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L Lemaitre

Publications and source records attributed to L Lemaitre.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Bilateral spontaneous perirenal hematoma: an unusual complication of polyarteritis nodosa].

INTRODUCTION: Spontaneous perirenal hematoma is a serious and unusual complication of polyarteritis nodosa. Its treatment is not standardized. A review of the literature shows that therapeutic arterial embolization is an alternative to nephrectomy. EXEGESIS: We report a new case of spontaneous bilateral perirenal hematoma due to a rupture of a renal aneurysm in a 68-year-old patient presenting with polyarteritis nodosa. The patient had no hypertension. Renal arteriography helped guide the diagnosis, and selective embolization was performed to treat the left hematoma. The right hematoma only required symptomatic treatment. CONCLUSION: Arteriography with selective embolization appears to be a good alternative to nephrectomy in spontaneous perirenal hematoma complicating polyarteritis nodosa. However, in this case, the right hematoma required neither arteriography nor nephrectomy. This raises the questions of the necessity of selective embolization when the clinical status remains satisfying with a symptomatic treatment.

Aged↗
PubMed1998

Correlation between genito-urinary anomalies, semen analysis and CFTR genotype in patients with congenital bilateral absence of the vas deferens.

OBJECTIVE: To evaluate the incidence of renal and seminal vesicle (SV) abnormalities, and the presence or absence of CFTR gene mutations, in a cohort of patients referred for congenital bilateral absence of the vas deferens (CBAVD). PATIENTS AND METHOD: Forty-one patients with CBAVD, confirmed by surgical exploration, were evaluated by ultrasonography for renal and SV anomalies. Semen variables (pH, fructose level and ejaculate volume), sweat chloride levels and mutations of the 3, 4, 7, 9, 10, 11, 13, 14b, 17b, 19, 20 and 21 exons of the CFTR gene were determined. RESULT: In eight patients with renal anomalies there were no detectable mutations of CFTR, compared with 23 in the 33 patients with no renal anomalies (P < 0.02). SV anomalies were not related to the presence or absence of mutations (11 of 23 vs 11 of 18), or in compound heterozygote patients carrying two mutations (eight of 13 vs three of 10). Semen variables (pH < 7.2, fructose < 1 g/L and ejaculate volume < 2 mL) did not differentiate patients with or without anomalies of the kidney, SV or with mutations, except in patients with a pH < 7.2 for which renal anomalies were less frequent (two of 25 vs six of 16, P < 0.05) and mutations more frequent (19 of 25 vs five of 12, P < 0.01). CONCLUSION: Renal anomalies associated with CBAVD should be considered as supporting maldevelopment as a cause, but analysis of CFTR mutations in these cases should not be omitted. Unlike anomalies of the SV, a low ejaculate volume or low fructose level, a semen pH of < 7.2 is the only nonspecific variable in patients with CFTR mutations.

Adolescent↗
PubMed1998

[Correlation of genitourinary abnormalities, spermiogram and CFTR genotype in patients with bilateral agenesis of the vas deferens].

OBJECTIVES: To evaluate the frequency of urogenital ultrasound and spermatic abnormalities in patients with bilateral vas deferens agenesis according to the presence or absence of CFTR gene mutation. METHODS: In 41 patients with bilateral vas deferens agenesis confirmed by surgical exploration between 1988 and 1997, renal and seminal vesicle anomalies were investigated by ultrasonography. Spermatic parameters (pH, fructose and ejaculate volume) were also studied, together with sweat chloride assay and PCR of mutations on exons 3, 4, 7, 9, 10, 11, 13, 14b, 17b, 19, 20 and 21 of the CFTR gene. RESULTS: None of the 8 patients with a renal anomaly presented a CFTR gene mutation, versus 23 out of 33 patients without a renal anomaly (p < 0.02). Seminal vesical anomalies were not more frequent in patients with or without mutations (11/20 versus 13/19, p = NS), except for composite heterozygous patients (with 2 mutations: 8/13 versus 4/11, p = NS). Spermatic parameters (pH < 7.2, fructose < 1 g/l and volume < 2 ml) could not distinguish between patients with or without renal or seminal vesical anomalies or mutation, except for patients with pH < 7.2, who presented fewer renal anomalies (2/25 versus 6/16, p < 0.05) and a higher incidence of gene mutation (19/25 versus 5/12, p < 0.01). CONCLUSION: Renal agenesis is considered to be pathognomonic of a developmental anomaly. Unlike a seminal vesical anomaly, a semen volume < 2 ml or fructose < 1 g/l, pH less than 7.2 is a nonspecific parameter, but more frequently present in patients with CFTR mutation.

