Publications by authors named "Fabrice-Guy Barral"

20 Publications

  • Page 1 of 1

Chordomas: A review with emphasis on their pathophysiology, pathology, molecular biology, and genetics.

Pathol Res Pract 2020 Sep 29;216(9):153089. Epub 2020 Jun 29.

Pathology Department, University Hospital of Saint-Etienne, France.

Chordomas are uncommon, bone, axial, or (rarely) extra-axial tumors that are malignant and frequently recur but less commonly metastasize. They usually affect adults, with a very small proportion being pediatric tumors. For children, such tumors present a different biology, since they are more common as scull rather than sacral tumors, with aggressive histological features, including a loss of SMARCB1/INI1 and a dismal prognosis. Histologically, chordomas, believed to derive from notochordal tissue, characteristically show physaliphorous cells in a myxoid or chondroid matrix. Dedifferentiated and poorly differentiated forms can be observed. Moreover, a grading scale for chordomas has been proposed. Cytokeratin, EMA, S100, and brachyury are expressed by most chordomas. These are chemo-resistant tumors, for which surgical resection and/or radiotherapy are the treatments of choice. In this review, the histological, immunohistochemical, molecular, and clinical data of chordomas are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.prp.2020.153089DOI Listing
September 2020

Boundary and vulnerability estimation of the internal borderzone using ischemic stroke lesion mapping.

Sci Rep 2020 02 3;10(1):1662. Epub 2020 Feb 3.

Department of Radiology, University Hospital of Saint Etienne, Saint-Priest-en-Jarez, France.

Distinction between deep and superficial middle cerebral artery (MCA) territories and their junctional vascular area (the internal borderzone or IBZ) constitutes a predictor of stroke patient outcome. However, the IBZ boundaries are not well-defined because of substantial anatomical variance. Here, we built a statistical estimate of the IBZ and tested its vulnerability to ischemia using an independent sample. First, we used delineated lesions of 122 patients suffering of chronic ischemic stroke grouped in deep, superficial and territorial topographies and statistical comparisons to generate a probabilistic estimate of the IBZ. The IBZ extended from the insular cortex to the internal capsule and the anterior part of the caudate nucleus head. The IBZ showed the highest lesion frequencies (~30% on average across IBZ voxels) in our chronic stroke patients but also in an independent sample of 87 acute patients. Additionally, the most important apparent diffusion coefficient reductions (-6%), which reflect stroke severity, were situated within our IBZ estimate. The IBZ was most severely injured in case of a territorial infarction. Then, our results are in favour of an increased IBZ vulnerability to ischemia. Moreover, our probabilistic estimates of deep, superficial and IBZ regions can help the everyday spatial classification of lesions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-020-58480-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6997399PMC
February 2020

Comparison of cytology, chest computed and positron emission tomography findings in malignant pleural effusion from lung cancer.

J Thorac Dis 2018 Dec;10(12):6903-6911

Departments of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France.

Background: Malignant pleural effusion (MPE) is a common medical problem in lung cancer (LC). Pleural fluid cytology (PFC), chest computed tomography (CCT) and positron emission tomography (PET) findings are helpful as first line approach. The objectives of this study were to evaluate whether there is a correlation between PFC, CCT and PET in patients with MPE due to LC.

Methods: We selected patients from our electronic files. Data of PFC, pleural biopsy (PB), CCT and PET have been recorded and analyzed.

Results: A total of 101 consecutive patients (66 males, 65.3%) with a mean age of 66.2±31 years were selected. Types of LC were adenocarcinoma in 71 patients (70.2%), squamous in 13 (12.8%), small-cell in 12 (11.8%) and large cell in 5 (4.9%). CCT showed nodules in 6 (5.9%), pleural thickening in 8 (7.9%) and both in 17 (16.8%) patients. PFC was positive in 55/91 thoracentesis (60.4%) and 32/52 thoracoscopy (61.5%), while PB in 38/40 performed (95%). PET fixation was found in 32/47 (68%) patients who had MPE at diagnosis. When we associate PFC to CCT and PET findings, the yield in our study becomes 90%. No correlation was observed between CCT findings and PFC (P=0.62) between PFC and PET fixation (P=0.63) or between CCT and PET (P=0.06).

