Biomedical subjects

P Fréger

Publications and source records attributed to P Fréger.

18 recordsLinked to original sources

PubMed2005

[Unruptured intracranial aneurysm: possible therapeutic strategies?].

Intracranial unruptured aneurysm (ICUA) has become a common condition for patient consultation. The mortality rate after fissuration is estimated to be between 52% and 85.7%. The final therapeutic decision results from a balance between the risk of rupture and risks related to the aneurysmal exclusion. Analysis of the risk of rupture risk enables a classification of risk factors. Depending on the circumstances of diagnosis, we considered the ICUA at high risk of rupture for incidental ICUA larger than 7 mm and in the event of associated aneurysms. Classifying by morphologic features, high-risk ICUA were located in the vertebrobasilar system (RR: 4.4; 95%CI: 2.7-6.8), those with a size between 7 and 12 mm (RR: 3.3; 95%CO: 1.3-8.2), larger than 12 mm (RR: 17; 95%CI: 8-36.1), those that were multilobular or a larger size and those ones with a index P/L superior to 3.4 (risk x20). Familial ICUA would expose to a major rupture risk (2 to 7 times sporadic ICUA). Some systemic factors were related to ICUA rupture: arterial hypertension (RR: 1.46; 95%CI: 1.01-2.11) and smoking addiction (RR: 3.04; 95%CI: 1.21-7.66). After microsurgical exclusion, the morbidity and mortality rates were 10% and 2% respectively. Some microsurgical morbidity factors were identified: age (32%>65 years), size (14%>15 mm), vertebrobasilar location and temporary occlusion. The rupture incidence after microsurgical exclusion was estimated 0.26%/year. After endovascular exclusion, the morbidity and mortality rates were 8% and 1% respectively. The complete exclusion rate varied between 47% and 67%. The rupture risk was estimated at 0.9%/year. Treatment recommendations were classified into 3 categories.

Humans↗

PubMed2002

The synovial fold of the humeroradial joint: anatomical and histological features, and clinical relevance in lateral epicondylalgia of the elbow.

The synovial fold of the humeroradial joint is known, and sometimes considered as a meniscus that could be injured by chronic repeated trauma related to pronation and supination. The aims of this study were to determine the gross anatomy and histological structure of this fold, and to clarify its participation in the painful lateral syndromes of the elbow. Fifty elbows from adult cadavers were dissected. The capsule of the humeroradial part of the elbow joint was resected with the annular ligament. The presence of a synovial fold, and its location relative to the cranial edge of the annular ligament divided into five sectors (ventral, ventrolateral, lateral, laterodorsal and dorsal) were noted; morphological parameters such as thickness, width and length were measured. The histological examination determined the structure of the folds. Five synovial folds were resected during surgery for epicondylalgia in five patients who suffered from pain precisely at the level of the joint between the capitulum and the fovea radialis, and were also examined. A fold was present in 43 cases, and in two cases two folds were seen at the deep side of the junction between the capsule and the annular ligament. The most frequent positions were: dorsal ( n=11), laterodorsal and dorsal ( n=6;), lateral to dorsal ( n=5), lateral ( n=5), ventral ( n=4) and circular ( n=4). The mean length was 21.4 mm (range from 9-51 mm). The mean width was 2.9 mm (range 1-10 mm), and the mean maximal thickness 1.7 mm (range 1-4 mm). The histological study showed two types of folds: a rigid structure, with oriented fibrous tissue, triangular with a peripheral capsular base, covered on its two sides and along the free edge by a synovial layer; and a pliable structure, formed of two synovial layers that surrounded a thin fatty tissue, with a villous appearance of the free edge. No fibromyxoid structure, as in a real meniscus, was observed. Some nerve fibers were seen in the folds. The five folds resected in operated patients were hypertrophic, and showed an increased number of nerve fibers, along the capsule but also close to the synovial layer. Some painful syndromes of the lateral side of the elbow are not related to tendinitis or to posterior interosseous nerve compression, but have an intra-articular origin. This study showed that the synovial fold is not a meniscus, and may be involved in the etiology of lateral epicondylalgia.

