High-flow priapism: Highly selective embolization of a traumatic arterio-cavernosal fistula.

We report the case of a 14-year-old man who arrived at the emergency department affected by a high-flow priapism due to a traumatic left arterial-sinusoidal fistula. After clinical examination, a colour Doppler ultrasound of the penis was performed which showed a left arterial-sinusoidal fistula measuring 7×16×30mm, with high-speed and turbulent flow. The fistula was successfully treated by three highly selective endovascular embolizations and at the 20days follow-up, clinical examination resulted normal.

Postmortem computed tomography findings in suicide victims.

Suicide is the eighth cause of mortality in France and the leading cause in people aged between 25 and 34 years. The most common methods of suicide are hanging, self-poisoning with medicines and firearms. Postmortem computed tomography (CT) is a useful adjunct to autopsy to confirm suicide and exclude other causes of death. At autopsy, fractures of the hyoid bone or thyroid cartilage, or both, are found in more than 50% of suicidal hangings. Cervical vertebra fractures are rare and only seen in suicide victims jumping from a great height. Three-dimensional reconstructions from CT data are useful to visualize the ligature mark on the neck. In suicides by firearm, postmortem CT shows entry and exit wounds, parenchymal lesions along the bullet path, as well as projectiles in case of penetrating trauma. However, in the chest and abdomen it is more difficult to identify the path of the projectile. Postmortem CT also shows specific features of suicide by drowning or stabbing, but its use is limited in cases of self-poisoning. The use of postmortem CT is also limited by decomposition and change of body position. This article presents the imaging features seen on postmortem CT according to the method of suicide.

Treatment of atheromatous renal artery in-stent restenosis in 51 patients.

OBJECTIVE: To evaluate our treatment of renal artery in-stent restenosis. PATIENTS AND METHODS: Monocentric retrospective study of 53 cases of restenosis and two occlusions in 51 patients detected via systematic follow-up with imaging (72.5%) and/or deterioration of kidney function (5.9%) and/or blood pressure failure (54.9%), 15.7 months (5-121) after implantation, giving rise to 49 recalibrations via a balloon and five additional stentings. Analysis of the technical results, the effects on blood pressure and kidney function after repeated revascularizations. RESULTS: Secondary permeability of 38 arteries (63.2%) after 12.4 months (3-64) with 14 second restenoses; 33.3% after redilation with a balloon, 60% after renewed stenting, more common in smokers (P=0.02), in case of peripheral arterial disease (P=0.02), ostial location (P=0.049) and kidney function impairment at the time of diagnosis of the restenosis (P=0.012). After 12.7 months (3-64) post-revascularization, kidney function was improved in 30% of patients and stabilised in 50% of patients. Treatment of second restenoses: one failure (7.1%), nine dilations with a balloon, three cutting balloon, one second stent. Treatment of third restenoses: 71.4% treated with a balloon (2), cutting balloon (2) or coated stent (DES) (1); then permeability at a later point in time: 50%. CONCLUSION: The treatment of repeated restenoses with conventional techniques is of imperfect efficacy, and currently remains un-codified.

Hypersplenism due to portal hypertension: retrospective evaluation of 17 patients treated by splenic embolization.

PURPOSE: The objective of this retrospective study was to analyze the efficacy and morbidity associated with splenic artery embolization for hypersplenism due to portal hypertension (PHT), as a function of the volume of the splenic parenchyma embolized and the type of PHT (due to intrahepatic block or segmental PHT). PATIENTS AND METHODS: This study retrospectively included 17 patients with hypersplenism secondary to PHT (intrahepatic block, n=14; segmental, n=3) treated by splenic artery embolization. The splenic volume embolized was estimated by computed tomography (CT) one month after embolization. A clinical assessment and platelet count took place at 7 days, 1 month and 6 months after the embolization. RESULTS: In the group with PHT due to intrahepatic block, the mean volume of embolized splenic parenchyma was 63% of the initial volume (range: 30-95%). Six months later, the platelet level had increased by an average of 232%. All patients with fewer than 80,000 platelets/mL at 6 months had an embolization volume less than 50%. In the segmental PHT group, the mean volume of the embolized parenchyma was 62% of the initial volume (range: 20-95%), bleeding symptoms had disappeared in all patients, and the platelet level exceeded 80,000/mL. Six patients (6/17, 35%) had complications, two minor and four major: two splenic abscesses, one respiratory distress with ascites, and one pancreatitis with ascites. Five of the six complications were observed in patients with a volume of embolized splenic parenchyma more than 70%. CONCLUSION: Our results show that splenic embolization of more than 50% of the parenchyma is effective in the treatment of hypersplenism due to PHT, but that when the embolized volume exceeds 70%, the procedure is associated with considerable morbidity.

Preoperative uterine artery embolization (PUAE) before uterine fibroid myomectomy.

PURPOSE: To evaluate the potential of uterine artery embolization to minimize blood loss and facilitate easier removal of fibroids during subsequent myomectomy. METHODS: This retrospective study included 22 patients (median age 37 years), of whom at least 15 wished to preserve their fertility. They presented with at least one fibroid (mean diameter 85.6 mm) and had undergone preoperative uterine artery embolization (PUAE) with resorbable gelatin sponge. RESULTS: No complication or technical failure of embolization was identified. Myomectomies were performed during laparoscopy (12 cases) and laparotomy (9 cases). One hysterectomy was performed. The following were noted: easier dissection of fibroids (mean 5.6 per patient, range 1-30); mean intervention time 113 min (range 25-210 min); almost bloodless surgery, with a mean peroperative blood loss of 90 ml (range 0-806 ml); mean hemoglobin pretherapeutically 12.3 g/dl (range 5.9-15.2 g/dl) and post-therapeutically 10.3 g/dl (range 5.6-13.3 g/dl), with no blood transfusion needed. Patients were discharged on day 4 on average and the mean sick leave was 1 month. CONCLUSION: Preoperative embolization is associated with minimal intraoperative blood loss. It does not increase the complication rate or impair operative dissection, and improves the chances of performing conservative surgery.

