Denis Regent

Spiral-computed tomography versus pulmonary angiography in the diagnosis of acute massive pulmonary embolism

Abstract Similar to imaging and Doppler echocardiography, which permit assessment of cardiovascular compromise, 6 spiral CT represents a safe and effective diagnostic tool for acute and massive pulmonary embolism. Because this method is efficient in detecting emboli in the second to fourth division pulmonary vessels, it is probably also well suited for diagnosing submassive PE, but most likely ineffective in diagnosing peripheral PE.

Prognostic value of exercise pulmonary haemodynamics in pulmonary arterial hypertension

The aim of the study was to investigate the prognostic value of right heart catheterisation variables measured during exercise. 55 incident patients with idiopathic, familial or anorexigen-associated pulmonary arterial hypertension (PAH) underwent right heart catheterisation at rest and during exercise and 6-min walk testing before PAH treatment initiation. Patients were treated according to recommendations within the next 2 weeks. Right heart catheterisation was repeated 3–5 months into the PAH treatment in 20 patients. Exercise cardiac index decreased gradually as New York Heart Association (NYHA) functional class increased whereas cardiac index at rest was not significantly different across NYHA groups. Baseline 6-min walk distance correlated significantly with exercise and change in cardiac index from rest to exercise (r=0.414 and r=0.481, respectively; p<0.01). Change in 6-min walk distance from baseline to 3–5 months under PAH treatment was highly correlated with change in exercise cardiac index (r=0.746, p<0.001). The most significant baseline covariates associated with survival were change in systolic pulmonary artery pressure from rest to exercise and exercise cardiac index (hazard ratio 0.56 (95% CI 0.37–0.86) and 0.14 (95% CI 0.05–0.43), respectively). Change in pulmonary haemodynamics during exercise is an important tool for assessing disease severity and may help devise optimal treat-to-target strategies. Exercise cardiac index correlated with exercise capacity and was associated with long-term survival in PAH http://ow.ly/vG2bb

Assessment of the superior labrum of the shoulder joint with CT-arthrography and MR-arthrography: correlation with anatomical dissection

The ability to detect and categorize SLAP (Superior Labrum Anterior to Posterior) lesions of the scapular labrum is of practical importance to the orthopedic surgeon and the radiologist. The aim of this study, performed on cadaveric shoulders, was to determine whether CT arthrography or MR arthrography is able to show normal anatomical variation of the glenoid labrum and detect labral abnormalities. CT arthrography, MR arthrography followed by anatomical dissection were performed on twenty three fresh frozen cadaveric shoulders and analysed by a radiologist and two orthopaedic surgeons. As Gadolinium intra-articular injection is not allowed in France, we used an iodinated contrast media for both MR arthrography and CT arthrography. In this study, the sensitivity of MR arthrography seemed higher than CT arthrography (respectively 4 and 3 labral lesions diagnosed out of five), although no significant statistical conclusions can be made due to the small number of cases. In conclusion, under such specific conditions, MR arthrography seems to be the method of choice for the detection and classification of labral lesions.

Case report 656

: A case is presented of a 55-year-old man with a MFH in a previous BI. The poor prognosis of such secondary MFH is related in part to the difficulty of its early diagnosis, its aggressive behavior, and its tendency to metastasize (mainly to bone sites and lungs). Nevertheless, although biopsy of asymptomatic bone marrow infarction is not indicated, MRI seems consistent in detecting sarcomatous transformation of symptomatic BIs and plays an important role in the patients preoperative evaluation.

MR Patterns of Dialysis Arthropathy

Ten patients (average age 51 years) on long-term hemodialysis (average duration 13.5 years) were examined by magnetic resonance (MR) (all cases) and CT (five cases) for cystic radiolucencies of the wrist, shoulders, and hips. MR and CT revealed more lesions of smaller size than plain films and both showed a constant communication with the joint space. Synovial hypertrophy was generally absent or very mild even in the case of large osseous erosions. The MR analysis of the content of the lesions in the wrist was quite variable: low signal on T1- and T2-weighted images (12 of 24), low signal on T1- and high signal on T2-weighted images (10 of 24), and high signal on T1- and T2-weighted images (2 of 24). The patterns of transplanted (four cases) or ungrafted (six cases) patients were indistinguishable. These results suggest an articular origin of the lesions, but different from synovial processes such as rheumatoid arthritis, and confirm their probable multifactorial pathogenesis.

