Biomedical subjects

J J Merland

Publications and source records attributed to J J Merland.

At least 127 records · Page 7Linked to original sources

PubMed1991

MRI in spontaneous dissection of vertebral and carotid arteries. 15 cases studied at 0.5 tesla.

Fifteen patients were observed between 1987 and 1990: there were six with angiographically confirmed vertebral artery dissection, and 9 with carotid artery dissection. Results showed concordance of MRI and angiographic findings, in all cases but one. The dissected portion consistently showed a semilunar hyperintensity narrowing the residual eccentric signal void of the lumen when the artery was not completely occluded. In one angiographically occluded vessel, MR detected a small signal void within the hyperintensity, indicating that the artery was not completely occluded. The length of the dissected portion was clearly demonstrated by MR. Follow up MR and angiographic studies confirmed the regression of the dissection, and also allowed examination of the cerebral parenchyma.

Aortic Dissection↗

PubMed1991

Percutaneous transvenous catheterization and embolization of vein of galen aneurysms.

Seven cases of vein of Galen aneurysms treated by percutaneous transvenous endovascular occlusion of the aneurysmal vein are presented. In one case, the approach was via the femoral vein, and in the other six cases, by the jugular vein. All of the malformations were multipedicular and, additionally, in six of the seven there was an intervening arterial-arterial network between the posterior thalamoperforating arteries and the wall of the venous aneurysm. This fistulous network was interpreted as purely arterial and not as an associated arteriovenous malformation. For this reason, the transvenous approach was considered justified, and was performed without risk of hemorrhage caused by retrograde venous hypertension. Measurement of intra-aneurysmal pressure during the course of treatment allowed better understanding of the hemodynamics of the lesions, guided the amount of occlusion to be accomplished during each treatment session, and thus may have prevented the phenomenon of normal perfusion pressure breakthrough. The percutaneous transvenous approach offers all the advantages of the transtorcular approach but avoids surgery. Because of our excellent angiographic and clinical results--five complete and two partial occlusions, with favorable outcomes and no major complications--we believe that this technique is better for the treatment of multipedicular vein of Galen aneurysms than transarterial embolization or surgery.

Basilar Artery↗

PubMed1991

Endovascular occlusion of vertebral arteries in the treatment of unclippable vertebrobasilar aneurysms.

Twenty-one patients with aneurysms of the vertebrobasilar circulation underwent unilateral or bilateral endovascular occlusion of the vertebral artery. Six patients presented with subarachnoid hemorrhage (SAH), 10 with mass effect, four with mass effect and SAH, and one with ischemic symptoms. Thirteen patients had good outcomes with complete clinical and angiographic cure. Six patients had partial thrombosis of their aneurysms. There was one death and one treatment failure. One patient suffered transient stroke. It is concluded that endovascular occlusion of the vertebral artery following test occlusion is a safe and effective treatment for proximal aneurysms of the vertebrobasilar circulation.

Adolescent↗

PubMed1991

Curative treatment of scalp arteriovenous fistulas by direct puncture and embolization with absolute alcohol. Report of three cases.

Three cases of direct arteriovenous fistulas of the scalp (two involving cirsoid aneurysms) are presented. All three patients were treated with direct puncture of the venous pouch and injection of absolute ethyl alcohol during compression of the venous outflow of the fistula. Two of the three patients were cured with this treatment alone. The third patient, with a very high-flow giant fistula, required injection of glue to close the fistula and subsequent surgical extirpation of the resulting hard mass lesion.

Adult↗

PubMed1991

Endovascular occlusion of intracranial vessels for curative treatment of unclippable aneurysms: report of 16 cases.

Among 121 intracerebral aneurysms presenting at one institution between 1984 and 1989, 16 were treated by endovascular means. All 16 lesions were intradural and intracranial, and had failed either surgical or endovascular attempts at selective exclusion with parent vessel preservation. The lesions included four giant middle cerebral artery (MCA) aneurysms, one giant anterior communicating artery aneurysm, six giant posterior cerebral artery aneurysms, one posterior inferior cerebellar artery aneurysm, one giant mid-basilar artery aneurysm, two giant fusiform basilar artery aneurysms, and one dissecting vertebral artery aneurysm. One of the 16 patients failed an MCA test occlusion and was approached surgically after attempted endovascular selective occlusion. Treatment involved pretreatment evaluation of cerebral blood flow followed by a preliminary parent vessel test occlusion under neuroleptic analgesia with vigilant neurological monitoring. If the test occlusion was tolerated, it was immediately followed by permanent occlusion of the parent vessel with either detachable or nondetachable balloon or coils. The follow-up period ranged from 1 to 8 years. Excellent outcomes were obtained in 12 cases with complete angiographic obliteration of the aneurysm and no new neurological deficits and/or improvement of the preembolization symptoms. Four patients died: two related to the procedure, one secondary to rupture of another untreated aneurysm, and the fourth from a postoperative MCA thrombosis after having failed endovascular test occlusion. The angiographic, clinical, and cerebral blood flow criteria for occlusion tolerance are discussed.

