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M H Bernard

Publications and source records attributed to M H Bernard.

At least 19 recordsLinked to original sources
PubMed2002

[Unsuccessful surgery of Cushing's disease. Role and efficacy of fractionated stereotactic radiotherapy].

BACKGROUND AND PURPOSE: To optimize and reduce the toxicity of pituitary adenoma irradiation, we evaluated the feasibility and effectiveness of fractionated stereotactic radiotherapy (FSR) in 51 patients with functional adenoma; 12 of them had Cushing's disease. PATIENTS AND METHODS: Eleven females and one male, median age: 49 years, 8 of them relapsed and 4 had persistent hormonal secretion after surgery. The delivered dose was 50 grays (Gy) (5 x 1.8 Gy/week) using 5 convergent micro-beams scanning in arc therapy mode. The median planned target volume (PTV) receiving 90 to 100% of the total dose was 2,1 cm(3). We used relocatable non-invasive stereotactic device Brain Lab, and adapted Linac for stereotactic radiotherapy. RESULTS: Nine out of twelve patients (75%) presented with complete remission after a median time of 29 months, 3/12 patients with partial remission. Actuarial probability to have hormonal persistent secretion was 88% at on year, 44% from 3 to 5 years, 22% at 7 years, and 11% to 0% after 7 years. The 12-corticotroph adenomas were significantly (p=0.007) more radiosensitive than 39 non-corticotroph adenomas. Toxicity was significantly lower for corticotrope adenoma, with no radio-induced pituitary deficiency and no neurological or optic injury. CONCLUSIONS: Combined surgery and FSR appears to be safe and effective for treatment of pituitary adenomas. However, long-term follow-up is required to determine the impact in terms of tumor response and hormone deficiency. The focused treated volume obtained by FSR seems more suitable for these benign tumours than standard radiotherapy. In addition to this conformal approach, the use of standard fractionation reduced the risk of severe damage to the optic chiasma, which is sometimes observed after radiosurgery and is inherent in single fraction radiotherapy.

Adenoma↗
PubMed2001

[Medical secrecy].

Explore the source record for details and available documents.

Confidentiality↗
PubMed2001

[Hygiene, architecture and autopsy].

The 24(th) August 1998 decree related to technical prescriptions applicable to hospital mortuaries, to be enacted as of September 11(th) 2001, compels hospital administrations and involved personnel to consider architectural concepts of autopsy room. Nevertheless, the technical prescriptions of this decree seem to be inadequate because an autopsy room requires specific functional and technical organization such as adequate flooring, adapted air-conditioning system and plumbing and of course appropriate autopsy tables. Due to imminent enactement of accreditation procedures, it is likely that in the near future, autopsies will only be performed in centres combining scientific competence and sanitary requirements.

Autopsy↗
PubMed1998

[Papillary microcarcinoma of the thyroid. 179 cases reported since 1973].

OBJECTIVES: Defined as a tumor measuring < or = 1 cm, the prognosis and treatment of occult papillary thyroid carcinoma has been the topic of some controversy. The aim of this study was to report experience with a series of 179 cases observed since 1973. PATIENTS AND METHODS: Occult papillary thyroid carcinoma was discovered in 179 patients aged 12 to 81 years (151 women and 28 men) at cervicotomy prescribed for Graves' disease (n = 9), toxic adenoma (n = 16), isolated nodule (n = 71), multinodular goiter (n = 74) or cervical node enlargement (n = 9). The surgical procedures were lobo-isthmectomy (n = 79), subtotal thyroidectomy (n = 74), or total thyroidectomy (n = 26) with node dissection in case of enlargement. Thyroxin was prescribed in all cases and annual follow-up was programmed. Five patients were lost to follow-up. RESULTS: Two cervical recurrences were observed warranting reoperation. None of the patients died from cancer-related causes. CONCLUSION: Minute papillary carcinomas of the thyroid are frequently discovered, but prognosis is generally excellent. Systematic total thyroidectomy and node dissection are not warranted. Only those lesions with an extrathyroid extension, associated node enlargement or inaugural metastasis require wide resection. These results are in agreement with a critical analysis of data reported in the literature demonstrating the exceptional nature, and in half of the cases, cure of metastatic occult papillary thyroid carcinoma.

Adolescent↗
PubMed1997

[Thyroid nodules: assay of serum thyrotropin and cytopuncture versus scintigraphy as first-line tests. Prospective study with 150 cases].

