Biomedical subjects

Jacques Chiras

Publications and source records attributed to Jacques Chiras.

At least 19 recordsLinked to original sources

PubMed2006

Pott's disease occurring after percutaneous vertebroplasty: an unusual illustration of the principle of locus minoris resistentiae.

We report an unusual case of a multifocal tuberculous spondylitis that has been diagnosed after several percutaneous vertebroplasty. This event supports the theory that surgical or radiological intervention such as a percutaneous vertebroplasty should be considered as an intentional traumatism that can lead to the initiation of a locus minoris resistentiae, probably by reactivating an inactive tuberculous lesion.

Aged↗

PubMed2006

Characterization of the muscle involvement in dynamin 2-related centronuclear myopathy.

Centronuclear myopathy (CNM) is a slowly progressive congenital myopathy characterized by abnormal centrally located nuclei in a large number of muscle fibres. Recently, different missense mutations affecting the middle domain of the dynamin 2 (DNM2) have been shown to cause autosomal dominant CNM. In order to better define the phenotype of DNM2-related CNM, we report here on the clinical and muscle imaging findings of 10 patients harbouring DNM2 mutations. DNM2-CNM is characterized by slowly progressive muscular weakness usually beginning in adolescence or early adulthood. In addition to bilateral ptosis, our data show that distal muscle weakness often exceeds proximal involvement. Furthermore, electrophysiological investigations frequently demonstrated signs of mild axonal peripheral nerve involvement, and electromyographical examination may show neuropathic changes in addition to the predominant myopathic changes. These features overlap with findings seen in the phenotype of DNM2-related autosomal dominant Charcot-Marie-Tooth disease type 2B. In all 10 DNM2-CNM patients, muscle computer tomography assessment showed a consistent pattern of muscular involvement and a characteristic temporal course with early and predominant distal muscle involvement, and later affection of the posterior thigh compartment and gluteus minimus muscles. The recognition of this specific imaging pattern of muscle involvement--distinct to the reported patterns in other congenital myopathies--may enable a better selection for direct genetic testing.

Adolescent↗

PubMed2006

Percutaneous vertebroplasty for spinal metastases: complications.

PURPOSE: To retrospectively evaluate complications of percutaneous vertebroplasty (PV) performed with polymethylmethacrylate cement to treat pain in patients with metastases to the spine. MATERIALS AND METHODS: This study had institutional review board approval; patient informed consent for the review of records and images was not required. In 2 years, 117 patients (38 men [32.5%] and 79 women [67.5%]; mean age, 58.2 years) underwent 159 fluoroscopy-guided PV procedures to treat 304 vertebrae. Spinal metastases included osteolytic, osteoblastic, and mixed lesions. Complications were characterized as local or systemic. Evaluated data included immediate imaging findings (on radiographs and computed tomographic scans) and clinical findings at 30-day follow-up. Chi2 or Fisher exact testing was performed for univariate analysis of variables. RESULTS: The primary cancers were breast cancers (45.3%), lung cancers (14.5%), myeloma (7.7%), or other cancers (32.5%). Among the 423 cement leakages identified, 332 (78.5%) were vascular and 91 (21.5%) were nonvascular. Vascular leaks were classified as venous epidural leaks, paravertebral and foraminal plexus leaks, and leaks to the vena cava, while nonvascular leaks included puncture trajectory leaks, paravertebral soft tissue leaks, and diskal leaks. Patients with nonvascular leaks were asymptomatic. Eight (6.8%) patients experienced complications, and seven of these complications were symptomatic. Among these eight patients, six (5.1%) had local complications (puncture site hematoma in two patients and radicular pain [successfully treated with nonsteroidal anti-inflammatory drugs or corticosteroids] in four patients), and two (1.7%) had systemic complications (pulmonary embolism resulting from cement migration through the vena cava). One of the latter patients died. Univariate analyses revealed a significant association between cement migration through the vena cava and pulmonary embolism (P = .001) but not between foraminal venous leakage and radicular pain (P = .123). CONCLUSION: Despite numerous technical incidents (leaks), PV-induced complications were rare, leading to the hypothesis that systemic complications are a consequence of intravascular leakage while local complications are a consequence of cement-related irritation, compression and/or ischemia, and/or needle-induced trauma.

