Postoperative abdominal bleeding.

Postoperative bleeding following abdominal surgery is relatively rare and mainly depends on the type of surgery. Although bleeding is usually controlled by simple local treatment of symptoms, specific treatment including surgery or interventional radiology is sometimes necessary. This article reviews the clinical features that must be recognized depending on the type of surgery and especially focuses on the role of the radiologist in the management of this complication.

[Radiation therapy for pleomorphic adenoma of the parotid]. / Adénomes pléomorphes parotidiens récidivants : place de la radiothérapie.

Parotid pleomorphic adenoma is the most frequent tumor of salivary glands. The prognosis depends on the recurrences because they could lead to iatrogenic events (facial paralysis). Moreover the risk of malignant transformation increases with the number of local relapses. This article aims at reviewing histological and radiological criteria and the surgical techniques. To improve local control, adjuvant irradiation (in first intention or after recurrence) may be useful but is still controversial for benign tumors in young patients with a risk of radio-induced cancer. We listed studies in which adjuvant radiotherapy was used so as to define its place in the treatment strategy. Prognostic factors were found by some authors. Other studies have to be done before strong evidence-based recommendations are issued.

Initial staging of squamous cell carcinoma of the oral cavity, larynx and pharynx (excluding nasopharynx). Part 2: Remote extension assessment and exploration for secondary synchronous locations outside of the upper aerodigestive tract. 2012 SFORL guidelines.

OBJECTIVES: This report presents the French Society of ORL (SFORL) guidelines for exploration for remote metastasis and synchronous second cancer in initial staging of head and neck squamous cell carcinoma. MATERIALS AND METHODS: An exhaustive literature review was analyzed by a multidisciplinary work-group. RESULTS: The thorax is the most frequent location of remote metastases and synchronous second cancer outside of the upper aerodigestive tract. Thoracic CT is recommended as first-line examination in all cases (grade B). 18-FDG PET/CT is recommended when the thoracic CT image is doubtful or in case of high metastatic risk (grade B), for the detection of non-pulmonary remote metastasis. Esophageal exploration is recommended in case of significant risk of synchronous esophageal cancer (hypopharyngeal or oropharyngeal tumor, chronic alcohol intoxication) (grade B). The reference examination is flexible endoscopy of the upper digestive tract (grade B). CONCLUSION: The present grade B recommendations rationalize the roles of the various first-line radiological and endoscopic examinations for remote metastasis and synchronous second cancer, so as to limit the number of examinations performed, thereby reducing the time needed for initial staging.

Initial staging of squamous cell carcinoma of the oral cavity, larynx and pharynx (excluding nasopharynx). Part I: Locoregional extension assessment: 2012 SFORL guidelines.

OBJECTIVES: To set out good practice guidelines for locoregional extension assessment of squamous cell carcinoma of the head and neck (excluding nasopharynx, nasal cavities and sinuses). MATERIALS AND METHODS: A critical multidisciplinary review of the literature on locoregional extension assessment of squamous cell carcinoma of the head and neck was conducted, applying levels of evidence in line with the French health authority's (HAS) literature analysis guide of January 2000. CONCLUSION: Based on the levels of evidence of the selected articles and on work-group consensus, graded guidelines are set out for clinical, endoscopic and imaging locoregional extension assessment of head and neck cancer.

[Role of imaging in the pre-treatment assessment and post-treatment follow-up of sinonasal malignancies]. / Place de l'imagerie dans le bilan préthérapeutique et la surveillance post-thérapeutique des tumeurs malignes du massif facial.

Malignant sinonasal tumors are the most frequent facial malignancies in adults. Assessment of these tumors requires a multidisciplinary approach and imaging plays a major role to define the precise tumor location, volume and extension and to plan post-treatment follow-up. MRI provides superior differentiation between tumor and surrounding tissues and depiction of intracranial or perineural extension. CT is a useful complement to demonstrate bone erosion or extension into the skull base.

Paranasal sinus fungus ball: epidemiology, clinical features and diagnosis. A retrospective analysis of 173 cases from a single medical center in France, 1989-2002.

