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J Chiras

Publications and source records attributed to J Chiras.

At least 19 recordsLinked to original sources
PubMed1995

Memory disorders in probable Alzheimer's disease: the role of hippocampal atrophy as shown with MRI.

Magnetic resonance based volumetric measures of hippocampal formation, amygdala (A), caudate nucleus (CN), normalised for total intracranial volume (TIV), were analysed in relation to measures of cognitive deterioration and specific features of memory functions in 18 patients with probable Alzheimer's disease. Neuropsychological examination included the mini mental state examination (MMSE), the Mattis dementia rating scale (DRS), tests of executive functions, assessment of language abilities and praxis, the Wechsler memory scale (WMS), the California verbal learning test (CVLT) and the Grober and Buschke test. The volume of the hippocampal formation (HF/TIV) was correlated with specific memory variables: memory quotient and paired associates of the WMS; intrusions and discriminability at recognition for the Grober and Buschke test. By contrast, except for intrusions, no correlations were found between memory variables and the volume of amygdala (A/TIV). No correlations were found between the volume of caudate nuclei (CN/TIV) and any neuropsychological score. The volume of the hippocampal formation was therefore selectively related to quantitative and qualitative aspects of memory performance in patients with probable Alzheimer's disease.

Aged↗
PubMed1995

Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage.

PURPOSE: To review the symptoms and progression of dural arteriovenous fistulas (AVFs) and correlate the findings with various angiographic patterns. MATERIALS AND METHODS: Patterns of venous drainage allowed classification of dural AVFs into five types: type I, located in the main sinus, with antegrade flow; type II, in the main sinus, with reflux into the sinus (IIa), cortical veins (IIb), or both (IIa + b); type III, with direct cortical venous drainage without venous ectasia; type IV, with direct cortical venous drainage with venous ectasia; and type V, with spinal venous drainage. RESULTS: Type I dural AVFs had a benign course. In type II, reflux into the sinus induced intracranial hypertension in 20% of cases, and reflux into cortical veins induced hemorrhage in 10%. Hemorrhage was present in 40% of cases of type III dural AVFs and 65% of type IV. Type V produced progressive myelopathy in 50% of cases. CONCLUSION: This classification provides useful data for determination of the risk with each dural AVF and enables decision-making about the appropriate therapy.

Arteriovenous Fistula↗
PubMed1995

[Cerebral toxoplasmosis. Neuroradiologic diagnosis and prognostic monitoring].

Cerebral toxoplasmosis remains the most frequent etiology of cerebral masses in AIDS. In most cases, the disclosure of multiple enhanced masses is suggestive of diagnosis of toxoplasmosis and leads to undertake presumptive therapy. Sometimes, the pattern is less suggestive, and the possibility of primary cerebral lymphoma (PCL) is a diagnostic dilemma, because this is a short term life-threatening lesion in the absence of an undelayed fitting therapy. However, apart from the periventricular form of PCL, where directly proceeding to biopsy should be suggested, there is no distinctive pattern of PCL. The most reliable features in distinguishing between PCL and toxoplasmosis are: solitary lesion, homogeneous enhancement of a lesion whose diameter is larger than 2 cm, situation in deep periventricular white matter and limited edema and mass effect. The presence of haemorrhagic foci in the lesion, if there is no steroid therapy is rather indicative of toxoplasmosis. The lack of enhancement on enhanced CT-scan does not allow to eliminate cerebral toxoplasmosis, and indicate MR examination, or empiric antitoxoplasmic treatment. The radiologic follow-up depends on clinical response and on initial pattern. The criteria of response to antitoxoplasmic treatment are: the decrease in volume or number of lesions, the decrease of edematous reaction and mass effect (if no steroid was administered). If the lesion was initially equivocal, the lack of growth in a 8-day delay is a criterion for toxoplasmosis, just as the occurring of haemorrhage in the lesions (if there is no steroid-therapy).

AIDS-Related Opportunistic Infections↗
PubMed1995

[Orbital paraganglioma. Apropos of a case and review of the literature].

