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Biomedical subjects

M Kakou

Publications and source records attributed to M Kakou.

14 recordsLinked to original sources
PubMed2002

Atherosclerosis of carotid arteries and the ace insertion/deletion polymorphism in subjects with diabetes mellitus type 2.

BACKGROUND: The aim of the present study was to investigate the association of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism with the ultrasonographically evaluated severity and characteristics of carotid artery atherosclerosis in subjects with diabetes mellitus type 2. METHODS: We assessed 184 subjects with diabetes mellitus type 2, 75 males and 109 females, mean age 61.4+/-7.7 years. All subjects were receiving oral antidiabetic drugs for glycemic control and were free of cardiovascular events. The ACE genotype was analyzed by the polymerase chain reaction (PCR) technique. The ultrasonographic examination of the carotid arteries was performed in both B-mode imaging and Doppler ultrasound. The common carotid artery intima-media thickness was assessed 15-20 mm proximal to the dilatation of the carotid bulb. The atheromatous lesions were classified according to their echogenic characteristics as predominantly echolucent, mixed and predominantly echogenic with under 30, 30-70 and over 70% of the total plaque area echogenicity, respectively. RESULTS: From the total cohort 29 (15.8%) subjects had the II, 86 (46.7%) the ID and 69 (37.5%) the DD ACE genotypes. The mean carotid artery diameter stenosis was 37+/-17%, 43+/-19% and 40+/-20% (p=NS) and the intima media thickness was 0.94+/-0.24 mm, 0.97+/-0.20 mm and 0.98+/-0.20 mm (p=NS) in the II, ID and DD subgroups, respectively. When the echogenicity was analyzed according to the ACE I/D polymorphism, 12 subjects (41.4%), 13 (44.8%) and 4 (13.8%) with II genotype had predominantly echogenic, mixed and predominantly echolucent lesions, respectively. The ID genotype diabetics were found to have predominantly echogenic plaques in 41 cases (47.7%), mixed in 30 (34.9%) and predominantly echolucent in 15 cases (17.4%). From the 69 DD subjects 19 (27.5%) had predominantly echogenic plaques, 26 (37.7%) had mixed and 24 (34.8%) had predominantly echolucent lesions. Predominantly echolucent plaques were more frequently encountered among diabetics with the DD genotype (p<0.05), even after correction for demographic characteristics, the main risk factors of atherosclerosis and blood glucose control. CONCLUSIONS: The ACE genotype seems to be associated with the echogenicity of carotid artery atheromatosis but not with the common carotid artery intima media thickness or the degree of internal carotid artery stenosis in subjects with type 2 diabetes mellitus. The DD genotype may be implicated in the increased cardiovascular risk that characterizes echolucent plaques.

Aged↗
PubMed2001

[Spondylodiscitis due to Histoplasma duboisii. Report of two cases and review of the literature].

We report two cases of African histoplasmosis caused by Histoplasma duboisii located in the spine, on two Malian adults aged 40 and 47 years respectively. Clinical signs consisted of dorsal spinal syndrome in both cases and a paraplegia in one case. Radiography and CT scan revealed a spondylodiscitis without any bone reconstruction in both cases and a prevertebral abscess in one case. Diagnosis was confirmed by mycological and pathological examinations of surgical specimen which revealed Histoplasma duboisii fungus. Medical treatment, after surgical repair, consisted in ketoconazola with positive results after 12 months. This localisation is rare. It raises diagnosis problems with tuberculous spondylodiscitis because of their radio-clinical resemblance.

Abscess↗
PubMed2001

[Secondary subdural hematoma in dural metastasis of prostatic adenocarcinoma].

Non traumatic subdural hematoma secondary to dural metastases is a rare event but is well documented. We report a case of a 73-year-old man who presented a subdural hematoma secondary to dural metastases from prostatic adenocarcinoma. The diagnostic was made during the operation. The bone and the dura-mater were infiltrated by tumor cells. Mechanisms of transdural invasion by metastatic adenocarcinoma and production of hematoma are discussed and the relevant literature is reviewed.

Adenocarcinoma↗
PubMed2000

Microanatomy of the pericallosal arterial complex.

OBJECT: The pericallosal arterial complex supplies the callosal and pericallosal regions, as well as the anterior two thirds of the medial and superomedial aspects of both hemispheres. It is composed of the pericallosal artery (that is, the segment of the anterior cerebral artery located distal to the anterior communicating artery [ACoA]) and the median callosal artery (or third pericallosal artery), which originates from the ACoA. This system was studied in 46 specimens (23 human cadaver heads) injected with colored latex. METHODS: After being injected with colored latex, embalmed, and bleached, the specimens were studied with the aid of optic magnification. The pericallosal artery was found to be divided into four segments (A2-A5 in the proximodistal direction). After giving rise to central, callosal, and cortical branches, it terminated near the splenium of the corpus callosum as the posterior pericallosal artery, or on the precuneus as the inferomedial parietal artery. CONCLUSIONS: The authors propose a logical classification of the different variations in the pericallosal arterial complex based on embryological development. This complex can be considered a hemodynamic solution to an abnormal regression of one of its parts, which is balanced by the development of supplemental channels from other parts.

