Abstract: Although optical colonoscopy is still the gold standard for diseases of the colon, radiologic examination of the colon is now being performed by CT scan. Evaluation of the colon is enhanced by distension, which "de-folds" the intestinal wall, thus facilitating its examination for abnormalities of the mucosa, the wall as a whole, and the diameter of the bowel lumen. Water or gas (CO(2)) may be used for the distension, depending on the suspected lesions. The water enema method of colonography combines filling the bowel lumen with water and intravenous injection of a contrast medium. It is indicated when there is a clinical suspicion of colon cancer, or for initial discovery of liver metastases, and for staging of colon tumors. This technique, which requires little or no colon cleansing preparation, can be performed with no special equipment and has a short learning curve. The gas enema method of colonography, or virtual colonoscopy, is performed by distending the colon with CO(2), without any intravenous injection of contrast medium. Its purpose is to detect polyps as part of a screening for precancerous growths. This technique, which does require bowel cleansing preparation, uses a dedicated console for reading and requires specific training.
Abstract: Reports on the accuracy of computed tomographic colonography (CTC) mainly involve series from expert institutions. The aims of this study were to assess CTC accuracy in a nationwide population and to relate it to radiologist performance in their initial training.
Abstract: At one month, the acetabular depth from a standard lateral coronal section is 4.6 ± 1.0mm. The correlation between experienced and junior radiologists is high (kappa 0.795). A treshhold of 6mm with a Δ (difference between right and left) less than 1.5mm provides a sensitivity of 100% for the detection of DDH at one month. Universal US screening at one month of all high-risk infants in 2009 resulted in a reduction of delayed diagnosis of DDH (zero girls, two boys) in Ille-et-Vilaine due to continuous medical education of general radiologists.
Abstract: To quantify hepatic and splenic iron load, which is a critical issue for iron overload disease diagnosis. MRI is useful to noninvasively determine liver iron concentration, but not proven to be adequate for robust evaluation of splenic iron load. We evaluated the usefulness of MRI-derived parameters to determine splenic iron concentration in mice.
Abstract: The high frequency of benign and asymptomatic liver cysts must not underevaluate the potential diagnostic difficulties of liver cystic diseases. Complicated liver cyst or cystic mass of various origin, such as developmental, neoplastic or inflammatory, are important to be recognized by the radiologist. The diagnostic approach is depending on the number of lesions and their dissemination. The presence of a wall, the internal structure of the lesion, particularly the MR signal and the proximity of the biliary tree are the main diagnostic criteria. Some less frequent but characteristic unusual features need to be memorized.
Abstract: The metallic component of coronary stents makes it difficult to study their lumen by angio scanner. The object of this preliminary study was to appreciate the factors influencing the diagnosis of restenosis after stenting the left main coronary artery by 16-slice spiral angio CT. This Monocentric study included 27 patients who underwent 16-slice spiral angio CT six months after stenting of the left main coronary artery. It was possible to assess the stent lumen in 21 patients (78%) and no cases of > 50% restenosis were observed. In 4 patients, hypodense zones adjacent to the stent links were observed suggesting moderate intimal hyperplasia. The tests for ischaemia were normal in 3 of these patients. Coronary angiography and endocoronary ultrasound excluded significant restenosis in the fourth patient. In univariable analysis, the facors associated with good or excellent angioscanner quality (45% of patients) were Ostial stenosis (p = 0.03), no or minimal calcification on initial coronary angiography (p = 0.0S), stent diameters > 3.5mm (p = 0.03), heart rates < 60/min (p = 0.04), absence of extrasystoles (p = 0.05) during acquisition. In multivariable analysis, the only significant factors were absent or minimal calcification and stent diameters > 3.5mm (p = 0.02). The multidetector scanner seems a very promising method of investigating patients who have undergone stenting of the left main coronary artery but this study shows that certain clinical and angiographic parameters are limiting factors of surveillance with a 16-slice angioscanner.
Abstract: The risk of complications and the severity of pancreatic trauma depend on the status of the main pancreatic duct. Endoscopic retrograde pancreatography (ERCP) has emerged as the technique of reference for assessing pancreatic ductal anatomy, and it also permits therapeutic intervention by the endoscopic placement of an endoprosthesis.
