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P Chastanet

Publications and source records attributed to P Chastanet.

At least 19 recordsLinked to original sources
PubMed2001

[Video-assisted thoracoscopic surgery].

We describe our experience with video-assisted thoracoscopic surgery (VATS). Twenty-nine patients were operated on with this technique for various anterior thoracic spinal lesions. There were 6 cases of disc herniation with simple resection, 6 with acute thoracic fractures requiring anterior grafting and stabilization, 7 old fractures and malunions treated by corporectomy, grafting and anterior stabilization in 3, 4 with spinal metastases that were resected and stabilized, 3 with a paravertebral spinal tumor (2 schwannomas and 1 chondroblastoma), and 3 osteoid osteomas that were resected with anterior grafting in one case. Indications for these procedures are specified and the technical considerations discussed for each group of pathologies. We had three complications: one conversion to thoracotomy in a case of spinal metastasis, one pleural effusion, and one incomplete resection of a thoracic disc herniation. We emphasize the need for minimally invasive approaches in spinal surgery.

Adult↗
PubMed2000

MR imaging of the knee at 0.2 and 1.5 T: correlation with surgery.

OBJECTIVE: The purpose of this study was to compare the diagnostic efficacy of low- and high-field-strength MR imagers in the diagnosis of anterior cruciate ligament tears and meniscus tears. SUBJECTS AND METHODS: In 219 patients with suspected internal derangement of the knee, MR imaging at 0.2 and 1.5 T was performed with similar sequences. Only patients with surgically confirmed diagnosis (n = 90) were included in the statistical analysis. Radiologists were unaware of diagnosis and field strength. Sensitivity, specificity, diagnostic accuracy, and inter- and intraobserver variability were determined. RESULTS: There was excellent correlation between the field strengths in accuracy, sensitivity, and specificity for anterior cruciate ligament and meniscus tears. Accuracy for medial meniscus, lateral meniscus, and anterior cruciate ligament tears was 91-93%, 88-90%, and 93-96%, respectively, at 0.2 T and 91-94%, 91-93%, and 97-98%, respectively, at 1.5 T. Inter- and intraobserver variability values showed excellent correlation (kappa > 0.8). CONCLUSION: The level of diagnostic accuracy in anterior cruciate ligament tears and meniscus tears is comparable for low- and high-field-strength MR imagers.

Adolescent↗
PubMed2000

Long-term efficacy of percutaneous drill-biopsy under computed tomography guidance of osteoid osteomas of the hip and femur. A review of seven cases.

UNLABELLED: En bloc surgical excision of osteoid osteomas of the hip and femur is difficult because of problems with tumor boundary identification and the need to use internal fixation or bone grafting. We report our experience with seven cases treated by percutaneous drill-biopsy under computed tomography guidance. PATIENTS: Six adults and one child with a mean age of 22 years treated since 1995. All seven patients reported insomnia due to pain during a mean of 10 months, improved by aspirin or other nonsteroidal anti-inflammatory agents. The tumor was seen on plain radiographs in four cases and on computed tomography scans in all seven cases. Magnetic resonance imaging was diagnostic in only two cases. The tumor was in the femoral neck in four patients, in the acetabulum in one, in the proximal femur in one, and at the distal diaphyseal-metaphyseal junction of the femur in one. METHOD: A trephine was used to remove the tumor under computed tomography guidance during a short general anesthesia. RESULTS: No serious complications were recorded. Full weight bearing was allowed starting at the forty-eighth hour in six of the seven patients. Immediate pain relief and a full recovery were obtained in every case. Results were excellent in four patients and good in three after a follow-up of 14 to 44 months. CONCLUSION: Percutaneous drill-biopsy of osteoid osteomas is a valuable alternative to conventional surgery in patients with tumors at sites that are difficult to access. The technique allows early weight bearing and ensures a full recovery.

Adolescent↗
PubMed2000

[Imaging of synovial lesions, neoplastic or non-neoplastic].

The purpose of this paper is to present the contribution of imaging in the assessment of synovial diseases, especially in the differentiation between infectious synovitis and rheumatoid arthritis, and in the diagnosis of tumoral and pseudotumoral synovial lesions (idiopathic (osteo)chondromatosis, pigmented villonodular synovitis, synovial hemangioma, lipoma arborescens...).

Bone Neoplasms↗
PubMed2000

Rheumatologic manifestations of pachydermoperiostosis and preliminary experience with bisphosphonates.