OBJECTIVE: Fine-needle aspiration (FNA) is now considered as the first-line investigation for the diagnosis of thyroid nodules. We searched for a more accurate and cost-effective methodology as this technique fails to recognized hot nodules, frequent in certain countries. PATIENTS AND METHODS: A prospective study was conducted in 150 patients to compare two diagnostic procedures: scintigraphy first combined with FNA in case of cold nodules versus TSH measurement plus FNA when TSH measurement plus FNA when TSH was not depressed. The results were subjected to cost/benefit analysis. RESULTS: Cystic nodules were found in 28 cases (including 3 hyperfunctionning nodules, with 5 suspicious smears (1 carcinoma). FNA was non-diagnostic in 26 patients; 12 were operated on (1 carcinoma), 14 had further FNA (5 suspicious, 9 benign). Altogether 56 nodules were removed, for toxic adenoma (n = 5), for suspicious (n = 21) or malignant (n = 12) smear, or on personal (n = 18) demand; 16 carcinomas were found (2 medullary, 13 capillary, 1 follicular carcinomas). With scintigraphy first, the cost was 787 French francs (FF) per patient. With TSH measurement and FNA, the cost was 554 FF per patient. In both cases, the same number of carcinomas were removed, and all the hot nodules (11 including 5 toxic adenomas) were detected. CONCLUSION: Serum TSH measurement, with scintigraphy if TSH is low, and FNA in all the other cases, is accurate and more cost-effective than scintigraphy as a first-line investigation for the diagnosis of thyroid nodule.

Biopsy, Needle↗
PubMed1997

[Treatment of differentiated thyroid cancers of nodular type].

Papillary and follicular carcinomas are the most frequent thyroid cancers. The choice of the treatment is dependent on the prognostic scoring systems. A good prognosis is linked to the small size of the nodule (especially) microcarcinoma) the age of the patient (less than 40), the lack of extra-thyroid (for papillary cancer) or extra capsular (for follicular carcinoma) extension. Total thyroidectomy decreases the number of recurrences but does not modify the mortality. The risk of laryngeal nerve palsy and hypoparathyroidism is not negligible. Lobo-isthmectomy thus can be used in the low risk tumors. Radioactive iodine administration is rational after total thyroidectomy but its efficacy is questioned. Thyroxine treatment is always prescribed. Taking into account the risk of osteopenia and cardiovascular disturbances induced by iatrogenic thyrotoxicosis, the desirable serum TSH level is debated.

Adenocarcinoma, Follicular↗
PubMed1996

Lhermitte-Duclos disease associated with syringomyelia.

A 23-year-old man presented with a 2-week history of intracranial hypertension. CT showed a large, nonenhancing cerebellar mass with surrounding calcification and displacement of the fourth ventricle. MRI revealed a septate lesion, with low signal on T1-weighted and high signal on T2-weighted images. The cerebellar tonsils were displaced below the foramen magnum and there was associated syringomyelia. The MRI features were characteristic of Lhermitte-Duclos (LD) disease (dysplastic gangliocytoma) and the diagnosis was confirmed following surgery. In this case, we emphasise the usefulness of MRI in the diagnosis of LD disease and consider the possible pathogenesis of the associated syringomyelia.

Adult↗
PubMed1993

[Comparison of 2 consecutive series of aneurysmal subarachnoid hemorrhage with or without nimodipine and study of the temperature curve].

A total of 210 consecutive patients with aneurysmal subarachnoid hemorrhage (S.A.H.) of any clinical grade admitted from January 1985 through May 1990 were retrospectively studied to determine the effect of intravenous Nimodipine on survival and functional results and to analyse temperature curve as a prognosis factor. The 106 patients admitted from January 1985 through November 1987 constituted the reference series termed G1. The 104 patients admitted from December 1987 through May 1990 and treated with intravenous Nimodipine constituted the series termed G2. Of the 210 patients, 172 (82%) could be operated on with a similar mean operative delay in both series (G1 = 9.5 days, G2 = 9.8 days). Of the 210 patients, 153 (73%) survived with an average follow-up of 111 weeks for G1 and of 64 weeks for G2. Nimodipine treatment was associated with a significant increase of survival (11.8%, P = 0.05) which was not the result of improved operative technique but of a lower incidence of deaths caused by postoperative vasospasm (G1 = 5 deaths, G2 = 0 deaths, P = 0.05) and by rebleeding (G1 = 15 deaths, G2 = 5 deaths, P = 0.03). No significant difference between the two series G1 and G2 was observed regarding functional results in the 153 survivors, frequency and seriousness of clinical signs of vasospasm during the waiting phase for surgery, radiologic signs of vasospasm on initial and second angiography, cerebral infarctus on second C.T.-Scan. Analysis of temperature curves of the 210 patients revealed that a delayed fever with a plateau pattern was associated with a higher incidence of vasospasm, rebleeding, and deaths.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Discrepancy between the basal level of TSH and the thyrotropic response to TRH during thyroid hormone treatment of differentiated thyroid cancers].

