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Biomedical subjects

C Lions

Publications and source records attributed to C Lions.

At least 19 recordsLinked to original sources
PubMed2006

[Nefopam by continuous intravenous injection and adverse drug reactions: which causality assessment?].

We report the case of a 77-year-old man, with nefopam postoperative analgesia, who developed subacute neurological symptoms, whereas he had profound hypoprotidemia and acute renal failure. Chronological, semiological and bibliographical criteria are in favour of causality assessment. The plasma nefopam concentration (135 ng/ml) during the neurological symptoms is another argument.

Acute Kidney Injury↗
PubMed2006

[Subsequent pregnancy following uterine artery embolization for interstitial pregnancy].

Subsequent pregnancy following an interstitial pregnancy is rare. The risk of uterine rupture may be increased in this situation. Uterine selective embolization has been proposed as an effective treatment. However, no further pregnancy has ever been described after this method of management. We are reporting a case of subsequent pregnancy following interstitial pregnancy managed by embolization. The pregnancy was uneventful. A healthy male infant was delivered by C-section. This case supports the hypothesis that selective embolization for interstitial pregnancy may respect fertility. However, as actual risk of uterine rupture in subsequent pregnancies remains unknown, a C-section is advised.

Adult↗
PubMed2006

[Post-partum broad ligament hematoma embolization: a case report].

We relate the embolization of a hematoma of the broad ligament which developed suddenly in the post-partum period. The radiological intervention could be considered as an alternative treatment. The decision for embolization must be a multidisciplinary decision involving all the specialists concerned (interventional radiologist, intensive care specialist, and obstetrician).

Adult↗
PubMed2005

[Important hypercalcaemia due to hyperparathyroidism induced by lithium].

Lithium treatment, which is still extensively used in bipolar affective disorders, may give rise to hypercalcaemia induced by hyperparathyroidism. We present a patient of 50-year-old treated with lithium for 19 years for bipolar illness and who developed an important hypercalcaemia. After symptomatic treatment of the hypercalcaemia and extrarenal dialysis the clinical evolution was favorable but measurements of serum calcium and parathormon showed that he had developed hyperparathyroidism. Neck exploration was performed and parathyroid adenomas, which had been detected by scintigraphy was removed. The lithium treatment expose to many side effects. Among other biologically and clinically important effects of lithium the possible induction of hyperparathyroidism was first suggested in 1973. Since, 1973, since about forty case reports have been described. Few cross-sectional studies show a relationship of lithium to hyperparathyroidism. Unusual metabolic features are associated with hyperparathyroidism and long-term lithium treatment: low urinary calcium excretion, normal urinary cyclic AMP excretion. The mechanism probably results from lithium linking with the calcium receptor on the parathyroid and then stimulating PTH secretion. The cessation of lithium therapy does not lead to normocalocaemia and a parathyroidectomy is usually indicated.

Antimanic Agents↗
PubMed2004

[Imaging of the renal arteries: when, how and why?].

The objectives of this course are both: to describe acquisition, injection and reconstruction parameters of volumic images for renal arteries examination and specific signs; to discuss the role of the different images in the diagnosis and in the therapeutic management. Ultrasound is one of the best imaging for the analysis of renal arteries in the detection of stenosis even if the sensitivity is less (around 85%)compared to CT Angiography (95%) and MR Angiography (90%). Because of this advantage and of 3D evaluation, CTA and MRA are sometimes in the first line for renal artery evaluation and can assess morphology before angioplasty. Renal scintigraphy with Captopril test and renin dosage are only used for small kidney evaluation. Arteriogram is systematically followed by angioplasty if possible. With the new endovascular materials, complications decrease (less than 5% with a major reduction in cholesterol emboli) and indications of endoprosthesis increase (71% of stenting with half of it in direct stenting technique). This course will give practical tools for imaging acquisition, specifically 3D imaging, for indications and management of lesion in accordance to symptoms and morphology.

Angiography↗
PubMed2002

Stent-graft repair of the thoracic aorta: short-term results.

