Primary retroperitoneal teratoma in the adult: correlation of MRI features with CT and pathology.

Primary benign teratoma of the retroperitoneum is a rare tumor in the adult population. Only one case with an MRI examination has been reported in the English literature. This paper describes the CT and MRI features of a retroperitoneal teratoma in a 24-year-old male and discusses the value of MRI in the diagnosis and the preoperative imaging of such a tumor.

[MRI of the normal portal system: the artefacts. Apropos of 45 cases]. / Aspect normal du système porte en IRM: les artefacts. A propos de 45 témoins.

The protal system of 45 normal patients have been retrospectively studied on spin echo MRI sequences (interleaved cuts): multiple artifacts have been evaluated and 24% of them were visualized at the portal system level. Thus, partial volume effect responsible for almost 25% of the artifacts is not always easily seen on a single sequence. Respiratory and aortic artifacts can deteriorate the visualization of the vascular lumen but cannot be confused with a thrombosis. Well-known artifacts, as slice entry phenomenon and even echo rephasing, represent more than 60% of the artifacts: they are readily recognized when they are typical and indicate flowing blood. On the contrary, an other artifact, representing less than 5% of the total and seen at the level of the left portal vein, simulates a thrombus, on T2 weighed images. We conclude that the frequency and polymorphism of the artifacts are limiting factors of MRI value in the diagnosis of portal vein thrombosis.

[Rectosigmoid hemangioma. Specific aspects in x-ray computed tomography. Apropos of a case]. / Hémangiome rectosigmoïdien. Aspect spécifique de la tomodensitométrie. A propos d'un cas.

This observation illustrates the use of CT in the diagnosis of rectosigmoid hemangiomas and the assessment of their extension. The CT appearance of hemangiomas is very specific and therefore allows confirming a diagnosis that is often difficult to make with other radiological techniques and with endoscopy: phleboliths within the thickened rectal wall are a characteristic sign. CT is primarily required when radical surgery is contemplated due to disabling repeated proctorrhagia: it provides a better delineation of trans- and extraparietal hemangioma extension, knowing that adhesion (...).

MR imaging of adult Wilms' tumor: correlation with US, CT, and pathology.

The magnetic resonance (MR) features of an adult nephroblastoma are presented. The MR appearance is correlated with ultrasound (US), computed tomographic (CT) and pathology. The tumor appeared heterogeneous with calcifications and areas of necrosis and hemorrhage. MR correctly staged the tumor.

[The value of pulsed Doppler for the follow-up of the transplanted kidney in the first 3 months of transplantation]. / Intérêt du Doppler pulsé pour la surveillance du rein transplanté dans les trois premiers mois de la greffe.

This prospective study was conducted in 34 consecutive renal transplant patients. Pulsed doppler was used to evaluate the peripheral resistance (PR) in the transplant vessels. Under normal conditions, the PR of the graft is low, resulting in a continuous diastolic blood flow. The intensity of this blood flow was evaluated by means of a resistance index (RI), Pourcelot's index, calculated as follows: RI = systolic peak - end-diastolic peak/systolic peak This study demonstrated values for RI of 0.71 +/- 0.087 in 14 totally asymptomatic patients. In 10 cases of acute rejection, the RI increased to 0.91 +/- 0.12. The 7 patients with acute tubular necrosis had an RI equal to 1. In patients with cytomegalovirus infection of suffering from cyclosporin overdose, the RI was not modified in relation to asymptomatic subjects. This study demonstrates the existence of a rise in the PR in cases of acute rejection and acute tubular necrosis with a sensitivity of 90% and 100% respectively for these two diagnoses. However, this method cannot be used to distinguish between acute rejection and acute tubular necrosis.

[Value of digital angiography in the preoperative evaluation of arteritis of the leg. Results of a national survey]. / Intérêt de l'angiographie numérisée dans le bilan pré-opératoire de l'artérite des membres inférieurs. Résultats d'une enquête nationale.

The results of a survey on the role of digital angiography in the preoperative assessment of chronic lower limb arteritis demonstrate the diagnostic utility of combining digital image processing and arteriophlebography in a radiological system. This technique allows a practically complete assessment at one go, which is also made possible by the use of small material and of low-osmolarity contrast media, thus reducing the need for extensive anesthesia other than local anesthesia.

[Focal infectious lesions of the renal parenchyma. Comparative contribution of echography and x-ray computed tomography]. / Lésions infectieuses focales du parenchyme rénal. Apport comparé de l'échographie et de la TDM.