Embolization of hepatic and adrenal metastasis to treat Cushing's syndrome associated with medullary thyroid carcinoma: a case report.

We report functionally successful hepatic and left adrenal embolization with particles to treat Cushing's syndrome associated with a medullary thyroid carcinoma.

[Management of severe post partum hemorrhage with embolization: the French experience]. / Prise en charge des hémorragies du post-partum par embolisation en France.

PURPOSE: To gain a better understanding of the management of severe post partum hemorrhage in France. PATIENTS AND METHODS: A national survey of members of the Société Française d'Imagerie Cardio-Vasculaire (SFICV) and angiography units was performed in spring 2004. RESULTS: A total of 465 (2002) and 497 (2003) embolizations were performed in 64 centers: 13 in Ile de France (Paris area), including 8 university hospitals (2002: 45% of all cases, 2003: 42.5%); 51 in the other French regions (24 university hospitals) (2002: 55% of all cases, 2003: 57.5%). In 2002, an average of 7.26 embolizations was performed in each center (0-36); in 2003: 7.77 (0-47). On call coverage was available in 77,6% of centers, with 1 to 8 participating radiologists (mean: 3.5). 98% of embolizations were performed in angio suites, located in the same building as the maternity ward for 53.4%, or 100m to 7km (mean: 1100m) with mean transfer time of 18 minutes (5 to 60 minutes). CONCLUSION: Embolization is accurate and safe. When available, it should be considered as the first line treatment for validated indications. Multidisciplinary management of patients remains essential and protocols established by gynecologists, anesthesiologists and radiologists must be in place.

[Comparison of transobturator tape (TOT) and tension-free vaginal tape (TVT) using perineal ultrasound]. / Les trajets anatomiques des bandelettes sous-urétrales, rétropubiennes TVT et transobturatrices TOT, sont-ils différents? Apport de l'échographie introïtale.

OBJECTIVE: Using perineal ultrasound in two groups of patients having either TVT or TOT procedure to know if TOT is sufficiently oblique and if the large dissection in TOT procedure might be responsible for migration of the tape. PATIENTS AND METHODS: Thirty-two patients, 16 TVT and 16 TOT, had a sonography. The tape is visualised in the sagittal and frontal planes at rest, maximum holding and valsalva straining. The angle between the two limbs of the tape is measured as well as the distance tape-bladder neck and the width of the tape. RESULTS: The aspect of the tape at rest is like a V, in both groups. During straining, the urethra is flattened on the tape which becomes round. During maximum retaining, the V closes by traction on the limbs. The mean angle under the urethra at rest is 109.9 degrees. In the TVT group it is 101.6 degrees versus 118.1 degrees in the TOT group. This difference is statistically significant (P=0.001). The width of the tape is 6.7 mm (2.4-10.3). The distance tape-bladder neck is 14.8 mm (8.2-25.7), 14.6 mm for the TVT group and 15.6 mm for the TOT group, the mean urethral length being 33.1 mm. DISCUSSION AND CONCLUSION: The angle of TOT is more open. It remains sufficiently oblique and allows the tape to be put with light tension if needed in low-pressure urethra. In spite of larger urethrovaginal dissection in TOT, the tape does not migrate close to the bladder neck and remains at mid-urethra.

[MRI and arrhythmogenic right ventricular dysplasia (ARVD). Retrospective evaluation of 50 patients]. / IRM et dysplasie arythmogène du ventricule droit (DAVD). Evaluation rétrospective chez 50 patients.

PURPOSE: To retrospectively evaluate the contribution of MRI to the diagnosis of arrhythmogenic right ventricular dysplasia (ARVD). PATIENTS AND METHODS: Thirty two men and 18 women (mean age: 48.7 years) were imaged using gated spin echo scans and short axis cine MR. References were McKenna criteria (gold standard), and also what we called "strong presumption" which may correspond to early or localized patterns, but correspond to negative McKenna scores. RESULTS: One patient was claustrophobic; another one was lost to follow-up. In reference to McKenna score, diagnosis of ARVD was established in 12 patients (2 of whom had familial dilated biventricular cardiomyopathy with rhythmic expression). Sensitivity, specificity, positive predictive value, negative predictive value and prevalence were respectively: 75%, 75%, 50%, 90% and 25%. Using "strong presumption" criteria, we observed 14 true positives (with sensitivity of 82%, specificity of 87%, PPV of 78%, NPV of 90% and prevalence of 35%). CONCLUSION: In our group, MRI was always performed before angiography. In our series, right ventricular wall T1W hyperintensity was the most frequent finding.

Chondroblastoma of the temporal bone associated with a persistent hypoglossal artery.

A case of a chondroblastoma of the skull-base associated with a persistent hypoglossal artery (PHA) is presented. Neuroradiological findings of the PHA and the tumour are reported. The existence of a carotico-basilar communication such as a PHA should be recognized prior to skull base surgery because of the potential risk of cerebral ischemia.