Computer-assisted anthropometry for outcome assessment of cleft lip.

Anthropometry and clinical examination best evaluate the morphology of repaired cleft lip and nose. An original, accurate, and practical image analysis of the lip and nose, which takes advantage of the mathematic, geometric, and organizational capabilities of public domain NIH-Image software (http://rsb.info.nih.gov/nih-image/), has been developed and tested over the past 6 years. A modified structured physical examination form that complements this analysis is under study. Accuracy of NIH-Image-based anthropometry was compared with direct measurements of 22 linear distances on the lip and nose. Twenty-five sets of direct measurements were taken, prospectively, on 15 children with repaired cleft lip over a 6-year period. The results were submitted to regression analysis. Then, relevant lip and nasal tip aesthetics were evaluated by the measuring capabilities of NIH-Image to create a quantitative assessment tool. For each episode, 15 possible faults were weighted, according to aesthetics and deformity, to provide an adverse score. The sum of the 5 lip scores, 10 nose scores, and combination gave respective grades. The analysis was modified to stratify congenital deformity to relate severity of disease to outcome. This analysis was applied to digitized images of 19 consecutive children, immediately prior to repair of complete unilateral cleft lip and nose, at the time of palate repair, and annually from the age of 3 to 6 years. There were 19 NIH-Image-based measurements of the congenital deformity and 35 measurements of surgical results; four children had three sets of records, eight had two sets, and seven had one set Descriptive statistics were applied. Following 556 paired direct and computer-assisted measurements, exceptional linear correlation was shown with a Pearson R coefficient of 0.96. The best correlation was lines within the plane of the camera lens, with the average difference ranging between 0.025 and 0.997 mm. Visual inspection of frontal and submental photographs of excellent, good, and poor results substantiates the ability of this analysis to quantify and grade a spectrum of relevant cleft lip and nasal anatomy. For these 19 patients, there was a broad range of performance scores, approximating a normal distribution. The mean of the NIH-Image-based analysis scores, 16.91, was a (very) good grade. A single standard deviation of 6.88 extended up into excellent and down to fair. The congenital analysis indicated a range of deformity. Comparing deformity with outcome, simple regression analysis had a coefficient of determination (R2) of 0.223, indicative of a weak positive relationship. An accurate and practical morphologic computer-assisted outcome assessment of repaired cleft lip and nasal deformity has been developed. There is a weak direct correlation between severity of deformity and outcome. Testing in multiple clinics is warranted.

Internal jugular vein and carotid artery anatomic relation as determined by ultrasonography.

BACKGROUND: Cannulation of the internal jugular vein (IJV) is associated with a 95% success rate when external landmarks are used. Anatomic variability has been implicated as the cause for difficulty in cannulation without ultrasound. In contrast to an IJV located lateral to the carotid artery (CA), an IJV overlying the CA may result in CA puncture. The authors' purpose in this study was to examine, using ultrasound, the anatomic relation of the IJV and CA as viewed from the perspective of a cannulating needle. METHODS: Ultrasound imaging was used in 1,136 patients to examine the relation between the IJV and CA. A 7.5-MHz transducer was placed in the direction of a cannulating needle on the right neck at the apex of the angle formed by the division of the sternocleidomastoid muscle. A Polaroid photograph of the image was later scored by three blinded investigators according to the percentage of the CA overlaid by the IJV (0 to 4). RESULTS: Of the 1,136 Polaroid photographs of the ultrasound images, 1,009 were suitable for scoring. Fifty-four percent of all patients received a score of 4, which indicated that the IJV overlies more than 75% of the CA in an imaging plane positioned in the direction of a cannulating needle. Patients older than 60 yr were more likely to have this anatomy than patients younger than 60 yr (P < 0.05). None of the other patient characteristics recorded were predictive of this anatomic relation. CONCLUSIONS: In a majority of patients, the IJV is not lateral to the CA in an ultrasound imaging plane positioned in the direction of a cannulating needle. Instead, the IJV overlies the CA in 54% of patients overall, predisposing these patients to CA puncture if the cannulating needle traverses the IJV.

