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Publications (21)56.65 Total impact

  • Journal de Radiologie 10/2008; 89(10):1611-1611. · 0.35 Impact Factor
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    ABSTRACT: To determine whether spiral computed tomography (SCT) is helpful in the management of adult patients with acute pain of the right lower quadrant. The prospective study included 204 patients with acute pain of the right lower quadrant during two periods: 104 before and 100 after the introduction of SCT. A questionnaire was completed for each patient before and after standard clinical and laboratory assessment and SCT, indicating the suspected diagnosis and a provisional therapeutic option. In the pre-SCT period the negative laparotomy rate was 29% vs. only 13% in the SCT period. During the SCT period 10 of the 24 nonoperated patients were discharged on the same day, and 14 were hospitalized 1.6+/-1 days, and only one was readmitted for operation on day 7. The accuracy of SCT assisted by results of clinical and laboratory findings (true positives + true negatives/total of patients) was 86% (vs. 73% for standard clinical and laboratory assessment): 93% in men (vs. 76% for standard clinical and laboratory assessment) but only 63% in women (vs. 60% for standard clinical and laboratory assessment). SCT changed the therapeutic decision guided by standard clinical and laboratory assessment in 18 cases, accurately in 16 cases (90%). SCT is helpful in the management of adult patients with acute abdominal pain of the right lower quadrant. In our study it reduced negative laparotomy rate from 29% (guided by standard clinicobiological evaluation) to only 13%.
    International Journal of Colorectal Disease 04/2003; 18(2):126-30. · 2.24 Impact Factor
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    ABSTRACT: To prospectively evaluate the effectiveness and safety of selective embolization of the uterine arteries in the management of symptomatic uterine leiomyoma. Eighty consecutive women (mean age, 44.7 years) with symptomatic uterine leiomyoma, none of whom desired future pregnancy, underwent superselective embolization of the uterine arteries with polyvinyl alcohol particles. In all women, arterial embolization was performed because of persistent, fibroid-related menorrhagia after failure of hormonal therapy. Follow-up consisted of office visits at 2, 6, 12, and 24 months and of ultrasonography at 2 and 6 months after the procedure. Bilateral embolization of the uterine arteries was performed in 76 women; unilateral embolization, in four women. Menorrhagia disappeared in 72 (90%) women. In five (6%) women (including three women with unilateral embolization), clinical improvement was not observed, and myomectomy was needed. In one woman with a large submucosal uterine leiomyoma, hysterectomy was needed because of septic uterine necrosis. Normal menstruation resumed in all but six women. Full-term pregnancy occurred in three women after the procedure. Superselective arterial embolization of the uterine arteries is an effective means of controlling symptomatic uterine leiomyoma. However, the ideal embolic regimen remains to be determined.
    Radiology 06/2000; 215(2):428-31. · 6.34 Impact Factor
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    ABSTRACT: Because of improvement in survival rate of patients with abdominal cancer, gastrointestinal complications following external radiation therapy are becoming more frequent. Thus, an increased number of patients are commonly investigated with imaging because of suspected radiation-induced injury of the gastrointestinal tract. This pictorial review highlights the spectrum of CT and barium study manifestations of radiation-induced injury of the gastrointestinal tract. The major role of CT in the evaluation and management of patients with radiation injury of the gastrointestinal tract is highlighted. Emphasis is placed on CT imaging signs that may help in distinguishing between radiation-induced injury and recurrent disease.
    European Radiology 02/2000; 10(6):920-5. · 4.34 Impact Factor
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    ABSTRACT: Crohn's disease is characterized by transmural inflammation and chronic disorder of the gastrointestinal tract. Abdominal complications of Crohn's disease are frequent and quite variable and their diagnosis is commonly performed with CT. The purpose of this article is to review the CT features of the abdominal complications of Crohn's disease, including ileocolitis, abscess, phlegmon, fistula, bowel obstruction, portal vein gas, colonic distention, as well as urinary, hepatobiliary and pancreatic complications.
