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PubMed1976

[Morphological aspects (optical and ultrastructural) of hypertrophy of the olivary bulb].

The present paper is an anatomical study of 3 cases which evolved with hypertrophy of the inferior olives: a case of zoster encephalitis, a multifocal leucoencephalopathy and a post-traumatic encephalopathy. In all three cases a relationship was demonstrated between the dentate nucleus and dento-olivary pathway - a relation of topical order in some instances - and the hypertrophic lesion of the inferior olive. Examination in the electron microscope revealed in the hypertrophic olivary cell not only dystrophic lesions but also progressive intracellular phenomena, such as maintenance of the Nissl bodies, multiplication of the mitochondria and especially marked proliferation of the neuro-filaments. This shows that, at least in some of the evolutive phases, hypertrophy of the inferior olives is based upon a real hypertrophy of the olivary cell. In addition, lesions of the glial system of the hypertrophic inferior olives were noted with the presence of osmiophil degeneration whose morphology clearly differed from that of Rosenthal's fibres.

Adult↗
PubMed1990

[Initial epileptic crisis after the age of 60: etiology, clinical aspects and EEG].

We reviewed retrospectively a series of 100 inpatients with onset of epileptic seizure after the age of 60. All of them were investigated by EEG and 96 by CT scan. The most frequent cause of seizure was previous stroke, with 25 cerebral infarcts and 5 hemorrhages. Neoplastic lesions were present in 18 cases, with glioma (high grade), meningioma and metastases in the same proportion. Other etiologies included toxico-metabolic (18 cases), post-traumatic (9 cases), cerebral atrophy (4 cases) and miscellaneous (14 cases). The causes of seizure remained unknown in 7 patients, of whom 6 had focal signs in either clinical examination or EEG. Focal seizures (with or without secondary generalization) accounted for 65% of all cases and generalized seizures for 35%. The EEG was normal in 12 patients and abnormal in 88, with diffuse slowing in 55 patients and focal signs in 70 (some patients had both diffuse slowing and focal signs). Fourteen patients presented status epilepticus. Ten died during hospitalization. We conclude that epileptic seizure with onset after age 60 is nearly always symptomatic, and neuroradiologic investigations are necessary in the search for cerebral lesions. In our study, the prevalence of "idiopathic epilepsy" is lower than previously described.

Aged↗
PubMed1986

[Difficult diagnosis of a rapidly developing post-traumatic tumor of the thymus region. Encysted hematoma or intracystic hemorrhage?].

We report a case of rapidly developing (subacute) post-traumatic mediastinal haematoma which initially suggested a malignant tumour of the thymus region. The lesion, discovered on the basis of non-specific signal symptoms 2 months after a mild chest injury, consisted of a voluminous tumour of the thymus region associated with pericardial effusion. At angiography, the mass proved to be extravascular. CT scans of the thorax showed that it surrounded, but did not compress, the mediastinal vessels. Surgery revealed an organized encysted haematoma of the thymus region that had ruptured into the pericardial cavity containing a blood collection. The possibility of an intracystic haemorrhage in a cystic tumour preexisting to the trauma is discussed, but a more likely diagnosis would be chronic haematoma, especially since a similar case independent of any injury has already been published.

Adult↗
PubMed1992

Papillary and cystic tumor of the pancreas possibly concealed within a pseudocyst.

A 17 year old girl, with a papillary and cystic tumor of the pancreas, probably concealed within a previous post-traumatic pseudocyst of the pancreas is described. At 10 years of age, she had received a drainage procedure for a pancreatic pseudocyst, following a blunt abdominal trauma. The histological examination of the cyst wall did not show an epithelial lining. Seven years after that, she developed anemia and a computer tomography and ultrasonography of abdomen revealed a 10 cm x 9 cm x 8 cm, cystic, multilocular pancreatic mass with solid parts. On operation, a fist-sized, solid and multilocular cystic tumor, located in the body and tail of the pancreas, and infiltrating into the colonic serosa but with no metastasis, was found and completely excised. Histologic and electron microscopic examination revealed the characteristic features of a papillary and cystic tumor of the pancreas. This report suggests that cystic lesions of the pancreas should be carefully checked to decide the best surgical therapy.