Adult↗

PubMed2002

[Ewing's sarcoma of the ethmoid bone. Case report].

Ewing's sarcoma is rarely located at the base of the skull. We report a case of ethmoid Ewing's sarcoma. Diagnosis was established on microscopic examination. A complete surgical resection was performed, followed by cranial base reconstruction. During the postoperative period, a combined course of chemotherapy and radiotherapy was performed. We also present a review of the literature.

Adult↗

PubMed2002

[Primary cauda equina epidermoid cyst. A case report].

A primary epidermoid cyst of the cauda equina was diagnosed in an eleven-year-old boy. The patient had a previous two months history of lumbar pain with unilateral L 4 radicular pain. The diagnosis of an epidermoid cyst of the cauda equina, suspected by MRI, was confirmed by histology following surgery. Wide tumor resection, as complete as possible, was performed with minimum trauma. Presence of an epidermoid cyst in the filum terminale is a rare finding, few cases have been reported in the literature. However, surgical treatment and favorable post-operative course are similar to that observed in intraspinal localizations. MRI is helpful for the preoperative and differential diagnosis and for post-operative follow-up.

Cauda Equina↗

PubMed2002

Angiographic cerebral vasospasm and delayed ischemic deficit on anterior part of the circle of Willis. Usefulness of transcranial Doppler.

BACKGROUND AND PURPOSE: After subarachnoid hemorrhage (SAH), cerebral vasospasm (VS) may be revealed by cerebral angiography, during follow-up clinical examination with the occurrence of delayed ischemic deficit (DID). Moreover, transcranial Doppler (TCD) could be useful in determining the level of the velocimetric threshold. The aims of the study were, on a prospectively collected series of 460 patients, to assess angiographic VS incidence, to determine possible risk factors, and to evaluate diagnostic sensitivity and specificity of TCD. PATIENTS AND METHOD: A total of 460 patients consecutively operated on for an aneurysm located on the anterior portion of the circle of Willis (mean age 47.2 +/- 14 years, sex ratio F/M=1.18) were included in the study. Preventive treatment against VS was administered in all patients. On the 10(th) day, we performed the following routine examinations: cerebral angiography, CT scan and TCD. RESULTS: Angiographic VS occurred in 38.5% of the patients, and the single risk factor was delayed admission (p=0.02, Mann-Whitney test). DID occurred in 15.6% and was complicated by cerebral infarct in 4.7%. The risk factors were admission date (p=0.001, Mann-Whitney test) and severity of arterial narrowing (significant tendency). Diagnostic sensitivity of TCD decreased from 83.6% for MCA aneurysms, to 66.6% for ICA aneurysms and 40.6% for AcoA aneurysms. Diagnosis specificity remained between 88.6% and 97.6% for the 3 locations. CONCLUSION: The unique risk factor for angiographic VS and DID was the admission date. TCD demonstrated high specificity but its sensitivity was too low for the aneurysms located far from the middle cerebral artery bifurcation.

Albumins↗

PubMed2001

Arterial blood supply of the proximal humeral epiphysis.

