The article gives precise details of the neurosurgical procedures carried out in this pregnant woman and how and what neurosurgical anaesthesia was administered while the aneurysm was cured and the pregnancy continued. Finally the obstetrical and neurosurgical care is discussed. The neurosurgeons decided on the operation in view of the neurological findings. Once the neurosurgical decision has been made, the obstetrical procedures depend practically on the length of amenorrhoea. Briefly, we would suggest the following: before 31 weeks of amenorrhoea: curing the aneurysm and going on with the pregnancy; after 32 weeks of amenorrhoea: first to carry out a caesarean section and during the same operation to treat the vascular malformation.

Adult↗
PubMed1986

[Outcome of intracranial meningioma in adults. Retrospective study of a medicosurgical series of 161 meningiomas].

The authors report the retrospective study of a medico-surgical series of 161 patients with intracranial meningiomas, diagnosed over a period of 9 years, with a follow-up period varying from 18 months to 9 years. Out of 185 cases studied, 24 were excluded because information or perspective were inadequate. Of the 161 cases retained, 133 (82.6%) were given surgical treatment and 28 (17.4%) were given conservative treatment because the clinical state was poor or the location was deemed inoperable. The sex ratio was 3 women to 1 man. The average age was 58 years. The most frequent locations were the convexity (27.9%) and the sphenoid ridge (24.7%). Among the clinical signs, apart from the usual general seizures or pyramidal signs should be noted the importance of psychological disorders. The operative mortality rate was 14.3% with a very high peak in the sixth decade, reaching 27%, while it was only 9% in the seventh decade and 13% in those over seventy. The internal sphenoid ridge location had a mortality rate of 31.5%, which is significantly higher than for all the other locations. Quality of survival was identical for all age groups. Complications were mainly seizures, functional deficits and psychological disorders. Recurrences were relatively few (10%), but insufficient lapse of time and the presence of only one malignant meningioma explain the lowness of this figure. The use of scanner was not determinant in our series, neither on the earliness of diagnosis, nor on prognosis, comparison of figures before and since scanning showing no significant differences.

Adult↗
PubMed1986

[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.

Adult↗
PubMed1984

[Estrogen and progesterone hormonal receptors in meningioma. Results and comments apropos of 26 cases].

In the first part: the charcoal-assay method was briefly described (sensitivity: PR = 10 fmol/mg protein, ER = 5 fmol/mg protein), and criteria for the validity of this method were analysed: sufficient amount of tumor (150-200 mg) minimum protein concentration should be 2 mg/ml choice of a suitable labeled hormone plotting of Scatchard curve with at least 4 aligned points and systematic control of the dissociation constant (Kd) systematic assay of a reference cytosol. In the second part: the results were analysed and compared with those of various authors: PR were positive in 13 out of 23 determinations (56,5%), 12-230 fmol/mg protein (mean: 93 fmol/mg protein) ER were positive in 2 out of 25 determinations (8%), 5 and 16 fmol/mg protein. Only one tumor showed positive ER and PR and no significant difference was shown between ER and PR results on male and female patients. In conclusion, the physiopathological significance of ER and PR is discussed and a new approach to treatment of some meningiomas is mentioned.

Adolescent↗