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L Brunereau

Publications and source records attributed to L Brunereau.

At least 19 recordsLinked to original sources
PubMed2004

Contrast enhanced magnetic resonance imaging underestimates residual disease following neoadjuvant docetaxel based chemotherapy for breast cancer.

AIMS: We prospectively compared the ability of magnetic resonance imaging (MRI) to measure residual breast cancer in patients treated with different neoadjuvant chemotherapy regimen. METHODS: Forty patients with locally advanced breast carcinoma underwent neoadjuvant chemotherapy. Twelve patients received 5-fluoro-uracyl-epirubicin-cyclophosphamide (FEC-group, six cycles), 28 (DXL-group) received docetaxel-based chemotherapy (six cycles DXL-epirubicin: 13 patients, eight cycles DXL alone: 15 patients). All patients had baseline and preoperative MRI. The spread of pathologic residual disease (PRd) was compared to preoperative MRI measures according to chemotherapy regimen. RESULTS: MRI over/underestimation of the spread of residual tumour was never superior to 15mm in FEC group, whereas it appeared in 11/28 (39%, 30-48%-95% CI) patients in DXL group (p=0.017). Tumour shrinkage led to single nodular residual lesions in FEC group, whereas vast numerous microscopic nests were observed in docetaxel group in pathology. CONCLUSION: Among tumours treated with a taxane-containing regimen, residual disease was frequently underestimated by MRI because of PRd features.

Adult↗
PubMed2004

[Imaging neurological complications from bronchogenic carcinoma].

The natural history of bronchogenic carcinoma shows that 42% of patients are diagnosed with cancer-related neurological complications either at initial presentation or at follow-up that can be separated in 3 different categories: - locoregional involvement of cervicothoracic nerves (recurrent laryngeal nerves, phrenic and vagus nerves, brachial plexus and sympathetic cervical chains), - metastatic disease characterized by intracranial lesions (brain, meningeal, ependymal and pituitary metastases) and spinal (extradural, subarachnoid and medullary metastases) lesions, - paraneoplastic syndromes including limbic encephalitis, Lambert-Eaton syndrome and paraneoplastic cerebellar degeneration. These neurological disorders usually are associated with advanced cancer for which radical surgical management seldom is indicated. All imaging studies performed at the time of initial staging for bronchogenic carcinoma should therefore be carefully reviewed in order to detect signs that could suggest the presence of one or several neurological complications. The goals of this paper are to describe the clinical signs and to illustrate the imaging features of neurological complications related to bronchogenic carcinoma at conventional radiography, CT and MRI.

Carcinoma, Bronchogenic↗
PubMed2004

[Low dose helical CT pelvimetry: evaluation of radiation dose and image processing].

PURPOSE: to estimate from phantom measurements the radiation dose and the accuracy of helical ct pelvimetry. MATERIALS AND METHODS: Eight helical CT acquisitions using different tube current (100, 50, 25 or 10mAs) and pitch factor (1.125 or 1.375) settings but identical collimation (2mm) and kilovoltage (120 kVp) were evaluated using a four-channel MDCT scanner and compared with conventional CT pelvimetry including a single scout and two transverse images. A plexiglas phantom combined with an ionization chamber was used to calculate the CTDIw and DLP for each acquisition. Then, an ex vivo phantom of bony pelvis was used to evaluate the accuracy of helical acquisitions for the measurement of pelvic diameters (i.e. the antero-posterior inlet, the transverse inlet and the interspinous distance). Reconstructions of helical acquisitions were performed using 2D MPR, 3D MIP and 3D SSD algorithms. RESULTS: CTDIw and DLP of conventional pelvimetry were 26 mGy and 42 mGy.cm respectively. The radiation dose of helical acquisitions decreased linearly with tube current (CTDIw: from 13 to 1.3 mGy, DLP: from 218.3 to 18.7 mGy.cm). Compared to conventional CT, the dose was nearly similar at 25 mAs and reduced at 10 mAs. Helical acquisitions provided accurate measurements of pelvic diameters with a pitch of 1.125 and a 2D MPR algorithm to evaluate the AP inlet and a 3D MIP algorithm to evaluate the transverse inlet and the interspinous distance. Variations of tube current did not influence the accuracy of pelvic diameter measurement. CONCLUSION: Our results suggest that accurate low-dose helical CT pelvimetry using 10-25 mAs and a pitch factor of 1.125 combined with 2D MPR and 3D MIP reconstructions is possible.

