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Biomedical subjects

J Guyotat

Publications and source records attributed to J Guyotat.

At least 19 recordsLinked to original sources
PubMed1995

Non-metastatic childhood ependymomas.

PURPOSE: Intracranial ependymomas of childhood are relatively infrequent. There are significant disagreements concerning optimal postoperative treatment as well as the patterns of relapse following treatment. The purpose of this retrospective study was the analysis of the recurrence pattern and therefore the implication on the extent of the radiotherapy fields. Data from 37 patients referred within 19 years were used for this study. PATIENTS AND METHODS: From April 1975 to July 1993, 37 children aged 1-14 years were referred for postoperative treatment of an intracranial ependymoma. Twenty-eight children received postoperative radiation therapy and 26 patients received chemotherapy. The median follow-up is 6 years (range 2 months to 19 years). RESULTS: Overall survival and event free survival at 5 and 10 years were 40%. Eighteen children relapsed. Relapses occurred from 1.5 months to 3.6 years post treatment. Relapses were distant in four cases and local in 14. Age, sex, extent of primary resection, chemotherapy and type of radiation therapy did not influence the outcome. Children with poorly differentiated tumors who did not receive postoperative radiation therapy had a higher relapse rate but this difference is not statistically significant. CONCLUSIONS: Despite doses of radiation > or = 50 Gy the majority of recurrences were local. Our results, despite the small number of patients are in accordance to those previously published, suggest that prophylactic craniospinal irradiation is superfluous. Better means of achieved local control are required, such as three-dimensional conformal radiation therapy with dose-escalation study or hyperfractionation regimen.

Adolescent↗
PubMed1994

Tectal plate gliomas. Part I: Microsurgery of the tectal plate gliomas.

A series of 12 patients with tectal plate gliomas, is presented treated by direct surgery. Mean age was 19 years. All patients presented with signs of raised intracranial pressure and supratentorial hydrocephalus on CT scan. Diplopia was the most common local sign. CT scan and MR imaging showed 4 intrinsic, 6 exophytic, and 2 ventrally infiltrating tectal tumours. The histological diagnosis was low-grade astrocytoma in 7, high-grade astrocytoma in 2, oligodendroglioma in one, oligo-astrocytoma in one, and ependymoma in one case. The suboccipital supra- and transtentorial approach was used in every cases. Tumour resection was generous at the level of the superior colliculi, but on the contrary, resection was limited at the level of inferior colliculi due to the auditory risk. Tumour removal was total (macroscopically) in 9 cases and partial in 3 cases. There were 4 surgical complications and one death related to surgery. Parinaud's syndrome was the most-common postoperative sequelae. Auditory hallucinations and the acoustic neglect syndrome were seen once. In three cases additional radiotherapy and chemotherapy were given once with severe sequelae. The treatment of tectal plate gliomas is controversial. The role of different therapeutic options remains open. We consider the tectal plate as a relatively safer territory for surgery than the ventral part of the midbrain. The brain stem auditory evoked potentials (BAEPs) and middle latency potentials (MLPs) monitoring can help to determine the appropriate limit of surgery.

Adolescent↗
PubMed1994

Tectal plate gliomas. Part II: CT scans and MR imaging of tectal gliomas.

CT scans and MR images were analyzed in 12 patients with histologically proved tectal plate gliomas. In an attempt to identify the nature of these lesions, their radiological characteristics were correlated with the histological results. In four of our patients CT scan failed to show the tumour. MR imaging demonstrated the tectal distortion in all cases. Contrast enhancement, calcification, cystic portions, exophytic nature were observed in both high and low-grade gliomas. We conclude that in the case of intrinsic tectal tumours, the most probable diagnosis is that of low-grade astrocytoma while in the case of exophytic tectal tumours, the differential diagnosis from pineal region tumour is required and a histological verification is necessary.

Adolescent↗
PubMed1994

Tectal plate gliomas. Part III: Apparent lack of auditory consequences of unilateral inferior collicular lesion due to localized glioma surgery.