The purpose of this study was to evaluate clinical feasibility and immediate outcome of stent-graft repair of the thoracic aorta. From December 1999 to January 2001, a total of 14 patients underwent stent-graft repair of the thoracic aorta. The underlying etiologies were traumatic rupture of the aortic isthmus in four cases, Stanford type B dissection in four, thoracic aortic aneurysm in three, penetrating atherosclerotic ulcer in two cases, and postoperative aortoesophageal fistula in one case. Stent-graft placement was performed under angiographic control in all cases in association with transesophageal echography in seven cases. The procedure was performed under emergency conditions in five cases. Thirteen patients presented contraindications for surgery. Stent-graft placement was successful in all cases. No further surgery has been performed in any case. Thus we conclude that endovascular treatment of the thoracic aorta using stent grafts is a promising therapeutic modality in patients with contraindications for conventional surgical treatment.

Adult↗
PubMed2002

[Renovaascular hypertension and Von Recklinghausen neurofibromatosis].

This clinical case illustrates the diagnosis of a secondary cause of hypertension in a patient with Von Recklinghausen's disease. The hypertension resulted from a complex malformation of the right renal artery and dysplasic stenosis of the left inferior polar artery treated successfully by simple angioplasty. This case illustrates the high proportion of vascular (renal artery dysplasia, coarctation of the aorta) and endocrine (pheochromocytoma) causes of hypertension in patients with neurofibromatosis.

Adult↗
PubMed2001

Rupture of an aneurysm of the coronary sinus of Valsalva: diagnosis by helical CT angiography.

A 75-year-old man presented with a 5-day history of upper chest discomfort. On auscultation, there was a systolic murmur in the left parasternal area that radiated to the apex. Electrocardiography showed flat T waves in the anterior precordial leads. Chest X ray revealed mediastinal enlargement. Transthoracic echocardiography showed a dilated proximal ascending aorta with moderate aortic regurgitation. A contrast-enhanced helical CT scan, performed to eliminate an aortic dissection, showed a ruptured left coronary sinus of Valsalva aneurysm, confirmed at surgery. This case highlights the fact that helical CT, in patients with suspected aortic dissection, may reveal other pathology that accounts for the clinical presentation.

Aged↗
PubMed2001

Prospective evaluation of magnetic resonance imaging after endovascular treatment of infrarenal aortic aneurysms.

OBJECTIVES: to evaluate the sensitivity and specificity of magnetic resonance imaging (MRI) in the detection of type II endoleaks during follow-up after endovascular treatment of intra-renal aortic aneurysms. DESIGN: prospective study. MATERIAL AND METHODS: between March 1996 and November 1999, 31 patients with infra-renal aortic aneurysms who underwent stentgraft implantation were followed with helical CT and MRI, including magnetic resonance angiography (MRA), at 1 and 6 months after the procedure. Arteriography was performed between 6 and 12 months after intervention. The parameters studied included the change in the maximum anteroposterior and transverse diameters, the nature of the signal on T1 and T2 weighted sequences (homogeneous vs heterogeneous), the presence or absence of Gadolinium uptake on MRI or of contrast uptake on helical CT (early and late phases) in the sac of the aneurysm. On MRA, stentgraft patency and endoleak detection were studied. RESULTS: arteriography demonstrated an endoleak in 19 patients (18 type II, and 1 type I endoleak). MRI at 6 months detected 18/19 endoleaks on T1 weighted sequences after injection of Gadoliniumj; there were 2 false positives. MRA sequences confirmed stentgraft patency in all patients, but did not diagnose type II endoleaks. Helical CT (late phase) at 6 months detected 10/19 endoleaks; there was 1 false positive. The sensitivity of MRI after injection of Gadolinium and of helical CT for the detection of type II endoleaks were 94% and 50% (p=0.003) respectively. The mean maximal anteroposterior and transverse diameters were similar on MRI and on helical CT at 1 month and at 6 months. CONCLUSION: MRI after injection of Gadolinium is more sensitive than helical CT in the detection of type II endoleaks after stentgraft implantation. Its more widespread use may permit earlier intervention in such patients.

Aged↗
PubMed2001

Embolization of type II endoleaks after aortic stent-graft implantation: technique and immediate results.

