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Biomedical subjects

J M Garcier

Publications and source records attributed to J M Garcier.

At least 19 recordsLinked to original sources
PubMed2006

[Long-term MRI follow-up of aortic dissection in 56 patients: therapeutic impact].

PURPOSE: To retrospectively assess the value of MRI in long-term follow-up of aortic dissection (AD) and its impact on therapy. MATERIALS AND METHODS: Comparison of clinical progression and analysis of 215 MRI examinations performed on 56 patients in our center from 1991 to 2002. RESULTS: Twenty-six patients (46%) had AD complications: 14 (54%) were asymptomatic and eight (31%) had subsequent surgical repair (native aorta upstream prosthesis disease in three patients and aneurismal dilatation of false lumen in five cases). Of the eight patients with secondary surgery, five (63%) were clinically asymptomatic. The delay between initial dissection and secondary surgery was less than 5 years in five patients and exceeded 10 years in three cases. The remaining 30 patients (54%) had unmodified radiological findings after a mean follow-up of 3.5 years (6 months to 9 years). CONCLUSION: MRI depicted AD complications in long-term follow-up of sometimes asymptomatic patients, allowing for adaptation of surgical treatment in 26 cases (46%).

Adult↗
PubMed2006

Portal vein stenosis and occlusion stenting after liver transplantation in two adults.

We report two cases of percutaneous transhepatic stenting of the portal vein to treat stenosis and occlusion disclosed 5 and 18 months, respectively, after orthotopic liver transplantation in two adult patients. If long-term patency is satisfactory, this technique should allow long-term management of portal vein stenosis and occlusion without the use of thrombolysis.

Constriction, Pathologic↗
PubMed2005

[Helical CT of abdominal aorta].

The purpose was to illustrate that single or multirow spiral CT angiography has become the main modality for the examination of the abdominal aorta. Our multidisciplinary group investigates weekly 15 abdominal aortas, with a single slice spiral CT since 1995, and a 4 row detector spiral CT since 1999. CT scans protocols and parameters optimization for the 2 CT systems are described. Indications and results of CT to investigate the various abdominal aortic diseases are illustrated and discussed: aneurisms (pretherapeutic staging, selection of indications of endovascular stent-grafting); obstructive aorto-arteriopathies (pretherapeutic staging, follow up after endovascular revascularization); dissection (diagnosis, pretherapeutic staging, follow up); inflammatory diseases; normal patterns and principal complications after surgery. Situations where multislice CT is superior to single slice CT and compared advantages of MRI are discussed. CT is at the present time the main technique to image abdominal aorta. Multislice CT is especially interesting to explore the whole aorta, poly traumatisms, and to plan and follow up endovascular treatments.

Aortic Dissection↗
PubMed2005

[Femoral superficial artery angioplasty: long term results, initial predictive factors. 101 patients].

OBJECTIVE: To evaluate immediate results, clinical improvement, long-term patency and predictive factors of long-term outcome after superficial femoral artery percutaneous angioplasty. PATIENTS AND METHODS: Restrospective monocentric study of 101 patients (142 lesions: 105 stenoses and 37 occlusions) technical results, long-term patency (19 months), and clinical improvement (27,5 months) were analyzed. A multifactorial analysis was performed. RESULTS: Technical success was obtained in 99%, complications and mortality rates were respectively 3% and 2%. At the end of follow-up, 55 patients were clinically improved (20 lost to follow-up), and femoral artery remained patent in 62 patients (10 to follow-up). Statistical analyses revealed 8 significant predictive factors of a good outcome (P<0.05): female gender, non-diabetic, at least one patent artery below the knee, AHA classification <2, no stent, treatment of an occlusion, number of dilatations<3, treatment by statins for hypercholesterolemia. CONCLUSION: Femoral superficial artery angioplasty is usually achieved with low complication rate. We found eight factors predictive of long-term outcome, to keep in mind when indications are discussed.

Aged↗
PubMed2004

Evolution of healthy thoracic aortic segment diameter during follow-up of patients with aortic aneurysm or dissection: a magnetic resonance imaging study.

We studied the normal evolution over time of the diameter of the healthy descending aorta in patients suffering from aneurysm or dissection of the ascending aorta, in order to anticipate potential complications of endoprosthetic treatment in this aortic segment. During their follow-up (average 35.9 months), 52 patients suffering from aneurysm or dissection of the ascending aorta had 168 aortic MRI examinations (2-7; average 3). Measurements were taken according to conventional reference landmarks making it possible to study the evolution of the diameter of the supposed healthy descending thoracic aorta. The variations in diameter with time were on average 5 mm, and there was no significant variation in this diameter, either for early controls or for the controls carried out after more than 1 year or 3 years, whatever the age group. Thus according to our series it seems that patients with a descending aorta endoprosthesis are not exposed to graft endoleak due to inadequate contact of the prosthesis and aorta within the 5 years following its implantation.

