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J J Merland

Publications and source records attributed to J J Merland.

At least 19 recordsLinked to original sources
PubMed2005

Intra-arterial thrombus visualized on T2* gradient echo imaging in acute ischemic stroke.

BACKGROUND: MR signal loss related to arterial thrombosis leading to vascular susceptibility artifacts (VSA) has recently been reported on gradient echo images. The time course and sensitivity of VSA in acute stroke patients has been scarcely investigated. The aim of this study was to assess the frequency and course of VSA in acute stroke patients, to compare its sensitivity to distinct features of arterial occlusion as detected on FLAIR images or on CT scan. METHODS: Twenty-nine patients were scanned from 45 min to 6 h after stroke onset using identical MR parameters. All had an acute ischemic lesion identified on diffusion-weighted images, 25 had an occlusion of MCA or PCA confirmed by magnetic resonance angiography. RESULTS: VSA was detected in 22/25 patients having an occluded artery at the time of MRI examination. Flair disclosed a hyperintense vessel in all of these 25 cases, but CT scan revealed a hyperdense artery in only 15 cases. Follow-up studies showed that VSA can vanish or disappear after partial recanalization. When the artery remains occluded, VSA can decrease, disappear or increase in the next hours, possibly related to structural modifications of the thrombus with time. Most occlusions were due to cardiac and arterial emboli or to intracranial extension of carotid occlusion. CONCLUSIONS: VSA are frequent in the first hours of MCA or PCA occlusion in acute stroke patients. The sensitivity of VSA appears lower than the arterial hyperintensity on FLAIR images but higher than the hyperdense artery sign on CT scan. The extent and intensity of VSA can change with recanalization or structural modifications of the thrombus.

Adolescent↗
PubMed2004

[Rhinocerebral mucormycosis].

We report a case of a rhinocerebral mucormycosis with extensive cavernous sinus thrombophlebitis and internal carotid artery thrombosis. This case illustrates the usual clinical and imaging features of the disease, which is a potentially devastating infection in immunocompromised patients.

Carotid Artery Thrombosis↗
PubMed2001

Thrombolysis of extracranial and intracranial arteries after IV abciximab.

Abciximab was administered intravenously to three patients to treat thrombus associated with atherosclerotic stenosis of a supra-aortic artery. In two cases, the thrombi had been identified on a previous angiography more than a week before treatment. Successful thrombolysis was achieved with abciximab in all three cases. In this small series, abciximab had a thrombolytic effect on established thrombi that were refractory to previous antithrombotic treatment attempts.

Abciximab↗
PubMed2001

Spinal subdural haematoma: a study of three cases.

AIMS: To define the clinical, computed tomography (CT) and magnetic resonance imaging (MRI) features and the role of MRI in the follow-up of spinal subdural haematoma (SSH), and to compare these findings with those of spinal epidural haematomas (SEH). METHODS: We report three cases of SSH (two women, one male, age: 50-74 years). Two patients were on anticoagulant therapy; in the other case the SSH was spontaneous. All the patients were examined 1-3 days after the onset of the symptoms. All of them had CT, two had MRI and one had angiography. Two patients underwent surgery. RESULTS: The haematoma was located in the thoracolumbar region (two) and in the thoracic region (one), extending from five (two) to 11 vertebral body levels (one). The haematomas were posteriorly located with lateral extension. The transverse shape differed with the level: biconvex, biloculated or circumferential. The haematomas were hyperdense on CT. On MRI, SSH yielded high signal on both T1 and T2. The integrity of the posterior fat pads, which was well shown on CT and MRI, and the visualization of the dura mater demonstrated the intradural location of these collections, making them easily distinguishable from spinal epidural haematoma. MRI provides better evaluation of the longitudinal extent. Our results are compared with those reported in the literature. CONCLUSION: MRI is superior to CT for diagnosis and follow-up of SSH. Our findings and those reported in the literature show that the MR features of SSH are quite specific and allow differentiation from SEH.

Aged↗
PubMed2001

Arterial blood supply to the uterus in nonpregnant sheep: a pertinent model for clinical practice?

RATIONALE AND OBJECTIVES: Our goal was to study the arterial supply to the sheep uterus to compare its similarity with that of women and to evaluate the interest of this animal model for training in uterine artery embolization. METHODS: Ten nonpregnant sheep underwent aortography and selective study of the ovarian, internal iliac, uterine, and vaginal arteries. RESULTS: The uterus was supplied mainly by the uterine arteries in all sheep. The ovarian artery, which was identified in five sheep, had a thin anastomosis with the ipsilateral uterine artery at the tubal junction. The vaginal artery provided blood flow to the inferior part of the cervix and anastomosed with the ipsilateral uterine artery. CONCLUSIONS: Because uterine vascularization of nonpregnant sheep is similar to that of women, the sheep represents an appropriate model for experimental uterine artery embolization. This model should be used for interventional radiologists in training not familiar with endovascular navigation inside pelvic arteries.

