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Biomedical subjects

D Reizine

Publications and source records attributed to D Reizine.

At least 37 records · Page 2Linked to original sources
PubMed1993

Economic assessment of magnetic resonance imaging for inpatients: is it still too early?

This economic assessment of the implementation of magnetic resonance imaging (MRI) in a French hospital examines data on the diagnostic resources used in neurology and neurosurgery before and after MRI was available. Given a similar patient population and case mix, there was no change in the resources used other than the addition of MRI. So far, MRI appears to be a complement to, and not a substitute for, other imaging techniques used in neuroradiology. The focus of this work is purely economic; its conclusions do not challenge the major scientific contributions of MRI.

Adult↗
PubMed1993

[Cervical spondylosis. Resection by oblique transcorporeal approach].

Spondylosis at the cervical level inducing anterior spinal cord compression is generally treated by anterior transcorporeal resection of the osteophytic spurs. We report on 12 cases over 2 years in which a new technique has been applied; it uses the lateral approach exposing and retracting laterally the vertebral artery; then, the vertebral bodies are drilled out obliquely from the anterolateral corner to the posterolateral one on the opposite side. The vertebral bodies were drilled using this technique on 1 level in 2 cases, on 2 levels in 4, on 3 levels in 5 and on 4 levels in 1; the C4-C5, C5-C6 and C6-C7 levels were the most frequent sites involved in 9, 8 and 6 cases respectively. No graft or arthrodesis was used since the stability of the spine was never compromised. Improvement of the neurological symptoms was observed in all the cases with the best results achieved on the motor deficit and sphincter disturbances. Every case was controlled by dynamic standard radiographies (flexion-extension), CT scan and MRI. The results were good in all cases in terms of osteophytes resection, spinal cord decompression and spinal stability. This technique of oblique resection of the cervical bodies seems quite efficient to alleviate spondylotic compression of the spinal cord; moreover, it appears simpler and safer than the anterior route since the operative field is much wider with all the vital structures protected and retracted medially and bone grafting is never necessary.

Adult↗
PubMed1993

Percutaneous embolization with Ethibloc of lymphatic cystic malformations with a review of the experience in 70 patients.

Cystic lymphatic malformations (CLM) are superficial vascular hemodynamically inactive malformations of the lymphatic compartment. We propose a new approach which uses a sclerosing agent as an alternative to surgical resection. In the past nine years we treated 70 patients with CLM. Fifty-five percent were younger than five years of age with a male preponderance and most (80%) of the CLM were located in the maxillofacial region. They usually presented with functional impairment from the mass effect; others had infections, bleeding, or inflammation. The CLM were injected under fluoroscopic control with a sclerosing agent, Ethibloc, which dries up the pockets and reduces the mass. On follow-up the results were good in 62%, unchanged in 5%, and continued progression in 20%. Fifteen percent underwent surgery failures (24%) occurred in mixed forms of cystic and cellular lymphangiomas. Complications were minors. Percutaneous embolization is useful for CLM, with minimal risk, absence of scar, and it avoids surgery. It should be the first line of treatment for these lesions.

Adult↗
PubMed1992

Endovascular treatment of intracranial dural arteriovenous fistulas with spinal perimedullary venous drainage.

Intracranial dural arteriovenous (AV) fistulas with spinal perimedullary venous drainage are rare lesions that have distinctive clinical, radiological, and therapeutic aspects. Five patients presented with an ascending myelopathy, which extended to involve the brain stem in three cases. Myelography and magnetic resonance imaging showed slightly dilated spinal perimedullary vessels. Spinal angiograms were normal in the arterial phase. Diagnosis was only possible after cerebral angiography, which demonstrated posterior fossa AV fistulas fed by meningeal arteries and draining into spinal perimedullary veins. Endovascular treatment alone resulted in angiographic obliteration of the lesion in three patients. Two patients required surgery in addition to endovascular therapy. One patient died postoperatively, and in one a transient complication of embolization was observed. Improvement after treatment was good in two cases and fair in two. Transverse sinus thrombosis was observed in three cases and was probably the cause of the aberrant venous drainage of the fistula into the spinal perimedullary veins. The pathophysiology is related to spinal cord venous hypertension. These lesions were classified as Type 5 in the Djindjian and Merland classification of dural intracranial AV fistulas. Endovascular therapy is a safe effective method in the treatment of these fistulas and should be tried first.