Aged↗

PubMed1991

[Superficial vascular (arterial and venous) malformations: clinical aspects and complementary tests].

A simple and precise classification has been established during a ten-year international cooperation. There are two major groups: hemangiomas, always regressive; and vascular malformations, which never regress; they grow, throughout life, to varying degrees. Management of vascular malformations has been clearly defined. Capillary malformations do not require examination, unless they are associated with other anomalies, such as hypertrophic underlying bone, or the leptomeningeal vascular anomaly of the Sturge-Weber syndrome. Venous type malformations are diffuse, and consist of entirely anomalous channels, with low flow. CT scan and MRI clearly demonstrate the extent of tissue involvement in venous malformations; for these slow-flow malformations the evaluation is performed without resorting to invasive diagnostic techniques: phlebography is rarely performed, and arteriography is unnecessary. Arteriovenous malformations are dangerous high-flow vascular malformations, leading to skin ischemic necrosis, and congestive cardiac failure. Arteriography shows enlarged tortuous arteries, with arteriovenous shunting, and early venous drainage. CT scan and MRI show the deep components of the lesions. Doppler ultrasound evaluation is used to follow the course of the disease.

Arteriovenous Malformations↗

PubMed1991

[Interventional imaging: a new specialty in between radiology and surgery].

Interventional radiology can be defined as the medical field of all diagnostic and therapeutic procedures performed with imaging techniques (Sonography, angiography, X-scanner, Magnetic resonance, radionuclides ... ). Interventional Radiology comprises 350 types-procedures in common use, that represent more than half a million acts/year in France. Its development was promoted by all the innovations in imaging and by pioneers of Radiology who created new and adaptative tools in order to act as atraumatically as possible but specifically on the pathological process. Interventional radiology needs practitioners who received a double education in imaging and medico-surgical specialty (before entering in an interventional imaging training). To develop and evaluate the tools of tomorrow, Interventional Radiology needs to develop one or several research interfaces where interventional radiology, companies and searchers could meet and work altogether.

Humans↗

PubMed1991

[Transluminal angioplasty of the brachiocephalic artery with cerebral protection].

The authors report one case of percutaneous angioplasty of atherosclerotic symptomatic stenosis of brachiocephalic artery. Angioplasty had been performed using an occlusive balloon in internal carotid artery to realize a cerebral protection. This safer technics allowed to heal the stenosis and the brachiocephalic steal syndrome, without cerebral embolies.

Angioplasty, Balloon↗

PubMed1991

[Pseudo-Kaposi syndromes of vascular origin].

Pseudo-Kaposi's Sarcoma with vascular disease concern mainly acroangiodermatitis described by Mali--(with chronic venous insufficiency)--, arteriovenous malformations with angiodermatitis described by Stewart and Bluefarb, and pseudo-Kaposi's Sarcoma occurring after placement of arteriovenous shunt for hemodialysis. Search for relation ships between classical Kaposi's Sarcoma and new AIDS Kaposi's Sarcoma explains new interest devoted to Pseudo-Kaposi's Sarcoma.

Acquired Immunodeficiency Syndrome↗

PubMed1991

[Emergency preoperative embolization using coils of ruptured sylvian aneurysm. Apropos of a case].

The authors report a case of a 73 year old patient who presented with a right temporal lobe hematoma secondary to rupture of a right middle cerebral artery bifurcation aneurysm. Treatment consisted of partial thrombosis of the aneurysm by the endovascular introduction of metallic coils followed by surgical hematoma evacuation and aneurysm clipping. Thrombus of the aneurysm done probably diminished the risk of intraoperative rupture. Partial endovascular treatment has a very small risk and may be done on a emergency basis at the same time as the diagnostic arteriogram. It can also be suggested for patients in poor condition to diminish the risk of recurrent hemorrhage until the patient is well enough to undergo definitive surgical clipping.

