[Respiratory manifestations of hemorrhagic fever with renal syndrome. Retrospective study of 129 cases in Champagne-Ardenne and Lorraine]. / Manifestations respiratoires de la fièvre hémorragique avec syndrome rénal. Etude rétrospective de 129 cas en Champagne-Ardenne et Lorraine.

OBJECTIVES: The contradiction between airborne transmission of Puumala virus and the low rate of airway manifestations reported in hemorrhagic fever with renal syndrome (HFRS) caused by this virus led us to conduct this study to check whether the incidence of respiratory manifestations may have been underestimated. PATIENTS AND METHODS: We retrospectively reviewed 129 consecutive cases of HFRS diagnosed between 1983 and 1995 in the eastern France. RESULTS: Clinical manifestations of airway involvement and chest X-ray abnormalities were observed in 30% and 50% of the patients respectively. Analysing the radiological anomalies by serum creatinine level showed that in two-thirds of the cases (33% of all the HFRS cases) they were concomitant with acute renal failure and probably related to pulmonary edema, and that in one-third (17% of the HFRS cases) they were compatible with pneumonia. These cases of pneumonia could correspond to specific manifestations of the hantavirus Puumala at the site of penetration. CONCLUSION: Although minimally expressive, respiratory manifestations were found to be more frequent than expected in hemorrhagic fever with renal syndrome. Incidence may have been formerly underestimated.

Relations between occupational exposure to coal mine dusts, erythrocyte catalase and Cu++/Zn++ superoxide dismutase activities, and the severity of coal workers' pneumoconiosis.

OBJECTIVES: To better understand the relations between occupational exposure, blood antioxidant enzyme activities, total plasma antioxidant concentration, and the severity of coal workers' pneumoconiosis (CWP). METHODS: Blood samples were obtained from miners without CWP exposed to low dust concentrations for > or = 4 years at the time of the study (n = 105), or exposed to high dust concentrations for > or = 14 years at the time of the study (n = 58), and from retired miners with CWP (n = 19). Miners without CWP were classified into three subgroups according to their estimated cumulative exposure to dust. Chest x ray films were obtained for each miner. Miners were classified in five subgroups according to their International Labour Organisation (ILO) profusion grades. Univariate tests were completed by multiple linear regression analyses. RESULTS: The estimated cumulative exposure to dust was strongly positively related to erythrocyte catalase activity and strongly negatively related to Cu++/Zn++ SOD activity only in miners exposed to high dust concentrations for > or = 14 years at the time of the study (F tests p = 0.006 and p = 0.004 respectively). Moreover, catalase activity was strongly related to the severity of CWP expressed as five subgroups of ILO profusion grades (F test p = 0.003); the greatest difference in the mean values was found between the group of 1/1 to 1/2 ILO profusion grades and the group of 2/1 to 3/3 ILO profusion grades. CONCLUSION: These results are in good agreement with the hypothesis that production of reactive oxygen species may be an important event in the exposure to coal mine dusts and the severity of CWP. Erythrocyte catalase and Cu++/Zn++ SOD activities are more closely related to recent exposure to high dust concentrations than to cumulative exposure, and could be considered as biological markers of exposure rather than as markers of early adverse biological effect.

Can the evolution to pneumoconiosis be suspected in coal miners? A longitudinal study.

To assess whether the evolution to pneumoconiosis may be suspected in coal miners, we conducted a 4-yr longitudinal study of 80 dust-exposed miners with chest X-ray findings classified 0/1 or 1/0 according to the International Labor Organization (ILO) classification (exposed to coal mine dust, suspected of pneumoconiosis [ES group]) and two control groups having normal X-rays. The first of these latter two groups included 80 miners with similar exposure to that of the first group (exposure with normal X-rays [EN]), whereas the second group consisted of markedly less exposed miners (no exposure with normal X-rays [NN]). The protocol comprised a questionnaire on respiratory symptoms and smoking, assessment of cumulative coal-mine-dust exposure, X-rays, computed tomographic (CT) scans, and lung-function tests. The study was conducted in 1990 and 1994 by the same medical team. At the end of the follow-up, 24 members of the ES group had worsened X-ray findings, and 10 of them had X-ray findings classified as 1/1 or greater. In the EN and NN groups, six and one subjects, respectively, had worsened X-ray findings. At the first examination, subjects who developed pneumoconiosis had significantly lower values for FEV1/FVC ratio, maximum midexpiratory flow (MMEF), and maximal forced expiratory flow at 25% of vital capacity (FEF25%), and higher CT-scan micronodule scores. This latter score and FEF25% were significantly associated with the evolution to pneumoconiosis in the ES group, and scanner micronodule score and MMEF were significantly associated with this in all three groups combined. Worsening findings on X-ray and change to pneumoconiosis must be controlled in coal miners. The findings in this study offer the possibility of identifying miners who especially need follow-up and monitoring.

