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Biomedical subjects

M H Bernard

Publications and source records attributed to M H Bernard.

50 records · Page 3Linked to original sources
PubMed1980

Fever and cerebral vasospasm in ruptured intracranial aneurysms.

The temperature curves of 262 patients affected by subarachnoid hemorrhage, including 107 arterial aneurysms, 26 arteriovenous malformations, 42 idiopathic subarachnoid hemorrhages, and 87 cerebral hemorrhages, were observed and classified into three types: Type I: absence of fever; Type II: fever oscillating between 37 degrees and 38 degrees C; and Type III: fever with a plateau between 38 degrees and 39 degrees C beginning on the fifth day at the latest and lasting an average of nine days, with a decline over the next three days. Type III was observed in 3.8% of the patients with arteriovenous malformations, 7% of those with cerebral hemorrhages, and 88.3% of those who had arterial aneurysms with severe angiographic vasospasm associated with delayed ischemic signs. We suggest that the delayed fever is not a simple sign of meningeal syndrome but a sign related to cerebral vasospasm.

Adult↗
PubMed1980

[Electrical anaesthesia in neurosurgery (author's transl)].

This study concerns 65 neuro surgical patients operated on under Electrical Analgesia method. Main advantage is lowering the use of toxic drugs during anesthesia, thanks to which immediate post operative recovery is quite simplified. According to their recent experience, the authors estimate the best indications to be old patients -- patients in poor clinical condition -- and posterior fossa interventions.

Adult↗
PubMed1979

[The narrow lumbar canal: 53 operated cases (author's transl)].

These 53 operated patients were divided into 2 groups: 29 had an intermittent claudication as Verbiest first described it soon as 1949, whereas 24 had permanent radicular pain in legs as Epstein emphasized it. We think emulsified Duroliopaque myelography to be the best investigation to make sure the diagnosis and to forecast the operative tactics: we gave up Dimer X myelography which occasioned serious complications in 2 cases and gas myelography which seems to us inadequate to this radicular pathology. Total-Body Scanner is rather an elegant method but a discontinuous one. The radiographic and operative findings have shown the stenosis of the lumbar canal to be congenital in 5 cases, development in 20 cases, degenerative in 27 cases (with 15 pseudo-spondylolisthesis) and tabetic in one case. A disc herniation was found in 25 cases over 53. The extent of the bone resection has been in relation with clinical picture, myelography and mainly operative findings, aiming at a "cut-to-measure costum". In every case the initial laminectomy was made easier by trenching the thickened laminae on each side of the spinal process prior to remove it. Only soft disc hernations were removed; the dura was never opened; no vertebral fusion was performed; for 2 years we have tried to avoid the "laminectomy membrane" by interposing an autogenous fat and aponevrotic graft between the dura and the overlying paraspinal muscles. The operative results are satisfactory with 75% of excellent and good; they are much better in patients with intermittent claudication than in those with permanent radicular pain. It is a question of functional surgery in one case, of pain surgery in the other. The major trick seems to us to be that of the associated disc hernation with the risk of missing the narrow canal.

Adult↗
PubMed1979

[Pre-operative non-shaving for neurosurgical operations (author's transl)].

The authors report their pre-operative technique for scalp attendance according to which they operated on more than 1000 cranial neurosurgical patients in three years without the classical complete hair shave. Major psychological advantages are obvious. Principle technical details are: as complete cleaning of scalp-grease as possible by repeated shampoos; in the operating room: shaving only a thin pathway along the skin incision drawn by the surgeon himself, and disinfection with tincture of iodine exclusively. During the same time, they observed a fall to 0,6% of surgical infections needing bone flap removal because of osteitis. Secondary but always transitory partial alopecia has been observed in three patients.

Brain↗
PubMed1978

[Intracrânial venous sinus thrombosis (22 cases) (author's transl)].

