P. Sarliève

Cecal volvulus: CT findings and correlation with pathophysiology

The purpose of this study is to report the computed tomography (CT) features of cecal volvulus and to determine the accuracy of CT in distinguishing the three pathophysiological types of cecal volvulus. The CT studies of ten patients with surgically confirmed cecal volvulus were reviewed. For each patient, CT findings were looked for and recorded. The precise location of the cecum within the abdomen, the presence of an ileocecal twist, and the clockwise or counterclockwise direction of the whirl sign were specifically analyzed. All these results were confronted to the surgical diagnosis retrospectively correlated with the three types of cecal volvulus. According to our classification based on the analysis of the location of the cecum within the abdomen and the presence or the absence of a whirl sign on CT scans, the cecal volvulus was defined as the axial torsion type in four (40%) patients, loop type in four (40%) patients, and cecal bascule type in two (20%). For each patient, the result was in full accordance with the type of cecal volvulus diagnosed at surgery. CT is not only a valuable diagnostic technique in diagnosing cecal volvulus and its complications, but it is also useful in distinguishing the three pathophysiological types of cecal volvulus.

Radiofréquence bipolaire et cimentoplastie dans le traitement des métastases osseuses

Bone metastases are the most common cause of pain in cancer patients. Pain management in cancer patients, often revealing the disease and always present at advanced stages, is an important and difficult task. Pain is not always properly controlled by high doses of specific medication, radiation therapy or chemotherapy. When these therapies do not provide adequate pain relief, percutaneous neurolysis, infiltrations, alcoholizations and cementoplasty may be considered. More recently RF ablation has been proposed. On weight-bearing bones, RF can be combined with acrylic cement injection. The authors present here this very effective new technique which is complementary to classical pain management techniques.

Valeur de l’épine du pubis comme repère TDM des hernies de l’aine

Resume But Evaluer la valeur de l’epine du pubis comme repere TDM pour differencier les hernies femorales et inguinales de diagnostic clinique incertain, avant leur prise en charge chirurgicale, dans le cadre d’un tableau d’engouement avec occlusion mecanique du grele. Materiel et methodes Il s’agit d’une analyse retrospective des examens TDM realises dans notre service pour occlusion mecanique du grele sur l’annee 2OO3. Douze cas de hernie de l’aine responsable d’une occlusion mecanique du grele ont ete retenus. Tous les examens TDM inclus dans l’etude ont fait l’objet d’une double lecture radiologique. Les 12 cas repondant aux criteres d’inclusion ont beneficie d’une recherche de leur compte-rendu chirurgical pour authentifier le type herniaire. Resultats Douze cas de hernie de l’aine responsable d’un syndrome occlusif ont ete diagnostiques en TDM pendant l’annee 2003 dans notre service. Huit cas correspondaient a des occlusions mecaniques sur hernie inguinale (dont 4 directes et 4 indirectes) et 4 a des occlusions mecaniques sur hernie femorale. Dans tous les cas, le diagnostic du type herniaire, evoque en TDM au moyen d’un repere orthogonal centre sur l’epine du pubis dans le plan axial, a ete confirme par la chirurgie. Conclusion L’epine du pubis constitue un excellent repere TDM pour authentifier la nature inguinale (directe ou indirecte) ou femorale d’une hernie de l’aine. L’authentification pre-chirurgicale des differentes formes herniaires est importante, puisque ces hernies justifient des abords chirurgicaux differents.

Intradural disc herniation with cranial migration of an excluded fragment

Intradural herniation is a rare complication of the intervertebral disc disease. The history and present clinical findings may suggest the diagnosis. Although the myelographic signs are well known, intradural hernias have seldom been illustrated by magnetic resonance imaging (MRI). We present the case of an intradural disc hernia with cranial migration of a sequestrated fragment illustrated by both myelography and MRI. To our knowledge, such a case has never been reported in the literature so far.

Le feces sign : valeur d’un signe TDM dans l’occlusion du grêle sur bride ou adhérences péritonéales

Resume Objectif Le but de ce travail est de decrire le feces sign et de definir sa valeur comme critere de non severite dans l’occlusion du grele sur bride ou adherences peritoneales. Materiels et methodes Nous avons analyse retrospectivement les occlusions du grele sur bride ou adherences peritoneales diagnostiquees en TDM entre janvier 2001 et decembre 2002. Tous les examens dans lesquels figurait un feces sign ont ete inclus dans l’etude. Le dossier clinique de chaque patient selectionne a ete ressorti et etudie. Resultats Vingt patients ont ete inclus dans cette etude. Douze patients ont beneficie d’un traitement conservateur efficace avec aspiration nasogastrique. Aucune complication ischemique digestive n’a ete retrouvee au decours des 6 laparotomies realisees en urgence et des 3 realisees de facon differee. A chaque fois, le traitement a consiste en une adhesiolyse et aucune resection intestinale n’a ete necessaire. Conclusion Recemment decrit dans la litterature radiologique, le feces sign peut etre considere comme le premier critere positif de non gravite d’une occlusion du grele sur bride ou adherences peritoneales.