Algorithms↗
PubMed2002

Prospective sonographic assessment of uterine artery embolization for the treatment of fibroids.

OBJECTIVES: To evaluate sonographic features following uterine artery embolization and to assess using ultrasound the efficacy of embolization as the primary treatment of fibroids. DESIGN: Fifty-eight women (mean age, 44.5 years; range, 33-65 years) suffering from symptoms due to fibroids (menometrorrhagia, bulk-related symptoms, pelvic pain) were followed-up after uterine artery embolization by ultrasound examination at 3 months, 6 months, 1 year and 2 years with assessment of volume and vascularization of fibroids as well as uterine vascularization. RESULTS: Fifty-eight patients were examined at 3 months, 46 at 6 months, 36 at 1 year and 19 at 2 years. Most patients were improved or free of symptoms at 3 months (90%), 6 months (92%) and 1 year (87%) and all monitored patients were free of symptoms at 2 years. Clinical failure of treatment occurred in only two cases (3%). Progressive significant reduction in fibroid size with reference to the baseline was demonstrated during follow-up from 3 months (-29%) to 24 months (-86%). Absence of intrafibroid vessels was observed in all except three cases as early as 3 months, whereas perifibroid vessels persisted in 21 cases. No changes in uterine vascularization or uterine artery resistance were noted. CONCLUSIONS: Uterine artery embolization is a valuable endovascular method for the treatment of fibroids, resulting in marked reduction in fibroid size and disappearance of intrafibroid vessels without reduction in uterine vascularization which is well depicted by sonography.

Adult↗
PubMed2002

[Staging and follow-up of renal cell carcinoma].

Surgery is the only curative treatment of renal cell carcinoma (RCC). Preoperative staging is aimed at evaluating surgical possibilities and optimal surgical technique. Thoracic and abdominal CT is the best way to routinely evaluate locoregional and metastatic extension of the tumor. However, there is no consensus concerning which laboratory and imaging studies should be obtained to assess patients after radical nephrectomy or conservative surgery. Objectives of this review

Aftercare↗
PubMed2001

Prospective follow-up of 33 asymptomatic patients with familial cerebral cavernous malformations.

BACKGROUND: Cerebral cavernous malformation (CCM) is one of the most common vascular malformations of the CNS. Familial CCM are increasingly diagnosed, but little is known about their natural history, especially in asymptomatic patients. OBJECTIVE: To determine the degree of spontaneous evolution of familial CCM in a population of 33 symptom-free patients. METHODS: During a previous national survey, the authors analyzed the clinical and MRI features of 173 patients from 57 unrelated French families, including 73 asymptomatic subjects. Of these 73 subjects, 33 prospectively underwent two serial clinical and MRI examinations. Cerebral MRI systematically included spin echo and gradient echo sequences. Occurrence of clinical symptoms and MRI changes of CCM, namely, hemorrhage, change in signal intensity, change in size, and appearance of new lesions, were recorded by means of comparison of the first and last MRI examinations. RESULTS: The 33 patients (234 CCM, mean 7.1 lesions/subject, range 1 to 85 lesions/subject) were followed during a mean period of 2.1 years (range 0.5 to 4.5 years). Two patients became symptomatic: One presented with brainstem hemorrhage and one with partial seizure. Comparison of the two serial MR images found changes in 15 patients (46%): 1) Bleeding occurred in three type II lesions (1.3%) in three patients (9.1%); 2) 30 new lesions appeared in 10 patients (30.3%); 3) change in signal intensity was observed in one lesion (0.4%) in one patient (3%); and 4) increase in size was observed in four lesions (1.7%) in three patients (9.1%). CONCLUSIONS: This prospective study confirms the dynamic nature of CCM. The appearance of new lesions in 30% of patients has to be retained as a hallmark of the familial condition.

