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Biomedical subjects

C Lagrange

Publications and source records attributed to C Lagrange.

At least 19 recordsLinked to original sources
PubMed2006

Clinical and economic results of bilateral subthalamic nucleus stimulation in Parkinson's disease.

BACKGROUND: High frequency stimulation of the subthalamic nucleus (STN) is an alternative but expensive neurosurgical treatment for parkinsonian patients with levodopa induced motor complications. OBJECTIVE: To assess the safety, clinical effects, quality of life, and economic cost of STN stimulation. METHODS: We conducted a prospective multicentre study in 95 consecutive Parkinson's disease (PD) patients receiving bilateral STN stimulation and assessed its effects over 12 months. A double blind randomised motor evaluation was carried out at 3 month follow up, and quality of life, self care ability, and predictive factors of outcome following surgery were assessed. The cost of PD was estimated over 6 months before and after surgery. RESULTS: The Unified Parkinson's Disease Rating Scale (UPDRS) motor score improved by 57% (p<0.0001) and activities of daily living improved by 48% (p<0.0001) at 12 month follow up. Double blind motor scoring improved by 51% at 3 month follow up (p<0.0001). The total PD Quality of Life Questionnaire (PDQL-37) score improved by 28% (p<0.001). The better the preoperative motor score after a levodopa challenge, the better the outcome after STN stimulation. Five patients developed an intracerebral haematoma during electrode implantation with permanent after effects in two. The 6 month costs of PD decreased from 10,087 euros before surgery to 1673 euros after surgery (p<0.0001) mainly because of the decrease in medication. These savings allowed a return on the procedure investment, estimated at 36,904 euros over 2.2 years. CONCLUSIONS: STN stimulation has good outcomes with relatively low risk and little cost burden in PD patients with levodopa induced motor complications.

Activities of Daily Living↗
PubMed2001

[Comparison between arteriography and magnetic resonance angiography in patients with leg peripheral arterial disease ].

PURPOSE: The anatomic information before surgical therapy must be precise. Contrast angiography fails to opacify distal vessels in a large number of cases. We have evaluated the capability of magnetic resonance angiography to depict peripheral arteries. Materials and methods. We examined fourty-eight patients. CA was performed from a femoral or humeral approach, with or without subtraction. MRA were obtained using a 1.5 T magnet. Ankles and feet were placed in a head coil; three sequences were performed: Reconstructions and axial source images were reviewed. RESULTS: MRA is superior to CA to demonstrate patent arterial segments in a majority of cases. CONCLUSION: MRA is an effective method to identify distal lower extremity arteries.

Aged↗
PubMed2000

Transcatheter ethanol renal ablation in 20 patients with persistent urine leaks: an alternative to surgical nephrectomy.

PURPOSE: We evaluate the efficacy of transcatheter ethanol renal ablation for destruction of a unilateral, poorly functioning kidney with persistent urinary leaks from fistulas or a nephrostomy tube. MATERIALS AND METHODS: From January 1992 to January 1999, 19 females and 1 male with a history of pelvic neoplasms, which were responsible for ureteral leaks through the nephrostomy tube in 13 cases or fistulas in 7, were treated with transcatheter ethanol renal ablation. Serum creatinine ranged from 60 to 140 micromol./l. (mean 90), and function of the involved kidney determined by diethylenetetraminepentaacetic acid scintigraphy in 16 patients or by morphological imaging in 4 was low. Drainage of the renal cavities and antibiotic therapy preceded renal ablation. After epidural anesthesia or intravenous sedation renal ablation was performed by catheterization of the renal artery and injection of 1. 5 to 12 ml. (mean 4.6) absolute ethanol, and completed by proximal occlusion with coils and absorbable gelatin sponge. RESULTS: Arterial flow was interrupted in all cases. Urinary flow ceased in 2 days in 18 of 20 patients, and drains were removed. Two patients had residual urine that was successfully treated with additional embolization. No complications occurred. CONCLUSIONS: Transcatheter ethanol renal ablation is safe and effective, and permits an in situ nephrectomy that can replace surgical nephrectomy for treatment of urinary leaks.