The pubic tubercle: a CT landmark in groin hernia

The aim of our study is to investigate the pubic tubercle as a reliable CT landmark in distinguishing the three types of groin hernia. CT scans of 42 patients with surgically confirmed groin hernia were reviewed. For each patient, both the anatomical structure within the hernia and the state of the hernia to the inferior epigastric artery were specifically recorded. Hernias were also located within a schematic construction of orthogonal lines focused on the pubic tubercle. In this construction, inguinal hernias were ventral to the X-axis while femoral hernias were dorsal to the X-axis. Among the inguinal hernias, direct inguinal hernias were located strictly lateral to the Y-axis while indirect inguinal hernias medially crossed the Y-axis. All these CT results were compared to the surgical findings. The inferior epigastric artery was visualized in 90% patients and, in these cases, the situation of the hernia to the artery on CT showed no discordance with surgical findings. Within the schematic construction of orthogonal lines focused on the pubic tubercle, 50% were considered as indirect inguinal hernias, 31% as direct inguinal hernias and 19% as femoral hernias. For each patient, the CT diagnosis was consistent with the surgical report.

Évaluation fonctionnelle et échographique de l’épaule après enclouage de Seidel

PURPOSE OF THE STUDY: Centromedullary nailing with a Seidel nail is a validated treatment for humeral shaft fractures which some teams have abandoned due to the injury caused to the rotator muscles. The purpose of this study is to assess shoulder function (Constant and DASH) after nailing procedures and to analyze sonographic findings. MATERIAL AND METHODS: Twenty-nine patients who underwent Seidel nailing between 1996 and 2002 were reviewed by an independent operator at 36 months follow-up on average (range 11-84 months). The sex-ratio was 1.64. Mean age at surgery was 41.5 years (range 17-81 years). The dominant side was involved in 17 cases. Fracture was caused by a traffic accident in 13 cases, a fall in 12, and a blunt injury in 4. The fracture was situated in the mid third of the shaft in 19 cases, the upper third in 3, the mid and lower third in 3 and mid and upper third in 3. Mean delay before surgery was 2.4 days. Initial complications were medioulnar palsy (n=1), complete brachial palsy (n=1), partial brachial palsy (n=1). There was one open Cauchoix I fracture. RESULTS: Bone healing was achieved in 27/29 patients at 3.5 months on average. Revision was required in nine patients. The Constant score was 69.1 (86.9% contralateral). The weighted Constant score was 81.7 and the DASH was 25. The Constant score was significantly better in patients aged less than 50 years and with transverse fractures. Sub-acromial space narrowing was observed in six patients at follow-up and only 9/28 sonographic examinations (32%) were normal; most shoulders presented transient healing lesions. DISCUSSION: This series was comparable with others regarding patient satisfaction, bone healing and complications, but was less satisfactory for the Constant score and time to healing. We have found that using a subjective function score (DASH) with an objective score (Constant) enables a better assessment of shoulder function. Like Gaullier, we consider that after cuff healing, anterograde nailing does not compromise shoulder function despite the injuries observed sonographically.

Rupture de kyste mucoïde dans la graisse rétro-fémorale : à propos de deux cas

Resume Les kystes mucoides, appeles aussi ganglions cysts, sont des cavites kystiques depourvues de revetement synovial, de topographie ubiquitaire, dont la communication avec la cavite articulaire est inconstante mais doit etre systematiquement recherchee. Les auteurs rapportent pour la premiere fois dans la litterature deux cas de rupture de kyste mucoide dans la graisse retro-femorale simulant une phlebite avec cellulite de cuisse. La connaissance de ce diagnostic permet une orientation medicale precise, un traitement simple en evitant les controles intempestifs d’imagerie, de biologie et l’emploi inapproprie des anticoagulants et des antibiotiques.Ganglion cysts are ubiquitous cystic lesions without synovial wall and inconstant communication with the articular cavity. The later must nonetheless always be carefully looked for. We report two cases of ganglion cyst rupture in the retrofemoral fat simulating phlebitis with thigh cellulitis. To the best of our knowledge, this has not been previously reported in the literature. Familiarity with this entity ensures adequate medical diagnosis and management, avoiding unnecessary imaging and laboratory work-up and inappropriate use of anticoagulant and antibiotic.

Occlusion colique sur hernie lombaire secondaire à un prélèvement de lambeau du muscle grand dorsal: À propos d’un cas

Resume Les auteurs rapportent le cas d’une femme de 46 ans presentant une occlusion colique sur hernie lombaire secondaire a un prelevement de lambeau du muscle grand dorsal pour reconstruction mammaire. Le diagnostic positif a ete pose au scanner. Cet article illustre l’aspect TDM de cette cause rare d’occlusion colique et y associe une breve revue de la litterature.The authors report the case of a 46-year-old woman with large bowel obstruction secondary to lumbar hernia following latissimus dorsi flap. Diagnosis was made by CT. This paper describes the CT features of this rare pathology. A brief review of the literature is also presented.

Modélisation tridimensionnelle des vertèbres types : Premières applications en radioanatomie et radiologie interventionnelle sous guidage tomodensitométrique

Purpose To model vertebrae in 3D to improve radioanatomic knowledge of the spine with the vascular and nerve environment and simulate CT-guided interventions.