Abstract: Hepatic iron overload conditions can be classified as genetic, mainly related to HFE haemochromatosis, and secondary, mainly associated with haematological and hepatic disorders and with metabolic syndrome. The strict affirmation of iron excess relies upon liver biopsy, MRI or calculation of the amount of iron removed through phlebotomies. Determination of its cause relies upon the assessment of transferrin saturation which, when increased, suggests the diagnosis of either haemochromatosis--implying HFE testing--or overload secondary to dysmyelopoiesis or to end-stage cirrhosis, and, when normal, suggests the diagnosis of dysmetabolic iron overload syndrome.
Abstract: We report a case of spontaneous peri-pancreatic hematoma which was associated with a celiac trunk stenosis. Hematoma was probably due to the rupture of a pancreaticoduodenal artery aneurysm. This diagnosis of pancreatic carcinoma, initially retained, illustrates the difficult diagnostic process. Therapeutic modalities for preventing recurrence are discussed.
Abstract: MRI has been proposed for non-invasive detection and quantification of liver iron content, but has not been validated as a reproducible and sensitive method, especially in patients with mild iron overload. We aimed to assess the accuracy of a simple, rapid, and easy to implement MRI procedure to detect and quantify hepatic iron stores.
Abstract: One third of French elite road cyclists were found to have hyperferritinemia on antidoping control tests performed during the Tour de France in 1998.
Abstract: We report the second case of squamous cell carcinoma arising in a hepatic foregut cyst (CHFC) in a 40-year-old woman. Microscopically, the lining of the cyst was composed of ciliated columnar epithelium, gastric and squamous epithelium. The squamous epithelium showed areas with dysplastic changes and other areas with carcinomatous transformation. In this congenital lesion, it was not surprising to find squamous and gastric mucosa because oesophagus, stomach, and tracheobronchic tree derive from the embryologic foregut. Squamous carcinoma might develop in a context of inflammation as in biliary cyst. In agreement with the first case described in the literature, this report also suggests that a large-sized symptomatic hepatic cyst should be excised.
Abstract: Aceruloplasminemia is an autosomal recessive disease of iron overload associated with mutation(s) in the ceruloplasmin gene. We report here a new case of aceruloplasminemia in a woman who is a compound heterozygote for two new mutations. Besides this novel genotypic profile, this observation provides new insights on: (i) iron metabolism with normal erythroid repartition, in the absence of serum non-transferrin-bound iron and with an increase of 59Fe plasma clearance; (ii) hepatic abnormalities associated with the presence of iron-free foci; (iii) the therapeutic management of the disease, chronic subcutaneous infusion of deferrioxamine being remarkably effective at reducing hepatic iron overload.
Abstract: The RETAIN project (Radiological Examinations Transfer on an ATM Integrated Network) has aimed at testing videoconferencing and DICOM image transfers to get advice about difficult radiological cases over an asynchronous transfer mode (ATM)-based network, which affords a more comfortable interface than narrow-band networks and allows exchange of complete image series using the DICOM format of studies. For this purpose, an experimental ATM network was applied between six university hospitals in four different countries. An assessment of the functionalities of the system was performed by means of log-file analysis, video recording of the sessions and forms filled out by the participants at the end of each session. Questionnaires were answered by the users at the end of the project to bring out perspectives of utilisation and added value. We discussed 43 cases during 20 sessions. For technical or organisational problems, only 20 of the 36 planned sessions took place. The throughput over ATM (10.5 Mbit/s, 20 times faster than six ISDN B-channels) was adequate. Despite the experimental configuration of the network, the system was considered as satisfactory by all the physicians. In 72 % of the sessions, the expected result (answer to the question) was gained. By common consent, videoconferencing was unanimously regarded as a prominent tool in improving the interaction quality. Asynchronous transfer mode is an efficient method for fast transferring of radiologic examinations in DICOM format and for discussing them through high-quality videoconferencing.