Aged↗

PubMed1990

Ethanol embolization of arteriovenous fistulas: a primary mode of therapy.

Arteriovenous fistulas (AVFs) can be posttraumatic or congenital vascular malformations. In the initial arteriographic evaluation, chronic AVFs potentially can be confused with arteriovenous malformations (AVMs). The authors studied five patients with a single AVF and one patient with numerous AVFs. Three patients had undergone surgery for treatment of their AVFs, one patient had undergone isobutyl-2-cyanoacrylate (IBCA) embolization, and two patients had undergone no prior therapy. The AVFs recurred in the three patients who had undergone surgery and in the patient who had undergone IBCA embolization. All patients underwent ethanol embolization of their AVFs. Angiograms obtained immediately after embolization documented closure of all AVFs. At follow-up, none of the embolized lesions have recurred. The authors conclude that ethanol embolotherapy can cure these problematic lesions. Extreme caution, however, must be employed with the use of intravascular ethanol because nontarget embolization can potentially result in tissue devitalization. In this study, two patients developed a small focal area of skin necrosis that did not require skin grafting and healed with conservative management.

Adult↗

PubMed1990

Vertebral hemangiomas: fat content as a sign of aggressiveness.

Thirty-two vertebral hemangiomas (VHs) were evaluated with nonenhanced computed tomography (CT), T1-weighted magnetic resonance (MR) imaging, CT enhanced with contrast material, and selective spinal arteriography. The stroma between the osseous trabeculae was found to correspond to either fatty tissue or soft tissue or both. All 11 asymptomatic VHs showed complete fatty stroma at CT and increased signal intensity at MR imaging. In contrast, all four compressive VHs had soft-tissue attenuation at CT. Three compressive VHs showed low signal intensity on MR images. Predominantly fatty stroma at CT and increased signal intensity at MR imaging were associated with normal or only slightly increased vascularization at selective spinal arteriography or contrast-enhanced CT, while soft-tissue stroma at CT and low signal intensity at MR imaging were associated with distinct hypervascularization. The authors' experience suggests that fatty VHs may represent inactive forms of VH, while soft-tissue content at CT and low signal intensity at MR imaging may indicate a more active vascular lesion with potential to compress the spinal cord. CT and MR imaging may be especially valuable for evaluating patients with clinical signs or symptoms of uncertain origin and findings compatible with VH at plain radiography.

Adipose Tissue↗

PubMed1990

Embolization with particles in thoracic intramedullary arteriovenous malformations: long-term angiographic and clinical results.

To evaluate the long-term results of endovascular treatment with particles in the management of thoracic intramedullary arteriovenous malformations (AVMs), the authors retrospectively reviewed the angiographic and clinical findings in 35 patients. Follow-up was 1-15 years (mean, 6 years) in 28 patients and 6-10 months (mean, 7 months) in seven. A total of 158 embolization procedures were performed in 35 patients. Revascularization occurred frequently, necessitating multiple endovascular sessions. Long-term clinical evaluation showed clinical improvement, compared with the initial status before treatment, in 63% of the patients. Clinical aggravation due to embolization was observed in seven patients (20%) after 12 of the 158 endovascular sessions (8%). These results are better than those reported after surgery and indicate that embolization with particles is an efficient and safe tool in the treatment of thoracic intramedullary AVMs.

Adult↗

PubMed1990

Management of alarming hemangiomas in infancy: a review of 25 cases.

During the past 10 years, 25 infants with alarming hemangiomas--lesions that impaired important functions and were life threatening, especially when there was visceral involvement--have been treated. A vascular mark was present at birth in 68% of these infants. Visceral hemangiomas were associated with bulky cervicocephalic hemangiomas or with small hemangiomas scattered over the body. Among the 25 infants, 12 had laryngeal hemangiomas, 3 had hepatic hemangiomas, and 1 had gastrointestinal hemangiomatosis. Ocular sequelae, malocclusion, and cutaneous distortion were the most important functional problems. Corticosteroid treatment was used for 23 of 25 infants with alarming hemangiomas. There was a varied treatment response: total failure (30% of the patients); excellent, dramatic, rapid improvement (30% of the patients); and moderate, doubtful response, with the natural course of the disease remaining unaltered (40% of the infants). Arterial embolization, used in 6 infants, gave inconstant results. Cardiac failure, frequently associated with large cutaneous hemangiomas and always seen with hepatic multinodular hemangiomas, required digitalization. In some cases arterial embolization reduced the increased cardiac output. Liver hemangiomas had a high mortality; all 3 infants with hepatic involvement died.

