Search PubMed⌕ Search

Biomedical subjects

J J Merland

Publications and source records attributed to J J Merland.

At least 37 records · Page 2Linked to original sources
PubMed2000

Fibroid-related menorrhagia: treatment with superselective embolization of the uterine arteries and midterm follow-up.

PURPOSE: To prospectively evaluate the effectiveness and safety of selective embolization of the uterine arteries in the management of symptomatic uterine leiomyoma. MATERIALS AND METHODS: Eighty consecutive women (mean age, 44.7 years) with symptomatic uterine leiomyoma, none of whom desired future pregnancy, underwent superselective embolization of the uterine arteries with polyvinyl alcohol particles. In all women, arterial embolization was performed because of persistent, fibroid-related menorrhagia after failure of hormonal therapy. Follow-up consisted of office visits at 2, 6, 12, and 24 months and of ultrasonography at 2 and 6 months after the procedure. RESULTS: Bilateral embolization of the uterine arteries was performed in 76 women; unilateral embolization, in four women. Menorrhagia disappeared in 72 (90%) women. In five (6%) women (including three women with unilateral embolization), clinical improvement was not observed, and myomectomy was needed. In one woman with a large submucosal uterine leiomyoma, hysterectomy was needed because of septic uterine necrosis. Normal menstruation resumed in all but six women. Full-term pregnancy occurred in three women after the procedure. CONCLUSION: Superselective arterial embolization of the uterine arteries is an effective means of controlling symptomatic uterine leiomyoma. However, the ideal embolic regimen remains to be determined.

Adult↗
PubMed2000

Superselective ophthalmic arterial fibrinolysis with urokinase for recent severe central retinal venous occlusion: initial experience.

PURPOSE: To investigate the effects of local ophthalmic arterial fibrinolysis on central retinal venous occlusion (CRVO). MATERIALS AND METHODS: Thirteen patients had recent severe nonischemic CRVO for which no alternative therapy was available. A flow-guide microcatheter was introduced coaxially via the femoral artery into the ophthalmic arterial ostium, and urokinase was perfused for 40 minutes. Vision, funduscopic findings, and retinal perfusion were assessed during 1 year of follow-up. RESULTS: Five of the 13 patients treated experienced visual improvement (P =.05) and retinal perfusion within 24-48 hours. Vision returned to normal within 24-48 hours in three patients, within 1 week in one patient, and within 1 month in one patient. These five patients exhibited progressive lesion regression within 2-4 weeks at funduscopy. Their clinical course prior to treatment resembled that of combined central retinal arterial occlusion (CRAO) and CRVO, which typically has a poor visual outcome. One patient relapsed 1 month after fibrinolysis. Of the remaining eight patients, one had normal vision at 12 months, and seven had no improvement. No technical complications were observed. CONCLUSION: Although there was no control group, the short period between fibrinolysis and substantial visual improvement, combined with marked retinal perfusion improvement, suggests that fibrinolysis is beneficial for CRVO, especially for recent CRAO and CRVO.

Adult↗
PubMed2000

[Arteriovenous malformations: a study of 200 cases].

OBJECTIVE: The aim of this study was to analyze the natural history of arteriovenous malformations by reviewing 200 consecutive cases observed in all localizations between 1992 and 1996 in a multidisciplinary angioma clinic. PATIENTS AND METHODS: Files concerning 200 arteriovenous malformations were reviewed with a standardized observation sheet applying the severity criteria defined by the International Society for the Study of Vascular Anomalies. We used the Schobinger staging system which includes 4 grades of severity: grade I=dormancy, grade II=expansion, grade III=destruction, grade IV=cardiac decompensation. RESULTS: There was no predominance by gender. Cephalic localizations were the most common. The malformation was present at birth as indicated by history taking in 40 p. 100 of the cases. Progression during childhood (grade II) was observed in 84 p. 100. At the first consultation, the patients generally were more often in grade II than in grade I or III. Bone destruction was observed in 3 cases, signs of cardiac decompensation in 5. Arteriovenous malformations were part of a more complex syndrome in 9 cases. We noted a flare-up in the prepuberty or puberty period in 75 p. 100 of the cases and the possible role of puberty (64 cases), trauma (39 cases) and pregnancy (25 p. 100 of the adult women). Explorations were generally completed (Doppler, arteriography) by grade II, expressing the need for a map of expanding lesions. Finally it was difficult to assess posteriorly the beneficial or deleterious effect of the often multiple treatments prescribed for these patients. DISCUSSION: The review of these 200 cases pointed out the "pediatric" nature of the problem of arteriovenous malformations in the large majority of the cases and the often misleading presentation of these vascular anomalies, particularly grade I malformations. A false aspect of capillary malformation could raise the risk of inappropriate treatment. This review also confirmed known factors of exacerbation (puberty, pregnancy, trauma) and demonstrated the severity of these vascular anomalies which can progress with loco-regional expansion and invasion without a cellular proliferation component. The analysis of treatments used showed that embolization alone cannot definitively and totally control a superficial arteriovenous malformation and that no one treatment, even combined embolization and large excision, can be a guarantee to provide total cure.