An unusual case of hip septic arthritis due to Bacteroides fragilis in an alcoholic patient.

We describe a 53-year-old alcoholic man who presented with hip septic arthritis due toBacteroides fragilis. This arthritis involved a severe destruction of the femoral head, which was completely devitalized. Recovery was achieved after 4 months of antimicrobial therapy with imipenem/cilastatin plus metronidazole, surgical debridement of the necrotic tissues and four sessions of hyperbaric oxygen. Wir berichten über einen Fall von septischer Hüftarthritis durchBacteroides fragilis bei einem 53 Jahre alten Alkoholiker. Die Arthritis führte zu einer schweren Femurkopfzerstörung mit völliger Devitalisierung. Nach chirurgischem Debridement des nekrotischen Gewebes, 4 Monaten Behandlung mit Imipenem/Cilastatin und Metronidazol und vier Behandlungen mit hyperbarem Sauerstoff trat Heilung ein.SummaryWe describe a 53-year-old alcoholic man who presented with hip septic arthritis due toBacteroides fragilis. This arthritis involved a severe destruction of the femoral head, which was completely devitalized. Recovery was achieved after 4 months of antimicrobial therapy with imipenem/cilastatin plus metronidazole, surgical debridement of the necrotic tissues and four sessions of hyperbaric oxygen.ZusammenfassungWir berichten über einen Fall von septischer Hüftarthritis durchBacteroides fragilis bei einem 53 Jahre alten Alkoholiker. Die Arthritis führte zu einer schweren Femurkopfzerstörung mit völliger Devitalisierung. Nach chirurgischem Debridement des nekrotischen Gewebes, 4 Monaten Behandlung mit Imipenem/Cilastatin und Metronidazol und vier Behandlungen mit hyperbarem Sauerstoff trat Heilung ein.

Virtual cystoscopy of the urinary tract

Today it is recommended that all patients with the suspicion of bladder, either because of an episode of hematuria or a previous bladder papilloma, be examined endoscopically. Conventional cystoscopy remains the mainstay for diagnosis, management and follow-up of urothelial tumors, and repeated surveillance cystoscopy examinations are requisites to assess disease control. Particularly in man, this clinical cystoscopy has its own drawbacks, including patient discomfort and relatively high cost. Generally, conventional cystoscopy is planned under general anesthesia, with antibiotic therapy and an overnight hospital stay. In order to avoid these requirements, a less invasive and costly method may be represented by virtual endoscopy or 3D CT endoscopy. 3D CT endoscopy is a new term used to describe computersimulated endoscopy procedures derived from thin section-CT of gas-filled or contrast enhanced hollow viscus of the human body, and has been widely applied to the paranasal sinuses, the upper respiratory tract, the tracheobronchial tree, the gastric and the colonic tubes, the vascular structures and more recently to the urinary tract and especially the bladder, in which carcinoma must be conceived as a focal expression of epithelial abnormalities that may be quite diffuse.

Progress in MR imaging in oncology

MR imaging is usually sufficient to display vessel involvement within or close to tumors. One example concerns the liver where hepatic vessel involvement is well identified, by the hepatocellular carcinoma or metastases [1]. In addition to the clinical diagnostic properties of MR imaging, MR angiography (fig. 45.1) and dynamic MR imaging studies have potential clinical applications in oncologic patients. However, a small number of studies limited their conclusions to the feasibility of the technique. Moreover, none of these described in the following pages concluded that MR angiography should substitute for other techniques (i.e. ultrasound and/or CT).

Traitement médical de l'échinococcose alvéolaire : 10 années d'expérience

Medical treatment of alveolar echinococcosis : 10 years of experience : report of 35 cas treated either with Flubendazole or Albendazole or Mebendazole. Treatment shall be lifelong.