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Biomedical subjects

P Robillard

Publications and source records attributed to P Robillard.

At least 19 recordsLinked to original sources
PubMed1999

The value of internal carotid systolic velocity ratio for assessing carotid artery stenosis with Doppler sonography.

OBJECTIVE: The purpose of this study was to assess the value of the ratio between the internal carotid systolic velocity (ICSV) at the carotid bulb and the distal internal carotid systolic velocity (DICSV) for the detection of carotid artery stenosis. SUBJECTS AND METHODS: Two hundred eleven patients were enrolled in a prospective study comparing several Doppler measurements with carotid angiography. The following spectral measurements were obtained with Doppler sonography: ICSV/DICSV ratio, ICSV, ICSV/common carotid systolic velocity (CCSV) ratio, and internal carotid (end) diastolic velocity (ICDV). Receiver operating characteristic curves were generated for two groups: the first group being 365 carotid arteries for which all Doppler measurements were successfully obtained and the second being a subgroup of 258 carotid arteries for which an ICSV of 100 cm/sec or greater was present. RESULTS: In the group of 365 carotid arteries, the ICSV/DICSV ratio improved the detection of stenosis of 60% or greater as compared with the ICDV (p = .03). In 258 carotid arteries with an ICSV of 100 cm/sec or greater, the ICSV/DICSV ratio allowed for a better angiographic correlation for identifying stenoses of 60% or greater and 70% or greater as compared with ICSV (p = .006 and .023, respectively), ICSV/CCSV (p = .0013 and .003, respectively), and ICDV (p = .0015 and .020, respectively). CONCLUSION: Using the ICSV/DICSV ratio for the Doppler detection of carotid artery stenosis is advantageous when the ICSV is 100 cm/sec or greater.

Aged↗
PubMed1999

Comparison of early and delayed scintigraphy with 99mTc-apcitide and correlation with contrast-enhanced venography in detection of acute deep vein thrombosis.

UNLABELLED: Preliminary studies with 99mTc-apcitide (99mTc-P280), a synthetic peptide that binds to glycoprotein IIb/IIIa receptors expressed on activated platelets, have shown promising results in the detection of acute deep vein thrombosis (ADVT). The purpose of this study was to compare the diagnostic value of early and delayed imaging with 99mTc-apcitide in patients with suspected ADVT, using contrast-enhanced venography as the gold standard. METHODS: Thirty-nine patients (17 women, 22 men; mean age 59 y) with signs or symptoms suggestive of ADVT (within 10 d of onset) and scheduled for contrast-enhanced venography were prospectively studied. The patients were injected with approximately 740 MBq (20 mCi) 99mTc-apcitide within 36 h of contrast-enhanced venography. Both anterior and posterior planar images (8-10 min/view) of the lower extremities using a dual-head gamma camera were obtained at 10, 60 and 120 min after the injection of 99mTc-apcitide. The three sets of images initially were interpreted randomly and separately by three experienced observers unaware of the clinical history, the site of ADVT and results of contrast-enhanced venography. All images from the three sets for a given patient were then analyzed together during a second session. Conventional contrast-enhanced venography was performed on 31 patients before 99mTc-apcitide scintigraphy and in the remaining 8 patients after 99mTc-apcitide scintigraphy. 99mTc-apcitide findings were considered positive forADVT when a focus of increased uptake was found to correspond to the location of a deep vein. Disagreements were resolved by consensus. RESULTS: Twenty-two patients had ADVT observed on contrast-enhanced venography, whereas 17 had normal findings. Six cases of ADVT were infrapopliteal. One patient did not complete the third set of images with 99mTc-apcitide. The sensitivity of 99mTc-apcitide in detecting ADVT was 63.6% (14/22), 68.2% (15/22), 76.2% (16/21) and 86.4% (19/22) for images obtained at 10, 60 and 120 min and for the three sets analyzed together, respectively. The specificity was 82.4% (14/17), 76.5% (13/17), 88.2% (15/17) and 88.2% (15/17) for images obtained at 10, 60 and 120 min and for the three sets of images together, respectively. CONCLUSION: Although the set of 99mTc-apcitide images obtained 120 min after injection showed good overall diagnostic accuracy, the combination of at least two sets of images provided the highest accuracy in detecting ADVT.

Acute Disease↗
PubMed1998

Lower extremity: nonstepping digital angiography with photostimulable imaging plates versus conventional angiography.