Angiography↗
PubMed2001

Carotid stenting for radiation-induced stenoses: A report of 7 cases.

BACKGROUND AND PURPOSE: Radiation-induced stenoses of the carotid artery are associated with fibrosis of the arterial layers and tissue planes that renders their surgical treatment difficult. We present our clinical experience in carotid angioplasty stenting (CAS) of patients harboring such stenoses. METHODS: Seven patients underwent transfemoral CAS of 10 radiation-induced stenoses located on either the common or the internal carotid artery. Six patients presented neurological symptoms. Four patients had undergone previous radical neck dissection, and 3 had permanent tracheostomies. Stenoses were primarily covered with a self-expandable stent before carotid dilation. RESULTS: All interventions were successful, with residual stenoses <20%. No permanent complication occurred. The mean follow-up was 8 months. Patients were symptom free at the last clinical examination, and Doppler control showed no evidence of restenosis. CONCLUSIONS: Carotid stenting appears very attractive for such "hostile neck" patients and seems a safe and efficient treatment for radiation-induced stenoses.

Aged↗
PubMed2001

Catheter modification for easier cannulation of the carotid artery during angioplasty and stenting.

PURPOSE: To present a modification of both the guiding catheter and stent delivery system to facilitate access into sharply curved supra-aortic vessels during carotid angioplasty. TECHNIQUE: Access failures during carotid interventions typically occur because either the vessel origin is acutely angled or the stenosis is located proximal to the carotid bifurcation, limiting access to the external carotid artery. We directly catheterized the left common carotid artery or brachiocephalic trunk with a guiding catheter whose tip had been curved by steam-shaping. The tip of the stent delivery system also was molded into a curve by this process so it engaged the curved part of the guiding catheter without pulling it out of the vessel. CONCLUSIONS: This simple modification can improve the success rate of carotid cannulation via the femoral approach and does not seem to increase the risk of the intervention.

Angioplasty, Balloon↗
PubMed2001

Spontaneous closure of dural arteriovenous fistulas: report of three cases and review of the literature.

SUMMARY: Three cases of spontaneously closing dural arteriovenous fistulas (AVFs) are presented, and 11 previously published cases are reviewed. On the basis of clinical and angiographic data, two types of spontaneously regressing dural AVFs are distinguished: posttraumatic and spontaneous. In all cases, the explanation for spontaneous closure is unknown. Some authors have hypothesized that the thrombosis of the draining sinus could be involved. We report three cases of spontaneous dural AVF closure with conservation of sinus patency.

Adult↗
PubMed2001

[Cerebral arteriovenous malformations treated by radiosurgery: a series of 705 cases].

BACKGROUND AND PURPOSE: After a review of the main radiosurgical published series, to evaluate our own series of 705 patients with cerebral arteriovenous malformations treated by radiosurgery alone or in combination with embolization or surgery. PATIENTS: and method. From January 1984 to December 1998, 705 patients were treated by a multidisciplinary team including neurosurgeons, neuroradiologists, radiophysicians and radiotherapists. Age of revelation of the cerebral arteriovenous malformations ranged between birth to 73 years (mean 27, median 25). Age at time of radiosurgery ranged between 7 and 75 years (mean 33, median 31). There were 410 males for 295 females (sex- ratio 1.4). Symptoms of revelation were hemorrhage for 59%, seizures for 23%, headaches for 14% and progressive deficits for 4%. Discovery of cerebral arteriovenous malformation was fortuitous in 4% of cases. Repartition following Spetzler's grading was 12% in grade I, 36% in grade II, 40% in grade III, 12% in grade IV and 0% in grade V. Maximal size ranged between 4 and 60 mm (mean 23, median 20). Volume ranged between 0.2 and 24.3 cc (mean 3.8, median 2.8). Majority of cerebral arteriovenous malformations were large size (42% with size higher than 25 mm) and large volume (54% higher than 10 cc. 54% of patients had treatment prior radiosurgery: 38% had embolization, 10% were operated, 4% were treated by radiosurgery (reirradiation) and 3% were operated and embolized. RESULTS: Overall complete obliteration rate was 55%. The obliteration rate was correlated with size (77% for cAVMs lower than 15 mm, 62% for cerebral arteriovenous malformations between 15 and 25 mm, and 44% for cerebral arteriovenous malformations higher than 25 mm), with volume (94% for cerebral arteriovenous malformations lower than 1 cc, 64% between 1 and 4 cc, 48% between 4 and 10 cc, and 62% for cerebral arteriovenous malformations higher than 10 cc), dose at reference isodose, minimal dose, morphological parameters (presence of dural components, arteriolovenous fistula, plexiform angioarchitecture, arterial steal, arterial recruitment, deep exclusive drainage, venous plicature, venous confluence, venous ectasia, venous reflux), sectional topography and good recovery of the target. Embolization was a confusion factor not associated with obliteration rate. After multivariate analysis, only Dmin and complete coverage of the cerebral arteriovenous malformations were correlated with obliteration rate. Delay of obliteration was significantly correlated after multivariate analysis with Dmin, complete coverage, arteriolovenulary angioarchitecture (positive correlation) and venous ectasia (negative correlation). CONCLUSION: Overall complete obliteration rate is unreliable data to assess efficacy of radiosurgical method in the tretment of cerebral arteriovenous malformations. The obliteration rate must be interpretated after stratification on several morphological and dosimetric parameters.

