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Biomedical subjects

A Vasdev

Publications and source records attributed to A Vasdev.

At least 19 recordsLinked to original sources
PubMed2005

Bilateral spontaneous rupture of Achilles tendons: a case report.

Spontaneous bilateral rupture of Achilles tendon is rare. Rupture of the Achilles tendon has been described in patients on oral corticosteroid therapy. The sudden dorsiflexion of the plantar-flexed foot is the usual mechanism of injury. Spontaneous bilateral rupture is common in the degenerated tendon, which is often seen in patients with long-term corticosteroid therapy. This case is unusual because the patient has never taken steroids. We discuss the mechanism of injury and other probable causes.

Achilles Tendon↗
PubMed1999

A persistent pharyngohyostapedial artery: embryologic implications.

A 3-year-old child was examined because of otorrhagia. CT scans showed an unusual vessel, confirmed by angiography, related to a persistent pharyngohyostapedial artery. This embryonic persistent artery associated with the normal internal carotid artery would explain the "duplication" aspect of the internal carotid artery.

Angiography, Digital Subtraction↗
PubMed1998

[Benign vertebral osteoblastoma. Report of 6 cases].

We present six cases of benign spinal osteoblastoma. This localization of this uncommon benign bone tumor occurring in young subjects is rare. The patients were explored with radiotomography, computed tomography, myelography and medullo-spinal angiography. These benign tumors may appear radiographically as pure bone lysis mimicking malignancy. The size of these tumors often leads to widening search for extension, particularly in recurrent, aggressive, multifocal forms which require wide resection, and sometimes total vertebrectomy. Medullo-spinal angiography can confirm the vascular involvement of the tumor nidus and is require to identify arteries supplying the spinal canal which would modify operative strategy.

Adolescent↗
PubMed1998

[Gadolinium and contrast medium MRI of the acoustic nerve in patients with meningeal neuritis and acoustico-facial syndrome].

Twelve cases of vestibular neuritis were investigated in gradient echo MRI with gadolinium. Only 3 severe cases associated with an acoustico facial syndrome (2 cases of herpes zoster oticus and one case after influenzae) demonstrated focal enhancement within the internal auditory canal on post contrast T1 weighted images. This enhancement involved at least 2 differents nerves. These 3 severe cases associating sensory neural hearing loss and facial palsy revealed a meningeal reaction after cerebrospinal fluid examination. The enhancement lasted a long time (up to 10 months) in one case of RAMSAY HUNT syndrome associated with a chronic lymphocytic leukemia. The MRI was able to confirm the anatomical reality of the vestibular neuritis and more precisely of the meningoneuritis and gave arguments for the theory of the polyneuropathy of Adour. Enhancement at MRI seems correlated with the severity of the affection (permanent vestibular areflexia in 3 cases and permanent hearing loss in 1 case).

Adult↗
PubMed1995

[Role of hormonal exploration in avoiding of the failures of anterior pituitary gland surgery in Cushing disease].

Patients with Cushing's disease are not cured by transsphenoidal microsurgery in about 30% of the cases. Beside the problem of invasive macroadenomas, these failures are due either to diagnostic errors, or to very small microadenomas that could no be found. Positive diagnosis of hypercortisolism is quite straightforward and the problem is sensitivity rather than specificity. Primary adrenocortical hypercortisolism should not be mistaken. Depression-related hypercortisolism can be difficult to distinguish from Cushing disease: most cases are recognized after clinical story and CRF stimulation test. Ectopic ACTH secretion by a carcinoid tumor represents at least 8% of ACTH-dependant hypercortisolism. It cannot be reliably distinguished from corticotroph microadenoma by either classical dynamic tests or anterior pituitary imaging. However measurements of ACTH in the inferior petrosal sinus under basal condition and CRF stimulation allow the diagnosis of central or peripheral ACTH secretion with a quasi 100% sensitivity and specificity. In contrast this technique is of poor help for the diagnosis of lateralization of corticotroph microadenomas, for which it gives erroneous results in 25 to 50% of the cases. Rapid intraoperative measurement of ACTH in peripituitary blood seems a more reliable approach. In our series it gave correct results in 11 out of 12 cases. In 1995 hormonal exploration of Cushing disease should limit the failures of anterior pituitary surgery to the cases of invasive macroadenomas that cannot be completely removed.

Adrenocorticotropic Hormone↗
PubMed1994

[Intracranial dural fistula with spinal cord venous drainage. Apropos of 2 cases].

