Search PubMed⌕ Search

Biomedical subjects

P Rousseaux

Publications and source records attributed to P Rousseaux.

At least 19 recordsLinked to original sources
PubMed2002

[Unsuccessful surgery of Cushing's disease. Role and efficacy of fractionated stereotactic radiotherapy].

BACKGROUND AND PURPOSE: To optimize and reduce the toxicity of pituitary adenoma irradiation, we evaluated the feasibility and effectiveness of fractionated stereotactic radiotherapy (FSR) in 51 patients with functional adenoma; 12 of them had Cushing's disease. PATIENTS AND METHODS: Eleven females and one male, median age: 49 years, 8 of them relapsed and 4 had persistent hormonal secretion after surgery. The delivered dose was 50 grays (Gy) (5 x 1.8 Gy/week) using 5 convergent micro-beams scanning in arc therapy mode. The median planned target volume (PTV) receiving 90 to 100% of the total dose was 2,1 cm(3). We used relocatable non-invasive stereotactic device Brain Lab, and adapted Linac for stereotactic radiotherapy. RESULTS: Nine out of twelve patients (75%) presented with complete remission after a median time of 29 months, 3/12 patients with partial remission. Actuarial probability to have hormonal persistent secretion was 88% at on year, 44% from 3 to 5 years, 22% at 7 years, and 11% to 0% after 7 years. The 12-corticotroph adenomas were significantly (p=0.007) more radiosensitive than 39 non-corticotroph adenomas. Toxicity was significantly lower for corticotrope adenoma, with no radio-induced pituitary deficiency and no neurological or optic injury. CONCLUSIONS: Combined surgery and FSR appears to be safe and effective for treatment of pituitary adenomas. However, long-term follow-up is required to determine the impact in terms of tumor response and hormone deficiency. The focused treated volume obtained by FSR seems more suitable for these benign tumours than standard radiotherapy. In addition to this conformal approach, the use of standard fractionation reduced the risk of severe damage to the optic chiasma, which is sometimes observed after radiosurgery and is inherent in single fraction radiotherapy.

Adenoma↗
PubMed2000

[Unilateral exophthalmos revealing agenesia of the greater wing of the sphenoid].

We present the case of a 3-year-old child who had painless pulsatory left exophthalmos which revealed sphenoidal agenesis. The radiological investigations including CT scan, MRI, and scintigraphy confirmed the diagnosis and excluded other bone abnormalities. Therepeutic behavior in this case was limited to simple inspection.

Age Factors↗
PubMed1997

[Postoperative spinal extradural hematomas. 14 cases].

We report 14 cases of post-operative spinal epidural hematoma and compare them with 17 cases reported in the literature. These 14 cases have been drawn from a continuous series of 7950 patients operated on at our institution by the posterior route for a non-traumatic spinal pathology. The symptom-free period after initial surgery was shorter than 5 hours in 13 cases out of 14. The clinical picture was characteristic 11 times. It started with a stabbing pain in the operated site, followed by paresthesia, radicular pain and neurologic palsy which were always bilateral even when the operation had been unilateral. The diagnosis was always established rapidly when the compression was cervical or thoracic and with some delay when the lumbar area was concerned. All patients, except one, have been reoperated without any radiological investigation. The source of bleeding was found 12 time out of 14. Full recovery was obtained in all 14 patients but delayed recovery of a few weeks occurred in 3 patients for whom reoperation was delayed. None of the potentiating factors studied in this work were found to be decisive. Post-operative spinal epidural hematoma is a rather uncommon complication of spinal surgery occurring at a rate of 1 to 2 per thousand. The diagnosis is more often obvious because its clinical picture is similar to that of spontaneous spinal epidural hematoma. Early reoperation allows a full recovery. Special attention during the first six post-operative hours for all patients after spinal surgery is essential for early detection of such a complication.

Adult↗
PubMed1994

[Initial prognostic factors of aneurysmal subarachnoid hemorrhage].