Anterior Cerebral Artery↗
PubMed2000

[Cerebro-meningeal hemorrhage secondary to ruptured vascular malformation during pregnancy and post-partum].

Thirty two new cases of vascular malformations discovered during pregnancy were reviewed in a multicentric retrospective study and compared to the literature. The authors studied both the influence of pregnancy and post-partum on cerebral vascular malformations and the corresponding neurosurgical and obstetrical management. The relative frequencies of arteriovenous malformations (AVMs) and arterial aneurysms (AAs) is the same for pregnant and non-pregnant women. Pregnancy does not increase the risk of first bleeding of vascular malformations but the risk of re-bleeding is increased for AVMs. The bleeding of a vascular malformation is more strongly correlated to age than to parity. The mean maternal age at the time of rupture is greater for AAs than for AVMs, as it is in the general population. The bleeding of a vascular malformations occurs more frequently during the second and third trimesters of pregnancy than in the first one and in the post-partum. Labor and delivery are not great-risk-periods. Management of vascular malformation in pregnant woman is proposed as follow : --a ruptured AA or AVM is managed as it is in non-pregnant woman, whatever the gestational age; no fetal extraction needs to be performed except ed if the rupture occurs at the very end of the pregnancy;--an non-ruptured AVM discovered during pregnancy is treated after delivery; an non-ruptured AVM that never bled before pregnancy is managed in the same way that an non-ruptured AA.

Aneurysm, Ruptured↗
PubMed1999

[Tentorial meningioma. Surgical experience with 20 cases].

We report our experience and long-term results of twenty patients with tentorial meningiomas who underwent surgical removal between 1987 and 1996. Computed tomography, angiography and magnetic resonance imaging were used as diagnostic tools for planning the surgical procedure. The tumor site was posterolateral in 6 cases (30%), posteromedial in 4 cases (20%), in the tentorium itself in 4 cases (20%), anterolateral in 3 cases (15%), at the apex of tentorial incisura in 2 cases (10%) and at the free border of the tentorial notch in 1 case (5%). Neuroradiologically, 70% of the meningiomas ranged from 1 to 3 cm. Lateral and medial tumors with solely or mainly supratentorial development were approached from above. The approach from below was selected for meningiomas with subtentorial involvement only. In meningiomas with both supra and subtentorial growth, a supratentorial bone flap was combined with a suboccipital craniectomy using a retromastoid incision. Radical surgical removal (Simpson's grade I and II) was achieved in 80% of the cases. There was no mortality. The follow-up averaged 4 years and revealed that 65% of patients were able to return to their premorbid activity. Complications were mainly postoperative brain oedema, functional deficits, seizures and psychological disorders. Recurrence rate amounted at 6.25% in the group where the tumors were totally removed (16 cases). From this retrospective study, the statistically significant prediction of a good outcome was: duration of symptoms from onset to the operation inferior or equal to 1 year (p < 0.01), good preoperative neurological conditions (Karnofsky scale from 80 to 100) (p < 0.05) and tumor size inferior or equal to 3 cm (p < 0.002).

Adult↗
PubMed1998

[Development of the corpus callosum (CC)].

Corpus callosum embryology can be divided into three parts: during "commissuration", a cellular mass develops between the two telencephalic vesicles. The primitive lamina terminalis corresponds to the closing point of the anterior neuropore. Its dorsal part grows and forms the lamina reunions (6-8 intra uterine weeks, IUW). From ventral to dorsal, this lamina reunions gives rise to the area praecommissuralis (origin of the anterior commissure), to the primordium hippocampi (10 I.U.W., fornix), and to the massa commissuralis (10 S.I.U., corpus callosum). Fibers arising from the developing hemispheres run through this primitive corpus callosum. The growth of the corpus callosum follows the expansion of the hemispheres, in a rostro-caudal and then dorso-ventral circular movement. The last part of the corpus callosum to form is the rostrum. Maturation occurs postnatally, and corresponds to axonal elimination, and myelination, progressively changing the callosal connection pattern of the newborn and infant into the adult pattern.

Animals↗
PubMed1998

[Morphologic anatomy of the corpus callosum].

