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Biomedical subjects

J P Chodkiewicz

Publications and source records attributed to J P Chodkiewicz.

At least 37 records · Page 2Linked to original sources
PubMed1990

Effects of 1.32-micron Nd-YAG laser on brain thermal and histological experimental data.

Considering that the 1.32-microns Nd-YAG laser should have physicothermal properties close to those of the CO2 laser, a series of experiments were conducted on rat cortex (N = 51). Three laser wavelengths were compared: CO2 laser (10.6 microns), 1.06-microns Nd-YAG, and 1.32-microns Nd-YAG lasers. For each shot, temperature measurements were recorded with an infrared thermographic videocamera. The digitized signals were figured as thermal profiles and temperature developments. Ninety-five shots were correctly studied and analyzed: CO2, N = 29; 1.06-microns Nd-YAG, N = 20; 1.32-microns Nd-YAG, N = 46. The histological lesions produced by these three lasers were compared on animals killed 24 hours (N = 20), 8 days (N = 20), and 30 days (N = 5) after the laser impacts. For equivalent densities of energy, the depth of cortical necrosis was comparable for the CO2 laser (200-250 microns) and the 1.32-microns Nd-YAG laser (210-260 microns) whatever the date of death; the 1.06-microns Nd-YAG laser shots were responsible for much more important damage (400-550 microns). Because of its important absorption in water and nervous tissue, the authors consider the 1.32-microns Nd-YAG laser most suitable for neurosurgery, particularly because it is conducted through optic fibers, and therefore is easy to handle during neurosurgical procedures.

Animals↗
PubMed1990

The use of 1.32 Nd:YAG laser in neurosurgery: experimental data and clinical experience from 70 patients.

The authors present their experience with the 1.32 mum Nd:YAG laser in neurosurgical procedures. In a first step, they conducted experiments on rat cortex. The thermic data and histologic results confirmed that the 1.32 Nd:YAG laser has physical properties quite close to the CO2 laser. Furthermore, the fact that the 1.32 mum wavelength can be conducted through optic fibers makes it well adapted to neurosurgery. The authors present experimental data (50 rats) and comment on their surgical experience with such a wavelength (70 patients). In the future, this laser should see its indications broadened in conventional neurosurgical procedures as well as in endoscopic and stereotactic neurosurgery.

Animals↗
PubMed1989

Diagnosis and treatment of colloid cysts of the third ventricle by stereotactic drainage. Report on eleven cases.

Between December 1979 and September 1986, 11 patients with colloid cysts of the third ventricle were operated on by a stereotactic procedure with Talairach's system. Stereoscopic angiography and ventriculographic study allowed for a percutaneous (twist-drill hole diameter: 2.5 mm) stereotactic aspiration of the cysts. The operations were successful, and there were no intraoperative or postoperative mortalities but just mild transient morbidity in three cases. Six cysts were evacuated completely, and five only partially. The mean residual volume was 19% of the initial one. Clinical and anatomical results are presented, and the advantages of this stereotactic procedure are discussed.

Adolescent↗
PubMed1988

H3-receptors control histamine release in human brain.

The regulation of histamine release was studied on slices prepared from pieces of human cerebral cortex removed during neurosurgery and labeled with L-[3H]histidine. Depolarization by increased extracellular K+ concentration induced [3H]histamine release, although to a lesser extent than from rat brain slices. Exogenous histamine reduced by up to 60% the K+-evoked release, with an EC50 of 3.5 +/- 0.5 X 10(-8) M. The H3-receptor antagonists impromidine and thioperamide reversed the histamine effect in an apparently competitive manner and enhanced the K+-evoked release, indicating a participation of endogenous histamine in the release control process. The potencies of histamine and the H3-receptor antagonists were similar to those of these agents at presynaptic H3-autoreceptors controlling [3H]histamine release from rat brain slices. It is concluded that H3-receptors control histamine release in the human brain.

Cerebral Cortex↗
PubMed1988

Dysembryoplastic neuroepithelial tumor: a surgically curable tumor of young patients with intractable partial seizures. Report of thirty-nine cases.