Adolescent↗
PubMed1997

Imaging of angiomyolipomas.

In this article we review renal angiomyolipomas (AMLs) from cases in the world literature and 60 cases from our own institution. We also analyze the role and the place of the various imaging techniques in the detection and diagnosis of AMLs. Discussion is focused on the natural history of this benign neoplasm as an isolated form or as a part of the tuberous sclerosis (TS) complex or as part of a third less certain group of multiple AML without stigmata of TS. We also consider the growth patterns and hemorrhagic risks of AML to help define an approach to the current management of this lesion.

Angiomyolipoma↗
PubMed1996

Urachal remnants: sonographic assessment.

OBJECTIVE: To evaluate the frequency of the visualization of urachal remnants (UR) with ultrasound and to determine their sonographic patterns. SUBJECTS AND METHODS: Two hundred and fifty consecutive patients were referred for abdominal and/or pelvic ultrasonography, 83 who had urinary tract symptoms. Patient age ranged from 1 month to 91 years (mean = 35 years). Patients were classified into four groups: (1) < 16 years (n = 47) (2) 16-35 years (n = 100), (3) 36-55 years (n = 49), (4) > or = 56 years (n = 54). Ultrasonography was performed using 3.75 MHz and 7.5 MHz transducers. Ultrasound criterion for diagnosis was a midline mass located between the rectus abdominus muscle and the upper part of the anterior bladder wall. RESULTS: UR were found in 90 cases (36%). UR demonstration was more frequent in groups 1 (61.7%) and 2 (49%) and 3 (20.4%) and 4 (3.7%). UR were nodular (87%) or tubular in structure (13%). Echogenicity was similar to or greater than adjacent muscle in 51% and less than in 49%. The length, width, and thickness mean and standard deviation values were 13.5 +/- 4.7 mm, 12.6 +/- 5 mm, and 5.2 +/- 1.5 mm, respectively. UR were observed in 50% of the asymptomatic patients of groups 1 and 2. CONCLUSION: Urachal remnants are commonly demonstrated with ultrasound, particularly in young patients. They should be considered to be a normal variant unless there is an increase in size or they are accompanied by clinical signs, without other possible causes for symptoms.

Adolescent↗
PubMed1996

Helical CT of the larynx: a comparative study with conventional CT scan.

AIM: To compare helical and conventional CT scans of the larynx. PATIENTS AND METHODS: Thirty-three patients underwent helical and conventional CT studies of the neck and the larynx using 3 mm section collimation for both studies and a table feed of 4 mm/sec for helical CT. Helical scans were reconstructed at 2 mm increments. Two independent observers rated the visibility of the laryngeal structures from 1 (poor and non diagnostic) to 5 (excellent and diagnostic), and motion artifacts from 1 (> or = 10 degraded scans) to 5 (no motion artifacts). RESULTS: The motion artifacts score was significantly better for helical CT. No significant difference was observed for the laryngeal structures score between helical and conventional CT studies. The interobserver kappa mean value was 0.756 and 0.68 for helical and conventional CT, respectively. CONCLUSION: Helical CT can be routinely performed and replace conventional CT study for the evaluation of laryngeal diseases.

Adult↗
PubMed1996

Petrous bone extension of middle-ear acquired cholesteatoma.

