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D Musset

Publications and source records attributed to D Musset.

At least 19 recordsLinked to original sources
PubMed1992

[Bronchial cancer: how can the anatomic mediastinal extension of the tumor be estimated?].

Determining the precise extension of a bronchial carcinoma is essential to decide the treatment and appreciate the outcome. Computed tomography (CT) remains the reference method for the evaluation of mediastinal invasion by tumor. It seems reasonable to purpose CT for every operable tumor after radio bronchoscopic examination (except for peripheral T1 tumor without contact with the pleura). The place of MRI is not yet definitely established. But one can expect it to be better defined in the years to come because of technical improvement. However MRI could be performed in place of CT or complementary to CT in some cases: tumor of pulmonary apices, tumor in contact with diaphragm cardiac cavities or large mediastinal vessels, suspicion of vertebral invasion. MRI is also indicated first in cases of contra indication to iodine injection. There is no more indication to angiographic examinations for the staging of bronchogenic carcinoma. Other imaging methods have to be evaluated in this field: i.e. esophagoscopy, endovascular, ultrasound or angioscopy.

Carcinoma, Non-Small-Cell Lung↗
PubMed1990

[Sclerosing cholangitis revealing histiocytosis X].

The case of a 3 year-old boy who presented isolated cholestasis as the initial symptom of histiocytosis X is described. Other symptoms occurred later on. Despite treatment (corticosteroid and Vinblastin), the disease continued to progress and the child died at the age of 4 1/2 years with HIV infection (contaminated blood product) and tuberculosis.

Child, Preschool↗
PubMed1989

Intravenous digital subtraction angiography and lung imaging: compared value in the diagnosis of pulmonary embolism.

In a prospective study, 42 consecutive patients with clinically suspected pulmonary embolism underwent ventilation-perfusion (V-Q) lung imaging and digital subtraction angiography (DSA) concurrently with selective conventional pulmonary angiography (CPA). Thirty-eight studies achieved within 24 hours were reviewed independently by two pairs of observers. The findings were compared using CPA as the gold standard. V-Q lung imaging had a high percentage of indeterminate results, but none were false negative nor false positive. DSA had a lower percentage of indeterminate results but missed four of the 25 positive cases and erroneously affirmed the presence of pulmonary embolism in three cases. Therefore, the authors think that V-Q lung imaging should remain the screening examination of choice for evaluating patients with suspected pulmonary embolism.

Angiography↗
PubMed1989

Acute inferior vena cava thrombosis. Early results of heparin therapy.

STUDY OBJECTIVE: To determine, during heparin therapy, the embolic risk associated with acute inferior vena cava thrombosis compared with noncaval thrombosis. DESIGN: Prospective controlled study. SETTING: University-affiliated general hospital. PATIENTS: Of 68 consecutive patients considered, 18 with cavographically proved inferior vena cava thrombosis and 45 with phlebography-proved noncaval proximal thrombosis met all other eligibility criteria and completed the study. INTERVENTIONS: All patients received adjusted continuous IV heparin therapy for ten days. MEASUREMENTS AND RESULTS: All 63 patients underwent systematic baseline and "day 10" perfusion lung scanning and phlebocavography. None suffered pulmonary embolism within the ten days, but 11/63 patients showed thrombus extension on day 10 phlebocavograms. Retrospectively, no significant difference could be found between the groups with and without extension. CONCLUSIONS: (a) The early embolic risk associated with heparin-treated venous thromboses appears low and does not seem to depend on the location (caval or more peripheral) of venous clots. (b) Thrombus extension may occur in spite of apparently "adequate" anticoagulation with heparin.

Acute Disease↗
PubMed1989

Almitrine decreases the distensibility of the large pulmonary arteries in man.

Almitrine improves blood gas values in patients with COPD, primarily through better ventilation-perfusion matching. The improvement comes largely from a vasomotor effect of the drug. The vasomotor mechanism is unknown. We suspected that decreased distensibility of the large pulmonary arteries was one probable effect of the drug. If present, reduced distensibility would explain many of the hemodynamic alterations produced by almitrine. To test this idea, we measured the diameter of the right pulmonary artery during systole and diastole both before and after almitrine administration in nine patients who were undergoing pulmonary cineangiography. Our calculations of the distensibility of the right pulmonary artery showed that almitrine caused a 60 percent decrease. This significant alteration in the stiffness of the large pulmonary arteries can account for the rise in systolic pressure, a change that would be expected to redistribute pulmonary blood flow upwards and thereby improve ventilation-perfusion balance.