Adolescent↗
PubMed2004

Hypogastric arterial selective and superselective embolization for severe postpartum hemorrhage: a retrospective review of 36 cases.

We report on embolization in 36 cases of postpartum hemorrhage (PPH). The 36 patients with severe PPH, including one patient who had undergone an emergency hysterectomy, were transferred to the regional interventional vascular radiology unit in a mean time of 6 hours 12 min. Bilateral occlusion of the anterior trunk of the hypogastric arteries was carried out using gelatin sponge. Immediate success was achieved in all cases. In 3 cases, however, a second embolization was necessary before day 2. In 17%, complementary nonvascular surgery was performed. Complications included one puncture site false aneurysm treated by compression, two cases of regressive lower limb paraesthesia, one femoral vein thrombosis, and nonsignificant puncture site hematomas (19.5%). Long-term follow-up was conducted in 23 patients: 91% resumed regular menstrual cycles, 8.7% dysmenorrhea. New pregnancy occurred in 13% (two full-term pregnancies and one voluntary termination). Immediate efficacy, low morbidity and preservation of fertility make embolization the technique of choice for severe PPH.

Adult↗
PubMed2004

[MRI and arrhythmogenic right ventricular dysplasia (ARVD). Retrospective evaluation of 50 patients].

PURPOSE: To retrospectively evaluate the contribution of MRI to the diagnosis of arrhythmogenic right ventricular dysplasia (ARVD). PATIENTS AND METHODS: Thirty two men and 18 women (mean age: 48.7 years) were imaged using gated spin echo scans and short axis cine MR. References were McKenna criteria (gold standard), and also what we called "strong presumption" which may correspond to early or localized patterns, but correspond to negative McKenna scores. RESULTS: One patient was claustrophobic; another one was lost to follow-up. In reference to McKenna score, diagnosis of ARVD was established in 12 patients (2 of whom had familial dilated biventricular cardiomyopathy with rhythmic expression). Sensitivity, specificity, positive predictive value, negative predictive value and prevalence were respectively: 75%, 75%, 50%, 90% and 25%. Using "strong presumption" criteria, we observed 14 true positives (with sensitivity of 82%, specificity of 87%, PPV of 78%, NPV of 90% and prevalence of 35%). CONCLUSION: In our group, MRI was always performed before angiography. In our series, right ventricular wall T1W hyperintensity was the most frequent finding.

Arrhythmogenic Right Ventricular Dysplasia↗
PubMed2004

[Imaging of abdominal aortic aneurysms: when, how and why?].

Usually atherosclerotic in origin, aneurysms of the abdominal aorta (AAA) tend to involve the infrarenal aorta. Their biphasic exponential growth pattern, initially slow then accelerated, results in a risk of rupture. Surgical management is recommended for aneurysm diameters of 45-50mm or for growth rates more than 5mm in 6 Months. Imaging is useful for detection and follow-up of nonsurgical aneurysms, presurgical evaluation of aneurysms, and postsurgical follow-up. Frequently asymptomatic, AAA frequently is an incidental finding at the time of abdominal US. The size of the aneurysm sac, the presence of a neck and the size of the iliac arteries are assessed at the time of initial US detection. US is sufficient for follow-up of small aneurysms. Cross sectional imaging evaluation is necessary when surgery is contemplated. Readily available, multidetector row CT scanners with advanced image post-processing capabilities provide all the necessary information prior to surgical or endovascular management: evaluation of the aneurysm sac and neck, iliac and visceral arteries, and adjacent organs. Angiography with graduated catheters remains sometimes indicated. MR angiography provides results similar to CT but is less readily available and is usually reserved for patients with contraindication to iodinated contrast material. While follow-up imaging after surgical management is seldom performed, it is mandatory after endovascular management and includes KUB, Doppler US and CT or MR angiography.

Anatomy, Cross-Sectional↗
PubMed2004

[Percutaneous treatment of obstructive lesions of the aortic bifurcation: results at 50 months from 28 patients].

OBJECTIVE: We conducted a retrospective analysis of short- and mid-term results of endoluminal treatment of obstruction lesions involving the terminal aorta and the initial portions of the iliac arteries in 28 patients. PATIENTS AND METHODS: Twenty-eight patients (9 women, 19 men, mean age 57.5 Years) presented 52 obstructive atheromatous lesions of the aorto-iliac bifurcation. The lesions were divided into three topographic groups (9 unilateral lesions, 19 bilateral ostial lesions, 5 widespread lesions of the terminal aorta) and identified as simple (44%) or complex (56%, more than 2 cm in length and/or calcified and/or eccentric). RESULTS: Technical success was achieved in 93% of the cases with only one hematoma of the puncture site. Primary and secondary patencies were 78.9% and 93% after a mean follow-up of 50 Months (range 4-85). Clinical outcome remained good at this term for all cases of technical success but complete resolution of the symptoms was more frequent when a stent was used (84%) than for simple balloon dilatation (49%). CONCLUSION: Percutaneous treatment of obstructive lesions of the aorto-iliac bifurcation may be proposed when possible as a first-line treatment.