Adolescent↗
PubMed2000

[Arterial embolization of uterine myoma: results apropos of 286 cases].

OBJECTIVE: Report outcome in non-surgical treatment of symptomatic uterine myomata by particulate arterial embolization. PATIENTS: and method: Two hundred eighty-six women aged 21 to 53 years with symptomatic uterine fibroids initially programmed for surgery were studied. The size and number of myomata were determined by pelvic ultrasound. After retrograde transfemoral introduction of a 4 French catheter, the left and right uterine arteries were successively catheterized. PVA particles were injected by free flow until devascularization. RESULTS: Two hundred sixty-two patients were evaluable. Complete resolution of symptoms was obtained in 245 cases. There were 17 failures. A marked reduction in the size of the myomata was observed (60% at six months). Hemorrhage disappeared in 80% of the cases immediately. Thirteen pregnancies were observed. No recurrence were observed. Complications were rare. CONCLUSION: Particulate embolization is a new minimally invasive treatment for uterine myomata which provides a alternative to hysterectomy and can replace myomectomy in young women.

Adult↗
PubMed2000

Aneurysm of a dural sigmoid sinus: a novel vascular cause of pulsatile tinnitus.

We report a newly evidenced cause of venous pulsatile tinnitus--the aneurysm of a dural sigmoid sinus. A 33-year-old patient presented with an incapacitating pulsatile tinnitus of 6 months' duration in the left ear. The radiological workup evidenced an aneurysm of the left sigmoid sinus. Selective endovascular coil occlusion of the aneurysm was followed by complete resolution of the tinnitus.

Adult↗
PubMed1999

Cultured endothelial cells from human arteriovenous malformations have defective growth regulation.

Vascular malformations are frequent in newborns, and they persist throughout life, which differentiates them from vascular tumors (eg, hemangiomas). Arteriovenous malformations are high-flow vascular malformations. They are considered nonmalignant but can expand and become a significant clinical risk when extensive. To characterize endothelial cells from arteriovenous malformations (AMEC), we cultured cells obtained from surgical specimens and studied their properties. After selection, the cells that grew out from explants had phenotypic and antigenic features (platelet endothelial cell adhesion molecule, von Willebrand factor) of human endothelial cells. Their spontaneous proliferation rate was higher (1.8 to 6.4 times) than that of human umbilical vein, arterial, or microvascular endothelial cells. The proliferation rate of AMEC was not sensitive to the inhibitory activity of various cytokines (interleukin-1beta, tumor necrosis factor-alpha, transforming growth factor-beta, Interferon-gamma). In basal conditions, intercellular adhesion molecule (ICAM-1) was detected at a higher level of expression (6- to 10-fold) on AMEC, but these cells failed to express E-selectin or the vascular cell adhesion molecule (VCAM-1) after cytokine stimulation. Expression of c-ets-1 proto-oncogene was shown by in situ hybridization. The low response to cytokines, the higher propensity to proliferate, and the ets-1 expression suggest that AMEC have a defective regulation of proliferation that may be due to a reduced apoptotic process.

Adolescent↗
PubMed1999

Deep cerebral venous thrombosis: imaging in eight cases.