Adolescent↗
PubMed2001

[Treatment of cerebral arteriovenous malformations: decision making strategy].

We have evaluated our therapeutic strategy through the results of modalities used alone or in association. Should the place of each modality be modified? What could be the influence of the first consulting physician? We feel at the present time that small cerebral arteriovenous malformations could be treated by radiosurgery, surgery and embolization according to their characteristics and location. For middle size and some large cerebral arteriovenous malformations, we consider that embolization and/or surgery are adjuvant modalities, specifically when the cerebral arteriovenous malformation is located in an eloquent area.

Case Management↗
PubMed2001

[Value of local ophthalmic artery fibrinolysis in severe forms of central retinal vein occlusion].

PURPOSE: To assess the value of selective ophthalmic artery thrombolysis as a treatment for central retinal vein occlusion (CRVO) for which no alternative therapy is available. MATERIALS AND METHODS: Patients included in this study presented with recent severe non-ischemic CRVO. Urokinase (300,000 IU) was perfused for 40 minutes into the ophthalmic artery. Visual acuity, fundoscopy and retinal arteriovenous transit time were assessed during one year of follow-up. RESULTS: Five of the 13 patients treated experienced a marked improvement of vision (p = 0.05) and retinal perfusion within 24-48 hours, and exhibited progressive lesion regression at fundoscopy within 2-4 weeks. The clinical course of the 5 patients prior to treatment resembled that of combined central retinal artery and vein obstruction (CRAO/CRVO), which typically has a poor visual outcome. One patient relapsed 1 month after thrombolysis. No technical complications were observed. CONCLUSION: Although there was no control group, the short period between fibrinolysis and significant visual improvement combined with marked retinal perfusion improvement, suggests that local thrombolysis is beneficial for CRVO, especially recent CRAO/CRVO.

Adult↗
PubMed2001

[Study of the middle ear. Value of multiplanar reconstructions in spiral tomodensitometry].

We point out the interest of computed tomographic reconstructions from spiral acquisition--particularly sagittal reconstructions--in the study of middle ear anatomy and adjacent structures: the facial canal and the chorda tympani. The reference reconstructions are axial and coronal reconstructions. So, we demonstrate the superiority of sagittal reconstructions for the visualization of the lateral process of the malleus, the body and long process of the incus, the third portion of the facial canal, and the chorda tympani. For the other structures of the middle ear and the other parts of the facial canal, these sagittal reconstructions are complementary. Besides, the best type of reconstruction to visualize the stapes and the vestibular window is the axial plane parallel to the stapes axis.

Ear, Middle↗
PubMed2000

Linac radiosurgery for cerebral arteriovenous malformations: results in 169 patients.