Conclusions: In our cohort of LC patients with MPE, we observed a high sensitivity for PFC, while in most of the cases no findings were observed in CCT. PET had a relative low sensitivity. However, when all 3 methods were combined the yield was 90%.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/jtd.2018.11.127DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6344746PMC
December 2018

Retro-odontoid pseudo-tumor due to calcium pyrophosphate crystal deposits with spinal cord compression and histopathological confirmation.

Joint Bone Spine 2018 07 27;85(4):497-498. Epub 2017 Jul 27.

Department of Rheumatology, North Hospital, University Hospital of Saint-Etienne, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France; Sainbiose, Inserm U1059, University of Lyon, 42023 Saint-Etienne, France. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jbspin.2017.07.008DOI Listing
July 2018

The eight year evolution of an osseous PEComa.

Pathol Int 2017 03 9;67(3):181-182. Epub 2017 Jan 9.

Department of Pathology, North Hospital, University Hospital of St-Etienne, France.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/pin.12500DOI Listing
March 2017

Supra-Epiglottic Upper Airway Volume in Elderly Patients with Obstructive Sleep Apnea Hypopnea Syndrome.

PLoS One 2016 23;11(6):e0157720. Epub 2016 Jun 23.

EA 4607 SNA EPIS, Clinical Physiology and VISAS Center, Pole NOL, CHU and Faculty of Medicine of Saint-Etienne, University Jean Monnet Saint-Etienne, COMUE Lyon Saint-Etienne, France.

Objective: Small upper airway measurements areas and high body mass index are recognized risk factors for obstructive sleep apnea syndrome (OSAS) in non-elderly populations; however, there is limited information regarding elderly patients. We evaluated whether upper airway volume is associated with OSAS and OSAS treated with continuous positive airway pressure (CPAP) treatment and whether BMI is correlated with upper airway volume and measurements in elderly subjects.

Methods: In 60 volunteers aged 75.58±0.9 years: 20 OSAS, 20 OSAS chronically treated with CPAP, and 20 controls, semi-automatic segmentation, retropalatal distance and transverse diameter of the supra-epiglottic upper airway were evaluated using 3DT1-weighted magnetic resonance imaging. Anteroposterior to transverse diameter ratio was defined as retropalatar diameter/transverse diameter.

Results: There were no significant differences in supra-epiglottic upper airway volume between OSAS, CPAP treated patients, and controls. There were significant differences in retropalatal distance and anteroposterior to transverse diameter ratio between OSAS, CPAP treated patients, and controls (P = 0.008 and P<0.0001 respectively). There was a significant correlation between body mass index and retropalatal distance (P<0.05) but not with supra-epiglottic upper airway volume.

Conclusion: In elderly subjects, OSAS and body mass index are not associated with changes in supra-epiglottic upper airway volume but are associated with modification of pharynx shape.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157720PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919063PMC
July 2017

Incidental findings on brain magnetic resonance imaging in the elderly:the PROOF study.

Brain Imaging Behav 2017 02;11(1):293-299

Clinical Physiology-VISAS Center, EA-4607-SNA-EPIS, CHU Saint-Etienne, COMUE-Lyon-St-Etienne, Saint Etienne, F-42055, France.

To prospectively evaluate the prevalence of incidental findings on standardized brain MRI scans in a cohort of elderly subjects. All participants provided written informed consent to participate in this prospective study, which was approved by the institutional review board and was HIPAA compliant. There were 503 subjects (75.3 ± 0.9 years of age, 58 % women) who received brain MRIs on a 1.5-T scanner using a standard acquisition protocol. All scans were reviewed by an experienced neuroradiologist. Incidental findings were stratified as follows: 1, no incidental findings; 2, incidental findings without clinical significance; 3, incidental findings with clinical significance or requiring clinical follow-up. Incidental findings were identified in 77.9 % of subjects. Among 392 scans that exhibited incidental findings, 494 abnormalities were identified. The most common findings in our study were cysts (45.9 % of subjects) and ear, nose, and throat (ENT) lesions (24.8 %) followed by stroke lesions (6.6 %) and neoplasms (3.8 %). There were 472 incidental findings that lacked clinical significance (group 2), and 22 incidental findings that required follow-up evaluation (group 3). Incidental findings on brain MRIs were commonly observed in this cohort of elderly subjects, but clinical follow-up was rarely indicated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11682-016-9519-4DOI Listing
February 2017

Visual Assessment of Age-Related White Matter Hyperintensities Using FLAIR Images at 3 T: Inter- and Intra-Rater Agreement.