Abstract: Iron overload involves primarily hepatocytes in case of digestive hyperabsorption (hemochromatosis and dyserythropoiesis) and macrophages in case of transfusional excess. Serum iron and transferrin saturation are poorly correlated with the degree of iron overload. Serum ferritin is a better reflect of iron stores but numerous clinical conditions, unrelated to variations of iron load, can increase the serum level. Biochemical determination of liver iron overload is the gold standard of iron quantification and well correlated to the level of iron burden appreciated by the amount of iron removed by venesection, but its determination necessitates a liver biopsy and is dependant of sampling error in case of heterogeneous iron deposits (cirrhosis). The sensitivity of computed tomography is insufficient, beeing unable to detect iron overload below 5 times the normal liver iron load, especially in case of associated steatosis. Magnetic resonance imaging is a valuable tool when using T2 weighted gradient echo sequences on 1.5 Tesla magnet and permits non invasive iron overload quantification.
Abstract: In hemochromatosis, areas of normal hepatic magnetic resonance (MR) signal intensity indicate the presence of iron-free-nodules, which are strongly suspected of being neoplastic. The goal of the study was to define the prevalence and the nature of these iron-free MR nodules at the time of diagnosis in 116 patients included in a prospective study assessing the accuracy of MR imaging (MRI) in the quantification of liver iron overload.
Abstract: We set out to assess the influence of a teleradiology network on the relations between a general hospital and a 100 km distant university hospital in the context of neurosurgical emergencies, and compared a commercially available technology, N-ISDN (Narrowband Integrated Service/Digital Network), to an emerging technology, ATM (Asynchronous Transfer Mode). The evaluation was conducted using records of advice request calls and patient transfers. Three phases were considered: without teleradiology, with transfer of digitized images over N-ISDN at 64 kbps, and with an experimental ATM network at 10.5 Mbps with DICOM image transfers and videoconferencing. Additionally, staff meetings over ATM videoconferencing were set up. To assess the ATM service, we used log files and questionnaires, 108 advice requests were studied over a 18 month period. The average transmission time for one examination was 38 s with full DICOM image resolution over ATM, versus 150 s with 10:1 JPEG (Joint Photographic Expert Group) compression over N-ISDN. Up to 50% unnecessary patient transfers were avoided. Advice requests increased fourfold, and non-urgent advice requests increased from 0 to 21%. Despite the experimental configuration of the ATM network, the service gave satisfaction to all the physicians. Videoconferencing was unanimously regarded as a prominent tool to improve the quality of interaction. It was particularly useful for non-urgent cases and distant staff meetings. Teleradiology can improve the relations between hospitals through an increase of urgent and non-urgent advice requests. Asynchronous transfer mode is an efficient way for fast transfer of radiological examinations in DICOM format and for discussing them through high-quality videoconferencing.
Abstract: We set out to validate the concept of three-dimensional (3D) angiography. We evaluated the sensitivity and the quality of morphological analysis mode possible by an experimental system for imaging cerebrovascular disease versus standard digital subtraction angiography (DSA). The system, the 3D Morphometer, is a computerised X-ray angiography unit capable of acquiring a set of two-dimensional (2D) projections during a rotation and then reconstructing a 3D volume from them. We studied 78 patients with suspected cerebrovascular disease. 3D and 2D images (standard 2D DSA performed during the same procedure), were reviewed blindly to assess detection and display of morphological characteristics of cerebrovascular diseases. We found 53 aneurysms, 22 arteriovenous malformations and two venous angiomas. On 3D angiography we detected two aneurysms we missed on 2D angiography. In 47 aneurysms on which further data were obtained during surgery or embolisation, the 3D angiography allowed more accurate analysis of the neck and surrounding vessels in cases in which the 2D angiographic findings were doubtful. Assessment of arteriovenous malformations was equivalent with both techniques. Under the conditions of our study, the technical constraints being the same for both methods, 3D angiography was superior to 2D angiography. Implementation on C-arm vascular systems is being evaluated.
