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Biomedical subjects

J Muchart

Publications and source records attributed to J Muchart.

13 recordsLinked to original sources
PubMed2004

Screening for occult cancer in patients with acute deep vein thrombosis or pulmonary embolism.

Patients with acute venous thromboembolism have an increased risk for occult malignancy. Limited screening for these malignancies has become common practice but little is known about its usefulness. This is a prospective cohort follow-up study in consecutive patients with acute venous thromboembolism. All patients underwent a routine clinical evaluation for malignancy, if negative, followed by a limited diagnostic work-up consisting of abdominal and pelvic ultrasound and laboratory markers for malignancy. Clinical follow-up was conducted to detect screening failures. The routine clinical evaluation was performed in 864 patients and revealed malignancy in 34 (3.9%) of them. Among the remaining 830 patients the limited diagnostic work-up revealed 13 further malignancies. During follow-up, cancer became symptomatic in 14 patients who were negative for cancer at screening (sensitivity of limited diagnostic work-up, 48.1%). Malignancies that were identified by the limited diagnostic work-up were early stage in 61% of cases vs. 14% in cases occurring during follow-up. Most patients with occult cancer had idiopathic venous thromboembolism and were older than 70 years. A limited diagnostic work-up for occult cancer in patients with venous thromboembolism has the capacity to identify approximately one-half of the malignancies. Identified malignancies were predominantly in an early stage.

Acute Disease↗
PubMed2004

[Endovascular resolution of iliac artery pseudoaneurysm in a transplanted patient].

A 58-year-old patient with end-stage idiopatic renal disease underwent kidney transplantation from a cadaveric donor. Approximately one year after the transplant he complained of abdominal pain and presented a pulsating mass in his right pelvic region. Dupplex study and arteriography were performed and showed a large pseudoaneurysm arising from the right common iliac artery. We report the case in which a covered stent placement and an embolization of the right internal iliac artery solved the problem with successful clinical and radiological results.

Aneurysm, False↗
PubMed2001

Prospective study on the usefulness of lung scan in patients with deep vein thrombosis of the lower limbs.

BACKGROUND: Asymptomatic pulmonary embolism (PE) is a common finding in patients with deep venous thrombosis (DVT) of the lower limbs, but the usefulness of seeking for silent PE in patients with acute DVT has not been evaluated. PATIENTS AND METHODS: This was a prospective study involving consecutive patients with acute symptomatic proximal DVT (confirmed by objective methods) and no clinical suspicion of PE. All patients underwent chest X-ray, ventilation-perfusion lung scan and arterial blood gases on admission, and received anticoagulant therapy. Those with scintigraphic evidence of PE underwent repeated lung scan and blood gases 7 days later. The aim of the study was to assess how many patients with silent PE develop symptoms while on heparin therapy, and in how many of them such symptoms are due to recurrent PE. RESULTS: 946 consecutive patients with acute, proximal DVT had no contraindications to full-dose anticoagulant therapy. Baseline lung scan revealed high-probability defects (silent PE) in 200 (21%). Seven of these 200 patients had symptomatic recurrences during the 7-day study period, and an inferior vena cava filter was inserted. Besides, 6 patients developed PE symptoms, but no new perfusion defects were found on repeated scan. They switched to coumarin therapy, and they did not develop any further complications. CONCLUSIONS: Lung scan in patients with symptomatic DVT and no clinical suspicion of PE may be useful, since some patients with silent PE may develop symptoms while on heparin therapy. Without a baseline scintigraphy all these patients would have been considered to have recurrent PE, and vena cava interruption could have been performed.

Adult↗
PubMed2000

Systemic to pulmonary fistulas in Hodgkin's disease.

Systemic to pulmonary fistula is an unusual entity and its association with hematological diseases like Hodgkin's is extremely rare. We present a case of a 26-year-old woman with a thoracic mass and large arteriovenous fistula. The diagnosis of Hodgkin's disease, nodular sclerosis, was obtained by a biopsy of the supraclavicular lymph node. We achieved an excellent response after combined treatment with chemotherapy, radiotherapy and arterial embolization with complete disappearance of the mass.

Adult↗
PubMed1996

Occlusion of the superior mesenteric artery in a patient with polycythemia vera: resolution with percutaneous transluminal angioplasty.

The case is reported of a 46-year-old male patient with polycythemia vera (PV) treated with phlebotomy who developed an occlusive thrombosis of the superior mesenteric artery 2 years after the diagnosis. He was successfully managed with percutaneous transluminal angioplasty. The patient did not develop any other thrombotic phenomena. To our knowledge, there are no previous reports on the use of percutaneous transluminal angioplasty in the management of arterial thrombotic complications in PV patients.

Angioplasty, Balloon↗
PubMedDate not supplied

Balloon catheter sphincteroplasty and biliary stone expulsion into the duodenum in patients with an indwelling T tube.

BACKGROUND: To present an alternate approach for treating residual biliary stones in patients with indwelling T tube that uses the immature tract created by the T tube to carry out both sphincteroplasty and expulsion of the calculi with the same angioplasty balloon catheter. METHODS: This technique was performed in five patients. Access to the bile duct was through an 8-Fr T tube. First a guidewire was inserted and advanced beyond the obstructing stone to the duodenal lumen. The T tube was removed over the guidewire, and a balloon catheter was introduced. Sphincteroplasty was carried out. Then the balloon was deflated and retracted to a position proximal to the stone. It was then reinflated and used to push the stone, expelling it into the duodenum. RESULTS: In all cases, all biliary stones were expelled without pain, in a single session, and with no immediate complications. All patients showed rapid clinical and analytic improvement. During clinical and echographic follow-up of 2-22 months (mean = 12.4 months), there were no complications or relapses. CONCLUSIONS: Our limited experience indicates that sphincteroplasty and expulsion of biliary stones with angioplasty balloon catheters through the T tube immature tract is a simple, safe, low-cost technique that gives good results.

