Biomedical subjects
J Lenelle
Publications and source records attributed to J Lenelle.
[Multifocal germ cell tumors].
A 16-year old male presented with a mediastinal germ cell tumor (seminoma) treated by combined surgery, radiotherapy and chemotherapy. Nine years later, he presented with an intracerebral germ cell tumor affecting both the suprasellar ventricles and the pineal area. After partial removal of the intraventricular tumor, the patient received radiotherapy and chemotherapy. No metastases could be found. He died 8 months later, probably from secondary cardiovascular disturbances. This case seems to be the first one to illustrate the possibility of multifocal extragonadal seminoma.
MRI-pathological correlations in acute traumatic central cord syndrome: case report.
Ante- and post-mortem MRI and detailed pathological examination were performed in a patient with a typical acute traumatic central cord syndrome (ATCCS) after a minor hyperextension injury to the neck who died 60 h later from heart failure. T2-weighted MRI showed a central hyperintense area at C3-4. There were disc protrusions, but no vertebral fracture or displacement. Histopathology disclosed severe axonal swelling and oedema in the dorsolateral fasciculi and, to a lesser degree, in the dorsal columns. In addition, an area of recent necrosis was found in the right anterior horn at C4-5. These findings suggest that the pathological hallmark of typical ATCCS is mechanical axonal disruption at a segmental level, but that more severe trauma may be accompanied by tissue destruction.
Primary intracerebral osteosarcoma.
A 64-year-old man was admitted because of a rapidly progressive left side hemiparesis. A computed tomography scan showed a right side intrathalamic mass, partially calcified. Surgical specimen proved to be an osteosarcoma. The patient died 3 days later from an acute myocardial infarct. Autopsy failed to discover any other significant lesion. A review of the literature disclosed that this case might be the second published primary intracerebral osteosarcoma and the first with immunocytochemical analysis.
Traction diverticulum of the hypopharynx following anterior cervical spine surgery. Case report and review.
Pharyngeal complications due to anterior cervical spine surgery (ACSS) are not rare. We describe the case of a traction diverticulum of the hypopharynx after ACSS, a complication that has not yet been reported. We discuss the possible mechanism. A review of the complications of ACSS that are of interest to the otolaryngologist is included.
[Treatment of facio-craniostenoses].
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[Ablation by the anterior transcorporeal approach of an ante-spinal cord cervical meningioma. Apropos of a case].
The authors report a case of an intradural spinal meningioma ventrally located just rear to the 5th cervical body. The patient (a 46-year-old woman) suffered from a spasmodic quadriplegia, walking was nearly impossible. Because of the strictly median and ventral localization the authors have chosen an anterior approach passing through the body of C5 after discectomy of C4-C5 and C5-C6 discs. The tumor and its dural attachment was totally removed with respect to the spinal cord and all rootlets. Reconstruction of cervical spine was performed with an iliac bone graft. The neurological recuperation was complete and quickly achieved. Bone fusion was obtained within 3 months with a good result. The authors emphasize the rarity of ventrally located meningiomas in the cervical spine and the advantages of anterior route which alone enables a total surgical removal of such lesions.
[Injuries of the cervical spine. Treatment procedures. Discriminating factors].
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Two-dimensional echographic localization of intracardiac cerebrospinal fluid shunt catheters.
This study evaluated the ability of two-dimensional echocardiography (2D echo) to detect and localize the distal end of ventriculoatrial shunt catheters in the cardiac chambers of hydrocephalic patients. Twenty-eight patients were studied, and the performances of 2D echo and standard chest x-ray filming were compared. Although standard chest x-ray filming allowed accurate determination of the catheter position in only half of the patients, 2D echo afforded clear visualization and accurate localization of the catheter in all instances. By its precise definition of intracardiac anatomical landmarks and its excellent time determination, 2D echo can provide valuable information on the movements of the catheter's distal end during the cardiac cycle, during head flexion or rotation, and during deep breathing movements. Some interesting observations were made with 2D echo. A to-and-fro motion of the catheter tip through the tricuspid orifice during the cardiac cycle was visualized in two instances. The combination of head movements and deep respiratory movements induced a variation in the position of the catheter tip. The magnitude of this displacement was 6 cm at the most. Two patients underwent reoperation for lengthening or shortening of the catheter. The operative findings confirmed the ultrasonic localization in both cases where the chest x-ray film had failed to identify or adequately locate the catheter tip. It is concluded that 2D echo is a safe, innocuous, and accurate method with which to locate the distal end of a ventriculoatrial shunt. It is the only available technique that provides visualization of intracardiac structures and cardiac cycle reference.(ABSTRACT TRUNCATED AT 250 WORDS)
[Practical assessment of brain dysfunction in severe head trauma (author's transl)].
Assessment of brain dysfunction in head injured patients is important as an index of severity of brain damage and forms the basis of monitoring. . The Glasgow Coma scale (G.C.S.) is a practical scale for nurses. The Liege Coma scale contains the three variables of the G.C.S. and provides informations concerning the brain stem reflexes. In a series of 60 head-injured patients, recovery rates were calculated on the basis of either Glasgow scores or Liege scores. The Liege Coma scale provides a more sensitive index of clinical course and a better prognosis.
[Total venous autograft of the superior longitudinal sinus. Experimental study in the dog (author's transl)].
The authors describe an original technique for the total replacement of a segment of the superior sagittal sinus in the dog. The graft, by its venous structure lined with a dural wall and by its triangular shape ensured through a certain tension, is close to the anatomical aspect. The authors use an autogenous vein graft. The latter is kept open by a wide suture to a fragment of dura which is fastened to the falx and to the dura of the vault. This fragment forms a "V" gutter in which lies the venous graft, thus protected from post-operative brain oedema. After suturing, a first sinusography is done, and a second one between the 7th and the 15th post-operative day. A study is thus made of the permeability of the graft. This permeability depends on the quality of the sutures and on the reconstruction of the dural wall of the sinus. Twenty operations have been carried out using various techniques. With the technique described, there were 11 permeable sinuses for 11 operations shown by the first sinusography. On second sinusography, 8 sinuses in 11 remained permeable.
Carotid cavernous fistula associated with Fogarty catheter angioplasty.
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[Facio-craniostenosis].
Facio-craniostenosis. Facio-craniostenosis is associated with premature stenosis of one or several cranial sutures. The clinical variety is defined by the affected suture. In the complex forms, major disturbances of the anterior fossa of the cranial base are observed. Intracranial hypertension sometimes observed may lead to impairment of the function of the brain or the eyes. The authors have observed 73 children with craniostenosis and have operated upon 49 of them. Three types of methods have been used. The stress is made on the latest one combining advancement of the orbito-frontal "bandeau" and the regularization of the vault. Operating early is essential for prevention of functional sequellae. The optimal age for surgical treatment seems to be between 3 and 6 months. Complications have been remarkable benign.