PURPOSE: To compare nonstepping digital subtraction angiography (DSA) (ie, storage phosphor radiography adapted to a stationary imaging plate changer) with conventional screen-film angiography in the evaluation of the lower extremities. MATERIALS AND METHODS: Fifty-one patients with peripheral vascular disease underwent both nonstepping DSA and screen-film angiography. The angiographic and radiologic techniques of both systems were kept identical for each patient. Three radiologists independently rated the overall quality of each angiogram. In their evaluations for each of 12 arterial segments on all 102 angiograms, they also rated the degree of opacification, the diameter reduction of the most severe stenosis, and their level of confidence. RESULTS: Mean overall quality scores and levels of confidence were better for nonstepping DSA than for screen-film angiography (P < .001). Full opacification was reported in 95.6% and 89.2% of all 1,836 segments with nonstepping DSA and screen-film angiography, respectively (P < .0001). The difference between the mean stenosis grades obtained with screen-film angiography and nonstepping DSA was not statistically significant. Intertechnique agreements were good (kappa = 0.77, 0.81, and 0.81), whereas interobserver agreements were influenced by the observer's experience with the imaging techniques. CONCLUSION: Nonstepping DSA images of the lower extremity were of better diagnostic quality than were screen-film angiograms. The development of dedicated nonstepping DSA equipment is warranted.

Adult↗
PubMed1997

Treatment of renal angioplasty failure by percutaneous renal artery stenting with Palmaz stents: midterm technical and clinical results.

OBJECTIVE: Renal artery stenting has recently been used to treat failures or complications of renal angioplasty. Although technical results and complication rates have been reported, clinical follow-up and long-term data are limited. The purpose of this study was to evaluate the midterm clinical efficacy and safety of Palmaz stents in rescuing renal artery angioplasty failures. MATERIALS AND METHODS: Palmaz stents were placed in 35 renal arteries of 33 patients (14 men and 19 women; 37-77 years old; mean age, 62.6 years old) for immediate angioplasty failure (29 arteries) or for recurrent stenosis after previous angioplasty (six arteries). Indications for treatment were hypertension alone (16 patients) or hypertension associated with renal failure (17 patients). Blood pressure, medication, and serum creatinine level were followed after stenting. RESULTS: No residual stenosis was found immediately after stenting. Mean clinical follow-up was 13.4 months (range, 1-34 months). Of the 33 patients, two (6%) were cured of their hypertension, 20 (61%) were improved, and 11 (33%) did not respond to renal artery stenting. Of the 17 patients whose serum creatinine level was greater than 132 mumol/dl (1.5 mg/dl), seven (41%) were improved by renal artery stenting, six (35%) were stabilized, and renal function deteriorated in four (24%). Of the 33 patients, seven developed complications including one renal artery thrombosis, four renal artery emboli, one cholesterol embolization to the lower limbs, and one femoral hematoma that required surgery. CONCLUSION: Midterm results of renal artery stenting with the Palmaz stent to treat immediate or late angioplasty failures reveal improvements in blood pressure and renal function similar to those of successful primary balloon angioplasty.

Angioplasty, Balloon↗
PubMed1995

Percutaneous stent placement for treatment of stenosis of a portacaval H-graft shunt.

Surgical treatment of an occluded or stenotic portacaval shunt carries a high risk of mortality, but the rate of restenosis after transluminal angioplasty is also high. The authors report high-grade stricture of a portacaval H-graft shunt in a 51-year-old man, who presented with hematemesis and melena. The patient was treated with concomitant balloon angioplasty and placement of a metallic stent through a percutaneous venous approach. The procedure was tolerated well by the patient, and stenosis had not recurred at follow-up 1 year later.

Angioplasty, Balloon↗
PubMed1994

Malignant biliary obstruction: preliminary results of palliative treatment with hepaticogastrostomy under fluoroscopic, endoscopic, and laparoscopic guidance.

PURPOSE: To report a technique of peripheral biliary decompression by means of anastomosis of a bile duct in segment II of the liver to the lesser curvature of the stomach. MATERIALS AND METHODS: Seven patients with unresectable biliary neoplasm were treated. After transhepatic catheterization of a segment II bile duct, the left lobe of the liver and the lesser curvature of the stomach were perforated under fluoroscopic and laparoscopic guidance. Anastomosis between the biliary tree and the stomach was maintained with a gastrostomy tube placed across the tract. After 2 weeks, the tube was removed and patency of the tract was preserved with a metallic stent. RESULTS: Three patients died, at 3, 6, and 9 months, respectively, without reocclusion; the other four were alive at 5 months without jaundice. One patient had an episode of cholangitis, which was resolved with antibiotic therapy. CONCLUSION: This method yields a good patency rate with few problems. Further investigation is required to evaluate long-term patency and the necessity of laparoscopic guidance.

Aged↗
PubMed1994

Effectiveness of and compliance to preventive measures against the occupational transmission of human immunodeficiency virus.

To prevent the occupational transmission of human immunodeficiency virus (HIV) and other blood-borne infections in health care settings, guidelines have been issued as universal precautions and body substance isolation. Patient testing has also been advocated. The literature on the compliance to and effectiveness of these measures was reviewed and analyzed to establish the state of knowledge and make appropriate recommendations to improve guidelines. It showed that workers' compliance to recommended measures is relatively poor. The effectiveness and cost-effectiveness of universal precautions and body substance isolation remain to be demonstrated. Testing patients for HIV infection and other bloodborne pathogens does not appear to be a more appropriate solution. Focus should be placed on preventing parenteral exposures and applying risk assessment methods to identify health care settings and procedures at higher risk. These measures would allow safer medical devices to be targeted and would ensure that financial resources would be available to implement appropriate preventive measures.

