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R Déry

Publications and source records attributed to R Déry.

At least 19 recordsLinked to original sources
PubMed1998

Segment 4 (the quadrate lobe): a barometer of cirrhotic liver disease at US.

PURPOSE: To evaluate the dimensions of segment 4 of the liver in patients with cirrhosis by using ultrasonography (US). MATERIALS AND METHODS: The transverse diameter of segment 4 was measured in 125 control subjects without liver disease and 167 patients with cirrhosis. The size of segment 4 was measured on oblique subcostal US scans obtained between the left wall of the gallbladder (or the main fissure after cholecystectomy) and the ascending or umbilical portion of the left portal vein at the point where it gives rise to the branch to segment 4. RESULTS: In the control subject group, the mean diameter of segment 4 was 43 mm +/- 8 (standard deviation). In the patient group, the mean diameter of segment 4 was 28 mm +/- 9. The cause or severity of cirrhosis had no influence on the size of segment 4. CONCLUSION: A decreased diameter of segment 4 may be a helpful adjunct sign of cirrhosis in the US investigation of chronic liver disease.

Adult↗
PubMed1997

Evaluation of gastric emptying function in clinical practice.

In this retrospective analysis, we compared different methods to evaluate gastric emptying function, aiming to improve the sensitivity and the clinical availability of our diagnostic testing. In the first study, we compared, in 72 patients clinically suspected of gastroparesis, the emptying of a meal containing two solid nutrients with different disintegration rates: 111In-labeled scrambled eggs and 99Tc-labeled liver cubes. Gastric emptying of 111In-labeled egg was delayed in 12 of our patients and the evacuation of the 99Tc-labeled liver was prolonged in 19 patients. The choice of the nutrient was not important for the identification of diabetic gastroparesis (43% vs 57%; NS), but it was determinant in the case of patients suspected of idiopathic gastroparesis (12% were positive with the egg and 25% with the liver; P < 0.05). In the second study, we compared two different diagnostic methods in 46 patients: a simple radiological detection of the gastric emptying of radiopaque pellets, and the scintigraphic emptying of a solid meal containing 99Tc-labeled liver cubes. Both tests correlated perfectly in 78% of our patients. In 15% of the population (six of these seven patients were diabetics suspected of gastroparesis) the scintigraphic method was normal, while the evacuation of radiopaque pellets was delayed. For clinical purposes, we therefore propose: (1) the scintigraphic method should use liver rather than egg as a radiolabeled tracer in order to improve the sensitivity of the test for detection of gastroparesis; and (2) the radiological detection of radiopaque markers is a reliable and convenient method for the detection of gastroparesis in clinical practice. It is possibly more sensitive than scintigraphy.

Adult↗
PubMed1996

Clinical impact of contrast-enhanced MR imaging reports in patients with previous lumbar disk surgery.

OBJECTIVE: We wanted to assess the clinical impact of the reports of contrast-enhanced MR imaging on the decision to repeat surgery and on the results of repeat surgery in patients with previous lumbar disk surgery. SUBJECTS AND METHODS: We interviewed 257 patients who had undergone lumbar disk surgery and who showed symptoms suggesting persistent or new disk herniation. We conducted our interviews 6-18 months after patients had undergone contrast-enhanced MR imaging. We then correlated patient outcome with original MR findings. RESULTS: Fifty-two patients underwent new surgical procedures after their MR examination. Findings of disk herniation on MR images were associated with a significantly greater frequency of repeat surgery. The size of main herniation seen on MR images was also a significant variable. Patients with Worker's Compensation Insurance files had significantly worse prognoses: Only two (8%) of 26 of these patients reported 50% improvement 1 year after repeat surgery. However, only 6 (23%) of 26 non-Worker's Compensation patients reported 50% improvement 1 year after surgery. CONCLUSION: Despite its documented high anatomic accuracy, the clinical usefulness of enhanced MR imaging for patients with previous lumbar disk surgery needs further evaluation. In our series, findings of disk herniations on enhanced MR examinations were associated with a greater frequency of repeat surgery, but such surgery relieved symptoms in few patients. The influence of enhanced MR imaging on the decision for repeat surgery and on the type of surgery may be misleading. Selection criteria for repeat surgery need to be reassessed using rigorous outcome research protocols.

