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Biomedical subjects

P Otal

Publications and source records attributed to P Otal.

At least 19 recordsLinked to original sources
PubMed2007

Familial adrenocorticotropin-independent macronodular adrenal hyperplasia with aberrant serotonin and vasopressin adrenal receptors.

ACTH-independent macronodular adrenocortical hyperplasia (AIMAH) is rare and generally presents as a sporadic disease. We describe a familial case of AIMAH with in vivo and in vitro demonstration of aberrant 5-HT4 and vasopressin adrenal receptors. Two sisters presented with clinical and biological features of mild Cushing's syndrome with bilateral macronodular adrenal enlargement on computerized tomography (CT)-scan evaluation. In vivo pharmacological tests showed a significant increase in plasma cortisol after terlipressin and metoclopramide administration. Unilateral adrenalectomy was performed in one of these patients. Reverse transcriptase-PCR analysis of the hyperplastic tissue revealed expression of 5-HT4 receptor isoforms (a), (b), (c), (i), and (n), and of vasopressin receptors, V1 and V2. Their father and brother were overweight, had easy bruisability and presented with biological features of subclinical Cushing's syndrome. CT scan showed moderate adrenal enlargement. In vivo pharmacological screening tests for the detection of adrenal aberrant receptors in the brother were negative. Finally, three out of the two sisters' children were evaluated. They had neither clinical nor biological features of Cushing's syndrome. Their adrenal glands were normal on CT-scan evaluation. In vivo evaluation for the detection of aberrant adrenocortical receptors performed in one of these subjects was negative. In conclusion, this study shows that (i) familial AIMAH could be an autosomal dominantly inherited disorder; (ii) aberrant 5-HT4 serotonin and vasopressin receptors can be expressed in familial AIMAH; and (iii) phenotypic expression of familial AIMAH could be varied in a same family and more pronounced in female than in male patients.

Adrenal Glands↗
PubMed2006

[Role of modern cross-sectional imaging in thanatology: a pictorial essay].

The development of new imaging modalities such as computed tomography and magnetic resonance imaging is a new phenomenon in thanatology. The growing accessibility to these technologies allows, under some conditions, the acquisition of cross-sectional images on cadavers. The authors present a practical pictorial review of post-mortem changes and deadly injuries, illustrating the contributions of modern cross-sectional imaging techniques in thanatology.

Adolescent↗
PubMed2006

[Role of embolization in renal angiomyolipomas].

OBJECTIVE: The purpose of this study is to present the role of embolization in the treatment of renal angiomyolipoma (AML) in cases of hemorrhage and to prevent bleeding. METHODS: Over a period of 10 years, 35 AMLs in 34 patients, recruited in two medical centers, were treated with embolization: 16/35 AML were treated urgently to stop bleeding, and 19/35 AML had preventive embolization. Six patients were completely asymptomatic and 13 had a history of previous hematoma or flank pain. Catheterization was highly selective in all cases (coaxial microcatheter in 19 cases), and for embolization we used nonresorbable microparticles, coils, and alcohol. RESULTS: When patients presented with acute bleeding, embolization was efficient in 80% of cases; another embolization was necessary in two cases, and surgery in two others. In six of these cases, surgery was planned and done at a later date. When treatment was preventive, one embolization was necessary in 17 cases, and two embolizations per case were necessary in the other two. Over a period of 18 months of follow-up, we observed a 28% decrease in tumor volume; four patients were treated by surgery at a later date. CONCLUSION: Embolization is the technique of choice to treat a bleeding AML urgently. When preventive treatment is considered, in symptomatic or asymptomatic AML, embolization can be an alternative for surgery, but more data is needed to specify its proper place in the management of these tumors.

Adult↗
PubMed2005

Acute traumatic aortic rupture: a comparison of surgical and stent-graft repair.

OBJECTIVE: The study's objective was to comparatively evaluate surgery and stent-graft repair of acute or subacute traumatic aortic rupture. METHODS: A total of 76 patients (14-76 years old; mean, 37 years; male/female ratio, 63/11) with a traumatic aortic injury were admitted to our hospital between 1981 and 2003. Six patients died within 1 to 9 days of another associated severe traumatic lesion. The 70 remaining patients were divided according to the type of rupture repair. In group 1, 35 patients were treated surgically: 28 with immediate repair and 7 with delayed repair (average time interval 66 days, 5-257 days). In group 2, 29 patients were treated with stent grafting of the aortic isthmus. In group 3, 6 patients with minor aortic lesions were treated medically with a close follow-up. RESULTS: In the 28 patients treated surgically in the emergency department, the mortality and paraplegia rates were 21% and 7%, respectively. No death or paraplegia was observed in the group with delayed surgical repair. With stent grafting, complete exclusion of the pseudoaneurysmal sac was observed in all patients. Except for 1 iliac rupture treated during the same procedure, there was no major morbidity or mortality during the mean follow-up of 46 months (13-90 months). No major complication was observed in group 3. CONCLUSIONS: In stable rupture of the aorta, initial conservative treatment is safe and allows management of the major associated lesions. Stent grafting of the aortic isthmus is a valuable therapeutic alternative to surgical repair, especially in patients considered high risk for conventional thoracotomy.