Over the last decade, we have observed a high frequency of Aspergillus rhinosinusitis in french medical centers. The epidemiological data, clinical presentations, radiology, mycology and histology results of 173 consecutive patients with paranasal sinus fungus balls who were admitted from 1989 to 2002 have been reviewed. The most common symptoms included purulent nasal discharges and nasal obstructions, with the maxillary sinus being the most common site of infection (152 cases, 87.8%). Computed tomography scans (CT scan) were performed in 92% (159/173) of the cases and heterogeneous opacities were observed in 132 patients (83%). Histology examinations were performed in all cases and proved positive in 162 patients. Fungi were recovered, mainly Aspergillus fumigatus, from samples of 50 patients, while specimens from the remaining 123 patients were negative. Since no specific clinical sign could be found, a diagnosis of fungus ball is frequently made after a long term symptomatic period. CT scan findings of metallic or calcified densities within an opacified sinus cavity are highly suggestive of a fungus ball, but mycological and histological studies are essential to confirm the diagnosis. Treatment consisted of functional endonasal sinus surgery and was successful in 172 out of 173 cases.

[Diffuse nasal polyposis and comorbidity: study of 65 cases treated by endonasal endoscopic surgery]. / Polypose naso-sinusienne diffuse et co-morbidité. A propos de 65 cas traités par chirurgie endonasale.

INTRODUCTION: Nasal polyposis is an inflammatory disorder which pathophysiology remains unclear. Several clinical associations are described according to co-morbidities (asthma, allergy...). OBJECTIVE: To analyze the efficacy of a standardized surgical procedure in 65 patients with nasal polyposis, enrolled in three categories according to the presence of co-morbidities (asthma, allergy...). STUDY DESIGN: Open prospective study of non-randomized cases from a single institution. METHODS: An inception cohort of 65 consecutive patients with nasal polyposis observed from January 1994 to December 1997. The same surgical procedure was performed in all patients. At the end of the study, an evaluation was performed to collect all the information concerning nasal and bronchial symptoms, asthma conditions, and medical treatment. RESULTS: 60 patients have finally completed the study. Polyposis was isolated in 29 patients, asthma was present in 21 patients, associated with aspirin intolerance in 10 patients (ASA Triad). Nasal obstruction and olfactory dysfunction was improved in 37 and 42 patients, respectively (p<0.0001), without a statistical significance between all groups. After surgery, topical treatment with steroids and local recurrences were more frequently observed in the ASA Triad group without statistical significance. CONCLUSION: Nasal polyposis appears to be less controlled in the ASA Triad group compared to isolated nasal polyposis, although such conclusion is not statistically significant.

[Mucocele of the sphenoid sinus]. / Les mucocéles sphénoïdales.

Sphenoid sinus mucoceles are pseudocystic expansile slow-growing processes that arise within the sphenoid sinus. A dynamic process of bone resorption and erosion results in a pseudo-tumoral development. Clinical features and potential risks are related to mass effect with compression of the optic nerves and intracranial extension of the process. CT and MRI allow diagnosis and distinguish mucoceles from skull base tumors or inflammatory diseases. Endonasal endoscopic approach is adapted to the treatment of sphenoid mucoceles and allows marsupialization of the mucoceles.

[Paranasal sinuses and facial imaging: exploratory strategies]. / L'imagerie des sinus de la face et du massif facial: stratégies d'exploration.

Advances in radiological and endoscopic imaging allow more accurate location and spread of nasosinusal diseases. These developments have led to a better understanding of sinusal anatomy and to widespread of surgical techniques as endoscopic sinus surgery. CT becomes the primary imaging modality for assessment of chronic rhinosinusitis and complex traumatic injury. Associated to CT, MRI is used to distinguish between inflammatory and neoplastic pathology and to assess lesions involving the skull base or intracranial structures. However, optimization of technical parameters according to the pathology is necessary.

A prospective radiological anatomical study of the variations of the position of the colon in the left pararenal space.

