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J P Pelage

Publications and source records attributed to J P Pelage.

At least 19 recordsLinked to original sources
PubMed2002

[Interventional radiology in managing post-partum hemorrhage].

UNLABELLED: EMBOLISATION OF THE UTERINE ARTERIES: Is the technique of choice for the management of post-partum hemorrhage, since it is efficient and virtually non-invasive. However, initial obstetrical measures and appropriate reanimation should never be neglected. The decision for embolisation must be made by all of the competent staff (obstetrician, reanimator, interventional radiologist). The clinical state of the patient must be assessed and the biological controls analyzed and eventually the decision can be made to transfer the patient to a specialized unit equipped not only with a team of interventional radiologists but also a multi-disciplinary team, experienced in the management of this type of pathology. PRACTICAL METHODS: An arterial inducer is placed in the femoral artery under local anesthesia. The angiographic exploration includes, when necessary, a global series showing the aorta and the pelvic vessels followed by the successive exploration of the two internal iliac arteries. Embolisation, conducted under scopic control, must be bilateral. Gelatin fragments or powder is the most appropriate embolus. LIMITS: Very few maternal delivery structures are able to perform an arterial embolisation at any time of the day or night. This raises the problem of transporting patients with uncontrolled hemorrhages; only those who exhibit no hemorrhagic disorders can be transported fairly easily. EFFICACY AND COMPLICATIONS: Concerning the three principle causes at the origin of post-partum hemorrhages, efficacy is constant in the case of uterine atonia; conversely, failures have been reported in the case of cervical-vaginal tearing and abnormal placental insertion (placenta accreta). In young women with healthy arteries, the complications of uterine embolisation during post-partum hemorrhage are exceptional.

Adult↗
PubMed2002

Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up.

OBJECTIVE: To evaluate the mid-term efficacy and complications of uterine artery embolisation in women with symptomatic fibroids. To assess reduction in uterine and dominant fibroid volumes using ultrasound and magnetic resonance imaging. DESIGN: Prospective observational single-centre study. SETTING: A district general hospital in Surrey and a private hospital in London. METHODS: Four hundred consecutive women were treated between December 1996 and February 2001. Indications for treatment were menorrhagia, menstrual pain, abdominal swelling or bloating and other pressure effects. Uterine artery embolisation was performed using polyvinyl alcohol particles and platinum coils. MAIN OUTCOME MEASURES: Imaging was performed before embolisation and at regular intervals thereafter. Clinical evaluation was made at regular intervals after embolisation to assess patient outcome. RESULTS: Bilateral uterine artery embolisation was achieved in 395 women, while 5 women had a unilateral procedure. With a mean clinical follow up of 16.7 months, menstrual bleeding was improved in 84% of women and menstrual pain was improved in 79%. Using ultrasound, the median uterine and dominant fibroid volumes before embolisation were 608 and 112 cc, respectively, and after embolisation 255 and 19 cc, respectively (P = .0001). Three (1%) infective complications requiring emergency hysterectomy occurred. Twenty-three (6%) patients had clinical failure or recurrence. Of these, nine (2%) had a hysterectomy. Twenty-six (7%) women had permanent amenorrhoea after embolisation including four patients under the age of 45 (2%). Of these, amenorrhea started between 4 and 18 months after embolisation, and only three had elevated follicle stimulating hormone levels when amenorrhea developed. Thirteen (4%) women had chronic vaginal discharge considered as a major irritant. Thirteen pregnancies occurred in 12 patients. Ninety-seven percent of women were pleased with the outcome and would recommend this treatment to others. CONCLUSIONS: Uterine artery embolisation is associated with a high clinical success rate and good fibroid volume reduction. Infective complications requiring hysterectomy, amenorrhoea under the age of 45 and chronic vaginal discharge may complicate the procedure.

Adult↗
PubMed2002

Fibroid embolization.

The most common surgical treatment for fibroids is hysterectomy and approximately 30,000 are carried out annually in the UK for this condition. The operation, however, carries a significant complication rate. Since the first case was carried out in 1989 there has been increasing interest in the interventional radiological procedure called fibroid embolization where angiographic techniques are used to occlude the vascular supply of fibroids. This article is a review of the world experience of fibroid embolization, its development, techniques, indications, results and complications. So far evidence indicates very promising mid-term results but more long-term comprehensive data is needed from large trials.

Adult↗
PubMed2001

Initial experience with use of tris-acryl gelatin microspheres for uterine artery embolization for leiomyomata.