    Journal de Radiologie 02/2000; 81(1):11-8. · 0.35 Impact Factor
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    ABSTRACT: To evaluate the efficacy and safety of selective arterial embolization of the uterine arteries in the management of intractable delayed postpartum hemorrhage. Fourteen consecutive women with secondary postpartum hemorrhage were treated with selective embolization of the uterine arteries. In all cases, hemostatic embolization was performed because of intractable hemorrhage that could not be controlled with the administration of uterotonic drugs or with uterine curettage. The causes of bleeding included genital tract tears in four women and endometritis in eight women; the endometritis was associated with proved, retained portions of placenta in four women. In two women, no evident cause of bleeding was found before angiography. Angiography revealed extravasation in three women. A false aneurysm of the uterine artery was found in two women. In one patient, an arteriovenous fistula was observed. Immediate resolution of external bleeding was observed in all women. No complication related to embolization was found. Normal menstruation resumed in all women. Selective arterial embolization of the uterine arteries is a safe and effective means of controlling secondary postpartum hemorrhage.
    Radiology 09/1999; 212(2):385-9. · 6.34 Impact Factor
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    American Journal of Roentgenology 05/1999; 172(4):989-94. · 2.90 Impact Factor
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    ABSTRACT: To evaluate the efficacy and safety of uterine embolization in the management of intractable post-partum hemorrhage. From July 1994 to December 1997, 51 patients with severe primary (n = 37) or secondary (n = 14) post-partum hemorrhage were treated by arterial uterine embolization. In all cases, hemostatic uterine embolization was performed because of persistent hemorrhage despite adapted obstetrical measures and early introduction of uterotonic drugs. In case of immediate post-partum hemorrhage, primary and secondary success rates were 89% et 97% respectively. In one patient with placenta accreta, delayed hysterectomy was necessary. One patient died of associated cerebral hemorrhage while vaginal bleeding had stopped. The success rate reached 100% in case of secondary post-partum hemorrhage. Emergency arterial embolization is a safe and effective means of controlling severe post-partum hemorrhage after failure with medical treatment.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 03/1999; 28(1):55-61. · 0.45 Impact Factor
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    ABSTRACT: In 197 patients, uterine embolization with a single femoral approach and a single 5-F cobra catheter was successful in 362 of 394 (92%) uterine arteries. In six patients (12 arteries), distal embolization with a coaxial 3-F microcatheter was safer. In 10 patients with a life-threatening condition, embolization was performed at the anterior division of both internal iliac arteries. Bilateral selective embolization of the uterine arteries can be performed with a single catheter.
    Radiology 03/1999; 210(2):573-5. · 6.34 Impact Factor
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    ABSTRACT: The objective of our study was to reassess the value of CT scan in the preoperative evaluation of gastric adenocarcinoma, using surgical and pathologic findings as the reference standard. Forty-five patients who had preoperative CT scan for gastric carcinoma were retrospectively included in the study. Images were analyzed by two readers working in consensus with respect to tumor detection, tumor location, depth of invasion, involvement of adjacent organs, lymph node involvement and presence of peritoneal carcinomatosis. Gastric tumor was visible in 91% of cases. Accurate tumor localization was obtained in 50% of cases. Depth of tumor penetration was correctly evaluated in 40% of the cases. Evaluation of regional and distant lymph node metastases was correct in 54% and 64% of cases, respectively. Peritoneal carcinomatosis was depicted in 17% of cases. CT scan allows detection of gastric adenocarcinoma in the majority of cases. However, this technique markedly underscores the extent of gastric adenocarcinoma. Therefore, CT scan should not be used to determine the preoperative staging of gastric adenocarcinoma.
    Annales de Chirurgie 02/1999; 53(2):115-22. · 0.35 Impact Factor
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    ABSTRACT: To prospectively evaluate the efficacy and safety of emergency selective arterial embolization in the management of intractable primary postpartum hemorrhage. Twenty-seven consecutively seen women with life-threatening primary postpartum hemorrhage underwent uterine embolization. In all cases, hemostatic embolization was performed because of intractable hemorrhage that could not be controlled with vaginal packing and administration of uterotonic drugs. The mean hemoglobin level before embolization was 7.48 g/dL +/- 2.39 (74.8 g/L +/- 23.9) (1 standard deviation). Hysterectomy performed in two patients before embolization failed to stop the bleeding. Angiography revealed extravasation in nine patients and spasm of the branches of the internal iliac artery in five. The procedure consisted of embolization of uterine (n = 46), vaginal (n = 5), or ovarian (n = 2) arteries or anterior division of internal iliac arteries (n = 8). Immediate disappearance or dramatic diminution of external bleeding was observed in all cases. Two patients needed repeated embolization the next day. No major complication related to embolization was found. In one patient with placenta accreta, delayed hysterectomy was necessary. Normal menstruation resumed in all women except the two who underwent hysterectomy. One woman became pregnant after embolization. Emergency arterial embolization is a safe and effective means of control of primary postpartum hemorrhage. The procedure obviates high-risk surgery and allows maintenance of reproductive ability.
