Sébastien Novellas

Centre Hospitalier Universitaire de Nice, Nice, Provence-Alpes-Côte d'Azur, France

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Publications (23)50.27 Total impact

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    ABSTRACT: The objective of our study was to define relevant MRI signs allowing preoperative diagnosis of posterior cul-de-sac obliteration in patients with deep pelvic endometriosis. This retrospective study included patients who underwent pelvic MRI completed by a laparoscopic examination. Three radiologists performed the MRI review blinded and recorded the following signs: sign 1, retroflexed uterus; sign 2, retrouterine mass; sign 3, displacement of intraperitoneal fluid; sign 4, elevation of the fornix; and sign 5, adherence of bowel loops. Laparoscopic results provided the criterion standard for diagnosis of posterior cul-de-sac obliteration. The performance of MRI was evaluated by calculating the average sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI results of the two more experienced radiologists for each sign and for combinations of signs. Interobserver agreement for each sign and impression for posterior cul-de-sac obliteration were calculated for all radiologists. Sixty-three patients were included in the study. Posterior cul-de-sac obliteration was diagnosed in 43 patients at laparoscopy. The mean sensitivity, specificity, and accuracy of each sign and impression of posterior cul-de-sac obliteration were, respectively, as follows: sign 1, 24.4%, 77.5%, 41.3%; sign 2, 97.1%, 83.7%, 92.8%; sign 3, 95.0%, 88.7%, 93.1%; sign 4, 30.2%, 97.5%, 51.6%; sign 5, 83.7%, 91.2%, 86.1%; and impression of posterior cul-de-sac obliteration, 91.9%, 91.2%, 91.7%. Interobserver concordance varied from 0.26 to 0.81 with best results obtained with the combination of signs 2, 3, and 5. Best concordances for junior radiologist evaluations were obtained with assessment of sign 3. MRI allows posterior cul-de-sac obliteration diagnosis. Pelvic fluid displacement may be the sign with greatest utility when considering both diagnostic accuracy and interobserver agreement.
    American Journal of Roentgenology 12/2012; 199(6):1410-5. · 2.90 Impact Factor
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    ABSTRACT: The purpose of this study is to assess retrospectively the effectiveness and safety of CT-guided percutaneous drainage and to determine the factors influencing clinical success and mortality in patients with infectious necrotizing pancreatitis. From April 1997 to December 2005, 48 consecutive patients (33 men and 15 women; median age, 58.5 years) with proven infectious necrotizing pancreatitis underwent percutaneous catheter drainage via CT guidance. Evaluated factors included clinical, biologic, and radiologic scores; drainage and catheter characteristics; and complications. Clinical success was defined as control of sepsis without requirement for surgery. Univariate analysis was performed to determine factors that could have affected the clinical success and the mortality rates. Clinical success was achieved in 31 of 48 patients (64.6%) and was significantly associated with Ranson score (p = 0.01) and with the delay between admission and the beginning of the drainage (p = 0.005), with a calculated threshold delay of 18 days (p = 0.001). The global mortality rate (14/48 [29%]) was also influenced by the Ranson score (p = 01) and the delay of drainage (p = 0.04) with the same threshold delay (p = 0.01). Only two major nonlethal procedure-related complications were observed. Percutaneous catheter drainage is a safe and effective technique to treat acute infectious necrotizing pancreatitis.
    American Journal of Roentgenology 07/2012; 199(1):192-9. · 2.90 Impact Factor
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    ABSTRACT: OBJECTIVE: MRI was the first imaging technique to permit the visualization of the uterine junctional zone and remains the imaging method of choice to evaluate it and its associated pathology. CONCLUSION: Adenomyosis can be diagnosed using MRI with a diagnostic accuracy of 85%. The most important MR finding in making the diagnosis is thickness of the junctional zone exceeding 12 mm. The principal limitation of MRI is the absence of a definable junctional zone on imaging, which occurs in 20% of premenopausal women.
    American Journal of Roentgenology 05/2011; 196(5):1206-13. · 2.90 Impact Factor
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    ABSTRACT: Malabsorptive syndromes and micronutrient deficiencies represent well-known long-term complications of bariatric surgery. Wernicke's encephalopathy (WE), a neurologic manifestation of thiamine deficiency, has been classically associated with alcoholism or severe malnutrition, but rarely reported after bariatric surgery. Herein, we describe the case of a 27-year-old woman that developed WE 10 months after laparoscopic Roux-en-Y gastric bypass for morbid obesity that was initially misdiagnosed with a consequent retard in the appropriate treatment. Although only a few sporadic cases have been reported in the literature, all surgeons and physicians involved in the care of bariatric patients must be aware of this potentially serious complication.
    Obesity Surgery 03/2010; 20(11):1594-6. · 3.10 Impact Factor
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    International Journal of Emergency Medicine 01/2010; 3(4):505-6.