Paragangliomas are exceptional in the orbit. Among the 47 cases reported in the world literature more than 1/3 has been classified as alveolar soft part sarcoma. Diagnosis of paraganglioma was confirmed on the basis of pathology reports in only 10. We observed a case in a 46-year-old woman who presented with a tumour of the orbit. The histology examination and the ultrastructure determined by electron microscopy confirmed the diagnosis of paraganglioma. Characteristic histologic features are discussed together with a review of the literature.

Chromogranins↗
PubMed1995

[An angiographic study of spinal vascularization at the thoracic-lumbar level].

In this retrospective work based on a series of spinal angiograms performed in the Neuroradiology Department of the Salpêtrière Hospital, Paris, we studied the number of examinations that showed one or several anterior radiculospinal arteries at the thoracolumbar level, as well as their origin at different levels from T6 to L3. Analysis of the whole group of 552 patients showed some deviation from the previously published radio-anatomical papers. This was confirmed and illustrated more clearly by the analysis of a series of 174 cases selected among these 552 patients. This second series was particular in that it featured bilateral catheterization of every artery likely to give off a radiculospinal artery at all levels from T6 to L3, thus providing more reliable statistical data. We found that 48% of the patients had their thoracolumbar blood supply based on two anterior radiculospinal arteries the lowest of which was located at, or lower than, T12, and the second and higher one between T6 and T10. Only 45% of the studies showed a blood supply relying on a single anterior radiculospinal artery which most frequently had its origin at T9. In 7% of the cases the thoracolumbar spinal cord was supplied by 3 anterior radiculospinal arteries. Our results demonstrate the presence of at least two different patterns of spinal cord blood supply at the thoracolumbar level, with a variation in the origin of the anterior radiculospinal arteries. These recent findings may increase the reliability and improve the technique of spinal angiography, especially in difficult cases.

Angiography↗
PubMed1992

Treatment of malignant gliomas with surgery, intraarterial chemotherapy with ACNU and radiation therapy.

Forty patients with malignant supratentorial gliomas received iterative intraarterial (IA) infusions of ACNU, 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea at a dose of 150 mg repeated every 6 weeks. Group A consisted of eighteen patients previously treated with surgery, radiation therapy (RT) and sometimes chemotherapy, who received IA ACNU at tumor recurrence. Group B consisted of twenty two patients who received IA ACNU in the postoperative pre-RT period. In group A, 8/18 patients (44%) had an objective response, including 6/12 anaplastic astrocytomas (AA) and 2/6 glioblastoma multiforme (GBM), while 10/18 patients (56%) did not respond. Median survival time was 6 months for GBM and 12 months for AA. In group B, 6/22 patients (27%) had an objective response (4/18 GBM and 2/4 AA) and 16/22 patients (73%) did not respond. Nine patients had such an extensive tumor after one or two courses of IA ACNU that RT was cancelled. Median survival time was 8 months for GBM and 8 months for AA. Three patients (8%) had ophthalmologic toxicity on the infused side. There was no case of leukoencephalopathy.

Adult↗
PubMed1992

Arteriovenous fistula of the internal maxillary artery in a child: case report.

Direct arteriovenous fistulae supplied by the external carotid artery are unusual. Rarely, congenital fistulae have been described involving the head and neck. We describe the first case of congenital internal maxillary arteriovenous fistula in a child. Balloon embolization is currently considered the method of choice for treatment of direct arteriovenous fistula.

Arteriovenous Fistula↗
PubMed1992

Endovascular treatment of intracranial dural arteriovenous fistulas with spinal perimedullary venous drainage.

Intracranial dural arteriovenous (AV) fistulas with spinal perimedullary venous drainage are rare lesions that have distinctive clinical, radiological, and therapeutic aspects. Five patients presented with an ascending myelopathy, which extended to involve the brain stem in three cases. Myelography and magnetic resonance imaging showed slightly dilated spinal perimedullary vessels. Spinal angiograms were normal in the arterial phase. Diagnosis was only possible after cerebral angiography, which demonstrated posterior fossa AV fistulas fed by meningeal arteries and draining into spinal perimedullary veins. Endovascular treatment alone resulted in angiographic obliteration of the lesion in three patients. Two patients required surgery in addition to endovascular therapy. One patient died postoperatively, and in one a transient complication of embolization was observed. Improvement after treatment was good in two cases and fair in two. Transverse sinus thrombosis was observed in three cases and was probably the cause of the aberrant venous drainage of the fistula into the spinal perimedullary veins. The pathophysiology is related to spinal cord venous hypertension. These lesions were classified as Type 5 in the Djindjian and Merland classification of dural intracranial AV fistulas. Endovascular therapy is a safe effective method in the treatment of these fistulas and should be tried first.