Adolescent↗
PubMed1999

Cystogastric transmural drainage for the treatment of symptomatic cystic metastases from ovarian carcinoma.

Approximately 80% of ovarian cancers are discovered when they have already progressed to stage III or IV lesions. The prognosis is, therefore, poor despite intensive treatment. Intraperitoneal dissemination is one of the most frequent pathways of distant spread ovarian cancer and pseudocystic metastases usually occur. When such cystic metastases remain symptomatic despite antitumor treatment, viable options are limited because palliative surgery generates high operative morbidity and mortality. For many years, in patients in whom the risks associated with surgery are high, percutaneous drainage and sclerosis under radiologic guidance has been performed as an effective alternative option for various forms of abdominal fluid collection. Such a collection in pancreatic pseudocyst benefits from cystogastric transmural drainage to avoid external drainage and achieves the same results as surgical cystogastrostomy. We report this transmural drainage technique under image guidance used to drain a symptomatic cystic metastasis, which was compressing the stomach.

Ascitic Fluid↗
PubMed1998

Endovascular management of bleeding iliac artery pseudoaneurysms complicating radiation therapy for pelvic malignancies.

OBJECTIVE: We evaluated arteriographic findings and endovascular treatments of eight patients who had bleeding iliac artery pseudoaneurysms and who had undergone radiation therapy (3000-6500 rad [30-65 Gy]) and surgery for pelvic malignancies. CONCLUSION: Angiography revealed contrast media extravasation in 75% of patients who had bleeding iliac artery pseudoaneurysms and failed to show the source of bleeding in 25%. The patients who had positive findings at angiography were all successfully treated percutaneously, although two patients required additional bypass surgery. Among embolic materials, coils and balloons were safe and efficient, whereas cyanoacrylate was unsafe and led to complications in two of three patients. A covered stent, which was not available for most of our patients, was used in one patient and may be an effective means of treating pseudoaneurysms.

Aneurysm, False↗
PubMed1996

Liver abscess formation after local treatment of liver tumors.

Our goal was to determine a subset of patients at high risk of developing liver abscesses after local treatment of liver tumors (LTLT) and establish guidelines for the conduct of LTLT in the safest conditions in such patients. Five hundred sixty-one LTLT, 489 transhepatic arterial chemoembolizations (TAC, 10 hepatic embolizations, and 62 percutaneous intratumor injections (PIT), were retrospectively reviewed for liver parenchyma necrosis and abscess formation. Four patients developed abscesses, three after TAC and one after PIT. Despite broad-spectrum antibiotherapy, percutaneous drainage, and surgery, two patients died. A left hepatectomy was required in the other two patients for cure. All four patients had a carcinoid or a neuroendocrine pancreatic tumor. Three out of four patients had bilioenteric anastomoses, and the fourth had recently undergone cholecystectomy and papillotomy. A Lipiodol/doxorubicin mixture without any particulate embolization was injected in the three patients who developed abscesses after TAC. LTLT in patients with bilio enteric anastomosis or papillotomy and/or neuroendocrine or carcinoid tumor should be performed with strict precautions during the procedure and for peri-procedural care.

Antineoplastic Agents↗
PubMed1996

Preoperative portal vein embolization for extension of hepatectomy indications.

