[Anatomical basis for perineal pain].
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Brain↗
Biomedical subjects
T Riant
Publications and source records attributed to T Riant.
[Perineal pain].
The investigation of patients suffering from perineal pain when sitting led us to perform an anatomical study of the pudendal nerve. We dissected 50 cadavers and found areas of conflict for the nerve fibers. The nerve trunk can become entrapped at the level of the ischiatic spine, in the Alcock's canal and when it crosses the falciform process. Considering the clinical and neurophysiological data, this type of chronic pain may arise from compression of the nerve between the sacro-tuberal and the sacro-spinal ligaments, and/or in the fascia of the internal obturator muscle. Much like treatment of entrapment of the median nerve in the wrist, we decided to treat chronic perineal pain by nerve blocks, and later by surgery. We describe here the clinical symptoms, the neurophysiological data, and the technique of the nerve blocks. For patients with persistent pain, we propose a posterior surgical approach which has provided successful pain relief in two third of patients.
Female↗
[Spontaneous splenic rupture disclosing a pheochromocytoma].
Clinical manifestation of a phaeochromocytoma may range from no symptoms to an acute abdominal emergency. These abdominal emergencies are related to haemorrhagic necrosis of the tumour, or massive bleeding in the retroperitoneal space. The authors report a case of splenic rupture revealing a phaeochromocytoma. The mechanism of splenic rupture is discussed as is the conservative treatment of phaeochromocytoma during splenic surgery. The authors observed no correlation between plasma catecholamine concentration and blood pressure.
Adrenal Gland Neoplasms↗
[Plasma catecholamines in brain death].
The purpose of this study was to find out whether a severe fall in plasma catecholamines levels can be observed in brain dead patients, that might contribute to haemodynamic disturbances in these patients. Plasma catecholamines (epinephrine and norepinephrine) were measured by HPLC combined with electrochemical detection in 18 consecutive brain dead patients referred to the multiorgan donors unit at the Bordeaux University Hospital. Two samples were obtained: the first one at the time of donor referral (11.2 +/- 9 h after the clinical onset of brain death), and the second one just before organ procurement (19.8 +/- 1 h after the clinical onset of brain death). The results showed that plasma catecholamines levels were similar in both samples, with mean values within the normal range. There was no correlation between the plasma levels of each of the catecholamines and the mean arterial pressures at the time of sampling. Very high plasma catecholamines levels have been found by other authors after brain injuries. After the onset of brain death, they return to basal rest values and do not continue to fall as is the case in animal experiments. The haemodynamic disturbances observed in brain dead patients therefore cannot be due only to sympathoadrenal failure.
Adult↗
[Spontaneous rupture of the spleen disclosing pheochromocytoma].
The authors report a case of spontaneous rupture of spleen inaugurating the symptomatology of a pheochromocytoma. After presenting the observation, clinical problems are considered with a deceptive abdominal symptomatology and myocardial ischemia that could be part of an "adrenergic myocarditis"; the mechanism of ruptured spleen is analyzed. The diagnosis approach is discussed through a reliability study of various explorations: computed tomography has a sensitivity ranging from 93 to 97% which approaches 100% when associated with magnetic resonance, methyl-iodo-benzyl-guanidine scanning seems to be provided with similar reliability. During checking up for pheochromocytoma spreading, ectopic location was not found, but a cold thyroid nodule was detected which allowed suspecting a SIPPLE syndrome. The three-stage surgical approach was required by symptomatology, hemostasis splenectomy, lateral pheochromocytoma excision after a short preparation by blocking alpha and beta, and then total thyroidectomy after extemporaneous confirmation of the existence of a medullary carcinoma of the thyroid. This pathologic association leading to a SIPPLE syndrome is listed as part of the multiple endocrine neoplasias of type II (MEN II).
Adrenal Gland Neoplasms↗