Biomedical subjects
Publications and source records attributed to B Bataille.
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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A 31-year old primigravida was admitted at 31 week gestation for subarachnoid haemorrhage. Cerebral angiography revealed an aneurysm on the left middle cerebral artery. Eleven days later, the aneurysm was clipped off. General anaesthesia was induced with thiopentone, pancuronium and fentanyl, and maintained with fentanyl (40 micrograms.kg-1) and isoflurane in air/O2 with a non-rebreathing circuit. The patient was mechanically ventilated to maintain mild hypocapnia. Arterial hypotension was induced by increasing the inspired isoflurane concentration from 1 to 3 vol%. The response was immediate and a mean arterial pressure of 60 mmHg was maintained for 80 min with an inspired isoflurane concentration of 2.5 vol%. Foetal heart rate was monitored before, during and after general anaesthesia. Loss of beat to beat variation was observed after induction, and foetal heart rate slowly decreased from 150 to 115 b.min-1 at the end of the operation. Postoperative state was good, except for transitory aphasia. At 35 week gestation, the patient went into premature labour, with hypothermia of 39.5 degrees C; an emergency caesarean section was performed. The 2,340 g female infant had a 10 min Apgar score of 8. One month later, clinical examination of the mother and daughter was quite normal. The precautions and anaesthetic management of patients suffering from ruptured cerebral aneurysm during the end of pregnancy are reviewed. Hypotensive agents are discussed.
Three cases of spinal cord tumor, revealed by hydrocephalus, are reported. Two patients showed symptoms of increased intracranial pressure and the third one presented himself with ataxic gait without intellectual impairment nor incontinence. In two cases ventriculo atrial shunt was initially inserted and the correct diagnosis was made only later on myelogram because lombosciatalgia or syndrome of the cauda equina. Clinical outcome was satisfying after surgical removal of the tumor. The nature of which was a neurinoma of the cauda equina; a lumbar intradural granuloma and an ependymoma of the cauda equina. The mechanism by which spinal cord tumors raised intracranial hypertension is discussed.
A case of a surgically verified neurinoma of the oculomotor nerve is presented. The diagnostic difficulties due to the parasellar localisation are discussed. Computed tomography scan data rarely allow to distinguish the nature of the tumor and in all cases are insufficient to distinguish a trigeminal nerve neurinoma of the oculomotor nerves.
The stability of anaesthesia and the quality of recovery obtained with low doses of enflurane were studied. Two groups of 20 patients operated for lumbar slipped disc were compared. The mean age and weight distribution of the two groups were not statistically different. Induction was the same in the two groups (diazepam, fentanyl, pancuronium and nitrous oxide). In one group, enflurane (0.4%) was added with controlled ventilation. Thiopentone was added if some spontaneous movements were observed, if arterial pressure and heart rate increased, and if the digital plethysmograph curve decreased. The quality of recovery was assessed by number-connection tests 1 and 2 h after the end of anaesthesia. Thiopentone was required five times in the group without enflurane, whilst it was never used in the group with enflurane. This difference was statistically significant (p less than 0.01) and showed a more important stability of anaesthesia when enflurane (0.4%) was used. No statistically significant difference was found in the recovery scores between the two groups 1 and 2 h after the end of anaesthesia. It was proposed that low doses of enflurane were sufficient to increase the effects of the other anaesthetic drugs without any residual effect on recovery. Low doses of enflurane could be used during anaesthesia induced with fentanyl and diazepam, giving better stability during anaesthesia without any pernicious effects on recovery.
A 22 year old woman had a seizure, and the skull X-ray showed an intracranial arched calcification. CT scan permitted diagnosis of dermoid cyst. Rupture of the cyst was testified by low density areas disseminated on the cortical surface and intra-ventricular fat level. Surgical removal confirmed dermoid cyst with rupture and fat fluid inside. Authors underline infrequency of such intra-ventricular fat level. CT scan, with low density of lipidic origin promote considerably such diagnosis both of the real nature of the cyst and of its rupture.
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The case is reported of an 18 year old patient who developed a peripheral neuropathy after being given 1.5 g ornidazole daily for 6 days and 2 g daily for 16 days (total dose: 41 g). Bilateral radial paralysis was noted clinically, whilst electrical investigations showed diffuse motor and sensitive anomalies. Three months after the drug had been stopped, all symptoms and signs had disappeared. The pathogenesis of this complication is discussed. The part played by ornidazole is suggested but cannot be proved because of the multiple disorders presented by the patient.
Intraspinal tumors with subarachnoid hemorrhage are exceptional. They are most often localized at the cauda equina. Ependymoma is the most common tumor. Low back pain followed by headache (Fincher syndrome) should suggest hemorrhage originating from a low lesion.
Third, fourth and sixth cranial nerve palsy is a less common complication of giant cell arteritis than ischemic optic neuritis. Nevertheless, it occurs in at least 10% of cases. A case of giant cell arteritis with third nerve palsy which resolved under corticosteroid therapy is reported. The incidence of ocular complications is assessed from a review of the cases previously seen in the department and of data from the medical literature. The authors believe that the index patient has ischemic neuritis rather than myositis. It is concluded that giant cell arteritis should be considered at an early reversible stage.
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From the minigranules of the theophylline-based that prepared by extrusion-spheronization, the authors have envisaged the study of one of the parameters of operation (spheronizer speed) on the physical properties and lyoavailability of the active ingredient. It emerges that there is a clear influence of that parameters on the particle size distribution, the hardness, the friability, the density and the lyoavailability.
The appearance observed with CT during and following eclampsia seem to be related to edema, hemorrhagic lesions and ischemic lesions. The authors report on a reversible appearance of hypodense central grey nuclei and of the calcarine cortex fitting into this new context.