Journal of Vascular and Interventional Radiology, 2009
The membership of the Society of Interventional Radiology (SIR) Standards of Practice Committee r... more The membership of the Society of Interventional Radiology (SIR) Standards of Practice Committee represents experts in a broad spectrum of interventional procedures from the private and academic sectors of medicine. Generally, Standards of Practice Committee members dedicate the vast majority of their professional time to performing interventional procedures; as such, they represent a valid broad expert constituency of the subject matter under consideration for standards production. Technical documents specifying the exact consensus and literature review methodologies, as well as the institutional affiliations and professional credentials of the authors of this document, are available upon request from SIR, 3975 Fair Ridge Dr., Suite 400 N., Fairfax, VA 22033. SIR produces its Standards of Practice documents using the following process. Standards documents of relevance and timeliness are conceptualized by the Standards of Practice Committee members. A recognized expert is identified to serve as the principal author for the standard. Additional authors may be assigned depending on the magnitude of the project. An in-depth literature search is performed with use of electronic medical literature databases. Then, a critical review of peer-reviewed articles is performed with regard to the study methodology, results, and conclusions. The qualitative weight of these articles is assembled into an evidence table, which is used to write the document such that it contains evidence-based data with respect to content, rates, and thresholds. When the evidence of literature is weak, conflicting, or contradictory, consensus for the parameter is reached by a minimum of 12 Standards of Practice Committee members by using a modified Delphi Consensus Method (Appendix A). For the purposes of these documents, consensus is defined as 80% Delphi participant agreement on a value or parameter. The draft document is critically reviewed by the Standards of Practice Committee members by telephone conference calling or face-to-face meeting. The finalized draft from the Committee is sent to the SIR membership for further input/criticism during a 30-day comment period. These comments are discussed by the Standards of Practice Committee, and appropriate revisions made to create the finished standards document. Before its publication, the document is endorsed by the SIR Executive Council. From the Division of Interventional Radiology (D.
A multilumen, multiple side hole infusion catheter was used for urokinase thrombolysis in 13 pati... more A multilumen, multiple side hole infusion catheter was used for urokinase thrombolysis in 13 patients with thromboembolic occlusions of peripheral arteries and grafts. Balloon angioplasty was performed following urokinase infusion in 6 patients and atherectomy in 1 patient. There was one hemorrhagic complication. The major advantage of the multiple sidehole infusion catheter was the elimination of the need to reposition the catheter during the infusion and the reduction of the time burden on the angiographic facility. The success rate for the thrombolysis (77%) was comparable to results recorded in the literature. The total duration of infusion was not reduced compared to other series.
Journal of Vascular and Interventional Radiology, 2012
Vascular complications in renal and pancreatic transplants are similar, and the recipient anatomy... more Vascular complications in renal and pancreatic transplants are similar, and the recipient anatomy is the same, which is why they are discussed together. However, the interventional radiology literature and experience are considerably more extensive in renal transplantation. Renal and Pancreatic Artery Stenosis Renal artery stenosis reporting commences with diagnostic workup description, and requires mention of clinical and imaging tools used to detect the arterial stenosis. Important clinical parameters are preprocedural serum creatinine, arterial blood pressures, insulin independence, and respective trends. To standardize blood pressure reporting before and after intervention, it is highly recommended that authors follow the
Peritoneovenous shunts are used in the treatment of recurrent ascites or recurrent pleural effusi... more Peritoneovenous shunts are used in the treatment of recurrent ascites or recurrent pleural effusions. Generally speaking, the shunts allow passage of ascites or pleural effusions (by either passive or active means) back into the central venous system. The most recent development in peritoneovenous shunts, known as the Denver Shunt, is a modification of a shunt developed for the treatment of hydrocephalus. In recent years, the Denver shunt has been placed by interventional radiologists. It is used to treat both cirrhotic and malignant effusions in the peritoneal and pleural cavities. Reported complications of the shunt are shunt occlusion, infection, post-shunt coagulopathy, deep vein thrombosis, catheter breakage, and leaks. This article discusses the technical aspects related to the percutaneous placement and maintenance of the Denver Shunt.