The authors report 2 new cases of intracranial dural fistula draining into spinal veins. Comparisons with 19 other published cases showed that dural fistulae of the spine share common features with intracranial fistulae. The first case concerned a 78-year old woman presenting with a thoraco-lumbar myelopathy which proceeded by increasingly severe bouts and ended within 6 months in a flaccid sensorimotor paraplegia with urinary incontinence. Paraclinical examinations consisted of MRI, myelography and spinal as well as cerebral arteriography. MRI and thoraco-lumbar myelography displayed marks of dilated retrospinal vessels. Spinal arteriography showed no arteriovenous malformation, but the venous return of Adamkiewicz artery was not visible. Diagnosis was made by cerebral arteriography which demonstrated an intracranial arteriovenous fistula in the occipital region, draining into the posterior spinal vein. Treatment was endovascular and consisted of embolization by micro-coils, but clinical improvement was mediocre. Six months later, as the clinical picture was getting worse a second arteriography was performed. It showed recanalization of the fistula which was embolized again, using both coils and particles. No improvement in spinal cord deficit was observed. The second case was that of a 42-year old man presenting with paraparesis, tetrapyramidal syndrome, sensory deficit at T9, peribuccal dysaesthesias and genito-urinary sphincteral disorders, all gradually getting worse. The paraclinical exploration was the same as in the first case. MRI and myelography showed retrospinal vascular impressions. Spinal arteriography was normal, except for the lack of venous return of Adamkiewicz artery. Cerebral arteriography detected an intracranial dural arteriovenous fistula in the occipital region, draining into the anterior and posterior spinal veins. Treatment was surgical, consisting of exclusion of the arteriovenous fistula. Partial clinical improvement was noted. These two cases, compared with those of the literature, shared a number of features with spinal dural arteriovenous fistulae: they occur in middle-aged and predominantly male patients, and the clinical signs of ascending myelopathy are caused by the same physiopathological mechanism of spinal vein hyperpressure. Lesions of the medulla oblongata or the cervical spinal cord are found only in intracranial arteriovenous fistulae draining into spinal veins. Diagnosis is based on data provided by myelography (impressions of dilated and sinous vessels) and MRI (low-intensity perispinal signals, widening of the conus medullaris with high-intensity centrospinal signal); spinal cord angiography only shows a lack of venous return of Adamkiewicz artery without any other abnormality, whereas cerebral arteriography confirmed the diagnosis of intracranial dural arteriovenous fistula draining into spinal veins.

Adult↗
PubMed1994

[Computed tomographic aspects of secondary cholesteatomas of the middle ear and petrous bone].

The authors present their experience of secondary cholesteatomas of the middle ear explored by computerized tomography (CT). Following a brief anatomicopathological description of secondary petrous bone cholesteatomas, and of the CT technique used for their exploration, they describe and illustrate the classical "bag-shaped" internal or external attical forms usually extended to the antrum and the mastoid process, and the less common locations often due to relapse or postoperative recurrences (anterior hypotympanic or posterior mastoidal). The holotympanic forms, usually due to "lamellar" cholesteatomas, create diagnostic problems with other opacities in the cavity, as also do certain forms that are evacuated spontaneously or by aspiration. One of the qualities of CT lies in the preoperative extension assessment. The lesion may extend towards the internal wall of the cavity (lateral semicircular canal, second portion of the facial nerve), towards the labyrinth to the petrosal apex and/or the geniculate ganglion, and above all towards the inferior labyrinth which might bring the cholesteatoma into contact with large vessels (e.g. jugular vein bulb for postero-inferior extensions, carotid canal for antero-inferior extensions). Extension into anfractuosities of the cavity walls (sinus tympani, subratubal fossette) must be systematically looked for in order to avoid postoperative recurrences.

Bone Diseases↗
PubMed1992

[Catheterization of the inferior petrosal sinus. Its role in the diagnosis of Cushing's syndrome. Experience with 23 explorations].

Selective catheterization of the inferior petrosal sinus has been performed in 23 patients: 11 Cushing's disease, 5 lung carcinoid tumors whose diagnosis has been confirmed by surgery and 7 ACTH-dependent hypercortisolism whose final diagnosis has not yet been proved. The pituitary origin of hormone secretion is accepted if the central-to-peripheral ratio (C/PR) is equal or greater than 2 on basal values and/or during CRF test. On basal values, all subjects but one with confirmed pituitary lesions exhibited a C/PR > or = 2; the carcinoid tumors never exceeded the value of 1.3. After CRF injection, all the pituitary tumors showed an increase in C/PR; one patient with a lung carcinoid tumor (CRF-negative) showed a pituitary ACTH secretion (C/PR = 3.7). The localization of pituitary adenoma by the lateralization of hormone secretion is disappointing, except, perhaps, for very small extremely lateral adenomas. No accident occurred in our series, nor in the literature. This investigation seems the most reliable approach to prove the pituitary origin of hormonal hypersecretion. We recommend it to be performed in ACTH-dependent Cushing's syndrome when the secretory pattern is not typical and/or pituitary imaging is normal.