Abstract: The retain project (Radiological Examination Transfer on ATM Integrated Network) consisted in teleradiology trials focused on pediatric imaging between two university hospitals. Rennes (France) and Barcelona (Spain) using an integrated broadband communication network based on ATM (asynchronous transfer mode), as part of a European research program. The network used was a full 10 Mbits/s ATM network directly connected to local PACSs (medical imaging hospital networks). One important reason to explicitly consider ATM for medical imaging is that multimedia applications on such networks allow integration of digital data and person-to-person communication. The utility of broadband communication for teleradiology has been confirmed. High quality video and sound are important for both human communication and medical video transfer. The project led to guidelines regarding technical options still open to improvement.
Abstract: Revisualization or image processing stations are constantly improving, but they have not yet been designed to replace the x-ray display unit for the interpretation of films. An improvement of the integration of these stations within the hospital computer system and functional enrichment must be achieved in order to prepare for the "digital" era. Although this prospect is not for the immediate future, it is important to develop tomorrow's tools with a minimum of intelligence to facilitate their acceptance.
Abstract: The paper starts by presenting the major PACS (Picture Archiving and Communication Systems) related concepts and highlights the medical motivations which resulted in PACS developments. The authors review some PACS experiments carried out during the last decade and draw the conclusions of these experiments; the experience of the University Hospital of Rennes is also briefly presented. Finally a discussion is engaged about the future of PACS and their position within the Hospital Information System. According to the authors, this process should not be confined within the small community of PACS specialists but should concern all actors of the hospital, namely medical staff involved in the production or utilisation of medical images, technical staff in charge of equipment and the Hospital Information System, and hospital administrators. Three major lines are proposed: the first one deals with the functional capacities of PACS and their adaptation to actual user needs; the second concerns the methodology required to set up such systems to ensure adequate integration within the HIS and the third concerns economic issues.
Abstract: Computed tomography (CT) scanning is not highly sensitive in the assessment of liver iron content and magnetic resonance imaging (MRI) appears to be more efficient. The aim of this study was to determine the effectiveness of MRI in the evaluation of liver iron content using a standard spin-echo technique. The study included 23 patients with genetic hemochromatosis and 24 non-iron-overloaded patients as controls. A comparison was made of: (a) MRI signal intensity of liver, spleen, paravertebral muscles and subcutaneous adipose tissue using two different spin-echo sequences (SE 500/28; SE 2000/28,56); (b) liver attenuation determined by a single energy CT scan; and (c) a biochemical determination of hepatic iron. There was a significant decrease in liver signal intensity in the genetic hemochromatosis group (256 +/- 201, mean +/- S.D.) compared with the control group (801 +/- 413, p less than 0.001), but there was no correlation with liver iron concentration. However, such a correlation was found and was even more highly significant than in CT when the ratio between the liver and another organ was taken into account. For a lower limit of liver/spleen ratio calculated at 0.46 (mean 2 S.D. in the control group), the specificity (0.96) of MRI was satisfactory, but the sensitivity (0.78) remained insufficient (MRI being unable to detect an iron overload of up to 125 mumol/g). Hopefully, these results might be improved in the near future by using more sensitive sequences such as gradient echo sequences.
Abstract: Superparamagnetic iron oxide (AMI 25) is a promising new contrast agent for imaging the reticuloendothelial-system. Iron oxide crystals possess a large magnetic susceptibility and enhance proton relaxation rates, especially transverse relaxation (T2). In order to guide the clinical utilization of this contrast media we analyzed 4 patients with malignant lesions of the liver before and after slow intravenous administration (20 mumol Fe/kg) of AMI 25. We performed two magnetic resonance (MR) sequences at different times using a 0.35 T magnet. MR signal-to-noise ratio (SNR) of the reticuloendothelial system (particularly the liver SNR) decrease promptly. The maximum decrease in SNR (67-72% for the liver, 46-65% for the spleen, 23-41% for the bone marrow) is observed 3 h after injection (P less than 0.01). However, except the peak of contrast enhancement in T1-weighted sequences of splenic tissue, the curve describes a plateau within 30 min and 6 h, allowing a delay between injection and imaging. T2-weighted sequences give a greater contrast-to-noise ratio (CNR) by adding the spontaneous tumor contrast to the effect yielded by AMI 25. These results suggest that images must be acquired between 1 and 6 h after intravenous administration of superparamagnetic iron oxide.
