Biomedical subjects

J J Merland

Publications and source records attributed to J J Merland.

At least 55 records · Page 3Linked to original sources

PubMed1998

Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization.

PURPOSE: To prospectively evaluate the efficacy and safety of emergency selective arterial embolization in the management of intractable primary postpartum hemorrhage. MATERIALS AND METHODS: Twenty-seven consecutively seen women with life-threatening primary postpartum hemorrhage underwent uterine embolization. In all cases, hemostatic embolization was performed because of intractable hemorrhage that could not be controlled with vaginal packing and administration of uterotonic drugs. The mean hemoglobin level before embolization was 7.48 g/dL +/- 2.39 (74.8 g/L +/- 23.9) (1 standard deviation). Hysterectomy performed in two patients before embolization failed to stop the bleeding. RESULTS: Angiography revealed extravasation in nine patients and spasm of the branches of the internal iliac artery in five. The procedure consisted of embolization of uterine (n = 46), vaginal (n = 5), or ovarian (n = 2) arteries or anterior division of internal iliac arteries (n = 8). Immediate disappearance or dramatic diminution of external bleeding was observed in all cases. Two patients needed repeated embolization the next day. No major complication related to embolization was found. In one patient with placenta accreta, delayed hysterectomy was necessary. Normal menstruation resumed in all women except the two who underwent hysterectomy. One woman became pregnant after embolization. CONCLUSION: Emergency arterial embolization is a safe and effective means of control of primary postpartum hemorrhage. The procedure obviates high-risk surgery and allows maintenance of reproductive ability.

Adult↗

PubMed1998

Aneurysmal bone cysts: percutaneous embolization with an alcoholic solution of zein--series of 18 cases.

PURPOSE: To assess the efficacy of percutaneous embolization with an alcoholic solution of zein in the treatment of aneurysmal bone cysts. MATERIALS AND METHODS: Eighteen patients with aneurysmal bone cysts were treated percutaneously with alcoholic zein. The cysts were in the lower limb (n = 7), upper limb (n = 5), pelvis (n = 3), cervical spine (n = 2), and mandible (n = 1). All patients were symptomatic, three had previously undergone surgery. Percutaneous embolization was performed with fluoroscopic or computed tomographic guidance with the patient under general anesthesia. Clinical and imaging follow-up lasted 18 months to 4 years. RESULTS: Percutaneous embolization was performed in 16 cases. In two cases, cystograms showed marked venous drainage and thus embolization was not attempted. Six patients underwent repeat embolization. Complications consisted of a local transitory inflammatory reaction (n = 5), aseptic osteitis (n = 1), and a small pulmonary infarct without sequelae (n = 1). Relief of symptoms was achieved in all patients except one, who underwent surgery. At imaging, improvement was total in 13 cases (87%) and partial in two cases (13%). No recurrence was noted during follow-up. CONCLUSION: Percutaneous embolization of aneurysmal bone cysts with alcoholic zein should be considered a reliable alternative to surgery, especially in cases with a difficult surgical approach or cases of postsurgical recurrence.

Adolescent↗

PubMed1998

[Kasabach-Merritt syndrome on a congenital tufted angioma].

INTRODUCTION: Kasabach-Merritt syndrome is a very rare disease of infancy, with profound thrombocytopenia and a mild to severe consumption coagulopathy; this biological phenomenon is difficult to control. CASE REPORT: A 1-month old boy had a congenital plaque-like lesion in the calf. It was a biopsy-proven tufted angioma. Five weeks later, Kasabach-Merritt syndrome developed. After failure of ticlopidine + aspirin, and oral betamethasone treatment, thrombocytopenia was cured with vincristine treatment, then the leg lesion slowly continued to shrink after cessation of the treatment. It had disappeared before the age of 1 year. DISCUSSION: We highlighted two points: 1) Kasabach Merritt does not appear as a complication of a classic hemangioma (infantile, "cellular", "capillary", involuting-type), as it has long been thought. In our experience, it develops on a different endothelial cell proliferation, in this case a congenital tufted angioma, but it can also engraft on a kaposiform hemangioendothelioma. 2) These patients are difficult to treat because, up to now, no single treatment has given constant by good results. Vincristine was recently introduced in the treatment of Kasabach-Merritt syndrome, with excellent, rapid outcome. CONCLUSION: What seems a therapeutic progress in a difficult field needs further control.

