[Lower urinary tract dysfunction and herniated disk]. / Troubles vésico-sphinctériens et hernies discales.

Lower urinary tract dysfunction related to herniated disk can raise complex diagnostic and management problems. This article reviews the two main clinical situations encountered: documented lower urinary tract dysfunction in a context of cauda equina syndrome secondary to herniated disk and lower urinary tract dysfunction representing the only clinical sign of herniated disk with no other alteration of the neurological examination. Regardless of the neurological signs, urodynamic assessment is essential to characterize any lower urinary tract dysfunction and to determine the modalities of long-term surveillance.

[Value of the pubic tubercle as a CT reference point in groin hernias]. / Valeur de l'épine du pubis comme repère TDM des hernies de l'aine.

PURPOSE: To assess the value of the pubic tubercle as a CT reference point in diagnosing the different types of groin hernia before surgery in patients presenting with mechanical bowel obstruction. MATERIALS AND METHODS: Retrospective review of CT examinations performed for small bowel obstruction in our department during 2003. Twelve cases of groin hernia causing small bowel obstruction were included. All CT examinations were reviewed by 2 abdominal radiologists. The surgical report of all 12 included cases was reviewed for final diagnosis. RESULTS: Twelve cases of groin hernia causing small bowel obstruction were reviewed in our department during 2003. Eight cases corresponded to small bowel obstruction caused by inguinal hernia (4 direct and 4 indirect) and 4 to small bowel obstruction caused by femoral hernia. In each case, the diagnosis suggested at CT using the pubic tubercle as a reference point was surgically confirmed. CONCLUSION: The pubic tubercle is an excellent reference point at CT for diagnosing inguinal and femoral hernias. Preoperative diagnosis is important because it may change the choice of surgical procedure.

[Contribution of quantitative radio-scintigraphy to diagnosis of wrist injuries undetected on plain films: a prospective study of 154 cases]. / Apport de la radioscintigraphie quantitative dans les traumatismes du poignet avec radiographies initiales normales: étude prospective de 154 cas.

PURPOSE OF THE STUDY: Fractures of the scaphoid must be diagnosed quickly to avoid persistent nonunion and the risk of osteoarthritis. Despite meticulous physical examination and adequate x-ray detection, numerous occult fractures still go unrecognized. The aim of this prospective study was to analyze the pertinence of quantitative radio-scintigraphy (QRS) presently used for the diagnosis of occult wrist fractures. MATERIAL AND METHODS: Quantitative radio-scintigraphy (QRS) is a new imaging technique associating quantitative bone scan and numerical fusion between bone scan images and x-ray images. We conducted a prospective study between November 1994 and March 1999 to evaluate the pertinence of this examination technique for the diagnosis of occult wrist fractures in patients presenting clinical symptoms suggestive of wrist fracture but whose plain x-rays were initially considered normal. Further some patients had several series of plain x-rays performed at several week intervals in order to search for fractures becoming progressively visible on plain x-rays. After the QRS data was acquired, these patients' x-rays were reviewed again. We also compared the cost of QRS, repeated x-rays, bone scan and MRI at the Besançon University Hospital. RESULTS: QRS was performed in all 154 patients and revealed 61 fractures (56 single-line and 5 multiple-line fractures). Thus 43.5% of these patients had occult wrist fractures (41% of which involved the carpal scaphoid). DISCUSSION: Occult fracture of the wrist, particularly the carpal scaphoid, is frequent. Repeated x-ray examination does not increase the rate of detection of these fractures. Bone scans may also fail to reveal occult fractures. MRI is a key examination in the assessment of wrist fracture symptoms, but is presently not available in all institutions. Bone scan is classically insufficiently precise. QRS is a rapidly available low-cost examination which we have found to be indispensable for the diagnosis of occult wrist fractures. With early QRS diagnosis, the risk of neglected carpal scaphoid fracture and subsequent nonunion and osteoarthritis together with the personal, social, and medicolegal consequences can be avoided.