The arterial blood supply of the proximal humeral epiphysis is known to derive mainly from the anterior humeral circumflex a. (ACA), but this description may minimize the role of the posterior circumflex humeral a. (PCA). The studies of Laing [9] and Gerber [3] emphasized the role of the ACA and of its branches, the ascending anterolateral artery and arcuate artery Thus, this description could not explain either the necrosis or the absence of necrosis in all the cases of fracture or dislocation of the glenohumeral joint. The evaluation of the risk of a vascular post-traumatic necrosis of the humeral head requires a knowledge of its arterial vascularization, and the aim of this study was to determine the respective areas of vascularization of both the humeral circumflex aa. 32 shoulders of adult cadavers were studied: the ACA and the PCA were injected with latex containing two differently colored fluids. The proximal humeral epiphysis was removed with the arteries. The extraosseous vessels and the coloration of the capsule were noted; then the epiphysis was sectioned in 5 mm horizontal scans, and the bone staining was studied in order to define the distribution of the arterial supplies. The origin of the ACA and PCA was common in only 10 cases. The mean diameters were: ACA 0.8 mm (0.3 to 2) and PCA 2.1 mm (1.5 to 4). The subchondral bone was colored in 29 specimens by the PCA, and by both the ACA in the cranial part and PCA in the caudal part in 3. The apex of the head was colored by the ACA in 7 cases, the PCA in 7 and both ACA and ACP in 1 case; the head was colored by the PCA in 17 and the ACA in 12 cases; the lesser tubercle by the ACA in 23, the PCA in 2 and both arteries in 7 cases; the greater tubercle by the PCA in 19, the ACA in 5 cases and both in 1 case; the intertubercular groove by the ACA in 29, the PCA in 1 and both arteries in 2 specimens. The arcuate a. was distributed along the metaphyseal side of the epiphyseal plate, and small branches crossed the plate to reach the epiphyseal side and give numerous anastomoses to the branches of the ACA or the PCA. The diameter of the ACA was constantly smaller than that of the PCA. Exclusive vascularization of the humeral head by the ACA was not confirmed. The roles of both the ACA and PCA remain important, and must be taken into account in evaluating the risk of necrosis after a fracture, by carefully considering the topography of the separation and the displacement of the different parts.

Adult↗

PubMed2001

Pediatric cerebral aneurysms.

OBJECT: The exceptional pediatric aneurysm can be distinguished from its adult counterpart by its location and size; however, patient outcomes remain difficult to evaluate based on the published literature. METHODS: Twenty-two children, all consecutively treated in three neurosurgery departments, were included in this study. Each patient's preoperative status was determined according to the Hunt and Hess classification. Routine computerized tomography scanning and angiography were performed in all children on the 10th postoperative day. Each patient's clinical status was evaluated 2 to 10 years postoperatively by applying the Glasgow Outcome Scale (GOS). Twenty-one children presented with a subarachnoid hemorrhage (SAH) and one child harbored an asymptomatic giant aneurysm. Thirteen patients were in good preoperative grade (Hunt and Hess Grades I to III) and eight in poor preoperative grade (Hunt and Hess Grade IV or V). The symptomatic aneurysms were located on the internal carotid artery bifurcation (36.4%); middle cerebral artery (36.4%), half of which were found on the distal portion; anterior communicating artery (18.2%); and within the vertebrobasilar system (9.1%). A giant aneurysm was observed in 14% of patients. Overall outcome was favorable (GOS Score 5) in 14 children (63.6%) and death occurred in five (22.7%). Causes of unfavorable outcome included the initial SAH in four children, a complication in procedure in three children, and edema in one child. CONCLUSIONS: Pediatric aneurysms have a specific distribution unlike that of aneurysms in the adult population. The incidence of giant aneurysms and outcomes were similar to those in the adult population. The major cause of poor outcome was the initial SAH, in particular, the high proportion of rebleeding possibly due to a delay in diagnosis.

Adolescent↗

PubMed1999

Simultaneous presentation of atypical teratoid/rhabdoid tumor in siblings.

Atypical rhabdoid/teratoid tumor (ATT/RHT) is a rare malignant neoplasm which appears in early childhood. The present paper describes clinical and pathological features of ATT/RHT which occurred simultaneously in 2 sisters diagnosed at a 15 day interval. Both children were treated by surgical resection, subtotal in the first case and total in the second. Postoperatively, chemotherapy followed by radiotherapy, 50.4 Gy on the posterior fossa, were administered. Despite this therapy, both sisters died at 14 months and 26 months respectively. The tumors express vimentin and EMA; cells contained intracytoplasmic inclusions. No karyotypic anomaly was detected. This is the first description of familial ATT/RHT.

Brain Neoplasms↗

PubMed1999

Usefulness of transcranial color-coded sonography in the diagnosis of cerebral vasospasm.

