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Biomedical subjects

B Aesch

Publications and source records attributed to B Aesch.

At least 19 recordsLinked to original sources
PubMed2004

[Management of cerebrospinal fluid fistulae: physiopathology, imaging and treatment].

Cerebrospinal fluid (CSF) fistulae can produce leakage through a defect in the bony skull and meninges into the contiguous air-filled cavities at the base of the skull. The major risk is central nervous system infection. When abundant clear rhinorrhea or otorrhea is present, the diagnosis is obvious and imaging is used to localize the fistula. Computed tomography (CT) with millimetric slices and magnetic resonance imaging (MRI) are the most effective diagnostic tools. CT cisternography, an invasive procedure, should only be used when the diagnosis remains uncertain following CT scan and MRI. When CSF leakage is sparse or intermittent, the diagnosis can be made by measuring beta-2 transferrine in the escaping fluid. CT scan followed by MRI are also useful for making the diagnosis and locating the fistula when exterior leakage is absent. CT scan alone is effective for assessing isolated otorrhea. If the diagnosis remains uncertain after all these studies have been used, the patient should be closely followed clinically and isotopic study or surgery should be considered.

Cerebrospinal Fluid Otorrhea↗
PubMed2003

Viral and bacterial DNA in carotid atherosclerotic lesions.

Atherosclerosis is a major health problem in industrialised countries. Several studies have suggested an association exists between certain microorganisms and the development of atherosclerosis. The aim of the study presented here was to assess the presence of viral or bacterial DNA in carotid atherosclerotic lesions. Nucleic acids were extracted from 18 carotid atherosclerotic lesions that had been collected surgically. Polymerase chain reaction was used to screen for specific genomic DNA from Chlamydia pneumoniae, cytomegalovirus and herpes simplex virus types 1 and 2. An original approach, based on the amplification by PCR of conserved bacterial 16S rDNA nucleotide sequences was also used to detect any bacterial species. The amplification product was identified by sequencing. Chlamydia pneumoniae, cytomegalovirus and herpes simplex 2 DNA were not detected in any of the samples. Herpes simplex 1 DNA was detected in 3 of the 18 samples. Genes encoding bacterial 16S rRNA were amplified and sequenced in eight atherosclerotic lesions. DNA sequences were identified by comparison with sequences registered in the GenBank database. These eight carotid atherosclerotic lesions were shown to contain several bacterial species belonging to human flora or the environment. The exact role of these microorganisms in the genesis or development of the atherosclerotic lesions remains unclear, but they may increase the inflammatory process or be an epiphenomenon.

Aged↗
PubMed2003

[Image-guided epidural blood patch as effective treatment of intracranial hypotension. A case report].

We report the case of a patient with postural headache. A CT scan revealed bilateral subdural hygroma. Brain MRI showed diffuse pachymeningeal enhancement. A diagnosis of intracranial hypotension was therefore made. Thoracic cerebrospinal fluid leak was proved by radionuclide cisternography and contrast myelography. Conservative medical treatment was ineffective. Two thoracic epidural blood patches with radiographic control were made. We think the blood patch is the most important element for success.

Blood Patch, Epidural↗
PubMed2000

[Doppler ultrasonography of carotid atheromatous lesions].

Carotid stenosis is the most frequently factor involved in stroke. The diagnosis of these lesions in routinely based on ultrasonic examination which allows to detect the carotid stenoses which were essentially atheromatous. B-mode evaluates the fine echostructure of plaques and Doppler helps to quantify the degree of stenosis using direct and indirect hemodynamic criteria. Echography with the help of color Doppler imaging identifies the site of stenosis in order to determine the degree of stenosis as a percentage of normal carotid area. Moreover echography is an essential method to appreciate the surface as well as the echostructure of the carotid lesion which have to be taking into account for a well-adapted therapy. The maximal velocities determined at the tight site of the lesion, the spectral changes downstream the stenosis and the hemodynamic changes observed upstream and downsteam of the carotid stenosis allow a precise quantification of this stenosis. The information obtained using sonographic methods (including 2 direct hemodynamic criteria, 2 indirect hemodynamic criteria and, if possible, a B-mode assessment of the area) are essential to appreciate the neurological risk in these patients.

Carotid Artery Diseases↗
PubMed2000

[Head injury and pregnancy].