Nineteen cases of focal infectious lesions of renal parenchyma studied included 10 cases of acute focal bacterial nephritis (AFBN) and 9 of abscess, cases of pyelonephritis without radiological signs being excluded from this report. Each patient had been investigated by intravenous urography (IVU), ultrasound and CT scan imaging. Comparison of value of the different radiological explorations showed that urographic signs were inconstant and only weakly specific, the most valuable examination being CT scan imaging. The latter images show hypodense zones, clearer with contrast, of a rather triangular form and either single or multiple in AFBN, and mainly nodular images in abscess cases. Ultrasound is of intermediate value, being of high performance in cases of abscess but failing to demonstrate AFBN in about half the cases. However, it should not be totally neglected because of its case of access.

[Rectosigmoid hemangioma: diagnostic value of associated phleboliths. Apropos of a case]. / Hémangiome rectosigmoïdien: valeur d'orientation des phlébolithes associés. A propos d'un cas.

When confronted with rectorrhagia in a young patient, combining a straight abdominal examination with a barium enema investigation may reveal the presence of phleboliths, atypical by their large number and central localization, and orientate towards the rare diagnosis of a colorectal hemangioma.

Technical and anatomic factors in filling of distal portion of internal pudendal artery during arteriography.

Left and right internal pudendal arteriography was performed in 9 nonimpotent male patients (mean age 29 years) who had normal erections. Filling of distal branches of the internal pudendal artery and inter-pudendal anastomoses was improved by superselective catheterization of the anterior trunk of the internal iliac artery or an ischiopudendal trunk, and by the choice of hyperosmolar contrast medium. In the 5 cases where these conditions were fulfilled, filling of the distal branches of internal pudendal arteries was always symmetrical, or showed bifid artery with bilateral distribution on one side, except for the dorsal artery of the penis which appeared to be single in 2 cases. Interdependence between the two internal pudendal arteries was noted in 7 of 9 patients, through either direct anastomosis (7 cases) or bilaterally distributed deep artery of penis (2 cases).

Leiomyosarcoma of the inferior vena cava. Ultrasonographic appearance.

Ultrasonographic features of six leiomyosarcomas of the inferior vena cava are described. In most cases, the presentation is typical enough to strongly suggest the histologic diagnosis. The tumor is usually greater than 10 cm long, hypoechoic, heterogeneous. Cystic components can be found. It is sharply demarcated from neighboring organs which are displaced. The mass is located at the very place of the inferior vena cava, the lumen of which is no longer seen. It is fusiform shaped, surprisingly sparing the aorta. Differential diagnosis along with other radiologic examinations, pathologic findings, and prognosis are discussed.

[X-ray computed tomographic aspect of gastric leiomyoma. Apropos of a case]. / Aspect T.D.M. du léiomyome gastrique. A propos d'un cas.

This report studies the diagnostic problem raised by benign pedunculated gastric leiomyoma identified by CT scan imaging and associated with hepatic metastases. Evaluation of the angle of attachment to the wall, the conventional feature enabling distinction between malignant and benign submucous tumours is not always a reliable indicator.

[Small intestine transit anomalies in a patient with chronic abdominal pain and treated for Hansen's disease]. / Anomalies du transit du grêle chez une patiente présentant des douleurs abdominales chroniques et traitée pour une maladie de Hansen.

This new case of enteropathy due to Clofazimine provided demonstration of the diagnostic value of small bowel follow-through examination in this complication. Various small intestine anomalies have been reported: ileal or partial jejunal lesions; variations in caliber; loss of physiologic folds; irregularly outlined surface and border lacunae and persistence of suppleness of pathologic loops. Knowledge of these anomalies should avoid exploratory laparotomy, Clofazimine-induced enteropathy regressing after discontinuation of treatment. Repeat small bowel follow up examinations can be performed to review course of this regression.

Hepatic plasma flow during sodium nitroprusside-induced hypotension in humans.

Changes in hepatic plasma flow (HPF) during sodium nitroprusside (SNP) induced hypotension were studied in 14 patients undergoing intracranial aneurysm surgery under neurolept anesthesia. Patients were monitored with the use of a radial artery catheter and a thermistor-tipped Swan-Ganz catheter. Hypotension was induced with incremental increases in the rate of SNP infusion until a stable mean arterial pressure (MAP) 35-55 mmHg had been achieved. In one group (Group A) of 10 patients, indocyanine green (ICG) clearance was determined simultaneously with hemodynamic variables, before and during SNP hypotension. In a second group (Group B) of four patients, a catheter was inserted into a hepatic vein to determine the ICG hepatic extraction (HE) coefficient. In Group A, MAP decreased from 73 +/- 10 (SD) to 41 +/- 9 mmHg, while cardiac index (CI) decreased in six patients and increased in four patients. However, the mean value of CI did not change significantly. The mean value of ICG clearance was not significantly affected by SNP hypotension. Nevertheless, a positive linear correlation existed between individual variation in CI and ICG clearance (r = 0.96). On the other hand, no correlation was noted between the change in MAP and ICG clearance. In Group B patients, the ICG HE coefficient remained unchanged during SNP hypotension, suggesting that ICG clearance varies only according to the variation in HPF. In conclusion, this study demonstrated that HPF did not decrease, despite a range of 20-60% decrease in blood pressure when CI is maintained during SNP hypotension.