PURPOSE: We report the procedural details and immediate results of treatment of type II endoleaks after aortic stent-graft implantation. METHODS: In a consecutive series of patients who had either Vangard (n = 53) or Talent (n = 7) aortic stent-grafts implanted, type II endoleaks were confirmed by means of angiography in 18 patients, with a mean (+/- SD) age of 69 +/- 11 years; 16 patients had Vangard stent-grafts, and two patients had Talent stent-grafts. After superselective catheterization of the feeding vessel, with 3F microcatheters, and liberal injections of vasodilators, embolization was performed with either a mixture of biologic glue and Lipiodol (n = 16) or Microcoils (n = 2). RESULTS: The procedure was performed through the femoral artery in 16 patients and through the brachial artery in the remaining two patients. Overall, superselective catheterization and embolization were successfully undertaken in 17 (94.4%) of 18 patients. In the remaining patient, superselective catheterization proved impossible. This patient was treated with an injection of microparticles completed by means of embolization of biologic glue more proximally in an iliolumbar branch. During follow-up (mean, 13.3 months) after embolization, the aneurysm sac shrank in 13 (72.2%) of 18 patients. A new type II endoleak was diagnosed on helical computed tomography or magnetic resonance imaging in two (11.1%) of 18 patients. CONCLUSION: Percutaneous embolization is a safe and effective technique for treatment of type II endoleaks. However, despite these initially promising results, large long-term follow-up studies will be required to confirm its efficiency.

Aged↗
PubMed2001

[Are demographic characteristics of hypertensive patients different with renal artery stenosis?].

UNLABELLED: Atheromatous renal disease is more and more involved in end stage renal failure in polyatheromatous patients. The goal of this work was to study the demographic differences between hypertensive patients with renal artery stenosis (RAS) or without RAS. METHOD: Between November 1995 and July 1997, 49 hypertensive patients were included consecutively for a suspicion of RAS. Age, sex, hypertension history, tabagism, cardiovascular heredity, body mass index, diabetes history, hypercholesterolemia, kalmia, serum creatinine, creatinine clearance, systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP) were studied. A renal echo-doppler and a renal TDM were performed in all patients. A renal arteriography was performed in 23 patients with a RAS suspicion after the two morphologic exams. The demographic characteristics of both clinical groups control (group 1) and patients with unilateral RAS (group 2), were compared. STATISTICS: Descriptive analysis, Wilcoxon test, Khi 2 test, spearman correlation (p < 0.05). RESULTS: Group 2 patients were significantly older than group 1 patients (p = 0.008) with a mean age difference of 8 years. Creatinine clearance was lower in patients suffering from RAS with a mean difference of 23 mL/min between groups 1 and 2 (p = 0.0007) but we also had to take into account the negative correlation existing between creatinine clearance and age (r = 0.63; p = 0.0001) when interpreting these results. The DBP was lower (p = 0.03) and the PP higher (p = 0.01) in group 2. The SBP was higher in group 2 but this result was not significant. Mean differences in SBP and PP between group 1 and group 2 were 6 mmHg and 15 mm Hg respectively. Smoking was more common in group 2 (p = 0.04). The history of hypertension, cardiovascular heredity, sex ratio (M/F), body mass index and prevalence of diabetic were comparable between the two clinical groups. CONCLUSION: Although there were demographic differences between the two clinical groups, no clinical or biological variable could be used alone to identify which patients suffered from renal stenosis, because the distribution of these variables did not differ significantly between the two groups and the effective was small. Then, we thought that Krijnen's predictive rule is interesting in the screening of hypertensive patients with RAS suspicion.

Adult↗
PubMed2001

[Method of studying renal morphology in hypertensive patients with and without renal artery stenosis].