Adult↗
PubMed1992

[Treatment of supratentorial glioma in adults by intra-arterial HECNU. Experience of the Pitié-Salpétrière group].

Between 1984 and 1988, patients suffering from malignant gliomas received intraarterial chemotherapy with HECNU (IAC). Three groups were identified. Group 1 consisted of 56 patients previously treated with surgery and radiation therapy (RT), who received IAC at recurrence. Group 2 consisted of 46 patients with unresectable tumors, and group 3 of 40 patients who had their tumor surgically removed. In groups 2 and 3, three courses of IAC were administered prior to conventional RT (50-54 Gy). Immediate tolerance was good but delayed ocular and cerebral toxicity occurred in 14% and 11% of cases, respectively. A better therapeutic response was observed with anaplastic gliomas than with glioblastomas (GBM). For anaplastic gliomas, median survivals (MS) were 18 months (group 1), 24 months (group 2) and 30 months (group 3). For GBM, MS were 4.5, 7.5 and 10.5 months in groups 1, 2 and 3, respectively. IAC does not seem to improve the prognosis of GBM.

Glioma↗
PubMed1992

MRI in neurosarcoidosis.

Nine patients with neurological manifestations of sarcoidosis were explored by MRI and, in some cases, CT. The MRI examinations were performed in T1- and T2-weighted spin-echo sequences in all patients, with gadolinium injection in seven. Several non-specific lesions were demonstrated, the most frequent of them showing on T2-weighted sequences as high-intensity signals in the periventricular white matter and the semi-oval centres. Other abnormalities, such as infiltrations of the hypothalamo-pituitary region, granulomatous masses within the brain tissue and meningeal infiltrations, were observed. These findings were in agreement with those found in the literature. Gadolinium injection seems to be important in this pathology, as it demonstrates lesions that are not visible on conventional T1- and T2-weighted spin-echo sequences.

Adult↗
PubMed1991

Treatment of recurrent malignant supratentorial gliomas with carboplatin (CBDCA).

Twenty patients with malignant supratentorial gliomas progressing after radiation therapy and chemotherapy with nitrosoureas received intravenous carboplatin, 450 mg/m2. Courses of therapy were repeated every four weeks. Therapeutic evaluation was performed monthly using neurologic examination and CT scan of the brain. Of 19 patients evaluable for response, 2 (10%) responded to therapy and 6 (30%) had stable disease. The estimated median time to tumor progression for responding and stable patients was 6 months. Median duration of survival was 6 months for all patients. Of 20 patients evaluable for toxicity, none had renal or auditory toxicity. Side effects consisted of hematologic toxicity in 4 patients (20%): one patient had grade 4 toxicity requiring discontinuation of carboplatin and 3 patients had grade 2-3 toxicity.

Adult↗
PubMed1991

Visual toxicity following intra-arterial chemotherapy with hydroxyethyl-CNU in patients with malignant gliomas. A prospective study with statistical analysis.