Abstract: The Waldmann's disease or intestinal lymphangiectasia is a rare disease. We observed a case which occurred in a 14 years old boy. The disease was discovered in the screening of an intermittent diarrhea. The diagnosis was suspected on biological signs of protein-losing enteropathy and the presence of lymphangiectasias seen during endoscopy. The lymphography was conclusive showing the abnormal opacification of the mesenteric region. The other examinations were also important to assert the idiopathic origin of the disease.
Abstract: Between June 1987 and October 1989, nine patients with suspected Cushing's disease were explored by magnetic resonance imaging (MRI), using an 0.35 or 0.5 Tesla magnet. All these patients underwent transsphenoidal surgery and radio-surgical correlations could be established. MRI showed a lesion in 5 cases; it was negative in 2 cases and doubtful in 2 cases. Surgery was positive for pituitary adenoma in 7 cases and negative in 2 cases (including 1 patient with subsequently discovered paraneoplastic syndrome). Using sagittal and coronal planes and combined with gadolinium enhancement, MRI proved to be the most sensitive and specific of all exploratory methods for the diagnosis of ACTH-secreting pituitary adenomas.
Abstract: A case of neonatal anterior rectal duplication is reported. Abdominal ultrasonography revealed a prerectal cystic mass. The different types of rectal duplications and the main differential diagnosis are described. Mechanical obstruction and neoplastic risk make early surgery necessary.
Abstract: The aim of the present study was to evaluate the effectiveness of single-energy computed tomography in determining iron overload in idiopathic hemochromatosis, with special reference to slightly overloaded cases. Liver attenuation was determined in 100 patients (46 cases of idiopathic hemochromatosis, 32 cases of chronic liver disease, and 22 normal controls). The iron load was determined for the first two groups by biochemical determination of liver iron concentration (performed in all but 12 subjects in the chronic liver disease group) and hepatic histologic grading. The main results for liver attenuation (upper normal limit, 72 Hounsfield units) showed that despite a high specificity (0.96), this parameter was of low sensitivity (0.63). Although mean liver attenuation in idiopathic hemochromatosis (77 +/- 14) was significantly higher than in chronic liver diseases (53 +/- 17; p less than 10(-4], and normal controls (66 +/- 3; p less than 10(-3], and despite an overall good correlation between liver attenuation and liver iron concentration (r = 0.72; p less than 10(-3], liver attenuation was unable to detect moderate iron overload. Fourteen of 18 patients with a liver iron concentration of less than 150 mumol/g dry liver wt had liver attenuation values of less than 72. Moreover, 3 of 18 subjects with a liver iron concentration of greater than 150 had a liver attenuation of less than 72. Of these 17 false-negatives, only 7 could be attributed to associated steatosis. On the whole, single-energy computed tomography, when used on a routine basis for diagnosing iron overload, is of limited clinical value in idiopathic hemochromatosis due to its poor sensitivity.(ABSTRACT TRUNCATED AT 250 WORDS)
Abstract: MRI has become indispensable to the positive diagnosis of brain stem tumours which develop preferentially in young people. The prognosis of these tumours, especially infiltrating gliomas, being relatively sombre, it is important to make a precise morphological diagnosis of the lesions (increase in size, signal abnormalities) which will help both neurosurgeons and radiotherapists. As regards post-therapeutic monitoring, MRI with gadolinium contrast injection is harmless and will make it possible to follow these patients regularly and to detect recurrences.
Abstract: The diagnosis of intraabdominal abscess or fluid collections is considerably helped by the precise anatomic delineation yielded by ultrasound and CT-scan. However, the lack of complete specificity of these modalities necessitates needle aspiration for diagnosis. The indications of CT-scan or US guided percutaneous drainage have been expanded with operator experience. Most of intra-abdominal collection, purulent or not, intra or retroperitoneal can be percutaneously treated. Percutaneous drainage can either replace surgery or "temporarize" a critically ill patient until he is able to undergo surgical treatment.