PURPOSE: To describe CT and MR features of extension to the petrous bone, which is a rare complication of acquired cholesteatoma (AC). MATERIAL AND METHODS: Postcontrast CT was performed in 4 patients, in axial (n=4) and coronal planes (n=2). The section thickness was 1.2 or 2.5 mm. MR was performed in 3 cases, using T1- and T2-weighted images (n=3) and postcontrast T1-weighted images (n=2). RESULTS: CT demonstrated a well-outlined lesion involving the petrous bone (n=4). Density could be assessed in 3 cases, showing a hypodense unenhanced mass. Lateral (n=1), superior (n=2), and posterior (n=2) semicircular canals were affected in 3 patients. AC extended to the vestibula, cochlea, and internal acoustic meatus (IAM) in 3 patients. Two ACs extended to the level of IAM, whereas 2 extended further, to the petrous apex. In one case the sphenoid sinus was affected. On MR imaging the lesion was hypointense relative to brain on T1-weighted images and hyperintense on T2-weighted images. MR imaging helped to delineate the lesion and to distinguish it from other cystic lesions of the petrous bone. CONCLUSION: CT and MR offer accurate preoperative assessment of the extension of cholesteatoma, which helps to choose the surgical approach.

Adult↗
PubMed1996

[Spiral scanners: the key to imaging of kidney injuries].

Whatever the mechanism or extent of other lesions, ultrasonography is essential in evaluating damage to the kidney after abdominal trauma in order to identify renal devascularization, fracture or fragment separation, to recognize the different blood or urine components in perirenal collections, to search for associated or prior lesions, and to obtain a baseline measurement for future follow-up. Progression introduced with spiral scans now provides 3-D images for then entire organ at different times during contrast product diffusion. The corticovascular time is used to analyse the renal pedicle and cortical vascularization; the tubular time is ideal for analysing fractures and dislocations; the calicial or excretory time, together with urography films give information on extravasation of contrast product, the upper tract and the bladder. 3-D images allow reconstructions in all three plans for the different structures, faciliting interpretation. Spiral scan should be available in all emergency centers to guarantee quality management or renal trauma.

Humans↗
PubMed1996

[Moderately severe kidney injuries. Changes in therapeutic indications].

The choice of treatment for moderately severe blunt trauma to the kidney is a controversial issue. Modern imaging techniques, especially computed tomography and more recently 3-D imaging, have greatly improved analysis of the lesions. Ultrasonography and computed tomography allow for precise noninvasive follow-up, widening indications for non-surgical management. The question is raised as to whether retarding surgery may have a consequence on the development of late complications which were long the reason for routine surgical treatment in case of infection, urinary extravasation, large interfragment gaps, or devascularization.

Humans↗
PubMed1995

Iohexol in patients undergoing urography: a comparison of polypropylene containers (Unique Soft Pack) and glass vials.

The purpose of the present phase IV multicentre trial was to evaluate general patient tolerance to Omnipaque 350 mgI/ml (iohexol) supplied in polypropylene containers compared to that of the same product supplied in routinely used glass vials, with emphasis on allergy-like adverse events. Polypropylene is a pure plastic material with practically no additives, and has been tested in vitro as a contrast medium packaging material for several years. Handling of these containers is easier and safer than handling of glass vials. Iohexol was administered to 1481 patients undergoing urography (741 patients in the glass vial group, 740 in the polypropylene container group), all of whom successfully participated in the trial. Six centres, representing four European countries, participated. Patients were randomized to receive iohexol from either polypropylene containers or traditional glass vials according to a double blind, parallel design. Pre-established inclusion and pre-admission exclusion criteria were followed, as well as routine procedures for preparation of the patients and conduct of the urography examinations at each hospital. Patient tolerance was assessed by recording all adverse events experienced over a period of up to 1 h after the procedure. Allergy-like events were defined as coughing, sneezing, nausea, vomiting, urticaria or itching. No adverse events were experienced by 56.5% of the patients in the glass vial group, nor by 58.0% of those in the polypropylene group. Discomfort (mainly a sensation of warmth) was reported by 39.4% and 38.6% of the patients, and adverse events other than discomfort by 7.4% and 5.9% of the patients, respectively. There seemed to be a correlation between the speed of injection and the frequency of discomfort (an increase with increasing speed), both of which varied a lot between centres. There was no significant difference in the incidence of allergy-like events between the two groups. Such reactions were seen in 2.0% of patients in the glass vial group and 1.9% of those in the polypropylene container group. There was no significant difference between the patients' tolerance to iohexol supplied in traditional glass vials or in polypropylene containers. Therefore, the new polypropylene container can be recommended as a container for Iohexol.