Neurodegener Dis 2016 9;16(3-4):279-83. Epub 2015 Dec 9.

Department of Radiology, University Hospital of Saint-x00C9;tienne, Saint-x00C9;tienne, France.

Background: Age-related white matter hyperintensities are frequent incidental findings on T2-weighted brain MRI, and they are evaluated in clinical practice using a visual rating scale.

Objective: To evaluate inter- and intra-rater agreement in MRI visual evaluations of age-related white matter hyperintensities made by two radiologists with different levels of experience using a visual rating scale.

Methods: Two radiologists of two different levels of experience separately rated age-related white matter hyperintensities in 40 consecutive 3-tesla brain MRI scans using the Fazekas and Schmidt visual rating scale. Ratings were made on axial FLAIR (fluid-attenuated inversion recovery) sequences. Two readings were made by each radiologist. Intra- and inter-rater agreement was statistically determined by using Cohen's weighted kappa analysis.

Results: Forty patients (21 females, 19 males; mean age = 57 ± 18.43 years) were included between September and October 2011. Mean values ± SD for visual scores were as follows: periventricular hyperintensities, between 1.175 ± 0.9 and 1.375 ± 0.89; number of deep white matter hyperintensity lesions, between 1.325 ± 1.18 and 1.575 ± 1.15, and extent of deep white matter hyperintensity lesions, between 0.925 ± 0.78 and 1.1 ± 0.74. Intra- and inter-rater agreement was very good (x03BA; values, 0.85-0.91 and 0.80-0.97, respectively) for each of the three visual scale criteria, with significant correlations between ratings (r = 0.95; p < 0.0001) and readings (r = 0.91; p < 0.0001).

Conclusion: Visual assessment of age-related white matter hyperintensities by radiologists using a visual scale on FLAIR sequence is reproducible. Differences in experience level do not influence readings. Visual scale use is thus justified in common practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000441420DOI Listing
December 2016

Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonary embolism: a randomized clinical trial.

JAMA 2015 Apr;313(16):1627-35

Université Nantes Angers Le Mans, France.

Importance: Although retrievable inferior vena cava filters are frequently used in addition to anticoagulation in patients with acute venous thromboembolism, their benefit-risk ratio is unclear.

Objective: To evaluate the efficacy and safety of retrievable vena cava filters plus anticoagulation vs anticoagulation alone for preventing pulmonary embolism recurrence in patients presenting with acute pulmonary embolism and a high risk of recurrence.

Design, Setting, And Participants: Randomized, open-label, blinded end point trial (PREPIC2) with 6-month follow-up conducted from August 2006 to January 2013. Hospitalized patients with acute, symptomatic pulmonary embolism associated with lower-limb vein thrombosis and at least 1 criterion for severity were assigned to retrievable inferior vena cava filter implantation plus anticoagulation (filter group; n = 200) or anticoagulation alone with no filter implantation (control group; n = 199). Initial hospitalization with ambulatory follow-up occurred in 17 French centers.

Interventions: Full-dose anticoagulation for at least 6 months in all patients. Insertion of a retrievable inferior vena cava filter in patients randomized to the filter group. Filter retrieval was planned at 3 months from placement.

Main Outcomes And Measures: Primary efficacy outcome was symptomatic recurrent pulmonary embolism at 3 months. Secondary outcomes were recurrent pulmonary embolism at 6 months, symptomatic deep vein thrombosis, major bleeding, death at 3 and 6 months, and filter complications.

Results: In the filter group, the filter was successfully inserted in 193 patients and was retrieved as planned in 153 of the 164 patients in whom retrieval was attempted. By 3 months, recurrent pulmonary embolism had occurred in 6 patients (3.0%; all fatal) in the filter group and in 3 patients (1.5%; 2 fatal) in the control group (relative risk with filter, 2.00 [95% CI, 0.51-7.89]; P = .50). Results were similar at 6 months. No difference was observed between the 2 groups regarding the other outcomes. Filter thrombosis occurred in 3 patients.

