[Cerebral magnetic resonance imaging: indications and contraindications].
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Biomedical subjects
Publications and source records attributed to B Richoz.
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We studied 15 patients 4 to 8 days after myocardial infarction by using ECG gated MR before and after administration of 0.2 mmol/kg Gd-DOTA. The diagnosis in each patient was confirmed by electrocardiographic criteria, elevated levels of fractionated creatine kinase (CK) isoenzyme, thallium scintigraphy, ventriculography and coronarography. T1-weighted, spin-echo images, were obtained before and immediately after injection of Gd-DOTA and were repeated 15 min later. The site of infarction was visualised in 10 patients as an area of high signal intensity after the injection of Gd-DOTA. Contrast between normal and infarcted myocardium was greatest 15 min after injection. Three patients were excluded because of failure to acquire adequate MR studies. In 2 other patients, the infarct were not detected. Before injection of Gd-DOTA, only 2 infarcts were detected. These results suggest that Gd-DOTA can improve MR visualisation and detection of acute myocardial infarction.
We reviewed the results of percutaneous transluminal coronary angioplasty (PTCA) in 200 consecutive patients from January 1988 to January 1989. The mean age was 55.8 years. Twenty-two per cent had unstable angina, 66% had stable angina and the other 12% had atypical chest pain or were asymptomatic after a myocardial infarction. Five percent had left ventricular function less than 45%. The angioplasty procedure was angiographically successful in 184 patients (92%). There was no significant difference in success rate in the different vessels or indications. Coronary bypass surgery was required in 3% of patients as an emergency procedure; myocardial infarction occurred in 2% less than 24 hours after the procedure. There has been no in-hospital death. The recurrence rate of ischemic symptoms was 26.5%. Considering lesions treatment, the procedure was successful in 71% of the 200 patients over a long-term follow-up period.
Percutaneous laser thermal angioplasty with a hot tip fiber was used in 26 patients to recanalize 20 femoropopliteal occlusions, 5 iliac thromboses and one occlusion of the left subclavian artery. Initial angiographic success was achieved in 85% for the femoropopliteal lesions and in 60% for the iliac occlusions. Eight complications did occur, but none necessitated emergency bypass surgery.
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Pseudoaneurysm is a classical but unusual complication of femoral catheterism. 22 cases are reviewed: 19 occurred after coronarography, 2 after peripheral percutaneous angioplasty and only one after a renal diagnostic arteriography. In all cases, the diagnosis of the pseudoaneurysm was established by I.V. D.S.A. 2 different medical teams are distinguished: the first using small catheters (4 and 5 F), the second using larger catheters (7 and 8 F) which are more aggressive. Two factors allow to avoid this complication: the diameter of the catheter and a correct compression dressing. The treatment of this complication, usually surgical, consisted in a simple manual percutaneous compression in 3 patients.
The absence of cerebral blood flow is the best criteria of cerebral death. Intravenous digital subtraction angiography (DSA) was performed in 110 patients with clinical signs of brain death. In 105 cases DSA, confirmed the stop of the intracranial circulation. In the other 5 cases, repeated examination a few hours later demonstrated arrested cerebral circulation. Organs transplantations were performed in 30 cases. DAS represents a relatively non invasive and quick to perform method to demonstrate brain death.
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Two cases of helicoidal coiling of iliac arteries are reported. This kind of coiling is relatively frequent in the carotid arteries but this is probably the first report of such a lesion in the aorto-iliac axis.