Guidelines as Topic↗
PubMed1994

Use of chromosome painting for marker chromosome identification in two children with congenital disorders.

Identification of supernumerary de novo marker chromosomes was considered up to now as difficult and sometimes impossible with classical cytogenetical banding methods. The determination of their chromosomal origin is now easier with fluorescent in situ hybridisation techniques and enables an exact correlation between chromosomal aberration and phenotypic features to be established. The authors describe the use of chromosome painting with chromosome 13 and 18 Whole library DNA probe for identification of supernumerary markers in tow patients with congenital disorders. Cytogenetic examination in the first cave revealed a mosaicism with a ring chromosome 13 but clinical findings were different from the classical "ring 13 syndrome', and chromosome painting revealed in an extra--dicentric 13 chromosome (mos : 47, XX, -13, +r (13) +dic (13) / 46, XX, r (13) / 45, XX, -13 / 48, XX, -13, +r (13), (12) dic (13) / 47, XX, -13, + (2) r (13), R-banding pattern on prometaphases and chromosome painting in the second case confirmed the marker to be a 18 p isochromosome (47, XX, +i (18p)). The feasibility and the usefulness of chromosome painting in ascertainment of the possible genetic significance of markers is discussed.

Chromosome Banding↗
PubMed1992

Effects of brief early exposure to partially hydrolyzed and whole cow milk proteins.

Clinical experience ("the dangerous bottle") and experimental evidence indicate that the early life of an infant is particularly important for the development of the immune responses to food antigens. However, the clinical and immunologic consequences of a brief exposure to, or avoidance of, food antigens during the neonatal period in human infants are poorly understood and documented. We present the preliminary results of a prospective controlled study of 256 normal breast-fed infants randomly assigned to receive (blind) either an adapted formula (Nidina) or a partially hydrolyzed formula (Nidal HA) as a supplement to breast-feeding for a few days when necessary, and to be examined at days 5, 90, 150, and 365. The results indicated that (1) the prevalence of clinical symptoms and of total and specific IgE responses was not statistically different in the two groups of infants and (2) infants fed a hydrolyzed formula had median titers of specific IgG lower than those fed an adapted formula; the difference was significant for alpha-lactalbumin at day 90 (p < 0.005) and for alpha-lactalbumin (p < 0.05), casein (p < 0.05), and hydrolyzed formula (p < 0.01) at day 150. Humoral immune responses of breast-fed infants to food antigens thus appear to be modulated by early, short-term exposure to them.

Breast Feeding↗
PubMed1991

Computer analysis and pattern recognition of Doppler blood flow spectra for disease classification in the lower limb arteries.

In the present study, a computer processing method was developed to objectively classify disease in the lower limb arteries evaluated by noninvasive ultrasonic duplex scanning. This method analyzes Doppler blood flow signals, extracts diagnostic features from Doppler spectrograms and classifies the severity of the disease into three categories of diameter reduction (0-19%, 20-49% and 50-99%). The features investigated were based on frequency features obtained at peak systole, spectral broadening indices and normalized amplitudes of the power spectrogram computed in various positive and negative frequency bands. A total of 379 arterial segments studied from the aorta to the popliteal artery were classified using a pattern recognition method based on the Bayes model. Two classification schemes using a two-node decision rule were tested. Both schemes gave similar results, the first one provided an overall accuracy of 83% (Kappa = 0.42) and the second an overall accuracy of 81% (Kappa = 0.35) when compared with conventional biplane contrast arteriography. These performances, especially for the 0 to 19% lesion category, are better than the one obtained by the technologist (accuracy = 76% and Kappa = 0.33), based on visual interpretation of the Doppler spectrograms. To recognize hemodynamically significant stenoses (50-99% lesions), the pattern recognition system has a sensitivity and a specificity of 50% and 99%, respectively, using classification scheme I. With classification scheme II, the sensitivity and the specificity are 50% and 98%, respectively. Visual interpretation of the Doppler spectrograms leads to a sensitivity and a specificity of 50% and 98%, respectively. These results are the first to be obtained by a pattern recognition system in classifying lower limb arterial stenoses.

Adult↗
PubMed1989

[Distention arthrography in the treatment of adhesive capsulitis of the shoulder].

Adhesive capsulitis of the shoulder is an idiopathic condition characterized clinically by pain and limitation of movement. The characteristic arthrographic features are those of limited capacity of the joint, pain during injection, and retracted recesses. Progressive distension of the capsule with 1% lidocaine and 40 mg of triamcinolone acetonide (Kenalog) is a recommended form of treatment for this condition. Twenty-five patients treated by this method were reviewed retrospectively. Eleven (44%) were completely relieved of their symptoms, 6 (24%) had a 50% improvement, and 8 (32%) had no relief. Patients with idiopathic adhesive capsulitis responded more favorably to the treatment than those with a traumatic etiology. The duration of symptoms had no correlation with the results of therapy. There were no complications from the treatment.

Adult↗