[Cervical spondylolysis : a rare fortuitous finding]. / Cas clinique. Spondylolyse cervicale : une découverte fortuite rare.

A young patient consulted in our physical and rehabilitation medicine department following the onset of pain on the scapula area and at the base of his right upper limb after carrying a heavy load. After a couple of weeks, the patient also developed cervical pain. Fortuitously, the cervical scanner displayed a right C6 spondylolysis. Further evaluation by bone scan confirmed that this lesion was not recent and so probably not the cause of the symptoms. Cervical isthmic spondylolysis is a rare condition, much more common at the lumbar level and often ignored at the cervical one. The etiology, pahophysiology, imaging and treatment options for this cervical pathology are discussed in this article.

Un jeune patient a consulté en médecine physique pour des douleurs aux niveaux de l'omoplate et de la racine du membre supérieur droit apparues suite au port d'une charge lourde. Après quelques semaines, le patient se plaignait également de cervicalgies. Un scanner du rachis cervical a objectivé fortuitement une spondylolyse C6 droite. Un bilan complémentaire par scintigraphie osseuse a révélé que la lésion était ancienne et qu'elle n'était probablement pas la cause de la symptomatologie. La lyse isthmique cervicale est une pathologie peu répandue. Très connue à l'étage lombaire, la spondylolyse est rare et souvent ignorée au niveau cervical. L'étiologie, la physiopathologie, l'imagerie et la prise en charge de cette pathologie cervicale sont discutées dans cet article.

[A rare complication of acute coronary syndrome : left ventricular pseudo-aneurysm]. / Complication rare du syndrome coronarien aigu Survenue d'un pseudo-anévrysme ventriculaire gauche.

We report a case of left ventricular pseudo-aneurysm and we take the opportunity to briefly review the literature concerning etiologies, diagnosis and management of this pathology, emphasizing some differences with the true aneurysm.

Nous rapportons un cas de pseudo-anévrysme ventriculaire gauche et nous en profitons pour réaliser une brève revue de la littérature concernant les étiologies, le diagnostic et la prise en charge de cette pathologie, en insistant sur certaines différences avec le vrai anévrysme.

[Cardiac amyloidosis, about an atypical case]. / Le cas clinique du mois. Amyloïdose cardiaque, a propos d'un cas atypique.

A 64 year old patient with heart failure due to primary cardiac amyloidosis is described. This case offers the opportunity to review the literature dealing with the cardiac involvement associated with this disorder and the differential diagnosis of restrictive heart disease.

[Multimodal cardiovascular imaging before aortic valve transcatheter replacement]. / L'imagerie cardiovasculaire multimodalités avant l'implantation d'une prothèse valvulaire aortique par voie percutanée.

Calcified aortic valve stenosis is the most frequent valvular heart disease in developed countries with a very poor outcome when symptoms develop. However, several of these patients are denied for surgery. The main reasons are their advanced age (elderly patient), co-morbidities, technical limitations and a very high surgical risk. It is currently possible to propose a Transcatheter Aortic Valve Implantation (TAVI). After selection of candidates, the feasibility of the intervention is analysed. The size of the aortic bioprosthesis must be selected according to the cardiac anatomy. Several cardiac imaging modalities (echocardiography, computed tomography and cardiac MRI) can be used to identify unsuitable situations. Heavy calcifications or tortuosity can thwart the retrograde approach use. The sub-clavian arteries (for the CoreValve) and trans-apical approach (for the Edwards-Sapien) constitute alternatives ways.

Improved cryopreservation of in vitro-produced bovine embryos using a chemically defined freezing medium.

This study evaluates a new synthetic substitute (CRYO3, Ref. 5617, Stem Alpha, France) for animal-based products in bovine embryo cryopreservation solutions. During the experiment, fetal calf serum (FCS) and bovine serum albumin (BSA) were used as references. A combination of a thermodynamic approach using differential scanning calorimetry and a biological approach using in vitro-produced bovine embryo slow-freezing was used to characterize cryopreservation solutions containing CRYO3, FCS and BSA. The CRYO3 and fetal calf serum (FCS) slow-freezing solutions were made from Dulbecco's phosphate-buffered saline containing 1.5 m ethylene glycol, 0.1 m sucrose and 20% (v.v(-1)) of CRYO3 or FCS. The bovine serum albumin (BSA) solution was made by adding 0.1 m sucrose to a commercial solution containing 1.5 m ethylene glycol and 4 g L(-1) BSA. These solutions were evaluated using three characteristics: the end of melting temperature, the enthalpy of crystallization (thermodynamic approach) and the embryo survival and hatching rates after in vitro culture (biological approach). The CRYO3 and FCS solutions had similar thermodynamic properties. In contrast, the thermodynamic characteristics of the BSA solution were different from those of the FCS and CRYO3 solutions. Nevertheless, the embryo survival and hatching rates obtained with the BSA and FCS solutions were not different. Similar biological properties can thus be obtained with slow freezing solutions that have different physical properties within a defined range. The embryo survival rate after 48 h of in vitro culture obtained with the CRYO3 solution (81.5%) was higher than that obtained with the BSA (42.2%, P = 0.000 12) and FCS solutions (58%, P = 0.016). Similarly, the embryo hatching rate after 72 h of in vitro culture was higher with the CRYO3 solution (61.1%) than with the BSA (31.1%, P = 0.0055) and FCS solutions (36%, P = 0.018). We conclude that CRYO3 can be used as a chemically defined substitute for animal-based products in in vitro-produced bovine embryo cryopreservation solutions.