Bone Cements↗

PubMed2005

Interictal diffusion MRI in partial epilepsies explored with intracerebral electrodes.

Patients with refractory partial seizures may benefit from epilepsy surgery. However, invasive investigations are often needed to define the precise location and limits of the epileptogenic zone (EZ). In this study, we asked whether diffusion tensor imaging (DTI) might provide a non-invasive alternative to locate the EZ or at least provide insights to help place intracerebral electrodes for stereo-electroencephalography (SEEG). Whole brain DTI and voxel-based analysis (SPM99) was used to assess diffusion properties objectively in 16 epilepsy patients investigated with SEEG. Epilepsy was symptomatic in two patients and cryptogenic in the 14 remaining patients. The suspected onset of seizures was temporal in 10 patients, frontal in 2 and occipital in 4. Individual maps of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were calculated and compared to a database of 40 healthy volunteers. Thirteen of 16 patients exhibited diffusion abnormalities. ADC abnormalities were better correlated with SEEG data than FA abnormalities which were usually located at a distance or in the white matter. A significant increase in ADC (P < 0.01) was found in 11 patients and was located in the regions explored with depth electrodes in 7 of them. Surgery outcome was available in 3 of these 7 patients (2 were seizure free and 1 not). DTI specificity was better in extratemporal lobe epilepsy (83%) than in temporal lobe epilepsy (20%). When abnormalities concurred with the SEEG data, the concordance was optimal between the localization of the diffusion abnormalities and the irritative zone defined by SEEG. These encouraging, preliminary results, suggest that DTI examinations may provide accurate spatial data on the location and extent of the epileptogenic network in extratemporal lobe epilepsies.

Adolescent↗

PubMed2005

Diffusion tensor imaging in medial temporal lobe epilepsy with hippocampal sclerosis.

Interictal diffusion imaging studies in patients with medial temporal lobe epilepsy (MTLE) accompanied by hippocampal sclerosis (HS) have shown an increased diffusivity in the epileptogenic hippocampus. In this study, we wanted to explore the whole brain in order to determine if MTLE could have an impact on the organization and the architecture of a large cerebral network and to identify clinical factors that could mediate diffusion abnormalities. Diffusion tensor imaging (DTI) and statistical parametric mapping of the entire brain were performed in 35 well-defined MTLE patients and in 36 healthy volunteers. SPM analyses identified three abnormal areas: an increased diffusivity was detected in the epileptic hippocampus and the ipsilateral temporal structures associated with a decreased anisotropy along the temporal lobe, a decreased diffusivity was found in the contralateral non-sclerotic hippocampus, the amygdala, and the temporal pole, and finally, a decreased anisotropy was noted ipsilaterally in posterior extratemporal regions. Duration of epilepsy, age at onset, and the frequency of generalized tonic-clonic seizures or partial complex seizures did not correlate with the presence of diffusion abnormalities. Region of interest analysis in the hippocampus/parahippocampus demonstrated a correlation between lower ipsilateral diffusivity values and occurrence of epigastric aura and between higher anisotropy values in both hemispheres and history of febrile seizures. In conclusion, this study showed that diffusion abnormalities are not restricted to the pathologic hippocampus and involve a larger network. This pattern may indirectly reflect the epileptogenic network and may be interpreted as a cause or a consequence of epilepsy.

Adult↗

PubMed2005

Unruptured intracranial aneurysms treated by three-dimensional coil embolization: evaluation of the postoperative aneurysm occlusion volume.