This report concerns the clinicopathological features of 39 cases of a morphologically unique and surgically curable group of neuroepithelial tumors associated with medically intractable partial complex seizures. All were supratentorial and characterized by intracortical location, multinodular architecture, and heterogeneity in cellular composition. The constituent cells included astrocytes, oligodendrocytes, and neurons. Because neuronal atypia was often inapparent, the tumors superficially resembled mixed oligoastrocytomas. The term "dysembryoplastic neuroepithelial tumor" (DNT) is proposed for these distinctive lesions, the clinicopathological features of which suggest a dysembryoplastic origin. With the exception of the occurrence of headaches in 2 patients, partial complex seizures were the exclusive symptom. Age at onset of symptoms ranged from 1 to 19 years (mean 9 years). In addition to the chronic nature of the seizures (range, 2 to 18 years; mean, 9 years), one-third of the patients showed radiological features, such as focal cranial deformity, indicating that the tumors had an early onset and were of long standing. In most cases, computed tomography showed a "pseudocystic," well-demarcated, low density appearance associated in some cases with focal contrast enhancement (18%) or calcific hyperdensity (23%). The tumor involved the temporal lobe in 24 patients (62%), the frontal lobe in 12 (31%), and the parietal and/or occipital lobe in 3 cases. Although tumor removal was considered incomplete or subtotal in 17 patients (44%), long term follow-up (range, 1 to 18 years; mean, 9 years) showed neither clinical nor radiological evidence of recurrence in any patient. Comparison of the survival data of the 13 subjects who had undergone postoperative radiotherapy with 26 who had not indicated that radiation therapy was of no obvious benefit. The identification of DNT has therapeutic and prognostic implications because aggressive therapy can be avoided, thus sparing these young patients the deleterious long term effects of radio- or chemotherapy.

Adolescent↗
PubMed1988

[Stereotaxic approach in extensive lesions of the septum-fornix-callosal region. Apropos of 14 cases].

Stereotactic approach of anterior midline lesions which involve the septum-fornix-callosal region is a logical alternative to open surgery as a first choice. It contributes to know anatomical relations--particularly vascular and ventricular--of the lesion; it provides an accurate neuro-pathological diagnosis, with grading and spatial configuration of the lesion, and therapy in some cases. In other cases, it is a guide for appropriate therapeutic choice.

Adolescent↗
PubMed1988

[Stereotaxic ventriculocisternostomy in the treatment of triventricular obstructive hydrocephalus. Apropos of 23 cases].

UNLABELLED: During the period January 1975-October 1987, we performed stereotactic ventriculocisternostomy (V.C.S.) on 23 patients (13 M., 10 F.; age: 11-73 years, m: 33). Sometimes used as an isolated therapeutic procedure, V.C.S. may also follow stereotactic biopsies using Talairach's methodology. Serial stereotactic biopsies were performed in 15 out of 23 patients showing 11 tumoral lesion, two arachnoïdal cysts and two cryptic vascular malformations. Eight patients presented with an isolated aqueductal stenosis. Among the 12 non tumoral patients, seven had very large triventricular hydrocephalus (6 with a retroclival dilatation of the third ventricle) and 5 showed significant dilatation. Of the 11 tumoral patients, 7 had significant ventricular dilatation (1 with a protrusion of the floor of the third ventricle) and 4 with modest dilation. V.C.S. is done by creating an opening (diameter: 5-6 mm) in the floor of third ventricle with a fine forceps introduced through a tubular guide (diameter: 2.45 mm). The percutaneous double oblique transfrontal trajectory (drill-hole: 2.5 mm of diameter) passing through the foramina of Monro, avoids superficial and deep vessels visualised on the previous Stereoscopic Tele-Angiographic and Ventriculographic study. A systematic verification of the V.C.S. patency is made intraoperatively by injection of iodine contrast medium into the third ventricle. RESULTS: (non tumoral patients: 12) (m follow-up: 4 years): two patients needed a ventricular shunt after 3 and 1 months respectively, the first one because of an associated communicant hydrocephalus, the second because of a post-operative meningeal infection. Long-term clinical and CT-Scan follow-up showed that complete resolution (7 cases) or partial (2 cases) improvement of symptoms and signs was not accompanied by normalization of ventricular size, even though the dilatation was significantly reduced in 8 cases and to a lesser extent in 2. RESULTS: (tumoral patients: 11) (m follow-up: 3 years). Hydrocephalus was reduced in 6 cases and remained unchanged in 5. Two patients needed a ventricular shunt 2 years after the V.C.S.: 1 patient, because of a tumoral recurrence involving the region of the fenestration, the second patient because of adhesive arachnoiditis following reoperation for suspicion of recurrence, though this was found to be granulomatous inflammation. Two patients died as a result of their tumors at 2 and 6 years. CONCLUSION: Stereotactic V.C.S. is the treatment of choice for triventricular obstructive hydrocephalus even when there is no retroclival dilatation of the floor of the third ventricle.