The authors report 22 cases of intracranial venous sinus thrombosis and study what is new about that old pathology. Sagittal superior sinus is still the most touched one, followed by the lateral sinuses. Half of the cases are traumatic: their clinical picture consists either of benign intracranial hypertension, either of intracranial hypertension and neurological signs. Puerperal thrombosis of the sinuses have quite disappeared and have been replaced by thrombosis in women taking oestro-progestional agents, whose clinical picture is absolutely the same. Infectious thrombophlebitis are quite less frequent than intracranial abcesses, whose diagnosis must be made first. About diagnosis, the certitude is still given by bilateral carotid arteriography which demonstrates the thrombosed sinus, whereas cerebral scintigraphy shows whether their is an adjacent infarction of venous origin or not. Treatment is a medical one. It consists rather of methods to reduce cerebral volum, aiming at maximal use of collateral varices. Heparin should be used only if there is no cerebral infarction of venous origin. Total mortality is 27% and among survivals there are few sequels. Prognosis depends on the thrombosed sinus, on the rapidity for clinical signs to appear and especially on the anastomotic venous collateral ability demonstrated by carotid angiography.

Bacterial Infections↗
PubMed1978

[4 cases of traumatic cerebral aneurysms are reported (author's transl)].

Among them: one aneurysm of the meningeal artery and 2 cases of aneurysm of cortical arteries. The delay between trauma--mild or severe--is variable: eight days to 3 weeks. Cerebral angiography is the only diagnostic procedure which can identify these traumatic aneurysms. Surgical treatment is discussed.

Adult↗
PubMed1977

[Thrombosis of the intracranial venous sinuses after ingestion of estroprogestative agents. 4 cases].

The authors report 4 cases of thrombosis of the superior longitudinal sinus (SLS) in women taking oestroprogestational agents. This complication is very rare, only 25 cases existing in the literature. The clinical picture consists of premonitory headaches associated with neurological signs suggesting lesions affecting both hemispheres in alternation. In the absence of treatment, sudden deterioration on about the tenth day is to be feared. This picture is similar to that of puerperal thrombosis of the SLS. The diagnosis should be confirmed by carotid arteriography, which demonstrates the presence of collateral varices and the thrombosed sinus giving a "negative" image on the AP view. Cerebral scintigraphy shows one or more areas of uptake in the form of adjacent rounded shapes, corresponding to cerebral infarctions of venous origin. As far as the responsibility of oestro-progenstational agents is concerned, the role is suggested by the analogy with puerperal thromboses and also by the absence of cases in men (with the exception of head injury, infections of the face and haematological malignancies). The prognosis is grave (19 deaths out of 29 cases), but surviving patients are completely cured. This prognosis would seem to be essentially dependent upon the possibilities of venous callateral circulation, which are variable in each individual patient. Anticoagulants and thrombolytic risk, in effective doses, to transform the venous thrombosis into a cerebral haemorrhage. Treatment consists rather of methods to reduce cerebral volume, aimed at maximal use of collateral varices and assisting the patient to overcome to acute phase of the first 2 weeks. Headache would seem to be the principal presenting symptom. In our opinion, no biological test gives a reliable indication as to those women most at risk and contraindictions are in fact of a clinical character.

Adult↗
PubMed1977

[Triple contrast ventriculography using air-lipiodol-dimer].

A mixture of three contrast media - air, Lipiodol and Dimer - was used in ventriculography in order to combine the advantages of each of them. Air is used for topographical localisation, Dimer shows the overall shape of the ventricular system and Lipiodol outlines blocks. This simple and rapid technique provides easily interpretable films, whatever the indication for the ventriculography.

Air↗
PubMedDate not supplied

[Fractionated stereotactic radiotherapy: results in hypophyseal adenomas, acoustic neurinomas, and meningiomas of the cavernous sinus].