Angioplasty, Balloon↗
PubMed2003

[Alveolar echinococcosis of the liver. Mass ultrasound screening in the Haut Cantal area].

OBJECTIVE: Mass systematic screening for alveolar echinococcosis (AE) of the liver in the Haut Cantal endemic area. MATERIAL AND METHODS: Targeted population was composed of the members of the Mutualité Sociale Agricole of the area, from 16 to 65 years old. 2077 notifications were sent, corresponding to 20% of the population of this area, defined by a triangle between Egliseneuve d'Entraigues, Riom ès Montagne and Saint Flour. Two screening tests were performed: Elisa serology test and liver ultrasound examination. RESULTS: Participation levels were relatively low-ultrasound: 18.92%, serology: 17%. Among 350 liver examinations, 2 suspicions of AE were found: CT and serology confirmed the diagnosis in the first symptomatic patient; CT and biopsy confirmed the diagnosis in the other asymptomatic patient in whom serology was normal. CONCLUSION: Ultrasound screening showed at least a 0.57% prevalence of AE, i.e., 2 cases out of 350. This low rate however confirms that Haut Cantal is an endemic area, but with a lower incidence rate than in other endemic areas.

Adolescent↗
PubMed2003

[Thrombosis of the superficial dorsal vein of the penis (penile Mondor's phlebitis). The interest of Doppler examination].

INTRODUCTION: Thrombosis of the superficial dorsal vein of the penis (TSDVP) is a frequent and benign pathology that is often underestimated. OBSERVATION: A patient consulted for acute erectile dysfunction and pain in the base of the penis due to a TSDVP, which was treated with non-steroidal anti-inflammatory agents and anticoagulants and was followed-up by Doppler ultrasound examination of the penis. CONCLUSION: Essentially clinical, the diagnosis of TSDVP can benefit from Doppler ultrasound of the penis in difficult cases, because it is a useful tool for correct diagnosis and therapeutic management of the pathology.

Acute Disease↗
PubMed2003

[Cost efficiency study of lacrimal canal obstruction treatment].

OBJECTIVE: To compare three methods used to clear the lacrimal canal. PATIENTS AND METHODS: A total of 32 files (20 for the dacryocysto-rhinostomy by endoscopic way, 5 for the dacryocysto-rhinostomy by external way and 7 cases of percutaneous stenting) were reviewed. For each, costs of performed interventions were reviewed. An average of the total cost per patient was calculated for all three methods and was then correlated to the initial efficiency of the method. RESULTS: Results show that the average cost for stenting is up to 1,366.80 EUR, for the endoscopic way is up to 2 001.53 EUR and for the external way is up to 2,220.46 EUR. ANOVA (Analysis of Variance) gives significant results when comparing stent to endoscopic way (p=0.000007) and to the external way (p =0.02). The analysis of sensitivity concerning the success rate of various treatments shows that the stent was potentially the most cost-effective and that a failure rate of 35.1% is rather acceptable by comparison to the endoscopic method. If the stent is considered as an outpatient intervention, then, a failure rate of 50% is acceptable. CONCLUSION: If the failure rate stays under 35.1%, the stent may be considered as a short-term cost-effective method.

Aged↗
PubMed2003

[Idiopathic epiphoras in adults treated with lacrymal-nasal stents].

Fluoroscopic nonsurgical placement of an expandable polyurethane stent is less invasive than surgery for the treatment of epiphora due to obstruction of the nasolacrimal duct. It needs to be performed with the collaboration of an ophthalmologist, using a high resolution digital subtraction imaging unit.

Adult↗
PubMed2003

[Graves'ophthalmopathy: usefulness of T2 weighted muscle signal intensity].

OBJECTIVE: Immunosuppressive treatments may be usefull when Graves' ophthalmopathy is active. We evaluated the interest of hypertrophied muscle T2 weighted signal intensity as an argument of disease activity, to help for the therapeutic decision. PATIENTS AND METHODS: 46 MRI in 37 patients with Graves' ophthalmopathy were retrospectively studied. RESULTS: During the active phase of the disease, centro-muscular hypersignal was always observed (6 cases); signal intensity was not so bright or even disappeared with immunosuppressive treatment (7 cases). We never observed hypersignal when the disease was inactive (4 cases). When there was no hypersignal on T2 weighted images, the disease was inactive in 70% cases, and of low activity in the other cases. CONCLUSION: T2 weighted centro-muscular signal intensity analyse helps for the therapeutic decision in Graves' ophthalmopathy.

Graves Disease↗