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Biomedical subjects

A Sibert

Publications and source records attributed to A Sibert.

At least 55 records · Page 3Linked to original sources
PubMed1987

[X-ray computed tomography in the course of mediastinitis after sternostomy for heart surgery].

Results are reported of a prospective study of 79 CT scan examinations in 50 patients who had undergone sternotomy for cardiovascular surgery. In 69 cases the examination was conducted during the course of a progressive postoperative mediastinitis treated surgically. Mediastinitis was confirmed in 13 cases, including 12 relapses. In 2 cases the CT scan image was normal (2 false negatives) whereas mediastinal drains had been inserted. The CT scan image of mediastinitis shows mainly hypodense fluid collections (0 to 16 UH) in anterior mediastinum or between sternotomy borders (8 of 13 cases). But this type of image, detected 11 times in the absence of recurrence (favorable course), can result from a residual serous collection after ablation of drains. In 8 cases, a CT scan-guided puncture (7 cases) or one under ultrasound control (1 case) eliminated recurrence. The CT scan imaging also allowed diagnosis of 5 cases of osteitis, confirmed surgically. These findings indicate the definite interest of CT scan imaging in postoperative follow-up review of median sternotomies. It appears to be particularly indispensable for surveillance of surgically treated mediastinitis, because of the serious consequences of relapses and the often clinically silent chronic bone lesion. However, the possibility of residual serous collections emphasizes the importance of the clinical context and should lead to guided puncture investigation in doubtful cases.

Cardiovascular Diseases↗
PubMed1987

[Prognostic value of x-ray computed tomography in acute pancreatitis: contribution of the injection of intravenous contrast media].

Thirty seven patients suffering from acute pancreatitis were explored using contrast-enhanced computed tomography (CT). The authors found a good concordance between the extension of the lesions on the initial CT examination, prognostic criteria on admission and the course of the disease. In addition, a new prognostic CT sign was reported in the early phase of parenchymal contrast perfusion, i.e. the lack of contrast-enhancement in a limited portion of the pancreas. This sign was present in 8 patients, all with severe clinical symptoms. These 8 patients showed the highest morbidity rate in the series with abscess-type complications occurring in all, compared with 24 p. 100 among the 29 other patients who did not exhibit this CT sign. Moreover, these 8 patients showed the highest mortality rate (25 p. 100 compared with 3.5 p. 100 among the other patients). An histological analysis of partial pancreatectomy specimens was performed in 7 out of the 8 patients. Devitalized pancreatic tissue, at the site of the parenchymal abnormalities on CT scan, was found in all cases. One false negative case was reported. Contrast-enhanced CT scan seems to be the most reliable method for diagnosing pancreatic necrosis during acute severe pancreatitis. It appears to be an useful prognostic predictor of morbidity. It can improve the outcome of the disease by depicting and guiding needle aspiration of a fluid collection, and/or surgery in case of clinical findings suggesting abscess formation.

Acute Disease↗
PubMed1986

[Benign ureteral stenoses. Dilatation with an angioplasty balloon].

An angioplasty balloon was used to dilate 23 benign ureteral stenoses in 21 patients. The anterograde approach through percutaneous puncture of the kidney was used in 19 cases. Following dilatation, an 8 F to 24 F catheter was left in the ureter. Dilatation was successful in 13 out of 23 cases (56%) followed up for 1 month to 2 years. It failed in 8 cases, and 2 patients are undergoing ureteral remodelling. Thus, dilatation of benign ureteral stenoses after percutaneous renal puncture was effective in about 60% of the cases. The follow-up period is still too short for us to determine the indications of this technique according to the cause and duration of the stenosis.

Adolescent↗
PubMed1986

[Value of ultrasonography in the diagnosis of carcinoma of Vater's ampulla. Apropos of 9 cases].

In ten patients where ampullary carcinoma was proved, ultrasonography has been performed in 9 cases and failed in 1 case. The results reported, could be put into two different groups. In 7 cases out of 9, sonogram did not show any specific signs: In 3 of these cases, it mimicked a pancreatic carcinoma; in the other 4 cases, dilatation of biliary and/or pancreatic ducts has only been evaluated. In the 2 remaining cases (20% of the 10 patients of the series) the diagnosis of ampullary carcinoma could be suggested on sonographic features. It showed the "double duct sign" and a bulging mass filling the lumen of the distal common bile duct. In one of these 2 cases, the mass was also detectable in the second duodenum, previously filled with water. Endoscopy with biopsy is the most reliable procedure in the diagnosis of ampullary carcinoma but the interest of ultrasonography is: 1 degree to show suggestive findings when the tumor bulges in the common bile duct and the duodenum; 2 degrees to evaluate the tumor extension in the pancreatic parenchyma.

Aged↗
PubMed1986

[Real-time echography in the evaluation of the venous extension of cancer of the kidney. Prospective study of 50 cases].