Adult↗
PubMed1995

Bronchogenic cyst of the right hemidiaphragm.

A rare case of bronchogenic cyst of the right hemidiaphragm is reported. The literature is reviewed briefly. Clinical presentation, diagnosis, and treatment of this entity are discussed further.

Bronchogenic Cyst↗
PubMed1995

Focal sparing of liver parenchyma in steatosis: role of the gallbladder and its vessels.

The purpose of this study was to determine the prevalence and localization of focal areas of sparing in a population of patients with fatty infiltration (steatosis) of the liver. We also sought to determine if the blood supply of the gallbladder has an effect on fatty infiltration of the liver adjacent to it. We studied 290 patients with sonographic signs of fatty infiltration of the liver with gray scale sonography. In 58 of the patients, the gallbladder had been removed previously. A zone of focal sparing was found in 67% of patients with liver steatosis (78% in patients with an intact gallbladder versus 33% in patients with previous cholecystectomy). In patients with an intact gallbladder, segments 4 and 5 were spared most often. These segments were rarely spared in patients with previous cholecystectomy. Other sites of focal sparing were observed with the same frequency in the two groups. We conclude that focal sparing occurs frequently in patients with liver steatosis, especially in segments 4 and 5. When the gallbladder is absent, areas of focal sparing are less frequent, and they rarely involve segments 4 and 5. This suggests that the blood supply of the gallbladder plays a role in the distribution of the fat in the adjacent liver. Focal sparing might serve as an additional sign in the diagnosis of steatosis of the liver, especially in patients with an intact gallbladder.

Adolescent↗
PubMed1995

[Role of extracorporeal shock wave lithotripsy in the treatment of common bile duct and intrahepatic calculi].

The management of intrahepatic and common bile duct stones has been modified by the advent of endoscopic sphincterotomy and percutaneous extraction through a T-tube tract or transhepatic access. Occasionally, nonoperative extraction is incomplete. The use of extracorporeal lithotripsy is reviewed in this setting. From May 1990 to February 1994, 18 patients (age 68.4 +/- 4.6 years) were treated by extracorporeal shockwave lithotripsy combined with endoscopic sphincterotomy and retrograde extraction or percutaneous approach. 72% of patients had previously undergone a cholecystectomy and 44% exploration of the common duct. Patients were submitted to 1.56 +/- 0.17 session of lithotripsy (5.546 +/- 701 shockwaves). Hospital stay was 19.5 +/- 3.3 days. After the lithotripsy, 1.17 +/- 0.19 endoscopic or percutaneous procedures per patient were necessary to clear the biliary tract. Seventy-eight percent of patients became stone-free. The five failures were treated by endobiliary prosthesis (n = 4) or cholecystectomy and bile duct exploration (n = 1). Lithotripsy in association with the usual therapeutic modalities contributes to clearing the bile duct from stones and avoids surgery in the majority of patients. A multidisciplinary approach is necessary in order to obtain those results.

Aged↗
PubMed1994

Postoperative changes, complications, and recurrent disease after Whipple's operation: CT features.

Whipple's operation consists of resection of the pancreatic head and duodenum, followed by pancreaticojejunostomy, choledochojejunostomy, and gastrojejunostomy or duodenojejunostomy. Indications include neoplasms of the periampullary region, symptomatic chronic pancreatitis, and, occasionally, trauma CT is useful in diagnosing postoperative complications and in detecting disease recurrence during long-term follow-up. This complex surgical procedure causes alterations of the normal anatomy, which may lead to difficulty interpreting images. Familiarity with the appearance of postoperative changes and common complications and with patterns of disease recurrence is a prerequisite to accurate interpretation of CT scans in these patients.

