Duplication of the extracranial internal carotid artery.

We describe a case of duplication of the left internal carotid artery from a point 1 cm distal to the origin to the proximal petrous segment where the vessel reunites. Duplication and fenestration of the internal carotid artery are discussed. A review of embryologic development is presented. Identification of these entities is important, especially in patients who require surgical intervention involving the internal carotid artery.

A multispectral analysis of brain tissues.

With the increasing use of three-dimensional MRI techniques it is becoming necessary to explore automated techniques for locating pathology in the volume images. The suitability of a specific technique to locate and identify healthy tissues of the brain was examined as a first step toward eventually identifying pathology in images. This technique, called multispectral image segmentation, is based on the classification of tissue types in an image according to their characteristics in various spectral regions. The spectral regions chosen for this study were the hydrogen spin-lattice relaxation time T1, spin-spin relaxation time T2, and spin density, rho. Single-echo, spin-echo magnetic resonance images of axial slices through the brain at the level of the lateral ventricles were recorded on a 1.5 Tesla imager from 20 volunteers ranging in age from 17 to 72 years. These images were used to calculate the T1, T2, and rho images used for the classification. Tissue classification was performed by locating clusters of pixels in a three-dimensional T1(-1)-T2(-1)-rho histogram. Gray matter, white matter, cerebrospinal fluid, meninges, muscle, and adipose tissues were readily classified in magnetic resonance images of the volunteers with a single set of T1, T2, and rho values. Cluster characteristics, such as size, shape, and location, provided information on the imaging procedure and tissue characteristics.

Prevalence of osseous changes in the temporomandibular joint of asymptomatic persons without internal derangement.

There is a controversy in the literature regarding the prevalence of osseous changes in the temporomandibular joint (TMJ) of asymptomatic persons. Using cephalometrically corrected tomograms, we assessed one TMJ of each of 34 asymptomatic persons who had no arthrographic or magnetic resonance imaging evidence of internal derangement. Minimal flattening of the condyle or articular eminence was seen in 12 joints (35%). More advanced osseous changes such as erosion, osteophytosis, or sclerosis were not seen in any joint. The findings suggest that generally no osseous changes occur in the TMJ in asymptomatic persons without internal derangement. When osseous changes occur, they are confined to minimal flattenings. Minimal flattening is probably of no clinical significance because the persons were asymptomatic, and arthrography and magnetic resonance imaging showed no evidence of abnormalities in the soft tissues.

Temporomandibular joint: improved MR image quality with decreased section thickness.

To determine if the quality of spin-echo magnetic resonance (MR) images of the temporomandibular joint (TMJ) could be improved by reducing section thickness, coronal and sagittal 3.0- and 1.5-mm MR images of the same joints were evaluated. Depiction of the disk, trabecular pattern, and cortex of the condyle was better on coronal 1.5-mm images than on 3.0-mm images (P less than .01), and 1.5-mm sagittal images were better for depiction of the trabecular pattern of the condyle than were 3.0-mm images (P less than .05). The ability of MR imaging with thinner sections to reveal more anatomic details should result in improved diagnostic accuracy.

Evaluation of the carotid artery bifurcation: comparison of magnetic resonance angiography and digital subtraction arch aortography.

Thirty-four carotid artery bifurcations were examined using both magnetic resonance angiography (MRA) and digital subtraction arch aortography to determine their accuracy when compared to selective carotid angiography. The sensitivity of MRA was 73% and its specificity was 91% when compared with selective carotid angiography. The sensitivity of arch aortography was 27% and its specificity was 100%.

[Radio-anatomical study of the calcaneus. Accuracy of Böhler's angle measurement]. / Etude radio-anatomique du calcanéum. Validité de la mesure de l'angle de Böhler.

The authors have studied variations of Böhler's angle by various radiographic incidences. They have defined anatomic references of this angle on the correspondent dry bone. With the same radiographic incidences, Böhler's angle was 32 degrees. This value remained constant when X-ray incidences were modified with 15 degrees in all the directions from the external profile. Anatomic variations of the 3 references on dry bone which define this angle, were very small. Böhler's angle is therefore a good morphologic reference for evolutive study of each patient. It's variation in population needs comparative radiographic control of the opposite side.

The potential usefulness of condensed image processing of sequential lymphoscintigrams in patients with lymphedema.

Condensed image processing (CIP), a computerized technique of scintiscans that generates a vertical distribution of activity as a function of time in a single image, was applied to isotopic lymphoscintigrams of four patients with leg lymphedema. By "condensing" information gained from multiple images into a single image, CIP better evaluates ascending progression of radiolabeled colloid in peripheral lymph and better localizes stagnant areas. In "high lymph flow failure," CIP also depicts radioactive "bursts" suggestive of increased lymphatic truncal contractility. This data processing method improves interpretation of dynamic scintiscan recordings and seems ideally suited for evaluation of peripheral lymph kinetics.

[A survey of the French-speaking Association of Lymphology on the use of pressotherapy in France during the treatment of lymphedema]. / Enquête de l'Association de Lymphologie de langue française sur la pratique de la pressothérapie en France au cours du traitment des lymphoedèmes.

116 physicians out of the 1000 who were questioned use pressure-therapy in the treatment of lymphedema of the extremities. Another 170 are interested in the technique and await this report before possibly adopting it. Overall, the devices utilized are compartmented and use discontinued pressure that is asynchronous in relations to heart beat; each session lasts 30 minutes, on average, with compression and resting phases lasting 45 seconds and 15 seconds, respectively. The usual schedule is one session daily, three days per week, in two series clustered within a single year. Although manual drainage of lymphatics is combined with pressure-therapy in 71.55% of the times, only 43.47% of physicians use elastic support following the treatment. Results are good or very good in 64.4% of cases, and the incidence of post-therapeutic events is rather low (polyuria, pain recrudescence of lymphangitis, etc.). Aside from lymphedema, venous insufficiency, hypodermitis and leg ulcers may also benefit from pressure-therapy.