Accidents, Traffic↗
PubMed2005

Stent-graft repair of thoracic aortic aneurysms.

Endovascular treatment of aortic disease has emerged as an alternative mode of treatment that is particularly attractive for patients with severe comorbidities who would not be ideal candidates for open surgery. Actually, short-term morbidity and mortality rates, of large series, compare favorably with those from surgery, and stent-graft placement is proving to be a safe, minimally invasive, and effective treatment for thoracic aortic diseases. However, although endoluminal interventions are minimally invasive, they are associated with complications, as are surgical methods. In this article, indications, technical aspects, and results of endovascular TAA repairs will be reviewed. We will also examine the advantages and limitations of stent-graft treatment. Finally, we will discuss the management of complications following aortic stent-graft implantation. We intentionally do not cover the topic of thoracic dissection, as it is being covered in another article in this volume.

Aortic Aneurysm, Thoracic↗
PubMed2004

[Imaging of the thoracic aorta in adults: when, how and why?].

CT, MRI and transesophageal echocardiography have become the standard of reference for evaluation of the thoracic aorta. Angiography is mainly performed as a presurgical procedure. Congenital pathologies observed during adulthood include coarctation, patent ductus arteriosus, and aberrant retroesophageal subclavian arteries. Imaging plays a major role for diagnosis and management of patients with acute aortic syndromes: intramural hematoma, dissection, penetrating ulcer and nondissecting aneurysms. Cross sectional imaging of the thoracic aortic wall allows evaluation of inflammatory diseases of the aorta or aortitis.

Adult↗
PubMed2003

Measurements of extracellular volume fraction and capillary permeability in tissues using dynamic spin-lattice relaxometry: studies in rabbit muscles.

Dynamic MR longitudinal R(1) relaxometry after administration of a gadolinium contrast bolus (Gd-DTPA) has been used for in vivo measurements of the extracellular volume fraction (v) and the capillary permeability (k min(-1)) in rabbit muscles to distinguish between red slow- and white fast-twitch muscle fiber types. For this purpose a protocol imaging sequence has been used which allows fast R(1) measurements during the contrast agent uptake. Physiological tissue parameters, k and v, were obtained by computing procedures assuming a simplified monoexponential plasma model. These were shown to be about twice as large in the slow-twitch semimembranosous proprius muscle (SP), containing 100% oxidative type-I fiber, that in the fast-twitch rectus femorus muscle (RF), containing only 6% type-I fiber type. The capillary permeability has been found to be 0.25 +/- 0.02 min(-1) for the (SP) and 0.10 +/- 0.01 min(-1) for the (RF). Similarly, the extracellular volume fractions were 0.189 +/- 0.015 and 0.082 +/- 0.006 respectively, in close agreement with literature data and experimental results obtained by invasive radionuclide measurements. For the pool of the 10 studied animals, no significant variation among animals was observed in the extracellular volume fraction and the capillary permeability for the different muscle fiber types. The dynamic relaxometry method used is easy to implement on conventional MR imagers and has potential applications in muscle diseases. The method has also potential applications for tissue characterization based on extracellular volume and capillary permeability quantification. In particular, the method can be used for the evaluation of tumors and their responses to therapies.

Animals↗
PubMed2003

[Leiomyosarcoma of the inferior vena cava].

Leiomyosarcoma of the inferior vena cava is a rare tumor of mesenchymal origin most commonly found in women. Clinical signs are non-specific. Imagery with ultrasound, CT, or MRI may strongly suggest the diagnosis, but it can only be confirmed by histologic examination of tissue obtained pre or intra-operatively. The tumor is slow growing but nonetheless carries a bad prognosis; it may grow to a large size before directly invading adjacent structures. Systemic spread is a late occurrence. Radical surgical resection is the only treatment which offers any hope for prolonged survival. Standard vascular surgical techniques are usually sufficient. Progress in the techniques of hepatectomy and liver transplantation have allowed the experienced surgeon to undertake the removal of retrohepatic lesions once considered unresectable. High-lying lesions adjacent to the hepatic veins or with thrombus extending into the proximal vena cava may require extracorporeal circulation with or without profound hypothermic circulatory arrest. The efficacy of chemotherapy, whether pre-operative for inaccessible tumors or post-operative for incompletely resected or recurrent tumor, is poorly defined and very limited.