Conclusions And Relevance: Among hospitalized patients with severe acute pulmonary embolism, the use of a retrievable inferior vena cava filter plus anticoagulation compared with anticoagulation alone did not reduce the risk of symptomatic recurrent pulmonary embolism at 3 months. These findings do not support the use of this type of filter in patients who can be treated with anticoagulation.

Trial Registration: clinicaltrials.gov Identifier: NCT00457158.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jama.2015.3780DOI Listing
April 2015

3D ultrasound compared to magnetic resonance imaging and 2D ultrasound in assessing rheumatoid arthritis activity: A 6-month pilot study.

Joint Bone Spine 2015 May 30;82(3):212-3. Epub 2014 Dec 30.

Inserm U1059, Rheumatology department, University Hospital of Saint-Étienne, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jbspin.2014.10.007DOI Listing
May 2015

Brain magnetic resonance imaging findings in cryptogenic stroke patients under 60 years with patent foramen ovale.

Eur J Radiol 2014 May 7;83(5):824-8. Epub 2014 Feb 7.

Department of Radiology, University Hospital of Saint-Etienne, France; Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne, France. Electronic address:

Purpose: To compare magnetic resonance imaging (MRI) brain feature in cryptogenic stroke patients with patent foramen ovale (PFO), cryptogenic stroke patients without PFO and patients with cardioembolic stroke.

Materials And Methods: The ethics committee required neither institutional review board approval nor informed patient consent for retrospective analyses of the patients' medical records and imaging data. The patients' medical files were retrospectively reviewed in accordance with human subject research protocols. Ninety-two patients under 60 years of age were included: 15 with cardioembolic stroke, 32 with cryptogenic stroke with PFO and 45 with cryptogenic stroke without PFO. Diffusion-weighted imaging of brain MRI was performed by a radiologist blinded to clinical data. Univariate, Fischer's exact test for qualitative data and non-parametric Wilcoxon test for quantitative data were used.

Results: There was no statistically significant difference found between MRI features of patients with PFO and those with cardioembolic stroke (p<.05). Patients without PFO present more corticosubcortical single lesions (p<.05) than patients with PFO. Patients with PFO have more often subcortical single lesions larger than 15mm, involvement of posterior cerebral arterial territory and intracranial occlusion (p<.05) than patients with cryptogenic stroke without PFO.

Conclusion: Our study suggests a cardioembolic mechanism in ischemic stroke with PFO.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejrad.2014.01.022DOI Listing
May 2014

The 'where' and the 'when' of the BOLD response to pain in the insular cortex. Discussion on amplitudes and latencies.

Neuroimage 2013 Jan 21;64:466-75. Epub 2012 Sep 21.

Central Integration of Pain, Lyon Neuroscience Research Center, INSERM U1028, F-69000, France.

The operculo-insular cortex has been recently pointed out to be the main area of the pain matrix to be involved in the integration of pain intensity. This fMRI study specified the pattern of response to laser stimuli by focusing on this cortical area, by optimizing the temporal sampling and by investigating pain-related differences in the amplitudes and latencies of the BOLD responses. Canonical and temporal derivative hemodynamic response function (HRF) and finite impulse response (FIR) modeling provided consistent results. Amplitude of BOLD response discriminated painful from non-painful conditions in posterior and mid-insular cortices, bilaterally. Pain conditions were characterized by a shortened latency (as compared to non-painful conditions) in the anterior insula. In the functional organization of the insula, these results suggest a double dissociation that can be summarized as the 'where' and the 'when' of the BOLD response to pain. These results suggest that differences in the amplitude of the BOLD activity in the posterior and in the mid-insular cortices as well as shortened latency of the response in the anterior insula deal with discriminative processes related to painful conditions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.neuroimage.2012.09.038DOI Listing
January 2013

Spatial segregation of somato-sensory and pain activations in the human operculo-insular cortex.

Neuroimage 2012 Mar 5;60(1):409-18. Epub 2012 Jan 5.

Neurology Department, University Hospital, St-Etienne, France.