[Cancer of the esophagus after mediastinal radiotherapy for Hodgkin's disease. Apropos of a case]. / Cancer de l'oesophage après radiothérapie médiastinale pour maladie de Hodgkin. A propos d'un cas.

Malignant solid tumors induced by radiotherapy for Hodgkin's disease are uncommon. We report one case of thoracic esophageal squamous carcinoma diagnosed 19 years after mediastinal irradiation. The criteria usually accepted for the diagnosis of radiation cancer were all present in this case. An oesophagectomy was performed and the patient made a good recovery from the operation.

[Semiology of benign diseases of the breast in mammography (author's transl)]. / La sémiologie mammographique des mastopathies bénignes. Etude expérimentale et clinique. Critique conceptuelle.

Mammography is a basic examination which must never be dissociated from the clinical background. A statistical blind study of 330 cases shows that only well definite syndroms are reliable. The presence of absence of a single sign has no value. Difficulties arise in the diagnosis of suspect nodule in a dense dystrophic breast. Hydratation of the connecting tissue is a fundamental concept for analysis of mammographic pictures. The densities change according to hormonal influence, growth of dystrophy and specific signs of fibrillary or hyalin fibrosis. A histological study of serial cuts of the breast shows that the must reliable signs are found in the center of the nodule ande immediately around it. As in the histological study, serial cuts are indispensable in X-ray examination. Tomography improves the examination of dystrophies.

[Mammotomography, a new technic of breast examination]. / La mammotomographie, nouvelle méthode d'exploration mammaire

The authors present the first results of a new technique of breast examination: tomo-mammography. This new method allows a complete study of the whole gland without any compression and any modification of histological and anatomical structures, and an analysis of the center of breast lesions in which are rassembled the most reliable radiological signs. These first results enable to hope a large increase of possibilities of diagnosis of breast lesions in the most difficult anatomical and clinical cases.

[Anatomical and histological approach to the radioraphic appearance of the breast (author's transl)]. / Approche anatomo-histologique de la radio-anatomie mammaire

The authors present first correlations between histology, anatomy and serial radiography of the breast, in order to establish a new understanding of the mammographic picture, with respect to the tridimensional histological structures. Several essential points are considered: - Mammographic pictures only show fibrous, connecting and fatty tissues. The epithelium of the galactophores is not shown, because of its low radio-opacity. Mammographic densities are due above all to fibrous connecting tissue, which has a high percentage of water. Benign or malignant breast tumors present with a proliferation of epithelium and connecting tissue, but only connecting tissue, more or less hydrated is shown on the mammographic picture. Many mammographic patterns are related to various superimposed fibrous strands, appearing as pseudotumoral opacities. The benign or malignant tumoral opacities are hidden or modified by multiple superimposed adjacent structures. - The mammographic patterns is related to the degree of hydratation and components of the connecting tissue.

[Xeroradiography in rheumatology]. / Xeroradiographie en rhumatologie

Xeroradiography is a new and simple radiodiagnostic technique that makes it possible to analyse on one positive film not only the bone tissue but also the neighbouring structures (ligaments, muscles, fatty tissue, the vessels, and the skin). On the basis of about 100 examinations, the authors indicate the value and the limitations of the technique in rheumatological practice. Because of the technical aspects of the technique, the dorsolumbar spine and the facial massif are poorly visualized. The swamping of the contrast also limits its use for cases of demineralization (osteoporosis). On the other hand, the information provided by the technique in cases of Paget's disease, articular or para-articular calcification, pathological conditions of the tendons (rupture, calcification), and bone tumours appears to be of great value. The early diagnosis of cases of inflammatory rheumatism and the surveillance of Silastic prostheses used in surgery on rheumatic hands are also facilitated.