Deposits of the Tamanduá River contain evidence for four major paleohydrologic stages in the last... more Deposits of the Tamanduá River contain evidence for four major paleohydrologic stages in the last 33,000 years. A wet period between 33,000 and 20,000 14C yr B.P. produced a high water table that allowed organic-rich deposition in the Tamanduá valley. A dry interval 17,000-10,000 14C yr B.P. produced sandy deposits of braided channels and alluvial fans. River aggradation during this period probably resulted from a high sediment load promoted by intense slope erosion and from flash floods. A wet period after 10,000 and before 6000 14C yr B.P. was marked by reduced slope erosion and by high discharge that led to erosion of the valley fill. During that time forests developed widely in Brazil. A drier climate after 6000 14C yr B.P. caused a reduction of discharge but allowed a high water table to be maintained.
t~ 48 02 55 00-fax48 47 30 88 Conception maquette, réalisation M. Zerbib -ORSTOM Bondy 13 17 21 2... more t~ 48 02 55 00-fax48 47 30 88 Conception maquette, réalisation M. Zerbib -ORSTOM Bondy 13 17 21 27 31 37 39 43 47 53 55 57 Thème I -Le cadre climatique actuel 1 1 Poster Stabilité de la variabilité pluviométrique de l'Afrique tropicale entre 1951 et 1988 S. Bigof, E Comberlin, I! Moron, L Richord et I! ROUCOU La variabilité interannuelle des précipitations en Bolivie 1. Ronchoil Conférence Observation et simulation de la variabilité inter annuelle des précipitations en Afrique et en Amérique tropicale I! Roucou, S. Bigot, I! Cumberlin, B. Fontoine, I! Moron, L Richord, 1. Ronchoil, A. Sontiogo, S. kzosko Poster l'influence des formations vegetales sur la convection dans la zone de contact forêt-savane au Cameroun. Traitement et analyse d'images Approche diagnostique et numérique de l'influence du gradient thermique atlantique en situation ENS0 sur Ia variabilité de la circulation de mousson boréale A. Sontiogo-legoden S. Rzasko, I! Moron, B. Fonfoine Thème II -Indicateurs écologiques, géochimiques 35 et sédimentologiques des écosystèmes Poster tes phytolithes, marqueurs paléogéogrophiques. Dendrochronologie et Okoumé (Congo). Application de la minéralogie quantitative ò des reconstructions paléoenvironnementales : l'exemple du lac de la "Lagoa Campestre", Salitre, Minas Gerais, Brésil.
Philippe MOURGUIART, Abdelfetah SIFEDDINE et Bruno TURCQ Résumé -Les forts phénomènes EI Niño pro... more Philippe MOURGUIART, Abdelfetah SIFEDDINE et Bruno TURCQ Résumé -Les forts phénomènes EI Niño provoquent d'impotantes perturbations climatiques dans différentes régions d' Amérique du Sud. Le même type de perturbations a été observé au cours de l'Holocène dans ces mêmes régions. Un scénario expliquant ces anomalies holocènes par l'existence de conditions de type EI Niño de longue durée est proposé. Records of El Niño-like conditions in South America during the last 7,000 years Abstract -During preseni-day strong EI Niño events, climatic anomalies appear in different regions of South America. A conceptual model, explaining these climate anomalies during the Holocene by long-term EI Niño-like Conditions, is proposed.
L'étude pétrographique et l'étude géochimique de la matière organique des sédiments d'... more L'étude pétrographique et l'étude géochimique de la matière organique des sédiments d'une carotte prélevée au centre d'une dépression marécageuse située sur un étroit plateau cuirassé émergeant de la forêt amazonienne, ont permis de caractériser et d'évaluer en pourcentages relatifs les différentes fractions organiques. L'approche pétrographique permet de compléter et de renforcer les informations fournies par les paramètres géochimiques utilisés et de mieux les comprendre. Cette étude a permis de définir de nouveaux marqueurs de paléoenvironnements, tout à fait concordants avec les données palynologiques obtenues sur la même carotte. Pendant les phases de plein développement de la forêt autour du plateau (conditions humides), la matière organique est mieux préservée et le sédiment est caractérisé par des valeurs importantes du flux de COT. En revanche, pendant les phases de reprise de la forêt, succédant à des périodes d'ouverture de celle-ci (retour à d...