Choledochostomy↗
PubMed1991

Air in the portal vein: sonographic and Doppler manifestations.

Three patients with portal venous gas (one with radiographic and computed tomographic findings) had similar sonographic and Doppler patterns in the portal vein (PV). These patterns consisted of hyperechogenic foci moving within the lumen of the PV, producing sharp bidirectional spikes superimposed on the usual Doppler tracing of the PV. An injection of 0.25-0.50 cm3 of air, oxygen, nitrogen, and carbon dioxide into the jejunal vein of nine dogs yielded identical portal venous sonographic and Doppler patterns. In addition, the liver parenchyma of the dogs became hyperechogenic after the injection of gas. Gas in the PV is accompanied by the following signs: echogenic, moving foci within the lumen of the PV; sharp spikes on Doppler spectral display; and hyperechogenic foci within the liver parenchyma.

Adult↗
PubMed1990

Temporal lobe abnormalities in panic disorder: an MRI study.

Brain mapping studies have shown abnormal changes in cerebral blood volume and oxygen consumption, or other neurophysiological abnormalities, in panic disorder (PD) patients. Because of these intriguing reports, we decided to assess the neuroanatomical aspects of patients with PD using magnetic resonance imaging (MRI). We included 31 consecutive cases with a diagnosis of PD according to the DSM-III criteria, and 20 controls. All subjects had to be right-handed and between 20 and 40 years of age. The usual exclusion criteria were applied. We carried out the MRI tests with a General Electric Signa Machine operating at 1.5 Tesla. Over 100 images were obtained per patient with an emphasis on assessing temporal lobe. There were no significant differences in age, gender, or weight between the patients and controls. We found a statistically significant higher number of abnormalities in PD patients (40%), as compared with the controls (10%). The most striking findings were focal abnormalities in the temporal lobes: areas of abnormal signal activity, and asymmetric atrophy of the temporal lobe occurred mostly on the right side. These results implicated the limbic system and may prove to be of particular relevance in panic and phobic disorders. However, the significance of our findings remains unknown and challenging. Further MRI studies in PD will be required for a better understanding of the illness.

Adult↗
PubMed1989

Correlation of severity of panic disorder and neuroanatomical changes on magnetic resonance imaging.

Thirty consecutive lactate-sensitive panic disorder patients were studied with magnetic resonance imaging (MRI) to investigate the relationship between temporal lobe abnormalities and panic disorder. Neuroanatomical abnormalities, most involving the right temporal lobe, were found in 43% of patients, compared with 10% of the control subjects. Patients with temporal lobe abnormalities were significantly younger at the onset of panic disorder and had more panic attacks compared with patients with normal MRI scans (p less than .05). These results suggest that panic disorder could be secondary to temporal lobe dysfunctions and that panic disorder patients with abnormal MRIs could have a worse prognosis than those with normal MRIs and would require long-term pharmacological treatment.

Adult↗
PubMed1987

Atrial-level shunts: sensitivity and specificity of MR in diagnosis.

Gated transverse cardiac magnetic resonance (MR) images from 31 patients with proved atrial septal defect (ASD) and from 33 control subjects were reviewed retrospectively by a panel of cardiac radiologists. The panel, by consensus, determined the presence and the type of ASD and assigned a confidence level for each diagnosis. A total of 97% of ASDs were correctly identified at high levels of specificity (primum, 100%; secundum, 96%; common atrium, 100%). Sensitivity and specificity are illustrated by receiver operating characteristic curves. Pulmonary veins were demonstrated at rates exceeding those reported for echocardiography. Further, all cases of anomalous pulmonary venous connection proved by angiography were also demonstrated by MR. Thus, MR has high sensitivity and specificity in the diagnosis and location of atrial-level shunts and is at least as accurate as, and possibly more accurate than, traditional techniques for the diagnosis of anomalous pulmonary venous connection.

Adolescent↗