Biomedical subjects
Publications and source records attributed to M Kasbarian.
The authors report a case of pseudocoarctation of the aorta associated with a retro-aortic left brachiocephalic vein. This exceptional congenital malformation, never described before, was studied by aortography, computed tomography and magnetic resonance imaging.
The authors report a case of left IVC with a preferential hemiazygos-azygos drainage associated with an accessory left superior intercostal vein drainage. This exceptional congenital malformation which finds its place in polysplenia was studied by cavography, CT and MR imaging.
MATERIALS AND METHODS. A multicenter study was undertaken to determine the long-term results of renal angioplasty. Five teams with considerable experience in the procedure replied to a computerized questionnaire concerning transluminal angioplasty (TLA) performed with immediate success from 1979 to 1985 and followed up regularly (minimum of four years). The main purpose of the study was to assess the long-term results, both anatomical results and clinical, of renal TLA. Consideration was given to anatomical of average quality and their possible correlation with long-term results, in an attempt to foresee and even prevent restenosis. The main points of the study are given in figure 1. Two hundred and forty-seven renal TLA performed in 210 patients were included (insofar as clinical and radiologic follow-up was adequate, with a minimum of one control angiography beyond six months). Patients who had immediate failure (dilatation not possible or ineffective dilatation) were excluded from the analysis of long-term results. Likewise, TLA of the renal artery of grafted kidneys were not included in this study. The histogram of patients ages shows a clear predominance of subjects 60 to 65 years of age, with extremes ranging from 10 to 80 years (mean 53 years). TLA were done mainly by the femoral route according to a technique using a balloon catheter positioned on a previously inserted guide at the level of the stenosis. The examination was performed under local anesthesia. Balloon size was determined according to the diameter of the renal artery upstream from the stenosis and that of the contralateral renal artery. A balloon of the same or slightly larger caliber was used. The indication of angioplasty was determined after multidisciplinary discussion according to two main criteria: First, treatment of hypertension presumed to be in relation with a stenosis of the renal artery (renovascular hypertension). Secondly, conservation of the nephrotic capacities of a patient with a renal stenosis possibly associated with arterial hypertension, in relation with a bilateral stenosis of the renal arteries or with a unilateral stenosis affecting a functionally or anatomically single kidney. In this latter case, the purpose of TLA was to avoid development toward thrombosis of the renal artery and worsening of renal insufficiency. RESULTS. Two hundred and forty-seven TLA in 210 patients were included in the study. Nineteen patients (9%) had bilateral TLA. The lesions treated are indicated in figure 3. These were most often simple atheromatous and truncal lesions of the renal artery (73%) which were significant (greater than 50%) in 99% of cases. TLA was indicated in 77% of cases for treatment of arterial hypertension presumed to be renovascular. In 23% of cases, treatment of the stenosis was intended to conserve, especially, kidney vascularization, i.e., an indication of nephrotic protection. There were 9.7% immediate failures...
Our experience with 91 operated cases in 84 patients (47 men, 37 women) relates essentially to arterial diseases resulting from overloading and diabetic arteriopathy. Diagnosis of critical ischemia is easy in clinical conditions, but it is advisable to rely on universally recognized hemodynamic standards to define this condition. Ankle pressure should be less than 400 mmHg and the Doppler trace flat or barely perceptible. Patients in our series had a mean ankle pressure of 32.4 mmHg. Local examination can determine the extent of gangrene, whereas general examination detects numerous, often associated defects diabetes, coronary artery disease, rhythm disorders, arterial hypertension, etc. As far as possible, these defects are to be corrected before surgery. X-ray examination (M. Kasbarian) is frequently done in conjunction with conventional aorto-arteriography and digital angiography. The later technique allows arteries to be visualized which are not seen with the conventional technique. The x-ray examination will indicate whether revascularization is feasible, although it cannot show whether it will be efficient. In our series, opacification of the plantar arches was predictive neither of success nor failure. But do tests exist which can predict the success of a revascularization attempt? It would be necessary to be able to estimate ankle pressure after the operation, and several methods have tried to do this. TcPO2 would seem to be a good examination. The possibilities of nuclear magnetic resonance are being studied, and the results thus far are promising. Preoperative explorations are carried out in a different situation. Arteriography performed in the operating room is a simple act which can reveal a usable downstream bed not indicated in preoperative X-rays, although it provides no hemodynamic data. Measurement of peripheral resistances would appear to be a very good predictive examination. Flow measurements by infusion or electronic flowmeter also seem to be predictive for bypass results. Unfortunately, these measurements are at present not widely performed and the critical threshold is assessed differently. Given the difficulty of correctly estimating the value of these numerous methods, many surgeons, ourselves included, have chosen to revascularize patients whenever the upstream bed as evaluated by X-ray indicates the presence of at least one viable artery.