Adolescent↗
PubMed1988

[Stereotaxic diagnosis and treatment of colloid cysts of the 3d ventricle. Apropos of 7 cases].

The clinical and anatomical results of the treatment of 7 colloid cysts of third ventricle by stereotaxic aspiration are reported. A history of increased intracranial pressure was reported in all patients (4 females aged of 12, 16, 28, 38 years; 3 males aged of 36, 54, 59 years). A ventricular shunting device has been inserted in 4 patients. Pre-operative clinical findings were: signs of increased intracranial pressure (1 case), isolated memory disturbances (3 cases); motor weakness, memory disturbances and psychomotor slowness (2 cases); 1 of the 2 last cases had also thymic disturbances. Clinical examination was normal in 1 patient. CT-Scan revealed 5 hyperdense lesions, 3 with slight enhancement; 1 hypodensity encircled by an hyperdense ring without enhancement, 1 not enhancing isohypodensity. 6 colloid cysts were between the Foramens of Monro, 1 in the posterior third ventricle. Cyst volume ranged from 1.8 to 6.3 cc. (m: 3.4). Biventricular hydrocephalus was present in all but 1 patient. Stereotaxic aspiration of the cyst performed according to Talairach's system resulted in a release of C.S.F. circulation in all cases. 3 colloid cysts were aspirated completely, 4 were reduced to 3%, 11%, 12%, 33% of the initial volume. Post-operatively 2 patients presented with a transient meningeal reaction, 1 with a transient "myoclonic" syndrome. In 1 "completely aspirated" case a control CT-Scan showed, 5 years later, a small hyperdensity corresponding to 4% of the initial cyst volume. All patients lead a normal and useful life (Follow-up: 8-78 months, m: 45). Neurological examination is normal in 6 cases and shows a pre-existent facial asymmetry in 1. Ours results suggest that stereotaxic investigation should be the first safe procedure in order to achieve both diagnosis and treatment of colloid cysts of third ventricle.

Adolescent↗
PubMed1987

Serial stereotactic biopsies and CT scan in gliomas: correlative study in 100 astrocytomas, oligo-astrocytomas and oligodendrocytomas.

Histologic features of 100 supra-tentorial astrocytomas, oligodendrogliomas and oligo-astrocytomas obtained from serial stereotactic biopsies were compared with the corresponding CT scans. Topographic comparisons provided by visualization of the biopsy trajectories on post-biopsy CT scans were available in 24 cases. Areas of contrast enhancement and low attenuation were compared with the histologic grade of malignancy, tumor delimitation and structural type. The latter was determined as follows: Type I-solid tumor tissue without significant peripheral isolated tumor cells; Type II-solid tumor tissue associated with peripheral isolated tumor cells; Type III-isolated tumor cells only. There was a strong correlation between areas of contrast enhancement and tumor microvascularity. In addition, contrast enhancement occurred only in the solid tumor tissue component of the neoplasm. This correlation accounted for the relationship observed between CT images and the structural type of glioma. Contrast enhancement was constant in structural type I gliomas, inconstant in structural type II, and absent in structural type III. No correlation was found between malignancy and contrast enhancement. Contrast enhancement occurred in all grades of malignancy but was a constant feature of grade 4 gliomas. The volume of the tumors could not be reliably determined from CT images alone. Areas of low attenuation on contrast CT scans could correspond to either peritumoral edema or to edematous parenchyma infiltrated by isolated tumor cells. Serial stereotactic biopsies combined with calculations based on the CT scan provided a more precise definition of the tumor volume and identification of structural type. Such classification may prove useful in prospective analysis of various modes of therapy.

