[Endovascular embolization of ophthalmic artery branches for control of refractory epistaxis: report of one case]. / Traitement endovasculaire d'un épistaxis réfractaire par embolisation dans le territoire ophtalmique: à propos d'un cas.

Embolization of the internal maxillary artery is an accepted method for control of severe or recurrent posterior epistaxis. Such endovascular treatment may fail if the vascular supply to the bleeding vessels originates in branches of the ophthalmic artery. We report one case in which embolization of the ophthalmic artery was performed to control epistaxis. Distal catheterisation at least beyond the second portion enables safe embolization.

[Percutaneous osteosynthesis of pelvic fractures with CT control]. / Ostéosynthése percutanée des fractures du bassin sous contrôle tomodensitométrique.

Pelvis fractures, most often multiple, are frequently unstable. Orthopedic treatment is hardly bearable (traction in bed sometimes up to 45 days), the open reduction and internal fixation (ORIF) is heavy. Percutaneous fluoroscopy guided fixation lacks precision in depth. Percutaneous screw fixation with CT scan control answers these drawbacks and represents a quick solution, with few hazard when performed by a trained team and allows a very early resumption of standing.

[Triple and quadruple images in scan of fractures of the articular processes of the lower cervical spine]. / "Triple et quadruple images" au scanner des fractures des apophyses articulaires du rachis cervical inférieur.

The authors describe the triple and quadruple image aspects of the articular pillar, which are encountered respectively in one-sided uni- and biarticular fractures of the lower cervical spine, and they have analysed these images' specificity from a retrospective study. This study concerned 52 cases out of a group of 220 patients hospitalised between 1979 and 1992, with an injury of the lower cervical spine and who underwent a CT-scan examination in addition to the conventional radiographic check-up. Among a total of 70 lesions, 14 uniarticular and 4 biarticular one-sided fractures were recorded. All presented these characteristic aspects, formed by the separated fragment of the articular process; the unseparated component of the process and, concerning the triple image the intact process, or concerning the quadruple image the fragments of the second fractured process. An only case of a transisthmian fracture associated with a fracture of the lower articular process showed a similar aspect, which underlines the high specificity of these images.

Fracture of the spine, spinal epidural haematoma and spondylitis. Report of one case and review of the literature.

We report the case of a patient suffering from spinal epidural haematoma and thoracic spinal fracture, and from ankylosing spondylitis. Fourteen cases of spinal epidural haematoma in association with ankylosing spondylitis have been reported in the literature, 12 of them at a cervical level. Spinal epidural haematoma found in patients suffering from ankylosing spondylitis share the same clinical picture as other haematomas, the notion of time being the main feature. Serious neurological complications caused the death of five patients. The case we report is singular for its thoracic localization and two attacks of total paralysis both followed by spontaneous and complete recovery. Today, MRI is the best method to reach a clear and reliable diagnosis. Widespread use of MRI will certainly increase the number of diagnoses made. Our patient underwent operation including osteosynthesis using Cotrel-Dubousset instrumentation. This enabled him to resume his professional activities only 30 days after his accident.

Pull-out strength of sacral implants using Cotrel-Dubousset fixation devices.

Our aim was to determine the bone structure of the sacrum and the optimum location in the sacrum for the insertion of lumbosacral screws in osteosynthesis. Anatomical tests were performed on mortuary specimens at the Medical School in Nice, France, on frozen sections of sacrum and in computed tomographic (CT) sections with 3-dimensional reconstruction. Density assessment of different structures from the first and second sacral vertebrae (S1, S2) was performed and expressed in Hounsfield units. The ala and the lateral part of S1 contained yellow marrow forming a fatty mass bounded by the cortex of the sacroiliac joint at the linea terminalis and by the cancellous bone in the pedicles and the body of S1 and S2. These studies were undertaken prior to the experimental tests. The experimental tests were made using Cotrel-Dubousset instrumentation to determine the pull-out strength of sacral screws with a 7-mm diameter by assessing pull-out strengths of paired screws arranged either unilaterally with one screw in S1 and one in S2 or symmetrically to the left and right in S1. The devices demonstrating the best pull-out strength were the "corporopedicular" screw in S1 and the caudal lateral oblique screw in S1 passing through the sacroiliac joint. The paired screws with the best pull-out strength were those which included a corporopedicular screw in S1.

Lumbar spine, sport and actual treatment.

