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J Macho

Publications and source records attributed to J Macho.

9 recordsLinked to original sources
PubMed2002

[A study of 234 patients with subarachnoid hemorrhage of aneurysmic and cryptogenic origin].

INTRODUCTION: Subarachnoidal hemorrhage (SAH) is a medical emergency in all the patients. There are some known risk factors and, some complications associated to subarachnoid hemorrhage due to aneurysm rupture, being the rebleeding the main cause of mortality. POPULATION AND METHODS: We performed a retrospective study of 234 patients with non traumatic SAH treated in the Hospital Clínic i Provincial of Barcelona from January 1993 to December 1999. Diagnosis of SAH was done by CT, and ethiological diagnosis by brain angiography. We pay attention to previous pathological history, Hunt-Hess, WFNS and Fisher scales, and we divided our population in two groups depending on the treatment (surgery or embolization). We analyzed SAH complications and GOS at discharge and in a year. RESULTS: Population main age was 53.67 years-old (16-88 years-old). The relationship between male:female was 1:1.4. Almost out of 37% of the patients had previous history of high blood pressure, out of 25.9% were smokers. We saw a bleeding predominance within active hours (from 8:00 to 22:00), mostly during the morning (from 8:00 to 14:00). Between the complications associated to SAH, 45 patients (out of 19.2%) suffered clinical vasospasm, 24 patients (out of 10.25%) rebleeded, 61 patients (out of 26%) had some degree of hydrocephallus post-SAH, and 38 patients (out of 16.23%) had seizures. In 31 cases the bleeding pattern in CT scan was non-perimesencephalic (out of 62% of the 50 patients with negative angiography) and, in 19 cases (out of 38%) was perimesencephalic one. Patients with angiography had 150 aneurysms from anterior circulation and, 12 from posterior circulation. We performed surgery in ninety eight patients, and embolization in 38. We found among embolized patients a worse clinical status and massive hemorrhages than in surgery ones, and, those patients had higher mortality rates and severe sequelae. DISCUSSION: We noticed that sex, pathological history and bleeding timing rates similar than previously published, either than SAH complications. We deeply analyzed those patients with negative angiography and their bleeding pattern, finding that a perimesencephalic bleeding pattern could be caused by an aneurysm, as nowadays publications point out. Due to the above reason we tried to perform a second angiography to every patient with a negative first one. We want to highlight among treated patients, those embolized had a most severe clinical status and then their prognosis and mortality rate was higher. Finally, surgical group, had a high rate of ischemic complications, and most part of this patients group didn't get a control angiography, thus lead us to change our policy, seeing the final results. CONCLUSIONS: This study has been specially self-helpful in order to analyze our medical policy in front of this entity, and in this way, to elaborate a protocol of treatment taking account nowadays tendencies and our experience.

Adolescent↗
PubMed2001

Percutaneous repair of an iatrogenic laceration of the left bile duct with a covered stent.

The presence of biliary leaks after liver resections is not an unusual problem, especially after extended hepatectomies. The usual treatment of choice for biliary duct injuries is to decompress the biliary system with draining catheters. Persistent biliary fistulas are nevertheless a challenging problem when endoscopic or percutaneous approaches fail to achieve occlusion of the bile leakage. The authors report a bile duct injury after a right lobe hepatectomy treated percutaneously with placement of a covered stent. After 6 months, the patient was tube-free and without any episode of cholangitis or bile duct dilation. Longer follow-up will clarify the future role of this kind of device in biliary system lacerations.

Bile Ducts↗
PubMed2001

Acute spontaneous hemorrhage after embolization of brain arteriovenous malformation with N-butyl cyanoacrylate.

PURPOSE: To investigate factors predisposing to spontaneous hemorrhage in the early period after embolization of brain arteriovenous malformations (AVMs). METHODS: The authors report 15 cases of spontaneous hemorrhage in a consecutive series of 492 brain AVMs totally or partially treated with intranidal injections of a polymerizing mixture, from 1984 to June 1998. Retrospective analysis of the records was performed with special attention to the angio-architectural features before embolization, details of embolization procedures and induced angiographic modifications. RESULTS: Pre-embolization features of greater incidence were the presence of steal phenomena (87%), multiple feeding arteries (100%), a compact aspect of the nidus (93%), and lobar topography (87%). In most cases the volume of injected glue exceeded 1 ml (80%), venous embolization was significant (67%) and immediate angiographic control showed venous stagnation in and/or around the nidus (80%). Four patients were asymptomatic (incidental discovery on systematic CT at day 3). Among the remaining 11 symptomatic patients, 6 were operated to evacuate an intracerebral hematoma, outcome was good for 4, 5 were left with sequelae and 2 died. CONCLUSION: Spontaneous hemorrhagic complications affected 3.04% of embolized patients. The combination of certain angio-architectural features, significant venous embolization and persistent venous stagnation within the nidus seem to have some predictive value of high risk hemorrhage. In light of this, additional preventive measures must be taken and a neurosurgical team systematically kept on standby.

Acute Disease↗
PubMed2000

Selective use of tube cholecystostomy with interval laparoscopic cholecystectomy in acute cholecystitis.