    Radiology 09/1998; 208(2):359-62. · 6.34 Impact Factor
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    ABSTRACT: Intrahepatic pseudocyst complicating pancreatitis is a rare event. The goals of this paper are to report the computed tomographic (CT) features of intrahepatic pseudocyst and to analyze the role of percutaneous puncture and percutaneous drainage in the diagnosis and treatment of intrahepatic pseudocyst. Three cases of intrahepatic pseudocyst studied by CT were retrospectively reviewed. Percutaneous puncture of the intrahepatic pseudocyst was performed in two cases, and was subsequently followed by percutaneous drainage of the intrahepatic pseudocyst in one case. In the three cases, intrahepatic pseudocysts appeared like multiple, hypoattenuating, homogeneous intrahepatic fluid collections, associated with intrahepatic bile duct dilatation in one case. In the two cases in which it was performed, percutaneous puncture of the pseudocyst revealed an elevated amylase level, thus confirming the diagnosis. In one case, percutaneous puncture revealed superinfection, thus indicating percutaneous drainage of the pseudocyst. The diagnosis of intrahepatic pseudocyst should be suggested in the presence of pancreatic lesions and a single or multiple intrahepatic fluid collections visible on CT. CT allows percutaneous puncture of the pseudocyst to be done, thus confirming the diagnosis and indicating subsequent performance of percutaneous drainage in complicated cases.
    Journal de Radiologie 09/1998; 79(8):751-5. · 0.35 Impact Factor
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    ABSTRACT: Color velocity imaging is a color sonographic technique that uses data contained in gray-scale B-mode image scan lines to determine blood flow velocity. We prospectively determined if color velocity imaging and power Doppler sonography can be used to differentiate acute from chronic cholecystitis. We analyzed the potential role of using these two color imaging techniques as an adjunct to conventional gray-scale sonography to differentiate acute from chronic cholecystitis. One hundred twenty-nine patients with acute right upper quadrant pain or clinically suspected cholecystitis underwent color velocity imaging and power Doppler sonography of the gallbladder as an adjunct to gray-scale sonography. Morphologic criteria were analyzed on gray-scale sonography, and the presence of flow within the gallbladder wall was assessed with color velocity imaging and power Doppler sonography. Imaging findings were compared with pathologic findings in the 50 patients who underwent cholecystectomy and with clinical and biologic findings in the 79 patients who did not undergo cholecystectomy. Twenty-two patients had surgically proven acute cholecystitis, 28 patients had surgically proven chronic cholecystitis, and 79 patients had no gallbladder disease. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of gray-scale sonography for revealing acute cholecystitis were 86%, 99%, 92%, 87%, and 97%, respectively. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of color velocity imaging and power Doppler sonography for revealing acute cholecystitis were 95%, 100%, 99%, 100%, and 99%, respectively. The accuracy of color velocity imaging and power Doppler sonography in revealing acute cholecystitis is significantly greater than the accuracy of gray-scale sonography.
    American Journal of Roentgenology 08/1998; 171(1):183-8. · 2.90 Impact Factor
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    ABSTRACT: The case of a 50-year-old woman with pathologically proven tuberculous colitis is reported. Clinical course, single-contrast barium enema, and colonoscopy suggested Crohn's disease. Computed tomography allowed the correct diagnosis of tuberculous colitis as it showed asymmetric thickening of the colonic wall and enlarged necrotic lymph nodes. This case suggests that the diagnosis of tuberculous colitis may be difficult and raises the differential diagnosis with Crohn's disease. Our observation suggests that computed tomography can be helpful for the diagnosis and may avoid unnecessary exploratory laparotomy.