Percutaneous puncture of the kidney allows direct access to the pyelocalicial cavities. The posterior approach of this retroperitoneal organ can be complicated of transcolic punctures due to the postrenal position of the colon. A prospective radiological anatomical study of the relationship between the left kidney and the descending colon was undertaken. One hundred computed tomograms of adult subjects were obtained from which the anatomy of the left perirenal area was determined: the descending colon is more frequently behind the kidney in the young females. Two main factors determinants of this situation are: 1) colon ontogenesis in relation to the attachment of the primitive mesocolon, permitting a 'fixed' left colon, or 'moving' left colon at the end of a long mesocolon, allowing it to pass behind the kidney; 2) a mechanical factor whereby the accumulation of perirenal fat with increasing age may be a limiting factor in lateral displacement of the colon.

[Adenoid cystic carcinoma (CAC) of the naso-sinonasal cavities: report of 5 cases, review of the literature]. / Carcinome adénoïde kystique (CAK) des cavités naso-sinusiennes: à propos de 5 nouveaux cas, revue de la littérature.

Adenoid cystic carcinoma is a rare tumour which mainly affects the major and accessory salivary glands. We report 5 new cases affecting the nose and sinuses, and based on these review the literature to determine how this disorder can be better treated, given the significant morbidity and mortality of the condition.

[Radiology and pathologies of the paranasal cavities]. / Radiologie et pathologie rhinosinusienne.

The radiologic exploration of the paranasal cavities are one of the main exams when ENT is dealing with a sinus pathology. CT scan, MRI, angiography of the paranasal cavities are now easily available to explore the different pathologies including infection, chronic rhinosinusitis or tumors. The authors report their experiences with these exams, to suggest guidelines and recommendations to obtain the best radiologic management of the sinus pathologies.

MR assessment of the brain maturation during the perinatal period: quantitative T2 MR study in premature newborns.

The purpose of our study is to trace in vivo and during the perinatal period, the brain maturation process with exhaustive measures of the T2 relaxation time values. We also compared regional myelination progress with variations of the relaxation time values and of brain signal. T2 relaxation times were measured in 7 healthy premature newborns at the post-conceptional age of 37 weeks, using a Carr-Purcell-Meiboom-Gill sequence (echo time 60 to 150 ms), on a 2.35 Tesla Spectro-Imaging MR system. A total of 62 measures were defined for each subject within the brain stem, the basal ganglia and the hemispheric gray and white matter. The mean and standard deviation of the T2 values were calculated for each location. Regional T2 values changes and brain signal variations were studied. In comparison to the adult ones, the T2 relaxation time values of both gray and white matter were highly prolonged and a reversed ratio between gray and white matter was found. The maturational phenomena might be regionally correlated with a T2 value shortening. Significant T2 variations in the brainstem (p < 0.02), the mesencephalon (p < 0.05), the thalami (p < 0.01), the lentiform nuclei (p < 0.01) and the caudate nuclei (p < 0.02) were observed at an earlier time than they were visible on T2-weighted images. In the cerebral hemispheres, T2 values increased from the occipital white matter to parietal, temporal and frontal white matter (p < 0.05) and in the frontal and occipital areas from periventricular to subcortical white matter (p < 0.01). Maturational progress was earlier and better displayed with T2 measurements and T2 mapping. During the perinatal period, the measurements and analysis of T2 values revealed brain regional differences not discernible with T2-weighted images. It might be a more sensitive indicator for assessment of brain maturation.

Sacrococcygeal and transsacral epidural anesthesia in the laboratory pig: a model for experimental surgery.

The laboratory piglet is currently the preferred animal for experimental digestive surgery. In order to ensure optimal perioperative analgesic control with motor blockade during surgery together with rapid postoperative recovery, epidural anesthesia techniques were developed in this animal. We report the anatomo-radiologic studies (10 animals) and clinical experiments (51 transplantations of the liver and the small intestine) which led to the refinement of this anesthesia. In laboratory piglets, epidural anesthesia by distal transsacral (S4-S5) or sacrococcygeal approach is possible in a reproducible manner. The localization of the injection site is simple and epidural space catheterisation is easy without risk for the dural sac which ends at S1-S2.

