Biomedical subjects
R Rymer
Publications and source records attributed to R Rymer.
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.
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.
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.
Gadolinium chelate-enhanced subtraction spoiled gradient-recalled echo MR imaging of hepatic tumors.
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Arterial anatomy of the female genital tract: variations and relevance to transcatheter embolization of the uterus.
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[Hepatocarcinoma invasion of the portal vein: detection using lipiodol computed tomography. Apropos of 2 cases].
Portal vein involvement is a major complication of hepatocellular carcinoma and has an important impact on management and prognosis. Iodized-oil computed tomography is a well-established imaging technique for the pretherapeutic assessment of hepatocellular carcinoma because it allows detection of the primary tumor site and any daughter nodules. We report two cases of hepatocellular carcinoma extending to the portal vein which was documented by iodized-oil computed tomography. In both cases, tumor thrombus demonstrated marked retention of the iodized-oil on computed tomography. Our two cases demonstrate that iodized-oil computed tomography can depict portal vein extension of hepatocellular carcinoma. In addition, these two cases suggest that iodized-oil retention within the portal vein is a clue to the diagnosis of hepatocellular carcinoma.
[Preoperative evaluation of gastric adenocarcinomas: comparison of CT results with surgical and patholgic results].
PURPOSE: The objective of our study was to reassess the value of CT scan in the preoperative evaluation of gastric adenocarcinoma, using surgical and pathologic findings as the reference standard. MATERIALS AND METHODS: Forty-five patients who had preoperative CT scan for gastric carcinoma were retrospectively included in the study. Images were analyzed by two readers working in consensus with respect to tumor detection, tumor location, depth of invasion, involvement of adjacent organs, lymph node involvement and presence of peritoneal carcinomatosis. RESULTS: Gastric tumor was visible in 91% of cases. Accurate tumor localization was obtained in 50% of cases. Depth of tumor penetration was correctly evaluated in 40% of the cases. Evaluation of regional and distant lymph node metastases was correct in 54% and 64% of cases, respectively. Peritoneal carcinomatosis was depicted in 17% of cases. CONCLUSION: CT scan allows detection of gastric adenocarcinoma in the majority of cases. However, this technique markedly underscores the extent of gastric adenocarcinoma. Therefore, CT scan should not be used to determine the preoperative staging of gastric adenocarcinoma.
[Rectal malignant stromal tumor (leiomyosarcoma): echoendoscopic, computed tomographic aspects and anatomopathologic correlations].
We report the CT and endorectal us features of a malignant stromal tumor of the rectum (leiomyosarcoma). On CT scan, rectal leiomyosarcoma appeared as a large soft tissue mass, arising from the anterior rectal wall with exorectal extension. On endorectal US, the rectal leiomyosarcoma presented as a well-defined hypoechogenic and heterogeneous mass arising from the rectal muscularis propria. The uncommon location of leiomyosarcoma to the rectum may simulate other rectal tumors such as adenocarcinoma on CT. As suggested by this report, endorectal us demonstrated the muscular origin of the tumor.
[Management of severe post-partum hemorrhage using selective arterial embolization].
OBJECTIVES: To evaluate the efficacy and safety of uterine embolization in the management of intractable post-partum hemorrhage. MATERIALS AND METHODS: From July 1994 to December 1997, 51 patients with severe primary (n = 37) or secondary (n = 14) post-partum hemorrhage were treated by arterial uterine embolization. In all cases, hemostatic uterine embolization was performed because of persistent hemorrhage despite adapted obstetrical measures and early introduction of uterotonic drugs. RESULTS: In case of immediate post-partum hemorrhage, primary and secondary success rates were 89% et 97% respectively. In one patient with placenta accreta, delayed hysterectomy was necessary. One patient died of associated cerebral hemorrhage while vaginal bleeding had stopped. The success rate reached 100% in case of secondary post-partum hemorrhage. CONCLUSION: Emergency arterial embolization is a safe and effective means of controlling severe post-partum hemorrhage after failure with medical treatment.
[Interventional radiology and the medical applications of information systems: what consequences for the radiology department?].
The French health care system reform has introduced some changes in the distribution of hospital budgets according to the distribution of admitted patients in diagnosis related groups (DRGs). This new model of budget allocation does not take into account the more technical nature of some medical procedures and services and does not promote the implementation of new technologies. Using four simulated clinical cases, we studied the length of stay in different DRGs and the number of associated points (points d'indice synthétique d'activité, ISA). The addition of the interventional radiologic procedures did not modify the DRG (which remained unchanged from the initial DRG). In order to achieve recognition of the specific nature of interventional radiology procedures, a database should be created and an economical evaluation conducted.
Selective arterial embolization of the uterine arteries in the management of intractable post-partum hemorrhage.