Our purpose was to evaluate the postoperative aneurysm occlusion volume and clinical results of treating unruptured intracranial aneurysm using three-dimensional (3D) coils. Over a 2-year period 62 aneurysms (39 with a neck < or =4 mm, 23 with a neck >4 mm) in 62 patients in five participating centres were treated. The procedure consisted, firstly, of framing the aneurysm with one or more spherical 3D coils, and secondly, of filling it with two-dimensional (2D) helical coils. Anatomical and clinical results were evaluated by univariate analysis. Multivariate analysis was used to identify independent predictors of these results. For neck sizes < or =4 and >4 mm, angiographic occlusion was complete in 31 (79%) and 16 (70%) aneurysms, respectively; the mean percentage of occlusion volume was 31.4% and 29.5%, respectively, and postoperative morbidity was 3% and 4%, respectively, with no significant differences between the two groups. There were no deaths. However, occlusion volume correlated with sac size (P = 0.037) and sac-to-neck ratio <1.5 (P = 0.073), except when three or more 3D coils per aneurysm were used (P = 0.516 and P = 0.308, respectively). Occlusion volume correlated with the number of 3D coils per aneurysm (P < 0.001) and was an independent predictor of angiographic complete occlusion (P = 0.002). The use of the largest number of 3D coils per aneurysm was safe and may improve the postoperative volume and angiographic occlusion of aneurysms with a neck >4 mm, provided the sac-to-neck ratio is > or =1.5.

Adult↗

PubMed2005

Brain magnetic resonance imaging findings in patients with mitochondrial cytopathies.

BACKGROUND: Mitochondrial cytopathies (MCs) are a heterogeneous group of clinical entities, some of which have classic phenotypes. Magnetic resonance imaging (MRI) has been reported to be helpful in the diagnosis of MC. OBJECTIVE: To correlate the most common brain MRI findings reported in patients with MC with the clinical findings in patients in different MC subgroups. DESIGN: Case series. SETTING: Patients with MCs seen at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico. PATIENTS: Twenty-one patients with MC with the following phenotypes: chronic progressive external ophthalmoplegia (n = 7), Kearns-Sayre syndrome (n = 7), mitochondrial neurogastrointestinal encephalopathy (n = 6), and myoclonic epilepsy with ragged red fiber myopathy (n = 1). RESULTS: Brain MRI abnormalities were found in 20 (95%) of 21 patients. The most frequent abnormalities were widespread white matter hyperintensity in 19 patients (90%), supratentorial cortical atrophy in 18 patients (86%), and cerebellar atrophy in 13 patients (62%). Widespread white matter hyperintensity (P<.001) and supratentorial cortical atrophy (P = .001) were each correlated significantly with MC. Subsequent subgroup analyses showed that the absence of basal ganglia hyperintensity was correlated with Kearns-Sayre syndrome (P < .001) and the presence of supratentorial cortical atrophy was correlated with mitochondrial neurogastrointestinal encephalopathy (P = .005). CONCLUSIONS: The presence of widespread white matter hyperintensity and/or supratentorial cortical atrophy in brain MRI may help to establish the diagnosis of MC. The radiologist has a role to play in the workup of MC by confirming the diagnosis and possibly distinguishing different subgroups of MC.

Adult↗

PubMed2005

Cerebral fat embolism: usefulness of magnetic resonance spectroscopy.

We report a case of cerebral fat embolism which occurred in a 33-year-old man after a diaphyseal femoral fracture without cranial traumatism. The initial examination showed an incomplete picture of coma with tetrapyramidal syndrome and cutaneomucous purpura. There was no respiratory damage. We present a magnetic resonance spectroscopy analysis of the cerebral lesions observed in the initial phase of the embolism, as well as follow-up, which has strengthened the clinical and imaging features for the diagnosis.

Adult↗

PubMed2005

Brain activations during letter-by-letter reading: a follow-up study.

