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Biomedical subjects

C Lapras

Publications and source records attributed to C Lapras.

At least 73 records · Page 4Linked to original sources
PubMed1987

[Lumboperitoneal shunt in persistent or recurrent fistulae of the base of skull. Apropos of 20 cases].

The authors describe the use of the lumbo peritoneal shunt (L.P.S.) in 20 cases of C.S.F. rhinorrhea following either cranial injury [13] basal skull surgery [2] or of unknown etiology [5]. 16 patients had previously undergone an attempt at direct closure of their fistula and are therefore cases in which the direct approach failed. 4 patients underwent the L.P.S. straightaway. In 17 cases the fistula was healed by the L.P.S. without any recurrence, though a shunt removal was necessary in 5 cases. The method was unsuccessful in only 3 cases.

Adult↗
PubMed1986

[Monitoring cerebrospinal fluid shunts by thermography].

The authors have used a thermographic system to evaluate cerebrospinal fluid (CSF) shunt patency. Thermographic detection of the catheter rests on the gradient that exists between the temperature of the CSF-containing tube and that of the nearby skin. The equipment consists of an infra-red sensitive camera connected to a television screen. No cooling or warming of the reservoir was performed. The entire length of the superficial part of the shunt could be explored. The present study concerns 36 thermographic examinations in 31 patients. The CSF-containing catheter was usually warmer than the skin, but in some circumstances its upper part appeared to be cooler than the skin of the head and its lower part warmer than the skin of the neck. The thermographic results are in agreement with the clinical findings and the course of the disease. The method, which is harmless, simple and easily reproducible, seems to be useful for the determination of CSF shunt patency.

Adult↗
PubMed1986

Cerebellar astrocytomas in childhood.

According to CT appearance and surgical observations, cerebellar astrocytomas can be separated into three types. On CT scan, cystic astrocytomas have a typical mural nodule; with contrast injection only the nodule becomes hyperdense; the wall of the cyst is not modified. In these cases, only the mural nodule is removed since the wall does not contain tumor cells. In contrast, false cystic astrocytomas present an irregular wall, diffusely enhanced and thick. Then the wall is invaded by tumor cells, it must be totally removed. Solid astrocytomas may invade the peduncle, the IV ventricle, and the subarachnoid spaces. Removal is sometimes questionably total. As recurrences are not frequently observed in these cases, radiotherapy is not always recommended. Rather, radiotherapy is only used in cases of undoubted partial removal or after partial removal of a recurrence. Of 63 cases, early postoperative mortality was 4.7% and late recurrence 6.3%.

Adolescent↗
PubMed1986

Lumbo-peritoneal shunt in non-hydrocephalic patients. A review of 41 cases.

A population of 41 non-hydrocephalic patients in whom a lumbo-peritoneal shunt (LPS) was inserted for various conditions is reviewed. 19 had persistent cerebro-spinal fluid rhinorrhoea following cranial injury, basal skull surgery or of unknown origin, 3 had recalcitrant benign intra-cranial hypertension, 14 had a persistent bulging craniotomy site after operations for intra-cranial tumours or head trauma, 4 had syringomyelia and 1 had a postoperative cervical meningocele. There was no shunt-related mortality. LPS was effective in treating the initial symptomatology in 31 patients. Further revision or removal of LPS were needed on 9 occasions in 8 patients showing shunt-related mechanical or infectious complications or persistent postural headaches. This report demonstrates the safety of the LPS procedure experienced in another population of 146 patients with communicating hydrocephalus operated on in the meantime. According to the authors' experience, the versatility of the clinical applications of LPS seems well established. LPS should be considered when a CSF diversion is required in patients showing absent or minimal ventricular enlargement in the CT scan.

Adult↗
PubMed1986

Intra-operative embolization of cerebral arteriovenous malformations by means of isobutylcyanoacrylate (experience in 20 cases).

