[Extraction of intravascular foreign bodies]. / Extraction des corps étrangers intra-vasculaires.

OBJECTIVE: Loss or displacement of foreign material within the cardiovascular system is not an uncommon event. Foreign bodies include fragments of diagnosis equipment, ruptured catheters or malpositioned or displaced intravascular prostheses. The incidence has increased with the development of endovascular catheterism and raises the problem of extraction. METHODS: We report our experience with percutaneous extraction of intravascular foreign bodies. RESULTS: There were 56 cases. Percutaneous extraction was successful in 53. In 11 cases, the procedure was carried out during a catheterism procedure and in the others the initial event had occurred earlier. The delay to extraction varied from a few hours to several years. CONCLUSION: Percutaneous extraction of intravascular foreign bodies should be attempted before surgical removal, an often difficult high-risk procedure. The literature does not provide data on the frequency of intravascular foreign bodies.

[Indirect approach of stenosis of transplanted kidneys by Doppler echography]. / Approche indirecte des sténoses des reins transplantés par échographie Doppler.

Pulsed Doppler ultrasound for the detection of rejection and renal artery stenoses involving transplanted kidneys was evaluated. Using mean velocity curves, the time interval between the ECG R wave and the onset of peak velocity was measured successively on the renal and ipsilateral iliac arteries and divided by the R-R interval. In 27 patients, a Doppler index defined as the ratio of the standardized renal artery and iliac artery time intervals, was determined and compared to angiographic data. The DI index failed to detect stenoses associated with rejection; conversely, in the absence of rejection, clear separation of patients without (n = 14, DI = 1.03 +/- 0.6) and with (n = 6, DI = 1.24 +/- 0.05) stenosis (t = 7.48, p less than 0.001) was achieved. Thus renal artery stenoses in transplant recipients can be detected by the comparative study of time intervals calculated for renal vessels and for the neighbouring iliac artery.

[Role of computerized pulmonary angiography by peripheral venous approach in the study of deep venous thromboses of the legs]. / Place de l'angiographie pulmonaire numérisée par voie veineuse périphérique dans l'exploration des thromboses veineuses profondes des membres inférieurs.

A pulmonary angiography through peripheral venous approach was systematically performed in 40 consecutive patients presenting a recent deep venous thrombosis. None of these patients had been sent for a suspected pulmonary embolus. The analysis of the images that were obtained, enabled to confirm the diagnosis of pulmonary migration in 9 of these patients (22.5%). The retrospective study of the files confirms the fact that these pulmonary emboli present few symptoms or are asymptomatic in 17.5 p. cent of the cases. The quality of the images, the good acceptability and the moderate cost of pulmonary angiography through peripheral venous approach allow the performance of this examination during the initial work-up of a deep venous thrombosis. The demonstration of a latent pulmonary embolus must enable to separate high risk patients and thus guide subsequent therapy.

[Comparative study of the carrying out of iliac angioplasty with digital and conventional angiography. Impact on real (consumable) costs]. / Etude comparative de la réalisation des angioplasties iliaques en angiographie numérique et conventionnelle. Incidence sur les coûts réels (consommables).

Differences in time and cost were evaluated between the performance of iliac angioplasty with conventional (AC) and digital subtraction (AN) angiography, after a total of 27 angioplasties (13 with AC and 14 with AN). Excluding amortization of material and personnel costs, findings confirmed a certain number of advantages for AN: gain in time of about 34%, decrease of about 14% in charges, and notably of 83% in expenditure on films and 50% on contrast media.

Acute peripheral arterial and graft occlusion: treatment with selective infusion of urokinase and lysyl plasminogen.

Thirty-five patients hospitalized for recent angiographically documented arterial occlusion in the legs (27 femoropopliteal arteries and eight grafts) benefited from local fibrinolytic therapy delivered at the site of the occlusion with a 4- or 5-F catheter. This therapy combined a continuous urokinase (UK) infusion of 1,000 U/kg/hour and a lysyl plasminogen (LYS-PLG) infusion of 15 microkatals every 30 minutes. Angiographically confirmed lysis was obtained in 85% of the cases. Only 3% of the patients had major and 6% had minor groin hematomas. Only two patients had concentrations of fibrinogen as low as 100 mg/dl. Intravascular infusion of UK-LYS-PLG is as effective as streptokinase. Its excellent tolerance makes it a good alternative in the treatment of acute ischemia in the lower limbs.

[Posttraumatic occlusion of the 2 vertebral arteries]. / Occlusion post-traumatique des deux artères vertébrales.