Adult↗
PubMed1989

[Diagnostic value of the combination of echography-plethysmography in deep venous thromboses of the legs].

The association of two non invasive methods: real time ultrasonography and plethysmography was studied prospectively for the diagnosis of deep vein thrombosis (DVT) in 70 patients. Their results were compared to contrast venography considered to the reference procedure. Venography showed DVT in 32 patients. Ultrasonography had a sensitivity of 69% and a specificity of 98%. The false negative results were related to iliac or calf vein thrombosis. Plethysmography had lower results than US (Se = 57%, Sp = 90%). In this study the sensivity of the two methods, either isolated or associated was not sufficient to allow their substitution to venography. Their association in all cases did not give better results than US alone. Because of its high specificity US can be performed first in cases of suspicion of DVT, especially in high risk patients. Plethysmography seems not to be necessary for the diagnosis.

Adolescent↗
PubMed1989

[Therapeutic approach to pulmonary embolism].

The purpose of this study is the retrospective evaluation of the treatment of 196 cases of pulmonary embolism. Therapeutic attitude was standardized. Intravenous heparin followed early on by oral anticoagulants remains the basic treatment of the majority of patients (74%). This treatment could be associated with: (1) Fibrinolysis with urokinase bolus at the time of massive pulmonary embolism with clinical and hemodynamic signs of shock (14%). No severe hemorrhagic complication was observed. 2) Inferior vena caval interruption in case of contraindications or failure of anticoagulation (29%). Only one death was observed in this study.

Anticoagulants↗
PubMed1988

Acute pulmonary embolism: diagnostic value of digital subtraction angiography.

Digital subtraction angiography (DSA) performed via a peripheral vein was compared prospectively with selective conventional pulmonary angiography (CPA) in 54 patients suspected of having pulmonary embolism (PE). All patients also underwent ascending venography. In contrast to the conventional pulmonary angiograms, all of which were considered satisfactory, 13 of 54 digital subtraction angiograms (24%) were technically unsatisfactory. The interpretable digital subtraction angiograms had 81% sensitivity and 64% specificity. With DSA, one cannot exclude the diagnosis of PE on the basis of normal angiograms (27% false-positive results) as one can with perfusion scanning. On the other hand, DSA showed good sensitivity (94%) in medium to major PE. Therefore it may be the technique of choice in the screening of life-threatening PE for which curative emergency treatment with thrombolytic agents or embolectomy is often necessary.

Acute Disease↗
PubMed1987

Recurrence of pulmonary embolism during anticoagulant treatment: a prospective study.

The risk of early recurrence of pulmonary embolism in patients with venous thromboembolic disease treated by anticoagulants is not well established. To determine the risk linked to contemporary proximal deep venous thrombosis, a prospective study was organised to give clinical and scintigraphic surveillance to 50 patients with angiographically proved pulmonary embolism plus phlebographically proved proximal deep vein thrombosis during the first 15 days of anticoagulant treatment. Perfusion lung scans were performed initially and on days 3, 7, and 15. Only two patients had a recurrence of pulmonary embolism during this period; both episodes were revealed by new symptoms, and one recurrence was fatal. The systematic performance of angiography in four patients found to have new scintigraphic defects led to the diagnosis of "spurious scintigraphic recurrence" in three of them. It is concluded that (a) adjusted anticoagulant treatment showed an effectiveness of 96% for preventing early recurrence of pulmonary embolism in this group of supposed high risk patients, and (b) in patients with recent pulmonary embolism new defects on systematic perfusion lung scans are not specific indicators of recurrent pulmonary embolism.

Adult↗
PubMed1987

[Transfontanelle echography: correlation with anatomopathological data. Apropos of 39 cases in newborn infants].