Fifty patients with renal carcinoma were evaluated with real time ultrasonography: 15 tumors involved the renal vein (group Ia), 12 of them presented with caval tumor extension (group Ib); 35 tumors did not involve the renal veins (group II). In 3 cases, the renal vein could not be visualized. If the renal veins could be adequately delineated, evaluation of venous extension could be achieved in 100% cases (groups Ia and II). Nevertheless, caval tumor extension could be detected in only 70% cases (group Ib). This prospective study suggests that in the case of renal vein free of thrombus on ultrasonography, further investigations are not necessary to evaluate the venous extension of renal carcinoma. In case of inadequate delineation, or tumor involvement of the renal vein on ultrasonography, evaluation of inferior vena cava is mandatory, either by computed tomography, or inferior cavography.

Humans↗
PubMed1985

[Sensitivity of fine-needle puncture-biopsy in the histologic diagnosis of hepatic and pancreatic malignant tumors].

Aspiration-biopsies under ultrasound guidance, using a fine needle (external diameter inferior to 1 mm) have been performed in 61 malignant hepatic tumors (group I) and 25 pancreatic carcinomas (group II). Malignancy was diagnosed in 83 p. 100 cases; in group I, the sensitivity is 87 p. 100; the difference between hepatocellular carcinoma and liver metastases could be made in 88 p. 100 cases and in case of metastases, the site of the primitive carcinoma could be suggested in 77 p. 100 cases. In group II, the sensitivity is 72 p. 100. No complications were noted.

Biopsy, Needle↗
PubMed1985

[Can histological diagnosis of hepatic metastases be made by fine needle? Apropos of 70 hepatic punctures guided by echography].

The fine needle diagnosis of a malignant hepatic tumour is usually based on the cytology of the specimen. There have been very few reports concerning the possibilities of histological examination using the same needle. The authors report the histological results of 70 cases of aspiration biopsy of malignant hepatic tumours. They stress the importance of ultrasound guidance. The aspiration biopsy diagnosed the malignancy in 86 p. cent of cases. The difference between a primary tumour and a secondary tumour was established in 85 p. cent of cases and, in the group of 34 cases of hepatic metastases, the primary tumour was identified in 75 p. cent of cases. No complications were observed. The use of real time ultrasonography allows the visualisation of the needle throughout its course, so that large intra-hepatic vessels can be avoided and enabling the aspiration of deep intra-hepatic metastases and the aspiration of the periphery of necrotic tumours.

Biopsy, Needle↗
PubMed1985

[Percutaneous drainage of intra-abdominal abscesses guided by real-time ultrasonography].

From October 1982 to October 1984, a percutaneous drainage under realtime ultrasound guidance was performed in 53 patients with abdominal abscesses. The location of the abscesses was subphrenic (23), retroperitoneal (16), and intrahepatic (14). A safe access route was found by using ultrasound and fluoroscopy in 53 out of 55 patients (96 p. 100). Percutaneous drainage failed in 8 patients and 3 of these patients died. The causes of death were: cerebral abscess (1), renal failure after surgery for correction of a duodenal fistula (1), and pancreatic abscess (1). The other five patients were cured by surgical drainage. Two complications were observed: one case each of pneumothorax and purulent peritonitis. Forty-five patients were healed by percutaneous drainage without operation. The duration of the catheter drainage was 14 days +/- 13 (m +/- 1 SD). Our results suggest that percutaneous drainage under realtime ultrasound guidance is an efficient and safe way to treat abdominal abscesses.

Abdomen↗
PubMed1985

[Percutaneous nephrostomy and its applications. Personal experience].

211 percutaneous nephrostomies (PCN) have been performed on 189 patients under combined fluoroscopic and reel time ultra-sound guidance. 4 major complications occurred with consisted in one hemorrhage and 3 septicemias. Indication of the PCN was diagnostic in 35 cases and therapeutic in 176 cases. Decompression of pyelo-caliceal system (89 cases) among with 72 in emergency, drying of an urinary fistula (8 cases), balloon dilatation of benign ureteral stenoses (18 cases) and treatment of 60 renal stones (3 dissolutions and 57 extractions). Results showed the drying of the fistula in all cases, the long term success of the balloon dilatation in 50% cases and 80% success rate of stone extraction.

Adult↗
PubMed1984

[Echography of tumors with multiple localizations in the urinary tract. Apropos of 2 cases].

The authors report 2 cases of unilateral non functioning hydronephrotic kidney, associated with homolateral bladder tumoral filling defect. Cystoscopy and histology showed a non infiltrating tumor. In one case, sonography showed a diffuse tumoral proliferation from the renal pelvis to the bladder and in the other case revealed a tumor located in the lower ureter prolapsed into the bladder. Both were non infiltrating ureteral tumors on histologic examination. These sonographic features, suggesting that the level of obstruction was not the bladder, accounted for the contradiction between urographic findings and lack of histological infiltration.

Adult↗
PubMed1984

[Real time echographic study of the normal Wirsung duct. Comparison with retrograde catheterization].