Follicle development in cryopreserved bitch ovarian tissue grafted to immunodeficient mouse.

The present study evaluated: (1) in vivo follicular development in canine ovarian tissue after slow freezing and xenotransplantation; and (2) the use of erythropoietin (EPO) as an angiogenic factor to optimise the transplantation procedure. Frozen-thawed ovarian tissue from five bitches was grafted into severe combined immunodeficient (SCID) mice (n=47) treated with or without EPO (500 IU kg(-1), once daily for 3 days) (Groups A and B, respectively) and analysed after 0, 1, 8 or 16 weeks. Follicle grade, follicle density, follicle morphology and stromal cells density were assessed by histological analysis, whereas vascularisation of the graft was quantified by immunohistochemistry with anti-α-smooth muscle actin antibody. Despite a massive loss of follicles after grafting, secondary follicle density was higher at 8 and 16 weeks than at 1 week regardless of EPO treatment. EPO significantly improved early follicle morphology and stromal cell density after 8 weeks and blood vessel density at 16 weeks after transplantation (P<0.05). Intact secondary follicles with more than three granulosa cells layers were observed 16 weeks after transplantation. The results suggest that canine ovarian tissue can be successfully preserved by our slow-freezing protocol because the tissue showed follicular growth after xenotransplantation. EPO treatment did not lessen the massive loss of follicles after transplantation.

Amino acids in cat fallopian tube and follicular fluids.

Aminograms of tubal and follicular fluids were obtained using fluids collected by aspiratory puncture from six cats. The amino acids were separated and quantified by high-performance liquid chromatography analysis. The serum of the cats was used as control. The three most prevalent amino acids quantified in cat tubal fluid were glycine, glutamic acid, and taurine. Their mean concentrations were 840 µmol/l (µm), 808 µm and 596 µm, respectively. The three most prevalent amino acids quantified in cat follicular fluid were alanine, glutamine, and taurine. Their mean concentrations were 359 µm, 351 µm, and 258 µm, respectively. This result is consistent with aminograms of tubal fluid previously determined in other mammals. As previously observed in other species and humans, glycine was quantitatively the most abundant and most prevalent free amino acid in cat tubal fluid. The total quantity of amino acids in tubal fluid was similar in cats and other species. However, in contrast with other species studied, hypotaurine was not detected in tubal and follicular fluids of female cats.

Can video cameras replace visual estrus detection in dairy cows?

A 6-mo experiment was conducted in a dairy herd to evaluate a video system for estrus detection. From October 2007 to April 2008, 35 dairy cows of three breeds that ranged in age from 2 to 6 yr were included in the study. Four daylight cameras were set up in two free stalls with straw litter and connected to a computer equipped with specific software to detect movement. This system allowed the continuous observation of the cows as well as video storage. An observation method related to the functionality of the video management software ("Camera-Icons" method) was used to detect the standing mount position and was compared to direct visual observation (direct visual method). Both methods were based on the visualization of standing mount position. A group of profile photos consisting of the full face, left side, right side, and back of each cow was used to identify animals on the videos. Milk progesterone profiles allowed the determination of ovulatory periods (reference method), and a total of 84 ovulatory periods were used. Data obtained by direct visual estrus detection were used as a control. Excluding the first postpartum ovulatory periods, the "Camera-Icons" method allowed the detection of 80% of the ovulatory periods versus 68.6% with the direct visual method (control) (P = 0.07). Consequently, the "Camera-Icons" method gave at least similar results to the direct visual method. When combining the two methods, the detection rate was 88.6%, which was significantly higher than the detection rate allowed by the direct visual method (P < 0.0005). Eight to 32 min (mean 20 min) were used daily to analyze stored images. When compared with the 40 min (four periods of 10 min) dedicated to the direct visual method, we conclude that the video survey system not only saved time but also can replace direct visual estrus detection.

[Single cervical metastasis of breast cancer]. / Métastase unique cervicale d'un cancer du sein.