PURPOSE: To assess the safety and effectiveness of tris-acryl gelatin microspheres (Embospheres) in the treatment of leiomyomata by uterine artery embolization. MATERIALS AND METHODS: This was a Phase I study of 30 patients with symptomatic leiomyomata. Each patient underwent ultrasound imaging and completed questionnaires regarding symptoms and health status at baseline and 3 and 6 months after treatment. Bilateral embolization was performed with use of tris-acryl gelatin microspheres. Summary statistics were used to characterize the demographic and procedure data. Paired t-tests were used to assess change in the severity of menstrual bleeding and health-related quality of life. RESULTS: Bilateral embolization was technically successful in all patients. Three months after treatment, menstrual bleeding was markedly improved as assessed by menorrhagia questionnaire (P <.0001) and menstrual calendar (P <.0001). Pelvic pain and discomfort was improved in 92% of cases. Physical component summary scores of the SF-12 also increased from baseline at 3 months (P =.02) and at 6 months (P =.01). Minor complications occurred in nine patients; there were no major complications. CONCLUSION: Although limited, this initial experience suggests that tris-acryl gelatin microspheres are an effective and safe embolic agent for the treatment of uterine leiomyomata.

Adult↗
PubMed2001

Fibroid calcification after uterine artery embolization: ultrasonographic appearance and pathology.

PURPOSE: To describe the ultrasonographic (US) appearance of fibroid calcification occurring after uterine artery embolization (UAE) and discuss its etiology and pathology. MATERIALS AND METHODS: Twenty-seven of a total of 38 patients were followed up clinically and with duplex US for longer than 6 months after UAE for uterine fibroids. At US, changes in uterine size, fibroid vascularity, and morphology have been recorded. Pathologic studies were performed by one of the authors on resected specimens from a different cohort of patients, at intervals ranging from 4 months to 1 year after UAE. RESULTS: Twenty patients reported complete resolution of symptoms. In 16 of these, a reduction in fibroid volume of 70%-85% was recorded and, at US, the development of a peripheral hyperechoic rim around an increasingly hypoechoic fibroid was noted. Computed tomography in two patients revealed it to be a rim of calcium. Histologic studies in a different cohort of patients who had undergone hysterectomy at variable intervals after UAE demonstrated early aggregation of polyvinyl alcohol (PVA) particles, an intermediate giant cell inflammatory reaction, and calcification in the periphery of the infarcted fibroid at 6-12 months. CONCLUSION: Calcification is the end stage of hyaline degeneration. However, its peripheral location is unlike that of natural fibroid involution and hyaline necrosis. Pathologic studies in resected human fibroids after embolization suggest that its development is the end result of aggregation of PVA particles in peripheral fibroid arteries.

Adult↗
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

[Imaging of primary carcinoid tumor of the pancreas].

PURPOSE: To describe the imaging features of primary carcinoid tumors of the pancreas. Materials and Methods. The sonographic and computed tomographic examinations of six patients with pathologically proven primary carcinoid tumor of the pancreas were retrospectively reviewed. RESULTS: In all cases, sonography showed hypoechoic and well circumscribed tumors. CT scan demonstrated hypoattenuating tumors on noncontrast images, with variable enhancement on postcontrast images. Small tumors (less than 2cm in diameter) were homogeneous whereas larger tumors were heterogeneous with areas of cystic necrosis. In two cases, enlarged lymph nodes were found in association with ascitis. In one case, hepatic metastases were present. CONCLUSION: Primary carcinoid tumors of the pancreas display various and non specific imaging features. Small tumors are likely to be homogeneous and hypervascular whereas larger tumors are heterogeneous and hypovascular.

Adult↗
PubMed2000

[Primary epiploic appendicitis: CT diagnosis for conservative treatment].

OBJECTIVE: Primary epiploic appendicitis is an uncommon, self-limited disease with spontaneous resolution. Diagnosis is usually made at surgery as the disease is generally mistaken for acute appendicitis or sigmoid diverticulitis. CT allows a non-invasive diagnosis, thus avoiding unnecessary surgery. The condition can be managed conservatively with the use of analgesic drugs only, and clinical evolution is uneventful. The aim of this study is to report the CT features of this pathologic process before and after medical treatment by analgesics. PATIENTS AND METHOD: Six patients (4 men and 2 women aged from 23 to 70 year old mean; 29 year old) underwent abdominal CT scan because of acute abdominal pain located in the left lower quadrant (n = 3) and right lower quadrant (n = 3). No patient had fever. Laboratory findings were normal in all cases. Follow-up CT scans were obtained in 4 patients respectively at 2, 4, 8 and 80 weeks. RESULTS: CT scan showed in all cases a fatty mass located to the anterolateral wall of the colon, delineated by an hyper attenuating rim. Infiltration of the pericolic fat was noted in all cases. Follow up CT scans obtained in 4 patients showed that the inflammatory signs had cleared in all cases, the lesion had disappeared (n = 2), decreased in size (n = 1) or a residual paracolic node was observed (n = 1). CONCLUSION: Primary epiploic appendicitis is a rare disease. Knowledge of CT signs allowed the correct diagnosis and a conservative management.

