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Biomedical subjects

J J Merland

Publications and source records attributed to J J Merland.

At least 73 records · Page 4Linked to original sources
PubMed1996

Place of emergency arterial embolisation in obstetric haemorrhage about 16 personal cases.

Delivery bleedings which persist despite of an efficient medical treatment must be offered embolization without delay. Embolization is efficient in nearly 100% of cases; sometimes it has to be repeated. Embolization will it correct coagulopathy in few hours. It is a conservative treatment. It is nowadays undoubtedly the treatment of choice. Territorial organization for the hospital without interventional radiology is needed to organize the transfer of the bleeding patients without delay. Thus, mortality and morbidity as well as hysterectomy will not exist anymore.

Embolization, Therapeutic↗
PubMed1996

Cerebral dural arteriovenous fistulas: percutaneous transvenous embolization.

PURPOSE: To evaluate angiographic and clinical results in patients with a dural arteriovenous fistula (AVF) who underwent percutaneous transvenous embolization. MATERIALS AND METHODS: Retrospective chart analysis and radiologic studies were performed in 24 patients (aged 20-87 years) with a dural AVF treated with percutaneous transvenous embolization. Lesions were located in the transverse and/or sigmoid or superior sagittal sinus. Clinical follow-up was 3-44 (mean, 10.8) months. RESULTS: After percutaneous transvenous embolization of 24 dural AVFs, there was complete occlusion in 17 patients, important flow reduction in three, and moderate flow reduction in four. Twenty patients were clinically cured, 17 with complete occlusion and three with important flow reduction. In patients with moderate flow reduction, clinical improvement was good in two and moderate in one. One patient remained clinically unchanged. A transient complication was seen in one patient, and a permanent complication was seen in one patient. One patient, whose preexisting clinical status was poor, died. During long-term follow-up, the condition of two patients worsened. CONCLUSION: Percutaneous transvenous embolization appears to be effective in the treatment of dural AVFs. More experience is needed to evaluate long-term results.

Adult↗
PubMed1996

Treatment of brain arteriovenous malformations by embolization and radiosurgery.

Embolization was used to reduce the size of brain arteriovenous malformations (AVMs) prior to radiosurgical treatment in 125 patients who were poor surgical candidates or had refused surgery. Of these patients, 81% had suffered hemorrhage, and 22.4% had undergone treatment at another institution. According to the Spetzler-Martin scale, the AVMs were Grade II in 9.6%, Grade III in 31.2%, Grade IV in 30.4%, and Grades V to VI in 28.8% of the cases. Most embolizations were performed using cyanoacrylate delivered by flow-guided microcatheters. Radiosurgery was performed using a linear accelerator in 62 patients treated by the authors, and 34 patients were treated at other institutions using various methods. Embolization produced total occlusion in 11.2% of AVMs and reduced 76% of AVMs enough to allow radiosurgery. Radiosurgery produced total occlusion in 65% of the partially embolized AVMs (79% when the residual nidus was < 2 cm in diameter). Embolizations resulted in a mortality rate of 1.6% and a morbidity rate of 12.8%. No complications were associated with radiosurgery. The hemorrhage rate for partially embolized AVMs was 3% per year. No patient with a completely occluded AVM experienced rehemorrhage. Angiographic follow-up review of AVMs embolized with cyanoacrylate demonstrated a 11.8% revascularization rate, occurring within 1 year. It is concluded that after partial embolization with cyanoacrylate, the risk of hemorrhage from the residual nidus is comparable to the natural history of AVMs and that the residual nidus can be irradiated with results almost as good as for a native AVM of the same size.

Adolescent↗
PubMed1996

[Surgical treatment of superficial vascular malformations. Indications for tissue expansion].