Adrenal Cortex Hormones↗

PubMed1990

[Endovascular treatment of intracranial aneurysms. Value and prospects based on a series of 92 cases].

Endovascular treatment of intracranial aneurysms is a recent technique which needs to be evaluated in large series. From 1978 to 1988, 92 cases of aneurysms were balloon-treated at Lariboisière Hospital either by parent vessel occlusion (O.V.P.) (N = 48) or by selective obliteration (O.S.A.). Treatment in all but 5 cases was performed 3 weeks after S.A.H. since the main reason for choosing endovascular technique was contraindication of early surgery. Giant aneurysms account for 31 cases, vertebro-basilar for 38 and cavernous carotid for 27. In O.V.P. group, there were 17 patients referred after subarachnoid hemorrhage and 30 after tumoral symptoms, while in O.S.A. group, 30 bled and 5 presented with oculomotor palsies. Results in the O.V.P. group are good with 8% morbidity and mortality. In O.S.A., they are worse: 16% (morbidity and mortality) and 22% of secondary balloon deflation; however, because of the features of these aneurysms (size and location), the results seem quite acceptable. Endovascular treatment of intracranial aneurysms is a promising technique which should already replace parent vessel ligation when indicated, and progressively supplant surgical clipping when the remaining technical problems are resolved.

Catheterization↗

PubMed1990

[Endovascular treatment of intracranial aneurysms: techniques and results. Report of 130 cases].

Endovascular treatment of intracranial aneurysms is gaining an important development thanks to the further technical advances in catheters and occlusion materials (detachable and non detachable balloons). This treatment, performed under slight neuroleptanalgesia, allows access to the aneurysmal sac for selective occlusion with preservation of the parent vessel. In cases of fusiform or wide neck aneurysms, and if selective endosaccular occlusion is impossible or hazardous, the parent vessel occlusion can be performed with a test occlusion. Tolerance test occlusion of the parent vessel includes clinical monitoring, angiographic demonstration of good collateral supply and functional measures with local cerebral blood flux studies and transcranial doppler. This therapeutic approach is relatively simple in regard of neurosurgical treatment and allows improvement of the management of surgical high risk lesions.

Catheterization↗

PubMed1989

Spinal dural arteriovenous malformations with perimedullary drainage. Indications and results of surgery in 30 cases.

70 patients were treated for spinal dural arteriovenous fistula in the same centre, during a period of 10 years. Conus medullaris and cauda equina syndromes were observed in all patients as the clinical stereotyped presentation. Diagnosis was based on myelography in the first instance and then on angiography. 40 patients were treated by intravascular neuroradiological embolization, whereas the other 30 were operated on. Surgery was proposed because embolization was contraindicated (7 cases of hazardous catheterisation) of inefficient (23 cases = 38%). The results of the operative series are presented, and compared with those of embolization. Improvement was observed in 50% of the 20 patients with follow up, but a complete recovery to an asymptomatic state was never obtained. For the other patients (47%) complete stabilization of the disease could be obtained, whereas in one of the patients (3%), who was operated upon because of failure of embolization, surgery was also completely ineffectual. The long-term results of patients treated surgically are comparable with those patients efficiently embolized. 5 patients of the operative series were submitted to MRI before and after surgery: the results and the place of MRI are discussed.

Adult↗

PubMed1989

[Radiologic evaluation of an isolated vertebral hemangioma].

CT scan and M.R.I. features have been evaluated in case of compressive (H.V.C.) and asymptomatic (H.V.A.) vertebral hemangiomas. The main datas observed in H.V.C. are: 1) thoracic localization; 2) whole vertebral body involvement; 3) extension to the pedicles; 4) irregular trabeculation; 5) swelling of bone contours with 6) epidural and perivertebral extension. H.V.C. always exhibit at least three of these six datas while H.V.A. are associated with 2 or less. Also H.V.C. frequently present intravertebral contrast enhancement on CT and low signal intensity on T1 weighted and high signal intensity on T2 weighted M.R.I.

Hemangioma↗