Serum TSH (Thyroid Stimulating Hormone) was measured before and 30 minutes after a 200 microgram intravenous TRH (Protiréline*) injection in 270 patients. These patients have been treated for one year at least, by a suppressive thyroid therapy after thyroidectomy for a differentiated thyroid carcinoma. 314 tests were performed. We used an ultrasensitive TSH method (Ciba-Corning-Diagnostics). The normal range (mean :1.68 mUI/l; range: 0.45 to 3.80 mUI/l) was determined in 116 euthyroid patients. Minimal response to TRH was studied in 35 untreated patients with hyperthyroidism (TSH TO: less than 0.30 mUI/l and delta TSH: less than 0.09 mUI/l). There was a relationship (r = 0.916) between TSH response 30 minutes after TRH stimulation (T30) and basal TSH value: in a logarithmic scale (fitting of the data by a bi-gaussian model). TRH tests were classified too, by basal TSH values (TO) and delta TSH (TSH at T30-TSH at TO). In 201 tests in which TO TSH was less than 0.30 mUI/l (maximal value in hyperthyroidism), 50 showed a delta TSH higher than 0.15 mUI/l (25% of the cases) and in 6 cases (3%), delta TSH was even higher than 2.0 mul/l; in 67 of the 75 tests (89.3%) where TSH TO is less than 0.15 mUI/l, delta TSH is no (less than 0.15 mUI/l). In 93 tests where TO TSH was upper than 0.45 mUI/l (minimal value in euthyroidism), delta TSH was higher than 2.0 mUI/l in 87 cases (93.6%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Synovial cysts and synovialomas of the lumbar spine. Histo-pathologic and neuro-surgical aspects apropos of 8 cases].

Based on 8 personal cases and a 81-cases review of literature, it's authors' opinion that cystic or solid masses issued form posterior lumbar articular process and called according to the cases synovial cyst, ganglion cyst, benign synovialoma, pigmented villonodular synovitis, are a single variety of benign degeneration of soft articular tissues. The cystic or solid feature of these masses depends upon the extent of their histiocytic granulomatous proliferation. They may be asymptomatic, accompany chronic lumbar pain or cause sciatica, seldom cauda equina syndrome. In case of sciatica, clinical picture rather consists of a narrow lateral recess than a discal protrusion. CT scan is the best investigation to get a right preoperative diagnosis. Postoperative prognosis is excellent and no anatomical recurrence has been reported.

Adult↗
PubMed1989

[Myelopathies caused by dorsal spinal canal spondylotic stenosis. 3 cases and a review of the literature].

Thoracic spondylotic myelopathies are exceptional, only 29 observations could be found in the literature; we intend to describe three new cases here. The patients, two women and one man, 64, 69 and 72 years old, complained of weakness of the lower limbs, more marked on one side, which had been progressing slowly from several months to eight years. Examination revealed asymmetrical paraparesis with distal sensitivity deficits without thoracic sensory level. In the first case, the myelography remained virtually unchanged in front of T11, T12; in the second and third cases, there was slight extradural compression at T9 and T10 respectively. Magnetic Resonance Imaging (M.R.I.) performed in two patients was evocative of a thoracic disk herniation. A chest CT scan enabled us to establish correct diagnosis: in the three cases irregular hypertrophy of the posterior elements was evident at T11 and T12, T9 and T10, T10 and T11 respectively, with osteophytes originating in the articular process and deeply embedded in the spinal canal. Decompressive laminectomy associated with medial facetectomy resulted in the gradual improvement of walking in all three patients. Myelography and MRI are both useful in demonstrating the level compression, usually situated in the low thoracic spine, however only the CT allows differential diagnosis with other etiologies, especially anterior compression such as disk herniation.