The authors present one of their cases operated on for intrinsic tectal plate glioma. The complete resection of the right inferior colliculus (I.C.) had no apparent auditory consequences. The pre- and post-operative tonal and vocal auditory tests were normal. The brain-stem auditory evoked potentials (BAEPs) and middle latency potentials (MLPs) were recorded pre-, post- and intraoperatively. At the end of surgery all waves were present with a marked delay of wave V and a slight delay of the Pa component. The dichotic test showed a significant right ear extinction but admittedly much less important than expected. The role of inferior colliculus (I.C.) in hearing is discussed.

Astrocytoma↗
PubMed1994

Dural arteriovenous fistula of the posterior fossa draining into the spinal medullary veins--an unusual cause of myelopathy: case report.

In a 31-year-old male patient suffering from progressive myelopathy, a right carotid angiography disclosed an intracranial tentorial arteriovenous fistula (AVF) draining intrathecally into the spinal medullary veins. An embolization via the afferent meningohypophyseal artery was not technically feasible, and a microsurgical excision of the AVF was accomplished via a suboccipital approach, resulting in the angiographic cure of the fistula and progressive relief of the myelopathy. Fourteen reported cases of intracranial dural AVF draining intrathecally are reviewed. In most patients, authors encountered diagnostic difficulties similar to those noted in this case. Surgical and/or endovascular therapeutic methods have provided disappointing results, likely attributable to a prolonged course of spinal cord dysfunction. Pathophysiologically, a mechanism of venous congestion of the cord seems to be involved, as acknowledged by several magnetic resonance and angiographic studies. In patients who appear to have a clinical and myelographic picture of "vascular" myelopathy and who exhibit negative spinal angiography, a four-vessel cerebral angiography should be undertaken, aiming at the recognition of an intracranial AVF.

Adult↗
PubMed1993

[Giant ependymoma of the cauda equina. Long-term development apropos of 7 cases].

Seven cases of giant ependymomas of cauda equina, extending from the conus medullaris to the sacrum, are reported. Mean age of the patients was 36 years. The initial symptoms were not specific, including low back pain and radiculalgias. However, in two cases, the clinical presentation was related to hydrocephalus. At the time of the operation, 6 patients presented with pain, weakness and sphincter dysfunction. The diagnosis of tumor was made after myelogram in all cases. Metrizamide enhanced CT scan has been performed in one case. None patient had preoperative magnetic resonance imaging (MRI) but MRI allowed the follow up in 5 patients and detection of local and remote recurrences in 4 cases. All the tumors were attached to the filum terminale, and unless extended from L2 to S1. Pathologically, 3 patients had tumors classified as myxopapillary and 4 of the cellular type. Two patients had gross total resection of the tumor at the initial operation. Five patients had initial biopsy to make a diagnosis and required subsequent surgery for radical excision after an average of 16.8 months. Radiation therapy has been performed in 1 case after biopsy, in 1 case after total resection (grade III) and in 2 cases after recurrences. Three patients died 1 year, 5 years, 12 years post-operatively. Among these 3 patients, 2 had recurrences. Four patients are alive. One patient has no recurrence 5 years after initial surgery. Another patient remains symptom free 7 years after surgery but MRI showed a local recurrence. The last two patients present recurrences 7 years and 8 years after surgery. These recurrences have been treated by surgical removal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Effect of nimodipine on subintimal hyperplasia of autologous vein bypass grafts in rats: a placebo-controlled study.

Autologous vein grafts are commonly used conduits for coronary bypass grafts. However, as many as 20% of the grafts may occlude in the first year to a subintimal hyperplasia. Although the initiating mechanism remains unclear, it has been demonstrated that subintimal hyperplasia is dependent upon smooth muscle cell proliferation and migration from the medial to the intimal layer. The present study focused on the prevention of smooth muscle cell proliferation using a calcium antagonist. A vein bypass graft from the jugular vein on the abdominal aorta was performed in 40 rats, divided into two groups of 20. Animals in the treated group received nimodipine (15 mg/kg of body weight), and those of the control group received a placebo. Nine months after grafting, the results showed that the group receiving nimodipine presented no or only slight subintimal hyperplasia as compared with the placebo group (p less than 0.001). The data presented in this study show that nimodipine can reduce subintimal hyperplasia in rats and strongly suggest that a calcium antagonist could be employed in the prevention of venous graft disease.