The aim of this work was to demonstrate the feasibility of surgical exeresis of superficial vascular malformations using tissue expansion. A retrospective analysis of data from 15 patients who underwent surgery over a 9 year period for arteriovenous (n = 6) and venous malformations of the trunk and limbs was made. Indications for treatment were pain in six patients or complications of an arteriovenous malformation. Twenty-eight expanders were used in 15 patients. Most of the complications observed (25% of the cases) were minor. The program had to be interrupted due to complications in only one case (7%). Mean duration of tissue expansion was 105 days (30-165). Mean delay to cicatrization was 40 days and mean duration of the treatment program was 156 days. Indication for surgical exeresis of superficial vascular malformations can be widened due the contribution of tissue expansion. With acquired experience, the risk of complications has been reduced. The duration of the treatment protocol is the main drawback.

Adolescent↗
PubMed1996

Cerebral developmental venous anomalies associated with head and neck venous malformations.

PURPOSE: To study cerebral developmental venous anomalies in patients with extensive venous malformations of the head and neck. METHODS: All patients had undergone carotid angiography 10 to 15 years previously. Four-vessel cerebral angiography was carried out in 40 patients with venous malformations. All patients had a physical examination, 16 had CT, and 22 were examined with MR imaging. One patient had MR angiography. RESULTS: Eighteen developmental venous anomalies were noted in 8 (20%) of 40 patients. Four patients had multiple anomalies, and these were bilateral in 1 patient. Developmental venous anomalies seen in association with cervicofacial, cutaneous, and mucosal venous malformations were remarkable in their absence of neurologic events and associated cavernoma; significance of ectatic venous convergence, extension, and preponderance of deep drainage routes; and frequency with which they multiple in occurrence. CONCLUSION: Developmental venous anomalies have a remarkable prevalence of 20% in patients with extensive superficial venous malformations. Therefore, it is important to search for a cerebral developmental venous anomaly when confronted with a cervicofacial venous malformation.

Adolescent↗
PubMed1996

[Cervicofacial superficial venous malformations and developmental abnormalities of the cerebral venous system].

INTRODUCTION: Cerebral developmental venous anomalies (DVA) are uncommon trajectories of the brain venous drainage. They must be differentiated from cavernomas. Patients with head-and-neck venous malformations can have DVA in their brain, a finding much more frequent than in general population. OBSERVATIONS: Three patients had DVA in their brain; this was an incidental discovery when investigating their facial or cervical superficial venous anomalies using arteriography, CT, MRI and MRA. COMMENT: DVA are uncommon variations of the brain venous system. In a vast majority of patients, this anatomical variant appears to be tolerated well, in contrast to cerebral cavernoma that can cause intracranial hemorrhage and neurologic symptoms. We want to stress the fact that the frequency of DVA occurring in patients with cervicofacial VM is much higher than in general population. This pattern is often a fortuitous finding in the work-up of these patients and it must be known in order to stop confusing it with true cerebral venous "angioma": the carvernoma.

Adult↗
PubMed1996

Diagnosis and endovascular treatment of midbasilar dissecting aneurysm.

The authors present the case of a patient with a midbasilar dissecting aneurysm successfully treated by staged bilateral endovascular occlusion of the vertebral artery. The clinical and the radiological features are presented with references to the literature, and the choice of endovascular rather than neurosurgical treatment is discussed in light to our previously reported experience about the treatment of unclippable vertebrobasilar aneurysms.

Aortic Dissection↗
PubMed1996

Trisacryl gelatin microspheres for therapeutic embolization, I: development and in vitro evaluation.

PURPOSE: To develop a precisely calibrated, perfectly spherical, stainable, soft, and implantable but nonresorbable particulate embolization material. METHODS: Calibrated particles with a trisacryl gelatin polymer core and hydrophilic surface characteristics were obtained by reversed emulsion synthesis followed by application of a wet-sieving technique. Particles were suspended in saline, bottled, and sterilized. Quality control included analysis of particle diameters before and after sieving and of suspension sterility and apyrogenicity. Particles were subsequently tested to ascertain their compatibility with commercially available microcatheters. RESULTS: The resulting embolization material consisted of spherical, stainable microspheres of medical grade with diameters ranging from 130 microns to 1200 microns. Sieving the suspension produced particle groups of homogeneous size (accuracy, +/- 20-100 microns). At injection, the particles showed no tendency to build aggregates or to obstruct the microcatheters. CONCLUSION: Precisely calibrated and easy-to-use microspheres were obtained that satisfied the biomedical requirements for implantation as an embolization material.