Adult↗
PubMed1992

[Cystic lymphatic malformations of the head and neck. Role of interventional radiology].

Cystic lymphatic malformations are hemodynamically inactive vascular malformations of the lymphatic compartment. Over a 9 years period, 52 patients with superficial cystic lymphatic malformations of the head and neck underwent embolization by direct injections of Ethibloc (Ethicon, Ethnon Laboratories, Neuilly/France) under fluoroscopic control. Results were graded as excellent or good in 57% of patients after embolization alone. Treatment was completed by surgery in 19% of patients. Embolization was considered a failure in 24% (12 patients), although 10 of these patients showed regression of the cystic component after embolization. This safe, efficacious percutaneous technique has emerged as the first treatment to be considered for cystic lymphatic malformations.

Child, Preschool↗
PubMed1992

[Preoperative embolization of cervical bone metastasis with radio-controlled direct puncture].

Surgery of vertebral hypervascular metastasis can take advantage of preoperative embolization to make the surgical procedure easier to perform. Usually, embolizations are executed by vascular tract. We report a case of one cervical metastasis located in C4 for which embolization was executed with direct puncture of the vertebra. This method has the advantage to be feasible whatever tumoral vascularization, and more particularly in case of departure of radiculo-medullary artery or any other cephalic vessel from the tumoral site.

Biopsy, Needle↗
PubMed1992

[Contribution of therapeutic angiography in the management of tumors of the base of the skull].

Embolization of tumors of the skull base plays an important role in the treatment of these often complex lesions. Endovascular techniques provide important information concerning the circle of willis and facilitate surgery by reducing blood loss. The coordination of the different steps of embolization and neurosurgical treatment necessitate a preliminary multidisciplinary discussion of each case. Different procedures are possible: Arterial embolization of the branches of the internal and external carotid arteries, definitive or temporary champing of the internal carotid, and, most recently, embolization by direct injection.

Carotid Artery, External↗
PubMed1991

MRI in spontaneous dissection of vertebral and carotid arteries. 15 cases studied at 0.5 tesla.

Fifteen patients were observed between 1987 and 1990: there were six with angiographically confirmed vertebral artery dissection, and 9 with carotid artery dissection. Results showed concordance of MRI and angiographic findings, in all cases but one. The dissected portion consistently showed a semilunar hyperintensity narrowing the residual eccentric signal void of the lumen when the artery was not completely occluded. In one angiographically occluded vessel, MR detected a small signal void within the hyperintensity, indicating that the artery was not completely occluded. The length of the dissected portion was clearly demonstrated by MR. Follow up MR and angiographic studies confirmed the regression of the dissection, and also allowed examination of the cerebral parenchyma.

Aortic Dissection↗
PubMed1991

MRI in multiple vascular lesions: identification of the ruptured malformation.

4 patients were recently admitted for subarachnoid haemorrhage with multiple vascular lesions. 3 of them presented with multiple aneurysms, and one with an aneurysm associated with an arteriovenous malformation. In these 4 cases identification of the ruptured lesion was difficult in spite of clinical examination, CT scan, and complete panangiography; on magnetic resonance imaging (MRI) was found a signal hyperintensity, mainly on T2 weighted views, corresponding to blood clots around the ruptured aneurysm. This signal hyperintensity was completely absent in the vicinity of the associated vascular lesion, which appeared only as a signal void corresponding to the blood flow inside the unruptured lesion. Therefore MRI can be used in such cases to identify the ruptured lesion, so permitting the choice of the best approach and strategy of treatment.

Adult↗
PubMed1991

Endovascular occlusion of vertebral arteries in the treatment of unclippable vertebrobasilar aneurysms.