Abdominal Injuries↗
PubMed1986

Coma and the etiology of violence, Part 1.

Coma and the etiology of violence are explored by the author through a review of the literature. Animal studies, post-traumatic psychic disorder studies, post-traumatic anger and violence studies, tumor and lesion of the limbic system studies, temporal lobe epilepsy studies, and episodic dysfunction syndrome studies, minimal brain studies are reviewed in Part 1 of this article. Part 2, to be published in a later issue of the journal, will conclude the review with clinical surveys on violent individuals and studies on clinical treatment of violence.These studies reveal the etiologic significance of central nervous system dysfunction in the production of violent behavior. Because central nervous system factors are involved in some instances of violent behavior, physicians clearly have a role in the early identification of potentially violent subjects and in the intervention or treatment of individuals who have been violent toward others. Studies have consistently found that lower socioeconomic groups are more predisposed to brain injury from trauma, and several studies have indicated that this is true for segments of the black community. Therefore, investigations in the relationship between central nervous system injury and violence should be a major goal of the black community. Black physicians should assume a lead role in these inquiries and in the prevention and treatment of violence, specifically black-on-black murder.

Adult↗
PubMed1990

Enhanced release of plasminogen activator inhibitor(s) but not of plasminogen activators by cultured rat glial cells treated with interleukin-1.

Astroglial cells are known to proliferate during development of the nervous system, as well as during post-traumatic gliosis. We have previously shown that the proliferation of cultured astrocytes can be stimulated by the urokinase-type (uPA) of plasminogen activator (PA) and that astrocytes are able to release such uPA upon stimulation with basic fibroblast growth factor, which is known to act as a mitogen for these cells. Here we report studies on the effects of human interleukin-1 (IL-1) on the release of PA activity by cultured newborn rat astroglial cells. Whereas there is controversy in the literature as to whether IL-1 stimulates multiplication of astroglial cells, we failed to observe such an effect in our system. We did observe, however, a dose-dependent decrease in PA activity in the supernatant of the IL-1 treated cultures. Further analysis revealed that this apparent decrease in PA release was in fact due to an increased release of plasminogen activator inhibitor (PAI). A similar IL-1 induced increase in PAI release was also found to occur in cultures of transformed astrocytes (human glioma LN18) and in cultured Schwann cells, but not in cultures of neurons or neuronal tumour cells. Since protease inhibitors are known to possess neuritogenic properties, our results suggest that IL-1, by its capacity to induce PAI, may promote neuritogenesis.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

Anterior surgery of the upper cervical spine.

The authors report the results obtained in a series of more than 80 cases submitted to 76 operations of the upper cervical spine by transoral approach with a minimum follow-up of two years. The cases include: 15 unstable fractures or non-union of the odontoid processes; 28 cases of post-traumatic instability of C1-C2 level without fracture of the odontoid process; 13 cases of rheumatoid arthritis with instability at C1-C2; 14 cases of severe anomalies of the craniovertebral junction, often associated with basilar impression and spinal cord compression, of which 7 cases presented with tetraparesis; 6 malignant tumors. The method used involves an anterior transoral approach, more often without tracheotomy, and with exposure of the anterior aspect of the atlas and of the odontoid process by means of a midline incision of the posterior wall of the pharynx. When spinal cord lesion was present, decompression and reconstruction by bone grafts taken from the iliac crest were performed. In nearly all of the cases osteosynthesis with an anterior plate was used. Complications were mild. There were two cases of infection, observed at the onset of our experience, which were resolved after removal of the instrumentation. There was loosening of a screw in three cases; this was eliminated through the digestive tube with no consequences. There were no early intra- or postoperative deaths. Consolidation was obtained in most of the patients, and only in three cases did we observe a loss of postoperative reduction. Among patients affected with tetraparesis we observed many cases of neurological recovery.(ABSTRACT TRUNCATED AT 250 WORDS)

Cervical Vertebrae↗
PubMed1988

[Dynamics and pathogenesis of traumatic subdural hygroma].