Lesions affecting the ventral cortex of the left temporal lobe commonly yield a selective reading impairment known as pure alexia. It is thought to result from the disruption or deafferentation of the Visual Word Form Area (VWFA), a region in the left lateral occipitotemporal sulcus activated whenever normal subjects are viewing alphabetic strings. Most pure alexic patients retain the ability to identify single letters, and develop a strategy of letter-by-letter (LBL) reading. We recently studied fMRI activations in LBL readers and clarified the underlying mechanisms. However, LBL reading is a dynamic process which may improve over months or years of practice, although the cerebral bases of this continuing improvement are currently unknown. We had the opportunity to run the same behavioural testing and fMRI experiment a second time in an alexic patient, 8 months after collecting the data reported by Cohen et al. [Cohen, L., Henry, C., Dehaene, S., Molko, N., Lehéricy, S., Martinaud, O., Lemer, C., and Ferrieux, S. (2004). The pathophysiology of letter-by-letter reading. Neuropsychologia, 42, 1768-1780]. We analyze the changes that occurred over this period in the pattern of reading-related activations, while the patient's LBL reading improved. The activation level decreased in most of the overall network between the two sessions. This general trend contrasted with a focal increase restricted to specific left frontal and parietal areas. When studying the contrast between words and consonant strings, which may be taken as a correlate of LBL reading, we also found a general decrease, except for similar left frontal and parietal regions, which showed a significant increase. We suggest that the pattern of evolution fits with the minimal hypothesis of normal strategic abilities and skill learning, associated with perceptual tuning in right-hemispheric structures able to substitute the disrupted VWFA.

Adult↗

PubMed2005

Hemangioblastomas of the lower spinal region: report of four cases with preoperative embolization and review of the literature.

BACKGROUND AND PURPOSE: Hemangioblastomas (HBs) are rare lesions accounting for 1-5% of all spinal cord tumors. Seventy-five percent of spinal HBs are intramedullary. Lesions of the conus medullaris and the cauda equina are uncommon, and the filum terminale location is very rare. HBs of the lower spinal region are highly vascular tumors requiring surgery that is potentially complicated by excessive bleeding. In the literature, there are few reports concerning preoperative embolization of HBs, and only few cases are reported in spinal location. Presurgical embolization of HBs located in the lower spinal region has not been described. Although lower spinal HBs are predominantly fed by the anterior spinal artery (ASA), embolization of these lesions is possible and can reduce tumor vascular supply, thus facilitating surgery. We report our experience in four rare cases of solitary HBs occurring in the lower spinal region. METHODS: Clinical charts and radiologic studies of four patients with a preoperatively embolized HB of the lower spinal region were retrospectively reviewed. The lesions were located in the conus medullaris in one case, at the level of the cauda equina in another, and in the filum terminale in two. In the conus medullaris case, the neoplasm was associated with a syrinx. In three patients, the HB was sporadic, while the patient with the HB of the cauda equina had Von Hippel-Lindau disease. Devascularization of the tumor was performed through the ASA in all cases and also through the posterior spinal artery in one by using non reabsorbable calibrated microspheres in three cases and polyvinyl alcohol particles in the other one. RESULTS: Embolization caused no permanent complications, although one patient with a cauda equina HB mildly worsened after the endovascular procedure but recovered before surgery. At surgery, the tumor was completely removed in all cases. Blood loss was reported to be less than usually observed (100, 200, 200, and 400 mL). In addition, manipulation and removal of the tumor was reported to be easy in three of four tumors. Histologic examination confirmed the diagnosis. At 1-year postsurgical follow-up, two patient recovered completely from neurologic deficits, and two showed significant recovery. No tumor recurred during a follow-up period of 1-6 years (mean, 3.5 years). CONCLUSION: Our results indicate that preoperative embolization of HBs of the lower spinal region is an useful procedure in aiding surgical resection of these highly vascular tumors. With a meticulous technique, embolization can be performed through the ASA.

Adult↗

PubMed2005

Percutaneous vertebroplasty for metastatic involvement of the axis.