PURPOSE: To present the SALT group results using Linac radiosurgery (RS) for AVM in 169 evaluable patients treated from January 1990 thru December 1993. METHODS AND MATERIALS: Median age was 33 years (range 6-68 years). Irradiation was the only treatment in 55% patients. Other treatment modalities had been used prior to RS in 45%: one or more embolizations in 36%, surgery in 6%, and embolization and surgery in 3% patients. Nidus were supratentorial in 94% patients, infratentorial in 6% patients. Circular 15 MV x-ray minibeams (6-20 mm) were delivered in coronal arcs by a GE-CGR Saturne 43 Linac. Patient set-up included a Betti arm-chair, a Talairach frame. Prescribed peripheral dose was 25 Gy on the 60%-70% isodose (max dose 100%). Arteriographic results were reassessed in December 1997 at 48 to 96 months follow-up. RESULTS: The overall obliteration rate (OR) was 64% (108/169). AVM volumes ranged from 280 to 19,920 mm(3), median 2460 mm(3). OR was 70% for AVM </= 4200 mm(3) 4200 mm(3) (p 25 mm (p = 0.04). OR was 71%, in the absence of embolization, vs. 54% for previously embolized nidus (p = 0.03). OR was 71% for monocentric RS vs. 54% for multi-isocenters (p 28 Gy vs. 55% for values </= 28 Gy (p 79% vs. 57% for lower values (p 17 Gy, vs. 59% for mLd </= 16 Gy (p 40%, vs. 54% for mLi </= 40% (p 85% vs. 60% for CR </= 84% (NS). For patients treated according to our protocol, i.e., 24-26 Gy on the 60%-70% isodoses, OR was higher (68%) than for other patients (47%) (p = 0.02). After multivariate analysis, absence of previous embolization and mono isocentric-irradiation were independent factors predicting obliteration. Complications were: recurrent hemorrhage, 4 patients (1 patient died); brain necrosis on MRI, 2 patients; subsequent epilepsy, 4 patients; other subsequent neurologic deficits, 3 patients. CONCLUSION: Overall OR was 64% (48-96 months follow-up). After monovariate analysis higher ORs were associated with smaller volumes </= 4200 mm(3), smaller nidus size </= 25 mm, absence of prior embolization, monoisocentric RS, higher values for mean and minimum lesion doses and compliance to our protocol. Higher values for the peripheral dose and isodose tended to give better results. Multivariate analysis showed that the absence of prior embolization and monoisocentric irradiation were independent factors predicting successful irradiation.

Adolescent↗
PubMed2000

Percutaneous sclerotherapy for venous malformation of the lips: a retrospective study of 23 patients.

Labial venous malformations are relatively common. Depending on their size, they are responsible for functional and cosmetic handicap. When treatment is indicated, it will be based on percutaneous sclerotherapy, using Ethibloc or Aetoxysclerol, with surgery in some patients. Our purpose was to review 23 patients with soft-tissue venous malformations of the lips. Follow-up ranged from 6 months to 4 years. Sclerotherapy alone or with surgical resection achieved good results in 18 patients. In six patients mild improvement was obtained. No worsening of the initial clinical situation occurred, and no persistent complication was observed. We discuss the indications for treatment and the different types of sclerosing agent. Percutaneous sclerotherapy is safe and is effective for small and medium-size labial malformations. For larger lesions the treatment is more complex and combined long term sclerotherapy and surgery procedures may be required over several years.

Adolescent↗
PubMed2000

Pregnancy after embolization of uterine myoma: report of 12 cases.

OBJECTIVE: To treat uterine myomas with embolization, to look for pregnancy-induced myoma recurrences, and to assess pregnancy course and outcome after embolization. DESIGN: Observational clinical study. SETTING: University of Paris VII hospital. PATIENT(S): Nine women had embolization for symptomatic myoma, with 12 pregnancies observed. INTERVENTION(S): Embolizations were highly selective and performed bilaterally through the uterine arteries with polyvinyl alcohol. MAIN OUTCOME MEASURE(S): Pregnant women were evaluated by physical and sonographic examinations. RESULT(S): Before embolization, the mean uterine volume was 450 cm(3), and in six patients polymyomas were present. The median age at embolization was 40 years; the median delay before pregnancy was 9 months; and the median age at first pregnancy outcome was 41 years. Five early miscarriages occurred. The seven other pregnancies were uneventful, although three premature births and one case of late toxemia occurred unrelated to previous embolization. Three women delivered vaginally and four by cesarean section. Neither myoma recurrence nor abnormality in uterine function was observed. CONCLUSION(S): The results of this first series of 12 pregnancies after myoma embolization are promising. If these preliminary results are confirmed, embolization could be a major breakthrough in the management of myoma and could replace conventional medical and surgical treatments.

Adult↗
PubMed2000

Cranial epidural tuberculoma. A case report.

A 33-year-old patient with cranial epidural tuberculoma without history of tuberculosis is described. CT and MR imaging showed a lesion located on both sides of a right frontotemporal bone destruction with epidural extent. Except for a small necrotic core, the lesion enhanced intensely after contrast medium administration. Osteitis and subgaleal abscess were associated. The displaced dura mater delineated the epidural tuberculoma. Diagnosis was verified by histology and identification of Mycobacterium tuberculosis. After removal of the tuberculoma and combination therapy, there was a complete regression of abnormalities. Differential diagnoses are dural tuberculoma, focal tuberculous pachymeningitis and tuberculous epidural empyema.

Adult↗