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Biomedical subjects

P Bret

Publications and source records attributed to P Bret.

At least 91 records · Page 5Linked to original sources
PubMed1985

Treatment of cerebrospinal fluid rhinorrhea by percutaneous lumboperitoneal shunting: review of 15 cases.

Fifteen patients with recalcitrant cerebrospinal fluid (CSF) fistula underwent the insertion of a lumboperitoneal shunt. The shunt consists of a two-piece Silastic tube and has been used in a population of 150 patients with communicating hydrocephalus, persistent postoperative meningocele, and benign intracranial hypertension. The spinal catheter is introduced subcutaneously and no flushing device is used. We studied three groups: 9 patients had a history of head trauma, and 7 of these had undergone one or several ineffective direct approaches to the dural leak. Four patients presented with a presumably congenital fistula. Two patients had persistent rhinorrhea due to previous intracranial procedures. Indium-111 cisternography was performed in 10 patients before lumboperitonel (LP) shunting and failed in 2 of those to document the site of leakage. Twelve patients showed cessation of rhinorrhea after LP shunting. In 4 of these, shunt-related complications responded to shunt removal with no further recurrence of rhinorrhea. Two patients underwent revision of the shunt. In 3 patients, the LP shunt failed to control the CSF leak and further intracranial procedures were indicated. The LP shunt provides an attractive and technically simple solution when direct methods of treatment have failed. Additionally, LP shunting should be considered as a primary mode of treatment in elderly patients or when impairment of CSF dynamics is documented by radionuclide cisternography and computed tomographic scanning. When an LP shunt is ineffective, shunt function should be checked by isotopic studies before additional surgery is performed.

Adult↗
PubMed1985

[Pseudo-optic neuritis as a manifestation of craniopharyngioma (2 cases)].

In two case of cystic craniopharyngioma the initial presentation was misleading and suggested acute retrobulbar optic neuritis: 1) isolated and unilateral drop of visual acuity of recent onset; 2) total remission in a few weeks, then a relapsing and steroid-sensitive course; 3) increase of C.S.F. gammaglobulins content in one case, normal CT scan in the second one. The diagnosis was corrected 36 and 18 months respectively after the onset of the clinical disorders.

Adult↗
PubMed1984

Radiotherapy of high bile duct carcinoma using intra-catheter iridium 192 wire.

The authors developed an original procedure of endo-curietherapy of high bile duct carcinoma. An iridium 192 wire is inserted into either a percutaneous transhepatic catheter or a surgically implanted external diversion catheter. The delivered dose varies between 10 and 60 Gy at 1 cm from the wire. Four of the seven patients analyzed also received external irradiation. There were no systemic or local complications. All patients experienced symptomatic relief and four are alive with no evidence of disease. This well-tolerated procedure permits symptomatic palliation without excessive side effects for the patient. In some cases, a curative effect can be expected.

Adenocarcinoma↗
PubMed1984

[Epidermoid cysts of the cerebellopontile angle. 6 cases].

6 cases of cerebello-pontine angle (CPA) epidermoid cysts were encountered from 1970 up to 1983. This series accounts for 3,3% of 177 CPA tumours operated on during the same period. Epidermoid cysts result from heterotopia of ectoblastic tissue and CPA is their most frequent site of development. The wall of the cyst is composed of a stratified squamous epithelium. The inside of the cyst is filled with soft waxy material resulting from the desquamation of keratin of the cyst wall. Macroscopically, the cyst is extensive and usually closely attached to the brain stem, cranial nerves and vessels. The commonest clinical picture is that of a trigeminal neuralgia usually typical of tic douloureux. Plain x-ray films of the skull disclose no abnormalities. Air encephalography was performed in an early case: it showed an obliteration of the cerebello pontine cistern by the cyst mass, with no air injection of the tumor as mentioned elsewhere. Computerized tomography made other procedures obsolete in our 4 latest cases: it showed a non-enhancing low-density mass filling the CPA. Hypodensity characteristics can make differentiation from dermoïd and arachnoid cysts. In a patient, auditory evoked response were lengthened bilaterally and suggested a brain stem compression rather than a cochlear nerve involvement. Operative treatment was performed in all of our 6 patients through a suboccipital craniotomy with the aid of the operative microscope. The aim of surgery should be, whenever possible, total removal of the capsule. A partial section of the fifth nerve is not needed. No patient died postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Outcome of ruptured intracranial aneurysms treated in accordance with the principle of deferred surgery. 308 consecutive cases over an 11 year period].

