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Gangi A, Catchpole K, Blocker R, Wiegmann D, Gewertz B, Blaha J, Ley E. Time to Prepare Impacts Emergency Department Efficiency and Flow Disruptions. J Surg Res 2013. [DOI: 10.1016/j.jss.2012.10.871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Charles YP, Buy X, Gangi A, Steib JP. Fracture in ankylosing spondylitis after minor trauma: radiological pitfalls and treatment by percutaneous instrumentation. A case report. Orthop Traumatol Surg Res 2013; 99:115-9. [PMID: 23270725 DOI: 10.1016/j.otsr.2012.09.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 08/10/2012] [Accepted: 09/07/2012] [Indexed: 02/02/2023]
Abstract
Patients with ankylosing spondylitis may experience spinal fractures even after minor injuries. The diagnosis of non-dislocated spinal fracture is based on clinical symptoms and radiological findings. Difficulties in interpreting the imaging studies can result in considerable diagnostic delays. We describe the steps of the radiological diagnosis in a patient with a fracture of L2 that was not visible on standard lumbar spine radiographs. Magnetic resonance imaging (MRI) T2 STIR sequences allowed determining the location and showed signs of a recent fracture. Then, MRI T1 images and computed tomography provided a detailed evaluation of the fracture line. In patients with ankylosing spondylitis, fracture instability is common, making surgical treatment mandatory. Open surgery is associated with substantial rates of infection and implant loosening. Percutaneous instrumentation has not yet been evaluated for the treatment of spinal fractures in patients with ankylosing spondylitis. This minimally invasive surgical technique enables multilevel internal fixation and may constitute an interesting alternative to open surgery.
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Catchpole K, Blocker R, Ley E, Gangi A, Blaha J, Gewertz B, Wiegmann D. Flow Disruptions in Trauma Care Handoffs. J Surg Res 2013. [DOI: 10.1016/j.jss.2012.10.529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gangi A, Singer M, Clond M, Bukur M, Margulies D, Salim A, Ley E. Elevated Admission Blood Pressure After Trauma: Tolerated in the Elderly. J Surg Res 2012. [DOI: 10.1016/j.jss.2011.11.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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55
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Gangi A, Buy X, Garnon J, Tsoumakidou G, Moser T, Bierry G, Muller A. Traitement de la douleur en oncologie. ACTA ACUST UNITED AC 2011; 92:801-13. [DOI: 10.1016/j.jradio.2011.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 07/21/2011] [Indexed: 10/17/2022]
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Buy X, Lang H, Garnon J, Gangi A. Thermoablation percutanée des cancers rénaux : radiofréquence ou cryoablation ? ACTA ACUST UNITED AC 2011; 92:774-88. [DOI: 10.1016/j.jradio.2011.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 07/21/2011] [Indexed: 11/25/2022]
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Ehlinger M, Moser T, Adam P, Bierry G, Gangi A, de Mathelin M, Bonnomet F. Early prediction of femoral head avascular necrosis following neck fracture. Orthop Traumatol Surg Res 2011; 97:79-88. [PMID: 21087905 DOI: 10.1016/j.otsr.2010.06.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 05/28/2010] [Accepted: 06/21/2010] [Indexed: 02/02/2023]
Abstract
Femoral neck fracture puts at risk functional prognosis in young patients and can be life-threatening in the elderly. The present study reviews methods of femoral head vascularity assessment following neck fracture, to address the following issues: what is the risk of osteonecrosis? And what, in the light of this risk, is the best-adapted treatment to avoid iterative surgery? Femoral head vascularity depends on retinacular vessels and especially the lateral epiphyseal artery, which contributes from 70 to 80% of the femoral head vascular supply. Fracture causes vascular lesions, which are in turn the prime cause of necrosis. Other factors combine with this: hematoma tamponade effect, reduced joint space and increased pressure due to lower extremity positioning in extension/internal rotation/abduction during surgery. Head deformity is not due to direct cell death but to the repair process originating from the surrounding living bone. In post-traumatic necrosis, proliferation rapidly invades the head, with significant osteogenesis. Pathologic fractures occur at the boundary between the new and dead bone. Many techniques have been reported to help assess residual hemodynamics and risk of necrosis. Some are invasive: superselective angiography, intra-osseous oxygen pressure measurement, or Doppler-laser hemodynamic measurement; others involve imaging: scintigraphy, conventionnal or dynamic MRI. The future seems to lie with dynamic MRI, which allows a new classification of femoral neck fractures, based on a non-invasive assessment of femoral head vascularity.