Adenoma↗
PubMed1991

Three-dimensional reconstruction in routine computerized tomography of the skull and spine. Experience based on 161 cases.

Three-dimensional (3D) reconstruction in routine computerized tomography (CT) presupposes that the referring clinicians are motivated, software programs are of good quality, a second working console is available and manipulations are made by experienced persons. Maxillofacial surgery is the main, conventional indication, but the method is also used to plan the surgical treatment of craniofacial malformations and that of injuries and tumours. 3D reconstruction cannot replace a thorough analysis of the acquisition sections since its spatial definition is not as good as theirs. Without competing with pure research-work, a number of applications remain in the realm of speculative imaging, but it cannot be denied that 3D reconstruction has an interesting potential for teaching.

Adult↗
PubMed1991

[Malformations of the bony labyrinth and deafness].

17 new cases of malformation of the bony labyrinth detected radiologically (tomography, CT) and associated with perceptive or composite deafness are reported. 2 cases discovered in spontaneous or traumatic recurrent meningitis are described, as well as 1 case discovered after the occurrence of total deafness following stapedial surgery. The malformations were unilateral in 7 cases, bilateral in 10. Deafness was of the composite type in 6 cases. An associated malformation of the middle or external ear was noted in 4 cases. 5 cases were included in a context of multiple malformations, including 1 case of otobranchiorenal syndrome, 1 case of Apert's syndrome and 3 cases of craniostenosis. Referring to the classification given by Mrs Vignaud and Jardin, we have encountered 1 case of stage I malformation, 9 cases of stage II, pseudo-Mondini malformation, 1 case of stage III or true Mondini malformation, 1 case of stage IV malformation, 3 cases of malformation of the aqueduct of the vestibule, ie. stage V. We have also encountered 2 isolate cases of stenosis of the internal auditory canal. On the basis of these cases, we report a few physiopathogenetic hypotheses and various classifications currently described in the literature. We also list the various associated external and middle ear malformations and the multiple-malformation syndromes that are commonly described. Stress is laid on the fact that these malformations often go undetected in congenital deafness, as well as on the usual course of these types of deafness for which there is no medical or surgical treatment.

Abnormalities, Multiple↗
PubMed1990

Apparently primary malignant melanoma of the cerebellopontine angle. One case.

We report a case of primary malignant melanoma of the cerebellopontine angle. This tumour showed RMI features that were totally different from those reported for secondary melanomas, and therefore its nature could not be suspected before surgery. Intracranial primary melanomas are so rare that no other published case is available for comparison, and our tentative explanations for the atypical RMI signals cannot be supported by evidence from the literature.

Cerebellar Neoplasms↗
PubMed1989

Osteoid osteoma of the spine: radiological aspects and value of arteriography. Four cases.

The authors present four cases of osteoid osteoma of the spine and review the usual clinical and paraclinical data leading to its diagnosis. The value of radionuclide bone scanning is emphasized: it supersedes the often disappointing radio-tomography and guides computerized tomography which, with modern scanners, virtually always demonstrates the lesion and locates it with accuracy. In the author's experience, spinal and spinal cord arteriography plays an important role: it identifies the radiculospinal vessels preoperatively and provides additional aetiological arguments based on the usual hypervascularity of osteoid osteomas and on the pain induced by injection of the feeding vessels. Data from the literature concerning the vascularization of the nidus suggest that treatment by embolization alone can be envisaged but must be demonstrated.

Adolescent↗
PubMed1989

Spinal metastases of carotid paraganglioma. One case and review of the literature.

Paragangliomas of the carotid body are uncommon tumours usually regarded as benign or locally malignant. Metastasis occurs in 5 to 25% of the cases, involving mainly the liver, lung and bones. A case of carotid body tumour without histological evidence of malignancy but with local invasion and, subsequently, multiple spinal metastases is reported. Since the histological prognosis of the initial tumour is impossible to make in most cases, the authors underline the importance of signs of local invasion which is predictive of metastasis and requires regular monitoring with radionuclide bone scanning and MRI.

Adult↗
PubMed1989

Magnetic resonance imaging in ischaemic accidents of the brain stem.

Seven cases of ischaemic accident affecting the brain stem are reported. There were two lacunar infarctions and five infarctions due to occlusion of major arteries (two lateral medullary infarctions, one pontine infarction and two thalamo-mesencephalic infarctions). In every case the abnormalities detected at MRI were concordant with the clinical findings. The authors underline the value of MRI in establishing clinico-topographic correlations in vivo and in differentiating lacunar infarctions from infarctions due to stenosis of major arteries in the vertebro-basilar system.

Aged↗