Adolescent↗
PubMed2001

Familial form of cerebral cavernous malformations: evaluation of gradient-spin-echo (GRASE) imaging in lesion detection and characterization at 1.5 T.

The purpose of this study was to evaluate the turbo gradient-spin-echo sequence (GRASE) in the MR assessment of the familial form of cerebral cavernous malformations (CCM). Twenty-one patients (15 male, six female) aged from 21 to 68 years (mean = 42.2 years) were prospectively examined with cerebral MR imaging, including T2-weighted turbo gradient-spin-echo (TGSE), turbo spin-echo (TSE) and gradient-echo (GRE) sequences. All sequences were performed in the same plane, the same matrix and the same field of view and were analyzed for signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), susceptibility effects, number of CCM, size of CCM and signal of CCM. It was found that SNR and CNR in the TGSE sequence were significantly inferior to those in both TSE and GRE sequences. TGSE and TSE sequences were significantly less prone to susceptibility effects than the GRE sequence. The sensitivity of TGSE and TSE sequences in detecting CCM was significantly lower than that of the GRE sequence. TGSE and TSE sequences provided comparable information about CCM size and signal. It was concluded that GRASE imaging was less sensitive than the GRE sequence in the detection of CCM and provided information similar to that yielded by the TSE sequence in the characterization of lesions, but with a higher number of artifacts. GRASE imaging cannot therefore replace TSE or GRE sequences in the MR evaluation of the familial form of CCM.

Adult↗
PubMed2001

Pneumorachis and pneumomediastinum caused by repeated Müller's maneuvers: complications of marijuana smoking.

Pneumomediastinum may occur during marijuana inhalation but only rarely has pneumorachis (epidural pneumatosis or aerorachia) been reported. The usual mechanisms that produce pneumomediastinum include severe acute asthma, toxic-induced bronchial hyperreactivity, and barotrauma caused by Valsalva's maneuver (expiration through resistance). We report a case in which barotrauma resulted from repeated deep inspiration through a device with airflow resistance equivalent to Müller's maneuver. Inspiration occurred through a homemade apparatus resembling a narrow outlet bong with 2 piled compartments. Pneumomediastinum combined with subcutaneous emphysema and pneumorachis occurred, without identified pneumothorax. There were no neurologic complications. Because of the absence of bronchospasm, expiration either through the apparatus or actively against a closed glottis, or apnea, this phenomenon is likely a result of repeated Müller's maneuvers. Successive inhalation through resistance could have resulted in extreme negative intrathoracic pressure, which would have caused a transmural pressure gradient inducing barotrauma and release of extrarespiratory air. High-concentration oxygen therapy to achieve nitrogen washout was used.

Adult↗
PubMed2001

Appearance of new lesions in two nonfamilial cerebral cavernoma patients.

Cavernomas are vascular malformations mostly observed in the central nervous system. They occur in sporadic and familial forms. Familial forms are characterized by the presence of multiple lesions, an autosomal dominant pattern of inheritance and possible de novo lesions. We report two sporadic cases whose follow-up showed the appearance of new lesions.

Adult↗
PubMed2001

Utility of balloon-assisted Guglielmi detachable coiling in the treatment of 49 cerebral aneurysms: a retrospective, multicenter study.