Animals↗
PubMed1991

Inhibition of subintimal hyperplasia of autologous vein bypass grafts by nimodipine in rats: a placebo-controlled study.

An arterial bypass may be required for the management of neoplastic or cerebrovascular disease. When an arterial graft is not suitable, autologous vein grafts are the most commonly used conduits; however, as many as 20% of the vein grafts used in vascular surgery may occlude as a result of subintimal hyperplasia. Although the mechanism initiating subintimal hyperplasia remains unclear, it is known that subintimal hyperplasia is dependent upon smooth muscle cell proliferation and migration from the media to the intimal layer. The present study focused on the prevention of smooth muscle cell proliferation using a calcium antagonist. Forty rats received an autologous vein bypass graft from the jugular vein to reconstruct the abdominal aorta. They were randomly divided into two groups of 20 rats each. Animals in the treated group received a calcium antagonist (nimodipine), and those in the control group received a placebo. Nine months after grafting, the group receiving the calcium antagonist presented no or only slight sub intimal hyperplasia as compared with the placebo-treated group (P less than 0.001). These data suggest that a calcium antagonist could be used for the prevention of venous graft disease.

Animals↗
PubMed1991

[Meningioma of the apex of the tentorial incisura. Diagnostic and surgical aspects apropos of a series of 7 cases].

Seven cases of meningiomas implanted on the medial portion of the free edge of the tentorium are reported. The denomination "meningiomas of the apex of the tentorial incisura" is proposed. In 4 patients, the clinical presentation was that of an intracranial hypertension without signs of compression of the quadrigeminal plate involvement. In the other 3 patients, the initial symptoms were those of the triad of the adult chronic hydrocephalus (N.P.H.) syndrome. Angiographic evaluation provides useful informations on the arterial supply (which is mainly from the tentorial branches of the internal carotid arteries and occasionally from the middle meningeal arteries) and the relationships of the tumor with the deep venous system. C.T. and M.R.I. facilitate earlier diagnosis and better demonstration of implantation and extension of the tumor, which the selection of a surgical approach is based upon. Four patients have undergone an occipital supratentorial approach and 2 a supra-cerebellar infra-tentorial approach. The meningioma was totally removed in 5 patients, sub-totally in 1 to avoid bilateral lesions of the visual pathways and cortical areas. The 7th patient was treated by C.S.F. shunt alone. No operative mortality occurred. The follow-up is averaging 18 months: 4 patients are symptom-free, 3 exhibit minor sequelae (epilepsy: 1, visual field defects: 2, memory impairement: 2). Six patients of the series have resumed their previous activities. Discussion is focused on the difficulties of surgical removal of this particular type of tentorial meningioma, resulting from volume, implantation and relationships of the tumor with the deep veins.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Brain tumors in infants].

In 76 of 575 children operated on for intracranial tumors during a 15 year period, symptoms had started during the first 2 years of life. Excision of the tumor was complete in 44, subtotal in 13, partial in 13, and in 6 only a biopsy was taken. Surgical mortality was 13% (10/76). 31 died later as their tumors progressed. The overall survival rate was 46% and 27 of the survivors are leading useful lives, with no signs of recurrence, 8 months to 14 years after operation. All of these had total or subtotal removal of the tumor. Only 3 required oncologic treatment. Despite radical surgery, the late neuropsychological results were good. However, 8 children who had had brain irradiation are severely handicapped. We conclude that in infancy functional recovery from a focal surgical lesion, even if extensive, is more complete than after diffuse damage to the immature central nervous system caused by irradiation. In this age group brain irradiation leads to severe handicapping in the great majority of cases. Radiotherapy should therefore be used only for highly malignant tumors, especially when surgical excision is incomplete. Radical surgery gives the best results in terms of survival and satisfactory neuropsychological state.

Brain↗
PubMed1989

Development and use of a self-administered questionnaire for assessment of psychologic attitudes toward pregnancy and their relation to a subsequent premature birth.