Even mild, head injury during pregnancy can threaten either the maternal or the fetal life. Traffic accidents are the main causes so head injury is often associated with other lesions, frequently abdominal trauma. Among all these possible lesions, head injury and hemorrhagic shock are the main sources of fatality in pregnant women. All kinds of trauma and especially head injuries have a potentially deleterious effect on fetal viability. This risk is associated with systemic and cerebral consequences of post-traumatic arterial hypotension, anoxia or anemia. Moreover, diagnostic procedures and medications can add their noxious secondary effects, contributing more or less to poor fetal outcome. Decision making is necessarily dictated by the severity of the consciousness disorders and/or the encephalic lesions. A convergent discussion between the intensive care physician, the neurosurgeon, the obstetrician and the anesthesiologist is needed. Severe or prolonged traumatic coma is highly dramatic situation because the maternal outcome remains largely unknown for days or weeks. Technically, for these severe comas, there are no substantial differences with what is usually done in a similar case without pregnancy. Neurosurgical indications follow the usual rules, except that some non-urgent indications should be delayed for a while. Usually, this simple rule of independency in indications also applies to the obstetrician. Special care must be taken for fetal monitoring required throughout the initial critical phase.

Brain Injuries↗
PubMed1998

[Emergency EEG and brain injuries].

The aim of this study is to review indications for emergency EEG in case of brain trauma. The authors emphasize the indication of emergency EEG for the diagnosis of either cerebral death or early post traumatic seizures, and for the monitoring of intensive neurological treatments. Emergency EEG and diagnosis of cerebral death has been reviewed in another issue of this journal. Diagnosis of early post-traumatic seizures may be difficult in case of cranial trauma in either the presence or the absence of coma. Emergency EEG help guide the diagnosis of electrical signs of seizures, thus indicating that treatment with antiepileptic drugs is advisable. Severe post-traumatic coma requires barbiturate impregnation and moderate hypothermia. In this last case, emergency EEG is essential for the monitoring of pharmacological treatments. The authors conclude that continuous EEG monitoring could in the future substitute for standard EEG recorded in emergency.

Brain Death↗
PubMed1995

Massive osteolysis of the cervical spine. A case report.

STUDY DESIGN: This study described the course of a case of massive osteolysis (Gorham's disease) of the cervical spine and discussed the literature data. OBJECTIVES: To describe a case of massive osteolysis of the cervical spine with fatal outcome and to discuss the classification of the disease among osteolysis and its therapeutic modalities. SUMMARY OF BACKGROUND DATA: Massive osteolysis is a rare condition (fewer than 100 cases reported in the literature) of unknown etiology, which may involve any bone in the body, with a propensity for the shoulder and pelvic girdle. Few cases of cervical spine involvement were reported. METHODS: The case of a 32-year-old man with fatal progressive massive osteolysis of the cervical spine despite multiple attempts to achieve surgical stabilization was reported. RESULTS: Massive osteolysis was characterized by complete destruction of all or part of a bone by angiomatous tissue and may have represented a local disturbance of osteoclastic activity. No successful therapy was proposed, and the prognosis of spine involvement was very poor. CONCLUSIONS: Massive osteolysis is a rare condition with no successful therapy. The hypothesis of involvement of circulating preosteoclasts in the osteolytic process may suggest treatment attempts with diphosphonates because of the futility of standard bone grafting techniques in spine involvement.

Adult↗
PubMed1994

Granular cell tumor of the pituitary stalk. Case report.

The case is described of a granular cell tumor of the pituitary stalk in a 40-year-old woman with secondary amenorrhea. A computerized tomography scan showed a large contrast-enhancing mass, and T1-weighted magnetic resonance images demonstrated a tumor isointense to the brain parenchyma with nonhomogeneous enhancement after intravenous administration of gadolinium diethylenetriamine penta-acetic acid. Histopathological examination, especially immunocytochemical and electron microscopic studies, showed elements supporting an astrocytic origin for this type of tumor, a hypothesis advanced by many authors but still controversial.

Adult↗
PubMed1993

MRI of cranial chordomas: the value of gadolinium.

Two intracranial chordomas are presented: a typical chordoma and a chondroid tumour. MRI with gadolinium showed different enhancement patterns, which may be related to pathological findings. The value of differentiating the two types of chordoma lies in their very different prognosis.

Adult↗
PubMed1991

Multiple cerebral angiomas and Rendu-Osler-Weber disease: case report.

A 25-year-old man was hospitalized after suffering a subarachnoid hemorrhage. Arteriograms disclosed two arteriovenous malformations, one of which was asymptomatic. Rendu-Osler-Weber disease was suspected because of the concomitant existence of cutaneous telangiectases. Review of the literature shows that in 12 previously published cases involving multiple arteriovenous malformations, this diagnosis was established five times. The indications for surgical treatment are discussed.