BACKGROUND AND PURPOSE: The noninvasive diagnosis of cerebral vasospasm with the use of conventional transcranial Doppler ultrasonography (TCD) is based on a velocity study of the middle cerebral artery (MCA). The authors report a prospective comparative study between transcranial color-coded sonography (TCCS), conventional transcranial Doppler (TCD), and angiography in the diagnosis of cerebral vasospasm after surgical treatment for aneurysm. METHODS: Thirty consecutive patients underwent routine angiography after surgical treatment for intracranial aneurysm. The distribution of vasospasm was determined after a prospective calculation of the angiographic diameter of the MCA, internal carotid artery (ICA), and anterior cerebral artery (ACA). The blood flow velocities (systolic and maximum) of the MCA, ICA, and ACA were evaluated by TCCS and TCD. RESULTS: The correlation between mean maximum velocity and angiographic diameter was significant for the MCA (r=-0.637, P<0.0001), ICA (r=-0.676, P<0.0001), and ACA (r=-0.425, P<0.01). TCCS sensitivity and specificity were higher than those for TCD for MCA (100% and 93%, respectively) and ICA (100% and 96.6%, respectively). For ACA, the sensitivity and specificity were 71.4% and 84.8%, respectively. CONCLUSIONS: The authors suggest that TCCS is useful for accurate monitoring of cerebral vasospasm in the MCA and ICA. In the ACA, TCCS monitors the hemodynamic state of the anterior part of the circle of Willis, which could expose the patient to a delayed ischemic deficit.

Adult↗

PubMed1998

[Combination treatment for pilocytic astrocytoma: stereotaxic radiosurgery and endocavitary radiotherapy].

The treatment of a pilocytic astrocytoma located in a functional area can be performed using radiosurgery. We report a 7 year old male, right-handed, who presented with a pilocytic astrocytoma in the left parieto-occipital lobe. After a 7 year follow-up, the tumor became symptomatic (partial and generalized seizures). The CT scan and nuclear magnetic resonance imaging revealed an increased size of the mural tumor and the development of a cystic component. Multi-beam irradiation of the tumor (dose of 30 Gy at the center with 21 Gy on the isodose 70%) was performed with a LINAC for radiosurgery coupling a modified Saturne 18 MeV linear accelerator and a Talairach stereotactic frame. Following multi-beam irradiation, the increase in size of the cyst imposed further intracavitary radiation using Rhenium 186 (186Re) to deliver 400 Gy to the cyst wall. After a period of intense cerebral edema, resolutive with steroid treatment, we obtained progressive cyst disappearance and mural nodule retraction. A PET scan, performed 3 years after this treatment, revealed no metabolic activity in the persistent mural nodule. The patient remains totally asymptomatic.

Astrocytoma↗

PubMed1997

Outcome in 43 patients with distal anterior cerebral artery aneurysms.

BACKGROUND AND PURPOSE: The aim of this retrospective multicenter study was to evaluate the outcome of distal anterior cerebral artery (DACA) aneurysms and to determine the incidence, causes, and consequences of unfavorable outcomes. METHODS: 43 patients with 50 DACA aneurysms (27 females and 16 males, mean age 49 years) were studied retrospectively. Forty-four DACA aneurysms were treated surgically (83% with an interhemispheric approach), and 2 were embolized. At postoperative day 10, all patients underwent routine angiography. The outcome at 6 to 12 months was scored according to the Glasgow Outcome Scale (GOS). RESULTS: 35 DACA aneurysms were ruptured. Among the 26 "good"-grade patients (Hunt and Hess grades I through III), 18 (69.2%) were in GOS 1, 2 in GOS 2 (7.7%), 2 in GOS 3 (7.7%), and 4 in GOS 5 (15.4%); among the 9 "poor"-grade patients (Hunt and Hess grades IV and V), 1 (11.1%) was in GOS 1, 2 in GOS 2 (22.2%), 2 in GOS 3 (22.2%), and 4 in GOS 5 (44.5%). The initial intracerebral hemorrhage (ICH) (40%) induced neurological aftereffects in 8 patients. An operative rupture occurred in 40%, with a temporary occlusion in 28.6% that was responsible for mediocre results in 3 patients (8.7%). A postoperative thrombosis was observed in 4 patients (11.4%) and an aneurysmal remnant in 1 (2.8%). Ten DACA unruptured aneurysms were clipped without operative rupture or thrombosis. CONCLUSIONS: The authors suggest that the proportion of ruptured DACA aneurysms evolving to a GOS 1 or 2 was similar to that of aneurysms found in other locations, after early surgery. Endovascular treatment should be considered in the management of uncommon ruptured fusiform DACA aneurysms.