OBJECTIVE: Pachydermoperiostosis is manifested by finger clubbing, hypertrophic skin changes, and periosteal bone formation. We describe 5 cases revealed primarily by their rheumatologic manifestations. Also reported are preliminary experiences on the use of intravenous pamidronate as a treatment. METHODS: This is a retrospective study including the analysis of clinical manifestations, laboratory results and morphological examinations gathered from patients' medical records. We evaluated efficacy of treatment with 1 mg/kg iv pamidronate in the 3 new cases. RESULTS: Before treatment with iv pamidronate, the patients' global assessment was poor (twice) and very poor (once). The physician's global assessment was poor in 3 patients. After treatment with iv pamidronate, 2 patients had significant improvement. Physician and patient global assessments were very good, good, and moderate. No side effects were observed. All biological variables were within normal ranges at 12 month followup visit. CONCLUSION: Pachydermoperiostosis must be recognized by the rheumatologist, since it can present symptomatically through articular manifestations. When conventional treatment modalities fail, iv pamidronate might be useful.

Adult↗
PubMed1999

Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study.

OBJECTIVE: To assess the efficacy and safety of percutaneous vertebroplasty in osteoporotic vertebral compression fractures responsible for severe and persistent pain. METHODS: Sixteen patients were included in this open prospective study. Inclusion criteria were: one or 2 vertebral fractures responsible for severe pain, i.e., higher than 50 mm on a visual analog scale (VAS: 0-100 mm), scores 3, 4 or 5 according to the McGill-Melzack scoring system, and evolving for more than 3 months. Assessment criteria were the changes over time (Days 3, 30, 90, 180) in VAS and McGill-Melzack scoring system. The changes over time in a generic health status instrument score [the Nottingham Health Profile (NHP)] were also assessed. Statistical comparisons were performed using the Wilcoxon T test. RESULTS: There were 9 women and 7 men: postmenopausal osteoporosis (n = 7), corticosteroid induced osteoporosis (n = 2), and male osteoporosis (n = 7). Vertebroplasty was performed in 20 vertebrae. A statistically significant decrease of both VAS (-53%, p < 0.0005) and McGill-Melzack scoring system (p < 0.005) was observed at Day 3. The results were also significant at Days 30, 90, and 180 for both scales (p < 0.005 and p < 0.01, respectively). A significant decrease over time for 5/6 dimensions of the NHP score was also noted: pain (p < 0.01), physical mobility (p < 0.05), emotional reactions (p < 0.05), social isolation (p < 0.05), and energy (p < 0.05). We observed no adverse event, and no vertebral fracture has occurred after 6 months of followup. CONCLUSION: Percutaneous vertebroplasty is a useful and safe procedure for treating persistent painful osteoporotic fractures. Controlled studies with longterm followup are required.

Aged↗
PubMed1998

[Malignant melanoma of soft tissues. Apropos of a case].

A case of malignant melanoma of the quadriceps tendon is reported. This is an uncommon soft tissue sarcoma of melanocytic origin. The appearance on MRI depends on its melanin content. The microscopic appearance is distinctive and prognosis is poor. This tumor should be kept in mind when a nodular lesion is detected in specific tendon or aponeurosis.

Diagnosis, Differential↗
PubMed1997

Natural course of erosive arthropathy of the hand in patients undergoing hemodialysis.

OBJECTIVE: To assess the radiographic features of erosive arthropathy of the hands occurring in patients undergoing hemodialysis, and its relationship with metabolic abnormalities. PATIENTS AND DESIGN: A retrospective study of hand radiographs of 80 patients on maintenance hemodialysis was performed with the aim of detecting erosive arthropathy. RESULTS AND CONCLUSIONS: Ten patients showed erosive arthropathy of the hands with a predilection for distal interphalangeal joints. The first joint abnormality was joint space narrowing with or without erosion. The mean duration of hemodialysis was 5 years (range 1-15 years). The development of arthropathy could not be related to a metabolic factor. The pathogenesis of arthropathy of the hands is possibly multifactorial, accounting for the disparate descriptions of the radiographic features in the literature.

Adult↗
PubMed1997

Percutaneous vertebroplasty in patients with osteolytic metastases or multiple myeloma.

UNLABELLED: Osteolytic metastases and spinal myeloma lesions are difficult to treat because they denote disseminated malignant disease. The pain-relieving and other effects of radiation therapy are delayed. We evaluated short- and medium-term outcomes of vertebroplasty in this indication, in patients with severe or excruciatingly severe pain (McGill-Melsack score 4 or 5) unresponsive to narcotics. PATIENTS AND METHODS: forty vertebras were treated in 37 patients including 29 with bone metastases and eight with multiple myeloma. Mean age was 58 years (range 36-83). The spinal segment involved was the cervical spine in five cases, the thoracic spine in 12 and the lumbar spine in 23. Vertebroplasty was done under fluoroscopy guidance after premedication and local anesthesia. RESULTS: thirty-six patients (97.3%) reported a decrease in their pain 48 hours after the procedure; five of these patients (13.5%) were completely free of pain, 20 (55%) were significantly improved and 11 (30%) were moderately improved. One patient failed to respond. The clinical results were not correlated to the extent of vertebral body filling. Beneficial effects were increased or unchanged in 100% of cases after one month, 88.9% after three months and 75% after six months. Leakage of the cement outside the vertebral body occurred in 29 cases (72.5%), usually into the paraspinal soft tissues (n = 21,52.5%). Leakage was usually clinically silent and only two patients developed severe nerve root pain due to leakage into a neural foramen, with in both instances a favorable outcome after surgery. CONCLUSION: Vertebro- plasty is simple and effective for the treatment of osteolytic metastases and multiple myeloma lesions, but should be performed only in centers with neurosurgical and/or orthopedic surgery units because of the possibility of severe complications.