PURPOSE: In order to optimize cerebral benign tumor irradiation, fractionated stereotactic radiotherapy allows a focused-volume irradiation (2.1 cm3, 16 mm diameter) under standard fractionation conditions. Results of a retrospective and multicentric analysis are presented. PATIENTS AND METHODS: Fractionated stereotactic radiotherapy uses the ballistic principles of the radiosurgery: stereotactic localization, multi-beam irradiation, secondary collimation, three-dimensional dosimetry. Standard fractionation is possible with a re-locatable non-invasive stereotactic device. The technique has been used for treating pituitary adenomas (86 patients), acoustic neuromas (32 patients) and cavernous meningiomas (26 patients). RESULTS: 1) pituitary adenomas: cumulative tumoral objective-response rates (42 patients) were respectively 42%, 69% and 88% at 24, 48 and 60 months. The cumulative endocrinologic objective-response rates (32 patients) were respectively 53%, 75% and 85% at 24, 48 and 60 months. The cumulative risk of radio-induced hormonal deficiency varied from 18% (growth hormone [GH]) to 42% for TSH (thyroid stimulating hormone) at 48 months. No other complication was observed; 2) acoustic neuromas: 33 tumors, < 25 mm in diameter, were treated in 32 patients. Tumor control was observed in 29/33 tumors: 14 were stable, 15 decreased and three progressed. Useful hearing was maintained in 9/10 patients. Only three patients (9%) presented persistent complications; 3) cavernous meningioma: 17/19 clinical responses were noted, 20 tumoral stabilisations, one partial response and one progression (22 magnetic resonance imaging [MRI] evaluable patients). One unilateral radio-induced blindness was observed. CONCLUSION: For these benign tumors, the focused target volume obtained by the fractionated stereotactic radiotherapy seems to be better adapted to the treatment of limited benign tumors than standard radiotherapy. The use of standard fractionation reduces the risk of severe normal tissue damage, sometimes observed for radiosurgery and inherent in the use of single fraction.

Adenoma↗
PubMedDate not supplied

[Serum thyroglobulin assay after total unilateral thyroid lobectomy in differentiated thyroid cancer].

Thyroglobulin (Tg) levels (ng/ml) were measured in the sera of 51 healthy volunteers (range: 0 to 20), 116 unselected blood donors (0 to 50) and 431 patients under thyrotropin suppression therapy for differentiated thyroid carcinoma. Among these 431 patients, 133 had undergone total thyroidectomy: 107 were in remission (mean +/- standard error of the mean = 0.84 +/- 2.29) and 26 had a recurrence (1974 +/- 586); 298 had undergone unilateral thyroid lobectomy: 292 were in remission (4.65 +/- 12.79) and 6 had a recurrence (1003 +/- 673 range: 18 to 12,000). The degree of thyrotropin suppression had no effect on serum Tg levels, but these were significantly increased by the presence of anti-Tg antibodies. Moderately elevated but stable Tg levels were observed without detectable recurrence during a follow-up period of at least 5 years. Tg was frankly elevated in 4 patients with overt post-lobectomy recurrence (range: 77 to 5,200). A rise, even moderate, of Tg levels after lobectomy is suggestive of a recurrence if it progresses regularly as time goes on (n = 2). It is concluded that in the absence of anti-Tg antibodies Tg assays should be included in the follow-up of patients with differentiated thyroid carcinoma under thyrotropin suppression therapy after unilateral thyroidectomy.

Female↗
PubMedDate not supplied

[Two cases of sellar chordomas. Ultrastructural and histochemical study (author's transl)].

Two cases of sellar chordomas are reported, with ultrastructural and histochemical study. The embryological origin and the histochemical data are discussed. The question of chondroid chordomas is evoked and the results of the ultrastructural study are interpreted on the basis of the cases hitherto reported. Special attention is called to the methods for the detection of polysaccharides by electron microscopy in such proliferations. Tissue culture seems to be able of providing a good information as to the secretory activity of the chordomas located at the skull base.

Chordoma↗