[Intra-arterial chemotherapy for hepatic metastases. Experience of the Pitié-Salpêtrière Hospital Group]. / Chimiothérapie par voie intra-artérielle des métastases hépatiques. Expérience du Groupe Hospitalier Pitié-Salpêtrière.

Intra-arterial chemotherapy of hepatic metastases is theoretically interesting because of the essentially arterial blood supply of these metastases in contrast with the healthy tissue and because of the theoretical pharmacokinetic advantage for certain drugs, depending on their quotient of hepatic extraction and the wole body clearance. We have treated 43 patients with this technique. The primary cancer was a cancer of the colon in 10 patients, a breast cancer in 16 patients, a melanoma in 7 patients and cancers of other sites in 10 patients. The chemotherapy was initially administered by selective catheterisation of the hepatic artery via an axillary approach and usually consisted of a bolus injection of adriamycin 40 mg/m2 and mitomycin 10 mg/m2 and an infusion of 5 FU 1 g/m2 for 24 to 72 hours. In 15 patients, we surgically implanted a subcutaneous reservoir and catheter. To date, we have performed 114 arterial injections via the catheter and 60 injections into sub-cutaneous reservoirs. We have observed few complications, apart from thrombosis of the axillary artery (3 cases) and of the hepatic artery (5 cases). We have obtained 4 complete responses, 16 partial responses, 8 stabilisations, 10 failures and, unfortunately, 5 patients died rapidly after a single course of chemotherapy and could not be evaluated. The response rate was particularly high for the breast cancers (about 60 percent) and the cancers of the colon (more than 50 percent). We have also observed 3 complete responses in patients treated by intravenous chemotherapy with the same protocol.

[Hepatic metastases. Value of chemotherapy by the intra-arterial route]. / Métastases hépatiques. Intérêt de la chimiothérapie par voie intra-artérielle.

Forty-three patients with metastatic liver cancer were treated with multiple chemotherapy by the intra-arterial route. Metastases originated from primary cancer of the breast (16) or colon (10), melanoma (7) and miscellaneous tumours (10). In 35 patients chemotherapy was administered by selective catheterization of the hepatic artery via the axillary artery; it usually (31 cases) consisted of doxorubicin (60 mg/m2) and mitomycin (10 mg/m2) injections, and continuous infusion of 5-fluorouracil (1 g/24 or 72 hours). In 14 patients (10 responders to the above method and 4 new cases), a catheter with subcutaneous chamber was implanted surgically so that chemotherapy could be continued through the chamber. Blood toxicity was usually moderate. The main complication of injections through the catheter (114) or through the chamber (60) was thrombosis. However, except for 1 lethal cerebral thrombosis, the others (axillary artery 3, hepatic artery 5) were unattended by functional symptoms. Transient biochemical signs of hepatic cytolysis were frequent after each course. Hepatic insufficiency was severely aggravated in 2 cases. Painful digestive disorders were relieved by symptomatic treatments. Four complete responses, 16 partial responses, 8 stabilizations and 10 failures were observed; 5 patients died soon after one single course of intra-arterial therapy. The high response rates (greater than 50%) in metastases from cancer of the breast and colon, and chiefly the 3 complete responses obtained in patients with mammary carcinoma were most encouraging, bearing in mind that one of these 3 patients had not responded to intravenous chemotherapy.

[Horton's disease with bilateral axillohumeral localization. Arteriographic aspects. 2 cases]. / Maladie de Horton à localisation axillo humérale bilatérale. Aspects artériographiques. Deux observations.

These lesions, which may present with ischaemic symptoms or which may be detected by routine examination of the pulse and blood pressure, need to be recognised, as they may lead to the diagnosis of Horton's disease which requires corticosteroid treatment. Subclavian angiography demonstrates bilateral segmental lesions with areas of thrombosis. The histology confirms the arteritis. Corticosteroid treatment caused the ischaemic signs to disappear and the pulse to return.

[The effect of the injection of water-soluble triiodized monomer contrast media for intravenous urography on glomerular filtration, uricemia and urinary elimination of uric acid in normal subjects]. / Effets de l'injection de produits de contraste triiodés hydrosolubles monomères pour l'urographie intraveineuse. L'uricémie et l'élimination urinaire sur la filtration glomérulaire de l'acide urique chez le sujet normal.

One mechanism suggested as being the cause of nephrotoxicity following the administration of triiodized contrast media is intratubular urate precipitation. Thirty healthy volunteers were investigated by IVU using three different media. The iodized injections (0,56 g/kg) failed to produce significant modifications of glomerular filtration and were followed by only very moderate variations in blood and urine uric acid levels.