BACKGROUND AND PURPOSE: The management of wide-necked aneurysms or aneurysms with a neck-to-body ratio close to 1 is a difficult challenge for the interventional radiologist because of the risk of coil migration or coil protrusion into the parent vessel. Our objective was to evaluate the efficacy and safety of balloon-assisted coiling as well as the follow-up results of occlusion for those difficult aneurysms in which conventional treatment with Guglielmi detachable coils (GDCs) had failed. METHODS: A nondetachable balloon was used in 49 procedures performed in 44 patients (35 women and nine men) who underwent GDC coiling of aneurysms. Every aneurysm had either a wide neck or a sac diameter/neck size ratio (SNR) of 1.5 or less. RESULTS: In four (8%) of the procedures, balloon placement failed, leaving a total of 45 aneurysms treated with balloon-assisted coiling. Final results consisted of total occlusion in 30 cases (67%), subtotal occlusion in 11 cases (24%), and incomplete occlusion in four cases (9%). We found a correlation between the diameter of the sac and the occlusion rate, but not between the size of the neck or the SNR and the occlusion rate. Two thromboembolic complications occurred, but neither had clinical consequences. No aneurysmal rupture was observed during treatment. Final angiographic follow-up time ranged from 3 months to 5 years (mean, 16 months). CONCLUSION: Balloon-assisted coiling is an important adjunct in the treatment of aneurysms with a wide neck or low SNR. In our experience, this technique allowed safe and efficient treatment of aneurysms when conventional GDC treatment had failed.

Adult↗
PubMed2001

[Does renal transplantation increase the risk of breast diseases?].

PURPOSE: To evaluate the risk of breast pathology occurrence in a group of kidney transplanted patients. MATERIAL: and methods. In the last five years, 30 kidney-transplanted women underwent systematic breast evaluation in our institution and were included in this retrospective study (exposed-group). To compare with this exposed-group, 90 non transplanted women undergoing breast evaluation in the same period at our institution (non-exposed group), were retrospectively randomized. In both groups, results of breast evaluation were classified in two categories (normal and abnormal) and distribution of benign and malignant breast pathologies were evaluated. The mean exposition-time was determined in months in the exposed-group. Comparative analysis of both groups included a comparison of mean patients age and evaluation of the relative risk (RR) of breast pathology occurrence. RESULTS: Mean exposition time was 72.7+/-66.6 months. The percentages of benign breast pathology were 93.7% in the exposed-group and 83.3% in the non-exposed group. Percentages of cancer were respectively 6.3 and 16.7%. Mean patient age was quite similar in the exposed-group (50.7+/-10 years) and in the non-exposed group (50.6+/-10.5 years). The relative risk of breast pathology occurrence was 1.70 (0.99<RR<2.91) and was not significant. CONCLUSION: In this retrospective series, no risk of breast pathology occurrence was demonstrated in a population of kidney-transplanted patients.

Adult↗
PubMed2001

[Incidental detection of a rare liver tumor: angiomyolipoma].

We report the case of a woman who presented a single liver lesion with no evidence of specific findings at Doppler US, CT, nuclear studies and MRI to suggest angiomyolipoma. The final diagnosis was confirmed at anatomopathology and immunohistochemistry which demonstrated positive anti-HMB 45 aspect.

Angiomyolipoma↗
PubMed2001

[Beginning rheumatoid arthritis revealed during bronchiectasis surinfections. Value of cyclic antibiotherapy?].

Incidence of symptomatic bronchiectasis (BR) occurs in around 2% in patients with late rheumatoid arthritis (RA). Its seems that the association BR-RA could be a worsening factor for outcome of RA patients. A 58-year-old woman without dry syndrome, suffering from bronchial purulence over one year was admitted to the Department of Pneumology for hemoptysis and arthritis (knees, ankles, and wrists). Three prior episodes of inflammatory articular pain had occurred after transient bronchial purulence or pneumonitis. CT-scan showed bilateral bronchiectasis. Diagnosis of early RA was proved after the third episode of bronchial purulence related to a strain of Haemophilus influenzae. A strain of Coxiella burnetii was probably responsible for one of the three bronchial surinfections. Latex and Waaler Rose tests were transiently positive during the first episode, and became positive after the third one. At that time, RA was relevant in view of ARA criteria. Cyclic prophylactic antibiotic regimens could be proposed to patients suffering from RA-BR association, in contrast to the cases of patients with isolated BR. This approach could prevent destabilization of RA and reinforce of anti-rheumatic therapy. Activation and release of cytokines (NFk-B, TNF-alpha), and/or bacterial epitopes seems to be directly responsible for the articular destabilization.