Animals↗
PubMed1996

Trisacryl gelatin microspheres for therapeutic embolization, II: preliminary clinical evaluation in tumors and arteriovenous malformations.

PURPOSE: To evaluate an embolic agent that is precisely calibrated, perfectly spherical in shape, and soft but nonresorbable for use in the embolization of vascular disease of the head, neck, and spine in humans. METHODS: We used supple, hydrophilic, and calibrated trisacryl gelatin microspheres 200, 400, 600, 800 and 1000 microns in diameter for superselective embolization in 105 patients (27 tumors, 14 facial arteriovenous malformations [AVMs], 37 spinal cord AVMs, 21 cerebral AVMs, and 6 miscellaneous diseases). We used particles in 200 to 600 microns in diameter for tumors and for facial AVMs, particles 400 to 600 microns in diameter for spinal cord AVMs, and particles over 1000 micros in diameter for cerebral AVMs. RESULTS: Delivery of the embolic material was easy: microspheres did not aggregate and catheters did not become obstructed by particles. It was possible to control the embolization through precise accounting of the amount of microspheres and matching of the particle size to the size of the pathologic vascular network. CONCLUSION: The microspheres are easy to use and allow precise control of the embolization procedure. Their physical characteristics make them a safe embolic agent.

Adolescent↗
PubMed1996

Intracranial dural arteriovenous fistulas with spinal venous drainage: relation between clinical presentation and angiographic findings.

PURPOSE: To investigate why some patients with an intracranial dural arteriovenous fistula (DAVF) with spinal venous drainage have myelopathy and others do not. METHODS: We reviewed the clinical and radiologic data for 12 patients who had a DAVF with spinal venous drainage diagnosed at our institutions from 1982 to 1995. RESULTS: Six patients had progressive spinal cord indications of disease (patients with myelopathy) and six others (patients without myelopathy) had cerebral indications (five had intracranial hemorrhage and one had a seizure). Cerebral angiography showed a posterior fossa DAVF with spinal venous drainage in all cases. The clinical presentation of DAVFs with spinal venous drainage was compared with the extent of the drainage. In patients without myelopathy, the spinal venous drainage exited the intradural canal via the cervical medullary-radicular veins and was therefore limited to the cervical perimedullary veins. In patients with myelopathy, no medullary-radicular vein was seen, and the venous drainage descended along the perimedullary veins of the entire spinal cord toward the conus medullaris. CONCLUSION: We found an exact relation between clinical presentation and venous drainage of DAVFs with spinal venous drainage. Patients had no myelopathy when the venous drainage was limited to the cervical cord; myelopathy was present when the venous drainage descended toward the conus medullaris.

Adult↗
PubMed1995

Arterial embolisation to treat uterine myomata.

Haemorrhage, probably related to hypervascularisation, is the commonest complication of uterine myomata and is difficult to treat. 16 patients, aged 34-48 years, with symptomatic uterine myomata, for which a major surgical procedure was planned after failure of medical treatment, were treated by selective free-flow arterial embolisation of the myomata with Ivalon particles. With a mean follow-up of 20 months (range 11-48) in the responders, symptoms resolved in 11 patients; menstrual cycles returned to normal in ten of these. Three patients had partial improvement. Two failures required surgery. In 14 cases embolisation caused pelvic pain, which required analgesia in all.

Adult↗
PubMed1995

Percutaneous transcatheter embolization in multiply injured patients with pelvic ring disruption associated with severe haemorrhage and coagulopathy.