We compared the long-term costs and outcomes of gastric bypass versus medical therapy (very low-c... more We compared the long-term costs and outcomes of gastric bypass versus medical therapy (very low-calorie diet plus weekly behavioral modification) for obese patients. A successful outcome was defined as the loss of at least one third of excess weight that was maintained for the duration of the study. A minimal cost was assigned: $3000 for medical and $24,000 for surgical treatment. A cost per pound of weight lost for all patients successfully monitored was calculated. The Federal Trade Commission recently asked all weight loss programs to report this cost for patients at least 2 years after therapy. A total of 201 patients entered surgical and 161 entered medical therapy. The surgical group was initially heavier (mean body mass index [kg/m2] +/- SE = 49.3 +/- 0.6 versus 41.2 +/- 0.7, p < 0.01), but each group's lowest mean body mass index was similar (31.8 versus 32.1, respectively). A significantly higher percentage of patients in the surgical versus the medical group were still successful at year 5: 89% versus 21%. The cost per pound lost for medical therapy exceeded the cost of surgical therapy in the sixth posttreatment year (both more than $250/pound). Surgical treatment appears to be more cost-effective at producing and maintaining weight loss. It is imperative that long-term follow-up studies be funded to definitely establish this finding.
... connectable to a wide variety of courses in different sites, provided that these courses are ... more ... connectable to a wide variety of courses in different sites, provided that these courses are open to the ... The companion is a virtual peer able to discuss with the learner, giving some hints or asking ... LANCA : A Distance Learning Architecture Based on Networked Cognitive Agents ...
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Advances in endoscopic techniques have transformed the management of urolithiasis. We sought to e... more Advances in endoscopic techniques have transformed the management of urolithiasis. We sought to evaluate the role of such urological interventions for the treatment of complex biliary calculi. We conducted a retrospective review of all patients (n=9) undergoing percutaneous holmium laser lithotripsy for complicated biliary calculi over a 4-year period (12/2003 to 12/2007). All previously failed standard techniques include ERCP with sphincterotomy (n=6), PTHC (n=7), or both of these. Access to the biliary system was obtained via an existing percutaneous transhepatic catheter or T-tube tracts. Endoscopic holmium laser lithotripsy was performed via a flexible cystoscope or ureteroscope. Stone clearance was confirmed intra- and post-operatively. A percutaneous transhepatic drain was left indwelling for follow-up imaging. Mean patient age was 65.6 years (range, 38 to 92). Total stone burden ranged from 1.7 cm to 5 cm. All 9 patients had stones located in the CBD, with 2 patients also hav...
Journal of Vascular and Interventional Radiology, 2009
The membership of the Society of Interventional Radiology (SIR) Standards of Practice Committee r... more The membership of the Society of Interventional Radiology (SIR) Standards of Practice Committee represents experts in a broad spectrum of interventional procedures from the private and academic sectors of medicine. Generally, Standards of Practice Committee members dedicate the vast majority of their professional time to performing interventional procedures; as such, they represent a valid broad expert constituency of the subject matter under consideration for standards production. Technical documents specifying the exact consensus and literature review methodologies, as well as the institutional affiliations and professional credentials of the authors of this document, are available upon request from SIR, 3975 Fair Ridge Dr., Suite 400 N., Fairfax, VA 22033. SIR produces its Standards of Practice documents using the following process. Standards documents of relevance and timeliness are conceptualized by the Standards of Practice Committee members. A recognized expert is identified to serve as the principal author for the standard. Additional authors may be assigned depending on the magnitude of the project. An in-depth literature search is performed with use of electronic medical literature databases. Then, a critical review of peer-reviewed articles is performed with regard to the study methodology, results, and conclusions. The qualitative weight of these articles is assembled into an evidence table, which is used to write the document such that it contains evidence-based data with respect to content, rates, and thresholds. When the evidence of literature is weak, conflicting, or contradictory, consensus for the parameter is reached by a minimum of 12 Standards of Practice Committee members by using a modified Delphi Consensus Method (Appendix A). For the purposes of these documents, consensus is defined as 80% Delphi participant agreement on a value or parameter. The draft document is critically reviewed by the Standards of Practice Committee members by telephone conference calling or face-to-face meeting. The finalized draft from the Committee is sent to the SIR membership for further input/criticism during a 30-day comment period. These comments are discussed by the Standards of Practice Committee, and appropriate revisions made to create the finished standards document. Before its publication, the document is endorsed by the SIR Executive Council. From the Division of Interventional Radiology (D.
