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Biomedical subjects

P Janny

Publications and source records attributed to P Janny.

At least 19 recordsLinked to original sources
PubMed1994

Low grade supratentorial astrocytomas. Management and prognostic factors.

BACKGROUND: The authors examined the principal prognostic factors for supratentorial low grade astrocytomas and the effects of treatment on survival time. METHODS: Fifty-eight patients, 32 males and 26 females, treated from January 1970 through December 1990 are reported. Thirty-five patients underwent surgery, of whom three died. Among the survivors there were 7 gross total resections, 13 subtotal resections, and 12 partial resections. Of the 23 remaining patients, diagnosis was obtained by stereotactic biopsy. Twenty-five patients were irradiated and eight received chemotherapy. The histologic material, originally graded 1 or 2 according to Kernohan's system, was reviewed using the St. Anne-Mayo Clinic system, with which there were 18 Grade 3 tumors. RESULTS: Six patients had pilocytic astrocytomas (mean age, 18 years), of which three astrocytomas could be removed, and the patients were well 128, 152, and 254 months, respectively, after diagnosis. Among the other three patients, one with a hypothalamic localization refused any form of treatment and died rapidly. The remaining two patients also had deep-seated tumors and were irradiated: one died 17 months later, and the other remained relapse free 56 months after diagnosis. The 49 patients with ordinary astrocytomas who survived surgery (mean age, 37 years) had a median survival time of 64 months and 5- and 10-year survival rates of 54.6% and 34.1%, respectively. Patients with Grade 1 or 2 tumors had a median survival time of 108.6 months, compared with 39.4 months for patients with Grade 3 tumors. Gross total and subtotal resections were significantly associated with longer survival time only in patients with Grade 1 and 2 tumors: in this group, the 5- and 10-year survival rates were 87.5% and 68.2%, respectively, when tumor was completely resected, instead of 57% and 31.2% in patients with incomplete or no surgical resection. There was a trend suggesting that antimitotic drugs and X-ray therapy could benefit patients with Grade 3 tumors. CONCLUSION: The importance of an accurate histologic grading system and a gross total resection of Grade 1 and 2 astrocytomas is emphasized.

Actuarial Analysis↗
PubMed1990

[Chronic hydrocephalus in adults].

The aim of this study is to sum up our current knowledge on the so-called "normal pressure hydrocephalus" syndrome, revisited by the authors as the "adult chronic hydrocephalus" syndrome (A.C.H.). It is based upon 1) a review of the literature dealing with the subject (518 references) and 2) an original series of 243 cases summarizing a 10 year experience of 2 french neurosurgical teams (Lyon: 123 cases, Clermont-Ferrand: 120 cases). Part I is devoted to the review of pathologic and pathophysiologic data. Both autopsy and microscopic findings clearly show 2 categories of anomalies in the brains of patients showing this condition: "non specific" lesions may be either causative (leptomeningeal thickening, villositar sclerosis) or secondary to hydrocephalus (ependymal wall disruption, sub-ependymal "edema"). Conversely, "specific lesions" are either degenerative (Alzheimer-type) or ischemic in origin. They seem unrelated to hydrocephalus, but may play a role in the ventricular enlargement by favoring changes in brain elastic properties. Data available from brain biopsies (13 cases) have confirmed the high incidence of such "specific lesions" of the parenchyma. Following the Hakim's initial hypothesis, several mechanisms have been proposed to explain the progressive ventricular dilation despite a fall in C.S.F. pressure. Experimental and clinical data (namely those referring to the pathogenesis of secondary A.C.H.) are reviewed. The sequence of events following acute ventricular obstruction is analysed. The ultimate state of chronic uncompensated hydrocephalus involve multiple factors among which a trans-cerebral mantle pressure gradient may play a major role. The intervention of compensatory mechanisms (reduction of C.S.F. production, establishment of alternative pathways of C.S.F. absorption) is also discussed. Part II is devoted to the presentation of the clinical material. Series of the literature including more than 20 surgical cases are briefly reviewed together with the authors' material and methods. Criteria of selection of patients, methods of clinical evaluation and of statistical analysis of results are exposed. Of the 243 patients of the present series, 225 were managed by C.S.F. shunt (V.A.: 137, V.P.:60, L.P.:28). Results were as follows (mean follow-up:31 mths +/- 28): good results (including excellent results): 128 (52.6%), fair: 52 (21.3%), poor and aggravated: 49 (20%), early deaths: 14 (5.7%), 12 of those post-operatively. The rate of surgical complications was 35% (S.D.H.: 16.8%, sepsis: 4%, seizures: 4%, shunt malfunction: 10.6%) leading to reoperation in 25.7%. Long-term survival rate was 75% (172 alive patients and 57 late deaths).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1989

[Ventricular subarachnoidal hydrocephalus of arachnoid villi origin].