Deep cerebral venous thrombosis (DCVT) is a rare, potentially fatal disease. We carried out a retrospective analysis of eight patients presenting with DCVT, using CT and MRI data. Digital subtraction angiography (DSA), MR angiography (MRA) (2D phase-contrast), and angiography were performed in four, four and two patients, respectively. Direct (venous abnormalities) and indirect (parenchymatous involvement) signs of thrombosis were assessed. Follow-up MRI and MRA were performed on two patients. CT was initially normal in two patients, demonstrated a "cord sign" in deep veins in five and deep venous infarcts in three. When performed within a week of admission (seven patients), MRI showed thrombosis as into intense or high signal in deep veins on sagittal T1-weighted spin-echo images in all patients, and on axial T2-weighted spin-echo images in two. Deep venous infarcts were found in five patients. Direct or indirect signs of sagittal or lateral sinus thrombosis were present on CT in two patients and on MRI in five. CT angiography, MRA and DSA were concordant with MRI findings. CT venography showed persistent flow in thrombosed veins. MRI follow-up demonstrated progressive deep venous recanalisation.

Adolescent↗
PubMed1999

Effects of contrast media on blood rheology: comparison in humans, pigs, and sheep.

PURPOSE: To compare whole blood viscosity and erythrocyte aggregation in humans, pigs, and sheep, before and after adding water-soluble iodinated contrast medium (CM). METHODS: Two CMs were studied: iopromide (nonionic) and ioxaglate (ionic). The blood-CM viscosity was measured with a Couette viscometer. Erythrocyte aggregation was measured with an erythroaggregometer. RESULTS: The blood-CM viscosity was increased up to +20% (relative to pure blood) with a CM concentration of 0%-10%. At CM concentrations from 10% to 50%, the viscosity decreased. The disaggregation shear stress was increased (relative to pure blood) at low CM concentration (0%-10%). When the CM concentration increased from 10% to 20%, the disaggregation shear stress was decreased, except with the pig blood-ioxaglate mixture. CONCLUSION: At low CM concentration the blood viscosity was increased in pig, sheep, and humans and the disaggregation shear stress was increased in pig and humans. The aggregation of sheep blood was too low to be detected by the erythroaggregometer. This rise can be explained by the formation of poorly deformable echinocytes. At higher CM concentration, the viscosity and the disaggregation shear stress decreased in relation to the blood dilution. We conclude that pig blood and sheep blood can both be used to study the effect of CM injection on blood viscosity. Nevertheless, the rheologic behavior of pig blood in terms of erythrocyte aggregation is closer to that of human blood than is sheep blood when mixed with CM. Pigs could thus be more suitable than sheep for in vivo studies of CM miscibility with blood during selective cannulation procedures.

Animals↗
PubMed1999

Thrombosis of angiographic catheters in humans: experimental study.

One of the major problems in the use of catheters is their thrombogenicity since the embolization of clots near the central nervous system or the coronary arteries can cause permanent damage. Catheter thrombogenicity was evaluated in humans during angiographic procedures by their tendency to become occluded. Characterization of catheters was achieved using roughness measurements, FTIR with ATR, DSC and ESCA. The catheters were 5 commercially available catheters, made mainly of polyethylene, Pebax or polyamide sterilized and ready for clinical use. Thirty-one patients due to have an angiographic procedure and with normal blood and hemodynamic parameters were included in the study. The 50 cm catheter test sample was inserted through an introducer into the femoral artery at the beginning of an angiographic procedure. The outcoming blood flow rate (BFR) was continuously monitored by a special computerized device for 15 min or until the total amount of blood reached 30 ml. The angiographic procedure was then normally resumed. DSC and FTIR showed results consistent with the expected composition of catheters. ESCA results showed very high Si/C ratios and could not be explained in all instances. Occlusion of the catheters occurred in 44% of the cases and the average time to obtain occlusion was 8.5 min (3-15 min). Values of the decrease rate of BFR in ml/min2 allowed separation of the catheters into 3 groups of low, medium and high thrombogenicity. However, occlusion occurred at least one time for each type of catheter. Blood volume and BFR curves vs. time allowed the determination of 3 main types of thrombotic behavior: type I shows no significant reduction of BFR; type II shows a progressive decrease in flow rate; type III is much less frequent and shows an abrupt decrease of BFR either quickly followed by a compensatory increase and resuming of a steady flow or by abrupt occlusion. In type II curves the pattern of occlusion follows a classical diffusion model because the Peclet number is greater than 1 and then the classical Higbie solution for diffusion could be used. The most thrombogenic material was the smoothest. There was no correlation between surface chemical composition and thrombogenicity. However, catheters that were based on PE appeared less thrombogenic than PA catheters in this study.