Adult↗
PubMed1997

[Sacral nerve root cysts. Discussion on the mechanism of nerve root suffering. Apropos of 4 cases].

Low back pain, sciatia or perineal chronic pain are sometimes related to perineural sacral cysts. Surgical treatment is difficult and may lead to pain or neurological worsening. We report four cases of symptomatic perineural cysts; three of them where operated on with two good results and one increasing perineal pain. Anatomical and radiological description are reviewed. From a therapeutical point of view, we can distinguish two clinical types of radicular suffering. Perineural cyst can cause a commun radicular extrinsic compression; in such a case surgical operation will improve radicular pain. The cystic nerve root can present an intrinsic suffering because of on intradural dilaceration. Then surgery must be avoided specially when many roots are involved because it may worsen the pluriradicular suffering.

Adult↗
PubMed1997

[Value of peroperative endoscopy in treating giant lumbosacral meningocele].

Lombosacral meningocele may be responsible for sciatica, low backache, cauda equina syndrome according to their localization and size. When they are symptomatic, the surgical purpose is to close the communication between the meningeal sac and the cyst. For giant meningocele, acute localization of the communication may be difficult. In such cases, peroperative endoscopy may be useful. We present a case of sciatica related to a giant meningocele extended from L2 to S2. MRI, CT scan and myelography were unable to localize the communication. We used peroperative endoscopy for direct visualization of the communication in order to minimize the surgical approach. An intrathecal nerve root was found strangulated in the communication suggesting an original kind of nerve root suffering. The communication was only closed. The patient made an uneventful recovery with complete relief of symptoms. Magnetic resonance imaging 3 months later showed a significant decrease of the meningocele without any further radicular compression.

Adult↗
PubMed1997

[SAPHO syndrome and aseptic osteitis].

Palmoplantar pustulosis and severe acne are sometimes associated with aseptic skeletal lesions, but such skeletal conditions can be observed without skin lesions. The acronym SAPHO (Synovitis, Acne, Palmoplantar pustulosis, Hyperostosis, Osteitis) has been suggested for this cluster of manifestations. The most frequent site of the disease is the upper anterior chest wall, characterized by predominantly osteosclerotic lesions, hyperostosis, and arthritis of the adjacent joints. Osteosclerosis of the vertebral bodies, hyperostosis, and erosions of the vertebral plates can be encountered. Unilateral sacroiliitis of frequently observed. Long bone involvement consists of osteosclerosis or osteolysis with periosteal new bone formation. Peripheral arthritis is rarely associated with joint destruction. The pathogenesis of this syndrome remains unknown, but a link with seronegative spondylarthropathies is probable. Awareness of the SAPHO syndrome should facilitate proper diagnosis and treatment.

Acquired Hyperostosis Syndrome↗
PubMed1996

Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up.

PURPOSE: To determine whether the percentage of vertebral lesion filling and the leakage of methyl methacrylate have any clinical significance at follow-up. MATERIALS AND METHODS: Forty percutaneous vertebroplasties were performed for metastases (30 cases) and myeloma (10 cases) in 37 patients. A computed tomographic scan was obtained 1-8 hours after methyl methacrylate injection and was used to assess the percentage of lesion filling by methyl methacrylate and the leakage of methyl methacrylate into the epidural tissues, neural foramina, intervertebral disks, venous plexus, and paravertebral tissue. The results were correlated with those obtained at clinical follow-up. RESULTS: Partial or complete pain relief was sustained in 36 of 37 patients. Pain relief was not proportional to the percentage of lesion filling. Clinical improvement was maintained in most patients. The 15 epidural leaks, eight intradiskal leaks, and two venous leaks of methyl methacrylate had no clinical importance. Two of eight foraminal leaks produced nerve root compression that required decompressive surgery. One of 21 paravertebral leaks produced transitory femoral neuropathy. CONCLUSION: Pain relief can occur despite insufficient lesion filling. In most patients, intradiskal and paravertebral leaks of cement had no clinical importance.

Bone Cements↗
PubMed1996

Evaluation of destructive spondyloarthropathies in hemodialysis by computerized tomographic scan and magnetic resonance imaging.

