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Biomedical subjects

J Golzarian

Publications and source records attributed to J Golzarian.

At least 19 recordsLinked to original sources
PubMed2002

[Uterine fibroids embolization: a review].

Uterine artery embolization for symptomatic leiomyomas is a new attractive treatment in patients who do not desire pregnancy and for whom conventional therapy has failed. Uterine fibroid embolization can also be considered for patients who desire pregnancy when myomectomy is technically difficult or/and in case of recurrence after myomectomy. 90% improvements are commonly reported in abnormal bleeding, pelvic pain, and in bulk-related symptoms. This technique allows reduction of the hospital stay, the convalescence period, the morbidity and the mortality rate compared to conventional surgical treatment.

Angiography↗
PubMed2002

[Embolization of uterine fibroids].

Uterine artery embolization (UAE) for symptomatic leiomyomas is a new attractive treatment in patients who don't desire pregnancy and for which conventional therapy has failed. Uterine fibroid embolization can also be considered for patients who desire pregnancy when myomectomy is technically difficult or impossible and in case of recurrence after myomectomy. 90% improvements are commonly reported in abnormal bleeding, pelvic pains, and in bulk-related symptoms. Although numerous pregnancies have been reported after UAE, the fertility rate after UAE remains to be compared to myomectomy. Absolute contra-indications are pregnancy, endometrial carcinoma, gynaecologic infections, adnexal masses, and rapid growth of uterine leiomyomas (considered as a significant sign of sarcoma). Besides procedure related risks of angiography some specific complications are reported: deep pelvic vein thrombosis with exceptional pulmonary embolus, vaginal discharges with sometime transcervical expulsion of fibroid (5%), transient or permanent amenorrhea (4-5%) and extensive necrosis (1-2%) with possible perforation and infection. A hysterectomy is needed to manage this complication in 0.9 to 0.3% of case. The mortality rate of embolisation is evaluated to 1/3.000 against 6/10.000 for the hysterectomy. UAE is proposed as a less invasive alternative to hysterectomy and myomectomy for the treatment of symptomatic leiomyomas. This technique allows reducing the hospital stay, the convalescence period, the morbidity and the mortality rate compared to conventional surgical treatment.

Contraindications↗
PubMed2002

[The medical imaging and radiology department].

Technological developments arising from research have affected the whole wide spectrum of medical endeavor and have made a very significant impact on clinical practice and especially on imaging sciences. Ultrasonography brought spectacular advances, but CT and MRI became important landmark techniques. A further important development, which greatly increased the involvement of radiologists in direct patient management, was the growth of interventional and therapeutic techniques, called interventional radiology. Some statistics: approximately 155,000 patients per year including 19,000 CT Scans, 10,000 MRI exams, 21,000 ultrasound examinations and 1,000 therapeutic procedures. Some research activities: CT quantification of pulmonary emphysema, respiratory mechanics, MR and CT angiography, antenatal diagnosis of congenital and genetic diseases of the fetus, quantification of portal haemodynamics, MR imaging of bile and pancreatic ducts, morphologic and functional imaging of the brain, radiology of bone trauma, MR characterization in hepatic lesions.

Belgium↗
PubMed2001

Imaging of complications after endoluminal treatment of abdominal aortic aneurysms.

Endovascular repair of abdominal aortic aneurysm is becoming a valuable alternative to open surgery in selected patients. With the recognition of this new treatment, however, many complications, some of them life-threatening, are reported. Imaging plays a major role in the detection of these complications. This article reviews the role of imaging techniques in the detection of these complications.

Aortic Aneurysm, Abdominal↗
PubMed2001

The 6-F nitinol TrapEase inferior vena cava filter: results of a prospective multicenter trial.

PURPOSE: The authors report the first results of a new 6-F symmetrically designed permanent nitinol inferior vena cava (IVC) filter, the Cordis TrapEase, evaluated in a multicenter prospective study with 6-months of follow-up. MATERIALS AND METHODS: A total of 65 patients (29 men, 36 women) who ranged in age from 37 to 96 years (mean age, 68 years) and who were at high risk of pulmonary embolism (PE) were enrolled in 12 centers in Europe and Canada. The study was approved by the institutional review boards at all centers. Study objectives were to evaluate filter effectiveness, filter stability, and caval occlusion. Indications for filter placement were deep vein thrombosis with recurrent thromboembolism and/or free-floating thrombus with contraindication to anticoagulation in 37 patients, and complications in achieving adequate anticoagulation in 28 patients. Follow-up included clinical examination, plain film, Doppler ultrasound, CT scan, and nuclear medicine. RESULTS: The analysis of the data revealed a technical success of 95.4% (three filter-system related implantations not at the intended site, no events of filter tilting) and a clinical success of 100% at 6 months (no cases of symptomatic PE), the study primary endpoint. There were no cases (0%) of filter migration, insertion site thrombosis, filter fracture, or vessel wall perforation. During the study period, there were two cases of filter thrombosis: one case of early symptomatic thrombosis that was successfully treated in the hospital, and one case of nonsymptomatic filter thrombosis detected at 1-month follow-up, with spontaneous recanalization at 3 months. In the latter patient, some residual thrombus was still detected at 6 months. Of the study population of 65 patients, there were 23 deaths. These deaths were not related to the device or the implantation procedure but to the underlying disease process. CONCLUSION: This study demonstrates the new nitinol permanent IVC filter to be a safe and an effective device, with a low overall complication rate, for use in patients with thromboembolic disease at high risk of PE.

