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Biomedical subjects

D Didier

Publications and source records attributed to D Didier.

At least 19 recordsLinked to original sources
PubMed1992

Value of liquid crystal contact thermography and plasma level of D-dimer for screening of deep venous thrombosis following general abdominal surgery.

Because the use of radioactive fibrinogen uptake test (FUT) has become questionable both for ethical (risk of virus transmission) and technical (lack of sensitivity) reasons, we investigated the potential value of two alternative methods for screening of asymptomatic deep venous thrombosis following elective digestive surgery: liquid crystal contact thermography (LCCT) and measurement of plasma concentration of D-dimer (DD), as compared with bilateral ascending phlebography. Out of 194 patients, 185 underwent phlebography on the 8th (0-19, median and range) postoperative day. Despite prophylaxis with low-molecular-weight heparin and elastic stockings, DVT was detected on phlebography in 58 legs of 45 patients. Sensitivity of LCCT with respect to the presence of DVT was 55% (n = 184 patients) or 28% (n = 368 legs) with a specificity of 67% and 82%, respectively. These poor performances were obtained despite a good interobserver agreement for the LCCT assessments (overall kappa coefficient of 0.66 between three experts). The most accurate cut-off of DD for discriminating patients with or without DVT was 3,000 micrograms/l, as determined by ROC curve analysis. Sensitivity of a DD level of more than 3,000 micrograms/l for the presence of phlebographically documented DVT on the 8th postoperative day was 89% for a specificity of 48%. Thus, LCCT cannot be used for screening of postoperative, mainly asymptomatic DVT following general surgery. On the other hand, measurement of plasma DD may be useful for initial screening, a negative result (level less than 3,000 micrograms/l) allowing to exclude DVT (negative predictive value of 93%) and a positive result (positive predictive value of 35%) requiring confirmation by phlebography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Echocardiographic and angiographic findings in superior-inferior cardiac ventricles.

The anatomy of superior-inferior ventricles was studied in 17 patients, aged 1 day to 22 years, using echocardiography and angiography. In all patients, the right ventricle was located superiorly and the left ventricle inferiorly. The right ventricular sinus was underdeveloped in 14 of the 17 patients. Conversely, the right ventricular outflow tract was normally developed in all 17 patients. The visceroatrial situs was solitus in all patients, and it was associated with a concordant D-loop in 9 patients and with a discordant L-loop in 8. There was a high incidence of associated transposition of the great arteries (9 patients) or double-outlet right ventricle (5). Segmental combination was unpredictable, D-loop being associated with L-position of the great arteries in 4 of 8 patients and L-loop being associated with D-position of the great arteries in 4 of 9. There were only 3 concordant ventriculoarterial connections. Frequently associated anomalies included ventricular septal defect (17 patients), atrioventricular valve malformations (17) subaortic conus (14) and pulmonary outflow tract stenosis or atresia (11). Criss-cross hearts were present in only 7 patients.

Adult↗
PubMed1988

[A new treatment of deep venous thrombosis: low molecular weight heparin fractions. Randomized study].

Sixty-eight patients with acute deep vein thrombosis were allocated at random to two treatment groups. One group (n = 33) received a fixed dose of 750 anti-Xa units of a low molecular weight heparin (CY 222 Choay Institute); the other group (n = 35) received standard heparin in doses of 500 IU/kg/24 h. Both treatments were given for 10 days in two daily subcutaneous injections. A second phlebography was performed on the last day of treatment. No haemorrhagic complication was observed in the group treated with CY 222, as opposed to three cases of haemorrhage in the group treated with standard heparin. The initial phlebographic score and the location of deep vein thrombotic lesions were the same in both groups. Angiographic improvement, with more than 30% thrombolysis, was obtained at the end of treatment in 64% of patients in the CY 222 group and in 65% of patients in the standard heparin group (NS). In 2 patients treated with standard heparin the second phlebography showed extension of the thrombosis. The initial score remained unchanged in 1/3 of patients in both groups. The activated partial thromboplastin time was prolonged (2 or 3 fold the normal value) in the standard heparin group and unchanged in the CY 222 group. Anti-Xa activity was significantly higher in the CY 222 group than in the standard heparin group. It is concluded that CY 222 and standard heparin were equally effective in patients with deep vein thrombosis. However, haemorrhagic complications were more frequent with standard heparin that with CY 222.