This paper describes both the development of and results of the use of a self-administered questionnaire designed specifically to investigate the relation between the psychologic attitudes of pregnant women toward pregnancy and an eventual subsequent premature birth. The questionnaire (entitled Pregnancy Psychologic Attitudes Test--in relation to Premature Birth [PPAT(p)]) was derived from the synthesis of interviews with women who had given birth prematurely, comprised 40 questions grouped in six dimensions, and was used in a prospective survey. All women who had an antenatal visit in their fifth to sixth month of pregnancy in one of four maternity hospitals in Lyon, France, between October 1983 and March 1985 were asked to complete this questionnaire. A quantitative PPAT(p) score (ranging from 0 to 6) was constructed in a working sample (n = 643), and its relation with a subsequent premature birth was analyzed in a study sample (n = 1,500). Application of the logistic regression model showed, after controlling for personal and medical factors, that this relation was statistically significant. The risk of premature birth increased from 1 to 1.5 when the PPAT(p) score increased one point (p less than 0.001). This study contributes to a better understanding of psychologic factors that may affect pregnant women and be associated with premature birth. This new component must be considered in the development of policies for preventing premature birth.

Adult↗
PubMed1989

[Intradural spinal metastasis from visceral neoplasms. Apropos of 4 cases. Review of the literature].

Four patients were referred during the last year for treatment of an intradural metastasis. Primary sites were a bronchogenic carcinoma (one case), a prostatic carcinoma (one case) and in the two other cases the primary tumor was not found. In all cases Noot pain had lasted 1 to 5 months, despite CT examination during this painful period. Except in case n.4, diagnosis was not established until the onset of myelopathy. Surgical removal was complete in one case and subtotal in the three other cases, with complete postoperative relief of the pain in all cases and significative improvement of neurological status. The authors emphasize the importance of root pain as an early sign in these patients as well as the difficulty in establishing diagnosis. They discuss the different pathogenic mechanisms and the methods of treatment.

Aged↗
PubMed1988

[Evaluation using DSM-III of the clinical activity of a psychiatry department at a general hospital].

The DSM-III multiaxial classification was used to evaluate the one-year clinical activity of a psychiatry and medical psychology department in a general hospital. Compared to the general population, the patients (n = 1,071) corresponded to a sample of professionally active subjects in which top and middle executives as well as students were over=represented. Fifty-one per cent of the patients suffered from anxiety or affective disorders, while 9 per cent presented somatoform disorders. Histrionic and dependent personalities were more frequent in women. Thirty six per cent of the subjects had a concurrent physical illness. Psychosocial stress and altered adaptation were higher in unemployed people and in patients with physical illness. Specific diagnostic and socioprofessional patterns corresponded to the various types of mental care: psychoanalytically oriented psychotherapy, behaviour therapy, psychopharmacological treatments, consultation-liaison, pain consultation.

Adult↗
PubMed1988

Brain tumors in infants: a study of 76 patients operated upon.

Seventy-six children were studied who had been operated on for intracranial tumors; they ranged in age from 0 to 2 years. Twenty-nine cases were under 1 year and 47 between 1 and 2 years of age. The outlook was relatively poor regarding the highly malignant tumors, but surprisingly encouraging in benign and low-grade malignant neoplasms. The undesirable effects of complementary oncological treatment in this age category are stressed. On the other hand the importance of radical surgery is emphasized as the best treatment for these lesions.

Antineoplastic Agents↗
PubMed1988

[Partial recovery of the oculomotor nerve after section and repair during the excision of a tumor].

The authors report the case of a patient having suffered a section of the oculomotor nerve during the excision of a tumor located in the tentorium incisura. The nerve was immediately sutured (end to end anastomosis). After 18 months, a partial recovery of the function of the nerve was seen clinically and on EMG. Ptosis had disappeared and adduction of the eye reappeared. An analysis of available data on the suture of oculomotor nerves is then given: reparation of the third nerve in animals and man give variable and partial results. Partial recovery and aberrant regeneration are explained by the fact that this nerve innervates many muscles and by the absence of ultrastructural systematisation. On the contrary, some still rare studies have indicated that the suture of the fourth and sixth cranial nerves give better results probably because these nerves have a simple ultrastructural organization, are purely motor and innervate only one ocular muscle.

Adult↗