Thirty-nine neonates including 29 prematures had correlation studies of trans-fontanelle ultrasounds with post-mortem anatomic findings. Occipital hyper-echogenicity can be physiological when it is symmetric in the premature infant, and may indicate ischemia and/or anoxia when it is asymmetrical. No abnormal pathology went undetected by echo. Cortical gyri were never seen prior to 32 weeks gestational age.

Cerebral Hemorrhage↗
PubMed1986

Primary lung cancer staging: prospective comparative study of MR imaging with CT.

Forty-four patients with bronchogenic carcinoma were studied prospectively by both computed tomography (CT) and magnetic resonance (MR) imaging of the thorax during the week preceding thoracotomy. Transaxial MR imaging sequences included T1- and T2-weighted sequences. Coronal and sagittal T1-weighted sequences were added according to tumor location. CT and MR studies were reviewed separately, and the results were compared with surgical and pathologic findings on the basis of TNM classification. No statistically significant differences were found between the two imaging methods for the evaluation of tumor extent or node involvement. T2-weighted sequences did not yield further information on tumor extent or node involvement. Additional imaging planes (coronal or sagittal) appeared useful to study chest wall invasion. Analysis of concordances and discordances did not indicate whether one modality could be substituted for the other, or which diagnostic strategy might be more useful.

Adenocarcinoma↗
PubMed1986

Bronchiectasis: assessment by thin-section CT.

To assess the accuracy of computed tomography (CT) in the evaluation of bronchiectasis, we performed thin-section CT in 36 patients with clinical findings suggestive of this diagnosis. CT was performed with 1.5-mm section thickness and 10-mm intersection spacing. Bilateral (eight patients) and unilateral (28 patients) bronchograms were obtained. CT and bronchographic findings were correlated in 44 lungs. In 15 lungs no bronchiectasis was observed on CT scans and bronchograms. In 25 lungs both examinations accurately indicated the presence and extent of bronchiectasis. In two lungs the extent of disease was underestimated on CT, which failed to indicate bronchiectasis in one segment of the affected lobe. In one case CT findings suggested focal bronchial disease, but the lung was misinterpreted as not bronchiectatic; the bronchogram showed cylindric bronchiectasis. In one case CT disclosed cylindric bronchiectasis in a lobe that was bronchographically normal, but in this case the bronchogram was probably misinterpreted as false negative. In two cases lung findings were better visualized on CT scans than on bronchograms. It is concluded that thin-section CT is an accurate procedure in the recognition of bronchiectasis.

Adolescent↗
PubMed1986

[Magnetic resonance imaging in the study of pulmonary hilar involvement].

A retrospective analysis of results of magnetic resonance imaging (MRI) was conducted in 28 patients with uni- or bilateral pulmonary hilum lesions and findings compared with those of computed tomography (CT). All abnormal hilar masses examined were between 1 and 5 cm in diameter and were easily detected by transverse axial imaging. Contrast of their images was very high in relation to hilar bronchovascular elements in the two types of spin echo sequence with a short TR (0.5-0.7 s) and a long TR (1.5-2 s). Differentiation between tumoral or adenopathies and vessels was simpler than with CT with intravenous contrast. For screening of possible extension of hilar tumors. MRI appears to be superior to CT for providing data on vascular relations of lesions but inferior to CT for determining bronchial relations. Mediastinal extension of hilar tumors is easily defined by the short TR sequence but MRI supplies data of greater value than CT only in a low proportion of cases and then partly as a result of complementary coronal and sagittal imaging.

Adult↗
PubMed1986

[Resectable bronchial cancer. Contribution of computed x-ray tomography in the evaluation of loco-regional extension].

A prospective study of 107 patients was performed for assessing the CT contribution in preoperative staging of lung carcinoma. Thoracotomy was performed in all patients. The results demonstrated that CT is useful in all cases when surgery is indicated. Nevertheless CT gave not benefit in cases of peripheral small tumors T1N0 classified after standard chest radiograph and fibroscopy. The statistical analysis allowed to define the most accurate size criteria to declare mediastinal nodes as hypertrophied. Furthermore this study confirms that CT criteria of mediastinal and chest wall involvement have to be very strict.

Adult↗