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Biomedical subjects

J Théron

Publications and source records attributed to J Théron.

At least 19 recordsLinked to original sources

[Impotence of vascular origin. Techniques of exploration and therapeutic orientations].

Vascular problems of arterial and/or venous origin are often found as the cause of erectile dysfunction. Clinical examination alone is insufficient and must followed up by a number of non or minimally invasive tests in order to confirm the etiology. Such testing should include: Doppler measurements or, better, duplex sonography, nocturnal penile plethysmography, psychological status, clinical biochemistry and intracavernous injection of vasoactive drugs. Occasionally, it may be necessary to complete these tests by more invasive examinations: pharmacoarteriography and/or pharmacocavernosography. Several novel therapeutic approaches have been developed in recent years and have given rise to encouraging improvements.

Adult

Dynamic digitized cerebral parenchymography.

Aortic arch injections centred on the head have been performed routinely in patients with cerebral ischaemia. Digital angiograms with modified windowing (low and narrow) have been used. This "cerebral" arch injection allows much improved analysis of the cerebral parenchymal vascularization, giving better understanding of hemispheric ischaemia and making the decision about revascularization more rational.

Angiography, Digital Subtraction

[Ioversol 350: clinical experience in skull x-ray computed tomography].

A single, open trial was conducted in 40 patients to evaluate the diagnostic efficacy and safety, in cranial computed tomography, of ioversol (350 mgl/ml), a new nonionic, monomeric, low-osmolality contrast medium. Ioversol is characterized by a hydrophilicity which is not only the highest of all nonionic agents available to date, but also evenly distributed among the various sides of the benzene ring. Diagnosis was possible in 100% of cases with a mean degree of certainty of 90.8%. Six minor adverse reactions requiring no treatment were recorded, of which two were observed by the investigator and four reported by the patients. No pain sensation was found and heat sensations were of minor intensity. Ioversol 350, which showed good diagnostic efficacy and proved to be well tolerated, is therefore suitable for cranial computed tomography at a mean dose of 1 ml/kg.

Adult

[Intravascular technics of cerebral revascularization].

Two techniques of cerebral revascularization have been developed: angioplasty of the brachiocephalic vessels (204 cases) and local intra-arterial fibrinolysis in the carotid region (26 cases). Angioplasty appears to be the treatment of choice for inflammatory and atherosclerotic stenoses of the main trunks arising from the aortic arch (82 cases). Stenoses of the origin of the vertebral artery are not often ulcerated and may also be treated by angioplasty (42 cases) as long as the stenosis has been recognized as the cause of vertebral insufficiency symptoms. Among the stenoses of the carotid bifurcation, recurrent postsurgical ones are rather easily treated by angioplasty, particularly when they are recognized early by Doppler examination. Postsurgical and inflammatory stenoses do not require cerebral protection during angioplasty. Conversely, cerebral protection is mandatory for treatment of atherosclerotic stenoses because of the risk of embolic detachment of particles in to brain circulation. A new triple coaxial catheter system has been designed which seems so far to be very efficient. Local intra-arterial fibrinolysis in the carotid region is selected on the basis of clinical signs, the delay after onset and results of CT and complete cerebral angiographic workup. A classification into three topographic groups is proposed. The group at highest risk of post-fibrinolysis hemorrhage is the one with occlusion of the lenticulostriate arteries. It would seem hazardous to undertake fibrinolysis in a patient of this group unless it can be started no later than 4 or 5 hours after clinical onset. Rapid transportation of stroke patients is recommended so that CT and complete arteriography may be performed before deciding whether to use fibrinolytics.

Angioplasty, Balloon

[The history of Horton's disease or ... 10 centuries of a fascinating adventure].