In 102 infants (0.5 to 22 months), the C.T. scan performed for various neurological symptoms, was systematically reviewed with analysis of ventricular size, pericerebral space and interhemispheric fissure. In 70% of the cases, an increase of the intracranial volume of C.S.F. was noted, with a good correlation between the ventricular and pericerebral volume. The authors discuss the pathophysiological mechanism of this condition an evoke the possibility of an idiopathic disturbance of the C.S.F. reabsorption. In two cases, suffering from severe axial hypotonus, this fact was explored by four methods: continuous monitoring of intracranial pressure, intraventricular infusion test, isotopic cisternography through ventricular injection and venous phase of angiography. From these investigations showing no venous anomaly, and because of the lack of any pathological event able to induce a C.S.F. obstruction, we suggest a delay in the maturation of arachnoïd villi (normally ended at 18 months) to explain this condition.

Arachnoid↗
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↗
PubMed1986

Transfer kinetics of pefloxacin into cerebro-spinal fluid after one hour i.v. infusion of 400 mg in man.

Nine subjects (5 women) aged between 17-66 years, with hydrocephalus were studied. An external ventricular drain was introduced for diagnostic purposes. Cerebro-spinal fluid (CSF) and plasma samples were obtained at suitable intervals after 1 h infusion of 400 mg pefloxacin. In plasma, pefloxacin Cmax was 8.54 +/- 1.53 (mean +/- S.E.M.) mg/l, at the end of infusion, whereas N-desmethyl pefloxacin concentration was 0.17 +/- 0.03 mg/l. The metabolite accounted for only 2% of plasma levels of pefloxacin. In CSF, pefloxacin Cmax was 2.97 +/- 0.32 mg/l, 5-6 h after the start of infusion, whereas N-desmethyl pefloxacin Cmax varied between 0.1-0.2 mg/l. Apart from the 1 h sample, the CSF/plasma ratio of pefloxacin was 60% which is similar to the unbound fraction of pefloxacin in plasma. The apparent half-life (T1/2) of transfer of pefloxacin from plasma to CSF was 1.26 +/- 0.18 h, assuming a first order process, while the apparent elimination T1/2 in CSF was 13.40 +/- 1.76 h, which is similar to the elimination T1/2 found previously in plasma, thus accumulation of pefloxacin in CSF is unlikely. With the present dosage regimen, CSF quickly attains therapeutic levels of pefloxacin.

Adolescent↗
PubMed1986

[Prospective trial of treating aneurysmal meningeal hemorrhage by delayed operation under cover of antifibrinolytic therapy].

Seventy patients with subarachnoid haemorrhage due to ruptured intracranial aneurysms were managed by delayed intervention (third week) along with the prescription of antifibrinolytic drugs (tranexamic acid 6 g/daily). During the pre-operative period, 41 patients stayed in the same clinical status as on admission or improved, whereas 29 deteriorated due to rebleeding (4 cases), vasospasm (18 cases), large hematoma (4 cases), hydrocephalus (2 cases) and postarteriographic accident (1 case). Clipping the aneurysm was finally achieved in 42 patients only; with 3 deaths, 3 severe sequellae, 8 light handicaps, and 28 patients considered as cured with returning to previous occupations. As far as the whole series is concerned, these results yield a 38.5% rate of mortality, 20% morbidity, and 41.5% recovery. It is concluded that 1) Tranexamic acid was effective in reducing the risk or rebleeding, 2) Third week delayed intervention associated with this drug significantly reduced the operative mortality, but probably favoured vasospasm, and finally had no beneficial effect on the overall results concerning the entire series of patients.

Adult↗
PubMed1985

Dilatation of the subarachnoid pericerebral space and absorption of cerebrospinal fluid in the infant.