Abstract: In this preliminary study, the authors studies MR imaging in four patients with malignant hepatic tumours before and after intravenous injection of 20 mumols/kg of superparamagnetic iron oxide (SIO). They obtained spin-echo sequences (SE 500/28/4, SE 2 000/28, 56/2) before and after injection and systematically compared the results with ultrasonography and computed tomography data. In every case, superparamagnetic iron oxide (SIO) resulted in a marked decrease in T2 and consequently in the signal of healthy hepatic and splenic tissue, considerably improving the visualisation of malignant lesions which remained unchanged. If the detectability of lesions is considered to depend on the contrast obtained between tumours and healthy tissue, these preliminary results are very promising.
Abstract: The authors present seven cases of apparently isolated spontaneous haematomas of the brain stem detected by computerized tomography (CT). Magnetic resonance imaging (MRI) was performed in all patients, and in three of these on two occasions at different stages of the lesion. Changes in MRI signal according to the moment this examination was carried out (acute, subacute or chronic stage) are described. In two of three patients operated upon the haematoma was found to be due to an occult vascular malformation.
Abstract: CT and MRI features of a multicystic mediastinal teratoma, which was surgically and pathologically confirmed, are presented. CT found 4 cystic tumors of mediastinum with water density content and thick capsule. One kyste contained a fat density area and peripheric calcifications. MRI showed will defined high signal intensity on Spin-echo T1 weighted images. CT and MRI are not reliables in predicting or excluding adherence to adjacent structures. The particularity of this case was the presence of a communication between the anterior right cyst and the posterior left one. This communication passed by the transverse sinus of pericardium.
Abstract: The authors have treated a 20-year-old man with a dorsal intramedullary epidermoid cyst in whom magnetic resonance imaging was performed both before evacuation of the cyst and 3 months later. Intraspinal epidermoid tumors are rare, and the intramedullary location is quite uncommon. To our knowledge, this is the first description of magnetic resonance imaging of an intramedullary epidermoid cyst. The frequency, possibilities, and limits of surgical treatment of such intraspinal benign tumors are reviewed.
Abstract: The aim of the present study was to evaluate the effectiveness of single-energy computed tomography in determining iron overload in idiopathic hemochromatosis, with special reference to slightly overloaded cases. Liver attenuation was determined in 100 patients (46 cases of idiopathic hemochromatosis, 32 cases of chronic liver disease, and 22 normal controls). The iron load was determined for the first two groups by biochemical determination of liver iron concentration (performed in all but 12 subjects in the chronic liver disease group) and hepatic histologic grading. The main results for liver attenuation (upper normal limit, 72 Hounsfield units) showed that despite a high specificity (0.96), this parameter was of low sensitivity (0.63). Although mean liver attenuation in idiopathic hemochromatosis (77 +/- 14) was significantly higher than in chronic liver diseases (53 +/- 17; p less than 10(-4) and normal controls (66 +/- 3; p less than 10(-3], and despite an overall good correlation between liver attenuation and liver iron concentration (r = 0.72; p less than 10(-3], liver attenuation was unable to detect moderate iron overload. Fourteen of 18 patients with a liver iron concentration of less than 150 mumol/g dry liver wt had liver attenuation values of less than 72. Moreover, 3 of 18 subjects with a liver iron concentration of greater than 150 had a liver attenuation of less than 72. Of these 17 false-negatives, only 7 could be attributed to associated steatosis. On the whole, single-energy computed tomography, when used on a routine basis for diagnosing iron overload, is of limited clinical value in idiopathic hemochromatosis due to its poor sensitivity. Hepatic histologic examination together with biochemical determination remains the most accurate means to assess liver iron.
Abstract: A 16 month-old girl presented with congenital common bile duct stenosis revealed by vague faintness. Percutaneous transhepatic cholangiography and surgical biliary opacification showed an abnormal junction of the pancreatico biliary ductal systems with an abnormally long common channel. These anatomic findings seem to be similar to those seen in congenital choledocal cysts and biliary tract dilatation.
