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Biomedical subjects

D Fohanno

Publications and source records attributed to D Fohanno.

52 records · Page 3Linked to original sources
PubMedDate not supplied

[Coccygodynia disclosing Tarlov's cysts].

In a 63-year old male patient coccygodynia, initially isolated then complicated by incomplete cauda equina syndrome, could be attributed to large perineurel meningeal cysts on the sacral nerve roots. The diagnosis was suspected at computerized tomography and nuclear magnetic resonance and confirmed by sacculoradiculography. Intradural injections of corticosteroids provided lasting pain relief. Arachnoid cysts are often asymptomatic, by they may be responsible for coccygodynia and/or incomplete cauda equina syndrome. Their presence is suggested by the characteristics of the symptoms which are paroxysmal, exacerbated in standing position, relieved in dorsal position and revived by percussing the sacrum. Treatment is medical in most cases. The decision to operate depends on the persistence and intensity of pain and on whether signs of neurological defecit are present.

Arachnoid Cysts↗
PubMedDate not supplied

[Importance of radiotherapy in stereotactic conditions (radiosurgery) in brain metastasis: experience and results of the Hôpital Pitié-Salpêtrière Group].

PURPOSE: Retrospective analysis of the influence of clinical and technical factors on local control and survival after radiosurgery for brain metastasis. PATIENTS AND METHODS: From January 1994 to December 1996, 42 patients presenting with 71 metastases underwent radiosurgery for brain metastasis. The median age was 56 years and the median Karnofsky index 80. Primary sites included: lung (20 patients), kidney (seven), breast (five), colon (two), melanoma (three), osteosarcoma (one) and it was unknown for three patients. Seventeen patients had extracranial metastasis. Twenty-four patients were treated at recurrence which occurred after whole brain irradiation (12 patients), surgical excision (four) or after both treatments (eight). Thirty-six sessions of radiosurgery have been realized for one metastasis and 13 for two, three or four lesions. The median metastasis diameter was 21 mm and the median volume 1.7 cm3. The median peripheral dose to the lesion was 14 Gy, and the median dose at the isocenter 20 Gy. RESULTS: Sixty-five metastases were evaluable for response analysis. The overall local control rate was 82% and the 1-year actuarial rate was 72%. In univariate analysis, theoretical radioresistance (P = 0.001), diameter less than 3 cm (P = 0.039) and initial treatment with radiosurgery (P = 0.041) were significantly associated with increased local control. Only the first two factors remained significant in multivariate analysis. No prognostic factor of overall survival was identified. The median survival was 12 months. Six patients had a symptomatic oedema (RTOG grade 2), only one of which requiring a surgical excision. CONCLUSION: In conclusion, 14 Gy delivered at the periphery of metastasis seems to be a sufficient dose to control most brain metastases, with a minimal toxicity. Better results were obtained for lesions initially treated with radiosurgery, theoretically radioresistant and with a diameter less than 3 cm.

Adenocarcinoma↗
PubMedDate not supplied

Infiltrating extradural spinal angiolipoma.

BACKGROUND: Angiolipomas are considered to be rare. They are benign mesenchymal tumors generally located in the subcutaneous tissue of trunk and limbs. METHODS: The authors report a thoracic epidural angiolipoma mimicking a vertebro-epidural metastasis. The patient suffered from medullary compression related to an extradural mass in T6. RESULTS: Pathological ex-, amination was obtained from tumoral samples. They consisted of mature adipose tissue with numerous sections of abnormal vascular channels. CONCLUSIONS: Reviewing literature particular attention is paid to some questions raised in connection with different kinds of vertebro-epidural tumors. The authors give importance to relationships between angiolipomas and angiomyolipomas using MRI as a tool in differential diagnosis. Pathogenesis is evokated especially regarding the role of corticotherapy, the case herein reported lying within this therapeutical context.

Aged↗
PubMedDate not supplied

[First treatment for brain metastases by stereotactic radiosurgery].

Local control of brain metastases is better with first treatment by stereotactic radiosurgery than with radiosurgery for recurrence. We reported a retrospective analysis of the influence of clinical and technical factors on local control and survival after radiosurgery realised in first intention. From January 1994 to December 1997, 26 patients presenting with 43 metastases underwent radiosurgery. The median age was 61 years and the median Karnofsky index 70. Primary sites included: lung (12 patients), kidney (7 patients), breast (2 patients), colon (1 patient), melanoma (2 patients), osteosarcoma (1 patient), it was unknown for one patient. Seven patients had extracranial metastases. Twenty-one sessions of radiosurgery have been realized for one metastase, and 9 for two, three or four lesions. The median diameter was 21 mm and the median volume 1.8 cm3. The median peripheral dose to the lesion was 14 Gy, and the median dose at the isocenter 20 Gy. Forty-two metastases were evaluable for response analysis. The overall local control rate was 90.5% and the 1-year, 2- and 3-year actuarial rates were 85% and 75%. In univariate analysis, theorical radioresistance was significantly associated with better local control (100% versus 77%, p < 0.05). All patients were evaluable for survival. The median survival rate was 15 months. Four patients had a symptomatic oedema (RTOG grade II). Two lesions have required a surgical excision. In conclusion, low dose radiosurgery (14 Gy delivered at the periphery of metastasis) can be proposed in first intention for brain metastases, in particularly for theorical radioresistant lesions.

Adult↗
PubMedDate not supplied

[Mortality and morbidity after complete surgical removal of 162 intracranial arteriovenous malformations (author's transl)].

A series of 162 arteriovenous malformations (A.V.M.) surgically removed is reported. All patients had a post operative control angiogram showing that the lesion had been totally excised. Supra and infra tentorial A.V.M. are included in the series as well as conscious and comatous patients. The overall mortality has been 11.1% and the mortality in conscious patients has been 6.9%. Mortality is higher when the volume of A.V.M. is over 60 cm3 and when a rupture has occurred. The influence of the operation on epileptic seizures, motor, speech or visual fields deficits has been reviewed in 109 patients who answered to the survey. Morbidity has been higher in patients with a cerebral heamorrhage, therefore the authors advise to operate these patients before the rupture when, for instance, seizures represents the only clinical picture. C.A.T. scan in these epileptic patients is a remarkable investigation to track down A.V.M.

Adolescent↗