Initial radioclinical examination of a 24 year old patient following a road accident showed a hemomediastinum on computed tomography imaging. Digital subtraction angiography by the arterial route demonstrated integrity of abdominal aorta and occlusion of both vertebral arteries soon after their origin. This bilateral occlusion had failed to provoke any neurologic sign imputable to the vascular lesion. A review venous digital subtraction angiography examination two months later gave similar angiographic appearance. Emphasis is placed on the asymptomatic nature of this acute occlusion of the two vertebral arteries and on the value of digital subtraction angiography for vascular exploration of this type of disease.

[Determination of the ejection fraction of the left ventricle by videodensitometric analysis of digital angiography. Preliminary results]. / Détermination de la fraction d'éjection du ventricule gauche par analyse vidéodensitométrique d'une angiographie numérique. Résultats préliminaires.

Digitalisation enables angiocardiography to be performed by a peripheral intravenous injection. Computer-assisted analysis of the date widens the possibilities of quantification. The authors have developed a videodensitometric method of studying the left ventricular ejection fraction. The research was performed on an experimental model and the technique validated in a series of 10 patients. The experimental model consisted of a series of balloons which, when inflated with contrast medium assumed an allipsoid shape resembling a left ventricle. The balloons were blown up in two stages with an automatic injector to simulate systole and diastole. The images were recorded in the same way as during ventriculography. Videodensitometric measurements showed 3 to 5% variations from the true values. The method was then applied to the calculation of the left ventricular ejection fraction in 10 patients: left ventricular function was also quantified by geometrical methods (Dodge) from the same angiogrammes and the 2 sets of results were then compared. The correlation coefficient between the two methods was 0.97, so validating the new technique. Videodensitometry opens up new perspectives in the study of left ventricular function. On the other hand it can be used to monitor the ejection fraction in severely ill or recently operated patients, and, on the other hand the principle of videodensitometry eliminates the geometrical approximations inherent in the classical methods of angiographic analysis and would therefore seem to be more suitable for the study of pathological left ventricules (aneurysm...). Finally, the technique of videodensitometry represents a new step towards the measurement of true volumes and flow rates.

[Results of in situ arterial thrombolysis by the combination of urokinase and lysyl plasminogen in acute arterial occlusive diseases of the lower limbs]. / Résultats de la thrombolyse artérielle in situ par association urokinase-lysyl plasminogéne dans les oblitérátions artérielles aiguës des membres inférieurs.

35 patients with acute arterial occlusions [27] and graft thromboses [8], responsible for severe and recent ischemia, were treated by fibrinolytic therapy (Urokinase: 1 000 units/kg/hour, and Lys Plasminogen). These drugs were delivered at the site of occlusions using a 5 French catheter. Angiographically, initial success was obtained in 30 patients (85%) and a significant clinical benefit persisted 5 months later, in 20 patients (57%). 4 distal embolisms during the treatment were noted, and one woman died a few hours after the withdrawal of an axillary catheter of a cerebellar infarction. Only two minor (6%) and one severe (3%) groin hematoma were encountered. No patient had at any moment a fibrinogen concentration lower than 1 g/l. Thus, the thrombolytic treatment used in the study appears as effective as locally administered Streptokinase but better tolerated.

[Value of numeric intravenous angiography in the study of coarctations of the thoracic aorta]. / Intérêt de l'angiographie numérique par voie veineuse pour l'exploration des coarctations de l'aorte thoracique.

The investigation of isthmic coarctation of the aorta comprises radiological opacification usually by a retrograde arterial approach. Digitised intravenous angiography (DIVA) is a new way of carrying out this task by a relatively simple and non-invasive technique. We investigated 32 patients with this method and now present our results: the investigation was performed for suspected coarctation in 22 cases and for postoperative assessment in 10 cases. The equipment used was characterised by a variable rate of acquisition from 1 to 3 images per second with a 512 X 512 matrix. The investigation consisted in an intravenous injection of 50 to 100 ml of contrast, usually via a peripheral vein (87.5 p. 100). Overall, DIVA demonstrated the coarctation or the appearances of the site of operation in 97 p. 100 of cases. This high success rate was related to the study population: young cooperative patients capable of maintaining apnoea and remaining still during the procedure. In the 21 patients referred for suspected coarctation (excluding the only failure of the series), the diagnosis was confirmed and the site of coarctation accurately located. The degree of stenosis was assessed subjectively: appearances of the site of coarctation, importance of the collateral circulation. In addition, a videodensitometric study, i.e. a study of the variations of the patterns of grey with respect to time, was carried out in 4 patients; in severe coarctation, a delay of about 4 seconds in the opacification of the zone distal to the stenosis was observed. This analysis is still at the experimental stage, but it may eventually allow reliable quantification of the degree of stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Quantification of left ventricular function by subtraction intravenous angiography]. / Quantification de la fonction du ventricule gauche par angiographie numérique par voie veineuse.