    European Radiology 02/1998; 8(7):1221-3. · 4.34 Impact Factor
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    ABSTRACT: Our goal was to report the CT manifestations of abdominal wall implantation metastases occurring after abdominal percutaneous procedure. CT scans and clinical data of six patients with abdominal wall implantation metastases at the puncture site following abdominal percutaneous procedure were reviewed. The abdominal percutaneous procedures included drainage of intraperitoneal abscess in patients with colon or gastric cancer (n = 2), transhepatic biliary drainage in a patient with hilar cholangiocarcinoma (n = 1), biopsy of intrahepatic hepatocellular carcinoma (n = 1), biopsy of a metastatic left adrenal gland (n = 1), and laparoscopic cholecystectomy in a patient with unsuspected gallbladder cancer (n = 1). CT enabled the diagnosis of abdominal wall implantation metastasis in all six patients and showed coexisting intraabdominal tumor sites in five patients. All abdominal wall implantation metastases were homogeneous before intravenous administration of iodinated contrast material and became moderately heterogeneous on contrast-enhanced CT scan with marked enhancement relative to adjacent tissues. Abdominal wall implantation metastases are moderately heterogeneous on contrast-enhanced CT scan with marked enhancement relative to adjacent tissues. In most cases of abdominal wall implantation metastasis following abdominal percutaneous procedure, CT shows additional intraabdominal tumor sites. This complication may occur following a variety of abdominal percutaneous procedures (either radiological or surgical).
    Journal of Computer Assisted Tomography 01/1998; 22(6):889-93. · 1.58 Impact Factor
  • The Radiologist 01/1998; 5(4):137-146.
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    American Journal of Roentgenology 10/1997; 169(3):781-5. · 2.90 Impact Factor
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    ABSTRACT: To determine the potential for use of an automated device for transjugular liver biopsy. In 29 consecutive patients with liver dysfunction in whom percutaneous transperitoneal biopsy was contraindicated because of thrombocytopenia, severe coagulopathy, or marked ascites, transjugular liver biopsy was performed with an 18-gauge automated device. Histopathologic specimens were quantitatively and qualitatively analyzed. Complications related to the biopsy procedure were noted. In all patients, an adequate biopsy specimen (mean length, 12.0 mm +/- 5.5; range, 5.0-20.0 mm) was obtained during a single pass. In all tissue samples, a confident histopathologic diagnosis was made. Additional information was obtained in 15 patients with cirrhosis who had coexisting diffuse hepatic disease. No complications related to the procedure were noted. Use of an automated biopsy device is recommended for transjugular liver biopsy, as it enables safe acquisition of high-quality hepatic tissue samples.
    Radiology 09/1997; 204(2):369-72. · 6.34 Impact Factor
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    ABSTRACT: Localized macronodular tuberculosis of the liver is rare. Tuberculous involvement of the liver is usually a diffuse process. We report 3 cases in which clinical and imaging features suggested the diagnosis of macronodular hepatic tuberculoma which was pathologically confirmed by percutaneous biopsy. In the first case, abdominal CT-scan showed a noncalcified hypodense nodular lesion in segment IV of the liver with an enhancing peripheral rim. In the second case, ultrasound showed 4 homogenous hypoechoic hepatic nodules. In the third case, a nodule was incidentally identified in segment VII of the liver. The lesion was hypoechoic with ultrasound, hypodense without enhancement on CT-scan, and hyperintense on both T1- and T2-weighted MR imaging. After percutaneous biopsy, pathologic examination showed peripheral granulomous lesions in all patients with central caseous necrosis consistent with tuberculosis in two patients despite a negative for Zielh stain. Specific M. tuberculosis culture was positive in the first patient, negative in the second patient, and was not performed in the third patient. Appropriate treatment resulted in disappearance of hepatic lesions on follow-up imaging examinations. These 3 cases show that clinical and imaging features of hepatic tuberculoma are not specific and that percutaneous biopsy of lesions provides a definite diagnosis.
    Gastroentérologie Clinique et Biologique 02/1997; 21(11):888-92. · 1.14 Impact Factor
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    ABSTRACT: A left lateral bisegmentectomy was performed in a 29-year-old man presenting a primary lymphoma of the liver. Surgical exploration revealed a left-side gallbladder, located under the left lobe of the liver. During hepatic parenchyma dissection, performed strictly at the left of the round ligament and the umbilical portion of the left portal vein, common bile duct was injured. Complete separation of hepatic pedicle structures showed that the upper biliary convergence passed on the left side of the umbilical portion of the left portal vein before reaching the hepatoduodenal ligament. This case report discusses the embryological mechanism that could explain this uncommon bile duct abnormality, focusing on its consequences during left ruled lobectomy.
    Hepato-gastroenterology 50(49):60-1. · 0.77 Impact Factor