Aged↗
PubMed1999

Imaging of abdominal aortic aneurysms after endoluminal repair.

The recently published clinical trials of endoluminal repair of aortic aneurysms underline the need for a close imaging follow-up of patients undergoing these procedures. This article discusses the role of different imaging modalities in the evaluation of these patients.

Angiography↗
PubMed1999

[Periventricular leukomalacia in premature infants: prognostic role of ultrasonography and MRI].

PURPOSE: To evaluate the role of cranial US and MRI to establish the neurological prognosis of premature infants with periventricular leukomalacia (PVL). PATIENTS AND METHODS: Follow-up results of cranial US and early MRI evaluation (before 25 weeks*) of 28 premature infants were retrospectively reviewed and compared to the neurological outcome at 18 months* (*corrected age). RESULTS: Follow-up by cranial US was more sensitive (8/28) than early MRI to detect cystic PVL lesions because of the transient nature of these cysts. This has prognostic implications since all patients (8/8) with cystic PVL lesions had neurological sequelae. MRI was useful, as a complement to cranial US, for the evaluation of non-cystic PVL lesions. Indeed, patients with evidence of hemorrhage or paucity of white matter at MRI had a higher risk of neurological sequelae (9/11) than infants with echogenic periventricular white matter at US without evidence of white matter abnormality at MRI (p < 0.013). CONCLUSION: MRI was useful, as a complement to cranial US, to evaluate the prognosis of infants with non-cystic PVL lesions.

Developmental Disabilities↗
PubMed1999

[Magnetic resonance angiography of the renal arteries].

Initially, the clinical use of magnetic resonance angiography (MRA) in the abdomen has been restricted because of motion and flow related artifacts. The advent of high performance gradient systems made possible the development of 3D gadolinium-enhanced MRA techniques and expanded the clinical applications of MRA into the abdominal area, particularly for the investigation of renal arteries. This technique is safe, because the administered contrast agent (gadolinium) is free of clinically detectable nephrotoxicity and has a low incidence of allergic reactions. Moreover, contrast MRA also eliminates the risks of ionizing radiation which allows repeating the examination without the accumulation of radiation exposure. The main disadvantages of the technique are its low availability and the fact that the use of contrast agents for this procedure is still not reimbursed by the social security. Many studies demonstrated that contrast MRA allows for the reliable assessment of renal artery morphology and pathologic states. Furthermore, within a single MR examination a comprehensive approach including renal artery morphology, hemodynamic significance of any stenosis and kidney perfusion is available. In this paper, we provide a review of the literature concerning the clinical performance of contrast MRA for the renal arteries and suggest its rationale for the investigation of patients suspected of renovascular disease in our specific environment.

Artifacts↗
PubMed1999

Tuberculous pseudoaneurysm of the descending thoracic aorta: successful treatment by surgical excision and primary repair.

Tuberculous pseudoaneurysm of the aorta is a rare disease with a high mortality rate. We present the case of a 27-year-old woman who had a tuberculous pseudoaneurysm of the descending thoracic aorta. The patient underwent successful excision and primary repair of the lesion while under hypothermic circulatory arrest and partial femoral bypass. To the best of our knowledge, this is the youngest patient to be successfully treated with surgery for a tuberculous pseudoaneurysm of the descending thoracic aorta. The pathogenesis, diagnosis, and treatment of this disease are reviewed, and the need to include tuberculous pseudoaneurysm in the differential diagnosis of chest lesions is emphasized.

Adult↗
PubMed1998

Occluding aortic endoluminal stent graft combined with extra-anatomic axillofemoral bypass as alternative management of abdominal aortic aneurysms for patients at high risk with complex anatomic features: a preliminary report.

PURPOSE: To describe an exclusion endoluminal technique for management of abdominal aortic aneurysms among high-risk patients with complex anatomic features. METHODS: From January 1995 to December 1996, among 143 patients with infrarenal abdominal aortic aneurysm treated by means of endograft placement, 9 (6.3%) had complex aortic or aortoiliac morphologic features. For these patients, the endograft was delivered through a femoral cutdown in an occluding aortoiliac configuration. The contralateral iliac artery was occluded with an iliac endograft. Axillofemoral bypass grafting was performed. Computed tomographic scans were obtained regularly. RESULTS: There was 1 postoperative death of severe arrhythmia. All aneurysms were found to be affected by thrombosis on immediately postoperative computed tomographic scans, except in 1 patient with a proximal leak, which was managed successfully with angiographic embolization. The mean follow-up time was 12 months. Aortic aneurysm diameter decreased from 2 mm at 6 months (2 patients) to 6 mm at 12 months (6 patients). All axillofemoral bypass grafts are patent. CONCLUSIONS: Placement of an occluding endograft associated with axillofemoral bypass grafting is a good alternative for patients at high risk with complex anatomic features. Longer-term follow-up study is needed to evaluate this endoluminal technique.