Aged↗
PubMed1988

[Meningioma of the optic canal. Diagnostic aspects apropos of 3 surgically treated cases].

Three cases of meningiomas originated in the optic nerve sheath in its intra-canalicular portion, have been operated on in Reims since we dispose of the TDM; it gave us the opportunity to re-define the way how to explore an area always difficult to investigate; indeed it has been impossible for a long time to clearly isolate meningiomas in the optic canal through the classical neuro-radiologic technics. The anatomic study confirms that the optic canal orientation is fixed, constantly inclined downward and forward with an angle of minus forty degrees with regard to the horizontal line; our work establishes that it is possible to apply it to the CT scan; in this incidence, TDM perfectly allows to visualize the optic canal and the optic nerve, from the anterior clinoid process to the posterior orbital pole. This incidence seems us to be interesting, in addition to classical neuro-ophthalmic planes, for early diagnosis or supervision of tumors of the optic canal.

Cranial Nerve Neoplasms↗
PubMed1988

[Cerebral abscess and Osler-Rendu disease. Apropos of 4 cases].

The authors report 4 cases of cerebral abscesses (C.A.) complicating Rendu Osler disease (hereditary haemorrhagic telangiectasia: H.H.T.). These cases and 43 others comparable found in literature enable to assess C.A. complicates H.H.T. by the way of pulmonary arteriovenous fistulas (P.A.V.F.). C.A. appears during known H.H.T. in only a quarter of cases; in all other cases C.A. reveals the disease. When the etiological search for metastatic C.A. fails to find any classical cause: O.R.L., stomatologic, cardiac, it seems important to suspect H.H.T., and research P.A.V.F. by chest X ray and pulmonary angiography. Preventive treatment consists in excluding pulmonary fistulas without waiting neurological complications of known H.H.T.

Adolescent↗
PubMed1988

[Spondylodiscitis after surgery of lumbar disk hernia. Apropos of 12 cases in 1796 operations].

Discitis is a rare complication of disc operation. The incidence rate varies from 0.2 to 0.8% according to the series. During a 6 year period (1980-1986) 1,796 patients were operated for lumbar disc protrusion at our institution and twelve of them (0.66%) developed a post operative discitis. Bacteriologic verification due to the infection was ascertained in ten cases. Direct contamination during surgical time is likely far more frequent than hematogenous contamination because the liable germ was staphylococcus in 9 cases. Ascertaining the diagnosis is base upon clinical picture and some selected investigations. It may be earlier than it has been said before. Discitis may be suspected within a week after operation in two cases out of three. The most prominent clinical feature is back pain with muscle spasm but sometimes diagnosis may be misled to a psychiatric condition or a visceral disorder. Among conclusive investigations we range in the first place the needle aspiration of the disc which permitted to isolate a germ nine times out of eleven. Next the bone scan with H.M.D.P. Te 99 (8 Mbq/kg) which revealed a significant uptake pattern in eight cases out of eight. Finally the blood culture which grew five times out of ten. Risks of discitis, i.e septicemia, polysegmental infection or death justify in our opinion an appropriate antibiotherapy during at least 8 weeks. Moreover, in our experience, it is the best antalgic treatment that we can offer and back pain decreases as soon as the second day with antibiotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Cervical spondylotic myelopathies. Apropos of 121 cases. Prognostic value of sensitive symptoms].

121 patients have been treated for cervical spondylotic myelopathy between 1972 and 1985; 88 patients have been operated on, most of them (84) by laminectomy and 4 cases by anterior approach; 33 patients have been treated conservatively in absence of evolution. We have used a clinical classification based on the different sensitive symptoms, the best predictive factor in our opinion; the typical form (2/3 of all cases) associates numbness and paresthesias of extremities of both hands, difficulties for manipulation, astereognosia, with a moderate pyramidal deficit of the lower limbs; this typical form obtains the best post-operative score with 75% of good results; the more the clinical sensitive form is far from the typical one, the poorest may be the evolution. Our results are similar with large series of literature, using either the posterior or the anterior approach; we have noted the frequency (1/4 of cases) of very late worsening, several years after initial good result, without residual compressive factor; it is supposed that organised intra-medullary lesions, may be of venous origin, continue to evolve for their own. 33 non operated patients have been treated conservatively, because of spontaneous stabilization of their disease, suggesting to try immobilization by cervical collar during few weeks before surgery.

Adult↗