Biomedical subjects

Pierre Champsaur

Publications and source records attributed to Pierre Champsaur.

13 recordsLinked to original sources

PubMed2006

A modified procedure for transjugular intrahepatic portosystemic shunt flow reduction.

The authors present a modified transjugular intrahepatic portosystemic shunt (TIPS) flow reduction procedure to treat TIPS-related refractory hepatic encephalopathy, giving the results and follow-up on six patients. A 6-mm-diameter Uni Wallstent was introduced over a guide wire and deployed beyond the angulated portion of the TIPS. A Wallgraft was then introduced over the same guide wire, pushed through the Uni Wallstent coaxially, and deployed in the TIPS. All cases were technically and clinically successful. There were no deaths in the first month after the procedure. In this study, three patients had more than 1 year's patency.

Adolescent↗

PubMed2005

"Occult" osteoporotic vertebral fractures: vertebral body fractures without radiologic collapse.

STUDY DESIGN: Retrospective observational study. OBJECTIVES: We report our experience with patients who presented with osteoporotic vertebral fractures with no visible deformation of vertebral body. SUMMARY OF BACKGROUND DATA: The diagnosis of osteoporotic vertebral fractures largely relies on the observation of vertebral deformations on plain radiographs, termed vertebral collapses. There are no data on the characteristics, or indeed of the reality, of osteoporotic vertebral fractures with no significant deformation of the vertebral body. METHODS: We retrospectively analyzed cases that presented with acute back pain with no initial deformation of the vertebral body on plain radiographs, and later proved to be fresh osteoporotic vertebral body fractures. All cases met each of the following criteria: 1) The incriminated vertebra appeared normal on initial radiographs (Genant's Grade 0 deformation). 2) The diagnosis of fresh vertebral body fracture was confirmed by MRI. 3) The diagnosis of osteoporosis was made by the combination of established osteoporosis, ruling out of underlying disease, and follow-up. RESULTS: We observed 21 fractures in 16 patients (11 female/5 male; mean age, 72 years). Most of these fractures affected the lumbar spine (14 of 21 occurred at L2-L5). Osteoporosis was known beforehand in 9 patients and newly diagnosed in 7 patients. At follow-up, radiographs were obtained for 19 of 21 fractures: in 15 cases, the vertebral fracture developed a vertebral collapse (Genant's Grade > or = 0.5) in a mean of 12.5 weeks (range, 4-24 weeks); in the 4 remaining cases, the vertebra remained normal. All cases had a clinically favorable outcome. CONCLUSION: Osteoporotic vertebral fractures with no sign of vertebral collapse on initial radiographs do indeed exist. They are analogous to occult stress fractures well known in other skeletal sites. They must not be misdiagnosed as malignant lesions.

Adult↗

PubMed2005

Anatomical bases of the bypass-flap: study of the thoracodorsal axis.

Cutaneous tissue loss in patients with lesions on the arterial axes remains difficult to treat. Currently, combined surgery associating distal bypass and free flap seems to be the technique that yields the best results. The hemodynamic advantages of this technique, recently demonstrated, are the distal resistance and the increase in bypass flow. Nevertheless, it is complex and its indications limited. Two major drawbacks can be noted: The increasing risk of thrombosis due to the multiplication of anastomoses on the same arterial axis and the deterioration in venous autograft. To overcome these inconveniences we propose a new technique that we call bypass-flap (BF): the graft of an anatomical entity comprised of one artery and one flap. This graft secures the cover of tissue loss and the revascularization of the limb. Apart from its combined nature this technique presents three major advantages. The arterial autograft is superior to the venous graft, the gradually decreasing diameter of the artery secures the congruence of the anastaomoses, and the arterial flow of the graft is higher than a simple bypass due to the joint vascularization of the flap. The arterial graft includes the subscapular and the thoracodorsal arteries. The free flap is composed of serratus anterior muscle supplied by branches of the graft. This investigation studied the feasibility of the bypass flap and determined the length and diameter of the arterial graft and its muscular branch. Forty anatomical preparations were performed on 20 cadavers. The dissections were performed after injection of Rhodorsil. The anatomical feasibility of the bypass flap was confirmed in 37 cases. The total length of the arterial graft that preserved an external diameter above 2 mm was measured at 13 cm (8.5-15.5). This includes the subscapular artery and the thoracodorsal artery with its intramuscular part (if external diameter of that part always above 2 mm). The length of the pedicle of the serratus anterior flap was measured at 7.5 cm (3.0-12.5 cm).

