Search PubMed⌕ Search

Biomedical subjects

P Bret

Publications and source records attributed to P Bret.

At least 73 records · Page 4Linked to original sources
PubMed1990

[Acetazolamide: an alternative to shunting in normal pressure hydrocephalus? Preliminary results].

From a series of 15 consecutive patients with a normal-pressure hydrocephalus examined over 2 years. 10 showed frank improvement with oral acetazolamide. The drug was a first-choice treatment in 5 cases and was given up after a spinal tap in 5 cases. Clinical response occurred even in the most severe cases, although it was slightly less impressive for intellectual impairment than for gait or bladder disturbances. Tolerance was excellent with a daily dose of 250 to 500 mg. The benefit remained stable on a more than 1 year follow-up in 8 cases. We suggest that acetazolamide should be tried in patients with normal pressure hydrocephalus prior to considering shunting.

Acetazolamide↗
PubMed1989

[Giant thrombosed aneurysm of the left vertebral artery developing in the fourth ventricle].

A case of giant, thrombosed, non haemorrhagic aneurysm of the distal portion of the left vertebral artery is reported. The patient came to medical attention with an acute cervical pain after a minimal cervical traumatism and a diagnosis of torticollis from rheumatologic cause was made. In fact, a few weeks before, he had suffered three episodes of right homonymous hemianopsia. Subsequently, hiccup, vomiting, orthostatic dizziness with postural hypotension appeared, suggesting a medullary lesion. CT scan showed a round, heterogeneous high-density lesion near the fourth ventricle. Angiography was normal. MRI showed an oval mass in the fourth ventricle, between the medulla and the cerebellum. Surgery found an aneurysm of the end of the left vertebral artery.

Adult↗
PubMed1989

[Meningioma of the lateral ventricle. 3 recent cases].

Three recent cases of intra-ventricular meningiomas are reported. The incidence of this tumor type is very low, since they account for only 0.2% of all intra-cranial neoplasms and 2% of all intra-cranial meningiomas in the adult. In our first 2 cases, the meningioma involved the right trigonal area. In our third patient, a 14 year-old girl, the tumor had involved the left occipital horn. It is usually assumed that their development is a result of meningothelial inclusion bodies normally present in the arachnoid of the tela choroidea. As mentioned in previous reports, their clinical presentation may be that of paroxysmal increased intra-cranial pressure and a mechanism of trapped ventricular horn has been advocated. However, under such circumstances, an intraventricular bleeding seems to be a more likely mechanism. Despite their rarety, intra-ventricular meningiomas are usually diagnosed on C.T. It typically shows a hyperdense mass, attached to the plexus and enhancing after contrast infusion. In one of our patients (obs. 2), the meningioma manifested on M.N.R. by a low signal intensity in T1 sequences and by a high signal in T2 sequences. In our third patient, the M.N.R. findings were indicative of a cystic lesion lying in the occipital horn, but not of a meningioma, the diagnosis of which was made on further microscopic examination. The angiographic evaluation remains useful to document preoperatively the arterial supply to the meningioma, which is mainly from the postero-lateral choroïdal arteries. At operation, anterior meningiomas lying near the foramen of Monro are easily exposed through a transfrontal approach and raise no technical problem.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Epidermoid cyst of the fourth ventricle.

The case of a 52-year-old patient with a fourth ventricle epidermoid is reported. The initial presentation included long-standing headaches, progressive anomalies of gait and slight impairment of mentation. CT showed a hypodense mass enhancing peripherally after contrast infusion. Brain auditory evoked responses (BAER) showed asymmetric increased latencies. At operation, total removal of an extensive fourth ventricle epidermoid was achieved. A delayed meningitis occurred postoperatively. Physical examination was normal at the 2 year follow-up and BAER were improved. The etiological and clinical features of fourth ventricular epidermoids are briefly reviewed. The diagnostic value of CT is emphasised but the possibility of CT-dense epidermoid cysts deserves a special mention. Total removal of the neoplasm is the theoretical aim of operative treatment, but this purpose may be harmful when the ventricular floor is involved by the capsule.

Brain Diseases↗
PubMed1988

[Tuberous sclerosis and trigonoseptal tumors].

A series of 9 patients having a tuberous sclerosis associated to a midline ventricular tumour is reported. Microscopically, the presence of giant cells within the lesion is a major characteristic of the disease. The origin of these subependymal giant cells tumours is questionable since astrocytic, neuronal and ependymal features have been noted by several authors providing various denominations. In the literature and in our series as well, the intra-ventricular tumour presented as the initial manifestation of the disease in most of cases, usually with increased intra-cranial pressure symptoms. On CT, the tumour arises in the area of the foramen of Monro and enhances after contrast injection while the other intracranial anomalies of the disease do not enhance. In 8 patients, a direct transcortical transventricular approach was used. 1 patient was treated by shunt only. The results were evaluated according to the degree of the preoperative neuropsychological impairement: there were 3 deaths, 3 "excellent", 2 "fair" and 1 "poor" results. The problem of the surgical indication raises mainly in patients in whom the diagnosis of the tuberous sclerosis is ascertained prior to the diagnosis of the tumour. Since acute C.S.F. blockage or intra-ventricular bleeding may occur during "conservative" treatment, direct approach seems preferable.