Digitised intravenous angiography (Diva), initially applied to the study of the aorta and great vessels, has benefited from technical advances, especially the possibility of recording 25 frames per second, which now allows studies of the heart itself. 22 subjects underwent angiography with digitised subtraction after injection of 50 ml of sodium diatrizoate and meglumine in the right atrium and selective left ventriculography in the same catheter session. The end diastolic and systolic indices and global ejection fractions were measured independently for each technique by Chapman's method by two observers. The model of digitised angiography used was a CGR Divas prototype functioning in the pulsed graphic mode at 25 images per second. The results showed that the Diva method gave reproducible values of the end diastolic index (101 +/- 29.8 and 104.5 +/- 30.7: r = 0.98), of the end systolic index (43.2 +/- 32.9 and 44.6 +/- 32.5; r = 0.98), and of the ejection fraction (62.5 +/- 17.16 p. 100 and 62.17 +/- 15.7 p. 100; r = 0.96). There was a close correlation between the results of Diva and selective ventriculography (end diastolic index: 97.8 +/- 21.1 and 101.6 +/- 10.3; r = 0.87; end systolic index: 38.82 +/- 24.8 and 43.9 +/- 21.17; r = 0.95; ejection fraction: 62.12 +/- 16.27 and 57.29 +/- 15.53; r = 0.95). There was a significant underestimation of the end systolic index using Diva (0.01 less than p less than 0.02). The originality of the pulsed graphic method is the totally digitised character of the data.(ABSTRACT TRUNCATED AT 250 WORDS)

[Value of rapid acquisition cadences synchronized with the electrocardiogram for the diagnosis of pulmonary embolism by digital subtraction angiography]. / Intérêt des cadences d'acquisition rapides synchronisées à l'électrocardiogramme pour le diagnostic de l'embolie pulmonaire par angiographie numérique.

Pulmonary digital subtraction angiography was performed in 130 patients referred with possible pulmonary emboli. Findings were interpreted as a function of apparatus used (acquisition cadence, size of matrix, ECG synchronization) and of site of injection (peripheral or central). It now appears possible to diagnose pulmonary embolism with satisfactory reliability in 80 to 85% of cases. This examination is safe (absence of selective catheterization of pulmonary artery), and it could become a standard emergency diagnostic procedure for pulmonary embolic disease.

[Combined study of carotid bifurcations using intravenous computed angiography and Doppler ultrasound in lower-limb arteritis]. / Etude couplée des bifurcations carotidiennes par angiographie numérique intraveineuse et ultrasonographie Doppler chez l'artéritique des membres inférieurs.

Carotid artery bifurcations were studied in 18 patients with arteritis, by Doppler ultrasound imaging and intravenous computed angiography. Both techniques are reliable examinations for detection of stenosed carotid artery lesions. Combining the two is increasingly used as a reliable means of exploration of stenosis of the carotid artery bifurcations. They therefore reduce the need for the more invasive conventional arteriography.

[Angiography and perfusion pulmonary scintigraphy in pulmonary embolism]. / Angiographie et scintigraphie pulmonaire de perfusion dans l'embolie pulmonaire.

Clinical signs suggestive of pulmonary embolism require diagnostic confirmation from complementary scintigraphic and/or angiographic examinations, therapy being adapted to the results obtained. A comparative study of the value of the two techniques was conducted in 20 patients with suspected pulmonary embolism investigated by a perfusion pulmonary scan and selective pulmonary angiography. Results confirmed the diagnostic superiority of angiography, the high percentage of false positives obtained by perfusion scintigraphy alone indicating the need for associated ventilatory function tests.

[A review of ten cases of aldosteronoma. Diagnostic and therapeutic conclusions (author's transl)]. / Dix observations de syndrome de Conn: déductions diagnostiques et thérapeutiques.

Ten patients with primary hyperaldosteronism resulting from a functioning adrenocortical adenoma were studied. The high incidence of hypertension and/or renal disease in the families of these patients suggests that hereditary factors play a part in the genesis of aldosteronomas. In patients with hypertension and hypokalemia the diagnosis of primary hyperaldosteronism is established by measurements of serum renin activity and serum aldosterone concentrations under normal conditions and during pharmacodynamic tests. The adenoma is demonstrated by radioactive iodocholesterol scintigraphy and computerized tomography. In nearly two-thirds of the patients, unilateral adrenalectomy is followed by complete definitive recovery.