Low back pains are very frequent in athletes by microtraumatisms and sudden efforts. The prolapse of the nucleus pulposus is created. After the failure of correct medical treatment, some new technics give good results: chemonucleolysis, trans-cutaneous nucleotomy, microdiscectomy. These techniques permit a faster and more active return to effort. The choice must be perfect: clinical examination and imagery manage this advance.

Anatomic and experimental basis for the insertion of a screw at the first sacral vertebra.

The authors present the anatomic and experimental basis of an original technique for screwing at the first sacral level employed in lumbosacral fusion. The anatomic studies were based on specimens from the anatomy museum, frozen sections of the sacrum and CT examinations with three-dimensional reconstruction and assessment of the density of the different structures of S1 in Hounsfield units (HU). The findings were that the ala and lateral portions of S1 contain yellow marrow forming what amounts to a fatty sphere bounded by the cortical bone of the sacroiliac joint, the linea terminalis and the spongy bone of the pedicles and of the body of S1. The experimental study was made by avulsion of sacral screws (system of Cotrel Dubousset), each of 7mm diameter. No screw perforated the sacral cortex. Three directions were tested. The insertion of a screw through the pedicle and body of S1 is advised, with the point of insertion below and lateral to the articular process of S1 and an oblique course forward and inward at an angle of 10 degrees to the sagittal plane. This internal obliquity is limited by the posterior prominence of the iliac ala.

[Osteosynthesis of the spine using Cotrel-Dubousset instrumentation. Contribution of x-ray computed tomography with 3D reconstruction]. / Ostéosynthèse du rachis par matériel de Cotrel-Dubousset (C-D). Apport du scanner avec reconstruction 3D.

3D reconstruction is of a great interest in the study of the osteosynthesis of the spine by C-D material, where MRI is impossible and CT usually artifacted. The results obtained by 3D reconstruction allow visualization of osseous, extra osseous (disks, ligaments...) and metallic structures.

[Budd-Chiari syndrome and membranous obstruction of the suprahepatic inferior vena cava. Treatment by percutaneous intraluminal angioplasty]. / Syndrome de Budd-Chiari et obstruction membraneuse de la veine cave inférieure sus-hépatique. Traitement par angioplastie intra-luminale percutanée.

A 38-year-old woman, suffering from a Budd-Chiari syndrome due to membranous obstruction of the inferior vena cava, has been treated by percutaneous trans-luminal angioplasty. The result is excellent six months after. The permeability of the vena cava has been studied by manometry and cavography. This innocuous procedure seems worth while in the treatment of Budd-Chiari syndrome with membranous obstruction of the inferior vena cava.

Liver involvement in chronic granulomatous disease: the role of ultrasound in diagnosis and treatment.

Ultrasonic features of liver involvement in six children with chronic granulomatous disease (CGD) are reported. Hepatic granulomas appeared as hypoechoic, poorly marginated areas without posterior enhancement. In two cases, the diagnosis of CGD was suggested by this sonographic pattern. Ultrasound follow-up of the granulomas was used to plan therapy: in three cases, the granulomas subsided with antibiotic treatment alone; three patients underwent surgery because of the persistence of the granuloma and/or its modification into a fluid-filled abscess with good sound transmission throughout. Percutaneous biopsy and aspiration under sonographic guidance were performed in the two cases where CGD had not been diagnosed previously; such procedures permitted recognition of the disease based on histologic study, drainage of a defined abscess, and identification of the infecting organism. Healing of the hepatic lesions was documented in all six patients.

[External retromalleolar lymphography of the superficial and deep lymphatics of the lower limb (author's transl)]. / Voies lymphatiques superficielles et profondes du membre inférieur explorées par la lymphographie rétro-malléolaire externe.

External retromalleolar lymphography was employed to explore lower limb lymphatics in 39 patients. Though this type of approach enables deep lymph vessels of the thigh to be studied--at the price of a more difficult catheterization than when the classical approach is used--it is ineffective for demonstrating deep lower leg lymph vessels, filling occurring only in the superficial network. Its indications are therefore limited to cases following unsuccessful attempts with the classical approach.

[Pneumoperitoneum. A remarkable technique for its detection (author's transl)]. / Le pneumopéritoine. Une remarque technique pour sa recherche

A study made in 30 cases indicated that, in contrast to current habits, the emergency erect plain film of the abdomen used to detect a pneumoperitoneum should be taken in expiration. A film in inspiration may be considered to be a supplementary view.