HYPOTHESIS: Tube cholecystostomy followed by interval laparoscopic cholecystectomy is a sale and efficacious treatment option in critically ill patients with acute cholecystitis. DESIGN: Retrospective cohort study within a 4 1/2%-year period. SETTING: University hospital. PATIENTS: Of 324 patients who underwent laparoscopic cholecystectomy, 65 (20%) had acute cholecystitis; 15 of these 65 patients (mean age, 75 years) underwent tube cholecystostomy. INTERVENTION: Thirteen patients at high risk for general anesthesia because of underlying medical conditions underwent percutaneous tube cholecystostomy with local anesthesia. Laparoscopic tube cholecystostomy was performed on 2 patients during attempted laparoscopic cholecystectomy because of severe inflammation. Interval laparoscopic cholecystectomy was attempted after an average of 12 weeks. MAIN OUTCOME MEASURES: Technical details and clinical outcome. RESULTS: Prompt clinical response was observed in 13 (87%) of the patients after tube cholecystostomy. Twelve patients (80%) underwent interval cholecystectomy. Laparoscopic cholecystectomy was attempted in 11 patients and was successful in 10 (91%), with 1 conversion to open cholecystectomy. One patient had interval open cholecystectomy during definitive operation for esophageal cancer and another had emergency open cholecystectomy due to tube dislodgment. Two patients (13%) had complications related to tube cholecystostomy and 2 patients died from sepsis before interval operation. One patient died from sepsis after combined esophagectomy and cholecystectomy. Postoperative minor complications developed in 2 patients. At a mean follow-up of 16.7 months (range, 0.5-53 months), all patients were free of biliary symptoms. CONCLUSIONS: Tube cholecystostomy allowed for resolution of sepsis and delay of definitive surgery in selected patients. Interval laparoscopic cholecystectomy was safely performed once sepsis and acute infection had resolved in this patient group at high risk for general anesthesia and conversion to open cholecystectomy. Just as catheter drainage of acute infection with interval appendectomy is accepted in patients with periappendiceal abscess, tube cholecystostomy with interval laparoscopic cholecystectomy should have a role in the management of selected patients with acute cholecystitis.

Acute Disease↗
PubMed1999

Comparison of laparoscopic ultrasonography and fluorocholangiography in 300 patients undergoing laparoscopic cholecystectomy.

BACKGROUND: This study compares laparoscopic ultrasonography to fluorocholangiography in detecting common bile duct (CBD) stones and delineating biliary anatomy. METHODS: A prospective nonrandomized study of 300 consecutive patients undergoing laparoscopic cholecystectomy in a university hospital was performed. After port placement but before dissection, laparoscopic ultrasonography of the extrahepatic CBD was performed in both transverse and longitudinal planes. Cystic duct fluorocholangiography was attempted in all patients. RESULTS: Of 300 patients, CBD stones were detected in 26 (9%) with 25 of these (96%) detected on laparoscopic ultrasonography. Sonography identified the location and size of the CBD as well as anomalous anatomy prior to dissection. No CBD injuries were encountered. End-fire transducers were easier to use than rigid or flexible side-fire transducers; all gave excellent image quality. CONCLUSIONS: In this large study, laparoscopic ultrasonography and fluorocholangiography were equally sensitive in detecting CBD stones. Sonography delineates the biliary anatomy noninvasively and does not require dissection or opening of the biliary system. Laparoscopic ultrasonography may improve the safety of laparoscopic cholecystectomy, especially in cases of acute inflammation or distorted anatomy.

Cholangiography↗
PubMed1998

3D angiography. Clinical interest. First applications in interventional neuroradiology.

3D angiography is a true technical revolution that allows improvement in the quality and safety of diagnostic and endovascular treatment procedures. 3D angiography images are obtained by reconstruction of a rotational angiography acquisition done on a C-arm (GE Medical Systems) spinning at 40 degrees per second. The carotid or vertebral selective injection of a total of 15 ml of non-ionic contrast media at 3 ml/sec over 5 seconds allows the selection of the "arterial phase". Four hundred sixty 3D angiographic studies were performed from December 1996 to September 1998 on 260 patients and have been analyzed in MIP (Maximum Intensity Projection) and SSD (Shaded Surface Display) views. The exploration of intracranial aneurysms is simplified and only requires, for each vascular axis, a biplane PA and Lateral run followed by a single rotational angiography run. The 3D angiography image is available on the workstation's screen (Advantage Workstation 3.1, GE Medical Systems) in less than 10 minutes after the acquisition of the rotational run. It therefore allows one to analyze, during the intervention, the aneurysm's angioarchitecture, in particular the neck, and select the best therapeutic technique. When endovascular treatment is the best indication, 3D angiography allows one to define the optimal angle of view and accurately select the microcoils dimensions. 3D angiography replaces the multiple oblique views that used to be required to analyze the complex aneurysms and therefore allows a reduction of the total contrast medium quantity, the patient X-ray dose and the length of the intervention time which is a safety factor. Also, in particular for complex cases, it brings additional elements complementing the results of standard 2D DSA and rotational angiograms. In the cervical vascular pathology, 3D angiography allows for a better assessment of the stenosis level and of dissection lesions. Our current research activities focus on the matching without stereotactic frame between 3D X-ray angiography and volumetric MR acquisition, which should allow us to improve the treatment of intracerebral arterio-venous malformations (AVMs).

Aortic Dissection↗
PubMedDate not supplied

[Epilepsy with normal CT: the MR contribution].

We present a study of 165 patients with fits with normal brain computerized tomography (CT) scan or else who showed no evidence as to the etiology of such attacks. We analyzed the magnetic resonance (MR) results obtained. In 36.6% of cases MR was pathological, the most frequent finding in our series being cerebral atrophy (12.8%). We comment on the most important pathology groups, highlighting the contribution MR made in our patients.

Adolescent↗