The purpose of this retrospective study is to explain, using a total of 210 consecutive patients with aneurysmal subarachnoid hemorrhage, the survival by several prognostic factors measured at the admission time. A multivariate analysis using the Cox proportional hazards model allowed one to recognize five prognostic factors: secondary arterial hypertension (risk ratio (RR) = 1.8; p = 0.03), the Hunt and Hess grade-3 (RR = 3.3; p = 0.002), the Hunt and Hess grade-4 (RR = 7.3; p = 0.007), and the hunt and Hess grade-5 (RR = 5.8; p = 0.03), the Fisher grade-3 (RR = 2; p = 0.01), and the Fisher grade-4 (RR = 2; p = 0.001). The determination of a prognostic score for each patient (using the coefficients of selected prognostic factors) allowed one to establish 3 prognostic stages with survival probabilities significantly different (p = 0.00005); stage-1; survival rate after 150 days (SR) = 97 %, confidence interval of 95 % (CI) = [0.90; 0.99], stage-2: SR = 66 %, CI = [0.56; 0.74], stage-3; SR = 34 %, CI = [0.17; 0.54]. The relative death risk for the stage-2 was 14 times higher than that for stage-1 (p = 0.00005), and the relative death risk for the stage-3 was 36 times higher than that for stage-1 (p = 0.00005). The age, the essential arterial hypertension, the sex and the angiographic classification of George have no prognostic value. The rebleeding incidence was correlated with prognostic stages (respectively from stage-1 to the stage-3: 8 %, 14 %, 34 %).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Should Tolosa-Hunt syndrome still be an exclusion diagnosis?].

Since Hunt et al's description (1961) Tolosa-Hunt syndrome has been a matter of controversies about its nosological identity and differential diagnosis. We report 7 cases diagnosed between 1979 and 1990. Four of them had a low-resolution CT and the diagnosis was made after a long follow-up, according to classical criteria of exclusion. The last 3 cases had a modern high-resolution CT or a MRI (2 cases) and the diagnosis was established in a few days. MRI has considerably simplified the differential diagnosis but it has not completely resolved it. Alterations of shape and signal of the cavernous sinus are similar to those of lymphoma, sarcoidosis and meningioma. When MRI is normal diabetic ophthalmoplegia, migrainous ophthalmoplegia and giant-cell arteritis must also be considered. We conclude that the diagnosis of the Tolosa-Hunt syndrome can generally be made in a few days, without a cavernous sinus biopsy. There is no reason to doubt that this syndrome is a specific nosological entity.

Aged↗
PubMed1993

[Comparison of 2 consecutive series of aneurysmal subarachnoid hemorrhage with or without nimodipine and study of the temperature curve].

A total of 210 consecutive patients with aneurysmal subarachnoid hemorrhage (S.A.H.) of any clinical grade admitted from January 1985 through May 1990 were retrospectively studied to determine the effect of intravenous Nimodipine on survival and functional results and to analyse temperature curve as a prognosis factor. The 106 patients admitted from January 1985 through November 1987 constituted the reference series termed G1. The 104 patients admitted from December 1987 through May 1990 and treated with intravenous Nimodipine constituted the series termed G2. Of the 210 patients, 172 (82%) could be operated on with a similar mean operative delay in both series (G1 = 9.5 days, G2 = 9.8 days). Of the 210 patients, 153 (73%) survived with an average follow-up of 111 weeks for G1 and of 64 weeks for G2. Nimodipine treatment was associated with a significant increase of survival (11.8%, P = 0.05) which was not the result of improved operative technique but of a lower incidence of deaths caused by postoperative vasospasm (G1 = 5 deaths, G2 = 0 deaths, P = 0.05) and by rebleeding (G1 = 15 deaths, G2 = 5 deaths, P = 0.03). No significant difference between the two series G1 and G2 was observed regarding functional results in the 153 survivors, frequency and seriousness of clinical signs of vasospasm during the waiting phase for surgery, radiologic signs of vasospasm on initial and second angiography, cerebral infarctus on second C.T.-Scan. Analysis of temperature curves of the 210 patients revealed that a delayed fever with a plateau pattern was associated with a higher incidence of vasospasm, rebleeding, and deaths.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Cerebral infarction in young people. A study of 148 patients with early cerebral angiography.