Adolescent↗
PubMed1995

Renal angiomyolipoma: growth followed up with CT and/or US.

PURPOSE: To follow up the growth of renal angiomyolipomas (AMLs). MATERIALS AND METHODS: Patients with known AML (n = 55) were divided into three groups on the basis of initial clinical and computed tomographic (CT) findings: group 1, isolated AML (n = 43); group 2, multiple AMLs without tuberous sclerosis (TS) (n = 6); group 3, multiple AMLs with TS (n = 6). Follow-up ultrasonography (US) and CT were performed in 55 and 31 patients, respectively. Growth of the AMLs (n = 59) was evaluated on the basis of area on initial and follow-up images. RESULTS: Mean percentage growth was 17%, 128%, and 47%, and mean growth rate per year was 5%, 22%, and 18% in groups 1, 2, and 3, respectively. New renal lesions were noted in three patients in groups 1 and 2, but no new lesions were detected in group 3, because of the large number of AMLs. New extrarenal lesions were observed in four, two, and three patients in groups 1, 2, and 3, respectively. No correlation was found between percentage of fatty tissue and growth rate. CONCLUSION: Multiple AMLs show more growth than solitary AMLs.

Adipose Tissue↗
PubMed1995

Congenital cholesteatoma of the temporal bone: MR findings and comparison with CT.

PURPOSE: To describe the MR findings of temporal bone congenital cholesteatoma and MR usefulness in preoperative diagnosis and follow-up, in comparison with CT. METHODS: Seven patients underwent CT and MR studies for facial palsy (n = 3), deafness (n = 3), vertigo (n = 1), tinnitus (n = 1), and otalgia (n = 1). Three patients had for congenital cholesteatoma previously undergone surgery. One of them was free of symptoms and referred for follow-up. Final diagnosis was obtained from surgical data in all the cases but one. RESULTS: Congenital cholesteatoma signal intensity was low or intermediate on T1-weighted images and high on T2-weighted images in all the cases. MR was useful in diagnosis in six cases, helping to differentiate congenital cholesteatoma from other nonenhancing tumors. When temporal bone wall erosion was observed with CT (n = 6), MR ruled out intracranial extension in five cases; in one case, MR found an associated epidermoid cyst of the cerebellopontine angle not identified with CT. However, CT assessed relationships with labyrinthine structures more easily. CONCLUSION: MR and CT are complementary in initial diagnosis and follow-up.

Adolescent↗
PubMed1995

Ultrasound assessment of ovarian stroma hypertrophy in hyperandrogenism and ovulation disorders: visual analysis versus computerized quantification.

OBJECTIVE: To extend our previous findings on the diagnostic validity of ovarian stroma hypertrophy in women with hyperandrogenic and/or menstrual disorders. DESIGN: Transvaginal ultrasonography was performed in 69 patients complaining of hyperandrogenism and/or menstrual disorders and in 48 normal ovulatory women in early follicular phase. To check the validity of stroma assessment by visual analysis, we used computer-assisted analysis, which allowed selective measurement of the stromal area on a longitudinal ovarian cut. Sensitivity and specificity of each method were estimated by using the normative data from the control group. RESULTS: Stromal area was considered to be increased using visual analysis and computer-assisted analysis in 74% and 61% patients, respectively. Specificity of this sign was 84% and 96% by visual analysis and computer-assisted analysis, respectively. In patients, the increase in stromal area correlated very significantly with the one of total ovarian area, whose upper normal limit was 5.5 cm2 per ovary. CONCLUSION: Visual assessment of stroma may be misleading in some cases, with the risk of overestimating its hypertrophy. An increased total ovarian area > 5.5 cm2 (which can easily be detected by carefully shaping a strict longitudinal ovarian cut) has the same diagnostic value as an increased stromal area by computerized measurement.

Adolescent↗