Six multiply injured patients with pelvic fractures were treated by percutaneous transcatheter embolization during a 10 month period. Diagnosis and therapy were carried out early in two cases (first day of admission into the trauma unit). Three patients were treated on the second day after admission. The last patient was embolized on the third day. Two patients underwent one and two remote embolizations. Embolization was indicated due to uncontrolled haemorrhaging, requiring large volumes of packed erythrocytes (median: 11.3) and fresh frozen plasma units (median: 6.8). Three patients had severe coagulopathy (disseminated intravascular coagulation). From two to 12 arteries were embolized per patient (median: 5). After successful transcatheter embolization, the circulation and coagulation stabilized rapidly without recurrence of haemorrhage or coagulopathy.

Adult↗
PubMed1995

Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage.

PURPOSE: To review the symptoms and progression of dural arteriovenous fistulas (AVFs) and correlate the findings with various angiographic patterns. MATERIALS AND METHODS: Patterns of venous drainage allowed classification of dural AVFs into five types: type I, located in the main sinus, with antegrade flow; type II, in the main sinus, with reflux into the sinus (IIa), cortical veins (IIb), or both (IIa + b); type III, with direct cortical venous drainage without venous ectasia; type IV, with direct cortical venous drainage with venous ectasia; and type V, with spinal venous drainage. RESULTS: Type I dural AVFs had a benign course. In type II, reflux into the sinus induced intracranial hypertension in 20% of cases, and reflux into cortical veins induced hemorrhage in 10%. Hemorrhage was present in 40% of cases of type III dural AVFs and 65% of type IV. Type V produced progressive myelopathy in 50% of cases. CONCLUSION: This classification provides useful data for determination of the risk with each dural AVF and enables decision-making about the appropriate therapy.

Arteriovenous Fistula↗
PubMed1994

[Interventional neuroradiology. Drug treatment, monitoring and function tests].

Specialized monitoring as well as function tests and drug therapy play an ever growing role in neuroradiological procedures. The particular route of administration and the territories involved in neuroradiology require special precautions. Anaesthesia must enable the operators to monitor the central nervous system since the patients must remain totally immobilized for several hours. Catheterization is made safe by careful asepsia and antibiotic prophylaxis and by preventing embolic events, particularly in neuro-cervico-facial interventions where an anticoagulant protocol is important. Arterial spasms can be prevented or cured with calcium inhibitors. The safety of the procedure itself is guaranteed by various function tests including sensitivity to ischaemia using anaesthetic barbiturates, controlled clampings or the lidocaine test. Undesirable effects of both emboli (e.g. toxicity of cyanoacrylate glue) and embolization (e.g. subsequent venous thrombosis) can be prevented by adapted anti-inflammatory drugs. Herein, we describe the routine monitoring conditions, drugs prescribed and function tests performed at the Therapeutic Angiography Department of the Lariboisière Hospital, Paris.

Anesthesia, Local↗
PubMed1994

Spinal epidural haematoma: report of 11 cases and review of the literature.

Spinal epidural haematomas (SEH) are rare; most are caused by trauma, anticoagulant therapy, vascular anomalies, hypertension, blood dyscrasias, epidural anaesthesia or, rarely, spinal surgery. We report 11 cases and review the literature (16 cases). The clinical picture is that of acute spinal cord compression. MRI characteristics are quite specific. On sagittal sections, the SEH appears as a biconvex mass, dorsal to the thecal sac, clearly outlined and with tapering superior and inferior margins. The dura mater is seen as curvilinear low signal separating the haematoma from the cord. Within 24 h of onset, the haematoma is isointense with the cord on T1-weighted images and heterogeneous on T2-weighted images. Later, it gives high signal on both T1- and T2-weighted images. Differential diagnosis must include subdural haematoma, epidural neoplasm and abscess. Complete neurological recovery rapidly follows laminectomy and removal of the clot. In three of our cases, the haematoma resolved spontaneously. MRI is the best examination for diagnostic and follow-up.

Adult↗