BACKGROUND: To evaluate the efficacy and safety of selective arterial embolization in the management of intractable post-partum hemorrhage. METHODS: Thirty-five consecutive women with severe post-partum hemorrhage (primary, n=25; secondary, n=10) were treated by selective embolization of the uterine arteries. The main cause of immediate post-partum hemorrhage was atonic uterus. Retained placental fragments with endometritis was the main cause of delayed hemorrhage. In all cases, hemostatic embolization was performed because of intractable hemorrhage. Hysterectomy had been performed in two cases before embolization but it had also failed to stop the bleeding. RESULTS: Angiography revealed extravasation in ten cases, spasm of the internal iliac artery in four cases, false aneurysm in two cases and arteriovenous fistula in one case. After embolization, immediate cessation or dramatic diminution of bleeding was observed in all cases. Two patients required repeated embolization the following day. No major complication related to embolization was found. In one patient with placenta accreta, delayed hysterectomy was necessary. Normal menstruation resumed in all women but two who had hysterectomy. One woman became pregnant after embolization. CONCLUSION: Selective emergency arterial embolization is an effective means of controlling severe post-partum hemorrhage. This procedure avoids high risk surgery and maintains reproductive ability.
Tuberculous colitis mimicking Crohn's disease: utility of computed tomography in the differentiation.
The case of a 50-year-old woman with pathologically proven tuberculous colitis is reported. Clinical course, single-contrast barium enema, and colonoscopy suggested Crohn's disease. Computed tomography allowed the correct diagnosis of tuberculous colitis as it showed asymmetric thickening of the colonic wall and enlarged necrotic lymph nodes. This case suggests that the diagnosis of tuberculous colitis may be difficult and raises the differential diagnosis with Crohn's disease. Our observation suggests that computed tomography can be helpful for the diagnosis and may avoid unnecessary exploratory laparotomy.
Selective salpingography and fallopian tubal occlusion with n-butyl-2-cyanoacrylate: report of two cases.
Selective salpingography with fluoroscopic guidance was used to perform fallopian tubal occlusion by using n-butyl-2-cyanoacrylate in two women. No other method of sterilization was possible, and a new pregnancy was considered to be life threatening. After 4 years of follow-up, neither woman had become pregnant. Tubal occlusion with n-butyl-2-cyanoacrylate is a safe, effective and inexpensive means of sterilization that provides long-term occlusion.
Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization.
PURPOSE: To prospectively evaluate the efficacy and safety of emergency selective arterial embolization in the management of intractable primary postpartum hemorrhage. MATERIALS AND METHODS: Twenty-seven consecutively seen women with life-threatening primary postpartum hemorrhage underwent uterine embolization. In all cases, hemostatic embolization was performed because of intractable hemorrhage that could not be controlled with vaginal packing and administration of uterotonic drugs. The mean hemoglobin level before embolization was 7.48 g/dL +/- 2.39 (74.8 g/L +/- 23.9) (1 standard deviation). Hysterectomy performed in two patients before embolization failed to stop the bleeding. RESULTS: Angiography revealed extravasation in nine patients and spasm of the branches of the internal iliac artery in five. The procedure consisted of embolization of uterine (n = 46), vaginal (n = 5), or ovarian (n = 2) arteries or anterior division of internal iliac arteries (n = 8). Immediate disappearance or dramatic diminution of external bleeding was observed in all cases. Two patients needed repeated embolization the next day. No major complication related to embolization was found. In one patient with placenta accreta, delayed hysterectomy was necessary. Normal menstruation resumed in all women except the two who underwent hysterectomy. One woman became pregnant after embolization. CONCLUSION: Emergency arterial embolization is a safe and effective means of control of primary postpartum hemorrhage. The procedure obviates high-risk surgery and allows maintenance of reproductive ability.
Color velocity imaging and power Doppler sonography of the gallbladder wall: a new look at sonographic diagnosis of acute cholecystitis.
OBJECTIVE: Color velocity imaging is a color sonographic technique that uses data contained in gray-scale B-mode image scan lines to determine blood flow velocity. We prospectively determined if color velocity imaging and power Doppler sonography can be used to differentiate acute from chronic cholecystitis. We analyzed the potential role of using these two color imaging techniques as an adjunct to conventional gray-scale sonography to differentiate acute from chronic cholecystitis. SUBJECTS AND METHODS: One hundred twenty-nine patients with acute right upper quadrant pain or clinically suspected cholecystitis underwent color velocity imaging and power Doppler sonography of the gallbladder as an adjunct to gray-scale sonography. Morphologic criteria were analyzed on gray-scale sonography, and the presence of flow within the gallbladder wall was assessed with color velocity imaging and power Doppler sonography. Imaging findings were compared with pathologic findings in the 50 patients who underwent cholecystectomy and with clinical and biologic findings in the 79 patients who did not undergo cholecystectomy. RESULTS: Twenty-two patients had surgically proven acute cholecystitis, 28 patients had surgically proven chronic cholecystitis, and 79 patients had no gallbladder disease. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of gray-scale sonography for revealing acute cholecystitis were 86%, 99%, 92%, 87%, and 97%, respectively. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of color velocity imaging and power Doppler sonography for revealing acute cholecystitis were 95%, 100%, 99%, 100%, and 99%, respectively. CONCLUSION: The accuracy of color velocity imaging and power Doppler sonography in revealing acute cholecystitis is significantly greater than the accuracy of gray-scale sonography.
Portal vein invasion by intrahepatic peripheral cholangiocarcinoma: a rare cause of portal hypertension.
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Abdominal wall metastatic tumor seeding along a percutaneous abscess drainage tract.
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