The aetiology of strokes was studied in a hospital based series of patients aged up to 40 years with precise clinical and radiological criteria. One hundred and forty five patients (75 males and 73 females) aged five to 40 years with cerebral ischaemia were evaluated. Aetiology was heterogeneous and could be classified into seven groups. Cerebral arteriograms were performed in all cases and indicated the aetiological diagnosis in most patients. Embolism was the most frequent recognised abnormality (38.4%). There were no complications of arteriography. Arterial dissections discovered by arteriography were the cause of the stroke in 10.1% of the patients. Atherosclerosis was diagnosed in 32 cases and was the commonest cause (21.6%). In one fifth of cases no cause was found. Contraceptive drugs were considered as potential cause of ischaemic stroke in 11.5%, cardiac diseases in 12.8% and haematological disorders in 8.1%. Other potential causes included migraine, inflammatory diseases, pregnancy and lacunas. Follow up in 126 cases showed that many patients had good functional recovery.

Adult↗
PubMed1989

[Synovial cysts and synovialomas of the lumbar spine. Histo-pathologic and neuro-surgical aspects apropos of 8 cases].

Based on 8 personal cases and a 81-cases review of literature, it's authors' opinion that cystic or solid masses issued form posterior lumbar articular process and called according to the cases synovial cyst, ganglion cyst, benign synovialoma, pigmented villonodular synovitis, are a single variety of benign degeneration of soft articular tissues. The cystic or solid feature of these masses depends upon the extent of their histiocytic granulomatous proliferation. They may be asymptomatic, accompany chronic lumbar pain or cause sciatica, seldom cauda equina syndrome. In case of sciatica, clinical picture rather consists of a narrow lateral recess than a discal protrusion. CT scan is the best investigation to get a right preoperative diagnosis. Postoperative prognosis is excellent and no anatomical recurrence has been reported.

Adult↗
PubMed1989

[Myelopathies caused by dorsal spinal canal spondylotic stenosis. 3 cases and a review of the literature].

Thoracic spondylotic myelopathies are exceptional, only 29 observations could be found in the literature; we intend to describe three new cases here. The patients, two women and one man, 64, 69 and 72 years old, complained of weakness of the lower limbs, more marked on one side, which had been progressing slowly from several months to eight years. Examination revealed asymmetrical paraparesis with distal sensitivity deficits without thoracic sensory level. In the first case, the myelography remained virtually unchanged in front of T11, T12; in the second and third cases, there was slight extradural compression at T9 and T10 respectively. Magnetic Resonance Imaging (M.R.I.) performed in two patients was evocative of a thoracic disk herniation. A chest CT scan enabled us to establish correct diagnosis: in the three cases irregular hypertrophy of the posterior elements was evident at T11 and T12, T9 and T10, T10 and T11 respectively, with osteophytes originating in the articular process and deeply embedded in the spinal canal. Decompressive laminectomy associated with medial facetectomy resulted in the gradual improvement of walking in all three patients. Myelography and MRI are both useful in demonstrating the level compression, usually situated in the low thoracic spine, however only the CT allows differential diagnosis with other etiologies, especially anterior compression such as disk herniation.

Aged↗
PubMed1988

[Meningioma of the optic canal. Diagnostic aspects apropos of 3 surgically treated cases].