Of 2005 patients, who had suffered blunt skull trauma, 108 developed post-traumatic subdural hygromas (TSH). CT was used to observe the course of subdural hygromas not treated surgically, with particular reference to the time of their appearance and regression. The relative incidence of TSH, and of the severity of head trauma quantified on a 5-grade scale was determined in different age groups. From the traumatic changes demonstrated on CT, some conclusions could be drawn regarding the pathogenesis. A hypothetical model has been developed which explains TSH as a result of shearing forces.

Brain Injuries↗
PubMed1986

Angiosarcomas in lymphedematous limbs.

The clinical and histopathological features of four cases of angiosarcoma in congenital, post-traumatic, and post-hysterectomy lymphedematous limbs are reported. A good correlation between histologic and ultrastructural findings and clinical course was observed.

Cell Transformation, Neoplastic↗
PubMed1991

Cone biopsy causes cervical endometriosis and tubo-endometrioid metaplasia.

Cervices from 42 hysterectomies performed from 1 to 91 months (mean 12.2) following conization were re-examined in order to assess the possible effects of post-traumatic regeneration on the endocervix. Twenty-nine (69%) showed a continuum of abnormalities in which the shared finding was the presence of tubo-endometrioid glands, accompanied in many cases by varying amounts of endometrial-type stroma. Thus, 18 post-conization cervices (43%) showed endometriosis, and a further 11 cases (26%) contained tubo-endometrioid glands without demonstrable endometrial-type stroma. These abnormalities were situated at the healed cone biopsy site, either superficially within the new transformation zone and/or within the cone biopsy scar. Post-conization cervical endometriosis occurred from 2 to 91 months (mean 17.8) and tubo-endometrioid metaplasia 2-24 months (mean 11.0) after the cone biopsy. It is concluded that cervical endometriosis and tubo-endometrioid metaplasia are common complications of conization, and that they represent aberrant differentiation following injury. The demonstration of endometriosis and tubo-endometrioid metaplasia in 69% of post-conization cervices has implications for the interpretation of cervical biopsies and smears from this group of women.

Adult↗
PubMed1975

Homovanillic acid and 5-hydroxyindole-acetic acid in the csf of patients after a severe head injury. II. Ventricular csf concentrations in acute brain post-traumatic syndromes.

Ventricular concentrations of homovanillic acid (HVA) and 5-hydroxyindole-acetic acid (5HIAA) were measured in 7 patients a few days after a severe traumatic brain injury. Both acid metabolites were elevated in respect to control patients values, however, the rise was more consistent for 5HIAA (258 +/- 86 ng/ml) with a 5HIAA/HVA ratio of 0.85 +/- 0.35. The data support previous hypothesis on the profound involvement of serotoninergic structures in the early stages of acute traumatic brain syndromes and on the role of 5HT in maintaining edema and vasospasm.

Adolescent↗
PubMed1991

[Post-traumatic hemoperitoneum: a rare complication of peritoneal splenosis].

Peritoneal splenosis is a frequent condition after traumatic spleen fracture, which, given that it is usually asymptomatic, is often not diagnosed unless a laparotomy is performed for some other reason. The case is presented of a 9 year old boy splenectomized a few years earlier because of traumatism, who again suffers abdominal injury with the development of hemoperitoneum, observing during surgery multiple splenosis foci disseminated all over the abdominal cavity, some of which present rupture and hemorrhage, constituting the cause of hemoperitoneum.

Abdominal Injuries↗
PubMed1987

[Post-traumatic astrocytoma].

A 25 year old woman developed a mixed pilocytic and fibrillary astrocytoma in scar tissue 20 years after the brain contusion. The case fulfilled the criteria of traumatic etiology of this brain tumor.