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    ABSTRACT: We wanted to show that at the time of cesarean delivery, the active process of labor itself was sufficient to create early alterations of the pelvic floor musculature as detectable via magnetic resonance imaging (MRI). Thirty primipara patients underwent pelvic MRI between the second and third day after cesarean delivery. Ten patients had a cesarean without labor while 20 patients underwent urgent cesarean delivery after the onset of labor. Patients undergoing active labor during cesarean had 2.7 times more abnormalities than the patients with cesareans without labor. The abnormalities the most frequently found were a hypersignal in the puborectalis (p = .004), a hypersignal in the iliococcygeus (p = .064) and a defect in the orientation of this same muscular bundle (p = .049). This preliminary study suggests that active labor during the time of a cesarean induces early lesions of the pelvic muscular floor.
    International Urogynecology Journal 12/2009; 21(5):563-8. · 2.17 Impact Factor
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    ABSTRACT: Post-partum hemorrhage is an obstetrical emergency. Pelvic artery embolisation offers an alternative to surgical intervention and increases the rate of conservative treatment. The objective of this review was to study the scientific literature on obstetrical outcomes following uterine-sparing arterial embolisation performed for post-partum hemorrhage in a prior pregnancy. A Medline and Sciencedirect search were performed in order to review all the French and English reports about pregnancy following pelvic arteries embolisation for post-partum hemorrhage. Nineteen articles were identified and 13 were selected for inclusion. We have included the fertility follow-up of a total of 168 women who underwent pelvic arteries embolisation for post-partum hemorrhage. We highlight the clinical success of embolisation in 154 of the 168 patients (92%). Following the embolisation procedures, 7 hysterectomies were required and 4 patients died. Two of the 4 deaths occurred in women who were transferred from an outlying institution to a tertiary referral center. In this population, 45 pregnancies were described. Among these pregnancies, 32 resulted in live births (71%), 8 were miscarriages (18%) and 5 patients carried out voluntary termination of pregnancy (11%). The cesarean section rate was 62%. Post-partum hemorrhage occurred in 6 cases leading to 2 hysterectomies. In conclusion, pelvic arterial embolisation offers a safe and conservative alternative to surgical interventions for post-partum hemorrhage in well-selected patients desiring to preserve future fertility.
    European journal of obstetrics, gynecology, and reproductive biology 05/2009; 145(2):129-32. · 1.97 Impact Factor
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    ABSTRACT: This article evaluates the results of portal vein (PV) stent placement in patients with malignant extrinsic lesions stenosing or obstructing the PV and causing symptomatic PV hypertension (PVHT). Fourteen patients with bile duct cancer (n = 7), pancreatic adenocarcinoma (n = 4), or another cancer (n = 3) underwent percutaneous transhepatic portal venous stent placement because of gastroesophageal or jejunal varices (n = 9), ascites (n = 7), and/or thrombocytopenia (n = 2). Concurrent tumoral obstruction of the main bile duct was treated via the transhepatic route in the same session in four patients. Changes in portal venous pressure, complications, stent patency, and survival were evaluated. Mean +/- standard deviation (SD) gradient of portal venous pressure decreased significantly immediately after stent placement from 11.2 mmHg +/- 4.6 to 1.1 mmHg +/- 1.0 (P < 0.00001). Three patients had minor complications, and one developed a liver abscess. During a mean +/- SD follow-up of 134.4 +/- 123.3 days, portal stents remained patent in 11 patients (78.6%); stent occlusion occurred in 3 patients, 2 of whom had undergone previous major hepatectomy. After stent placement, PVHT symptoms were relieved in four (57.1%) of seven patients who died (mean survival, 97 +/- 71.2 days), and relieved in six (85.7%) of seven patients still alive at the end of follow-up (mean follow-up, 171.7 +/- 153.5 days). Stent placement in the PV is feasible and relatively safe. It helped to relieve PVHT symptoms in a single session.
    CardioVascular and Interventional Radiology 10/2008; 32(3):462-70. · 2.09 Impact Factor
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    ABSTRACT: OBJECTIVE: Our objective was to show the usefulness of MR cholangiopancreatography in assessing biliary complications after liver transplantation. CONCLUSION: MR cholangiopancreatography is the best noninvasive tool for the diagnosis and assessment of biliary complications.
    American Journal of Roentgenology 08/2008; 191(1):221-7. · 2.90 Impact Factor
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    ABSTRACT: Relapses of lymphoblastic leukaemia traditionally involve the central nervous system and testes in boys. Involvement of the female pelvic organs is frequently found at autopsy; however, involvement of the cervical uterus is rare and even less commonly symptomatic. A 13-cm uterine mass was discovered in a 15-year-old adolescent with a history of lymphoblastic leukaemia during childhood. Pelvic MRI was the best tool to assess the size, characteristics and invasive nature of this lesion of the uterine cervix. To our knowledge, this is a unique case in that we describe the MRI appearance of a relapsing lymphoblastic leukaemic mass both before and after treatment.
    Pediatric Radiology 04/2008; 38(3):319-21. · 1.57 Impact Factor
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    ABSTRACT: Ocular melanoma has a strong tendency to metastasize often several years after its initial diagnosis was made. We report on the case of a 50-year-old woman who was treated 20 years earlier for an ocular melanoma and currently seen regularly in our institute for liver metastases that were treated by chemotherapy. After three treatments, a check-up with computed tomography demonstrated the presence of a right ovarian mass. An ovariectomy was performed, and the pathological examination confirmed the diagnosis of an ovarian metastasis from an ocular melanoma. This is the fourth case of metastasis to the ovary from an ocular melanoma reported in the medical literature.
