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Biomedical subjects

F Joffre

Publications and source records attributed to F Joffre.

At least 91 records · Page 5Linked to original sources
PubMed1990

Treatment of iliac artery stenoses with the Wallstent endoprosthesis.

Sixteen symptomatic iliac artery stenoses and three occlusions in 16 patients were treated by the percutaneous implantation of Wallstent endoprostheses (Medinvent SA, Lausanne, Switzerland). The endoprosthesis consists of stainless steel monofilaments braided into a self-expanding cylinder. The indications for placement were restenosis after angioplasty (10 cases), failed arterial dilations (eight cases), and restenosis after endarterectomy (one case). The prostheses used had a mean diameter of 8 mm (range, 6-10 mm) and were placed in the external iliac (14 cases) and common iliac (five cases) arteries. The 16 stenoses were greater than 80%, and the three occlusions were longer than 7 cm. Mean length of the lesions treated was 7 cm (range, 4-14 cm). Three of the arteries thrombosed after treatment, one 2 days later and two in the month after implantation of the stent. On clinical and angiographic follow-up (mean, 16 months; range, 1-24 months) no symptoms or stenoses reappeared in the remaining 16 cases. Our experience in these cases suggests that implantation of a Wallstent endovascular prosthesis is a valuable technique for the treatment of external and common iliac artery stenoses.

Adult↗
PubMed1990

["Wallstent" intra-urethral prosthesis in recurrent urethral stenosis].

Urethral strictures recur in about 30% of the cases whatever might be the treatment. We describe a new urethral stent, originally developed in our Institution for vascular use after transluminal angioplasty. Since january 1986, we previously have controlled the biocompatibility and tolerance into the normal urethra of dogs with a one year of follow-up. The stent has a braided structure, made of fine stainless steel wires and is self-expanding when released from a special endoscopic instrument. From november 1987, we have implanted the stent into 11 males (mean age 54 years), after a previous urethrotomy has been performed. In two patients a second stent has been implanted for incomplete result. Now with a mean follow-up of 12 months all patients recovered normal micturation, only two complained of slight stress incontinence.

Adult↗
PubMed1990

[Long-term results of percutaneous transluminal angioplasty of the iliac arteries].

A well-mastered technique will cause percutaneous transluminal angioplasty of iliac arteries to achieve long-term results comparable to those obtained surgically. In isolated iliac stenosis, a 95% good result rate is attained (81% cured, 14% improved). More complex cases of iliac stenosis yield 90% good results (72% cure), with a mean Doppler ankle/arm pressure index gain of 0.5 point in a series including 673 patients at 5 years follow-up. Only the presence of combined distal femoral lesions may cause the good result score to drop to 85%, including merely 35% cure. General complications are practically lacking and local complications are minimal, which incites one to propose this technique as a first-line treatment of iliac stenosis whenever distal blood circulation is maintained.

Angioplasty, Balloon↗
PubMed1990

[Femoral angioplasty. Long-term results].

A study on the long-term efficacy of femoral-popliteal angioplasty was carried out on 185 angioplasty cases over a 5 year follow-up period. A classification of data according to the type of lesion treated, revealed that results were favorable in case of stenosis (87%), short obstruction (70%) and long obstruction (35%). A special study of the outcome of treatments for stage IV arteritis was carried out. After comparing results with those obtained by other teams, the authors list the complications encountered, hematomas, and thromboses, and show their current tendency for regression. Lastly, the authors stress the advantages of angioscopy, which permits to identify the nature of the treated lesions and to predict possible complications, which are usually underrated by angiography.

Angioplasty, Balloon↗
PubMed1990

[Long-term results of transluminal angioplasty in the treatment of stenosis of the renal artery].