Three cases of meningiomas originated in the optic nerve sheath in its intra-canalicular portion, have been operated on in Reims since we dispose of the TDM; it gave us the opportunity to re-define the way how to explore an area always difficult to investigate; indeed it has been impossible for a long time to clearly isolate meningiomas in the optic canal through the classical neuro-radiologic technics. The anatomic study confirms that the optic canal orientation is fixed, constantly inclined downward and forward with an angle of minus forty degrees with regard to the horizontal line; our work establishes that it is possible to apply it to the CT scan; in this incidence, TDM perfectly allows to visualize the optic canal and the optic nerve, from the anterior clinoid process to the posterior orbital pole. This incidence seems us to be interesting, in addition to classical neuro-ophthalmic planes, for early diagnosis or supervision of tumors of the optic canal.

Cranial Nerve Neoplasms↗
PubMed1988

[Cerebral abscess and Osler-Rendu disease. Apropos of 4 cases].

The authors report 4 cases of cerebral abscesses (C.A.) complicating Rendu Osler disease (hereditary haemorrhagic telangiectasia: H.H.T.). These cases and 43 others comparable found in literature enable to assess C.A. complicates H.H.T. by the way of pulmonary arteriovenous fistulas (P.A.V.F.). C.A. appears during known H.H.T. in only a quarter of cases; in all other cases C.A. reveals the disease. When the etiological search for metastatic C.A. fails to find any classical cause: O.R.L., stomatologic, cardiac, it seems important to suspect H.H.T., and research P.A.V.F. by chest X ray and pulmonary angiography. Preventive treatment consists in excluding pulmonary fistulas without waiting neurological complications of known H.H.T.

Adolescent↗
PubMed1988

[Spondylodiscitis after surgery of lumbar disk hernia. Apropos of 12 cases in 1796 operations].

Discitis is a rare complication of disc operation. The incidence rate varies from 0.2 to 0.8% according to the series. During a 6 year period (1980-1986) 1,796 patients were operated for lumbar disc protrusion at our institution and twelve of them (0.66%) developed a post operative discitis. Bacteriologic verification due to the infection was ascertained in ten cases. Direct contamination during surgical time is likely far more frequent than hematogenous contamination because the liable germ was staphylococcus in 9 cases. Ascertaining the diagnosis is base upon clinical picture and some selected investigations. It may be earlier than it has been said before. Discitis may be suspected within a week after operation in two cases out of three. The most prominent clinical feature is back pain with muscle spasm but sometimes diagnosis may be misled to a psychiatric condition or a visceral disorder. Among conclusive investigations we range in the first place the needle aspiration of the disc which permitted to isolate a germ nine times out of eleven. Next the bone scan with H.M.D.P. Te 99 (8 Mbq/kg) which revealed a significant uptake pattern in eight cases out of eight. Finally the blood culture which grew five times out of ten. Risks of discitis, i.e septicemia, polysegmental infection or death justify in our opinion an appropriate antibiotherapy during at least 8 weeks. Moreover, in our experience, it is the best antalgic treatment that we can offer and back pain decreases as soon as the second day with antibiotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Cervical spondylotic myelopathies. Apropos of 121 cases. Prognostic value of sensitive symptoms].

121 patients have been treated for cervical spondylotic myelopathy between 1972 and 1985; 88 patients have been operated on, most of them (84) by laminectomy and 4 cases by anterior approach; 33 patients have been treated conservatively in absence of evolution. We have used a clinical classification based on the different sensitive symptoms, the best predictive factor in our opinion; the typical form (2/3 of all cases) associates numbness and paresthesias of extremities of both hands, difficulties for manipulation, astereognosia, with a moderate pyramidal deficit of the lower limbs; this typical form obtains the best post-operative score with 75% of good results; the more the clinical sensitive form is far from the typical one, the poorest may be the evolution. Our results are similar with large series of literature, using either the posterior or the anterior approach; we have noted the frequency (1/4 of cases) of very late worsening, several years after initial good result, without residual compressive factor; it is supposed that organised intra-medullary lesions, may be of venous origin, continue to evolve for their own. 33 non operated patients have been treated conservatively, because of spontaneous stabilization of their disease, suggesting to try immobilization by cervical collar during few weeks before surgery.

Adult↗