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1.
Rev Med Liege ; 71(9): 371-375, 2016 Sep.
Article in French | MEDLINE | ID: mdl-28383831

ABSTRACT

Spiegelian hernia is a rare anterior abdominal wall hernia, described in 1764 by a Hungarian surgeon. It often remains undiagnosed because of its unusual location on the semilunar line, laterally to the rectus muscle. CT presentation is specific. Because of its high risk of strangulation, a surgical management should be proposed, even in case of fortuitous discovery. We present three cases of Spiegelian hernia, two fortuitously discovered and one detected on the occasion of a small bowel incarceration. We also evoke a similar case of eventration on the lunate line requesting the knowledge of the detailed surgical antecedents for diagnosis.


La hernie de Spiegel est une hernie rare de la paroi abdominale antérieure, décrite en 1764 par un chirurgien Hongrois. Elle est souvent non diagnostiquée en raison de sa localisation inhabituelle pour une hernie, sur la ligne semilunaire, latéralement par rapport au muscle grand droit. Sa présentation tomodensitométrique est spécifique. Au vu de son grand risque d'étranglement, une prise en charge chirurgicale doit être proposée, même en cas de découverte inopinée. Nous présentons trois cas de hernie de Spiegel, deux où la découverte a été fortuite et le troisième à l'occasion d'une occlusion par incarcération du grêle. Nous évoquons aussi un cas similaire d'éventration sur la ligne semi-lunaire dont le diagnostic requiert la connaissance des antécédents chirurgicaux précis.


Subject(s)
Abdominal Wall/pathology , Hernia, Ventral/pathology , Abdominal Wall/diagnostic imaging , Aged , Female , Hernia, Ventral/diagnosis , Hernia, Ventral/therapy , Humans , Male , Middle Aged , Tomography, X-Ray Computed
3.
Rev Med Liege ; 70(2): 61-3, 2015 Feb.
Article in French | MEDLINE | ID: mdl-26011988

ABSTRACT

Intra-cystic renal calcium milk is a rare entity. The authors report a clinical case, and describe the radiographic and tomodensitometric appearances. This 50 year old patient has been followed up for more than ten years for urinary lithiasis with recurrent pain.


Subject(s)
Calcium Carbonate/metabolism , Kidney Diseases, Cystic/diagnostic imaging , Kidney Diseases, Cystic/metabolism , Humans , Lithiasis/complications , Lithiasis/diagnostic imaging , Lithiasis/metabolism , Male , Middle Aged , Radiography, Abdominal
4.
AJNR Am J Neuroradiol ; 36(3): 542-6, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25376806

ABSTRACT

BACKGROUND AND PURPOSE: The Silk flow-diverter stent is increasingly used to treat complex intracranial aneurysms including wide-neck, fusiform aneurysms. Sparse data are available concerning long-term results of this technique. We report our 5-year experience with Silk stent treatment of intracranial aneurysms. MATERIALS AND METHODS: A retrospective review of our prospectively maintained database identified all patients treated by the Silk stent in 2 institutions. Clinical charts, procedural data, and angiographic results were reviewed. RESULTS: Between July 2009 and May 2014, we identified 58 patients with 70 intracranial aneurysms. Endovascular treatment was successful in 93% of patients with 32 treated with the first-generation Silk stent and 26 with the new Silk+ stent. Mean follow-up in 47 patients was 22 months. Despite an 11% delayed complication rate, overall permanent neurologic morbidity was 5.5%. All complications were seen with the first-generation Silk stent. There was no procedure-related mortality. Long-term anatomic results showed 73% with complete occlusion, 16% with neck remnants, and 11% with incomplete occlusion. No recanalization or retreatment was performed. The midterm intrastent stenosis rate was 57%, of which 60% improved or disappeared, 28% were stable, and 12% led to vessel occlusion. Seventy-four percent of stenosis and all vessel occlusions occurred with the first-generation Silk stent. CONCLUSIONS: Endovascular treatment of complex intracranial aneurysms with the Silk stent is an effective therapeutic option. Despite a high rate of delayed complications with the first-generation stents, the current Silk+ stent appears safer. This treatment achieves a high rate of adequate and stable occlusion at long-term follow-up.