Adolescent↗
PubMed1987

[Value and technic of translating the data from x-ray computed tomography into the stereotaxic coordinates of the Talairach system].

The neuroradiological stereotactic examinations provide indispensable information to localize many intracranial lesions: the data obtained by the CT-Scan are complementary of the stereotactic ones. The transfer of the routine CT-Scan transverse axial slices into the Talairach stereotactic system needs a precise definition of the inclination of the plan of the slices and a correct evaluation of the mean magnification factor. The inclination of the slices is appreciated using the bony, vascular and ventricular landmarks clearly identified on the CT-Scan and stereoscopic stereotactic images. We compared the spatial "reconstructed" CT-Scan data with the histopathological findings obtained by serial stereotactic biopsies in 48 tumor patients. The error varied from 1.5 to 4.6% (m: 2.7 +/- 1.2) on the sagittal plane; from 1.3 to 10% (m: 5.8 +/- 3.4) on the transversal plane; from 2.5 to 4.3% (m: 3.5 +/- 0.7) on the axial plane. The mean global error was 3.7% +/- 2.3. The CT-Scan directly performed under stereotactic conditions (acrylic frame) seems to be the more useful procedure. Nevertheless considering the good precision obtained with our methodology applied to the Talairach's system, we consider it suitable when: a) the gantry of the CT-Scan apparatus is too narrow for the acrylic frame; b) the exploitation of previous CT-Scan examinations is necessary; c) patient refuses the discomfort of the acrylic frame.

Brain Diseases↗
PubMed1987

Stereotactic aspiration of colloid cysts of the third ventricle. Preliminary report.

From January, 1979, to July, 1986, 10 patients (6 females, 4 males; 12-59 years, mean 37) with colloid cysts of the third ventricle were treated by stereotactic aspiration (Talairach's method). Five cysts have been completely aspirated. The mean residual volume of the other 5 was 19% of the initial volume. Clinical symptoms completely cleared in all but one patient. The advantages of the procedure are discussed.

Adolescent↗
PubMed1987

[Ethmoidal adenocarcinoma surgically treated in one stage by transfacial and subfrontal approach after inductive chemotherapy. Preliminary results of a new therapeutic approach].

The authors present a new therapeutic protocol for ethmo++idal adenocarcinomas. It includes a pre-operative chemotherapy based on a four days continued infusion of cis-platinum and 5 F.U. (three cures with 3 weeks-intervals); it is followed by a carcinologic removal realized through a combined transfacial and intra-cranial approach. They discuss the interest of combined surgery which should allow a limitation of intra-cranial recurrencies. The intra-cranial extension must not be a limit to the removal even in case of dural, or even sub-dural extension. The reconstruction of the anterior basis of the skull has been simplified as much as possible: it has been performed either with a bone graft removed from the frontal flap inner table, or with a precut madreporic coral graft. In all cases, the dura has been doubled with a large shred of galea. They emphasize the efficiency of pre-operative chemotherapy. Eleven patients underwent such a protocol; two were operated in a recurrence, 9 in first hand. The preliminary results seem to be promising: the one year and two years actuarial survival rates are 84%.

Adenocarcinoma↗
PubMed1987

[Value of bifocal stereotaxic destruction in case of dyskinesia in patients with a motor deficit of cerebral origin].

Authors report a study concerning 12 dyskinetic patients with cerebral palsy. The clinical pre-operative examination shows that many signs and symptoms are associated: volitional and postural dyskinesia, athetosis and dystonia, pyramidal deficit and spasticity. Talairach's stereotactic methodology has been used for bifocal (VPL thalamic nucleus and internal pallidum) Yttrium 90 implantation. After stereotactic bifocal lesions, involuntary movements have been reduced in 45.5% of cases and have disappeared in 27% of cases. Impairment of previous motor deficit has been observed in 3% of cases; volitional and postural dyskinesia seems to be the most curable symptomatology. Clinical results in athetoid involuntary movements and dystonia are less rewarding. Because of important anatomical modifications often observed cerebral palsy patients, the authors stress the interest of individual acute neurophysiological study and discuss about the stereotactic targets and the modalities of destruction. They insist upon the necessity of rigorous selection of indications based on acute clinical examination in the perspective of improvement of global functional capacities.