An ultrasonogram (US) of the pancreatic duct was performed in 59 patients prior to a retrograde pancreatography (ERCP). In 41 patients with normal ERCP, the pancreatic duct in the body of the pancreas was found to be on US less than 2 mm. The diameter measured on ERCP on the same portion of the pancreas was found to be 2,5 larger. On 18 abnormal ERCP, 3 patients had normal US defined by a pancreatic duct less than 2 mm in internal diameter and a normal pancreatic parenchyma. These 3 patients had mild ductal abnormalities of chronic pancreatitis on ERCP, undetectable by US. These 3 false negative cases give to a normal pancreatic US a negative predictive value of 93%. The injection of 5 normal autopsy pancreas, combined with US of the pancreatic duct, showed that neither the radiological magnification nor the pressure of injection accounted for the discrepancy between US and ERCP in the measurement of the pancreatic duct diameter. It is thought to be due to an underestimation of the internal diameter of the duct which may be related to an apparent thickening of its highly echogenic walls.

Adult↗
PubMed1983

[Percutaneous nephrostomy under echographic guidance. Apropos of 31 cases].

31 percutaneous nephrostomies (P.C.N.) were realised under a combination of real time ultrasound and fluoroscopic guidance. No failure in placement of the nephrostomy tube was noted. 13 complications were noted in 9 patients: 3 were major, consisted in 1 severe hemorrhage and 2 septicemia and 10 were minor, mainly caused by secondary displacement of the tube. Three indications of P.C.N. are related to upper urinary tract obstruction: 1) Overdistension and fever or pain associated with poor patient's condition. 2) Short-term obstructions. 3) Diagnosis of the nature or location of the obstruction when other techniques don't provide the solution, and/or evaluation of renal function. The drainage of some ureteral fistules represent the fourth indication. P.C.N. allows ureteral antegrad catheterization and its applications. Results are discussed and present or future applications of interventional uro-radiology are related.

Aged↗
PubMed1983

[Real-time echography of the parathyroid glands].

Real time ultrasonography of the neck, using a sectorial scanner with an ordinary 5 MHz transducer, was performed on 24 patients with hypercalcemia. 21 of them were suffering from primary hyperparathyroidism and 3 from a severe paraneoplasic hypercalcemia. There were 18 true positive, 3 false positive, 1 false negative and 2 true negative. The sensibility and the negative predictive value of the method are 83%. The specificity and the negative predictive value are 95%. The accuracy is 91%. Real time ultrasonography of parathyroid glands is possible with a sectorial scanner using an ordinary 5 MHz transducer and is systematically done, in our institution, before cervicotomy.

Adenoma↗
PubMed1983

[Abdominal echography in the diagnosis and monitoring of retroperitoneal fibrosis. Apropos of 2 cases].

The authors report 2 new cases of unilateral ureteral obstruction due to a retroperitoneal fibrosis diagnosed by ultrasound examination. Retroperitoneal fibrosis presents as a hypo-echogenic, homogeneous mass, anterior to the sacral promontary, extending more or less cranially or caudally around the aorta and the iliac vessels where it gets a circumferential appearance. The complete regression of the mass has been followed by ultrasound on one patient. The authors underline the diagnostic problem posed with the R.P.F. secondary to metastatic neoplasm and discuss the place of ultrasound guided fine needle biopsy performed on one patient for the diagnosis of the affection.

Abdomen↗
PubMed1976

[Respiratory distress in evolutive tuberculosis (6 cases)].

The authors reported six cases of respiratory distress of tuberculous origin over a 3 year period. They underlined the failure to recognize the etiology despite a typical symptomatology and, on the opposite, the diagnostic difficulties met in a former tuberculous patient with chronic bronchitis. They insisted on the persistance of evolutive tuberculosis as a cause of respiratory distress, on the importance of any associated infection and on the little use of assisted ventilation.

Adult↗
PubMedDate not supplied

Two-dimensional time-of-flight magnetic resonance angiography of renal arteries without maximum intensity projection: a prospective comparison with angiography in 21 patients screened for renovascular hypertension.

PURPOSE: We compared magnetic resonance angiography (MRA) with conventional angiography to establish its value as a screening test in the workup for renal hypertension. METHODS: Twenty-one patients underwent MRA and angiography within a three-day interval. Fifteen patients were suspected of having renovascular hypertension on the basis of clinical findings; the remaining six had multivessel atherosclerosis with renal insufficiency. MRA was performed on a 1 Tesla magnet in three planes: axial, coronal and perpendicular to the axis of each renal artery, by means of several contiguous or overlapping individual slice acquisitions. The two examinations were read by the same two independent observers, before and after an interval of 3 months. RESULTS: Conventional angiography showed 48 renal arteries. All main and three of six accessory renal arteries were correctly identified by MRA, as well as 11 of 14 significant stenoses or thromboses. Overreading of stenoses by MRA was observed in 4 cases. There were two false negatives for the two readers. The sensitivity and specificity of MRA for the detection of stenoses of the main renal arteries were found to be 70 and 78% respectively, for the first reading and 85 and 86% for the second reading. CONCLUSION: MRA is considered a useful noninvasive method to determine the need for conventional angiography in patients in whom renal artery stenosis is suspected.

Adult↗