Abstract: TAR syndrome is usually an autosomal recessive disease; we report a family where the father of the propositus presented malformations of the feet, and review the known cases involving several generations. The authors of these cases concluded that the TAR syndrome is probably genetically heterogeneous.
Abstract: The authors report a case of soft tissue tumor discovered fortuitously in a 52 year old woman. This lesion was in the axilla and on standard films was seen as a well-defined radiotransparent zone, accompanied by a typical spiculated bone reaction of the lateral edge of the scapula. CT and MRI confirmed the fatty and noninvasive nature of the lesion. Histopathological examination of the operative specimen showed it to be a parostal lipoma.
Abstract: Pelizaeus-Merzbacher's disease is a progressive encephalopathy with demyelination of the cerebral white matter. The diagnosis can not be made on clinical or biological grounds: pathological investigation is necessary to confirm tigroid demyelination. CT scanning failed to visualize this type of anomaly but detection is now possible with the advent of magnetic resonance imaging (MRI). The authors studied the case of a boy who, at the age of 8 presented with symptoms characteristic of the disease: rotatory nystagmus, progressive encephalopathy, and inherited X-linked recessive traits. Magnetic resonance imaging revealed a high signal in the supra- tentorial white matter and the usual contrast was inverted. The authors believe that MRI can make an important contribution to the diagnosis of the disease.
Abstract: Over a 5-year period attempts at transhepatic introduction of a biliary endoprosthesis were made in 39 inoperable patients. The procedure was in 3 stages: transhepatic cholangiography, passage through the stenosis and positioning of the prosthesis. Stenosis was intrapancreatic in 20 cases, pedicular in 9 cases and hilar in 10 cases. The endoprosthesis was successfully set in 20 cases (51%), the success rate being related to the level of the obstacle: intrahepatic 60%, hilar 30%. Failure was more frequent in patients with right liver metastasis, cholangitis or prior unsuccessful palliative surgery. The prosthesis was effective for 1 month in 17 patients and for 6 months or more in 7 patients, two of whom were followed up for 14 and 18 months respectively. Provided patients are better selected and the procedure is used mainly for cholangiocarcinomas, we see no reason why the transhepatic route (combined, if necessary, with endoscopy) should no longer be used to introduce biliary endoprostheses.
Abstract: A diencephalic astrocytoma was diagnosed by ultrasonography in a 5 months old girl with nystagmus and emaciation. A 27 months follow-up with ultrasonography, computed tomography and magnetic resonance imaging, showed an initial improvement after irradiation and afterwards the development of complications with ventricular dilatation and parenchymal calcifications.
Abstract: The authors report 6 cases of portal hypertension with gastrorenal shunt. This shunt did not arise from the left gastric vein, but from the splenic vein. Portal hypertension was related to alcoholic cirrhosis in 3 cases, to extensive portal thrombosis in 2 cases, and to nodular regenerative hyperplasia of the liver in one case. A gastrointestinal hemorrhage revealed portal hypertension and the liver disease in the 3 cases of alcoholic cirrhosis and complicated the course of the disease in the other cases. Hemorrhage was either massive and life-threatening or often recurred. It was related to a rupture of fundic varices in all cases. The fundic varices were not associated with esophageal varices in the 3 cases of cirrhosis. The degree of portal hypertension was above 20 mm Hg, as assessed by the portohepatic gradient (one case), or the pressure gradient between a tributary portal system vein and the inferior vena cava during laparotomy (5 cases). Definitive control of hemorrhage could not be achieved by endoscopic variceal sclerotherapy (2 cases) or percutaneous transhepatic embolization (one case). Portacaval shunt or splenectomy was performed in 5 cases. These findings suggest that spontaneous splenogastrorenal shunt is a clinical and hemodynamic entity which requires specific treatment when associated with gastric variceal bleeding.