We studied the effects of intra-arterial chemotherapy (IAC) with a new nitrosourea (hydroxyethyl-chloroethyl nitrosourea: HeCNU) on the visual system of 68 patients with malignant gliomas. The intra-arterial chemotherapy was given as a complementary treatment of glioma after surgery (19 patients), after tumor recurrence (28 patients) and as the preliminary treatment before radiotherapy (21 patients). Eleven patients (16%) suffered a visual complication after two or more courses of chemotherapy. The main visual symptoms included mild to major decrease of visual acuity and in some cases ocular pain, palpebral edema and conjunctival injection. The delay in onset of ocular symptoms from the last course of IAC varied from 1 week to 9 months. From ophthalmoscopic findings, visual field testing and fluorescein angiography, the visual symptoms presented by our patients could be related to ischemic optic neuropathy or retinal vasculopathy. None of the patients had hypertension, diabetes, cardiopathy or hematological disease. Statistical analysis failed to demonstrate a relationship between the occurrence of visual toxicity and patient age, number of courses of HeCNU, the vascular axis treated, total systemic dose or dose by carotid artery, suggesting a possible specific sensitivity of some patients to chemotherapy. The pathophysiology and the therapeutic implications of this visual toxicity are discussed.

Adult↗
PubMed1991

Intracerebral stenosing arteriopathies. Contribution of three radiological techniques to the diagnosis.

Fifty-one patients with intracerebral stenosing arteriopathy were studied by computerized tomography (CT), magnetic resonance imaging (MRI) and cerebral arteriography. Clinical symptoms were varied, included impaired cognitive functions, progressive neurological deficit, headache and vomiting, and were sometimes not suggestives of the diagnosis. CT scans of the brain were normal in 25 percent of the cases or they were not probative because of various and non-specific abnormalities (hypodensity of various types or haemorrhagic hyperdensity). MRI always showed abnormalities but in many cases the lesions observed on T2-weighted images consisted of non-specific focal areas of high-intensity signal in the white matter. High-intensity signals in both white matter and cortex seemed to be more suggestive of the diagnosis. In this as in other studies, arteriography therefore remains the reference examination for stenosing arteriopathies. Inflammatory, infectious and atheromatous processes are the main causes of these arterial lesions. The aetiological value of radiological examinations is poor, and in most cases the morphology and distribution of the lesions does not point to any specific origin. However, herpes zoster arteritis usually affects the proximal segments of the anterior and middle cerebral arteries and spares the carotid siphon.

Adult↗
PubMed1991

[Vertebro-dural arteriovenous fistulae of the foramen magnum with perimedullary venous drainage].

Two cases of dural arteriovenous fistulae of the foramen magnum with perimedullary venous drainage are reported. Their arterial component was a dural branch of a vertebral artery. The localization and the origin of these fistulae appeared very uncommon but could be explained by the embryogenesis of the vertebral arteries, of which the third portion corresponds to the first cervical radicular artery. The first patient had signs and symptoms usually described in this disease, but the second presented a subarachnoid haemorrhage with neither motor and sensory deficit not sphincter disturbance. Myelographic findings, M.R.I. abnormalities and treatment of these rare dural arteriovenous malformations are discussed.

Arteriovenous Fistula↗
PubMed1991

[Spinal infarction in the anterior spinal territory with possible relation with bilharziasis].

We report a case of spinal cord infarction in the anterior spinal artery territory with selective involvement of the anterior horns. A 35-year-old Mauritanian woman was hospitalized because of an acute and severe flaccid paraplegia without any sphincter dysfunction or sensory disturbance. MRI abnormalities (hypersignal on T2-weighted sequences) were restricted to the anterior horns of the lower thoracic spinal cord and conus medullaris. Adamkiewicz's artery appeared abnormally thin at arteriography. The infarction was probably related to vasculitis of schistosomal origin.

Adult↗
PubMed1990

Treatment of malignant recurrent glioma by intra-arterial, infra-ophthalmic infusion of HECNU 1-(2-chloroethyl)-1-nitroso-3-(2-hydroxyethyl) urea. A phase II study.

53 patients suffering from malignant recurrent glioma were treated with iterative arterial infusions of HECNU. The intra-carotid injections were performed below the ophthalmic artery. The response rate was 49% and the median survival was 8.5 months. The results differ substantially according to the histological subtype. The response rate was 33% for glioblastomas, 50% for anaplastic astrocytomas and 92% for malignant recurrences of low grade astrocytomas. The median survival was 4.5 months for glioblastomas and 18 months for anaplastic astrocytomas and malignant recurrences of low grade astrocytomas. Serious complications were a monocular blindness in 3 cases and a leucoencephalopathy in 6 cases.

Adult↗