Biomedical subjects
Publications and source records attributed to P Mathurin.
The vascular tumors of the jaw bones are rare. Misdiagnosed, these tumors represent a vital danger for the patient submitted to a surgical work in this area. The treatment of these vascular tumors is oft difficult and leads yet too much to maxillofacial mutilations. The superselective embolisation has permit a more conservative therapeutic approach to these lesions.
A comparative study of the imaging findings of computed tomography (CT), selective arteriography, CT arteriography, and/or CT portography is presented in 4 patients with Budd-Chiari syndrome. Hepatic differences in attenuation and morphologic changes were generally found to be closely related with regional disturbances in portal flow. Areas with complete hepatic vein obstruction were hypodense on pre- and postcontrast scans, probably due to portal flow inversion. In 2 of 4 cases, these were subsequently atrophied, while areas receiving the remaining venous outflow appeared hypertrophied. They were markedly enhanced on postcontrast scans. Enhancement may be patchy due to portal and sinusoidal stasis.
A benign papilloma of the choroid plexus of the left lateral ventricle is found in a five-month old infant. An important dilatation of the isolated occipital horn is observed, without generalized enlargement of the ventricles. The clinical signs are limited to a moderate macrocephaly with deviation of head and eyes to the left. The absence of global hydrocephalus is rather exceptional in such cases, where overproduction of cerebrospinal fluid, in an amount proportional to the tumoral mass, is generally admitted. Nevertheless, the literature offers no absolute proof of the role of oversecretion alone in the origin of hydrocephalus, whilst an eventual obstruction of the circulatory pathways and resorption areas of the C.S.F. must be kept in mind. The absence of hydrocephalus, in the present case, suggests that the subarachnoid spaces and arachnoid villi remained patent.
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Sixteen patients, with a total of 18 abscesses, were treated by aspiration and systemic antibiotic therapy, to which antiepileptic prophylaxis and corticosteroids were added. Diagnosis of the abscesses and monitoring of their evolution relied principally upon computed tomography; this technique was also used per-operatively when aspirating small abscesses. Bacteriological examinations were positive in all our cases and a polymicrobial flora was found in half of these. One or, eventually, two aspirations within the same week were sufficient, in most cases, to promote healing. Nevertheless, in three patients, the abscesses, however sterilized, did not show any volume reduction, probably because of adhesions to the dura mater, of a large part of the abscess surface area. One patient died from concomitant cardiac disease and one patient remained seriously disabled. Epilepsy was observed as a sequela, in six patients. This study emphasizes the role of neuroradiological and bacteriological examinations, whilst surgery may be restricted, in most cases, to a simple aspiration.
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In a 9 month-old infant, who displayed an epileptic seizure, the Brain CT-Scan shows a ventricular enlargement and a bilateral pericerebral effusion, associated with a left parieto-temporal arterio-venous malformation. Angiogram reveals a small angioma shunting the blood flow from the left middle cerebral artery into the lateral sinus. Intracranial pressure, recorded with a fontanellar transducer, is borderline. The angioma is excised and the operation, during which the subarachnoid location of the pericerebral effusion is confirmed, is followed by gradual subsiding of the internal and external hydrocephalus, that was caused by enhancement of the pressure in the venous sinuses. This case belongs to an infantile form of Benign Intracranial Hypertension, in which CT-Scan has to be interpreted cautiously, to avoid the pitfall of a wrong diagnosis of brain atrophy.
The authors report their experience of three cases of carotid corpuscle tumors: two are bilateral and pertaining to the same family, one of them is associated with a bilateral tympano-jugular glomus. First they review the epidemiology and definitions of such tumors and then they develop the various clinical aspects and differential diagnosis of these tumors. They insist on the necessity of a CT scan examination and of an angiography. They give their experience of the preoperative embolization of the tumour vessels. They expose various aspects of the surgical technique, pointing out the interest of a large access, the need of a regular surgery and the necessary collaboration between head and neck surgeons and vascular surgeons. Finally they discuss the opportuneness to operate bilateral glomic tumors.
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Facet joint arthrography was performed in 11 patients with lumbar spondylolysis. An abnormal communication between the two facet joints bordering the separated par interarticularis was observed in nine of these patients. This communication occurred through a channel in the area of the defect. In one patient with bilateral spondylolysis of the L5 vertebra, both left adjacent apophyseal joints were observed to communicate not only with one another, but also with the contralateral facet joints, through a transverse channel joining the isthmic areas of L5. Significant pain relief following intra-articular administration of anesthetics and corticosteroids was recorded in 5 patients, for periods lasting from 2 to 10 months. Spondylolysis considerably alters the soft tissues of the adjacent facet joints. Irritation of these structures might explain certain complaints of patients with spondylolysis.
Low flow venous malformations in children are a diagnostic and therapeutic challenge. They are present at birth but may not be evident; they have a commensurate growth. They are pure or combined (capillary or lymphatic-venous). At examination, one observed soft, compressible bluish swellings; there is no thrill or bruit. They are slow flow anomalies with venous stasis which may induce thrombosis or localized consumptive coagulopathy. Skeletal distortion or bony hypertrophy or hypoplasia may also be observed; histological examination of surgical specimen reveals infiltration of adjacent structures (skin, bone, muscle); ultrasonography and duplex-Doppler may be helpful in differentiating the venous malformation from lymphatic or arteriovenous anomalies. Diagnosis from hemangioma will be obtained by magnetic resonance imaging; this last investigation will also provide informations on the infiltration of the adjacent tissues by the pathologic process. Standard X ray may show phleboliths of skeletal distortion. Most of venous malformations are asymptomatic and treatment consists in reassuring the child and in giving advice to the parents to prevent trauma to the lesion. Conservative treatment must be advocated (compression garments, prevention of thrombosis with salicylates) since total excision of venous malformation is illusory and postoperative morbidity may be important. Surgical excision of limited cumbersome malformations may be indicated; sclerotherapy of the lesion with Ethibloc makes surgery easier.
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