The accuracy of Magnetic Resonance Imaging in cervical carcinoma staging for clinical stages superior to IB was studied retrospectively in 27 patients. The MRI results were then correlated with operative findings in 12 cases and with examination carried out under general anesthesia in 15 cases for myometrial, bladder, rectal, parametrial, parietal and vaginal extension. The accuracy of MRI was 81.5% for bladder, 92.5% for rectal, 87% for parametrial and 73% for vaginal extension. The accuracy of staging by MRI was 59%. The contribution of MRI in pre-operative studies for cervical carcinomas has not been properly defined until now. Nevertheless it is a particularly valuable technique due to its non invasive nature.
Twenty three patients suffering from severe chronic ischemia of the lower limbs were explored by conventional and digital angiography. A comparative study of these 2 angiographic techniques was carried out to appreciate the pre-operative distal vascular tree and the surgical indications. In all cases, digital angiography was never found to be less informative than conventional angiography. In 14 cases, the surgical approach was changed as a result of digital angiography in 4 cases the method of revascularization and in 10 cases the surgical indication itself (distal bypass instead of amputation). The authors consider digital angiography to be essential in this surgical indication.
The authors report 2 cases of deliberate methanol intoxication explored by Computed Tomography and MR Imaging. These two methods gave similar results showing bilateral areas of putaminal necrosis. This characteristic finding is of great diagnostic value in these clinically-oriented cases. MRI gives better anatomical details and may reveal small haemorrhagic lesions.
A case of primary dissection of the celiac trunk in a young hypertensive patient is presented. The diagnosis, suspected by ultrasonography, was confirmed by angiography and CT which also allowed a study of the visceral complications. Appropriate surgical treatment was successfully carried out.
The authors report a case of hepatic tuberculosis on a pre-existing Hodgkin disease with hepatic localisations. They point out how echographic and CT imaging are non specific in this disease and so insist on the diagnostic interest of puncture-biopsy under guidance of the hepatic nodules.
In order to evaluate the reliability of medical imaging methods in the assessment of mediastinal invasion by lung cancers, a prospective study was conducted in 30 patients undergoing preoperative computed tomography (CT), magnetic resonance imaging (MRI) and pulmonary digital subtraction angiography. MRI improved the sensitivity of detection of surgically confirmed mediastinal lymphadenopathy, but its specificity in relation to histological results was poor and identical to that of CT. In terms of extension to vascular structures, MRI and CT gave comparable results for the pulmonary artery and vein with two false positives for the pulmonary veins and left atrium with the two methods. MRI was found to be superior to CT for the detection of invasion of the aortic arch. Digital subtraction angiography is not as reliable as the other two modalities, particularly for extension to the pulmonary vein for which it was found to be technically inappropriate. By means of sagittal and frontal scans, MRI was therefore found to be more effective than CT for examination of the subcarinal region and aorto-pulmonary window. In contrast, the persistence of false positives with the two methods and the impossibility of distinguishing between inflammatory lymph nodes and neoplastic lymph nodes means that thoracotomy can never be contraindicated on the basis of the results of imaging alone.
Transabdominal ultrasonography has long been a fist-line examination to explore most of the pelvic diseases. Transvaginal sonography is a simple procedure giving an accurate and reliable diagnosis. These two techniques complement each other and can usefully be performed concomitantly. Computed tomography should be reserved to the extension assessment and follow-up uterine and ovarian tumours. Magnetic resonance imaging is a non invasive technique providing for a three-dimensional, very high quality study of the female pelvis. Its main value resides in the exploration of gynaecological tumours, where it gives a reliable assessment of local and regional extension. These various imaging techniques, therefore, have a definite, non competitive role to play in the exploration of gynaecological diseases. They are the necessary complements of physical examination and endoscopic methods.
Twenty-four patients were included in an open study of iopromide 300, a new non-ionic contrast medium, to evaluate the feasibility of conventional arteriography of the brain. Iopromide 300 is a good candidate for this examination, on the basis of the safety and efficacy evaluated in this study.
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The authors report a case of pheochromocytoma of Zuckerkandl's organ revealed by permanent hypertension. Angiography, combined with the clinical and biological data suggesting a catecholamine secreting tumor, made the diagnosis of pheochromocytoma of Zuckerkandl's organ prior therapy.