Superior vena cava stent placement: results with the Wallstent endoprosthesis.

PURPOSE: To assess the clinical success and short-term patency of the Wallstent endoprosthesis in the treatment of superior vena cava (SVC) syndrome. MATERIALS AND METHODS: Twenty-one 14-mm-diameter endoprostheses were implanted in 15 patients (mean age, 60 years) treated for SVC syndrome due to malignant compression (n = 14) or postirradiation fibrotic stenosis (n = 1) of the SVC. RESULTS: Immediate technical success was achieved in all patients. Two early complications occurred: retroperitoneal hemorrhage due to venous iliac tear and early stent thrombosis. In the 14 patients without early stent occlusion, stent placement resulted in complete relief of SVC syndrome; clinical success was 93%. SVC syndrome did not recur from 1 to 14 months, until the patient died (n = 11) or until the end of the study (n = 3). Helical CT showed a patent stent in five patients, respectively, at 3, 6, 8, 10, and 11 months. CONCLUSION: SVC stent placement has good clinical results and a high patency rate at short-term follow-up in patients with SVC syndrome.

[Imaging of cervical and thoracic chordoma. Apropos of 2 cases]. / Imagerie des chordomes cervicaux et thoraciques. A propos de 2 observations.

Chordoma is a rare tumor in spine. Two cases, exceptional in adolescents, are reported. The clinical evolution is slow and progressive. CT shows a lobulated tumor, precises the degree of vertebral osteolysis and detects intra-tumoral calcifications. MRI is useful to determine especially in high in soft tissues and the vertebral canal. Arteriography is realised in pre-operative time and permits an embolization when the tumor is hypervascularised.

[Diseases of the diaphragmatic area. Difficulties of the radiological diagnosis]. / La pathologie des confins du diaphragme. Difficultés du diagnostic radiologique.

Following a reminder of anatomy, the semiology of standard radiology and modern imaging methods is described. The authors then deal with the phrenic-supraphrenic thoracic pathologies (air and liquid effusions, neighbourhood atelectasis, etc.) and with the phrenic-infraphrenic pathologies (transdiaphragmatic hernias, hepatic pathology, subphrenic abscess and pleural effusions). In each of these chapters, the often complex elements of standard radiology and modern imaging methods are detailed.

Pulmonary alveolar microlithiasis: CT findings.

We present five cases with confirmed diagnosis of pulmonary alveolar microlithiasis that illustrate the appearance of this rare chronic lung disease on conventional and high-resolution CT. Pulmonary alveolar microlithiasis is characterized by widespread intraalveolar calcification of both lungs. Conventional CT confirmed the inferior and posterior predominance of the lesions in four of our cases and showed an exceptionally high concentration of microliths in the subpleural parenchyma and along the bronchovascular bundles. High-resolution CT revealed a perilobular and bronchovascular distribution of the disease process at the level of the secondary pulmonary lobule. This pattern correlated closely with pathologic findings.

Computed tomography in the etiologic assessment of idiopathic spontaneous pneumothorax.

In an attempt to elucidate the origin of the so-called idiopathic spontaneous pneumothorax (ISP), clinical examination, pulmonary function tests, and computed tomography (CT) with visual quantification and density analysis were performed in 20 young patients two months after an ISP episode. Twenty controls were recruited for CT. The chest roentgenograms were normal in the two groups. The results indicated the presence of various types of emphysematous lesions (EL) in the ISP group located predominantly in the apical fields with subpleural location in 16 patients. Interestingly, diffuse but moderate centrilobular emphysema was noted in 12 of 20 patients. The EL visual quantification was always less than 5 percent of the CT slices' total areas. The lung mean density shifted significantly toward the air density in the patient group (patients: -743 +/- 57.5 HU vs controls -713 +/- 59.5 HU, p less than 0.01). These findings suggest that CT may be useful for early assessment of EL in patients with ISP.

Improved subtraction technique in intravenous digital left ventriculography: comparison with radionuclide studies.

Adequate processing of left ventricular angiograms depends on the visualisation of all segments of the ventricular wall. At the same time, subtraction of different images can enhance different heart segments but commercially available methods do not allow simultaneous viewing of several images masked by different processes. Using our software, for each studied frame, a four quadrant display permits the simultaneous visualisation of a mask mode image, a diastolic-systolic difference image, an image obtained by subtraction of a frame at the same cycle time and a composite mask subtracted image. The composite mask image is obtained by weighting three images according to videodensitometric measurements by reference to previously acquired data. This method facilitates contour delineation and computation of the ejection fraction by area-length method. Correlation with radionuclide estimates of left ventricular ejection fraction is higher (n = 60, r = 0.90, SEE = 8%) than using the classical mask mode display (n = 60, r = 0.82, SEE = 11%). In a subgroup of 30 patients the contrast medium was injected in an antecubital vein and the correlation coefficient remained satisfactory (n = 30, r = 0.89, SEE = 7%) when compared with the classical subtraction technique (n = 30, r = 0.70, SEE = 12%). We therefore conclude that the composite mask method gives comparatively similar values for left ventricular ejection fraction to those acquired by radionuclide angiography.