The diagnosis of the aneurysm rupture either was assessed at the time of admission, or was assessed after the admission into the surgical department. Most patients were admitted after the first 24 hours following the S.A.H. From the beginning the patients were separated in two groups: 1) The patients unsuitable for planned surgery (grade V--Botterrel, or general contra-indication, such as neoplasm), 2) The patients planned for surgery and called much less than operable patients much greater than (grade I to IV--Botterell, without extra neurological contra-indication). The general management attitude consisted of the delayed surgery according to the neurological status of the patients, and the risk of vaso spasm and ischemia. Thus, in most cases, the surgery was delayed after the 9th day, following S.A.H., and even after the 12th day for anterior communicating aneurysms. The following results were observed: 1) Unoperable patients: (15) The 12 patients in grade V at the time of admission died (with or without emergency surgery). The 3 patients with a general contra-indication have been lost of view. 2) 293 patients were considered for delayed surgery: 16 died before the day of surgery (5,5%). Out of these much less than operable and no operated patients much greater than, 10 died from cerebral ischemia (3,4% of operable patients) and 6 died from hemorrhage recurrence (2%).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1983

[119 cases of spina bifida treated surgically. Results of genetic investigations and genetic counseling].

After the surgical treatment of 119 cases of spina bifida, the authors present their experience of the genetic approach of the subject. From 1976 to 1978, a resolution not directing attitude towards the parents of the affected children has resulted in a total failure to recognize the recurrence risk, and in an absence of special care for the next pregnancies. The consequence has been recurrence cases of spina bifida in 4 families. Since 1979, a genetic inquiry has been systematically carried out, and all the parents have had a genetic counselling. This permitted the birth of 25 normal infants. In one case, the prenatal diagnosis revealed a fetal meningomyelocele, and motived a therapeutical abortion. Nowadays the fiability of the prenatal diagnosis and the possibility of a prevention through periconceptional vitamin supplementation are strong arguments to give a genetic counselling to all the parents of children with spina bifida.

Acetylcholinesterase↗
PubMed1983

[Astrocytoma of the cerebellum in children. Apropos of 57 cases].

57 children with a cerebellar astrocytoma have been operated on between 1964-1982. Since 1977, CT Scan has led to safer and earlier diagnosis. CT Scan has documented three macroscopical types of cerebellar astrocytomas; a cystic form with a mural nodule enhanced and the wall of the cyst non enhanced, a cystic form with a nodule and the wall of the cyst enhanced, and a massive form. 6 patients were submitted to a ventricular-atrial shunt before direct surgery. All the patients underwent posterior fossa surgery in the sitting position. Removal of the tumor was macroscopically total in 48 patients. Removal is limited to the nodule for cystic form with the wall non enhanced. Removal is extended to the wall of the cyst when it is enhanced. In 9 patients, the CSF pathway was restored at the end of the procedure by cannulation of the Aqueduct with silastic tube. 3 patients died postoperatively (5.2%), 2 others later on (4 and 8 years). 3 patients had a recurrency. In 6 patients, radiation therapy was used after surgery.

Adolescent↗
PubMed1982

Aneurysmal bone cyst of the cervical spine: report of a case investigated by computed tomographic scanning and treated by a two-stage surgical procedure.

The authors report the case of a 62-year-old woman with an aneurysmal bone cyst of the cervical spine. The patient presented with a progressive tetraparesis. Cervical computed tomographic scanning revealed a mass involving three contiguous vertebral bodies. The patient underwent two consecutive surgical procedures: (a) laminectomy and metallic plate osteosynthesis and (b) an anterior approach for curettage of the cyst and autologous grafting. Twelve months after operation, the patient was given a course of radiation therapy in the cervical area. She was found to be asymptomatic at the 20-month follow-up examination. The authors discuss the etiological, anatomical, and radiological features of vertebral aneurysmal bone cysts and evaluate treatment methods.

Bone Cysts↗
PubMed1982

[Venous graft bypass between the subclavian artery and a cortical artery, prior to carotid ligation for giant cervical carotid aneurysm].

Three cases of giant aneurysm of the cervical internal carotid artery are reported. In 2 cases the aneurysm was on the left side, with a symptomatology of repeated TI A's. In 1 case the aneurysm was on the right side, with a pharyngeal symptomatology. All 3 cases were an indication of cervical internal carotid artery ligation. Prior to the carotid ligation it was thought preferable to perform an extra-intracranial arterial By-pass. The superficial temporal artery not being available, a long By-pass was performed, between the subclavian artery and a cortical artery, by means of a saphenous vein graft. In 2 cases the By-pass was angiographically patent, 11 months and 1 year postoperatively. In one case, the postoperative angiogram (3 weeks) failed to show the By-pass. The advantages and disadvantages of the procedure are discussed.

Carotid Artery Diseases↗