To render hepatectomy feasible in patients with an initially deficient volume of the future remnant liver (FRL), we redistributed portal blood flow rich in hepatotrophic substances toward the FRL. Redistribution was achieved with preoperative portal vein embolization (POPE) feeding the future resected liver. POPE was performed in 31 patients, under fluoroscopic guidance, via a percutaneous access. POPE was well tolerated and surgery was practicable in 24 patients without severe postoperative liver failure. Seven operations were cancelled, but only one due to insufficient hypertrophy of the FRL. FRL volume values were 90 to 560 mL (mean 260 mL) before POPE and 160-783 mL (mean 443 mL) after POPE, which represents a median increase of 79% +/- 50%. Hypertrophy of the FRL was 90% +/- 52% after 30 days with cyanoacrylate, 53% +/- 6% after 43 days with Gelfoam, and 44% +/- 30% after 35 days with coils. Slight shrinkage was obtained in the volume of the embolized liver, for which resection was planned. Overall survival was 2-62 months (mean 26 months), disease-free survival was 0-60 months (mean 19 months), and 7 patients are disease-free and alive 14 to 60 months (mean 43 months) after surgery. Although exclusively applicable in a limited subset of patients, POPE widens the possibilities of curative hepatectomies, because it induces sound hypertrophy of unembolized liver segments. Cyanoacrylate seems to ensure better and faster hypertrophy.

Adolescent↗
PubMed1996

Quantification of tumor uptake of iodized oils and emulsions of iodized oils: experimental study.

PURPOSE: To optimize use of iodized oil for diagnostic computed tomography (CT) enhanced with iodized oil and for interstitial radiation therapy with iodine-131-labeled iodized oil, the authors quantified the distribution of iodized oil after injection of different formulations of iodized oil into the hepatic artery. MATERIALS AND METHODS: I-125-labeled iodinated ethyl ester of poppyseed oil in two viscosities (iodized oil ultrafluid [viscosity, 0.04 Pa/sec] and iodized oil fluid [viscosity, 0.17 Pa/sec]) was injected (pure forms and three different emulsions of each) into the hepatic artery of rabbits bearing VX2 tumors in the liver. All rabbits received a radiation dose of 4 MBq per kilogram of body weight in 0.1 mL/kg iodized oil. Animals were killed 4 days later, and iodized oil uptake was evaluated in the tumor, nontumorous liver, and lung. RESULTS: There were no statistically significant differences in uptake between pure iodized oil ultrafluid or fluid or between the same type of emulsions made with each type of iodized oil. Lung uptake was significantly higher with pure iodized oil ultrafluid and fluid (19.75 kBq/g +/- 3.25 [standard error of the mean] vs 19.48 kBq/g +/- 6.15, respectively) than with any emulsions (range, 3.72-8.14 kBq/g; mean, 5.68 kBq/g) except the small-droplet oil-in-water emulsion (10.51 kBq/g +/- 1.18). The ratio of tumor to nontumorous liver uptake of iodized oil was significantly higher with large-droplet water-in-oil emulsions made of iodized oil ultrafluid or fluid (10.26 +/- 2.88 and 9.53 +/- 0.64, respectively) than with any other product (range, 4.07-5.38; mean, 4.49). CONCLUSION: Use of large-droplet water-in-oil emulsions limited lung uptake and increased tumor uptake of iodized oil after intraarterial hepatic injection in rabbits bearing VX2 tumors in the liver.

Animals↗
PubMed1989

[Tumors of the pineal region: MRI aspects. Apropos of 20 cases].

MR imaging (0,5 T) was performed in twenty patients with a tumor of the pineal region (17 pathological correlations). To establish the place of this technique, MR imaging data are studied. There is a great variety of tumor types, but the signal of the tumor is usually non specific. The main indication of MR imaging appears to be the evaluation of the extension of the tumor before surgery.

Adolescent↗
PubMed1987

Embolization of the systemic arteries of the lung.

Embolization of the systemic arteries of the lung (described by Remy and colleagues in 1973) is now a useful method for the treatment of hemoptysis or hemorrhagic lesions of the lung prior to surgical treatment, or for local treatment of hemoptysis when surgery is contraindicated or unnecessary. The technique is based on the anatomy of the different divisions of the systemic circulation (bronchial and extrabronchial), which for various physiologic reasons may develop hypervascularization. The results, complications, and contraindications of systemic embolization have previously been described and the technique is now commonly practiced.

Embolization, Therapeutic↗