[Value of digital subtraction of left ventriculographies by the venous route. Comparison with balanced scintigraphy of the heart cavities]. / Intérêt de la numérisation des ventriculographies gauches par voie veineuse. Comparison avec la scintigraphie des cavités à l'équilibre.

The development of numerisation material in radiology currently permits to perform usual cardiovascular tests. The authors report a series of 48 patients who benefited from the determination by numerised left ventriculography, of their stroke volume (SV). In 37 cases, the peripheral venous route is used while in 11 cases the central venous route is used, in the pulmonary artery trunk. The SV values obtained with both methods (one advocated by the manufacture and another one developed by the authors), are correlated with the SV values obtained with the isotopic method, used as reference. The correlations are satisfactory, approximately 0.79 for all patients of the study, and markedly improve when the injection of the contrast material is performed in the pulmonary artery (approximately 0.95). The authors conclude that determination of the left ventricle SV by numerisation is an interesting technique in centers where there is no department of nuclear medicine, and is absolutely necessary to complement right catheterisation.

[Hemangiopericytoma. Apropos of a case in the thoracic muscles. Contribution of imaging technics (excluding MRI). Review of the literature]. / L'hémangiopéricytome. A propos d'un cas, musculaire, thoracique. Apport de l'imagerie (IRM exclue). Revue de la littérature.

The authors describe a recurrent case of an hemangiopericytoma of the left serratus anterior muscle, touching a 21 year-old woman. The different ways of imaging are exposed and compared with data of literature. It seems that none of them offers any decisive possibility of nature diagnosis. Conversely, radiological examinations are of greatest interest in the initial lesional statement, in the follow up and in early discovery of a possible recurrence, principally in case of difficulties in the pathological examination. CT appears to have the first role among the different ways of medical imaging, initially and in the appreciation of clinical course.

Spinal involvement in alveolar echinococcosis: assessment of two cases.

Two cases of spinal involvement in alveolar echinococcosis are reported. Conventional radiographs showed bone lysis and spondylitis; computed tomographic scans showed detail of local spread to the ribs, other vertebrae, and soft tissues. Differential diagnosis, which includes other infections and hydatidosis, is difficult, and the diagnosis may be suggested by evidence of a primary hepatic focus, geographic propensity to the infection, and laboratory findings.

[CRST syndrome with diffuse peri- and intra-articular calcifications. Value of x-ray computed tomography]. / CRST syndrome avec calcifications péri et intra-articulaires diffuses. Intérêt de la scanographie.

A patient with calcinosis universalis presented extensive calcifications involving fingers, shoulders, thoracic wall and cervical spine. Computed tomography imaging appeared to be a highly valid method of investigation of calcification of soft tissues and allowed detection of an intra-articular scapulohumeral calcium-provoked effusion.

[Adrenal metastases of bronchial cancer: value of x-ray computed tomography]. / Les métastases surrénaliennes des cancers bronchiques: intérêt de la tomodensitométrie.

Up until now, adrenal metastases from bronchial cancer have always been an autopsy diagnosis with a frequency as high as 45%. These metastases can now be diagnosed by means of computed tomography of the adrenal glands and most of the recent studies report an incidence of 10 to 15% of adrenal metastases independently of the histological type of bronchial cancer. The authors stress the need to perform this examination in the context of pre-treatment staging and for the follow-up of bronchial cancer. The outcome of these adrenal metastases is still poorly understood, but prospective studies could provide more information concerning their prognostic significance. In cases of operable bronchial carcinoma with an isolated adrenal metastasis, it is important to be able to detect this lesion which may be able to be excised prior to the thoracic surgery.

[The course of Cockett's disease (author's transl)]. / Aspects évolutifs du syndrome de Cockett.

The term of Cockett's syndrome stands for a lower limb dysfunction with venous stasis originating from the left common iliac compression by the right common iliac artery at the pelvic inlet level. For the authors, there are three evolutive stages. -- first stage: a simple compression without any anatomic venous parietal lesion. -- second stage: to the previous, are added left common iliac vein lesions consisting of an inner vascular band formation. -- third stage: final evolution: ilio-femoral thrombosis. Therefore, the diagnosis must be done as early as possible. It lies on the left lower limb phlebography.

[A case of parieto-pulmonary acquired shunt presenting with hemoptysis (author's transl)]. / Un cas de shunt pariéto-pulmonaire acquis révélé par une hémoptysie

The authors report the case of a 52 year old man with arteriovenous shunt developing from the 7th left intercostal artery, revealed by hemoptysis and proved by intercostal selective arteriography. The patient had a past history of serofibrinous pleurity 29 years previously and had undergone paracentesis at this level. The origin of this shunt is then discussed.