A multilumen, multiple side hole infusion catheter was used for urokinase thrombolysis in 13 pati... more A multilumen, multiple side hole infusion catheter was used for urokinase thrombolysis in 13 patients with thromboembolic occlusions of peripheral arteries and grafts. Balloon angioplasty was performed following urokinase infusion in 6 patients and atherectomy in 1 patient. There was one hemorrhagic complication. The major advantage of the multiple sidehole infusion catheter was the elimination of the need to reposition the catheter during the infusion and the reduction of the time burden on the angiographic facility. The success rate for the thrombolysis (77%) was comparable to results recorded in the literature. The total duration of infusion was not reduced compared to other series.
Journal of Vascular and Interventional Radiology, 2012
Vascular complications in renal and pancreatic transplants are similar, and the recipient anatomy... more Vascular complications in renal and pancreatic transplants are similar, and the recipient anatomy is the same, which is why they are discussed together. However, the interventional radiology literature and experience are considerably more extensive in renal transplantation. Renal and Pancreatic Artery Stenosis Renal artery stenosis reporting commences with diagnostic workup description, and requires mention of clinical and imaging tools used to detect the arterial stenosis. Important clinical parameters are preprocedural serum creatinine, arterial blood pressures, insulin independence, and respective trends. To standardize blood pressure reporting before and after intervention, it is highly recommended that authors follow the
Peritoneovenous shunts are used in the treatment of recurrent ascites or recurrent pleural effusi... more Peritoneovenous shunts are used in the treatment of recurrent ascites or recurrent pleural effusions. Generally speaking, the shunts allow passage of ascites or pleural effusions (by either passive or active means) back into the central venous system. The most recent development in peritoneovenous shunts, known as the Denver Shunt, is a modification of a shunt developed for the treatment of hydrocephalus. In recent years, the Denver shunt has been placed by interventional radiologists. It is used to treat both cirrhotic and malignant effusions in the peritoneal and pleural cavities. Reported complications of the shunt are shunt occlusion, infection, post-shunt coagulopathy, deep vein thrombosis, catheter breakage, and leaks. This article discusses the technical aspects related to the percutaneous placement and maintenance of the Denver Shunt.
Deposits of the Tamanduá River contain evidence for four major paleohydrologic stages in the last... more Deposits of the Tamanduá River contain evidence for four major paleohydrologic stages in the last 33,000 years. A wet period between 33,000 and 20,000 14C yr B.P. produced a high water table that allowed organic-rich deposition in the Tamanduá valley. A dry interval 17,000-10,000 14C yr B.P. produced sandy deposits of braided channels and alluvial fans. River aggradation during this period probably resulted from a high sediment load promoted by intense slope erosion and from flash floods. A wet period after 10,000 and before 6000 14C yr B.P. was marked by reduced slope erosion and by high discharge that led to erosion of the valley fill. During that time forests developed widely in Brazil. A drier climate after 6000 14C yr B.P. caused a reduction of discharge but allowed a high water table to be maintained.
t~ 48 02 55 00-fax48 47 30 88 Conception maquette, réalisation M. Zerbib -ORSTOM Bondy 13 17 21 2... more t~ 48 02 55 00-fax48 47 30 88 Conception maquette, réalisation M. Zerbib -ORSTOM Bondy 13 17 21 27 31 37 39 43 47 53 55 57 Thème I -Le cadre climatique actuel 1 1 Poster Stabilité de la variabilité pluviométrique de l'Afrique tropicale entre 1951 et 1988 S. Bigof, E Comberlin, I! Moron, L Richord et I! ROUCOU La variabilité interannuelle des précipitations en Bolivie 1. Ronchoil Conférence Observation et simulation de la variabilité inter annuelle des précipitations en Afrique et en Amérique tropicale I! Roucou, S. Bigot, I! Cumberlin, B. Fontoine, I! Moron, L Richord, 1. Ronchoil, A. Sontiogo, S. kzosko Poster l'influence des formations vegetales sur la convection dans la zone de contact forêt-savane au Cameroun. Traitement et analyse d'images Approche diagnostique et numérique de l'influence du gradient thermique atlantique en situation ENS0 sur Ia variabilité de la circulation de mousson boréale A. Sontiogo-legoden S. Rzasko, I! Moron, B. Fonfoine Thème II -Indicateurs écologiques, géochimiques 35 et sédimentologiques des écosystèmes Poster tes phytolithes, marqueurs paléogéogrophiques. Dendrochronologie et Okoumé (Congo). Application de la minéralogie quantitative ò des reconstructions paléoenvironnementales : l'exemple du lac de la "Lagoa Campestre", Salitre, Minas Gerais, Brésil.