Abdomen, Acute↗
PubMed2000

CT of radiation-induced injury of the gastrointestinal tract: spectrum of findings with barium studies correlation.

Because of improvement in survival rate of patients with abdominal cancer, gastrointestinal complications following external radiation therapy are becoming more frequent. Thus, an increased number of patients are commonly investigated with imaging because of suspected radiation-induced injury of the gastrointestinal tract. This pictorial review highlights the spectrum of CT and barium study manifestations of radiation-induced injury of the gastrointestinal tract. The major role of CT in the evaluation and management of patients with radiation injury of the gastrointestinal tract is highlighted. Emphasis is placed on CT imaging signs that may help in distinguishing between radiation-induced injury and recurrent disease.

Abdominal Neoplasms↗
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

[Uterine artery embolization: anatomical and technical considerations, indications, results, and complications].

The first reported use of transcatheter arterial embolization in the management of intractable bleeding related to pelvic trauma appeared in the literature in 1973. Other indications for pelvic embolization in women include postoperative and postpartum hemorrhage and bleeding related to gynecologic malignancy. Recently, the use of uterine artery embolization in the management of symptomatic leiomyoma has been reported as an alternative to surgery. The widespread acceptance of this procedure necessitates greater knowledge of the arterial anatomy of the female genital tract. In this paper, main arterial variations in uterine vascularization and procedure-relevant technical considerations will be discussed. Indications, results and potential complications of uterine artery embolization will be listed and explained.

Angiography↗
PubMed1999

Uterine arteries: bilateral catheterization with a single femoral approach and a single 5-F catheter--technical note.

In 197 patients, uterine embolization with a single femoral approach and a single 5-F cobra catheter was successful in 362 of 394 (92%) uterine arteries. In six patients (12 arteries), distal embolization with a coaxial 3-F microcatheter was safer. In 10 patients with a life-threatening condition, embolization was performed at the anterior division of both internal iliac arteries. Bilateral selective embolization of the uterine arteries can be performed with a single catheter.

Adult↗
PubMed1999

Cystic fibrosis in adolescents and adults: fatty replacement of the pancreas--CT evaluation and functional correlation.

PURPOSE: To compare the computed tomographic (CT) features of pancreatic fatty replacement in adolescents and adults with cystic fibrosis (CF) with those in control subjects and to correlate the degree of fatty replacement with the functional status of the pancreas. MATERIALS AND METHODS: CT scans in 15 patients with CF (group 1) and in 15 control subjects without CF (group 2) were evaluated for thickness and degree of pancreatic fatty replacement. Thickness was measured at four anatomic levels. The pattern of pancreatic fatty replacement was visually evaluated in four pancreatic regions. Images were semiquantitatively analyzed by two readers. The degree of fatty replacement was correlated with the functional status of the pancreas. RESULTS: In group 1, pancreatic glandular tissue was significantly thinner (P < .001) and the degree of fatty replacement was significantly greater in the four regions (P < .001) than those in group 2. In Group 1, no relationship was found between the degree of pancreatic fatty replacement and that of pancreatic endocrine dysfunction. A significant relationship was found between the degree of fatty replacement and that of pancreatic exocrine dysfunction (P < .001). CONCLUSION: In patients with CF, pancreatic glandular tissue is significantly reduced in size. Pancreatic fatty replacement is the most frequent pattern in older patients with CF and correlates with pancreatic exocrine dysfunction.

Adipose Tissue↗
PubMed1999

Secondary postpartum hemorrhage: treatment with selective arterial embolization.

PURPOSE: To evaluate the efficacy and safety of selective arterial embolization of the uterine arteries in the management of intractable delayed postpartum hemorrhage. MATERIALS AND METHODS: Fourteen consecutive women with secondary postpartum hemorrhage were treated with selective embolization of the uterine arteries. In all cases, hemostatic embolization was performed because of intractable hemorrhage that could not be controlled with the administration of uterotonic drugs or with uterine curettage. RESULTS: The causes of bleeding included genital tract tears in four women and endometritis in eight women; the endometritis was associated with proved, retained portions of placenta in four women. In two women, no evident cause of bleeding was found before angiography. Angiography revealed extravasation in three women. A false aneurysm of the uterine artery was found in two women. In one patient, an arteriovenous fistula was observed. Immediate resolution of external bleeding was observed in all women. No complication related to embolization was found. Normal menstruation resumed in all women. CONCLUSION: Selective arterial embolization of the uterine arteries is a safe and effective means of controlling secondary postpartum hemorrhage.

Adult↗