Adolescent↗

PubMed1997

Tentorial edge traumatic aneurysm of the superior cerebellar artery. Case report.

The authors report an unusual case of a traumatic aneurysm of the right superior cerebellar artery (SCA). A 22-year-old woman presented with continuous headaches that appeared 15 days after she experienced closed head trauma as a result of a cycling accident. Computerized tomography scanning performed 3 months later showed a nodular lesion on the free edge of the tentorium, which mimicked a meningioma. The aneurysm was identified on magnetic resonance angiography, which showed the SCA as the parent vessel. The parent vessel was trapped, and the aneurysm sac was excised via right temporal craniotomy. Pathological examination of the sac revealed a false aneurysm. The patient's outcome was excellent. The pathophysiology of traumatic aneurysm at such a location suggests that surgery may be the treatment of choice.

Accidents, Traffic↗

PubMed1997

[Isolated cerebral metastases disclosing rectal adenocarcinoma].

Colorectal cancer is usually revealed by modifications of bowel habit and/or signs of haemorrhage. Hepatic and lung metastases are the common sites of metastatic involvement of this cancer. Brain metastasis are rare, especially when they are isolated. We report the case of a 37-year-old patient presenting with isolated brain metastasis revealing a rectal cancer. The patient was initially treated by surgical excision of the symptomatic brain metastasis, followed several days later by anterior resection of the rectum and whole-brain radiotherapy. This unusual strategy, due to the lack of preoperative diagnosis, did not improve the poor prognosis of brain metastasis.

Adenocarcinoma↗

PubMed1997

[Intracranial meningioma in the elderly. Postoperative mortality, morbidity and quality of life in a series of 39 patients over 70 years of age].

UNLABELLED: The aim of this study was to assess the current morbidity and mortality in patients over 70 operated for intracranial meningioma. PATIENTS AND METHOD: We report a series of 39 consecutive patients (mean age: 73 y) operated for an intracranial meningioma over a period of 5 years (1990-1994). According to the Karnofski scale (KS), preoperative neurological status was inferior or equal to 70 in 21 patients (53.8%) and superior or equal to 80 in 18 (46.2%). All patients were followed up in order to precisely assess their post-operative condition and a computed tomographic scan (CT scan) was performed during the second semester of 1995 (mean follow-up 29 months). RESULTS: Operative mortality and permanent morbidity were respectively 7.6% and 10.3%. In 77% of this series, the KS score checked at the last follow up was 80 to 100 (good outcome). Poor outcome was defined by death or a postoperative (KS < or = 70, the principal cause being an hemorrhagic infarction. Three factors were predictors of poor outcome: poor preoperative neurological condition (KS < or = 70) (p = 0.07), location of the tumor on the base (p = 0.007), and the duration of surgery > 3 hours (p = 0.06). The logistical regression analysis showed that these three factors were independent. Tumor recurrence occurred in 5 (12.8%) of 39 patients. CONCLUSION: Preoperative KS is a prognosis factor, but a poor preoperative condition is not in itself a sufficient condition contraindicating surgery. The rates of operative mortality of 7.6%, and permanent operative morbidity of 10.3% can be given to patients and their families.

Aged↗

PubMed1995

[Stress-induced pituitary apoplexy in 2 phases].