Anti-Bacterial Agents↗
PubMed2000

The natural history of familial cerebral cavernomas: a retrospective MRI study of 40 patients.

Our objective was to determine the natural history and prognostic factors of familial forms of cerebral cavernous malformations (CCM). Cavernomas are one of the most common central nervous system vascular malformations. Familial CCM is increasingly diagnosed, but little is known about its natural history. In a national survey, we analysed clinical and MRI features of 173 patients from 57 unrelated French families. Of these 40 had undergone at least two clinical and MRI examinations. Occurrence of haemorrhage, new lesions, change in signal intensity and size of lesions have been studied by comparison between first and last MRI studies. The CCM were classified according to Zabramski et al. Mean follow-up was 3.2 years (range 0.5-6.5 years). We followed 232 cavernomas (mean 5.9 per patient, range 1-17). Serial MRI demonstrated changes in 28 patients (70%). Bleeding occurred in 21 lesions (9.1%) in 14 patients (35%). The haemorrhagic risk was 2.5% per lesion-year, higher in type I and brain-stem CCM. We saw 23 new lesions appear in 11 patients (27.5%), with an incidence of 0.2 lesions per patient year. Signal change was observed in 11 patients (27.5%), in 14 lesions (6%), while 9 lesions (3.9%) in 9 patients (22.5%) changed significantly in size.

Adolescent↗
PubMed2000

De novo lesions in familial form of cerebral cavernous malformations: clinical and MR features in 29 non-Hispanic families.

BACKGROUND: To evaluate clinical and MR features of de novo lesions (DNL) in the familial form of cerebral cavernous malformation (CCM) in 40 patients belonging to 29 unrelated non-Hispanic families. METHODS: Forty patients followed up by serial cerebral MR examinations were included in this retrospective study. First and last available MR examinations were retrospectively analyzed and compared for each patient to diagnose DNL. Gradient-echo (GRE) sequences were performed in only 11 of the 40 patients and were not considered for this study. Incidence of DNL was evaluated in terms of lesions/patient-year. All DNL were characterized by their clinical and MR features (location, size, type). Type of CCM was determined according to the classification of Zabramski (1994). Patient groups with and without DNL were compared for sex, age, number of pre-existing CCMs, and follow-up. RESULTS: Twenty-three DNL were recorded in 11 patients (27.5%) and the incidence was 0.2 lesions/patient-year (mean follow-up = 3.2 years). All but one DNL were asymptomatic. Twenty DNL were supratentorial and three were infratentorial. Mean diameter was 8 mm (2-35 mm). Six DNL were classified as type 1 (subacute hemorrhage), six as type 2 (hemorrhages and thromboses of varying ages) and 11 as type 3 (chronic hemorrhage with hemosiderin staining). No statistical difference between groups was found in terms of sex, age, or number of pre-existing CCMs. On the other hand, duration of follow-up was significantly longer in the group with DNL. CONCLUSION: The occurrence of DNL seems to be a hallmark of the familial form of CCM in non-Hispanic families as well as in Hispanic families. Such DNL are usually asymptomatic and are mainly classified as type 3 (chronic hemorrhage with hemosiderin staining). Within the limits of the retrospective study design and potential selection bias introduced by the varying indications for MR scanning, it does seem that DNL may occur at any time in the lifespan of CCM patients, and occurrence does not seem to depend on age, sex, or the total number of pre-existing lesions.

Adolescent↗