The role of operculo-insular region in the processing of somato-sensory inputs, painful or not, is now well established. However, available maps from previous literature show a substantial overlap of cortical areas activated by these stimuli, and the region referred to as the "secondary somatosensory area (SII)" is widely distributed in the parietal operculum. Differentiating SII from posterior insula cortex, which is anatomically contiguous, is not easy, explaining why the "operculo-insular" label has been introduced to describe activations by somatosensory stimuli in this cortical region. Based on the recent cyto-architectural parcellation of the human insular/SII cortices (Eickhoff et al., 2006, Kurth et al., 2010), the present study investigates with functional MRI (fMRI), whether these structural subdivisions could subserve distinct aspects of discriminative somato-sensory functions, including pain. Responses to five types of stimuli applied on the left hand of 25 healthy volunteers were considered: i) tactile stimuli; ii) passive movements; iii) innocuous cold stimuli; iv) non-noxious warm and v) heat pain. Our results show different patterns of activation depending on the type of somato-sensory stimulation. The posterior part of SII (OP1 area), contralateral to stimuli, was the only sub-region activated by all type of stimuli and might therefore be considered as a common cortical target for different types of somato-sensory inputs. Proprioceptive stimulation by passive finger movements activated the posterior part of SII (OP1 sub-region) bilaterally and the contralateral median part of insula (PreCG and MSG). Innocuous cooling activated the contralateral posterior part of SII (OP1) and the dorsal posterior and median part of insula (OP2, PostCG). Pain stimuli induced the most widespread and intense activation that was bilateral in SII (OP1, OP4) and distributed to all sub-regions of contralateral insula (except OP2) and to the anterior part of the ipsilateral insula (PreCG, MSG, ASG). However, the posterior granular part of insula contralateral to stimulus (Ig area) and the anterior part of SII bilaterally (OP4) were specifically activated during pain stimulation. This raises the question whether these latter areas could be the anatomical substrate of the sensory-discriminative processing of thermal pain.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.neuroimage.2011.12.072DOI Listing
March 2012

Modulation of the default mode network is task-dependant in chronic schizophrenia patients.

Schizophr Res 2011 Feb 13;125(2-3):110-7. Epub 2010 Dec 13.

Department of Radiology, University Hospital of Saint-Etienne, France; Jean Monnet University, Saint-Etienne, France.

The activity of brain regions of the so-called default mode network (DMN) attenuates during the performance of goal-directed tasks. These activity decreases (named task-induced deactivations; TID) are though to reflect the reallocation of cognitive resources from the DMN to areas implicated in the execution of the task. Recently, DMN activity suppression has been studied in schizophrenia patients. Although these works showed that TID are altered in schizophrenia, they also revealed inconsistent findings. We hypothesized that reallocation of resources is altered in schizophrenia patients and is context or task specific. We investigated TID using functional MRI in 26 schizophrenic patients and 13 control subjects while performing two different goal-directed tasks (the Hayling Sentence Completion Test and the N-Back task). Both whole brain and region of interest conjunction analyses were conducted to investigate brain areas commonly deactivated in the two tasks (task unspecific deactivations). Task-unspecific deactivations were not observed in the schizophrenia group, although these were strongly significant in the control group. Differences between patient and control participants were observed in different regions of the DMN depending whether the subjects performed the Hayling or the N-back task. These results suggest that reallocation of cognitive resources is altered in our patient sample. Moreover, TID were task-unspecific indicating that resources reallocation is context dependent in schizophrenia. DMN activity attenuates differently in schizophrenia patients depending on the cognitive processes involved in the task.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.schres.2010.11.013DOI Listing
February 2011

Brain activation during executive processes in schizophrenia.

Psychiatry Res 2009 Sep 29;173(3):170-6. Epub 2009 Jul 29.

Department of Psychiatry, University Hospital of Bellevue, Saint-Etienne, France.