A case of pituitary apoplexy occurring in the context of physical effort is reported. A 47-year-old man presented headache after a foot-race. Secondary visual deficit developed. On admission, bilateral cavernous sinus syndrome with bitemporal hemianopia was observed. The CT scan showed an enlarged sella eroded by an intrasellar soft tissue mass. Magnetic resonance imaging (MRI) confirmed the presence of the mass with peripheral enhancement following gadolinium injection. Decompression was carried out by transsphenoidal surgery. The microscopic study demonstrated infarction of the anterior hypophysis with peripheral tissular scarring. The post-operative outcome was characterized by visual recovery and anterior hypophyseal insufficiency. The possible pathophysiological mechanisms are discussed.

Endoscopy↗

PubMed1995

[Vasospasm after rupture of aneurysms of the anterior communicating artery. Sensitivity and specificity of transcranial Doppler].

This study was undertaken to determine the sensitivity and specificity of the transcranial Doppler (TCD) for diagnosis of vasospasm after rupture of anterior communicating artery (CoA) aneurysm. Results provided by 164 carotid angiograms and TCD measures were compared in 40 patients with CoA ruptured aneurysm. Twelve patients demonstrated a vasospasm on 22 angiographies. The distribution of angiographic vasospasm was 95.5% anterior cerebral artery (A1), 77.3% pericallosal artery (A2) and 59.1% middle cerebral artery (M1). A TCD velocity value equal or superior to 120 cm/sec was the criterion for TCD vasospasm on M1. The sensitivity of TCD on M1 for diagnosing vasospasm on M1 with high specificity (96.4%) was only 66.7%. A TCD velocity value equal or superior to 80 cm/sec, or superior to the homolateral TCD value on M1, was the criterion for TCD vasospasm on A1. The association of TCD criteria on A1 and M1 increased sensitivity to 83.3%, but specificity decreased to 75%. These results demonstrate that TCD is not yet efficient enough to diagnose vasospasm accurately when it is limited to A1. Moreover, the fact that vasospasm limited to A1-A2 was symptomatic in three patients suggests that angiography is still necessary to diagnose VS after CoA ruptured aneurysm.

Adult↗

PubMed1994

[Multiple cerebral aneurysms disclosed by subarachnoid hemorrhage. Apropos of 60 cases].

In a series of 60 consecutive patients, 137 multiple aneurysms (An) were discovered after subarachnoid hemorrhage. Multiple An were mostly double (83 % of the patients). The incidence of middle cerebral artery An was 42 %, internal carotid artery An 25.5 %, anterior communicating artery An 15 %. Both angiography (A degree) and CT scan could identify the ruptured An in 56 cases or at least the side of the ruptured An in the remaining 4 cases. Among the routine A degree criteria used to determine which one of the An had bled the most reliable ones appears to be: the existence of vasospasm of the parent artery, the bigger size of the sac, the irregular wall of the sac. The incidence of rupture is the highest in anterior communicating artery An (16/21). When an An located on the polygon of Willis is associated to a distal An, the former ruptures in 17 cases/18. All ruptured An were treated during the first operative session. In 47 patients (78.3%) all the An, ruptured and asymptomatic, were treated during the first procedure or in one or two additional surgical sessions. In 13 patients (22.7%) for several reasons only ruptured An and asymptomatic An that could be reached via the same craniotomy were treated. There was no morbidity or mortality related to the surgical treatment of asymptomatic An.

Aneurysm, Ruptured↗

PubMedDate not supplied

[Primary carcinoma of the pituitary gland with Cushing's syndrome and metastases. Apropos of a case with review of the literature].

We report the case of a 25 year old man with pituitary carcinoma with Cushing's syndrome. Though the diagnosis was initially proposed, it was only confirmed by the appearance of meningeal and lymphatic metastases. These were secretory, as confirmed by immunocytochemistry and electron microscopy. These tumours are rare, whether they secrete or not, and can be confirmed only by the existence of metastases, most often in the brain or the liver.

Adult↗