[The current role of lymphoscintigraphy in the study of lymphedema of the limbs]. / Place actuelle de la lymphoscintigraphie dans l'étude d'un lymphoedème des membres.

After a brief review of the classical methodology and results of lymphoscintigraphy, the technique is considered in terms of an original kinetic study approach. Immediately after distal subcutaneous injection of a technetium colloid (rhenium sulfocolloid), 40 1-min serial images of the limbs are recorded followed 4 h after injection by recording of static images. The main abnormalities detected by scintigraphy concern the lymphatic vessels, nodes and interstitium. They reveal the presence of lymphedema and provide information about its mechanism, indicating, particularly in the case of primary lymphedema, whether there is predominant hyperplasia or hypoplasia in vessels or nodes. Synoptic study of the initial dynamic recording based on simple examination of serial images is difficult. Complementary data provided by activity curves determined from manually selected regions of interest (ROI'S) are of limited value since the ROI'S correspond to superimposed spatial structures. Two data-processing techniques--the condensed image (CI) and factorial analysis (FA)--were therefore applied to dynamic scintigraphic recordings in order to study lymphatic progress of the radiotracer in the legs. A complete dynamic series is described in two IC, one for each leg. The CI, obtained by mounting the 40 serial images in vertical strips 1 pixel in width, describes the spatial distribution of radioactivity along the leg during recording. Factorial analysis provides automatic extraction of pure kinetic components or factors from the dynamic series despite their spatial superposition. The factors are described by factorial curves and factorial images representing the spatial identity of the factor. Three-factor FA was applied successively to each leg.(ABSTRACT TRUNCATED AT 250 WORDS)

[Surgical treatment of lymphedema]. / Traitement chirurgical des lymphoedèmes.

In our experience, indications for surgical management of lymphedema do not amount to more than 10% of cases. Surgery is significantly complemented by expert pre and postoperative physiotherapy. Excisional procedures are presently seldom carried out, although they may be helpful when carried out as simple "orange-slice"-type resection, or as the Thompson operation. Liposuction is an attractive alternative, but its effectiveness needs be confirmed yet. Actually, the most effective types of surgical treatment are microsurgical lymphovenous or lymphoveno-lymphatic bypass. Secondary lymphedema of the lower extremities (more rarely of the upper limbs) are primary indications. The Campisi-Casaccia team from Genoa has acquired interesting experience with congenital lymphedema. Results relating to surgical treatment of lymphedema can be assessed only after a follow-up of 3-5 years. About one third of cases, on average, do very well and another third do well. Elastic support of the leg must practically always be maintained.

[Osteogenic exostosis of the first rib: a rare etiology of thoracic outlet syndrome. Apropos of a case]. / Exostose ostéogénique de la première côte: une étiologie rare de syndrome de traversée thoraco-brachiale. A propos d'une observation.

The osteogenic exostosis of the ribs are unfrequent. Their location on the first rib is exceptional. One case is described. The authors, after a review of the literature, recall the particular symptomatology which can be observed, like thoracic outlet syndrome. A partial or total resection of the first rib is advocated. The surgical approach has to be discussed.

Comparative double-blind study of two dosage regimens of low-molecular weight heparin in elderly patients with a fracture of the neck of the femur.

A randomized double-blind study comparing the efficacy and safety of two different dosage regimens of a low-MW heparin, Enoxaparin (Lovenox) 20 mg twice (group A) or 40 mg once (group B), was carried out in 103 elderly patients with a fracture of the neck of the femur. Distal and proximal thrombosis occurred in 18.3% of patients in group A and in 10.4% in group B. No major hemorrhagic complication was observed, except for two hematomas in each group. This trial suggests that a total daily dose of 40 mg of Enoxaparin can be effective in the prevention of deep vein thrombosis in elderly surgically treated patients and does not involve a major risk of bleeding.

Factorial analysis in radionuclide lymphography: assessment of the effects of sequential pneumatic compression.

The effects of intermittent pneumatic compression (IPC) in 12 patients with lower or upper limb lymphedema were studied using a computer-based technique (factorial analysis) of dynamic lymphoscintigraphy. After subcutaneous injection of radiocolloid into the first interdigital web space of the arm or leg, scintigraphic recordings consisted of 40 consecutive one-minute frames of both lower extremities or an edematous upper extremity. Pneumatic compression by Euroduc (6 patients) or by Lymphapress (6 patients) was applied during the final 20 minutes of the recording. A three factors factorial analysis (FA) was performed successively for each extremity. FA allowed "uncontaminated" curves to be displayed distinct from neighboring structures and corresponded to dynamic tracer activity in the interstitium, at the injection site, and within lymphatic vessels. Based on the results of lymphatic vascular factorial analysis, a beneficial effect of IPC was detected in 18 of 22 limbs examined. FA processing suggested that IPC facilitated radiocolloid transport in the proximal portion of the limb and also propelled tracer from the injection site toward the lymphatics. The effect of IPC was evident as soon as external compression therapy began and was similar with either mechanical unit. Residual tracer activity in peripheral lymphatics 20 minutes after application of IPC was higher in the edematous as compared with the normal limbs. FA processing is a new and potentially valuable method to evaluate the effects of external pneumatic compression in the management of peripheral lymphedema.