Schizophrenia patients show some deficits in executive processes (impaired behavioural performance and abnormal brain functioning). The aim of this study is to explore the brain activity of schizophrenia patients during different inhibitory tasks. We used functional magnetic resonance imaging to investigate to investigate the restraint and deletion aspects of inhibition in 19 patients with schizophrenia and 12 normal subjects during the performance of the Hayling and the N-back tasks. The patients demonstrated impaired performance (more errors and longer reaction times) in the Hayling task. Schizophrenia subjects activated the same fronto-parietal network as the control subjects but demonstrated stronger parietal activations. For the N-back task, the deficit shown by the patients was limited to the number of target omissions. The reaction times and the number of false alarms did not differ in the two groups. We interpret this pattern of deficit as an alteration of working memory processes (and unaltered inhibition). Schizophrenia subjects showed higher activations in a fronto-parietal network. Since schizophrenia patients reached normal inhibitory performances in the N-back task and not in the Hayling task, the frontal hyperactivation may reflect an increased effort or a compensatory mechanism that facilitates the performance of executive tasks. During the Hayling task, this frontal hyperactivation was not achieved, and its absence was associated with a performance deficit relative to the performance of normal subjects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pscychresns.2009.02.009DOI Listing
September 2009

A prospective long-term study of 220 patients with a retrievable vena cava filter for secondary prevention of venous thromboembolism.

Chest 2007 Jan;131(1):223-9

Thrombosis Research Group, CIC-EC, Clinical Pharmacology Department, University Hospital, Saint-Etienne, France.

Background: The immediate and long-term clinical events associated with the placement and removal of a retrievable filter (ALN filter; ALN Implants Chirurgicaux; Ghisonaccia, France) remain largely unknown.

Methods: This was a prospective cohort study with an 18-month follow-up. All consecutive patients scheduled for placement of an ALN filter between April 1999 and June 2005 in the Radiology Department of our hospital were included.

Results: During the study period, placement of an ALN filter was indicated in 220 patients (mean age, 70.8 years), who were followed up for a median duration of 338.5 days (range, 1 to 561 days); 148 patients (67.3%) completed the 18-month follow-up. No patients were unavailable for follow-up. All patients had an acute or past venous thromboembolism. Main indications were recurrent venous thromboembolism despite adequate anticoagulation therapy (10.9%), transient bleeding event (21.8%), definitive contraindication for anticoagulant therapy (26.8%), or obligation to stop anticoagulant therapy due to major surgery, major trauma, or invasive procedure (37.7%). Filter insertion was successful in 98.6% of patients and resulted in an immediate complication in 11.8%. The median duration of filter implantation was 166 days (first to third quartiles, 34 to 478 days). Meanwhile, 17.0% (37 of 217 patients) had at least one venous thromboembolic event. Filter retrieval was attempted in 25.3% of patients after a median of 51 days (range, 6 to 352 days); removal was successful at the first attempt in 92.7% of patients.

Conclusions: The filter could be easily inserted and successfully removed up to 1 year after insertion. Its safety and efficacy in preventing pulmonary embolism should be properly assessed in a randomized study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1378/chest.06-0631DOI Listing
January 2007

Contrast medium-induced acute renal failure and cholesterol embolism after radiological procedures: incidence, risk factors, and compliance with recommendations.

Eur J Intern Med 2003 Nov;14(7):426-431

Centre Hospitalier Universitaire de Saint Etienne, France

BACKGROUND: After radiological procedures, the incidence of acute renal failure varies greatly, and cholesterol embolism may not always be recognized. Little, if anything, is known about whether recommendations for the prevention of either complication are correctly implemented. METHODS: We performed a prospective epidemiological study in a large population (n=809) of consecutive inpatients in a university hospital. The patients were monitored for risk factors, ongoing medications, and details of preventive measures and of radiological procedures. Contrast nephropathy was defined as a 25% rise in serum creatinine. Cholesterol embolism was defined by the presence of two typical signs. We analyzed the incidence, risk factors, and prevention of contrast nephropathy and cholesterol embolism. RESULTS: The most frequent procedure that our patients underwent was cardiac angiography (50%). The incidence of contrast nephropathy was 7%. We confirmed the classical risk factors (diabetes, dose of contrast medium, and renal insufficiency) and added potentially nephrotoxic medications as an independent risk factor. Fluid therapy, commonly proposed in high-risk patients, was adequately carried out in only 12% of patients. The incidence of cholesterol embolism was 4%, with 10% renal involvement. Arteriosclerosis and renal insufficiency were risk factors, but anticoagulation therapy was not. CONCLUSION: Adequate fluid therapy and discontinuation of nephrotoxic medications should be more systematically implemented in the prevention of contrast nephropathy. Recognition of cholesterol embolism is crucial.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejim.2003.08.007DOI Listing
November 2003
-->