Adolescent↗
PubMed1988

[Ultrasonoendoscopy: its indications in esophageal and gastric pathology].

Endoscopic ultrasonography (EUS), which uses a high sonographic frequency (7.5 mHz) is a recently developed diagnostic tool that enables detailed analysis of the digestive wall and visualization of adjacent structures, like the posterior mediastinum through the esophagus. Thus, EUS may provide accurate documentation of the extent of esophagogastric malignancies, and of the adjacent lymph-node involvement. From now, results in preoperative staging compare favourably with CT scan. EUS provides also helpful complementary informations for the diagnosis of giant fold gastropathies or submucosal (or extrinsic) abnormalities. Moreover it may be usefull for the post-therapeutic follow-up of cancers, ulcers or varices.

Esophageal Diseases↗
PubMed1987

Bilateral extradural haematoma. Report of two cases.

Two cases of bilateral extradural haematomas are reported. In case I, the haematomas developed simultaneously and were probably due to a tear in the sagittal sinus. In case II, the haematomas developed sequentially and were demonstrated by serial CT scannings after the removal of a seemingly unilateral lesion. A review of the literature points out the rarity of this condition which had been described even before the CT era, with varying clinical presentations and unusually poor surgical results. The advent of the CT has made the diagnosis of simultaneous bilateral extradural haematomas easier and is regarded as a significant factor in the improvement of the prognosis noted in recent reports. However, the possibility of delayed bilateral extradural haematomas escaping detection in the initial CT should be emphasized. This unusual clinical presentation stresses the value of a routine use of serial CT scannings in the acute phase of head injuries.

Adult↗
PubMed1987

[Complete excision of acoustic neurinoma. Preservation of the facial nerve and hearing].

Using microtechniques, total removal of acoustic neuromas with facial nerve preservation is possible today in most cases. The next barrier of operative treatment is hearing preservation which is routinely attempted, with the help of intraoperative brainstem auditory evoked responses monitoring. The present series deals with 176 operations performed sub-occipitally in 159 patients from 1970 up to 1985. Twelve patients were operated upon 29 times. According to the W.T. Koos classification, there were 16 type II, 39 type III and 121 type IV neuromas. Ten patients died postoperatively. In seven of these, death was related to surgery, in two it was caused by respiratory failure. In the last patient unexplained sudden death occurred. 169 patients had no facial weakness preoperatively, in 158 of these the facial nerve was anatomically preserved (93.5%). Facial nerve function was judged by evaluation of function of face at least 12 months after operation. Up to 36 months after surgery, a good facial result may be expected in cases where the facial nerve was macroscopically spared at completion of removal. Functional results have been reviewed in 151 patients according to the J.W. House's International Evaluation System, with an excellent or good result in 66 (44%), fair in 65 (43%), bad or poor in 20 (13%). The anatomical preservation of the cochlear nerve could be achieved in 80 patients of the group of 169 in whom the auditory function had not been damaged by a previous operation. In fact, the auditory function preservation could be reasonably attempted in 79 patients: showing a hearing loss below 70 dB on tone audiometry, whatever may be the result of speech discrimination score. 59 patients (75%) of this later group had their auditory nerve preserved, 14 (18%) showed preserved hearing function postoperatively, 10 of these with a speech discrimination score over 50%. Two of these showed an improvement of preoperative hearing, two others showed a total recovery of hearing function after removal.

Adolescent↗
PubMed1987

[Intracranial pneumocephalus under pressure. A possible cause of postoperative deterioration in neurosurgery. 10 cases].

10 patients in whom an early post operative alteration of the level of consciousness or of the neurological status could be related to a tension pneumocephalus are reviewed. Four underwent a surgical procedure in the sitting position. Among these, 2 had been previously shunted for hydrocephalus. A 5th patient underwent a IIId ventriculocisternostomy for tumorous occlusion of the aqueduct. The other five patients were involved with supra-tentorial conditions (hemispheric glioma: 1 case, meningioma: 1 case, chronic subdural hematoma: 3 cases). The post-operative deterioration clinically suggested a post operative hematoma. CT showed a very low density effusion either located in the operative area or in the subdural space or both, with significant mass effect. 9 patients steadily improved after conservative therapy. In 1 case, reoperation was required. Pathogenesis of symptomatic pneumocephalus remains controversial. The role of the sitting position and of CSF drainage seem likely. Spontaneous or nitrous oxide induced expansion of post-operative residual intra cranial air plays a debatable role. It is postulated that tension pneumocephalus may result from a discrepancy between spontaneous reexpansion of the cerebral mass and a residual air collection. Such complications are regarded as serious enough to justify several preventive measures.