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Gangi A, Tsoumakidou G, Buy X, Quoix E. Quality improvement guidelines for bone tumour management. Cardiovasc Intervent Radiol 2010; 33:706-13. [PMID: 20151138 PMCID: PMC2908451 DOI: 10.1007/s00270-009-9738-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 10/05/2009] [Indexed: 11/28/2022]
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Bierry G, Roy C, Buy X, Kellner F, Jlassi H, Gangi A. [ECG-gated chest CT angiography: value for atypical chest pain evaluation]. JOURNAL DE RADIOLOGIE 2009; 90:825-831. [PMID: 19752788 DOI: 10.1016/s0221-0363(09)73214-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE The aim of this study was to evaluate ECG-gated whole chest CTA as a routine triage tool for patients with acute chest pain. MATERIAL AND METHODS Whole chest CTA with retrospective ECG-gating was performed in 30 patients with acute atypical chest pain. The ten main segments of the coronary arteries, the pulmonary arteries, the aorta, and the myocardium (function, morphology) were independently analyzed by a resident and two senior radiologists. The inter-observer agreement between resident and senior radiologists was calculated. A final diagnosis was determined by consensus. RESULTS Thirty patients were included. The coronary artery segments, myocardium and pulmonary arteries were considered analyzable in 84%, 90% and 97% of cases respectively. A final diagnosis for the cause of pain was retained in 19 patients: significant coronary artery stenosis (5), pulmonary embolus (5), aortic dissection (1), hypokinetic cardiomyopathy (2), lung parenchymal abnormalities (5), and hiatus hernia (1). Inter-observer agreement ranged from 0.76 to 1 between senior radiologists and from 0.76 to 1 between resident and senior radiologists. The average time of image interpretation ranged from 14 to 15 minutes. CONCLUSION ECG-gated whole chest CT angiography appears as a promising tool for the evaluation of acute chest pain. Combined evaluation of appearance and function of the myocardium can reveal additional interesting information.
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Nicolau S, Pennec X, Soler L, Buy X, Gangi A, Ayache N, Marescaux J. An augmented reality system for liver thermal ablation: Design and evaluation on clinical cases. Med Image Anal 2009; 13:494-506. [DOI: 10.1016/j.media.2009.02.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 02/06/2009] [Accepted: 02/09/2009] [Indexed: 10/21/2022]
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62
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Moser T, Cohen-Solal J, Bréville P, Buy X, Gangi A. Évaluation de la douleur en radiologie interventionnelle du rachis. ACTA ACUST UNITED AC 2008; 89:1901-6. [DOI: 10.1016/s0221-0363(08)74785-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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63
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Moser T, Buy X, Goyault G, Tok CH, Irani F, Gangi A. [Image-guided ablation of bone tumors: review of current techniques]. ACTA ACUST UNITED AC 2008; 89:461-71. [PMID: 18477952 DOI: 10.1016/s0221-0363(08)71449-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Multiple interventional radiology techniques are available for percutaneous ablation of bone tumors: alcohol, laser, radiofrequency, microwave, ultrasound, and cryogenic ablation. Several indications have already been validated, including radiofrequency ablation of osteoid osteoma and bone metastases, with results superior to conventional treatment. More indications should be added over the coming years. The purpose of this article is to review the principles of the different ablation techniques, summarize their respective indications and results and discuss their implementation and the eventual combination with cementoplasty techniques.
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Gangi A. Skeletal interventions. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Moser T, Dosch JC, Gangi A, Buy X, Dietemann JL. Le bilan d’imagerie dans les traumatismes récents du rachis. ACTA ACUST UNITED AC 2007; 93:653-65. [DOI: 10.1016/s0035-1040(07)73250-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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66
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Gangi A, Buy X. Imagerie interventionnelle du cancer bronchique : du diagnostic au traitement. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)78147-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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67
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Gangi A, Buy X. [Interventional radiology in lung cancer: from diagnosis to treatment]. Rev Mal Respir 2007; 24:6S137-6S145. [PMID: 18235407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Interventional radiology has made great progress during the past decade. In thoracic oncology image guided, percutaneous procedures may be divided into two groups: diagnostic and therapeutic. The routinely performed diagnostic procedures include percutaneous biopsy of parenchymal and mediastinal lesions under fluoroscopic or CT guidance. The therapeutic procedures are mainly concerned with the relief of pain. Percutaneous injection of alcohol into bone metastases was one of the first techniques used. Percutaneous vertebroplasty by injection of acrylic cement into lytic lesions of the vertebral bodies is one of the most successful techniques in interventional radiology. Acrylic cement can also be injected into other flat bones such as the acetabulum. Finally, percutaneous tumour ablation by radiofrequency or cryotherapy represents a major advance in interventional oncology. In fact thermo-ablation of tumours has advantages over alcohol injection with better delimitation of the ablation without risk of leakage. It can be performed on different organs for palliation or cure. For pain relief, bone and other metastases can be treated with radiofrequency or cryo-ablation with excellent results. Lung tumours less than 5 cm in diameter can be treated with radiofrequency ablation if surgery is contra-indicated. Similarly, up to 5 lung metastases can be treated by either radiofrequency or cryo-ablation.