Adult↗
PubMed1985

[External immobilization of cervical spine with a halo vest--experience with 31 cases].

Post-traumatic or post-operative immobilization of cervical spine often requires long term bed-rest. But, bed-rest indeed gave discomfort to patients, nonetheless, sometimes complete external fixation cannot be gained. Since 1982, we have applied Halo vest to the patients who required external immobilization of cervical spine. In this paper, we reported our experiences with 31 cases who were treated by Halo vest. Thirty-one cases comprised 19 cases of cervical spinal trauma, 5 cases of atlanto-axial dislocation, 1 case of foramen magnum meningioma, and 6 cases of ossification of posterior longitudinal ligament (OPLL). In traumatic cases, Halo vest was used as external fixation of injured spine in 8 cases, and as an adjunct to surgical fusion in other cases. In case of atlanto-axial dislocation, 3 cases underwent posterior fusion, and 2 cases underwent anterior fusion. Anterior fusion of C1-2 was also done in case of foramen magnum meningioma after total excision of tumor. Six cases of OPLL underwent anterior decompression and anterior fusion. Mean immobilization time by Halo vest was as follows: 58 days (28-113) in case of cervical spinal trauma, 85 days (56-144) in case of atlanto-axial dislocation who underwent posterior fusion, 92 days (89-93) in case of atlanto-axial dislocation and foramen magnum meningioma who underwent anterior fusion, 59 days (54-70) in case of OPLL. Early ambulation was achieved in many cases. Good external fixation and result was obtained 27 cases out of 31 cases. Re-dislocation of cervical spine occurred in 1 case of cervical spinal trauma while he was in Halo vest.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1979

Microvascular surgery in maxillo-facial reconstruction.

The recent advances in microvascular surgery have been applied to maxillo-facial reconstruction in the area of the lower jaw and soft tissue of the face. Five cases are presented, demonstrating some of the techniques and results in patients suffering from congenital, post-traumatic and post-cancer resection deformities.

Adult↗
PubMed1984

Role of cholesterol and calcium bilirubinate crystals in acute postoperative acalculous cholecystitis.

Acute acalculous cholecystitis is rather unusual, but it is considered an increasing entity. Particularly interesting are the post-traumatic or post-operative forms of acute acalculous cholecystitis. Ischemia of the gallbladder and biliary stasis are the most likely pathogenetic factors. A case of acute acalculous cholecystitis after total gastrectomy for cancer is presented. Particular emphasis is put on the significance of cholesterol and calcium bilirubinate crystals findings in the bile of the gallbladder. The pathogenetic role of this microscopic form of lithiasis in post-operative acalculous cholecystitis is discussed. It is concluded that all surgeons should be aware of this pathology since it is becoming much more common to be faced with elderly patients having life-threatening post-operative gallbladder complications unrelated to macroscopic lithiasis.

Acute Disease↗
PubMed1981

[Desmoid fibroma of bone. An histoenzymological and ultrastructural study of the mandible in one case (author's transl)].

A case of post-traumatic desmoid tumor of the mandible is reported in a 4-year old girl. This tumor was considered typical clinically and by light microscopy. Four years later, the patient was symptomless, without evidence of recurrence. Histoenzymology showed a high level of leucine aminopeptidase activity. On electron microscopy, a part from a few primitive mesenchymal cells, abnormal fibroblasts represented the principal cellular component. These cells showed evidence of intracytoplasmic collagen fibers synthesis and of myoid differentiation (numerous filaments and endocytosis vacuoles). Myofibroblasts, with a microfibrillary network showing areas of dense osmiophilic condensation in the vicinity of cell membrane were also present. This atypical ultrastructural feature suggests, in this case, the non-neoplastic nature of this lesion. It seems to reflect an abnormal reaction to a traumatic aggression, characterized by proliferation of myofibroblasts (which normally disappear in the late stages of healing) and to have, thus, the signification of pathologic scar.

Child, Preschool↗