Guy Wilms

Ovarian vein embolization for the treatment of pelvic congestion syndrome: long-term technical and clinical results.

PURPOSE Ovarian vein embolization has been used recently to treat pelvic congestion syndrome. The purpose of this study is to evaluate the clinical efficacy and safety of ovarian vein embolization in the treatment of symptomatic pelvic varices. MATERIALS AND METHODS We performed ovarian vein embolization in 41 patients (mean age, 37.8 years; range, 30-58 years): 32 patients underwent unilateral embolization and nine patients underwent bilateral embolization. All had lower abdominal pain and pelvic varicosities were found on retrograde ovarian vein venography. Embolization was performed with a mixture of enbucrilate and lipiodized oil in all but one patient, in whom enbucrilate and minicoils were used. Initial technical success rate and clinical follow-up (1-61 months; mean, 19.9 months), conducted with use of mailed questionnaires, are reported. RESULTS Initial technical success rate was 98%. Immediate complications were noted in two patients (4%) in the form of migration of some fragments of glue (used as embolic agent), which was treated conservatively. Clinical follow-up reveals variable symptomatic relief in 9.7% of cases and a total relief of symptoms in 58.5% of cases. Results in patients who had insufficient ovarian veins bilaterally were no better than those in patients for whom only the left ovarian vein was found insufficient. CONCLUSIONS Transcatheter embolization of the ovarian veins is a safe and feasible technique leading to complete relief of symptoms in more than half of cases. No statistically significant difference in clinical outcome could be noted between patients presenting with bilateral insufficient ovarian veins, who underwent bilateral embolization, and patients presenting with an insufficient left ovarian vein, who underwent left unilateral embolization.

Diffusion-weighted MRI in sporadic Creutzfeldt-Jakob disease

Article abstract Diffusion-weighted MRI (DWI) was used in three patients with autopsy-proven sporadic Creutzfeldt-Jakob disease (CJD) to provide a rapid noninvasive way to make this sometimes confusing diagnosis. DWI prompted the diagnosis of CJD at an early stage and appears to be particularly useful for monitoring the progression of the disease. We suggest that patients with suspected CJD and no abnormalities on T2- and proton density-weighted images may have cortical involvement on DWI.

CT and MRI of ruptured intracranial dermoids

SummaryTwo patients with ruptured intracranial dermoids, examined with both CT and MRI are reported. Clinical presentation was transient cerebral ischemia in one patient and acute meningeal signs in the other. CT scan showed typical fat density of the tumor and the subarachnoid space. On MRI both the tumor and the subarachnoid fat, were strongly hyperintense on T1-weighted images.

Pregnancy after transcatheter embolization of a uterine arteriovenous malformation

A 25-year-old woman with a congenital uterine arteriovenous malformation had a long history of repeated excessive vaginal bleeding. She was successfully treated with transarterial embolization. She had normal menstrual periods for 6 months and subsequently conceived. She was delivered of a normally grown baby at 35 weeks. To the best of our knowledge, this is the third pregnancy described after successful embolization of an arteriovenous malformation.

MRI findings in acute cerebellitis

Acute cerebellitis is an inflammatory process involving the cerebellum. We report the clinical, CT and MRI features of four cases and a review of the literature. Bilateral diffuse hemispheric abnormalities represent the most common imaging presentations. Our observations demonstrate the various imaging appearances of acute cerebellitis. Simultaneous involvement of both hemispheres and the vermis has not been reported previously. The development of cerebellar atrophy following an initial normal MR imaging examination is also a new finding. In atypical clinical presentation, MR imaging can lead to the diagnosis. MR imaging findings have, however, no prognostic value.

