Biomedical subjects
R Boet
Publications and source records attributed to R Boet.
Childhood posterior fossa pial-dural arteriovenous fistula treated by endovascular occlusion.
Posterior fossa dural arteriovenous fistulae in children are rare lesions that are difficult to treat effectively. We report a case of a 2-year-old girl with such a fistula, who presented clinically with progressive neurological deficit. The lesion was treated by endovascular occlusion, resulting in radiological and clinical cure.
The management of residual and recurrent intracranial aneurysms after previous endovascular or surgical treatment--a report of eighteen cases.
OBJECT: We wish to report our experience in the management of residual or recurrent intracranial aneurysm after previous endovascular or surgical treatment. METHODS: We performed a retrospective review of the clinical notes, operation records and cerebral angiograms of eighteen patients who were known to have undergone treatment for residual or recurrent aneurysms. RESULTS: During the period of April 1994 to May 1999, 210 patients were treated for an intracranial aneurysm either surgically or by endovascular methods. Eighteen of these patients (8.6%) were subsequently treated for residual or recurrent aneurysm. Thirteen achieved a complete occlusion. Complete occlusion was achieved in five of the eight patients who underwent endovascular treatment as a second procedure. Seven out of ten surgical cases achieved complete occlusion. Fifteen patients made a good recovery according to the Glasgow Outcome Score. Two patients who presented in a poor grade subarachnoid haemorrhage (SAH) were left severely disabled. One patient died after retreatment. CONCLUSIONS: The treatment of cerebral aneurysm remnants can be performed effectively using a variety of modalities. The original purpose of the treatment, which is total occlusion of the lesion, can thus be achieved.
Spinal cord pilocytic astrocytoma with cranial meningeal metastases.
Dissemination of tumour cells along the cerebrospinal fluid (CSF) pathway has been reported mostly in medulloblastomas, germ cell tumours or high grade gliomas. Juvenile pilocytic astrocytoma (JPA) is usually a benign astrocytoma. However, drop metastases of indolent nature from intracranial tumours to the spinal cord are documented. All of the previously reported cases represent metastases of cerebellar or hypothalamic tumours spreading to the spinal cord. We document in this paper the first report of a spinal cord pilocytic astrocytoma spreading via the CSF to the cerebral meninges. A 9 year old girl had a JPA of C5 to C7 subtotally resected. Two and a half years later she presented with hydrocephalus with radiologically meningeal enhancement. The meninges were biopsied which showed metastatic JPA. The girl was relatively well 4 years after initial surgery with residual tumour. Spinal cord JPA can rarely metastasize to the cranial meninges. Similar to intracranial tumours which spread to the spinal cord, such metastatic lesions are indolent.
Magnesium sulfate in the management of patients with Fisher Grade 3 subarachnoid hemorrhage: a pilot study.
OBJECTIVE: To evaluate the effect of magnesium sulfate (MgSO4) on the clinical course of patients with severe aneurysmal subarachnoid hemorrhage (SAH). METHODS: Ten patients with Fisher Grade 3 aneurysmal SAH were evaluated. The patients were given a bolus as well as a constant infusion of intravenous MgSO4 up to 10 days postictus. Blood magnesium levels were obtained to adjust the daily requirement of MgSO4. The goal was to raise the serum level to 2.0 to 2.5 mmol/L or twice the baseline serum level. Daily transcranial Doppler (TCD) ultrasonography was performed on each patient, insonating both anterior cerebral and middle cerebral arteries. Further management followed standard protocols, including the use of nimodipine and hypervolemic therapy. TCD ultrasonographic findings, as well as clinical evidence of cerebral vasospasm, were documented. All patients had a 3-month assessment using the Glasgow Outcome Scale. RESULTS: After administration of a 20 mmol MgSO4 bolus infusion and an average daily continuous infusion of 84.7 mmol, 8 of 10 patients achieved the predetermined serum magnesium levels. No adverse affects were noted during the infusions. Five patients exhibited evidence of vasospasm on TCD ultrasonography; vasospasm was severe in two patients (velocities, >200 cm/s). Three patients, including the two patients in whom TCD ultrasonography demonstrated severe vasospasm, exhibited clinical evidence of vasospasm. Two patients had a Glasgow Outcome Scale score of 3; the remainder had Glasgow Outcome Scale scores of 5. CONCLUSION: Administration guidelines for the use of MgSO4 in aneurysmal SAH were established. A prospective double-blind placebo-controlled trial is required to establish the effectiveness of MgSO4 for treating vasospasm in aneurysmal SAH.
Mothers' understanding of the graphic representation of weight gain on 'Road to Health' cards.
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