Aged↗
PubMedDate not supplied

Secondary prevention of venous thromboembolism: A role for low-molecular-weight heparin.

BACKGROUND: After a short initial course of heparin therapy, patients with venous thrombo-embolism (VTE) require continuing anticoagulant therapy for several months after hospital discharge. At present, two small-scale studies have compared the efficacy and safety of low-molecular-weight heparin (LMWH) with warfarin in the secondary prevention of VTE. PATIENTS AND METHODS: We studied 654 consecutive patients, 202 with pulmonary embolism (PE) and 452 patients with deep vein thrombosis (DVT) of the lower limbs. 220/654 patients (34%) were considered to have some contraindications to coumarin, and were discharged on LMWH (dalteparin, Fragmin((R)), 10, 000 IU s.c. once daily). The remaining 434/654 patients were asked to choose between either coumarin or LMWH: 190 patients preferred LMWH and 244 coumarin. Patients were followed up for a 3-month (DVT patients) or 6-month (PE patients) period. RESULTS: 14/654 patients (2%) developed recurrent VTE while on anticoagulant therapy. One in every three recurrent episodes was PE (which was fatal in 2/5 patients), and half of the recurrent DVT were located in the contralateral leg. We failed to find any differences between patients receiving LMWH and those on coumarin therapy, but recurrences were more common in patients with cancer (hazard ratio: 17.15; 95% CI: 4.0-73.5; p < 0.001). 21 patients (3.3%) bled (major bleeding 5 patients; minor bleeding 16). Bleeding was more common in patients on coumarin therapy (hazard ratio: 3.14; 95% CI: 1.20-8.22; p = 0.02). CONCLUSIONS: Long-term LMWH therapy proved to be both effective and safe in the long-term treatment of VTE. Thus, we suggest long-term LMWH therapy should be considered for patients with contraindications to coumarin, or those with difficulties in coming to laboratory control.

Aged↗
PubMedDate not supplied

[Angioplasty for intracranial internal carotid artery stenosis].

INTRODUCTION: Percutaneous transluminal angioplastia has in recent years become an alternative to surgery and increasingly used for revascularization of the extracranial arteries in patients with cerebral ischemia. However, intracranial angioplasty is a technique which is still not widely used since it is technically more difficult and until now endoprotheses (stents) have not been available specifically designed for intracranial territory. CLINICAL CASE: A 73 year old patient with extensive extracranial and intracranial atheromatous lesions, multiple vascular risk factors and cardiac ischemia which contraindicated surgical treatment which was treated consecutively by angioplasty and angioplasty with implantation of stents in both carotid bifurcations. Subsequently, he was treated by angioplasty for a stenosing lesion of 90% of the right carotid siphon with clinical and hemodynamic repercussions. Following the procedure, which was well-tolerated by the patient, there was clinical and angiographic improvement and return to normal of the hemodynamic parameters measured by transcranial Doppler. CONCLUSIONS: Angioplasty is a technique which may be used in intracranial stenosing atheromatous lesions. Even without perfect angiographic correction, adequate blood flow is established in the hemodynamically affected lesions. As far as we know this is the first case of intracranial angioplasty of a lesion of the carotid siphon reported in Spain.

Aged↗
PubMedDate not supplied

[Ischemic brain lesions following carotid revascularisation procedures: a comparative study using diffusion-weighted magnetic resonance imaging].

INTRODUCTION: The risk of cerebral embolism following angioplasty-stent placement (AGP) is higher than that observed after a carotid endarterectomy (CE) using transcranial Doppler ultrasonography. Nevertheless, no studies have been conducted to compare the two revascularisation procedures with the latest neuroimaging techniques. AIMS: To analyse the presence and repercussion of acute cerebral ischemia detected by diffusion-weighted magnetic resonance imaging (DMR) following carotid revascularisation procedures. PATIENTS AND METHODS: Our prospective study included a sample of 20 consecutive patients with atherosclerotic stroke and symptomatic carotid stenosis > 70% according to NASCET criteria and treated by CE (n = 10) or AGP (n = 10). Patients were submitted to a DMR during the 48 hours prior to revascularisation and another within the 72 hours following the intervention in order to evaluate the existence of new acute cerebral ischemic lesions. Patients were explored by a neurologist before and after the intervention. RESULTS: DMR allowed new areas of cerebral ischemia to be detected in 10% of the CE and in 40% of the AGP patients. 50% of the post-AGP ischemic lesions were multiple and 10% of the lesions in each therapeutic group presented some clinical correlation in the form of transient neurological focal signs. No significant differences were observed with respect to the pattern of risk of complications between the two therapeutic groups and no factors associated to a higher risk of new ischemic lesions were detected by DMR in patients submitted to AGP. CONCLUSIONS: Carotid AGP is linked to a higher frequency of new ischemic lesions in the brain than in the case of CE. Nevertheless, these ischemic lesions detected by DMR are usually silent. Symptomatic complications were similar in the two procedures.

Aged↗