Biomedical subjects
Publications and source records attributed to B Bataille.
Among primary nerve sheath tumors, schwannomas and neurinomas are the most common. While the schwannomas (neurilemomas) originate in schwann cells, neurofibromas arise from all the constitutive parts of the nerve. The behavior of each tumor is quite different and only neurofibromas may present malignant transformation, especially when arising in patients with Von Recklinghausen disease (NF1 with multiple neurofibromas).
A 24-year-old woman with Rendu-Osler-Weber disease presented an intracranial hematoma during pregnancy. The main localizations of the Rendu-Osler-Weber disease, an inborn disease, are discussed. Neurological complications are rare. Vascular malformations are more fragile during pregnancy. The obstetrical attitude depends on the organ involved and the severity of the complications.
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This 67 year-old man experienced the sudden onset of generalized headache followed by visual troubles. Examination showed a poor visual acuity of the right eye with a palsy of the right third nerve and signs of panhypopituitarism confirmed by endocrinologic testing. CT- scan and MRI showed a large sellar tumor with a necrotic portion in the middle, so that the pre-operative diagnosis was: pituitary adenoma. The tumor was removed through a trans-sphenoïdal approach. The pathologic diagnosis was benign schwannoma. A review of the literature showed that this was the second reported case of an intra sellar schwannoma mimicking a pituitary adenoma clinically as well as radiologically. Surgical removal of these lesions by a trans-sphenoïdal approach seems to be more difficult than for an adenoma. The histopathogenic origin of such tumors could be either ectopic schwann cells of peri-vascular schwann cells in the sellar region.
The authors report two cases of brain metastasis of a testicular cancer in two young men. In the first case the histology was an embryonal carcinoma, in the second the association of a seminoma and a teratocarcinoma. The first patient was submitted to chemotherapy, neurosurgery and radiotherapy. The second one to chemotherapy alone. The survival time was respectively of 16 and 58 months. It looked interesting to review the different treatments and their indications in this extremely severe pathology to define the interest of surgery and radiotherapy, and the different prognostic factors. In the literature, among the various treatment, the role of chemotherapy is widely emphasized. The prognosis remains desperately bad when several brain metastasis exist, or if a brain metastasis develops during chemotherapy.
BACKGROUND: Spinal tuberculosis is now rare in developed countries; its appearance in sacral vertebrae is exceptional. CASE REPORT: A 6 year-old boy was admitted because he had suffered from lumbar pain and rigidity for 24 hours, limiting anterior flexion. X-rays of the spine was normal, but a CT-scan showed lytic lesions of the sacrum. Bone scintigraphy showed no inflammatory lesions. Ewing sarcoma was diagnosed: surgical biopsy showed a cold abscess containing many bacilli that where resistant to decoloration with acid-alcohol. They were cultured for 12 days and identified as Mycobacterium tuberculosis. The boy had been given a BCG vaccination at the age of 2 years and was not immunodeficient. He was treated with isoniazid, rifampin and pyrazinamide for 2 months followed by isoniazid plus rifampin for 1 year. A cold abscess in the presacral area rupturing into the sacro-iliac articulation pointed above the left iliac wing during treatment and was treated by surgical debridement. Eighteen months later, the boy is well but still avoids bending. CONCLUSION: A sacrally located bone tuberculosis is difficult to diagnose. Careful therapy is necessary to avoid sequelae that may lead to spinal curvature.
The authors report a case of a 5 year old child suffering from isolated sacral tuberculosis which presented as sudden and total loss of function of the left leg. The rarity of this bony site, and the recurrence at nine months of a presacral abscess after 9 months of anti-tuberculous treatment in an HIV negative child, vaccinated with BCG, justify the presentation of this observation.
We report 6 cases of corticotroph macroadenomas which show heterogeneity of clinical and biological features (from Cushing's syndrome to silent adenoma) and heterogeneity of immunocytochemical staining. One patient reported on had skin hyperpigmentation and ACTH hypersecretion without clear abnormal adrenocortical function; we believe that this patient's plasma contained ACTH with very low bioactivity.
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A retrospective study of thromboembolic complications after lumbar disc surgery has been performed. It included 16,656 patients from fifty neurosurgical units, operated on over the year 1989. The average number of operations was 333 +/- 19.5 in each unit, their average duration 55.2 +/- 20 minutes, and the hospital care 6.2 +/- 1.7 days. Surgery was performed using the genupectoral position in 64% of the cases, the supine position in 28%, and the lateral position in 8%. Two groups of patients have been individualized: a first group of patients with no preventive antithrombic treatment (46% of the units) including 10,351 patients, a second group (54% of the units) including 6,305 patients and receiving a systematic treatment with low molecular weight heparin (4,304 patients) or calciparin (1,001 patients) or antiplatelet agents or pentosane polysulfate (1,000 patients). 0.63% of the patients (105) had a thromboembolic accident: 0.65% in the first group (68 cases) and 0.58% in the second (37 cases). No statistically significant difference was noticed between the two groups concerning pulmonary embolism and/or lower-limb thrombophlebitis. Nevertheless, a prospective randomized study would be usefull to corroborate this first data.
Spheroids are prepared from microcrystalline cellulose in binary and compound combination with lactose and theophylline, in certain fixed conditions of extrusion and of spheronisation. The present work envisages the influence of combinated raw materials upon the physical-technique characteristic of the made spheroids. Besides a variation in the granulometric distribution a statical study through analysis of variance brings to the fore that the parameters of formulation contribute to modify the properties of hardness and of friability of the minigranules.
This report based on a series of 8 cases deals with the appearance of cerebral venous angiomas with computed tomography (CT), arteriography and magnetic resonance imaging (MRI). The CT data are not conclusive, and venous involvement is demonstrated by arteriography, as well as the site of involvement. Magnetic resonance imaging seems to be useful owing to the morphological information and data on flow phenomena it provides.
Brainstem auditory evoked responses were recorded in a neurosurgical intensive care unit in 38 patients who had all the clinical criteria for brain death. Of the brain-dead patients, 65.8% never showed a response. 3.42% showed a type I wave, which was unilateral in 26.3% and bilateral in the other 7.9%. Types II to VII waves were never seen. An increase in latency of type I waves (2.25 +/- 0.24 ms) was noted. The interest and the limits of this non invasive electrophysiologic technique for the diagnosis of brain death are discussed.
The authors report a case of L4-L5 foraminal disc herniation revealed by symptoms of bi-radicular and medullary lesions. Anatomical study allows to understand such association of symptoms.
The authors report the case of an isolated supratentorial hemangioblastoma occurring in a woman operated on for a cerebellar hemangioblastoma twenty years before. The data furnished by immunohistochemical technics don't seem to be deciding and don't work out the problem of hemangioblastoma histogenesis.
The authors report on the case of a young woman, seven months gone, with an history of sudden onset of successive lobar intracerebral hematomas. They revealed a Rendu-Osler-Weber disease. The mechanism is discussed.
A mixed ENT and neurosurgical approach is employed widely at present for exeresis of malignant ethmoidal tumors. The stability of the reconstruction of the anterior stage by bone graft is satisfactory in the long term even after radiotherapy. The transfacial approach, with or without conservation of the maxillonasal bone flap, procures a remarkable opening allowing in most cases a monobloc excision.
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