20 cases of cerebral arteriovenous malformations (AVM's) are reported, treated by direct intraoperative embolization. A 50% mixture of butyl-2-cyanoacrylate (IBC) and ethyl mono-iodostearate (Duroliopaque) was used. The clinical history of the patients was a long history of seizures in 10 cases, a haemorrhage in 9 cases, and a motor deficit in 1 case. In the immediate post-operative course, 1 patient died, 3 patients had a serious post-operative haemorrhage, 6 patients presented with a transient post-operative deficit, and in 10 patients the post-operative course was uneventful. During the following years, a late haemorrhage occurred after incomplete AVM eradication in 3 patients, leading to AVM resection. The AVM eradication was eventually complete in 3 cases with embolization only, and in 7 cases with embolization and AVM resection. The overall management of AVM in all 20 patients was: embolization only in 13 cases, embolization and resection in 7 cases. The long term results are: operative death 1, late death 3, long lasting deficit 1; uneventful 15. The authors discuss the technique of embolization, the effect of IBC on the vessel walls, the evolution of their general management of AVM's after this experience. Eventually the intra-operative embolization may be helpful after incomplete intra vascular embolization, to facilitate the AVM eradication.

Bucrylate↗
PubMed1985

[Electro-clinical data in medullary forms of the Chiari malformation without syringomyelia].

The electrophysiological findings in 18 patients with Arnold-Chiari malformation (ACM) revealed by spinal symptoms excluding syringomyelic syndrome (Brown-Sequard syndrome, paraparesis with or without posterior column involvement, motor neuron syndrome or more complex myelopathies) are reported. In 16 cases, EMG disclosed abnormalities consistent with lesion of anterior horn cells restricted to upper limb in 7 cases, and generalized in 9 cases. In 2 cases, motor and sensory conductions were abnormal. The occurrence of such abnormalities in patients with ACM is emphasized as they could lead to confusion with amyotrophic lateral sclerosis or spinal muscular atrophy. Neuroradiological studies are therefore necessary owing to possible surgical treatment. The hypothesis relating lower motor involvement and ACM are reviewed.

Adult↗
PubMed1985

[Peroperative embolization of cerebral arteriovenous malformations with butylcyanoacrylate (18 cases)].

18 cases of cerebral Arterio-Venous malformations (AVM) are reported, treated by direct intra-operative embolisation. A 50% mixture of Butyl-2-Cyanoacrylate and Mono-Iodo-Stearate of Ethyl was used. The clinical history of the patients was a long history of seizures in 8 cases a sub-arachnoid or intra-cerebral hemorrhage in 9 cases, and a transient motor deficit in 1 case. The AVM site was supra-tentorial in 16 cases, and infra-tentorial in 2 cases. The AVM size was large with numerous feeders in 13 cases, and limited with a few feeders in 5 cases. Technically, after catheterisation of a cortical feeder, an intra-operative angiogram was performed (except for the first 6 cases) then the polymerizing mixture was pushed inside the feeder (from 1 cc to 3 cc routinely, depending of the AVM size; exceptionally 7 cc and 11 cc were used). In the immediate postoperative course, 1 patient died (case with the 11 cc embolization), 3 patients had a serious postoperative hemorrhage, 4 patients presented with a transient postoperative deficit, and in 10 patients the postoperative course was uneventful. The long term results are: 1 postoperative death, 1 death after recurrence of intra-cerebral hemorrhage (3 years postoperatively), 1 hemiplegia, 15 patients without long lasting complication. The embolization was performed as unique treatment in 14 cases, and was followed with the AVM removal in 4 cases (immediately in 1 case, delayed in 1 case, late after recurrence of intra-cerebral hemorrhage in 2 cases, respectively after 3 years and 2 years).(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebral Angiography↗
PubMed1985

[Tethered conus syndrome or fixed spinal cord syndrome. Lumbosacral lipomas].

Fifty-eight cases presenting a tethered conus with spina bifida occulta are analysed. Twenty-three patients had a lipoma, the others had various malformations of the cord. Twenty patients had no symptom or sign, 38 had neurological symptoms and signs. Only 2 had no skin malformation. The aim of surgery is to reduce the volume of the lipoma, untether the cord, and reconstruct the posterior protection of the cord. Twenty-six patients were cured or improved, 12 patients were stabilized, 19 remained asymptomatic, 1 was worsened.

Abnormalities, Multiple↗
PubMed1985

Treatment of cerebrospinal fluid rhinorrhea by percutaneous lumboperitoneal shunting: review of 15 cases.