Aged↗
PubMed2003

[The lower limb of elderly patients (venous and arterial diseases)].

Elderly patients frequently suffer from vascular pathologies of the leg. In these more fragile patients, diagnostic work-up must cause as little trauma as possible. The clinical status and morphological appearance of the vessels make vascular investigations sometimes difficult to perform in the elderly. With arterial pathology, vascular imaging relies on numerous non invasive techniques (Duplex scan and vascular imaging techniques by reconstruction: helical CT and magnetic resonance angiography). The clinical exam, the evolution stage of arterial disease and these non invasive investigations must allow to select the patients that should benefit from an arteriography, more or less associated to revascularization. With thrombo-embolic pathology, venography has now been replaced by venous duplex scan of the lower limbs irrespective of the underlying thrombotic etiology.

Adult↗
PubMed2001

Long-term results of endovascular stent placement in the superior caval venous system.

PURPOSE: To present the long-term results in superior caval stenting for symptomatic obstruction. METHODS: Forty-nine stents were placed in 30 patients: 16 (53%) with malignant lesions, five (17%) with benign lesions and nine (30%) hemodialysis patients. Self-expandable stents were deployed on a first-line basis. Patients were followed clinically as well as by various imaging techniques and survival analysis was performed. RESULTS: Stent deployment was possible in all cases. Reocclusion was seen in 13 patients, of whom eight belonged to the hemodialysis group. Primary and secondary patency rates for malignant, benign and hemodialysis patients were respectively 74%, 50% and 22%, and 74%, 75% and 56% at 1 year. We had 7% complications and one death from iatrogenic superior vena cava injury. CONCLUSION: Primary stenting of superior caval obstruction is a first-choice treatment method achieving good mid-term patency. Patients with hemodialysis shunts must be closely monitored for early reintervention.

Adenocarcinoma↗
PubMed2001

[Risk of embolism in diagnostic and therapeutic intravascular procedures--in vitro model].

The purpose of the study was to evaluate the risk of distal embolisation in a silicon model during different endovascular diagnostic and therapeutic procedures. Endovascular technics, such as guidewire and catheter advancement, metal stent placement, balloon angioplasty and thrombectomy device were compared. Clots were produced from human blood sample. The transparent silicon model was filled with saline, flow was generated by an hydraulic pump. Stenosis was created by mechanical compression. The size of the circulating particles were measured with a mesh of nylon filters. No loose particles were detected using guidewire, pigtail and straight catheters. Balloon inflation induced embolisation of particles ranging from 100 microns-12 mm in length. Deployment of self expandable metallic stents did not result in particle migration but secondary angioplasty inside the stent detached particles (ranging from 400 microns to 12 mm in length). Use of thrombectomy device resulted in significant particle migration (ranging from 400 microns to 1500 microns in length).

Angioplasty, Balloon↗
PubMed2001

Imaging of retroperitoneal ganglioneuroma.

The aim of this study was to describe the radiological appearance of retroperitoneal ganglioneuroma. We retrospectively reviewed seven cases of histologically proven retroperitoneal ganglioneuroma. Ultrasound and enhanced CT were obtained in all cases, and MRI in three cases. The masses were well-circumscribed, ranged in size from 5 x 3 x 3 to 10 x 6 x 4 cm. In three cases close relationships between the tumor mass and major blood vessels were noted, resulting in vessel displacement or surrounding, but without compression or occlusion. On ultrasound examination the tumor showed a heterogeneous solid echostructure. Non-enhanced CT showed homogeneous or mildly heterogeneous low attenuation, and a punctate calcification was seen in one case. Contrast uptake was absent (n = 1) or delayed (n = 6). Progressive but incomplete enhancement was observed in three cases. On MRI, T2-weighted images showed a high signal intensity. Dynamic studies depicted the same enhancement pattern as described on CT. Ganglioneuroma is a rare tumor which should nevertheless be included in differential diagnosis of retroperitoneal masses when presenting as a well-delimited tumor with possible tendency to surround or displace major blood vessels, low density on non-enhanced CT, and delayed progressive enhancement on CT and MRI.

Adult↗
PubMed2001

The 6-F nitinol TrapEase inferior vena cava filter: results of a prospective multicenter trial.