Aged↗

PubMed2004

The bypass flap: an innovative technique of distal revascularization--anatomical study and clinical application.

Combined surgery for placement of a distal venous bypass and a free flap enables successful treatment of tissue loss caused by ischemia. This complex surgery has limited indications. The multiple anastomoses on the same arterial axis increase the risk of thrombosis and a certain number of venous grafts are likely to undergo mid-term deterioration. Because of these difficulties, we propose a new concept: the bypass flap (BF), which is based on the harvesting of an arterial axis to provide an arterial graft and a free flap supplied by a collateral branch of the graft. The aim of the anatomic part of this study was to evaluate the length and diameter of the arterial graft and its tissue branch and to study the feasibility of the BF. Thirty-two anatomic preparations were made by intraarterial injection of Rhodosil in 16 cadavers. The arterial graft included the subscapular artery and the thoracodorsal artery. The flap consisted of the anterior serrate muscle supplied by the branch of that graft. The distribution, length, and diameter of the arteries were examined. The mean length of the arterial graft line maintaining diameter above 2 mm was 12.5 cm (8.5-15.5). Three clinical applications of the BF based on the thoracodorsal artery axis were performed on three patients with tissue loss caused by severe ischemia of the lower limb. No occlusion of the BF occurred and healing of the tissue loss was achieved after 4, 7, and 10 months, respectively. This technique has the advantage of decreasing vascular distal resistance, which may contribute to improvement of vessel reconstruction patency. It is simpler because the anastomoses are fewer and it presents the advantage of requiring only autologous arterial material of an appropriate diameter.

Aged↗

PubMed2003

Magnetic resonance imaging in reflex sympathetic dystrophy syndrome of the foot.

OBJECTIVE: The purpose was to analyze magnetic resonance imaging (MRI) abnormalities in reflex sympathetic dystrophy syndrome (RSDS) of the foot, with the goal of helping to meet the difficult diagnostic challenges raised by this condition. METHODS: Retrospective study of 20 patients with RSDS of the foot, 15 at the warm phase and five at the dystrophic phase. RESULTS: Of the 15 patients at the warm phase, seven had evidence of bone edema (low signal on T1-weighted images and high signal on T2, T2 STIR, and fat saturation images) and five had occult fractures (linear band of low signal on T1 and T2 weighted images with no enhancement after contrast injection). Other abnormalities included soft tissue changes in three patients, joint effusion in five, and synovial hypertrophy in one. Of the five patients at the dystrophic phase, one had a fracture with a joint effusion, one had isolated joint edema, and three had normal MRI findings. CONCLUSION: Bone marrow edema is inconsistent at the warm phase of RSDS and is never present at the dystrophic phase. Thus, absence of bone edema does not rule out RSDS. Fractures may be visible by MRI in one-third of patients with RSDS and no clinical or plain radiography evidence of fracturing.

Adult↗

PubMed2002

Extraanatomical revascularization of the artery of Adamkiewicz: anatomical study.

Spinal cord ischemia is a major cause of complications after operative and endovascular treatment of descending thoracic or thoracoabdominal aortic aneurysms. Prior revascularization of the intercostal artery (IA) giving rise to the artery of Adamkiewicz (AA) using an artery of the thoracic wall would preserve circulation in the AA and allow obstruction of the IA at its origin. The purpose of this study was to determine the feasibility of revascularization of the IA giving rise to the AA using three thoracic wall arteries, i.e., lateral thoracic artery, thoracodorsal artery, and descending scapular artery. A total of 16 specimens from 8 cadavers (6 men and 2 women) were prepared. The length and diameter of the thoracic wall arteries were measured to ascertain the feasibility of revascularization of the IA giving rise to the AA. In addition, 12 preoperative spinal cord arteriograms were studied. We found that revascularization of the IA giving rise to the AA using thoracic wall arteries is feasible. This technique could be used to prevent spinal cord complications after treatment of descending thoracic or thoracoabdominal aortic aneurysms.

Aged↗

PubMed1997

Percutaneous Biopsy of the Synovial Membrane.