Philippe MOURGUIART, Abdelfetah SIFEDDINE et Bruno TURCQ Résumé -Les forts phénomènes EI Niño pro... more Philippe MOURGUIART, Abdelfetah SIFEDDINE et Bruno TURCQ Résumé -Les forts phénomènes EI Niño provoquent d'impotantes perturbations climatiques dans différentes régions d' Amérique du Sud. Le même type de perturbations a été observé au cours de l'Holocène dans ces mêmes régions. Un scénario expliquant ces anomalies holocènes par l'existence de conditions de type EI Niño de longue durée est proposé. Records of El Niño-like conditions in South America during the last 7,000 years Abstract -During preseni-day strong EI Niño events, climatic anomalies appear in different regions of South America. A conceptual model, explaining these climate anomalies during the Holocene by long-term EI Niño-like Conditions, is proposed.
L'étude pétrographique et l'étude géochimique de la matière organique des sédiments d'... more L'étude pétrographique et l'étude géochimique de la matière organique des sédiments d'une carotte prélevée au centre d'une dépression marécageuse située sur un étroit plateau cuirassé émergeant de la forêt amazonienne, ont permis de caractériser et d'évaluer en pourcentages relatifs les différentes fractions organiques. L'approche pétrographique permet de compléter et de renforcer les informations fournies par les paramètres géochimiques utilisés et de mieux les comprendre. Cette étude a permis de définir de nouveaux marqueurs de paléoenvironnements, tout à fait concordants avec les données palynologiques obtenues sur la même carotte. Pendant les phases de plein développement de la forêt autour du plateau (conditions humides), la matière organique est mieux préservée et le sédiment est caractérisé par des valeurs importantes du flux de COT. En revanche, pendant les phases de reprise de la forêt, succédant à des périodes d'ouverture de celle-ci (retour à d...
We compared the long-term costs and outcomes of gastric bypass versus medical therapy (very low-c... more We compared the long-term costs and outcomes of gastric bypass versus medical therapy (very low-calorie diet plus weekly behavioral modification) for obese patients. A successful outcome was defined as the loss of at least one third of excess weight that was maintained for the duration of the study. A minimal cost was assigned: $3000 for medical and $24,000 for surgical treatment. A cost per pound of weight lost for all patients successfully monitored was calculated. The Federal Trade Commission recently asked all weight loss programs to report this cost for patients at least 2 years after therapy. A total of 201 patients entered surgical and 161 entered medical therapy. The surgical group was initially heavier (mean body mass index [kg/m2] +/- SE = 49.3 +/- 0.6 versus 41.2 +/- 0.7, p < 0.01), but each group's lowest mean body mass index was similar (31.8 versus 32.1, respectively). A significantly higher percentage of patients in the surgical versus the medical group were still successful at year 5: 89% versus 21%. The cost per pound lost for medical therapy exceeded the cost of surgical therapy in the sixth posttreatment year (both more than $250/pound). Surgical treatment appears to be more cost-effective at producing and maintaining weight loss. It is imperative that long-term follow-up studies be funded to definitely establish this finding.
... connectable to a wide variety of courses in different sites, provided that these courses are ... more ... connectable to a wide variety of courses in different sites, provided that these courses are open to the ... The companion is a virtual peer able to discuss with the learner, giving some hints or asking ... LANCA : A Distance Learning Architecture Based on Networked Cognitive Agents ...
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Advances in endoscopic techniques have transformed the management of urolithiasis. We sought to e... more Advances in endoscopic techniques have transformed the management of urolithiasis. We sought to evaluate the role of such urological interventions for the treatment of complex biliary calculi. We conducted a retrospective review of all patients (n=9) undergoing percutaneous holmium laser lithotripsy for complicated biliary calculi over a 4-year period (12/2003 to 12/2007). All previously failed standard techniques include ERCP with sphincterotomy (n=6), PTHC (n=7), or both of these. Access to the biliary system was obtained via an existing percutaneous transhepatic catheter or T-tube tracts. Endoscopic holmium laser lithotripsy was performed via a flexible cystoscope or ureteroscope. Stone clearance was confirmed intra- and post-operatively. A percutaneous transhepatic drain was left indwelling for follow-up imaging. Mean patient age was 65.6 years (range, 38 to 92). Total stone burden ranged from 1.7 cm to 5 cm. All 9 patients had stones located in the CBD, with 2 patients also hav...
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