PURPOSE: The authors report the first results of a new 6-F symmetrically designed permanent nitinol inferior vena cava (IVC) filter, the Cordis TrapEase, evaluated in a multicenter prospective study with 6-months of follow-up. MATERIALS AND METHODS: A total of 65 patients (29 men, 36 women) who ranged in age from 37 to 96 years (mean age, 68 years) and who were at high risk of pulmonary embolism (PE) were enrolled in 12 centers in Europe and Canada. The study was approved by the institutional review boards at all centers. Study objectives were to evaluate filter effectiveness, filter stability, and caval occlusion. Indications for filter placement were deep vein thrombosis with recurrent thromboembolism and/or free-floating thrombus with contraindication to anticoagulation in 37 patients, and complications in achieving adequate anticoagulation in 28 patients. Follow-up included clinical examination, plain film, Doppler ultrasound, CT scan, and nuclear medicine. RESULTS: The analysis of the data revealed a technical success of 95.4% (three filter-system related implantations not at the intended site, no events of filter tilting) and a clinical success of 100% at 6 months (no cases of symptomatic PE), the study primary endpoint. There were no cases (0%) of filter migration, insertion site thrombosis, filter fracture, or vessel wall perforation. During the study period, there were two cases of filter thrombosis: one case of early symptomatic thrombosis that was successfully treated in the hospital, and one case of nonsymptomatic filter thrombosis detected at 1-month follow-up, with spontaneous recanalization at 3 months. In the latter patient, some residual thrombus was still detected at 6 months. Of the study population of 65 patients, there were 23 deaths. These deaths were not related to the device or the implantation procedure but to the underlying disease process. CONCLUSION: This study demonstrates the new nitinol permanent IVC filter to be a safe and an effective device, with a low overall complication rate, for use in patients with thromboembolic disease at high risk of PE.

Aged↗
PubMed2001

Macroporous polyester-covered stent in an experimental abdominal aortic aneurysm model.

PURPOSE: To validate a recently described animal model of abdominal aortic aneurysm (AAA) and to assess a new macroporous polyester-covered stent for endovascular AAA exclusion. METHODS: Twenty adult sheep had AAAs surgically created by replacing a segment of the infrarenal aorta with an autologous jugular venous graft. Three months later, surviving animals underwent percutaneous implantation of macroporous polyester-covered nitinol stents; 3 animals with untreated AAAs served as controls. Follow-up surveillance included spiral computed tomography at 1 month and digital subtraction angiography at 3 and 6 months. Endografted animals were sacrificed at 1, 3, and 6 months after implantation; specimens from all animals were examined grossly and microscopically. RESULTS: Seven (35%) animals died within 24 hours of causes related to the technique; 1 animal developed paraplegia and was sacrificed on day 1. Three (25%) animals died of spontaneous aneurysm rupture at <10 days, and 6 received the stent-graft at 3 months. The macroporous cover did not prevent continued perfusion of the sac early after stent-graft deployment, but all aneurysms were excluded on the 1-month CT. CONCLUSIONS: Spontaneous AAA rupture occurred earlier and was not as frequent as previously described for this model. Implantation of the covered stent was feasible, but aneurysm exclusion was not immediate.

Animals↗
PubMed2001

Pseudoaneurysm and aortobronchial fistula after surgical bypass for aortic coarctation: management with endovascular stent-graft.

PURPOSE: To report the endovascular repair of an aortobronchial fistula at the distal anastomosis of a complex thoracic graft. CASE REPORT: A 61-year-old man operated 18 years prior for aortic coarctation presented with hemoptysis. An aortobronchial fistula was suspected, but spiral computed tomography and angiography showed only a small pseudoaneurysm at the distal anastomosis without revealing the fistulous tract. A Talent stent-graft was successfully deployed through a femoral access, but the large delivery system injured the external iliac artery, producing a retroperitoneal hemorrhage. Prompt balloon occlusion of the aorta and subsequent bypass graft repair of the arterial injury prevented serious sequelae. The patient recovered without further complications. Follow-up imaging to 2 years has documented exclusion of the pseudoaneurysm with no hemoptysis or signs of new false aneurysm formation. CONCLUSIONS: Endovascular exclusion of anastomotic pseudoaneurysms even in complicated cases can be an efficient treatment option, but the procedure must be carefully planned and executed in order to achieve good results.

Anastomosis, Surgical↗
PubMed2001

[Radiologic study of renal colic].

Ureterolithiasis is a common disease responsible for a large number of admissions in emergency departments and a wide utilization of imaging studies. The purpose of this review was to analyze the respective role of the different available imaging techniques. Intravenous urography is the gold-standard for diagnosis of acute obstruction, but positive detection of a stone may prove difficult at times. US is less accurate than urography for both diagnoses of obstruction and lithiasis, but it represents a non invasive alternative to IVU (no ionizing radiation and no IV contrast). The information obtained from measurements of intra-renal resistive index is poorly contributive. Non contrast helical CT has become the gold-standard for the diagnosis of ureterolithiasis, the two main factors limiting its widespread use are its accessibility and the radiation exposure. Nevertheless, its excellent diagnostic performance tends to dramatically reduce the need for IVU.

Colic↗