Techniques of percutaneous synovial biopsy under fluoroscopic control of large joints of the limbs (other than the knee) may be useful in arthritis of undetermined etiology especially when infection is considered. Main technical refinements include adequate selection of an optimal approach and biopsy site using new imaging methods, use of a Tru-Cut(R) needle, and placement of the cutting window tangential to the joint surface, and selection of an optimal approach and biopsy site. Detailed technique of the synovial biopsy of hip, ankle, shoulder, and elbow joints is discussed.

Journal Article↗

PubMed1997

Lumbar Chymopapain Chemonucleolysis.

Lumbar chemonucleolysis is an alternative treatment of the sciatic pain due to a disc herniation. It gives good results in 70 to 80% of selected patients. When a correct technique is used, the complication rate is lesser than that of the open surgery. The indications of lumbar chemonucleolysis are larger than in the past and include lateral disc herniations, large or migrated disc herniations, and patients under 18 years or over 60 years. Further studies are necessary to determine if magnetic resonance imaging helps in patients selection and improve the success rate of chemonucleolysis.

Journal Article↗

PubMed1997

Steroid Injection of the Appendicular Skeleton and Sacroiliac Joints.

Steroid joint injections may be effective in painful joints due to degenerative disease and posttraumatic changes, as well as rheumatoid arthritis and seronegative spondylarthropathy. Fluoroscopic guidance may be necessary for deep (sacroiliac, hip, and shoulder) or small (wrist, hand, and foot) joints. Detailed technique of the steroid injection is given, especially for the sacroiliac joint.

Journal Article↗

PubMed1997

Distension Arthrography in Frozen Shoulder Syndrome.

Distension arthrography under fluoroscopic control may be useful in frozen shoulder syndrome. The technique consists of an intra-articular injection of 2 to 3 mL of contrast material, 3 mL of 2% lidocaine, 1.5 mL of cortivazol, and distension of the joint capsule with 30 to 40 mL of refrigerated sterile saline solution. This injection is immediately followed by a physiotherapy program. The authors report their experience of distension arthography in 30 shoulders. Results were good to very good in 90% of cases at 40-day follow-up. No recurrence of a frozen shoulder syndrome was observed and no complications were encountered in this series.

Journal Article↗

PubMed1997

Percutaneous Resection of Osteoid Osteomas.

Osteoid osteomas in almost all locations may be treated by percutaneous resection under CT scan guidance. The authors give their own experience with a series of 30 cases. The different techniques of percutaneous resection reported in the literature are reviewed. Advantages of the percutaneous resection are compared to those of classical surgery and other percutaneous techniques such as lesion destruction with thermocoagulation, photocoagulation, and intralesional injection of alcohol.

Journal Article↗

PubMed1997

Aspiration of Tendinous Calcific Deposits.

Needle aspiration of tendinous calcific deposits under fluoroscopic control may be a valuable tool in selected cases of painful shoulders with chronic and debilitating pain resistant to medical treatment. This article reviews the technique and results of this treatment. The aims of this procedure are (1) to evacuate a maximum amount of calcium; (2) to fragment the residual calcific deposits to facilitate its resorption during the following weeks; (3) to reduce the inflammation secondary to the presence and migration of residual calcific deposits by in situ injection of corticosteroids. Good results are obtained in 61Ð74% of cases. Surgical treatment should be restricted to failures of needle aspiration.

Journal Article↗

PubMedDate not supplied

Mechanisms underlying postmortem redistribution of drugs: a review.

Postmortem drug concentrations do not necessarily reflect concentrations at the time of death, as drug levels may vary according to the sampling site and the interval between death and specimen collection. These site- and time-dependent variations are called "postmortem redistribution" (PMR). The underlying mechanisms are complex and of different types. Passive drug release from drug reservoirs such as the gastrointestinal tract, liver, lungs, and myocardium may occur immediately after death and, later on, cell autolysis and the putrefactive process participate in redistribution. There is evidence that basic lipophilic drugs with a large distribution volume are particularly susceptible to PMR. Nevertheless, this cannot explain the actual PMR of some nonbasic, nonlipophilic drugs. In addition, the persistence of drug metabolism immediately after death must be considered. Consequently, it is of great importance to analyze specimens from different sampling sites in order to detect potential PMR and avoid misinterpretation of results.

Cadaver↗