OBJECTIVE: The incidence of destructive spondyloarthropathies (SpA) in hemodialysis can reach 50% after 10 years of treatment. Few studies have analyzed the magnetic resonance (MR) appearance of destructive SpA and data are controversial. Our objective was to evaluate the computerized tomographic (CT) scan and MR appearance of destructive SpA in comparison to infectious spondylodiscitis. METHODS: 23 destructive SpA were observed in 11 patients who had undergone hemodialysis [mean duration of treatment 12 years (89-228 mo)]: 17 SpA of the cervical spine, one of the dorsal, and 5 of the lumbar spine. CT scans at all levels demonstrating narrowing and discovertebral erosions were performed without injection. MRI was performed with T1 and T2* weighted spin echo sequences (0.5T) without gadolinium injection. Radiographs were analyzed by 2 independent examiners. The data concerning MRI of infectious spondylodiscitis were based on a study of 57 personal cases and literature reports. RESULTS: CT scan appearance was similar in all cases, especially showing multiple small well defined lucencies of the vertebral endplates. In 9 patients, MRI showed low signal intensity of the disk and the adjacent vertebral endplates on T1 and T2* sequences. In no case was discal or vertebral high signal intensity on T2* sequence noted. No periodontoidal pseudotumor was observed. CONCLUSION: CT scans and MRI of destructive SpA, even nonspecific, are different from those observed in infectious spondylodiscitis, particularly due to the absence of discal and vertebral hypersignal on T2* sequences.

Aged↗
PubMed1996

[Spinal tuberculosis. Study of clinical and radiological aspects from a series of 82 cases].

We present a retrospective study of 82 cases of spinal tuberculosis diagnosed over the last 30 years. An increasing incidence of this disease not related to HIV infection has become apparent since 1992. 24% of patients were born outside continental France. The intradermal reaction was negative in 10% of patients. Discovertebral lesions detected in 93% of patients was the most frequent radiological presentation. Spondylitis with osteolysis or bone sclerosis at single or multiple levels was seen in the others. Tuberculous lesion of the posterior arch was associated in 10% of patients. In most cases CT scan showed a fragmentary vertebral destruction which was characteristic of the disease. MRI revealed the precise extent of the lesions into the spinal canal. Morphologic features suggestive of the tuberculous nature of paravertebral abcesses could be demonstrated when slices were performed in the axial or coronal plan. Tuberculous involvement of the spine is still a frequent disease. The main clinical and radiological findings are presented.

Adolescent↗
PubMed1996

Preoperative percutaneous injection of methyl methacrylate and N-butyl cyanoacrylate in vertebral hemangiomas.

PURPOSE: To investigate the usefulness of preoperative percutaneous injections in vertebral hemangiomas. METHODS: Four patients presented with complicated vertebral hemangioma (spinal cord compression in three cases, intermittent spinal claudiction in one case). A three-part treatment was performed: initially, arterial embolization in three cases; 1 day later, percutaneous injections of methyl methacrylate into the vertebral body to strengthen it and of N-butyl cyanoacrylate into the posterior arch to optimize hemostasis during surgery; finally, the day after percutaneous injections, decompressive laminectomy and epidural hemangioma excision (when present). RESULTS: Laminectomy was performed with minimal blood loss. The epidural component present in three cases was excised without any difficulty. The follow-up (average, 20 months) showed no evidence of vertebral collapse. CONCLUSION: Percutaneous injections of methyl methacrylate and N-butyl cyanoacrylate might be useful before surgery for vertebral hemangiomas.

Aged↗
PubMed1995

Synovial haemangioma of the knee: a frequently misdiagnosed lesion.

OBJECTIVE: The objective of this study was to assess the contribution of magnetic resonance (MR) imaging in the diagnosis and surgical planning of five cases of synovial haemangioma of the knee. PATIENTS AND METHODS: The clinical, radiological and arthroscopic features of five pathologically proven synovial haemangiomas of the knee were retrospectively reviewed. RESULTS: A diagnostic delay, on average of 8 years, had occurred in four of the cases. Plain films were unremarkable, except for one case with arthropathy mimicking haemophilia, Arteriography, performed in three patients, was normal in one. CT, performed in three patients, showed the lesion, but the extent of the latter was better demonstrated with MR imaging. Synovial haemangiomas had a high signal intensity of T2-weighted images, without any extensive mass effect. Fibrofatty septa within the lesion were observed in three cases and muscular and/or fatty invasion in two. Arthroscopy allowed diagnosis of the lesion in two cases, but showed only nonspecific synovitis in another two. CONCLUSION: This study emphasizes the valuable contribution of MR imaging in the diagnosis and surgical planning of synovial haemangiomas.

Adolescent↗