Aged↗
PubMed1988

Ultrasound of the traumatized spleen: left butterfly sign in lesions masked by echogenic blood clots.

Ultrasonic display of blood on both sides of the splenogastric ligament (left butterfly sign) in the left traumatized patient indicates hemoperitoneum within the lesser sac. Particular attention must be paid then to the splenic parenchyma, where isoechogenic blood clots can mask a hematoma. The association of subtile parenchymal changes and of a left butterfly sign are relevant of frank splenic lesions.

Hematoma↗
PubMed1988

[Use of a tooth graft in mentoplasty. Apropos of a case].

The author reports the case of a young female patient who consulted for mentoplasty, during which a dental fragment, derived from the germ of a wisdom tooth, was used as an interposed graft. The result at 8 months revealed perfect tolerance and a tendency to osteo-integration of the tooth and demonstrates the simplicity of the procedure.

Adolescent↗
PubMed1988

[Ultrasonography and x-ray computed tomography in the diagnosis of intra-abdominal textiloma. Apropos of 12 cases].

Feared by every surgeon, retained surgical sponges (or gossypiboma) are rare iatrogenic entities. Ultrasonography and computed tomography are very valuable, providing an immediate answer in the majority of cases. We report 12 cases of intra-abdominal retained surgical swabs. The ultrasonic pattern was made whether of a large poorly echogenic mass with a hyper-echogenic center and sharply delineated posterior acoustic shadow (7 cases) or of a large acoustic shadow posterior to a solitary highly echogenic area (4 cases). Computed tomography demonstrated whether large peripherally enhanced cystic mass associated with serpiginous or spongiform central area (5 cases) or heterogeneous abscess-like fluid mass.

Abdomen↗
PubMed1987

Tumor thrombus of the inferior vena cava secondary to malignant abdominal neoplasms: US and CT evaluation.

Nineteen patients with histologically proved tumor thrombi of the inferior vena cava (IVC) secondary to abdominal neoplasms were studied with the use of ultrasonography (US) and computed tomography (CT). The primary neoplasms were renal cell carcinoma (13 cases), adrenal tumors (two cases), retroperitoneal tumors (two cases), and hepatic tumors (two cases). A positive diagnosis of tumor thrombus was achieved by both methods. The cranial extent of the tumor thrombus was better demonstrated by US studies, which showed echogenic endoluminal material within an enlarged IVC with a bulging anterior wall. On CT scans the tumor thrombus usually appeared as an endoluminal filling defect surrounded by a rim of contrast material. Tumor thrombus was better outlined by CT, particularly when it extended beyond the limits of the IVC wall, as in the retroperitoneal tumors. Neither method could accurately be used to predict IVC wall infiltration when the tumor thrombus remained within the confines of the IVC, nor could either method differentiate tumor from nontumor thrombi. US and CT are complementary in the preoperative assessment of tumor thrombus, and their use obviates the need for venacavography in many cases.

Adrenal Gland Neoplasms↗
PubMed1986

Identification and localization of ventricular septal defect by gated magnetic resonance imaging.

Gated magnetic resonance imaging was performed to identify the morphologic characteristics of the ventricular septum in 17 normal volunteers and to localize a ventricular septal defect (VSD) in 22 patients using the multisectional spin-echo technique (0.35 tesla). Location of VSDs was corroborated by 2-dimensional echocardiography or angiography or both. The 4 portions of the ventricular septum could be easily identified, especially on transverse images. The VSD was visualized in 20 of the 22 patients. The smallest VSD identified was 0.3 cm in diameter. The 2 VSDs not identified were a small membranous VSD under conditions of excessive patient motion, causing poor-quality images, and a VSD in a 3-month-old infant in which a 3-mm gap existed between sections. The exact location of the VSD could be identified in the other 20 patients. The VSD was perimembranous in 10 patients, inlet in 4, complete atrioventricular canal type in 3 and outlet in 6. The outlet consisted of 1 subpulmonic and 5 malalignment defects. Transverse images were most effective for identification of VSD. Thus, magnetic resonance imaging is a useful noninvasive technique for identifying the ventricular septum and assessing VSDs. It has the potential to be an alternative to angiography in patients beyond infancy for definitive diagnosis and localization of VSD before surgery.