Aged↗
PubMed1998

The wirsungorrhagies: causes and management in 14 patients.

BACKGROUND AND STUDY AIMS: Wirsungorrhagy is an extremely rare cause of upper gastrointestinal bleeding. The present study describes 14 cases observed over a seven-year period. MATERIAL AND METHODS: Among 10,000 endoscopic retrograde cholangiopancreatographies performed between 1989 and 1996 we have identified 14 wirsungorrhagies, which were reviewed retrospectively. They occurred in patients with chronic and acute pancreatitis, and primary and metastatic pancreatic cancer. RESULTS: Clinical signs of bleeding were present in six patients; three other patients had occult blood loss, and in five patients wirsungorrhagy was caused by endoscopic manipulation (n=3) or extracorporeal shock-wave lithotripsy (n=2) without clinical or hemodynamic effects. In six patients, wirsungorrhagy was managed by endoscopic methods. Five patients in unstable clinical conditions had an arteriography which allowed identification and treatment of the source of bleeding in three cases. Two patients with bleeding from a communicating cyst in chronic pancreatitis underwent surgery. CONCLUSIONS: Wirsungorrhagy can be responsible for massive bleeding in certain patients, especially those with chronic pancreatitis and pseudoaneurysm. In these cases, arteriography is most useful for identification and treatment of the bleeding. When it occurs during endoscopic manipulations, it can usually be managed endoscopically and/or stops spontaneously with appropriate main pancreatic duct drainage. When it occurs in patients with pancreatic tumors, optimal treatment is surgical resection; this is, unfortunately, usually not feasible.

Acute Disease↗
PubMed1998

Evaluation of two D-Dimer assays in the diagnosis of venous thromboembolism.

A qualitative (Instantia) and a quantitative (VIDAS D-Dimer) D-Dimer test have been evaluated and compared with an ELISA method (Asserachrom D-D) in a population of 74 patients suspected of presenting a deep vein thrombosis. Among the thirty-two patients presenting a deep vein thrombosis on phlebography, there were 16 (50%) proximal vein thrombosis and 16 (50%) distal vein thrombosis. Sensitivity and negative predictive value for proximal thrombosis were 100% in all three tests. For distal vein thrombosis, sensitivity and negative predictive value were respectively 81% and 81% for Asserachrom D-DI 75% and 76% for VIDAS D-Dimer and 63% and 82% for Instantia. In conclusion, this study shows that these D-Di assays are a useful tool to exclude proximal vein thrombosis, at least for patients who are not under anticoagulant therapy.

Adult↗
PubMed1998

Helical CT of aorta after endoluminal stent-graft therapy: value of biphasic acquisition.

OBJECTIVE: We report our prospective study evaluating biphasic helical CT of the aorta after endoluminal stent-graft placement. SUBJECTS AND METHODS: Biphasic helical CT scans in 95 patients with abdominal and thoracic aortic aneurysms who had undergone endoluminal stent-graft placement were reviewed. After a test bolus injection of 15 ml of contrast media at a rate of 3.5 ml/sec for the measurement of the optimal start delay, the aorta was scanned using the following parameters: collimation of 5 mm, table speed of 7 mm per rotation, tube rotation time of 0.75 sec, 120 kV, and 295 mA. A delayed helical CT scan was obtained 15 sec after the initial acquisition using the same parameters. RESULTS: Biphasic helical CT scans showed perigraft leakage in 45 (47%) of 95 patients. Leakage was shown only on arterial phase CT in eight patients and only on the delayed scans in three patients. In two patients, leakage shown on the delayed acquisition was retrospectively seen on the first scan. Leakage and outflow vessels were most visible on the arterial phase acquisition in 17 patients and on the second acquisition in six patients. Overall, biphasic acquisition was superior to arterial phase acquisition alone in 15 (16%) of 95 patients. CONCLUSION: The diagnostic value of biphasic helical CT is superior to arterial phase acquisition alone for the evaluation of the aorta after endoluminal stent-graft therapy.

Aged↗
PubMed1998

The CVC removal distress syndrome: an unappreciated complication of central venous catheter removal.

The removal of a central venous catheter (CVC) can be complicated by rare but potentially life-threatening neurocardiopulmonary distress. The clinical courses of eight patients who had CVC removal complications are reviewed. Seven patients had catheter removal from the right internal jugular vein, and one from the right subclavian vein. The complications occurred after complete removal of the catheter (four patients), after guidewire replacement for catheter change (three patients), and after detachment of the hemostasis side port of the Swan introducer during sheath removal (one patient). Each of them had more than one complication. The major complications were: neurologic paresis or coma (four patients), respiratory failure (four patients), and shock (two patients). One patient died of pulmonary sepsis. The overall mortality rate was 12.5 per cent. Guidelines for safe removal of central venous catheters are proposed. Possible mechanisms of the complications are discussed. We refer to the observed complications as the CVC removal distress syndrome.

Adult↗