Twenty-one patients with aneurysms of the vertebrobasilar circulation underwent unilateral or bilateral endovascular occlusion of the vertebral artery. Six patients presented with subarachnoid hemorrhage (SAH), 10 with mass effect, four with mass effect and SAH, and one with ischemic symptoms. Thirteen patients had good outcomes with complete clinical and angiographic cure. Six patients had partial thrombosis of their aneurysms. There was one death and one treatment failure. One patient suffered transient stroke. It is concluded that endovascular occlusion of the vertebral artery following test occlusion is a safe and effective treatment for proximal aneurysms of the vertebrobasilar circulation.

Adolescent↗
PubMed1991

Endovascular occlusion of intracranial vessels for curative treatment of unclippable aneurysms: report of 16 cases.

Among 121 intracerebral aneurysms presenting at one institution between 1984 and 1989, 16 were treated by endovascular means. All 16 lesions were intradural and intracranial, and had failed either surgical or endovascular attempts at selective exclusion with parent vessel preservation. The lesions included four giant middle cerebral artery (MCA) aneurysms, one giant anterior communicating artery aneurysm, six giant posterior cerebral artery aneurysms, one posterior inferior cerebellar artery aneurysm, one giant mid-basilar artery aneurysm, two giant fusiform basilar artery aneurysms, and one dissecting vertebral artery aneurysm. One of the 16 patients failed an MCA test occlusion and was approached surgically after attempted endovascular selective occlusion. Treatment involved pretreatment evaluation of cerebral blood flow followed by a preliminary parent vessel test occlusion under neuroleptic analgesia with vigilant neurological monitoring. If the test occlusion was tolerated, it was immediately followed by permanent occlusion of the parent vessel with either detachable or nondetachable balloon or coils. The follow-up period ranged from 1 to 8 years. Excellent outcomes were obtained in 12 cases with complete angiographic obliteration of the aneurysm and no new neurological deficits and/or improvement of the preembolization symptoms. Four patients died: two related to the procedure, one secondary to rupture of another untreated aneurysm, and the fourth from a postoperative MCA thrombosis after having failed endovascular test occlusion. The angiographic, clinical, and cerebral blood flow criteria for occlusion tolerance are discussed.

Aged↗
PubMed1990

Embolization with particles in thoracic intramedullary arteriovenous malformations: long-term angiographic and clinical results.

To evaluate the long-term results of endovascular treatment with particles in the management of thoracic intramedullary arteriovenous malformations (AVMs), the authors retrospectively reviewed the angiographic and clinical findings in 35 patients. Follow-up was 1-15 years (mean, 6 years) in 28 patients and 6-10 months (mean, 7 months) in seven. A total of 158 embolization procedures were performed in 35 patients. Revascularization occurred frequently, necessitating multiple endovascular sessions. Long-term clinical evaluation showed clinical improvement, compared with the initial status before treatment, in 63% of the patients. Clinical aggravation due to embolization was observed in seven patients (20%) after 12 of the 158 endovascular sessions (8%). These results are better than those reported after surgery and indicate that embolization with particles is an efficient and safe tool in the treatment of thoracic intramedullary AVMs.

Adult↗
PubMed1990

Transalar sphenoidal meningoencephalocele associated with buccal angiomatosis. One case.

Basal encephaloceles are uncommon congenital malformations occurring with an estimated frequency of one case in 35,000 births. They are frequently occult since they protrude into the orbit, nasal cavity, nasopharynx or paranasal sinuses. Basal encephaloceles are divided into five anatomical types. We report a case of transsphenoidal encephalocele which differed from the classical type in that it protruded through a congenital defect in the greater wing of the sphenoid bone. This case had an unusual clinical presentation, being responsible for trigeminal neuralgia and associated with an angioma of the soft palate.

Adult↗
PubMed1989

Spinal dural arteriovenous malformations with perimedullary drainage. Indications and results of surgery in 30 cases.