MATERIALS AND METHODS. A multicenter study was undertaken to determine the long-term results of renal angioplasty. Five teams with considerable experience in the procedure replied to a computerized questionnaire concerning transluminal angioplasty (TLA) performed with immediate success from 1979 to 1985 and followed up regularly (minimum of four years). The main purpose of the study was to assess the long-term results, both anatomical results and clinical, of renal TLA. Consideration was given to anatomical of average quality and their possible correlation with long-term results, in an attempt to foresee and even prevent restenosis. The main points of the study are given in figure 1. Two hundred and forty-seven renal TLA performed in 210 patients were included (insofar as clinical and radiologic follow-up was adequate, with a minimum of one control angiography beyond six months). Patients who had immediate failure (dilatation not possible or ineffective dilatation) were excluded from the analysis of long-term results. Likewise, TLA of the renal artery of grafted kidneys were not included in this study. The histogram of patients ages shows a clear predominance of subjects 60 to 65 years of age, with extremes ranging from 10 to 80 years (mean 53 years). TLA were done mainly by the femoral route according to a technique using a balloon catheter positioned on a previously inserted guide at the level of the stenosis. The examination was performed under local anesthesia. Balloon size was determined according to the diameter of the renal artery upstream from the stenosis and that of the contralateral renal artery. A balloon of the same or slightly larger caliber was used. The indication of angioplasty was determined after multidisciplinary discussion according to two main criteria: First, treatment of hypertension presumed to be in relation with a stenosis of the renal artery (renovascular hypertension). Secondly, conservation of the nephrotic capacities of a patient with a renal stenosis possibly associated with arterial hypertension, in relation with a bilateral stenosis of the renal arteries or with a unilateral stenosis affecting a functionally or anatomically single kidney. In this latter case, the purpose of TLA was to avoid development toward thrombosis of the renal artery and worsening of renal insufficiency. RESULTS. Two hundred and forty-seven TLA in 210 patients were included in the study. Nineteen patients (9%) had bilateral TLA. The lesions treated are indicated in figure 3. These were most often simple atheromatous and truncal lesions of the renal artery (73%) which were significant (greater than 50%) in 99% of cases. TLA was indicated in 77% of cases for treatment of arterial hypertension presumed to be renovascular. In 23% of cases, treatment of the stenosis was intended to conserve, especially, kidney vascularization, i.e., an indication of nephrotic protection. There were 9.7% immediate failures...

Acute Kidney Injury↗
PubMed1990

[Wallstent endourethral prosthesis in recurrent urethral stenoses].

Urethral strictures recur in about 30% of the cases irrespective of treatment. We describe a new urethral stent, originally developed in our institution for vascular use after transluminal angioplasty. We have previously controlled the biocompatibility and tolerance in the normal urethra of dogs in a study with a one year follow-up that was undertaken in 1986. The stent has a braided structure, made of fine stainless steel wires and is self-expanding when released from a special endoscopic instrument. Since November 1987, we have implanted the stent in 11 men (mean age 54 years), after a previous urethrotomy had been performed. In two patients a second stent was implanted for incomplete result. Now with a mean follow-up of 12 months all patients are continent, and only two patients have complained of slight stress incontinence.

Adult↗
PubMed1989

[Computerized tomographic diagnosis of hepatocarcinoma after injection of lipiodol into the hepatic artery].

Iodized oil (lipiodol) injected into the hepatic artery is selectively retained by hepatocarcinomas, as demonstrated by computerized tomography (CT) performed one week after the injection. The value of this technique for the diagnosis of hepatocarcinoma was assessed in a retrospective study of 45 patients. In 39 per cent of the cases intrahepatic tumoral extension was determined by the iodized oil which showed tumoral nodules that had not been detected by conventional methods, such as ultrasonography and CT alone. The lesions revealed by the iodized oil were small nodules around the main tumour. The combined iodized oil-CT technique plays an important role in the choice of treatment, especially when surgical excision is contemplated. It might also contribute to an early diagnosis of hepatocarcinoma in patients at risk, as illustrated by four of our cases where conventional morphological examinations had been negative.

Adult↗
PubMed1989

[Diagnosis of diseases of the urinary tract].

Radiological exploration of the urinary tract has become highly sophisticated. The information provided by the new imaging techniques is extremely accurate and useful in the diagnosis and pretherapeutic assessment of most urinary tract diseases. Interventional radiology has given radiologists an important role in the treatment of some types of pathology. The authors describe the value of modern imaging and its different aspects in each of the principal branches of urinary tract pathology, viz.: tumours, obstructions, infections, vascular and prostatic diseases.

Humans↗
PubMed1989

Self-expanding endovascular stent in experimental atherosclerosis. Work in progress.

To investigate the physiologic and histologic responses induced by the self-expanding endovascular prosthesis, rabbits subjected to a combination of high-cholesterol diet and intravascular trauma underwent stent implantation. The results were compared with those obtained with the placement of stents in the healthy aortas of rabbits. Stents in healthy aortic tissue led to stent intimalization, previously reported in canine studies. For stents placed in animals subjected to a high-cholesterol diet but no intimal trauma, it was found that the stent was not the source of atherogenesis. Stents placed in atheromatous plaque were found to radially compress plaque with time and to stimulate for formation of a fibrotic crust. The results suggest that the self-expanding stent protects against progressive encroachment of the vessel lumen by atherosclerotic tissue.

Animals↗
PubMed1989

[Interventional radiology and vascular pathology].