BACKGROUND AND PURPOSE: Percutaneous vertebroplasty in the upper cervical spine is a challenging procedure, and little is known about its therapeutic outcome. The purpose of this study was to assess the risks and benefits of percutaneous vertebroplasty for metastatic involvement of the axis. METHODS: From January 1994 to August 2004, 12 patients (mean age, 52.3 years) underwent percutaneous vertebroplasty via an anterolateral approach using fluoroscopic guidance for metastatic lesions involving the C2 vertebral body; pain intensity was scored on a scale ranging from 0.0 (no pain) to 10.0 (maximum pain intensity). Eight patients (66.7%) were followed up (mean, 6.9 months); 5 of them had percutaneous vertebroplasty indicated for pain control and spine stabilization and 3, for spine stabilization only. RESULTS: The mean volume of cement injected was 2.9 +/- 0.7 mL (range, 2.0-4.0 mL) with a mean vertebral filling of 60.7 +/- 14.6% (range, 25-80%). Cement leakage was detected in 7 treated vertebrae (58.3%). Pain improvement was achieved in 4/5 patients (80%). Spine stability was observed in 7 patients (87.5%), but 1 patient (12.5%) presented with a secondary spine deformity in association with partial vertebral filling. Two postprocedural clinical manifestations (16.7%) were observed: 1 patient (8.3%) had a transient occipital neuralgia and another (8.3%) had an ischemic stroke. Mortality and morbidity rates at mean follow-up were 0.0% and 12.5% (1 patient), respectively. CONCLUSION: Percutaneous vertebroplasty of C2 metastases by an antero-lateral approach is an effective option in the treatment strategy of patients with metastases to C2. Nevertheless, it is a challenging procedure and may carry regional and even intracranial risks due to the proximity to the vertebral artery.

Adult↗

PubMed2004

Productive and perceptive language reorganization in temporal lobe epilepsy.

The aim of this work was to determine whether productive and perceptive language functions are differentially affected in homogeneous groups of epilepsy patients with right and left temporal lobe epilepsy (TLE). Eighteen patients with left TLE, 18 with right TLE, and 17 healthy volunteers were studied using fMRI during performance of three tasks assessing the productive and perceptive aspects of language (covert semantic verbal fluency, covert sentence repetition, and story listening). Hemispheric dominance for language was calculated in the frontal and temporal regions using laterality indices (LI). Atypical lateralization was defined as a right-sided LI (LI<-0.20) in the frontal lobes during the verbal fluency task or in the temporal lobes during the story listening task. Control subjects and right TLE patients demonstrated a strong left lateralization for language in the frontal lobes during the fluency task, whereas activation was less lateralized to the left hemisphere in left TLE patients, although the difference did not reach significance. In the story listening and the repetition tasks, activation was significantly more right sided in the temporal lobes of patients with left TLE. Atypical language representation was found in 19% of TLE patients (five left and two right TLE). The shift toward the right hemisphere was significantly larger in the temporal than the frontal lobes in patients with atypical language lateralization compared to TLE patients with a typical language lateralization. Neuropsychological performances of patients with atypical language patterns were better than those of patients with typical patterns, suggesting that this reorganization may represent a compensatory mechanism.

Adolescent↗

PubMed2004

Selective intra-arterial chemoembolization of pelvic and spine bone metastases.

The purpose of this study was to determine the effect of interventional palliative therapy by using chemoembolization on metastatic bone pain and tumor bulk in inoperable metastases where chemotherapy and radiotherapy had failed. Twenty-five patients (mean age: 59 years) underwent chemoembolization of symptomatic lytic lesions involving the spinal column (n=10), iliac bone and sacrum (n=15). The study design consisted of at least three procedures based on combined chemoembolization performed under analog-sedation. Therapeutic agents were carboplatin for selective chemotherapy and pirarubicin mixed with polyvinyl alcohol foam for chemoembolization. Fifteen of 18 (83%) patients had significant pain relief, as shown by the decrease of analgesic drug use. Mean clinical response duration was 12 months. Radiologically, ten patients were stable. A partial response was observed in four patients, while a complete response was seen in two others. Selective intra-arterial chemoembolization gives longer pain relief than embolization, compared to the literature data, probably because of partial response with local anti-cancer drugs.