Antineoplastic Agents, Phytogenic↗

PubMed1998

[Maffucci syndrome: a false venous malformation? A case with hemangioendothelioma with fusiform cells].

BACKGROUND: Maffucci syndrome occurs as a sporadic disease. Progressive onset of both cutaneous vascular lesions (considered to be of venous type) and bony enchondromatous tumors (similar to those seen in Ollier disease) occurs throughout childhood. We report a case of a woman with Maffucci syndrome whose cutaneous vascular lesions revealed spindle cell hemangioendothelioma. CASE REPORT: An italian woman developed severe bone distortion and dwarfism due to multiple enchondromas, first diagnosed as Ollier disease during childhood. At puberty, multiple vascular nodules appeared mainly on the limbs, leading to the diagnosis of Maffucci syndrome. Clinical data suggested the diagnosis of cutaneous venous anomalies: blue color of some nodules, phleboliths, arteriographic pattern. Histopathological examination of the skin specimen showed features of spindle cell hemangioendothelioma, e.g. nodules of dense spindle cell infiltration in combination with dysplastic vessels. DISCUSSION: The few reports available do not clearly evidence the underlying histopathology progression of the lesions over years in a given patient. Skin lesions are classified among venous malformations. Bony enchondromatous involvement of the limbs is common and reported in 9 out of 10 patients. Both vascular and bony lesions classically develop from childhood to adulthood. Spindle cell hemangioendothelioma is a vascular tumor recently described. Cellular spindling in association with vascular spaces must not be misdiagnosed as Kaposi sarcoma. Some of the reported cases of spindle cell hemangioendothelioma had Maffucci syndrome. It is unknown whether Maffucci syndrome occurs in association with venous malformation or whether it is always present in the cutaneous vascular lesions of the disease.

Adult↗

PubMed1998

[Therapeutic strategy for cerebral arteriovenous malformations. Proposal for classification of individual hemorrhagic risk].

BACKGROUND AND PURPOSE: Therapeutic strategy for the cerebral arteriovenous malformations (cAVM) is mainly based on the assessment of hemorrhage risk. This risk is estimated between 2 and 4% according to various series. However, this is a collective risk projected upon a given population. To improve therapeutic strategy for cAVM, we propose a grading of the individual hemorrhage risk based on 5 angiographic parameters: 4 are increasing risk factors and one is a favorable index. METHOD: This grading system has been achieved by univariate then multivariate analysis by logistic regression from angiographic data of 250 consecutive patients with cAVM. Thirty angiographic parameters were studied. RESULTS: Grade I has no risk factors and has two subgrades: Ia with venous recruitment (which is the lonely favorable parameter), Ib without venous recruitment. Grade II is the presence of venous stenosis or venous reflux. Grade III is the presence of exclusive deep venous drainage. Grade IV is the presence of intra or juxta-nidal aneurysm. There were 13% of hemorrhage in grade Ia, 38% in grade Ib, 48% in grade II, 90% in grades III and IV. CONCLUSIONS: This model can be helpful for the treatment decision making and also contributes to a better understanding of the natural history of cAVM. It must be further confirmed by a prospective study.

Adolescent↗

PubMed1998

[Sinusoidal hemangioma].