The authors investigated intracranial pressure, resistance to cerebrospinal fluid (CSF) absorption following ventricular infusion and radiopharmaceutical absorption of radionuclide injected into the ventricles in two infants with dilatation of the subarachnoid pericerebral space. The results of this study showed an increased resistance to CSF absorption. Intraspinal CSF absorption was seen to predominate, as shown by isotopic cisternography.

Cerebrospinal Fluid↗
PubMed1984

[Plateau wave, unexpected cause of anoxo-ischemic syncope. Reflections on the pathogenesis of the plateau wave apropos of a case].

The case of a 56 year old female suffering from a carcinomatous meningitis with recurrent attacks of unconciousness is presented. The ischemic nature of the attacks was substantiated through a simultaneous recording of ICP, systemic arterial blood pressure, and EEG. Every syncope was clearly accompanied by 1) a typical ICP plateau-wave, 2) a systemic blood pressure wave of lower amplitude, 3) a considerable correlative diminution of the cerebral perfusion pressure and 4) a slowing down of the EEG. These phenomenons could be provoked by intraventricular injections of a few milliliters of artificial CSF, whereas a ventriculo-peritoneal shunting made them disappeared. The role played by the disturbances of the CSF flow in the production of the plateau waves is discussed.

Blood Pressure↗
PubMed1984

[X-ray computed tomography of intracranial fluid cavities in the infant (ventricles, the interhemispheric fissure and pericerebral spaces)].

The brain of 102 infants with an age range of 0,5-22 months was examined with computed tomography (C.T.). The main indications for C.T. investigations were psychomotor retardation or seizures. There were 70 infants with an increase of the volume of intracranial cerebrospinal fluid characterized by -a pericerebral effusion with a thickness from 1-14 mm -a dilatation of interhemispheric fissure -and most frequently an internal hydrocephalus. This phenomenon and his spontaneous remission suggested, that if arachnoïd will are observed in new-born infants, they increased in complexity with normal function as development proceeded.

Brain↗
PubMed1983

[Slit-ventricle. Apropos of 2 cases].

The so called slit-ventricle syndrome appears as a potential complication of the CSF derivations, whatever their types. It consists of repetitive episodes of elevated intracranial pressure, associated with collapsed ventricles as demonstrated by CT scan. Clinical symptoms happen after several months or years during which the derivation worked well, and then get more and more frequent. Between the episodes, the only statement one can do is the slow re-filling of the pump after it has been depressed with finger. The valveless lumbo-peritoneal derivations, and the ventriculo-atrial or ventriculo-peritoneal derivations using a low-pressure valve, are most often found in patients with the slit-ventricle syndrome. This suggests that overdrainage of the CSF is likely to be the main cause of this syndrome. Possible managements comprise: changing the valve, for an other one with a higher opening pressure,--adding to the derivation an antisyphon device, and making a subtemporal decompression.

Cerebral Ventriculography↗
PubMed1982

Intracranial hypertension and prognosis of spontaneous intracerebral haematomas. A correlative study of 60 patients.

Intraventricular pressure was recorded in 60 patients with intracerebral haemorrhage, and correlated with their clinical conditions and prognosis. The results show that an evaluated intraventricular pressure is statistically linked with the most serious situations, and with the most severe prognosis. However, two thirds of the decreased patients had died with an almost normal pressure, suggesting that intracranial hypertension is not always the immediate cause of death, but only an aggravating factor. From these results, it is proposed that intracranial pressure should be monitored only in stuporous or comatose patients, and always compared with CT scan images, which give better information regarding the harmful effect of midline structure displacement.

Adult↗
PubMed1981

Benign intracranial hypertension and disorders of CSF absorption.

Sixteen patients suffering from benign intracranial hypertension were studied by a continuous measurement of intraventricular pressure, a simultaneous recording of intraventricular and sagittal sinus pressures, and a measurement of the cerebrospinal fluid (CSF) resistance to drainage. Isotope cisternography was performed and the patency of the dural sinuses verified by direct sinography or phlebography or both. The same procedure was used to study 6 other patients suffering from disorders leading to the same type of intracranial hypertension. In 16, our results confirm a defect in CSF absorption mechanisms linked to an abolition of the pressure gradient between CSF and sagittal sinus in 6 patients, as well as an important increase in CSF resistance to drainage in 10 others. Despite this defect, the CSF circulation was normal in most patients (10 of 12) as demonstrated by isotope cisternography.

Absorption↗