The corpus callosum is a neopallial commissure. In inferior vertebrates, the pallial commissures are essentially represented by the anterior commissure. The corpus callosum appears in mammals only. Eutherians alone have a corpus callosum, the other mammals have an anterior commissure and hipocampal commissure. In humans, the different portions of the corps callosum are described on a median sagittal slice: rostrum, genu, body, isthmus, splenium. Klingler method allows to dissect fibers of each of these portions and their relationship with the corona radiata and optic radiations. These latter are separated from the ventricular ependyme by callosal radiations. Finally, each part of the corpus callosum participates in lateral ventricle wall formation.

Animals↗
PubMed1998

[Arterial and venous vascularization of the corpus callosum].

Blood supply of the corpus callosum is assured by two arterial systems, the carotid system mainly and the vertebrobasilar system accessorily. The carotid system intervenes via the pericallosal artery, portion of the anterior cerebral artery distal to the anterior communicating artery. This pericallosal artery can be bihemispheric in 4 to 12% of the cases or azygos in 0.26% of cases. In 20 to 80% of cases, the median callosal artery arises from the communicating artery. The vertebrobasilar system intervenes in splenium vascularization by its terminal branches. These two carotid and vertebrobasilar systems give rise to perforating arteries that assure intrinsic vascularization of the corpus callosum creating a system of regular vascular stitches around the fibers of the corpus callosum. The venous drainage of the corpus callosum is essentially via callosal veins and callosocingulate veins towards the deep venous system of the brain.

Animals↗
PubMed1998

[Surgical approaches to the corpus callosum].

There are no dedicated approaches to the corps callosum itself. The different approaches, subcallosal, supracallosal and posterior to the splenium are usually used to reach neighboring structures such as third ventricle or pericallosal arteries. MRI is the best guideline to reach a specific position in the corps callosum and must imperatively contribute to the choice of the type of approach. During the procedure, it is necessary to take great care to protect the vessels, arteries and veins especially, to avoid ischemic damage which is the main complication of these approaches.

Cerebrovascular Circulation↗
PubMed1994

[Medicosurgical approach of intracranial pyogenic bacterial suppurations in Abidjan. Analysis of 26 clinical cases].

We report 19 cases of cerebral abscesses and 7 cases of subdural empyemas in 5 months to 63 years old patients (1983-1991). Bacteriological agents in 13 cases are. 6 Staphylococcus aureus, 5 negative Gram bacilli, 1 Streptococcus, 1 pneumococcus. Predisposing factors are sepsis of adjacent organs (42%), septicemia (19%), post-traumatic and post-surgical infections (19%). Lethality is 11.5%. The authors stress the interest of CT scan and bacteriological studies now available in Abidjan with the creation of the Department of Neurosurgery.

Adolescent↗
PubMed1993

[Pituitary abscess, treated by medication].

Pituitary abscesses are rare. The case reported here concerns a 28-year old African. Gradual development of diplopia over 6 months was the first clinical manifestation. Three months later this development had reached a more severe and infectious context, with complete right ophthalmoplegia, meningitis and coma (GCS = 9). CT scan showed an image in favour of a pituitary abscess with suprasellar extension, associated with thrombophlebitis of the cavernous sinus. An antibiotic therapy consisting of cefotaxime and metronidazole administered for 1 month, and netilmicin for 15 days succeeded in controlling the infectious syndrome. This resulted in cure of visual disorders, reduction in size of the CT scan image and reconstruction of the pituitary sella which had been destroyed. The diagnosis of pituitary abscess should be made when confronted with an infectious syndrome (unexplained fever, repeated meningitis). CT does not recognize the nature of the hypophyseal mass it shows: necrosis of a pituitary adenoma, giant aneurysm or craniopharyngioma may mimic local infection. Surgery confirms the diagnosis and is regarded as the best treatment. The patient's life is threatened when meningitis is present, and the functional prognosis is poor when recovery from visual disorders is compromised due to late diagnosis. In this paper a comparative analysis of the clinical course of the disease and therapeutic data in our patient is presented and compared with other reported cases.

Abscess↗
PubMed1993

[Tuberculous abscess of the cerebellum].

Cerebral tuberculous abscess is exceptional. We report on the case of a H.I.V. positive 29 year-old man suffering from high intracranial pressure together with a cerebellar syndrome. The CT scan revealed a voluminous abscess of the left cerebellar hemisphere. Anatomical and pathological examination of the extracted mass showed a tuberculous abscess. 16 months after surgery and antituberculous treatment, the patient's symptoms have disappeared and he has resumed his professional activities. Though controversial, a pathogenic continuum between a tuberculoma and a tuberculous abscess may be assumed to exist. The A.I.D.S. pandemic reactivates the tuberculous foci, increases the risks of contagion reduced the effectiveness of treatment, and justifies a systematic search for the bacillus of Koch, after puncture, in any cerebral abscess.

AIDS-Related Opportunistic Infections↗