INTRODUCTION: Sinusoidal hemangioma (SH) was described by two pathologists, Calonje and Fletcher, in 1991. This uncommon cutaneous benign vascular lesions with distinctive histologic features was considered a subset of lesions known as "cavernous hemangiomas". It is made of dilated interconnecting ("sinusoidal"), thin-walled channels with a single-layered lining endothelium and a lobular architecture. PATIENTS AND METHODS: Clinical, radiological (CT, MRI and arteriography), evolutive, and histologic data of 4 patients, whose lesions appeared very similar clinically and histologically, were reviewed and compared to the patterns of the so-called SH. RESULTS: There were 2 males and 2 females. Lesions had an infantile onset in 3 (congenital in 2). They exhibited a protracted course over years in the 4, and they all invaded the right forehead, eyelids and orbit areas. Clinically, they appeared as multilobulated, building, firm tumors under a normal shiny skin. Radiologically, lesions were strikingly nodular, with criteria of slow-flow vascular lesions on MRI and arteriograms. Histologically, all lesions were comprised of well-circumscribed nodules with a lobulated architecture, made of greatly dilated, blood-filled, thin-walled vascular channels, with scanty fibrous stroma between them. Interconnecting channels had the distinctive sinusoidal pattern. There were some elongated pseudopapillary structures. Islands of spindle cells were noted in 2 lesions. DISCUSSION: On the one hand histologic features of the lesions in our 4 patients are identical to those described by Calonje and Fletcher as SH, a lesion not to be confused with classic, involuting-type, hemangioma of infancy and childhood, and with venous or lymphatic malformations of the same location. SH fits into the group of lesions defined by pathologists as "cavenous hemangiomas". On the other hand the lesions in our 4 patients differed from the clinical description of SH as a solitary acquired small (less than 3 cm) nodule in adults. Otherwise the four lesions described herein constitute a distinctive clinicopathologic entity with a striking aggressive local growth although there is a histologic malformative pattern. The presence in 2 cases of islands of spindle cells led us to discuss the differences with spindle cell hemangioendothelioma.

Adolescent↗

PubMed1997

Angioarchitecture associated with haemorrhage in cerebral arteriovenous malformations: a prognostic statistical model.

The overall haemorrhagic risk of a cerebral arteriovenous malformation (cAVM) is 2-4% per year. However, the individual risk of haemorrhage has never been determined. This study was undertaken to assess the haemorrhage risk of an individual cAVM. Neuroangiographic findings of 160 cAVM were analysed retrospectively, looking at 30 angiographic features. A statistical model was established by logistic regression to evaluate the risk of an individual cAVM. We statistically correlated 15 parameters with the haemorrhage risk. The statistical model includes five independent parameters. Four are unfavourable: exclusively deep drainage, venous stenoses, venous reflux and the radio of afferent to efferent systems; one is favourable: venous recruitment. This model quantifies the individual risk of haemorrhage. When this model is applied to the population studied, the error rate is 5%. This model can contribute to therapeutic strategy, and to a better understanding of the natural history of cAVM.

Adolescent↗

PubMed1997

Long-term changes in intracranial dural arteriovenous fistulae leading to worsening in the type of venous drainage.

We review seven patients with intracranial dural arteriovenous fistulae (ICDAVF), each altering the initial type of venous drainage to one with a higher grading during long-term follow-up. Five were discovered due to symptoms of intracranial hypertension, two due to changes in tinnitus and one case following subarachnoid haemorrhage. In five cases, cortical venous drainage developed during the follow-up period. Three different mechanisms were observed: stenosis or thrombosis in the draining veins in 4 cases: increased arterial flow in 2; and the appearance o a new fistula site or extension of the initial shunt in 2. Type I and type II a fistulae which are not completely cured, require both close clinical observation and Doppler examinations in the follow-up period. Any charge in the clinical pictures indicates a repeat angiogram. Stenosis of the venous drain-age, forecasting later worsening in the venous outlet, requires more thorough angiographic follow-up.

Adult↗

PubMed1997

MRI and MRA for diagnosis and follow-up of cerebral venous thrombosis (CVT).

OBJECTIVE: To assess the sensitivity of magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) in the diagnosis and the follow-up of cerebral venous thrombosis (CVT). To describe MRI and MRA features in CVT. MATERIAL AND METHODS: The clinical and neuroradiological studies of 20 patients with proven CVT were reviewed. All patients underwent computed tomography (CT), MRI (with MRA for 15 patients) and digital substraction angiography (DSA). Eleven patients had follow-up after treatment with MRI (nine with MRA). RESULTS: MRI and MRA together provided the diagnosis of CVT in all cases. The sensitivity of MRI alone was 90%. MRA showed abnormalities in all cases of CVT. Progressive sinus recanalization was demonstrated by follow-up with MRI and MRA at least 15 days after diagnosis and treatment. CONCLUSION: In most of cases, the combination of MRI and MRA is sufficient to allow diagnosis of CVT and obviates the need for invasive angiography. MR studies are also useful for the follow-up of CVT.

Adolescent↗

PubMed1997

Parenchymal changes after radiosurgery of cerebral arteriovenous malformations. Preliminary report of a proposed classification.