Subject(s)
Endovascular Procedures/methods , Intracranial Aneurysm/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Embolization, Therapeutic/methods , Female , Humans , Intracranial Aneurysm/diagnostic imaging , Male , Middle Aged , Prosthesis Design , Radiography , Retrospective Studies , Stents , Treatment Outcome , Young Adult
5.
AJNR Am J Neuroradiol ; 35(6): 1232-6, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24481329

ABSTRACT

Adhesive arachnoiditis is a rare condition, often complicated by syringomyelia. This pathologic entity is usually associated with prior spinal surgery, spinal inflammation or infection, and hemorrhage. The usual symptoms of arachnoiditis are pain, paresthesia, and weakness of the low extremities due to the nerve entrapment. A few cases have had no obvious etiology. Previous studies have reported one family with multiple cases of adhesive arachnoiditis. We report a second family of Belgian origin with multiple cases of arachnoiditis and secondary syringomyelia in the affected individuals.


Subject(s)
Arachnoiditis/congenital , Arachnoiditis/pathology , Magnetic Resonance Imaging , Syringomyelia/congenital , Syringomyelia/pathology , Adolescent , Adult , Belgium , Child , Female , Humans , Male , Middle Aged , Tissue Adhesions/congenital , Tissue Adhesions/pathology
6.
AJNR Am J Neuroradiol ; 34(6): 1209-14, 2013.
Article in English | MEDLINE | ID: mdl-23292529

ABSTRACT

BACKGROUND AND PURPOSE: The WEB is an intrasaccular flow disrupter dedicated to EVT of IA. We report our initial experience in a series of patients treated with this device. MATERIALS AND METHODS: This prospective study was approved by the authors' ethical committees. Nineteen patients with 20 unruptured wide-neck bifurcation IAs were treated by WEB placement. Technical issues, immediate posttreatment angiographic findings, and clinical and imaging follow-up at 3, 6, and 12 months were assessed. RESULTS: Failure of WEB placement occurred in 1 case because of unavailability of a suitably sized device. Embolization was successful in 18 patients with 19 IAs, and it required additional stent placement and/or coiling in 3 cases at the acute phase and in 1 case at follow-up. Two patients experienced a symptomatic complication, and 16 patients had normal neurologic examination findings at discharge. Immediate anatomic outcome showed 1 complete occlusion, 13 near-complete occlusions, and 5 incomplete occlusions. At follow-up, 17 patients had normal neurologic examination findings and 1 retained a hemiparesis. Angiographic controls were obtained in all patients (mean, 6 months), and they showed stable or improved results in all except 4 cases, including 2 complete occlusions, 15 near-complete occlusions, and 2 incomplete occlusions. CONCLUSIONS: In this initial series of patients, EVT of wide-neck bifurcation IAa with the WEB was feasible. Further studies are needed to evaluate the indications, safety, and efficacy of this new technique.


Subject(s)
Embolization, Therapeutic/instrumentation , Embolization, Therapeutic/methods , Endovascular Procedures/instrumentation , Endovascular Procedures/methods , Intracranial Aneurysm/therapy , Stents , Adult , Aged , Alloys/therapeutic use , Cerebral Angiography , Cerebrovascular Circulation , Female , Follow-Up Studies , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/physiopathology , Male , Middle Aged , Surgical Mesh , Treatment Outcome
7.
JBR-BTR ; 96(6): 369-71, 2013.
Article in English | MEDLINE | ID: mdl-24617181

ABSTRACT

We present a case of chronic hydrocephalus discovered in adulthood through an episode of acute decompensation. Multimodal imaging revealed the cause of this hydrocephalus to be a membranous septum of the aqueduct of Sylvius, a condition for which few reports exist.