Adult↗
PubMed1987

[Lumboperitoneal shunt in persistent or recurrent fistulae of the base of skull. Apropos of 20 cases].

The authors describe the use of the lumbo peritoneal shunt (L.P.S.) in 20 cases of C.S.F. rhinorrhea following either cranial injury [13] basal skull surgery [2] or of unknown etiology [5]. 16 patients had previously undergone an attempt at direct closure of their fistula and are therefore cases in which the direct approach failed. 4 patients underwent the L.P.S. straightaway. In 17 cases the fistula was healed by the L.P.S. without any recurrence, though a shunt removal was necessary in 5 cases. The method was unsuccessful in only 3 cases.

Adult↗
PubMed1986

Lumbo-peritoneal shunt in non-hydrocephalic patients. A review of 41 cases.

A population of 41 non-hydrocephalic patients in whom a lumbo-peritoneal shunt (LPS) was inserted for various conditions is reviewed. 19 had persistent cerebro-spinal fluid rhinorrhoea following cranial injury, basal skull surgery or of unknown origin, 3 had recalcitrant benign intra-cranial hypertension, 14 had a persistent bulging craniotomy site after operations for intra-cranial tumours or head trauma, 4 had syringomyelia and 1 had a postoperative cervical meningocele. There was no shunt-related mortality. LPS was effective in treating the initial symptomatology in 31 patients. Further revision or removal of LPS were needed on 9 occasions in 8 patients showing shunt-related mechanical or infectious complications or persistent postural headaches. This report demonstrates the safety of the LPS procedure experienced in another population of 146 patients with communicating hydrocephalus operated on in the meantime. According to the authors' experience, the versatility of the clinical applications of LPS seems well established. LPS should be considered when a CSF diversion is required in patients showing absent or minimal ventricular enlargement in the CT scan.

Adult↗
PubMed1986

Use of large silicone catheters in patients with long-term percutaneous transhepatic biliary drainage.

In 30 patients with inflammatory bile duct stenoses or slow-growing tumors of bile ducts, 12-18 F silicone catheters were placed with a percutaneous transhepatic approach in order to provide a more efficient and comfortable internal-external drainage. The main advantages were the large variety in size, improved flow, and softness of the catheter. However, because of the absence of distal tapering, the tubes had to be inserted several days after the initial drainage, when a tract was formed through the liver.

Bile↗
PubMed1986

Abdominal lesions: a prospective study of clinical efficacy of percutaneous fine-needle biopsy.

A prospective study was undertaken to assess the contribution of percutaneous fine-needle biopsy (PFNB) to the diagnostic workup and therapeutic management of 112 abdominal lesions in 106 patients (69 hepatic, 27 pancreatic, and 16 nondetermined). In 75% of the patients, PFNB contributed significantly to the diagnosis, in 22% it was of little help, and in 3% it confused the diagnosis. It confirmed a highly suspected diagnosis in 55% of patients and indicated a specific diagnosis that was not suspected in the remaining 45%. Results of PFNB guided treatment in 32% of cases, increased confidence in a previously planned therapy in 39%, and did not alter therapy in 29%. PFNB was instrumental in avoiding 61 planned invasive investigations and 11 surgical explorations, with a cost savings of about 35%. No significant complication was observed after PFNB.

Abdominal Neoplasms↗
PubMed1986

[Exclusion of an arteriovenous malformation of the left olfactory groove using endo-orbital ligation of the ethmoidal arteries].

A case history of a 59 year old male patient having an intra frontal cerebral hematoma due to a ruptured olfactory groove arteriovenous malformation (AVM) is reported. Following the operative removal of the hematoma, the patient improved steadily and the risk of a recurrent bleeding was considered. A total thrombosis of the AVM was achieved by a two step bilateral transorbital ligation of both anterior and posterior ethmoidal arteries, with no further intracranial approach. The simplicity of this technic is pointed out and its application in other pathological conditions-such as basilar meningiomas in which embolization is hazardous--is suggested. The authors more recently experienced the beneficial effect of transorbital ligation of ethmoidal arteries prior to removal of a highly vascular supra-sellar meningioma.

Arteries↗
PubMed1985

[Tethered conus syndrome or fixed spinal cord syndrome. Lumbosacral lipomas].

Fifty-eight cases presenting a tethered conus with spina bifida occulta are analysed. Twenty-three patients had a lipoma, the others had various malformations of the cord. Twenty patients had no symptom or sign, 38 had neurological symptoms and signs. Only 2 had no skin malformation. The aim of surgery is to reduce the volume of the lipoma, untether the cord, and reconstruct the posterior protection of the cord. Twenty-six patients were cured or improved, 12 patients were stabilized, 19 remained asymptomatic, 1 was worsened.

Abnormalities, Multiple↗