Radiosurgery of cerebral arteriovenous malformations (cAVM) can induce parenchymal changes seen on MRI. The purpose of this study was to classify these changes and to correlate them to clinical outcome and obliteration of the cAVM. 142 patients with cAVM underwent radiosurgery with a linear accelerator between 1994 and 1995. 60 clinical records, MR images, and postradiation angiograms were reviewed. Signal abnormalities and contrast enhancements were correlated with clinical deterioration and size decrease of the AVM. The Spearman nonparametric test was used for statistical correlation. MR findings allowed to differentiate between four grades: grade 1 = no parenchymal changes; grade 2 = hypersignal on T2-weighted sequences, grade 3 = grade 2 + contrast enhancement on T1-weighted sequences; grade 4 = grade 3 + central hyposignal (necrosis-like) + peripheral hyposignal surrounding the AVM on T1-weighted sequences. Grade 4 was significantly related (p < 0.001) to clinical deterioration (deficit, seizures, increased intracranial pressure). All grade 4 patients, and only them, had clinical symptoms. Most of these symptoms regressed with corticoid treatment. Grade 4 was also related to the proportion of obliteration of the cAVM at 1 year after radiotherapy: mean proportion of obliteration was 12.5% for grade 2, 25% for grade 3 and 82.2% for grade 4 (p < 0.01). The size of T2-weighted MR images was related to clinical symptom appearance (p < 0.001). Finally, contrast enhancement was not predictive of the occurrence of the clinical symptoms. This proposed classification allows one to differentiate between the various MR images, and seems to predict clinical complications and response to radiotherapy of the cAVM.

Brain↗

PubMed1997

Giant perimedullary arteriovenous fistulas of the spine: clinical and radiologic features and endovascular treatment.

PURPOSE: To present the clinical and radiologic features of giant perimedullary arteriovenous fistulas (GAVFs) in 12 consecutive cases and to evaluate the results of endovascular treatment. METHODS: We retrospectively reviewed the clinical and radiologic data as well as the results of balloon endovascular treatment obtained from 1980 to 1989. RESULTS: GAVFs, defined as large intradural perimedullary direct arteriovenous high-flow shunts, are revealed mainly in childhood either by subarachnoid hemorrhage or by progressive neurologic disorders. MR imaging and myelography show major vascular dilatations. The angioarchitecture of GAVFs can only be assessed by selective spinal angiography. Ten patients were treated by balloon occlusion resulting in eight anatomic cures and six good clinical results. One balloon migrated to the venous side, leading to clinical deterioration. CONCLUSION: GAVF is a special subgroup of intradural perimedullary arteriovenous fistula. The endovascular approach should be the first line of treatment, with surgery reserved for special circumstances. Nondetachable balloon occlusion is a safe and efficient method for treating GAVFs.

Adult↗

PubMed1997

[Recourse to particular arterial embolization in the treatment of some uterine leiomyoma].

UNLABELLED: In 88 women between the ages of 34 and 51 years with one or several symptomatic uterine leiomyomata (menometrorrhagia, mass syndrome) after failure of medical treatment, particulate arterial embolization was proposed as an alternative to the scheduled surgical operation. Free-flow embolization with Ivalon particles (150 to 600 microns) was performed under local anaesthesia after femoral artery puncture and catheterization of the hypogastric then uterine arteries (5 F catheter) including occlusion Pelvic pain was frequently observed immediately after embolization, lasting 12 to 18 hours, and required analgesia. Necrobiosis syndromes can be observed in the case of very large leiomyomata. No immediate complications directly related to vascular catheterization were observed in this series, but complete necrosis of a very large leiomyomatous uterus required hysterectomy. Five embolization failures were observed. The following results were observed in the 80 interpretable cases with a follow-up of 6 to 60 months: the menstrual periods returned to normal in 60 (89%) of the 67 menorrhagic patients, after six months a volume reduction of myomata equal to 69% of initial volume was observed. CONCLUSION: in of 80 interpretable cases, embolization constituted an alternative to surgical treatment, which was avoided in 71 cases, 9 failures were observed. The results of this preliminary series must be valited by further studies.

Adult↗

PubMed1997

Cerebral arteriovenous malformations: the value of radiologic parameters in predicting response to radiosurgery.