Angiography↗
PubMed1999

[Tuberculosis of the central nervous system. MRI features and clinical course in 12 cases].

OBJECTIVE: The aim of this study was to characterize the MR findings of various intracranial lesions in the central nervous system (CNS) tuberculosis. MATERIALS AND METHODS: The MRI findings (T1, T2 and T1 sequence after contrast) of 12 proved cases (10 males, 2 females, 24 to 64 years old, average: 35) of CNS tuberculosis were reviewed; 4 patients were seropositive for HIV. RESULTS: Several types of lesions were identified: tuberculomas called miliary lesions if they were smaller than 2 mm in diameter (7 cases), in 1 case the tuberculoma was revealed by two large lesions and bi-hemispheric localisations, leptomeningitis (5 cases), infarction (4 cases), abscesses (3 cases with solitary lesions in 2/3 cases), hydrocephalus (3 cases), pachymeningitis (2 cases). A tuberculomas-leptomeningitis association was found in 4 patients. The pachymeningitis form had an unusual aspect in one case. Patients with leptomeningitis showed thick meningeal contrast enhancement involving all basal cisterns, expanding to the sylvian fissures level, and causing narrowing of the sylvian arteries. Massive infarctions resulted from arterial englobement or embols. In three out of five patients, leptomeningitis was the initial presentation. In seropositive patients, tuberculosis was severe with high mortality (3/4 patients), and associated with other multiple lesions. CONCLUSION: Central nervous system tuberculosis has different appearances, mostly tuberculomas and leptomeningitis. MR with contrast is necessary for follow-up during treatment.

Adult↗
PubMed1999

Major complications of percutaneous embolization of skull-base tumors.

The technique of direct intratumoral injection of permanent liquid polymerizing agent was initially described in 1994 and has evolved significantly with experience. We report complications that occurred in two patients during injection of Histoacryl and offer suggestions to prevent such complications in the future. In one patient, the glue settled in the right middle cerebral artery; in the second, the glue entered the left ophthalmic artery through a collateral branch. Although the fundamental injection technique has not changed, we suggest additional precautions and modifications to make this procedure a safer and more valuable element in the overall management of patients with difficult skull-base tumors.

Adolescent↗
PubMed1998

[52 patients with cystic lymphatic vascular malformations. Percutaneous sclerotherapy--simple, fast and repeatable].

Cystic lymphatic malformations are haemodynamically inactive vascular malformations that never regress. During a nine-year period, 52 patients with cervico-facial superficial cystic lymphatic malformations underwent percutaneous sclerotherapy with Ethibloc (a corn-based alcohol derivative). In 57 percent (30/52) of cases, the outcome of sclerotherapy alone was excellent or good: in 19 percent (10/52), the procedure had to be combined with surgery for aesthetic reasons; and in the remaining 24 percent (12/52), the treatment failed. The results suggest percutaneous sclerotherapy with Ethibloc to be safe and effective, and that it is to be recommended as the treatment of choice in cases of superficial cystic lymphatic malformations.

Adult↗
PubMed1998

Therapeutic approach to arteriovenous malformations of the tongue.

Arteriovenous malformations (AVM) are developmental errors with a high complication rate because they are hemodynamically active. The aim of our study is to evaluate management of the rare subgroup of tongue AVM. From 1982 to 1994, 25 patients with AVM of the tongue presented to our department. All patients were discussed in our multidisciplinary staff consultation and were treated by embolization, surgery, or were followed-up clinically with no intervention. Thirteen patients were asymptomatic in a hemodynamically quiescent phase and did not require any kind of intervention. The 12 others underwent embolization procedures following which 6 became stable, 2 had complementary surgery, 1 was lost to follow-up, 1 had two minor bleeding episodes without the need for hospitalization, and 2 were improved. Arteriovenous malformations of the tongue must be followed clinically and treated only if they become active. Permanent embolization with a polymerizing liquid administered through supra-selective catheterization or by direct puncture of the malformation is recommended.