Subject(s)
Cerebral Aqueduct/diagnostic imaging , Cerebral Aqueduct/pathology , Hydrocephalus/diagnosis , Magnetic Resonance Imaging/methods , Multimodal Imaging/methods , Tomography, X-Ray Computed/methods , Adult , Cerebral Aqueduct/surgery , Chronic Disease , Constriction, Pathologic/complications , Contrast Media , Diagnosis, Differential , Humans , Hydrocephalus/etiology , Iohexol , Male , Radiographic Image Enhancement/methods
9.
JBR-BTR ; 94(6): 333-5, 2011.
Article in English | MEDLINE | ID: mdl-22338388

ABSTRACT

Diastematomyelia is a relatively rare congenital abnormality presenting as a sagittal separation of the spinal cord. Although cases of diastematomyelia have been previously reported, fully documented approaches by both prenatal and postnatal diagnostic workup are rare in the literature. We present a fully studied case of diastematomyelia type I investigated by prenatal US and MRI and postnatal US, MRI and radiography.


Subject(s)
Neural Tube Defects/diagnosis , Prenatal Diagnosis/methods , Adult , Female , Humans , Magnetic Resonance Imaging , Pregnancy , Ultrasonography, Prenatal
10.
J Neuroradiol ; 37(2): 83-8, 2010 May.
Article in English | MEDLINE | ID: mdl-20381147

ABSTRACT

INTRODUCTION: The Solitaire stent is the first fully retractable stent for endovascular treatment (EVT) of intracranial aneurysms. The aim of this study was to evaluate its use in a prospective series with mid-term follow-up. METHODS: A retrospective review of our prospectively maintained database identified all patients treated with a Solitaire stent. Clinical charts, procedural data, angiographic results were reviewed. RESULTS: Between June 2008 and September 2009, 15 patients with 17 wide-necked or fusiform aneurysms (16 unruptured/one ruptured) were identified. EVT was successfully performed in all but one patient in whom the stent was removed because it induced flow reduction in the 1.8-mm parent artery. Among 14 treated patients, 13 had an excellent outcome and one had a good outcome. In this latter patient, the first stent could not be delivered and was changed for another one that was successfully deployed. The patient experienced a thrombo-embolic complication 6 hours after EVT and kept a slight hand paresis. In all cases but one, the stent was thus easily navigated and positioned despite a relative poor visibility. Angiographic results included eight complete occlusions, two neck remnants, and six incomplete occlusions. Six-month control in 14 aneurysms showed 13 complete occlusions and one incomplete occlusion. CONCLUSION: The Solitaire stent is useful for EVT of complex intracranial aneurysms because it is fully retractable, easy to navigate and to precisely place. However, it should be used with caution in arteries less than 2mm in diameter.


Subject(s)
Intracranial Aneurysm/therapy , Stents , Adult , Cerebral Angiography , Databases, Factual , Female , Follow-Up Studies , Humans , Intracranial Aneurysm/pathology , Male , Middle Aged , Retrospective Studies , Stents/adverse effects , Treatment Outcome
12.
Endoscopy ; 40(5): 406-13, 2008 May.
Article in English | MEDLINE | ID: mdl-18459077

ABSTRACT

BACKGROUND AND STUDY AIMS: Bariatric surgical treatments have been proven to induce long-term weight loss in morbidly obese patients, but complications are relatively frequent. We recently reported a first human multicenter trial assessing the safety, feasibility, and weight loss results of the Transoral Gastroplasty (TOGA) system (Satiety Inc., Palo Alto, CA) at 6 months. Here we report the 6-month results of the second phase of the pilot trial with the TOGA system, with technical improvements to the device. PATIENTS AND METHODS: Patients met established criteria for bariatric surgery. The TOGA system, a set of transoral endoscopically guided staplers, was used to create a stapled restrictive pouch along the lesser curvature of the stomach. Follow-up was at 1 week and at 1, 3, and 6 months. At 3 months, re-treatment consisting in additional distal restrictions was allowed if necessary. RESULTS: Data were available for 11 patients in our center (7 female, mean age 44.2 years, mean body mass index 41.6). The procedure was completed safely in all patients. There were no serious adverse events. Mean excess weight loss was 19.2 %, 33.7 %, and 46.0 % at 1, 3, and 6 months, respectively. Average body mass index decreased from 41.6 before treatment to 33.1 at 6 months. Absolute mean weight loss was 9.9 kg, 17.5 kg, and 24.0 kg at 1, 3, and 6 months, respectively. A dramatic improvement in quality-of-life measures was observed in all patients. CONCLUSIONS: This second pilot trial confirmed the feasibility and safety of transoral gastroplasty. The early results and technical improvements reported in the present study are encouraging in terms of safety, early weight loss, and quality of life, and clearly allowed multicenter trials, which are planned to start soon.