We report a rare case of single cervical metastasis of breast cancer. Bone metastases are the most frequent in breast cancer. Early diagnosis combined with the new therapeutic advances have considerably improved the quality of life and increased the survival. Imaging plays a great role in the diagnosis, particularly scintigraphy and radiography, but sometimes also CT and MRI. The treatment is currently not standardized and it combines hormone therapy, chemotherapy, radiotherapy, and/or surgery.

A new hypo/oligodontia syndrome: Carvajal/Naxos syndrome secondary to desmoplakin-dominant mutations.

Dental agenesis is either syndromic or non-syndromic. Here, we describe a familial case with Carvajal/Naxos syndrome associating woolly hair, palmoplantar keratoderma, and biventricular dilated cardiomyopathy. In addition to these signs, all three affected family members had hypo/oligodontia ranging from absence of the lower left second molar to 15 missing teeth, the typical pattern of oligodontia being absent 2nd premolars and absent 2nd and 3rd molars. Mutation screening in the desmoplakin gene (DSP) revealed a de novo missense mutation (c.1790 C>T, p.Ser597Leu) changing a serine residue conserved in all vertebrates. In addition, this variation was absent from 100 control DNA samples. There were no mutations in the plakoglobin gene. This familial case report and two other previous reports demonstrate that autosomal-dominant mutations in the DSP gene are associated with hypo/oligodontia in the setting of Carvajal/Naxos syndrome. This study suggests that dentists discovering oligo/hypodontia should screen for woolly hair and palmoplantar keratoderma because of the probable cardiac involvement with an inherent high risk of severe cardiomyopathy. In addition, this study reveals the role of desmosomes in the development of teeth and suggests that other genes encoding proteins of the desmosome could be involved in oligo/hypodontia.

[Pseudoaneurysm of the left gastric artery]. / Pseudoanévrisme de l'artère gastrique gauche.

We report the case of a 65-year-old man admitted for an upper-GI hemorrhage. A CT scan performed with vascular reconstructions demonstrated a pseudoaneurysm of the left gastric artery. Proximal vascular control of the celiac axis was obtained by balloon occlusion with a Fogarty balloon inserted retrograde via the femoral artery: the pseudoaneurysm was then successfully controlled with direct suture.

[Cardiac computed tomography in preoperative management of a congenital coronary anomaly]. / La tomodensitométrie cardiaque dans la mise au point préopératoire d'une anomalie congénitale d'une artère coronaire.

We report the case of a 81-year-old man presenting with stable exercise angina pectoris. The stress test is positive and the coronaro-angiographic evaluation demonstrates a coronary fistula between the left anterior descending (LAD) artery and the pulmonary artery trunk. The mid LAD presents a significant lesion after the origin of the fistula. A cardiac computed tomography is used before surgical treatment. Coronary artery fistulas are unusual congenital or acquired coronary artery abnormalities in which blood is shunt into a cardiac chamber, great vessel or other structure. Low-pressure structure is the most common site of drainage of the coronary fistula. The clinical presentation of coronary fistulas is mainly dependent on the severity of the left-to-right shunt. Various cardiac imaging modalities are used for diagnosis and anatomical exploration before surgical or percutaneous intervention if the closure of the fistula is indicated.

[How I investigate... The coronary arteries in 2007: contributions of CT coronary angiography]. / Comment j'explore...Les artères coronaires en 2007: apports de la tomodensitomètrie.

Cardiac imaging has always been a challenge because of the continuous movement of the heart. Cardiac computed tomography (CT) has undergone an accelerated progression over the past decade, due to the combination of the high-speed rotation of the X-ray tube, the ECG-gating technique and the infra-millimeter spatial resolution. Multidetector CT allows visualisation of the coronary artery lumen and the detection of coronary stenosis after intravenous injection of contrast medium. Studies have demonstrated a high negative predictive value of CT coronary angiography (CTCA). CTCA may be reasonably used for the assessment of symptomatic patients, especially in the setting of equivocal treadmill or functional testing. Also, CTCA allows assessment of coronary bypass graft patency and recognition of aberrant coronary arteries. Limitations in the use of this technique exist: atrial fibrillation and other cardiac arrhythmias remain a contraindication; severe calcifications are the most frequent reason for impaired assessment of coronary arteries. High radiation doses prohibit the use of this test as a screening tool for asymptomatic patients.

[Rounded atelectasis: a follow up of 10 years by CT]. / Le cas clinique du mois. Atélectasie ronde: dix ans de suivi par tomodensitométrie.

We report the case of a 69-year-old man who presented with a rounded atelectasis (RA). During a 10-year follow-up by Computed Tomography (CT), the lobe showed a progressive shrinkage, and a moderate increase in size of the lesion led to a percutaneous biopsy which confirmed the diagnosis. RA is an unusual form of lung consolidation. The major cause of RA is asbestosis. RA is usually asymptomatic and may simulate a pulmonary neoplasm on chest Xray. The diagnosis is made by CT, demonstrating the pathognomonic "comet tail sign". No treatment is required.