Adolescent↗
PubMed1998

Failure in radiosurgery treatment of cerebral arteriovenous malformations.

OBJECTIVE: The aim of this study was to retrospectively analyze the reasons for the failure of radiosurgical treatment of cerebral arteriovenous malformations (AVMs). METHODS: Seventeen cases of noncured AVMs were reviewed 3 years after radiosurgical treatment. Follow-up ranged from 33 to 54 months (mean, 44.3 mo). Lesion dimensions varied from 9 to 55 mm (mean, 29.2 mm). The lesions were located in critical or near-critical brain regions. Angiography was performed under Talairach's stereotactic conditions. Two large AVMs bled 36 and 39 months after receiving irradiation, respectively. These two AVMs had been incompletely irradiated. RESULTS: Retrospectively, in four cases (23.5%) we observed errors in determining AVM target shape and size because of inaccurate definition of the nidus and/or because of stereoangiographic incompleteness (absence of external carotid artery injections). In five large and/or irregularly shaped AVMs (29.4%), a strategy of partial volume irradiation had been used. In one patient (5.8%), we observed the recanalization of previously embolized AVMs. In another case (5.8%), the target had been partially missed. The AVMs in one case (5.8%) had been treated with an ineffective peripheral dose. In one (5.8%), the failure occurred because of the lesion angio-architecture. In four cases (23.5%), no evident reasons for failure were determined. CONCLUSION: The results of this study suggest the necessity of complete irradiation of the nidus. The strategy of partial volume irradiation might be avoided, even if it necessitates lowering the doses to treat large AVMs. Accuracy in the target determination is required, and complete stereoangiography is necessary.

Adult↗
PubMed1998

Internal carotid artery dissection causes hypoglossal nerve palsy: CT, MRI, and angiographic findings.

A case of unilateral XIIth nerve palsy due to the dissection of the internal carotid artery is reported. The clinical and radiological features are described. In this patient, cranial nerve palsy is probably the result of compression by an enlarging carotid artery due to mural hematoma. Diagnosis is discussed with emphasis on magnetic resonance imaging findings. Magnetic resonance imaging is also useful for follow-up of arterial lesions.

Adult↗
PubMed1998

Dural arteriovenous fistulas as a cause of intracranial hypertension due to impairment of cranial venous outflow.

OBJECTIVES: A retrospective study was carried out on 13 patients with intracranial dural arteriovenous fistulas (DAVFs) who presented with isolated or associated signs of intracranial hypertension. METHODS: Nine patients presented with symptoms of intracranial hypertension at the time of diagnosis. Ocular fundoscopy available in 12 patients showed bilateral papilloedema in eight and optic disk atrophy in four. Clinical evolution was particularly noticeable in five patients because of chronic (two patients) or acute (after lumbar shunting or puncture: three patients, one death) tonsillar herniation. RESULTS: Two patients had a type I fistula (drainage into a sinus, with a normal antegrade flow direction). The remaining 11 had type II fistulas (drainage into a sinus, with abnormal retrograde venous drainage into sinuses or cortical veins). Stenosis or thrombosis of the sinus(es) distal to the fistula was present in five patients. The cerebral venous drainage was abnormal in all patients. CONCLUSION: Type II (and some type I) DAVFs may present as isolated intracranial hypertension mimicking benign intracranial hypertension. Normal cerebral angiography should be added as a fifth criterion of benign intracranial hypertension. The cerebral venous drainage pattern must be carefully studied by contralateral carotid and vertebral artery injections to correctly evaluate the impairment of the cerebral venous outflow. Lumbar CSF diversion (puncture or shunting) may induce acute tonsillar herniation and should be avoided absolutely. DAVF may induce intracranial hypertension, which has a poor long term prognosis and may lead to an important loss of visual acuity and chronic tonsillar herniation. Consequently, patients with intracranial hypertension must be treated, even aggressively, to obliterate the fistula or at least to reduce the arterial flow and to restore a normal cerebral venous drainage. The endovascular treatment may associate arterial or transvenous embolisation and/or surgery. Patients in whom the fistula is not obliterated after an endovascular therapeutic procedure, need continuous clinical and angiographical follow up.

Adult↗