Abstract: We report a case of partial pancreatic agenesis in a 25-yr-old man with insulin-dependent diabetes who exhibited abdominal pains in relation to a calcifying chronic pancreatitis. An endoscopic retrograde pancreatography through the accessory papilla revealed an abnormal duct configuration thought to be consistent with an obstruction of the main duct. Ultrasonography and computerized tomography scanning could not identify any pancreatic tissue in the region of the body or tail. Another endoscopic investigation revealed the main papilla in the third part of the duodenum. The ducts of Santorini and Wirsung were identified. Santorini's duct was dilated and contained calculi. Wirsung's duct was nearly normal. The junction between the two ducts was slightly narrowed. After papillotomy of the accessory papilla, the patient's abdominal pains disappeared. This new case of congenital short pancreas is discussed in relation to four other cases reported in the English and French literature.
Abstract: The authors report 3 cases of infants presenting with cerebral lesions related to violent head shaking. They emphasize the diagnostic difficulties when the classical signs of the battered child (marks of blows, fractures) are lacking. The traumatism is rarely recognized: only the negativity of the usual medical causes of subdural hematoma, meningeal or retinal hemorrhage and a peculiar familial history lead to the possible diagnosis of shaken baby syndrome. The value of skull CT-scan is major, showing intracranial lesions which could not be found before. Because of the observed lesions, evolution is often severe.
Abstract: Renal and perirenal staphylococcal suppurative processes are rare since antibiotic era. Three cases are reported. Gram negative organisms are nowadays the most prevalent bacterial species: a urinary tract disease must then be suspected. Early diagnosis is easier with recent event of new imaging techniques. (Ultrasonography and computerized tomography). Percutaneous drainage with the help of antibiotics is the treatment of choice: it is actually a very safe and efficient procedure.
Abstract: Of the 235 renal cancers treated between 1975 and 1984, twenty five cases were complicated by thrombus of the vena cava. Analysis by Kaplan-Meier's method shows a satisfactory survival rate for isolated thrombus of the vena cava (80 per cent at two years, and 45 per cent at five years). But associated lesions to the perirenal fat or lymph nodes considerably diminishes the survival rate, so that the overall survival rate in this series was only 37 per cent at two years and 20 per cent at five years. 57 per cent of the patients who seemed free of distant metastases during the preoperative investigations, nonetheless died within two years postoperatively, from a lung, liver or bone metastasis. CT scan at present allows diagnosis of renal cancer and assessment of the extension to the fatty capsule and the vena cava. It is to be hoped that nuclear spin electronic resonance will provide a better assessment of the prognostic factors, and, in particular, the lymph node extension.
Abstract: One mucopolysaccharidosis I-H (Hurler's Syndrome) found in 3 months infant, was complicated with an hydrocephalus at the age of 5 months. If macrocephaly is known in several genetic inborn errors of metabolism, specially in the different mucopolysaccharidosis, hydrocephalus is quite more rare. It is probably communicating and due to accumulation of storage material in the piaarachnoid causing an impairment in CSF absorption. It occurs in the evolution of the disease and the reported cases concern only older children; our case is special by the early beginning of hydrocephalus.
Abstract: CT scan examinations done in 356 children for epilepsy or occasional seizures showed normal results in over 50% of cases and abnormal results in 40%. The remaining 10% reflect the difficulties in ascertaining that a CT scan examination is normal, particularly regarding pericerebral spaces or ventricular size. The anomalies disclosed on CT scan are of little practical significance. Many of the abnormal results are not specific. An incidence on management was recorded in 5 cases. Other problems which may arise are the connexion between some CT scan findings and epilepsy, or the nature (tumoral or not) of abnormal images. In a few cases, diagnostic investigations or biopsies, which were negative in some instances, were carried out after demonstration of localized decreased density without signs of a space-occupying lesion. The differences in results between the various groups of epileptic patients underscore the necessity of a clinical selection of cases in which a CT scan is required.
Abstract: A double anatomic and computed tomographic study of the muscle levator ani has been performed in pediatric patients. In or study, we have used frozen anatomical specimens. The anatomic and computed tomographic sections have been made strictly comparable, every 3 millimeters. These actions provide the normal computed tomographic aspect of the muscle levator ani. This anatomic study may have a direct application in the evaluation of imperforate anus, which is often difficult to diagnose : it allows a more precise determination of the level of the terminal rectal pouch compared to the level of the levator ani.