Adult↗

PubMed2003

Proximal great vessels of aortic arch: comparison of three-dimensional gadolinium-enhanced MR angiography and digital subtraction angiography.

PURPOSE: To prospectively compare dynamic three-dimensional (3D) gadolinium-enhanced magnetic resonance (MR) angiography and digital subtraction angiography (DSA) for the detection of ostial stenosis of the craniocervical vessels. MATERIALS AND METHODS: Thirty-three patients with carotid stenosis of more than 50% at sonography prospectively underwent both MR angiography and DSA. The overall quality of each DSA and MR angiographic study was analyzed. For each craniocervical vessel (brachiocephalic, common carotid, subclavian, and vertebral arteries) (n = 231), ostial stenosis was graded as follows: normal, mild (<50%), moderate to severe (>50%), or occlusion. MR angiographic and DSA results were compared by means of the Spearman rank correlation coefficient (Rs). RESULTS: The overall diagnostic quality of MR angiography was excellent or adequate. Three studies were inadequate because of a poor signal-to-noise ratio (13 of 231 arteries) or a coverage error (five of 231 arteries). Findings at MR angiography and DSA agreed on the degree of stenosis (Rs = 0.82, P <.001). No cases of stenosis of more than 50% were missed at MR angiography. However, some discrepancies were noted between vertebral arteries and the other craniocervical vessels. The sensitivity and specificity for stenosis of more than 50% in other craniocervical vessels were 100% and 98%, respectively. The sensitivity and specificity for stenosis of more than 50% in the vertebral arteries were 100% and 85%, respectively. Findings at MR angiography tended to result in overestimation of the degree of ostial stenosis, especially in vertebral arteries (10 [15%] of 66 arteries). CONCLUSION: MR angiography is useful to rule out ostial stenosis of the craniocervical vessels. MR angiography is an adequate diagnostic tool for ostial stenosis, except in the vertebral artery.

Adult↗

PubMed2003

Radiotherapy and chemotherapy with or without carbogen and nicotinamide in inoperable biopsy-proven glioblastoma multiforme.

BACKGROUND: Nicotinamide and carbogen have been shown to enhance the radiation effect in tumour models. PURPOSE: Prospective evaluation of the toxicity and efficacy of carbogen and nicotinamide with external beam radiotherapy in the management of inoperable glioblastoma. PATIENTS AND METHODS: From April 1995 to December 1997, 33 patients with inoperable biopsy-proven glioblastoma multiforme (GBM) were enrolled in a phase II trial, to undergo radiotherapy (59.4 Gy in 1.8 Gy/fraction), intra-arterial cerebral chemotherapy (ACNU 100 mg/m(2), three cycles), carbogen breathing (15 l/min), and nicotinamide (85 mg/kg). This experimental group was compared to a control group of 38 patients with inoperable GBM treated with radiotherapy and three cycles of nitrosourea-based chemotherapy from January 1990 to March 1995, in our institution. RESULTS: In the experimental group, carbogen breathing was well tolerated, but only 51.5% of patients completed daily nicotinamide over the 6.5-week treatment period. Nausea and vomiting were the most frequent side effects of nicotinamide. No significant difference in overall survival was observed among the two treatment groups: median survival times were 36.7 and 35.3 weeks for patients treated with carbogen and nicotinamide, and for those treated in the control group, respectively. CONCLUSION: The association of carbogen and nicotinamide with radiotherapy is feasible, but tolerable only in 51.5% of patients with GBM. Carbogen and nicotinamide did not appear to modify the evolution of glioblastoma.

Adult↗

PubMed2003

In vitro study of the compatibility of tris-acryl gelatin microspheres with various chemotherapeutic agents.