UNLABELLED: Although the size of the kidney is still the most commonly used as morphological parameter, it is not enough sensitive for early detection of ischemic nephropathy. PURPOSE: To study a novel method of renal morphology analysis using spiral computed tomography angiography (CTA) in hypertensive patients with or without unilateral atheromatous renal artery stenosis (RAS). METHODS: Forty-nine hypertensive patients suspected RAS underwent spiral CTA. Arteriography showed significant RAS in 26 patients. Renal length, 3 upper and 3 lower cortical thicknesses were measured in 46 control kidneys (C) i.e. 23 patients without RAS (group 1), in 26 stenosed (S) and in 26 opposite kidneys (OPP) i.e. 26 patients with unilateral RAS (group 2). Mean cortical thickness (MCT), cortical area (CA), medullary length (ML) were calculated in the same groups. The reproducibility and agreement of measurements were investigated in two groups. The demographic parameters (age, sex, bodymass index, and history of hypertension) were correlated with morphological parameters in group 1. RESULTS: The reproducibility and agreement of measurements were confirmed (R2 = 0.53 to 0.93) except for anterosuperior thickness. The C kidneys were of comparable morphology: MCT (mm) = 9.1 +/- 0.6; 9.2 +/- 1.0, CA (mm2) = 950 +/- 119; 934 +/- 157, ML (mm) = 85 +/- 11. In group of Opp kidneys, MCT = 7.9 +/- 1.4 mm, CA = 806 +/- 210 mm2, ML = 84 +/- 13 mm. In group of S kidneys, MCT = 6.6 +/- 1.6 mm, CA = 612 +/- 193 mm2, ML = 77 +/- 14 mm. Demographic parameters were not correlated to renal morphology. CONCLUSION: Spiral CTA is a suitable method to study renal morphology. Cortical thickness and medullary length could be used to obtain a reliable diagnosis of early ischemic nephropathy.

Adult↗
PubMed2000

[Intravascular Doppler for the evaluation of renal blood flow: validation and demonstration of vessel reactivity].

AIM: To assess the feasibility and to demonstrate the potential clinical application of intravascular doppler in the evaluation of renal blood flow in patients with hypertension and normal renal arteries. MATERIALS AND METHODS: Intravascular doppler was used to measure renal blood flow in 19 patients (34 kidneys) during arteriography to rule out renovascular hypertension. Arteriography showed no evidence of renal artery stenosis in any patient. Hemodynamic parameters, renal artery diameter, and doppler measurements were undertaken at baseline, after injection of a bolus (10 ml) of normal (0.9%) saline, and after injection of isosorbide dinitrate (1 mg diluted in 10 ml normal saline). RESULTS: Repeated measurements of renal blood flow confirmed the reproducibility of the technique. Basal blood flow was similar in both right and left kidneys; injection of vehicle solution (10 ml normal saline) had no effect on doppler parameters. Injection of isosorbide dinitrate resulted in a significant increase in renal blood flow velocity reflecting an increase in renal blood flow; this demonstrates the existence of a renal flow reserve. The degree of increase in renal blood flow varied significantly between kidneys. CONCLUSIONS: Intravascular doppler is a safe, effective, and reproducible technique for measurement of renal blood flow. It allows evaluation of variations in renal blood flow in response to diverse vasoactive drugs or other vasomotor stimuli. The present study demonstrated the heterogenous response of renal blood flow in response to vasodilator stimuli.

Angiography↗
PubMed1998

The transcriptional regulator Hap1p (Cyp1p) is essential for anaerobic or heme-deficient growth of Saccharomyces cerevisiae: Genetic and molecular characterization of an extragenic suppressor that encodes a WD repeat protein.

We report here that Hap1p (originally named Cyp1p) has an essential function in anaerobic or heme-deficient growth. Analysis of intragenic revertants shows that this function depends on the amino acid preceding the first cysteine residue of the DNA-binding domain of Hap1p. Selection of recessive extragenic suppressors of a hap1-hem1- strain allowed the identification, cloning, and molecular analysis of ASC1 (Cyp1 Absence of growth Supressor). The sequence of ASC1 reveals that its ORF is interrupted by an intron that shelters the U24 snoRNA. Deletion of the intron, inactivation of the ORF, and molecular localization of the mutations show unambiguously that it is the protein and not the snoRNA that is involved in the suppressor phenotype. ASC1, which is constitutively transcribed, encodes an abundant, cytoplasmically localized 35-kD protein that belongs to the WD repeat family, which is found in a large variety of eucaryotic organisms. Polysome profile analysis supports the involvement of this protein in translation. We propose that the absence of functional Asc1p allows the growth of hap1-hem1- cells by reducing the efficiency of translation. Based on sequence comparisons, we discuss the possibility that the protein intervenes in a kinase-dependent signal transduction pathway involved in this last function.

Adaptor Proteins, Signal Transducing↗