70 patients were treated for spinal dural arteriovenous fistula in the same centre, during a period of 10 years. Conus medullaris and cauda equina syndromes were observed in all patients as the clinical stereotyped presentation. Diagnosis was based on myelography in the first instance and then on angiography. 40 patients were treated by intravascular neuroradiological embolization, whereas the other 30 were operated on. Surgery was proposed because embolization was contraindicated (7 cases of hazardous catheterisation) of inefficient (23 cases = 38%). The results of the operative series are presented, and compared with those of embolization. Improvement was observed in 50% of the 20 patients with follow up, but a complete recovery to an asymptomatic state was never obtained. For the other patients (47%) complete stabilization of the disease could be obtained, whereas in one of the patients (3%), who was operated upon because of failure of embolization, surgery was also completely ineffectual. The long-term results of patients treated surgically are comparable with those patients efficiently embolized. 5 patients of the operative series were submitted to MRI before and after surgery: the results and the place of MRI are discussed.

Adult↗
PubMed1989

Ruptured intracranial aneurysms. The influence of sex and fibromuscular dysplasia upon prognosis.

From a statistical analysis of a series of 214 cases of ruptured intracranial aneurysms, it was demonstrated that only four parameters among those collected on the admission day, are predictive of the final functional result: sex (p less than 0.001); age (p less than 0.02); clinical grade (p less than 0.001) and angiographic spasm (p less than 0.01). The surprisingly poor prognosis in women was explained by the higher frequency of spasm (p less than 0.005). Aneurysms in women predominated on the intracranial carotid artery (38%) and were frequently multiple (12%). A further angiographic study on 87 cases was then carried out including a systematic investigation of the cervical part of the vessels; it permitted one to identify angiographic features of fibromuscular dysplasia (FMD) on the cervical vessels in 20 cases. In those cases it was also observed that there was a marked female predominance (F/M = 5.6), a frequent localization on the internal carotid artery (50%), a high rate of multiple aneurysms (60%) and a poor prognosis related to spasm (50%). Therefore, intracranial aneurysms appear far more frequently than usually reported, to be related to FMD. The worse prognosis of ruptured intracranial aneurysms in females can be, at least partly explained by the association with FMD and the frequent occurrence of spasm. A careful investigation of patients exhibiting features of FMD in order to detect intracranial aneurysms before rupture, is suggested.

Arterial Occlusive Diseases↗
PubMed1989

Vascular abnormalities in the neck associated with intracranial aneurysms.

In 102 cases of ruptured intracranial aneurysms, the cervical as well as the cranial areas were explored by angiography. Loops in the course of the cervical vessels were present in 28 patients; features of fibromuscular dysplasia were present in 31 patients; and in 50 patients, no abnormalities were observed. In 7 patients, both cervical anomalies were present. Loops were associated with single aneurysms (95%), located primarily on the anterior communicating artery (76%), predominantly in men (M/F = 1.6). Aneurysms with fibromuscular dysplasia affected women more than men (F/M = 7), were frequently multiple (58%), and were located mainly on the intracranial part of the internal carotid and vertebral arteries (51%). These data suggest new concepts of aneurysm formation from inherited diseases and should permit the detection of some aneurysms before rupture.

Adolescent↗
PubMed1989

[Nosocomial sinusitis and nasotracheal intubation. Prospective study of 53 patients].

The authors studied the frequency of sinusitis in nasotracheally intubated patients in an Intensive Care Unit. All patients intubated nasotracheally during an 8 day period were included in a prospective study which included CT scanning with views of all the paranasal sinuses. Sinusitis was defined as opacification of the sinus with an air-fluid level. Transantral punctures were performed in cases of maxillary sinusitis. Fifty-three patients were included. Local symptoms and/or unexplained fever were present in 22% of cases. CT scanning showed sinusitis in 49 of the 53 cases (pansinusitis 42 cases, maxillary alone 5 cases, sphenoidal 16 cases). Bacteriological cultures of sinus punctures were positive in 39 cases, monomicrobial in 21 and polymicrobial in 18 cases. Twenty of the 53 patients developed a lower respiratory tract infection with the same germ and 10 developed septicemia (3 with isolated sinusitis and 7 with pneumonia). Eighteen patients died (6 of their infection and 12 of the underlying disease). This study shows the high frequency of bacterial sinusitis and the necessity of sinus puncture for bacteriological identification of the causal organism to adapt antibiotic therapy.

Aged↗