    Clinical imaging 01/2008; 32(4):318-20. · 0.73 Impact Factor
  • Journal of Vascular and Interventional Radiology 11/2007; 18(10):1334-6. · 2.00 Impact Factor
  • Thomas Caramella, Sebastien Novellas, Eric Cua
    Circulation 09/2007; 116(9):e312-4. · 15.20 Impact Factor
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    ABSTRACT: We report a case of a patient admitted to our hospital for acute pelvic pain. Ultrasounds and abdominal CT scan found a voluminous mass situated in the upper urinary bladder and contiguous to the uterus and to the ovaries. Magnetic resonance imaging identified a pedicle connecting the uterus to the mass which had an aspect of a necrobiotic leiomyoma. Laparoscopic surgery confirmed the diagnosis of acute torsion of a subserous uterine leiomyoma.
    Clinical Imaging 01/2007; 31(5):360-2. · 0.65 Impact Factor
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    ABSTRACT: The lipomatous tumors of the adrenals are hormonally inactive lesions, often of a benign nature, such as myelolipomas, lipomas, angiomyolipomas, or mature teratomas, and are rarely malignant, such as liposarcomas. The importance of recognizing their characteristic radiological images, which would lead to their correct treatment, is fundamental since there has been an increase in the demonstration of this lesion, often detected incidentally. The various imaging procedures, although not allowing to formulate a histological diagnosis, nonetheless permit to determine the volume of the tumoral mass and their evolution. These two factors are of significant importance in the planning of the correct surgical procedure, while a third important factor is the proper evaluation of the symptoms presented by the patient. Regarding the treatment, on the basis of our own experience, which agrees with that of other authors, the surgical removal of any lesion greater than 5 cm is mandatory.
    Clinical Imaging 01/2007; 31(5):335-9. · 0.65 Impact Factor
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    ABSTRACT: We report six cases of lipomas of the right colon, of which one was affected by two lesions. Two cases presented with episodes of partial occlusion; the others did not present with particular symptoms. The diagnoses were based on imaging by computed tomography, which demonstrated an intraluminal formation of fatty density, not associated with tissual components or hypervascularization.
    Clinical Imaging 01/2007; 31(6):390-3. · 0.65 Impact Factor
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    ABSTRACT: We evaluated and compared the radiological images of the spine of 111 patients affected by myeloma, bone metastases, and fractures secondary to osteoporosis demonstrated in low-dose computed tomographic (CT) scans and those demonstrated in conventional radiographic studies. From the analysis of the data obtained, it appears that the duration of the CT procedure is definitely shorter and that its diagnostic sensitivity is superior to that of conventional radiography. We should mention that the dose of radiation delivered by CT scanning does not constitute an unfavorable element in patients, usually elderly, for whom CT scanning was indicated.
    Clinical Imaging 01/2007; 31(4):225-7. · 0.65 Impact Factor
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    ABSTRACT: The epidemic of obesity and the introduction of laparoscopic techniques have greatly increased the popularity of bariatric operations such as Roux-en-Y gastric bypass (RYGBP). Acquired diverticular disease of the small bowel is a rare condition that becomes symptomatic in about 10% of the cases. We report a 48-year-old morbidly obese woman who presented 2 months after laparoscopic RYGBP with a perforated diverticulum of the Roux loop. The diagnostic and therapeutic implications are discussed.
    Obesity Surgery 10/2006; 16(9):1249-51. · 3.10 Impact Factor
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    ABSTRACT: Renal artery pseudoaneurysms are infrequent and are most often secondary to surgical or percutaneous renal biopsies. Their rupture can cause rapid clinical deterioration by massive haemorrhage. Diagnosis and treatment must, therefore, be rapid. Currently, surgical treatment remains the gold standard in most institutions while paediatric cases of endovascular embolization have seldom been described. We report a 13-month-old infant with a post-biopsy renal pseudoaneurysm successfully treated by selective arterial embolization.
    Pediatric Radiology 09/2006; 36(8):874-6. · 1.57 Impact Factor
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    ABSTRACT: Nineteen months after a Whipple procedure for pancreatic carcinoma, a 79-year-old woman developed recurrent tumoral strictures of the bile ducts and afferent Roux-en-Y limb with resultant jaundice, cholangitis, and liver abscess. Transhepatic abscess and biliary drainages were performed first. Afferent loop obstruction was too far from biliary anastomosis to be crossed via the transhepatic route. Percutaneous jejunostomy and stenting were performed to relieve the malignant afferent loop syndrome. After initial relief of symptoms, jaundice recurred in relation to peritoneal carcinomatosis progression and was treated with percutaneous jejunostomy drainage until patient's death. Therapeutic options of tumoral occlusion of afferent loops are reviewed.
    Clinical Imaging 01/2006; 30(4):283-6. · 0.65 Impact Factor