[Imaging aspects of primary cerebral lymphoma]. / Aspects par imagerie des lymphomes cérébraux primitifs.

Th CT and MRI appearance of 196 lymphomatous histologically proved lesions were rewied in 127 patients. A post contrast study was performed in all patients studied with CT; 118 lesions were also assessed before an iodine contrast injection. 40 lesions were both studied with CT and MRI, and 12 only with MRI. There is a single lesion in 86% of the cases with a supratentorial location in 87%. The lesion size is over 1 cm in 90% and 87% of the lesions appear with regular and sharp demarcation. A mild edema is associated in 86%. Most of the lesions display an infiltrative pattern with a soft mass effect on the surrounding cerebral parenchyma. The basal ganglion, corpus callosum and trigone location, or an infiltration of the periventricular ependyma, or a mirror pattern, appear strongly suggestive for a lesion of lymphomatous origin. The CT post contrast enhancement of the lesion is present in 99% and homogeneous in 82%.

Aspergillomas of the sphenoid sinus: a series of 10 cases treated by endoscopic sinus surgery.

We report our experience with 10 cases of sphenoidal aspergillomas treated by endoscopic sinus surgery (ESS). Chronic symptoms such as cough, post-nasal discharge, dysphonia and even facial pain can be encountered in the history. Computerised tomography and, occasionally, magnetic resonance imaging are of great help in the assessment of this disease, especially when extensive skull base involvement is present. The radiological presentation can vary from an heterogeneous to homogeneous opacity with or without bone lysis to a frank pseudotumoural appearance. Four diagnostic tools have been evaluated to confirm the diagnosis: histology, direct smear, fungal cultures, and serology for Aspergillus. ESS has been successfully carried out without morbidity in all cases. No recurrence of the disease is seen after a mean follow-up of 27 months.

[Unilateral choanal atresia and paranasal sinus growth]. / Atrésie choanale unilatérale et croissance sinusienne.

Mechanisms regulating sinus growth are poorly understood. We report a series of six cases of unilateral choanal atresia and discuss the role of nasal ventilation on sinus growth. The presence and the size of the sinus cavities are the main parameters. Our preliminary results suggest that sinus growth is independent of nasal ventilation.

Endoscopic approach of the pterygopalatine fossa: report of one case.

We report one case of schwannoma of the pterygopalatine fossa. The pre-operative management and post-operative follow-up are presented. For this uncommon localization, we propose an endoscopic approach via the nasal fossa and the maxillary sinus. The advantages and limitations of this technique are discussed.

[MRI in infectious and spontaneous tumoral epidural hemorrhagic pathology]. / IRM et pathologie épidurale tumorale infectieuse et hémorragique spontanée.

Several studies have served to underline the interest of MRI in the diagnosis and assessment of epidural abscess and malignant extradural spinal tumors. In our work, one of the quantitatively greatest published to this day, 64 patients presenting epidural pathology were evaluated by means of MRI. All the explorations were brought about through weighted multiplaned sequences T1, T2 and gadolinium injection. The pathological spectrum encountered is comprised of: metastatic extradural spinal tumors (58%), primary extradural spinal tumors (7%), epidural localizations of hematological diseases (9%), epidural abscess (25%), and one case of epidural hematoma. Assessment was brought to bear upon behavior in relation to type of sequence, spread of disease, medullary effects, type of enhancement following gadolinium injection. Degree of correlation with clinical data and surgical findings was also appraised. As concerns tumourous epidural pathology, positive diagnosis due to a lesion hinges upon the T1 and T2 sequences. Gadolinium's contribution is restricted to analysis of perivertebral and vertebral spreading; it also facilitates recognition of the spinal cord in circumferential epiduritis. So much said, gadolinium appears to be essential in frequently less compressive forms of infectious epiduritis; it plays a pronounced role in both follow-up of their evolution and recognition of acute epidural hematoma.