PURPOSE: To evaluate the in-vitro effects of chemotherapeutic agents on the physical structure of tris-acryl gelatin microspheres. MATERIALS AND METHODS: Microspheres (Embospheres) were mixed in vitro with carboplatin, mitomycin C, 5-fluorouracil, or pirarubicin as experimental samples and with distilled water as control samples and kept for 24 hours at 37 degrees C. The microspheres used measured 100-300 micro m and 700-900 micro m in diameter. Microsphere morphology, including appearance, overall shape, smoothness of surface, and thickness of gelatin coating, was examined with use of a microscope equipped with a cold light. Microsphere dimensions including larger diameter, smaller diameter, and surface area were measured by granulometry. Microsphere geometry was evaluated by calculating a sphericity index and surface regularity index. Qualitative and quantitative variables, respectively, were analyzed with the two-sided Fisher exact test and Wilcoxon signed-rank test for paired values, with a significance level of 0.05. RESULTS: No broken microspheres or microscopic degradations in the appearance, overall shape, smoothness of surface, or thickness of gelatin coating of any microspheres were observed. The respective distributions of large and small diameters, surface area, sphericity index, or surface regularity index of the microspheres were not significantly different between the experimental samples containing carboplatin, mitomycin C, 5-fluorouracil, or pirarubicin and the control sample of microspheres with similar diameters. CONCLUSION: Embosphere microspheres can be mixed with carboplatin, mitomycin C, 5-fluorouracil, or pirarubicin for chemoembolization therapy without any risk of damaging their morphology, dimensions, or geometric characteristics.

Acrylates↗

PubMed2002

Spinal cord arteriography: a safe adjunct before descending thoracic or thoracoabdominal aortic aneurysmectomy.

OBJECTIVE: Spinal cord arteriography (SCA) often has been considered difficult, hazardous, and unreliable. In this report, we question these assumptions. PATIENTS: From August 1985 to June 2000, a total of 480 patients underwent 487 SCA procedures during diagnostic examination for 498 aneurysms, which included 159 that involved the descending thoracic aorta and 339 that involved the thoracoabdominal aorta. The underlying cause was degenerative disease in 288 cases, chronic dissection in 132 cases, and other causes in 78 cases. RESULTS: Major procedure-related complications occurred in six patients (1.2%) and included spinal cord complications in two patients, renal complications in two patients, and stroke in two patients. Puncture-site complications occurred in three patients (0.6%). Rupture of the aneurysm occurred within 3 days after SCA in two patients (0.4%). Two deaths (0.4%) were directly imputable to SCA. In 476 patients (97.7%), SCA was devoid of major complications. The Adamkiewicz's artery was successfully located in 419 patients (86.0%) and arose from a left intercostal or lumbar artery in 323 patients (77.1%) and from between T8 and L1 levels in 361 patients (86.2%). On the basis of the extent of identification of spinal cord vasculature, the procedure was considered as a complete success in 321 patients (65.9%), as a partial success in 112 patients (23.0%), and as a failure in 54 patients (11.1%). Although the failure rates were comparable, the complete success rate was significantly higher in patients with degenerative rather than dissecting aneurysms (P <.001) and in patients with limited aneurysms (ie, types 1, 2, and 3 versus type 4 descending thoracic aneurysms, P <.05; and types 3 and 4 versus types 1 and 2 thoracoabdominal aneurysms, P <.001). CONCLUSION: SCA is a safe adjunct that warrants more widespread use in the management of descending thoracic or thoracoabdominal aortic aneurysms.

Aged↗

PubMed1999

Interventional Radiology for Treating Soft Tissue Sarcomas.

The role of interventional radiology for soft tissue sarcomas is only occasionally addressed in the literature. However, different techniques such as embolization, selective chemotherapy, chemoembolization, and acrylic cement osteoplasty can be helpful with the primary tumor, recurrences, and metastases. This article discusses these techniques and their complications in treatment of soft tissue sarcomas.

Journal Article↗