Adolescent↗
PubMed1987

[Combined ORL and neurosurgical approach in adenocarcinoma of the ethmoid. Preliminary results apropos of 15 cases].

Fifteen cases of adenocarcinoma of the ethmoid sinus treated by a combined subfrontal and transfacial approach after induction chemotherapy are reported. The surgical technique is described precisely including a paralateronasal approach combined with a bifrontocoronal incision, a bilateral ethmoidectomy and reconstruction of the anterior base of the skull by one sheets taken-out from the inner surface of the frontal flap or more recently madreporic coralline grafts; the dura is hermetically sealed and it is lined with a large galea flap. Results were as following: one post-operative death, no clinical rhinorrhea, no recurrence from the anterior cerebral fossa, one orbital and one sphenoidal recurrences. Surgical indications are discussed according to the different extensions of the tumor and a frontal lobe extension is not a contraindication. This surgical procedure should be employed for the adenocarcinomas of the ethmoid invading the superior cells even in the absence of lysis of the cribriform plate in order to avoid the endocranial recurrences.

Adenocarcinoma↗
PubMed1986

[Extradural hematoma in the Emergency Medical Assistance System and scanners. Comparison between 2 series at the Sainte-Anne Hospital Center].

The authors compare two groups of intracranial epidural hematomas treated in the Neurosurgical department of Sainte-Anne Hospital in Paris: the first group includes 262 patients operated upon between 1965 and 1977; the second group concerns 124 patients operated during the period 1979-1984. The mortality rate has been progressively diminishing from 1969 (50%) to 1984 (12.5%). Among the survivors, functional sequellae are still frequent; some improvement in the functional prognosis has although been noted; in the first group, 41% of patients are cured and 56% of them returned to work; in the second group, 50% are cured, and 62% returned to their professional activities. The detailed analysis of those data emphasizes the importance of CT-Scan and of the improvement of specialized neurosurgical intensive care; on the other hand, the particular role of an emergency care organisation, such as the SAMU, appears rather discreet referring to this type of pathology.

Adolescent↗
PubMed1986

[Management of cranial-injured patients in the era of the Emergency Medical Service and the scanner. Comparative epidemiologic study with a 12-year interval in the same department of neurosurgery, in the Paris region].

The authors present an analysis of the different data concerning the emergencies admitted in the Neurosurgical department of Sainte-Anne Hospital in Paris, during the one year-period extending from 1st June 1983 to 1st June 1984. These data have been compared to the corresponding findings established during 1972 in the same department. Traumatology appears to be a more and more limited activity among neurosurgical emergencies: 55% of admissions in 1972, 43% in 1983-84. The main characteristics of injured patients on admission have not changed: 65% are in a coma, 1.25 are operated in emergency, age distribution and types of lesion are identical. The sorting of the patients has improved: 25% of them were operated upon in 1972, 37% in 1983-84. Conveyance of injured patients has undoubtedly improved in quality during the last years; yet the duration of transport is still important, too important, even in Paris: 2 h 30 as an average-time. Another favorable factor has been the coming out of CT-Scan; it is of course of great help for diagnosis, but it must not let forget basic and fundamental therapeutic decisions.

Adolescent↗
PubMed1985

[The CO2 laser: a new instrument for intracranial neurosurgery].

Since 1983 we have been using an 80 watts CO2 laser unit (Ercelas 80, Robert et Carrière Biomédical) routinely in some neurosurgical procedures. Fifty tumours (34 intracranial, 4 intraorbital and 12 intraspinal) have been operated upon with laser. The CO2 laser appears to be particularly useful to excise solid tumours, such as meningiomas and neurinomas. When these lesions are located in the posterior fossa or lying deeply near highly functional or vital supratentorial structures (e.g. carotid arteries, optic nerves, chiasma), the laser beam should be coupled with an operating microscope. Laser being a non-touch technique, the tumour can be removed with minimal trauma to healthy tissues. Depending on the output power, the laser beam coagulates, cuts or vaporizes the target lesion.

Brain Neoplasms↗