Adult↗
PubMed1991

[Cranioplasties using free femoral osteo-periostal flaps].

Injuries, osteomyelitis, tumors are responsible of large skull defects. Their management is difficult. Three post traumatic and post infectious defects were repaired with an osteoperiostic flap taken from the internal face of the femur. A large defect due to the removal of a metastatic tumor was repaired with an iliac osseous flap. The choice of the donor site depends on the defect size (the femur provides a flap of 13 cm x 8 cm, the iliac bone a flap of 17 x 17 cm). The three head injured patients had a range of six previous unsuccessful surgical attempts using polymerised material or bone grafts. The post operative course in the post traumatic patients was uneventful, the domestic result good, the periostic consolidation less than three months. The free flap seems a good method for the management of risky cases.

Bone Transplantation↗
PubMed1991

[Hydrocephalus caused by obstruction of the foramina of Luschka and Magendie in adults. Report of a case. Etiopathogenic discussion].

The authors report the case of 30 years old patient presenting with an hydrocephalus responsible for high intracranial pressure and cerebellar ataxia. The fourth ventricle dilatation was predominant and there was no passage of the contrast media in the cisterna magna during ventriculography. For lack of neonatal antecedents and neurological pathology a congenital origin was evoked. The obstruction of the foramina of Luschka and Magendie with an hydraulic stability in the ventricles during the life before decompensation was likely. A ventriculo-peritoneal shunt, seemed to be the better treatment with regard to the permeability of the aqueduct.

Adult↗
PubMed1990

Hydrocephalus and cavernoma of the cauda equina.

The association of a tumor of the cauda equina and hydrocephalus is unusual. We report a case of hydrocephalus with normal pressure associated with an equally rare affliction, a cavernous angioma of the cauda equina, which regressed after surgical ablation. The physiological mechanism involved is discussed.

Aged↗
PubMed1990

[Cranioplasties using a free osteoperiostic femoral vascularized flap].

The management of large defects after head injury, osteomyelitis or both is usually solved by the use of bone grafts, polymerised material or metallic prosthesis. The post-operative course is often frustrating when those materials are close to the frontal sinus leading to the removal of this material. For these reasons, we decided to use free periostic flaps for the management of these skull defects. The flap comes from the internal part of the femur creating no other defect in the body. Three patients with post infectious and post traumatic skull defects have been operated. The postoperative course was uneventful, the cosmetic result good and the protection of the cranial content effective after three months. Of these three patients one had eleven previous attempts of repair for his defect. This method seems to be a good one for those risky cases, and somewhat better than the use of great omentum transfer sometimes associated with bone grafts.

Adult↗
PubMed1989

[Otoneurosurgery in the elderly].

An oto-neuro-surgical experience on patients older than 65 years is reported. 25 patients have been operated: 9 meningiomas, 5 trigeminal neuroglia, 2 vestibular neurectomies, 9 acoustic neuromas. The assessment, the indication, the surgical techniques are discussed. Are also evaluated the anesthetic technique, the patient drugs, position, and the post-operative survey.

Aged↗
PubMed1989

[Does nimodipine improve the outcome of perioperative complications of aneurysm rupture? Results of systematic treatment].

Morbidity after aneurysmal subarachnoid hemorrhages is proceeding from many factors; ischemic etiology is underestimated and frequently thought to be vasospasm related only. Other undoubted mechanisms are in the setting of ischemic disorders after ruptured aneurysms. The management of these disorders is relevant of new calcium blockers. Early administration of prophylactically oral nimodipine, with temporary intravenous administration of the therapy after surgery or in the setting of delayed ischemic deterioration, were assigned to 36 patients with aneurysm surgery. Efficacy was judged on prevention and outcome of ischemic disorders at discharge and three months later using the Glasgow Outcome Scale. On all, twenty-nine patients were disabled from any etiology; twenty made full or improved recoveries at discharge; twenty-eight get independent conditions of life at 3 months. Fourteen patients have return to their pre-rupture activity. Twenty-two surgical patients (61%) set an undoubtly ischemic disability during any time of their hospitalization, but many etiologies were identified in majority of cases. Spasm is the main factor of stroke in only 6 patients, and one of the ischemic factors in 15 cases. Among these ischemic deteriorations, twenty improved or made full recovery at discharge and get independent life at 3 months. No death with spasm. These data support the assumption that vasodilatating is not the only mode of nimodipine action. Hypervolemia must be adjunct with nimodipine to prevent regional hypoperfusion.

Adolescent↗