Percutaneous transluminal angioplasty (PTA) has been an important step in the therapy of arterial diseases. Nowadays, it opens the way to new techniques which main goals are to improve the PTA results and to enlarge the indications. This article review these new techniques. The principles, the therapeutic possibilities, the advantages and the inconvenience of each are evaluated, based upon the personal experience of the authors, the bibliography of current literature and the proceedings of a meeting organized on this topic (Toulouse, February 1988). All these procedures are encouraging and let foresee new possible therapy in vascular pathology.

Angioplasty, Balloon↗
PubMed1989

[Usefulness of a percutaneous endoprosthesis in the treatment of renal artery stenoses].

In approximately 10 p. 100 of the cases stenosis of the renal artery cannot be satisfactorily dilated by percutaneous transluminal angioplasty (PTA), and about 10 p. 100 of the patients successfully dilated have short-term restenosis. The excellent results obtained experimentally and clinically with the implantation of percutaneous intravascular stents have prompted us to use this material in the renal arteries. Stents were implanted in 10 patients who were followed up for periods of 1 to 16 months. Eight of them had restenosis after PTA; five of these stenoses were due to atheroma, 2 to fibromuscular dysplasia and 1 to Takayasu's disease. Two patients were implanted from the start owing to the insufficient results of PTA. Seven patients had severe arterial hypertension most probably of renovascular origin. Three patients had hypertension associated with moderate renal failure. Implantation was performed after a previous PTA. Adjuvant treatments and monitoring were the same in every case with, in particular, radiological control examination after one and six months. The implantations themselves were uneventful, and immediate control showed almost perfect anatomical restoration in all patients. On subsequent controls, arterial patency was preserved in all but one case. All patients showed significant clinical improvement. These results are most encouraging. They suggest that intravascular stents constitute an interesting solution when PTA is insufficient in the treatment of renal artery stenosis.

Adult↗
PubMed1989

[Application of auto-expansible endoprostheses to arteries of the legs].

An endovascular support inserted percutaneously, may represent an attractive solution to prevent early obstructions and recurrent stenoses after angioplasty (ATP). 23 iliac lesions and 40 femoro-popliteal lesions, symptomatic in 55 patients, were treated with endoprostheses of the Wallstent type. For the iliac implantations, it concerned in one case a recurrence after endarterectomy, 13 cases of recurrent stenoses after ATP and 9 cases of immediate failure of the angioplasty. The mean length of the lesions under treatment was 8 cm (extreme values between 4 and 14 cm). For the femoro-opoliteal arteries, the implants concerned lesions ranging between 3 and 7 cm, in 75 p. cent of the cases, and lesions exceeding 7 cm in 25 p. cent of the cases. Three iliac thromboses and six femoro-popliteal thromboses were reported at the beginning of this study; on the contrary, no thrombosis is present in the last 18 patients treated with oral anticoagulants. The rate of recurrent stenosis is low (none at the iliac level and 10 p. cent at the femoro-popliteal level); in all other cases an excellent clinical result was obtained with a mean follow-up of 18 months.

Adult↗
PubMed1989

["Wallstent" endo-urethral prosthesis in recurrent stenoses of the urethra].

Urethral strictures recur in about 30% of the cases whatever the treatment. We describe a new urethral stent, originally developed in our Institution for vascular use after transluminal angioplasty. Since January 1986, we have controlled the biocompatibility and tolerance in the normal urethra of dogs with a one year follow-up. The stent has a braided structure, made of fine stainless steel wires and is self-expanding when released from a special endoscopic instrument. From November 1987, we have implanted the stent into 11 males (mean age 54 years), after previous urethrotomy. In two patients a second stent was implanted for incomplete result. Now, with a mean follow-up of 12 months, all patients have recovered normal micturition and only two complain slight stress incontinence.

Adult↗
PubMed1989

[Value of x-ray computed tomography in muscular pathology. Personal cases and review of the literature].

The authors have studied the advantage of CT scans in muscular pathology. The scan, in addition to the diagnosis of tumors and muscular abscesses, permits to differentiate primary myopathies from neurogenic atrophies: in the course of myopathies, the muscle volume is preserved and they appear as a hypodensity; in neurogenic atrophies, the muscle volume is reduced with preserved density. The CT scan permits to determine the extension of these lesions. In the course of polymyositis, certain forms of rheumatoid arthritis, the scan discloses a trabecular and "worm-eaten" aspect of the muscles. This is also observed after long-term steroid therapy and other endocrine diseases (hyperthyroidism, osteomalacia) indicating an infra-clinical myopathy. In vertebral osteoporosis with fractures and patients with chronic lumbalgia, very often, an atrophy of the spinal muscle is observed. Finally, in the course of acquired kyphosis of the adult patient (camptocormia), the CT scan suggest an isolated myopathy, with late manifestations, of the paravertebral muscles.

Adult↗