PURPOSE: To define the morphological patterns of cerebral arteriovenous malformations (AVMs) that influence their response to radiosurgery at 2 years. METHODS: We retrospectively reviewed the yearly MR and angiographic follow-up studies in 102 patients who had radiosurgical treatment for cerebral AVMs between 1990 and 1992. Parameters studied were maximum length and volume of the nidus, position relative to the midline, anatomic structures involved, sectional anatomic location (depth within the brain tissue), angioarchitecture, and Spetzler and Martin grading. Statistical analysis determined their influence on treatment results at 2 years. RESULTS: Parameters that correlated with obliteration at 2 years were maximum length less than 25 mm, small volume, sectional location deep within brain tissue, and plexiform angioarchitecture. Ventricular and paraventricular locations correlated with nonobliteration at 2 years. CONCLUSION: This study highlights the role of two new morphological parameters in predicting the efficiency of radiosurgery in the treatment of cerebral AVMs: depth within the parenchyma and angioarchitecture. It also emphasizes the usefulness of sectional imaging in the work-up before radiosurgery.

Adolescent↗

PubMed1997

[Facial diplegia in the course of childhood Lyme disease: bilateral enhancement of the facial nerve and MRI after injection of gadolinium].

We report a rare case of Lyme disease presenting as a bilateral seventh cranial nerve palsy and meningitis. The MR appearance was an enhancement of the internal auditory canal segment and mastoid segment of the seventh cranial nerve, in the absence of parenchymal lesions. One should consider Lyme disease in the differential diagnosis of bilateral seventh cranial nerve palsy with enhancement.

Child↗

PubMed1997

[Hemangiomas and superficial vascular malformations of the head and neck. Classification, diagnosis, treatment].

Each kind of superficial vascular malformation (or "angioma") has been included in a widespread classification that has been elaborated by means of a multidisciplinary approach. At present, therapeutic management of these vascular malformations often needs one or several procedures of interventional radiology. The purpose of this paper in to illustrate embolization techniques in each indication and to describe advantages and drawbacks of these different techniques.

Diagnosis, Differential↗

PubMed1997

[Persistent trigeminal artery and its variant. Contribution of MRI and MR-angiography].

We describe the magnetic resonance imaging and magnetic resonance angiography findings in 5 cases of persistent trigeminal artery, and in two cases of variant trigeminal artery. Six patients underwent complete four-vessel angiography, performed to depict other pathology. Magnetic resonance imaging and magnetic resonance angiography allowed in each case to visualize this artery and to precise its latero or intrasellar situation. The variant is not defined on conventional magnetic resonance imaging, but may be individualized on magnetic resonance angiography. In each case, identification of these persistent artery is crucial if surgery of sellar or gasserian region is planned.

Adolescent↗

PubMed1997

[Angioplasty of atheromatous hemodynamic stenoses of intracranial vertebral arteries].

We describe three patients presenting transient ischemic attacks or minor stroke, relapsing despite anticoagulation and antiplatelet therapy, in relation to tight stenosis of the intracranial vertebral arteries, without functional communicating arteries. Percutaneous transluminal angioplasty was successfully performed. We have a 6, 24 and 36 months follow-up. After a review of the literature, we discuss indication and risks of this procedure.

Aged↗

PubMed1996

Fibrinogen binding and platelet retention: relationship with the thrombogenicity of catheters.

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. In this work we have compared the in vivo thrombogenicity of four different angiography catheters and their in vitro activation of fibrinogen binding and platelet retention. The thrombogenicity of catheters has been evaluated in angiographic conditions by kinetic evaluation of the reduction of blood flow rate through the catheters. The binding of adhesive proteins (fibrinogen and von Willebrand factor [vWF] was studied in vitro using a direct-ELISA technique after circulation of anticoagulated whole blood through sections of catheters. The retention of platelets was studied in vitro using 111Indium-labelled platelets. Fibrinogen binding and platelet retention both seem to be good predictors of catheter thrombogenicity, fibrinogen being the better of the two. The most thrombogenic material has the highest fibrinogen and platelet retention rate. This study also confirms the inefficiency of albumin precoating for the prevention of fibrinogen deposition. The determination of fibrinogen deposition by direct-ELISA technique and platelet retention rate is very useful for preclinical testing of catheters.

Biocompatible Materials↗