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Barbé L, Bayle B, de Mathelin M, Gangi A. Needle insertions modeling: Identifiability and limitations. Biomed Signal Process Control 2007. [DOI: 10.1016/j.bspc.2007.06.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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69
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Sauer B, Buy X, Gangi A, Roy C. Exceptional localization of extramedullary hematopoiesis: presacral and periureteral masses. Acta Radiol 2007; 48:246-8. [PMID: 17354150 DOI: 10.1080/02841850601128991] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We report an exceptional case of periureteral and presacral localizations of extramedullary hematopoiesis. To our knowledge, the association of presacral or periureteral masses has not been described before. Diagnosis was suggested by the association of computed tomography (CT) imaging findings and knowledge of the clinical context. Guided CT biopsy is a safe and efficient means to obtain final diagnosis of atypical extramedullary hematopoiesis localizations.
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Bierry G, Buy X, Mohan PC, Cupelli J, Steib JP, Gangi A. Percutaneous vertebroplasty in a broken vertebral titanium implant (titanium mesh cage). Cardiovasc Intervent Radiol 2006; 29:706-9. [PMID: 16604405 DOI: 10.1007/s00270-005-5278-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report the case of a percutaneous consolidation of a broken vertebral implant (Surgical Titanium Mesh Implants; DePuy Spine, Raynham, MA, USA) by vertebroplasty. Four years after anterior spondylectomy with cage implantation and stabilization with posterior instrumentation, the patient was admitted for excruciating back pain. Radiographs showed fracture of the cage, screw, and rod. An anterior surgical approach was deemed difficult and a percutaneous injection of polymethyl methacrylate into the cage was performed following posterior instrumentation replacement. This seems to be an interesting alternative to the classical anterior surgical approach, which is often difficult in postoperative conditions.
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Cotten A, Nordin JY, Gangi A, Laredo JD, Maestretti G, Passuti N, Roux C, Vallee C. [Vertebroplasty and cyphoplasty]. REVUE DE CHIRURGIE ORTHOPEDIQUE ET REPARATRICE DE L'APPAREIL MOTEUR 2006; 92:2S143-2S156. [PMID: 17088781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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72
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Gangi A, Basile A, Basille A, Buy X, Alizadeh H, Sauer B, Bierry G. Radiofrequency and laser ablation of spinal lesions. Semin Ultrasound CT MR 2005; 26:89-97. [PMID: 15856810 DOI: 10.1053/j.sult.2005.02.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Radiofrequency current and laser energy can be delivered locally through electrode-needle or optical fiber inserted in the tissue and allows local ablation of tissues, up to a volume of 4 to 5 cm in diameter with one application or vaporizes tissue. Tumor ablation guided with medical imaging proved a high local efficacy over 90% for tumors less than 25 mm in the liver, lung, and kidney. The spinal applications of the thermal energy of RF and laser are reported in this paper. First, the tumor ablation is reviewed with malignant and benign tumors. In malignant tumors, radiofrequency is very efficient in local tumor control and in pain management. The second part of this paper is devoted to disk diseases where laser and RF techniques increase their applications. The technique, indications and results of these techniques are reported and illustrated.
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Irani FG, Morales JP, Sabharwal T, Dourado R, Gangi A, Adam A. Successful treatment of a chronic post-traumatic 5-year-old osteoporotic vertebral compression fracture by percutaneous vertebroplasty. Br J Radiol 2005; 78:261-364. [PMID: 15730994 DOI: 10.1259/bjr/55389916] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Osteoporotic vertebral compression fracture (VCF) is a frequently encountered clinical problem associated with chronic pain and disability. Conservative treatment in the form of bed rest, pain control and bracing may create a vicious circle, in which reduced activity leads to further reduction in bone density and fracture risk. Percutaneous vertebroplasty (PVP) is an accepted treatment modality for osteoporotic vertebral body collapse present for less than 1 year, vertebral myeloma, haemangioma, metastasis and recent traumatic fractures (between 3 and 12 months). We describe an osteoporotic patient in whom successful PVP was performed, under general anaesthesia using CT and fluoroscopic guidance, in a post-traumatic 5-year-old VCF with complete alleviation of debilitating pain. In the light of our experience, we suggest that PVP should be carried out in a series of similar patients to asses its value as a treatment option in patients with chronic osteoporotic vertebral fractures for pain relief and improvement in mobility, independent of fracture age.
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Hide IG, Gangi A. Percutaneous vertebroplasty: history, technique and current perspectives. Clin Radiol 2004; 59:461-7. [PMID: 15145715 DOI: 10.1016/j.crad.2004.01.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2003] [Revised: 12/24/2003] [Accepted: 01/13/2004] [Indexed: 10/26/2022]
Abstract
Percutaneous vertebroplasty is a safe and efficacious technique for the treatment of persistent pain from a fractured vertebral body. Injection of cement into the vertebral body is made after insertion of a large-bore needle, frequently by a trans-pedicular approach. Vertebroplasty is most commonly used to treat painful osteoporotic fracture resistant to conservative therapy, but may be helpful in other conditions such as malignant collapse. NICE guidelines are now available for this procedure, which is relatively new in the UK, but has been performed for more than 15 years in continental Europe.
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Maurin B, Piccin O, Bayle B, Gangloff J, de Mathelin M, Soler L, Gangi A. A new robotic system for CT-guided percutaneous procedures with haptic feedback. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.ics.2004.03.326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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