Adolescent↗
PubMed1986

Congenital heart disease: gated MR imaging in 72 patients.

Seventy-two patients (aged 2 months to 75 years; mean 23 years) with a variety of congenital anomalies of the heart and great vessels underwent ECG-gated magnetic resonance (MR) imaging using the multisectional spin-echo technique (0.35 Tesla). The ability to define segmental anatomy and intracardiac anomalies on transverse, sagittal, and coronal images was evaluated. MR images were graded as excellent, diagnostic, or nondiagnostic, and MR findings were corroborated by angiography and/or two-dimensional echocardiography. Studies that were considered to be excellent or diagnostic were obtained in 96% of the cases. Visceroatrial situs, the type of ventricular loop, and the relationship of the great vessels could be identified in all patients with studies encompassing the entire heart. Forty-four of 47 abnormalities at the level of the great vessels were identified with MR, including coarctation of the aorta and vascular rings. MR showed 32 of 35 ventricular abnormalities; 2 small ventricular septal defects and 1 Ebstein anomaly were not demonstrated. All of the abnormalities at the atrial level and those of systemic and pulmonary venous return were seen on MR images. Complex cardiac anomalies, such as single ventricles, and the status of the pulmonary arteries were clearly demonstrated, and a good assessment of total and palliative postoperative anatomy was provided.

Adolescent↗
PubMed1986

Coarctation of the aorta: MR imaging.

Thirteen patients, aged 3-31 years, with coarctation of the thoracic aorta were examined by magnetic resonance (MR) imaging (total of 14 studies). Eight studies were performed preoperatively and six postoperatively. Catheterization data were available on 12 patients for verification of MR imaging findings. Electrocardiographically gated sagittal and left anterior oblique images best depicted the coarctations; however, involvement of arch vessels was best evaluated on transaxial images. MR imaging readily identified all coarctations but one, their site and extent, and involvement of the arch vessels. In addition, MR images depicted poststenotic dilatation and dilated collateral vessels. In patients studied postoperatively, restenosis could be evaluated, and complications such as postoperative aneurysm and perianastomotic hematoma were identified. MR imaging provides excellent anatomic detail of coarctation of the aorta, potentially obviating the need for angiography.

Adolescent↗
PubMed1986

Estimation of pulmonary vascular resistance by MRI in patients with congenital cardiovascular shunt lesions.

The intensity of the magnetic resonance signal in the pulmonary arteries was assessed in 15 patients with congenital left to right shunts and in 10 normal volunteers, using an ECG-gated multislice spin-echo technique. In normal subjects, magnetic resonance signal was only observed in great vessels of the thorax on images acquired near end-diastole; they disappeared in systole. Among the group of 15 patients, 10 had severe pulmonary hypertension (systolic pressures greater than 80 mm Hg) with severe elevation of pulmonary vascular resistances (greater than 787 dynes cm sec-1). The magnetic resonance signal persisted in systole in all 10 patients, and its intensity could be quantitatively assessed. On the other hand, in one other patient with high pulmonary artery pressure but only moderate elevation of pulmonary vascular resistance, and in patients with moderate pulmonary hypertension and normal pulmonary vascular resistance, the intravascular signal was minimal and no different from the signal recorded in normal subjects. A direct linear relationship was found between the pulmonary vascular resistance and the intensity of the magnetic resonance signal in the right pulmonary artery during systole (r = 0.84). An even closer correlation was found for the linear relationship between the ratio pulmonary vascular resistance/systemic resistance and the magnetic resonance signal in the right pulmonary artery (r = 0.93). Thus, magnetic resonance, with its sensitivity to slow-flow conditions, can potentially provide physiological information in congenital cardiovascular disease.