Subject(s)
Endoscopy, Digestive System , Gastroplasty/methods , Obesity, Morbid/surgery , Surgical Stapling/methods , Weight Loss , Adult , Anti-Inflammatory Agents/administration & dosage , Feasibility Studies , Female , Follow-Up Studies , Gastroplasty/instrumentation , Humans , Male , Middle Aged , Pilot Projects , Treatment Outcome
13.
AJNR Am J Neuroradiol ; 28(10): 1949-55, 2007.
Article in English | MEDLINE | ID: mdl-17898200

ABSTRACT

BACKGROUND AND PURPOSE: The purpose of this work was to assess intertechnique and interobserver reproducibility of 64-row multisection CT angiography (CTA) used to detect and evaluate intracranial aneurysms. MATERIALS AND METHODS: From October 2005 to November 2006, 54 consecutive patients with nontraumatic subarachnoid hemorrhage (SAH) underwent both CTA and digital substraction angiography (DSA). Four radiologists independently reviewed CT images, and 2 other radiologists reviewed DSA images. Aneurysm diameter (D), neck width (N), and the presence of a branch arising from the sac were assessed. RESULTS: DSA revealed 67 aneurysms in 48 patients and no aneurysm in 6 patients. Mean sensitivity and specificity of CTA for the detection of intracranial aneurysms were, respectively, 94% and 90.2%. For aneurysms less than 3 mm, CTA had a mean sensitivity of 70.4%. Intertechnique and interobserver agreements were good for the detection of aneurysms (mean kappa = 0.673 and 0.732, respectively) and for the measurement of their necks (mean kappa = 0.753 and 0.779, respectively). Intertechnique and interobserver agreements were excellent for the measurement of aneurysm diameters (mean kappa = 0.847 and 0.876, respectively). In addition, CTA was accurate in determining the N/D ratio of aneurysms and adjacent arterial branches. However, the N/D ratio was overestimated by all of the readers at CTA. CONCLUSION: Sixty-four-row multisection CTA is an imaging method with a good interobserver reproducibility and a high sensitivity and specificity for the detection and the morphologic evaluation of ruptured intracranial aneurysms. It may be used as an alternative to DSA as a first-intention imaging technique in patients with SAH.


Subject(s)
Aneurysm, Ruptured/diagnostic imaging , Cerebral Angiography , Intracranial Aneurysm/diagnostic imaging , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Aged, 80 and over , Angiography, Digital Subtraction , Female , Humans , Male , Middle Aged , Observer Variation , Predictive Value of Tests , Reproducibility of Results , Sensitivity and Specificity
14.
Rev Med Liege ; 61(2): 91-6, 2006 Feb.
Article in French | MEDLINE | ID: mdl-16566116

ABSTRACT

Vertebral angiomas are frequent and often asymptomatic. Sometimes although they do not seem invasive radiologically, they are responsible for local pain. If there is concordance between pain and vertebral angioma localisation, surgery such as vertebroplasty or cyphoplasty can be proposed. These techniques lead to a quick and complete removal of symptoms.


Subject(s)
Hemangioma/surgery , Orthopedic Procedures/methods , Spinal Neoplasms/surgery , Thoracic Vertebrae/surgery , Female , Hemangioma/diagnosis , Humans , Middle Aged , Pain/etiology , Pain/surgery , Spinal Neoplasms/diagnosis
16.
Clin Dysmorphol ; 13(4): 205-211, 2004 Oct.
Article in English | MEDLINE | ID: mdl-15365455

ABSTRACT

Congenital bony fusion of the maxilla and mandible is a rare condition. Two classifications were previously proposed dealing exclusively with craniofacial malformations. Most of the reported cases to date represent either aglossia-adactylia or hemifacial microsomia syndromes. We report a young girl with bony syngnathia associated with multiple defects (severe microcephaly, coloboma, vertebral segmentation defects), growth and mental delay. This patient is very similar to the patient described by Dobrow in 1983 and confirms the existence of this extremely rare disorder.