Fifteen patients with recalcitrant cerebrospinal fluid (CSF) fistula underwent the insertion of a lumboperitoneal shunt. The shunt consists of a two-piece Silastic tube and has been used in a population of 150 patients with communicating hydrocephalus, persistent postoperative meningocele, and benign intracranial hypertension. The spinal catheter is introduced subcutaneously and no flushing device is used. We studied three groups: 9 patients had a history of head trauma, and 7 of these had undergone one or several ineffective direct approaches to the dural leak. Four patients presented with a presumably congenital fistula. Two patients had persistent rhinorrhea due to previous intracranial procedures. Indium-111 cisternography was performed in 10 patients before lumboperitonel (LP) shunting and failed in 2 of those to document the site of leakage. Twelve patients showed cessation of rhinorrhea after LP shunting. In 4 of these, shunt-related complications responded to shunt removal with no further recurrence of rhinorrhea. Two patients underwent revision of the shunt. In 3 patients, the LP shunt failed to control the CSF leak and further intracranial procedures were indicated. The LP shunt provides an attractive and technically simple solution when direct methods of treatment have failed. Additionally, LP shunting should be considered as a primary mode of treatment in elderly patients or when impairment of CSF dynamics is documented by radionuclide cisternography and computed tomographic scanning. When an LP shunt is ineffective, shunt function should be checked by isotopic studies before additional surgery is performed.

Adult↗
PubMed1984

[Treatment of spondylolisthesis (stage I-II) by neurosurgical decompression without either osteosynthesis or reduction].

Between 1978 and 1982, 45 patients (44 adults, 1 child) with lumbar isthmic spondylolisthesis (SPL) were operated upon, through a classical posterior approach without setting or fixing. 46 SPL were at the L5-S1 level, 9 at the L4-L5, with 31 class I and 14 class II SPL, according to Meyerding. All the patients had experienced backache with radicular pain. A bilateral interlaminar way with preserving the posterior arch, allowed a large dural and radicular decompression. At the slipping level the wedge-shaped bone was removed while stripping off the disc together with its cartilaginous layer. Every possibility of root compression was cleared up: fibrosis, soft discs, osteophytic spurs, roof of the intervertebral foramina, with exploration of the adjacent levels. Neither bone graft or metallic devices were used. Apophyseal joints and their synovial membrane were denervated by coagulation. The postoperative course was uneventful. Bracing was needed for 2 months. X-ray postoperative follow-up demonstrated an important narrowing of the intervertebral space with constitution of a solid intersomatic fibrous joint without increase of slipping. Good and excellent results were obtained in 68% of cases, fair result in 20% with A 1 to 4 years follow-up. 80% of patients returned to their pre-operative occupation. After reviewing the data of the literature the authors ascertain that more complicated and sophisticated procedures do not bring out better results. They conclude that their safe and simple technique should be widely advocated for lumbar class I and II spondylolisthesis.

Adult↗
PubMed1983

[119 cases of spina bifida treated surgically. Results of genetic investigations and genetic counseling].

After the surgical treatment of 119 cases of spina bifida, the authors present their experience of the genetic approach of the subject. From 1976 to 1978, a resolution not directing attitude towards the parents of the affected children has resulted in a total failure to recognize the recurrence risk, and in an absence of special care for the next pregnancies. The consequence has been recurrence cases of spina bifida in 4 families. Since 1979, a genetic inquiry has been systematically carried out, and all the parents have had a genetic counselling. This permitted the birth of 25 normal infants. In one case, the prenatal diagnosis revealed a fetal meningomyelocele, and motived a therapeutical abortion. Nowadays the fiability of the prenatal diagnosis and the possibility of a prevention through periconceptional vitamin supplementation are strong arguments to give a genetic counselling to all the parents of children with spina bifida.

Acetylcholinesterase↗
PubMed1983

[Is valproic acid teratogenic?].

In more than 7 000 cases of neonatal malformations processed up to 1982 in a regional computer register 71 infants had been born from epileptic mothers. A significantly higher than expected number of spina bifida aperta were observed in this group, related to the administration to the mother of the anti-epileptic agent valproic acid. A pathogenic hypothesis and a possible preventive procedure for this type of malformation are discussed.

Abnormalities, Drug-Induced↗