Adolescent↗
PubMed1986

[Value of the subxiphoid approach in 2-dimensional echocardiography for the diagnosis of ductus arteriosus in premature infants and infants].

The preliminary results of our experience with the "inverted" subxiphoid approach for 2D echocardiographic visualisation of patent ductus arteriosus (PDA) in premature neonates and infants are reported. Eight premature ventilated neonates weighting 870 to 1,200 g with an isolated PDA were examined by this technique using a mechanical sector scanner and a 7.5 MHz transducer; three views were obtained (left ventricular outflow tract or "long axis"; an oblique view through the two atria and aortic arch; short axis view of the ventricles). A PDA was directly visualised in 6 of the 8 patients. It was possible to measure its diameter and observe its tortuous or rectilinear trajectory; the outcome of Indomethacin therapy or surgical ligature could also be evaluated. In the 2 patients in whom the PDA was not visualised, there were no clinical symptoms or echocardiographic signs of shunt: these PDA were therefore probably extremely small. In the neonate and infant, it is relatively easy to demonstrate a PDA by this approach. The PDA can also be followed up in "ductus dependent" congenital heart disease during treatment with Prostaglandin E. In conclusion, the subxiphoid approach represents an interesting alternative for the visualisation of PDA, especially in premature neonates in whom the suprasternal and parasternal views are often difficult to obtain.

Ductus Arteriosus, Patent↗
PubMed1985

Hepatic alveolar echinococcosis: correlative US and CT study.

A total of 24 cases of hepatic alveolar echinococcosis (HAE) due to Echinococcus multilocularis was assessed by US and CT. The diagnosis was confirmed in all cases by immunologic and histologic study. Both US and CT patterns of HAE showed changes of liver morphology in both contour and size. Abnormal areas of parenchyma were nodular or in fields, irregular, heterogeneous, and basically echogenic. On CT these lesions were hypodense (30 to 40 HU) and did not show enhancement after administration of intravenous contrast medium. Clustered microcalcifications were encountered within the abnormal parenchymal fields in 50% of cases, and necrotized zones occurred in 40% of cases. Dilatation of intrahepatic bile ducts was commonly seen, especially on US; hilar involvement was frequent. Follow-up by both techniques can display increases of primary lesions, occurrence of new foci, and local or regional extensions. Precise evaluation of the lesions arising from correlative use of US and CT permits adequate therapeutic management.

Adult↗
PubMed1985

[Coronary anomalies associated with the Williams-Beuren syndrome. Apropos of 2 cases].

Two coronary artery anomalies associated with the Williams-Beuren syndrome are reported. The first case was a 14 year old child with severe supra-aortic stenosis associated with severe hypoplasia of the ascending aorta; 2 D echocardiography and angiography showed a voluminous aneurysm of the left main coronary artery. Aortoplasty with a patch gave a good early result. The second case was a two and a half months old baby operated as an emergency after cardiac arrest and who died at the end of surgery. The baby had severe supra-aortic stenosis, occlusion of the left coronary ostium by the left anterior cusp which was abnormally adherent to the aortic wall with subendocardial infarction and reaction fibroelastosis. The frequency of coronary anomalies associated with the Williams-Beuren syndrome is probably underestimated. Because of their severity they must be looked for routinely, by echocardiography and angiography. Their tendency to progress is an indication for early surgical correction of severe supra-aortic stenosis.

Adolescent↗
PubMedDate not supplied

Quantitative assessment of average velocity in inferior vena cava by phase-display MR imaging: pulsed Doppler correlation.

A technique for measuring average velocity in the inferior vena cava (IVC) by using phase-display magnetic resonance (MR) imaging is described. Fifteen healthy subjects were imaged, and the velocities and spectra obtained by MR were compared with pulsed Doppler results. Distortions of the "zebra-striped" images obtained along the axis of the vessel were measured at the same level of the IVC as in pulsed Doppler. Measurements of average velocities in the IVC made by the two methods were very similar, and velocity curves obtained during the cardiac cycle were superimposable. Phase-display MR imaging has the potential to noninvasively assess blood flow in large vessels as accurately as pulsed Doppler.

Adult↗