Subject(s)
Coloboma/physiopathology , Intellectual Disability/physiopathology , Mandible/abnormalities , Maxilla/abnormalities , Microcephaly/physiopathology , Spine/abnormalities , Female , Humans , Infant , Infant, Newborn , Mandible/diagnostic imaging , Maxilla/diagnostic imaging , Microcephaly/diagnostic imaging , Radiography , Skull/abnormalities , Skull/diagnostic imaging
17.
Rev Med Liege ; 57(3): 155-60, 2002 Mar.
Article in French | MEDLINE | ID: mdl-12014263

ABSTRACT

Iatrogenic femoral pseudoaneurysms have traditionally been treated surgically. Since 1991, many non surgical methods have been developed: ultrasound guided compression repair, embolization, covered stenting and recently thrombin injection.


Subject(s)
Aneurysm, False/etiology , Aneurysm, False/therapy , Catheterization/adverse effects , Embolization, Therapeutic , Femoral Artery/pathology , Hemostatics/therapeutic use , Thrombin/therapeutic use , Hemostatics/administration & dosage , Humans , Pressure , Thrombin/administration & dosage
18.
Rev Med Liege ; 56(12): 830-4, 2001 Dec.
Article in French | MEDLINE | ID: mdl-11820035

ABSTRACT

The hypothenar hammer syndrome is an uncommon but underestimated lesion of the cubital artery caused by repetitive trauma at the level of the hamate bone. It characteristically occurs in patients with a history of manual work as metal workers, carpenters and motor mechanics. We present a case of a patient who developed this syndrome following intensive use of a dig. Clinical finding, diagnosis and treatment are discussed.


Subject(s)
Cumulative Trauma Disorders/pathology , Hand/blood supply , Ischemia/etiology , Occupational Diseases , Aged , Arteries/injuries , Diagnosis, Differential , Hand Injuries/complications , Humans , Ischemia/pathology , Ischemia/surgery , Male , Syndrome
19.
Clin Microbiol Infect ; 4(4): 192-198, 1998 Apr.
Article in English | MEDLINE | ID: mdl-11864325

ABSTRACT

OBJECTIVE: To report a single-center experience of compassionate use of amphotericin B lipid complex (ABLC) in patients with proven or suspected fungal infection who were or would have been unable to tolerate conventional amphotericin B. METHODS: Twenty-eight patients receiving 30 courses of ABLC for 22 proven invasive mycosis episodes (11 aspergillosis, seven candidosis, four miscellaneous) and eight suspected episodes are described. Seven patients were given ABLC first-line therapy because of conditions precluding the use of amphotericin B deoxycholate (Am B). Twenty-one patients, initially given Am B, were shifted to ABLC because of failure in four, nephrotoxicity of AM B alone or in combination with another drug in 15, and acute side effects in two. The initial dose of ABLC was 5 mg/kg per day; this could be lowered to 3 mg/kg per day or transiently interrupted in cases of impairment of renal function. RESULTS: A mean cumulative dose of 6107 mg (660--16 050) was given over a mean duration of 22 days (4--49). Clinical response rate was 63% (14/22), with mycologic eradication in 37% (9/17) in proven infections. For proven aspergillosis, corresponding rates were 54% (6/11) and 20% (2/10), and in proven candidosis 71% (5/7) and 60% (3/5), respectively. Twenty-one courses were complicated by one or more side effects: fever and chills (11), impairment of renal function requiring a transient reduction of drug dosage (14), hypotension (1). However, for the whole group, creatinine clearance before and after 2, 4 and 6 weeks of treatment remained quite stable. CONCLUSIONS: ABLC, with its low toxicity, enabled us to treat patients who were or would have been unable to tolerate an efficacious dose of Am B. No conclusions about efficacy can be drawn from this small-size, compassionate study. Well-designed studies to compare efficacy and safety of conventional amphotericin B and the various lipidic formulations should be implemented.

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