Thickening of dura surrounding meningiomas: MR features

Thickening of the dura in continuity with a convexity meningioma was noted on T1-weighted magnetic resonance (MR) images in seven patients. In five cases the corresponding CT image of the lesions was typical of meningioma. In two other cases the CT image of the lesions was atypical, owing to cyst formation in one and extensive edema in the other. After intravenous injection of paramagnetic contrast medium in four patients, the thickened dura demonstrated contrast enhancement at a variable distance from the tumor. In three patients the thickened dura was confirmed surgically. Pathology, available in one case, showed the thickened dura to correspond to tumoral extension within or around the dura. Magnetic resonance demonstration of thickening of the dura in continuity with a mass at the cerebral convexity may prove to be of importance in the differentiation of atypical lesions on CT and MR, especially with lower field magnets. Moreover, it could provide useful information to the neurosurgeon for more complete resection of the tumor.

Percutaneous transluminal renal angioplasty: initial results and long-term follow-up in 202 patients.

Percutaneous transluminal renal angioplasty was performed in 202 patients with 250 stenoses. The procedure was successful in 201 of 250 (83%). Results were better for postostial atherosclerotic lesions (94%), fibromuscular lesions (83%), and transplant kidneys (71%) than for ostial atherosclerotic lesions (29%). Of all the patients, 61% had reduced blood pressures following the procedure, with cure (diastolic blood pressure ≤90 mm Hg) in 31% of the patients. Cure rate with a mean follow-up of 25.8±19.4 months was 21% in bilateral atheromatous lesions, 30% in unilateral atheromatosis, 65% in unilateral fibromuscular disease, and 40% in bilateral fibromuscular dysplasia. Of the transplanted patients, 60% were cured. Complications occurred in 23 (11%) of the patients. Recurrence of stenoses occurred in 16 lesions (8%). 80% within the first year after the procedure.

Thrombolytic Therapy of Peripheral Arterial Occlusion With Recombinant Staphylokinase

BACKGROUND Recombinant staphylokinase (STAR) induces fibrin-specific coronary artery recanalization in patients with evolving myocardial infarction. The present pilot study evaluates its thrombolytic efficacy, safety, fibrin specificity, and immunogenicity in patients with peripheral arterial occlusive disease. METHODS AND RESULTS Thirty patients (37 to 86 years of age) with angiographically documented thromboembolic peripheral arterial occlusion of recent origin (21 +/- 5.5 days, mean +/- SEM) were treated with heparin and intra-arterial STAR given as a 1-mg bolus followed by a 0.5-mg/h infusion in 20 patients or as a 2-mg bolus followed by a 1-mg/h infusion in 10 subsequent patients. With 7.0 +/- 0.7 mg STAR infused over 8.7 +/- 1.0 hours, recanalization was complete in 25 patients, partial in 2, and absent in 3. Two major hemorrhagic complications occurred: one fatal hemorrhagic stroke and one hypovolemic shock caused by bleeding at the angiographic puncture site. Administration of STAR did not induce fibrinogen breakdown or a significant prolongation of template bleeding time. STAR-neutralizing activity and anti-STAR IgG were low at baseline, increased markedly from the second week on, and remained elevated for several months. CONCLUSIONS Intra-arterial administration of STAR restores vessel patency in patients with peripheral arterial occlusion in the absence of fibrinogen degradation.

The angiographic incidence of renal artery stenosis in the arteriosclerotic population

The incidence of renal artery stenosis was evaluated with intra-arterial digital subtraction angiography in 100 consecutive patients referred for peripheral arteriopathy. Fifty-seven patients were normotensive, 43 were hypertensive. In the normotensive group, renal artery stenosis was found in ten patients (17.5%). In the hypertensive group renal artery stenosis was found in twelve patients (28%). It is concluded that the incidence of renal artery stenosis is high in an arteriosclerotic population both in normotensive and hypertensive patients.

Synovial Cyst at the C1-C2 Junction

Intraspinal synovial or ganglion cysts of the cervical spine are rare. We present the third reported case of a degenerative articular cyst of the upper cervical spine, involving the quadrate ligament of the odontoid process. Magnetic resonance examination reveals typical images. A new, more general terminology is proposed.