In 1932, Horton, Magath and Brown reported two cases of a "new form of arteritis affecting the temporal vessels ... which probably represents a new clinical syndrome". In reality, several publications, devoted to the same pathology already preceded this article. The most ancient is that of an ophthalmologist from Baghdad, Ali Ibn Isa (940 to 1010). In his memories, translated and published in english in 1936, the author states that "he undertook excision and cauterisation of arteries to treat patients who were suffering from heat and inflammation of their temporal muscles and which sometimes ended in loss of vision ...". In 1890, J. Hutchinson, an English surgeon, reported a case "... of inflammed and swollen temporal arteries ...". This article was only brought to light in 1946. In 1930, M. Schmidt, published a probable case of temporal arteritis, subsequently reported in 1947. In 1934 and 1936, Horton published new cases of temporal arteritis and defined the clinical characteristics of the disease and its histology. In 1938, Jennings made a particular contribution in reporting the first case of blindness. From this time on, cases of temporal arteritis became increasingly common in the literature. The first French case was described by J. Paviot et al. in 1934, but remained largely unrecognized until 1942. In 1936, J. Chavany was the first to describe the pillow sign, but more particularly in 1948, he prescribed the first treatment with steroids, with spectacular results. It was only in 1950 that R.M. Shick et al. published the effects of steroid therapy in temporal arteritis.(ABSTRACT TRUNCATED AT 250 WORDS)

Bibliographies as Topic

Superselective cerebral arterial infusion of BCNU in high-grade glioma: the radiologist's point of view.

Thirty-two patients suffering from high-grade glioma were candidates for superselective cerebral arterial infusion of 1,3-bis-(2-chloroethyl)-1-nitrosourea (BCNU) after surgery and radiation therapy. There were 74 catheterizations using an 8-French guiding catheter through which a 2.5-French balloon catheter was placed into the main arterial trunk feeding the tumor. Eleven procedures were abandoned because of arterial spasm with a transient neurological deficit or because of prolonged catheterization time. Sixty-three infusions of BCNU were done, each lasting three hours. Eighty-one percent of patients showed stabilization or improvement on computed tomographic (CT) scans five weeks after treatment. We thus demonstrate the safety of supraophthalmic catheterization, the feasibility of prolonged catheterization, and the relative effectiveness of low doses of BCNU infused over a long period of time in the treatment of cerebral gliomas.

Brain Neoplasms

Treatment of bilateral spontaneous dural carotid-cavernous fistulas by coils and sclerotherapy. Case report.

A case of bilateral spontaneous carotid-cavernous fistulas producing increased intraocular pressure is reported. The fistulas lay between the meningeal branches of the internal carotid artery (ICA) and the cavernous sinus, but the ICA itself was not involved. Successful treatment was accomplished by the introduction of steel coils and a sclerotic liquid into the cavernous sinus via the distal superior ophthalmic vein.

Arteriovenous Fistula

[Chemoembolization of hepatic metastases. Preliminary study].

Twenty-one patients with hepatic metastases were treated by chemoembolization over a 2-year period, the technique consisting of selective injection of a mixture of Spongel powder and Adriamycin plus 5-FU into the hepatic artery. Indications and results are discussed as a function of clinical, biologic and radiologic criteria.

Adult

Superselective intracerebral chemotherapy of malignant tumours with BCNU. Neuroradiological considerations.

Early experience shows that: Superselective intra-arterial catheterization above the ophthalmic artery minimizes the orbital complications. Catheterization in a distal branch may lead to the non-infusion of a part of the tumor territory. A much higher concentration of the drug is achieved by superselective intra-arterial infusion than by intravenous injection. Longer infusions seem more efficacious than bolus injection. Early trapping of the drug appears to be essential for therapeutic efficacy.

Blood-Brain Barrier

Embolization with temporary balloon occlusion of the internal carotid or vertebral arteries.

Functional vascular anastomoses at the base of the brain allow for temporary occlusion of the carotid or vertebral arteries. Six embolizations with temporary balloon occlusion of the internal carotid or vertebral artery are reported. Polyvinyl alcohol was the embolic material in all cases and all procedures were performed using digital angiography. The size of the embolic particles and the positioning of the balloon related to the branches of the occluded vessel is discussed.

Adolescent