[Chronotherapy combining 5-fluorouracil, folinic acid and carboplatin as first line treatment in metastatic colorectal cancer. A phase 2 study]. / Chronothérapie associant le 5-fluorouracile, l'acide folinique, et le carboplatine en première ligne thérapeutique dans le cancer colorectal métastatique. Une étude de phase 2.

Seventy-two patients suffering from a metastatic colorectal cancer received, as first line treatment, a combination chronotherapy with 5-FU and folinic acid (infused from 10 pm to 10 am with a peak at 4 am, respectively at doses of 700 and 300 mg/m2 per day) and carboplatin (infused at the dose of 40 mg/m2 per day from 10 am to 10 pm with a peak at 4 pm). The courses of four days were repeated every two weeks. A major tumoral response was observed in 60% cases (68% in those not previously treated with adjuvant chemotherapy). The median times to progression and overall survival established at 11 and 27 months. The clinical (grades 3-4 in maximum 5% cases) and hematological (grades 3-4 in maximum 10-29% cases) toxicities were quite limited. Our observations suggest the interest to incorporate carboplatin in the combined infusional treatment of colorectal cancer.

Duplex ultrasound as first-line screening test for patients suspected of renal artery stenosis: prospective evaluation in high-risk group.

Our objective was to assess how far the progress in ultrasound devices has increased feasibility and accuracy of Duplex ultrasound (DUS) for the diagnosis of renal artery stenosis (RAS), in a population with high prevalence of atherosclerotic renovascular lesions. Ninety-one hypertensive patients with atherosclerotic disease were prospectively evaluated by both DUS and digital subtraction angiography (DSA) of the renal arteries. Only proximal criteria (peak systolic velocity >180 mm/s or renal-to-aortic ratio >3.5) were used for the diagnosis of significant RAS (>60% narrowing). For both techniques, two readers were involved for interobserver variability study. Two hundred one arteries were demonstrated by DSA on 182 available kidneys. The prevalence of RAS among the study group was 37%. Sixteen of the 19 accessory arteries were not seen at DUS; in 8 patients, one renal artery was not seen at DUS (feasibility 91%). On the 177 arteries assessed, in comparison with DSA, DUS yielded 96, 91, and 97% mean values of accuracy, sensitivity, and specificity, respectively. Kappa for interobserver agreement was 0.95 for DUS and 0.92 for DSA. Although still unreliable for the detection of accessory arteries, DUS is in our experience an accurate and reproducible diagnostic test for RAS.

[MR aortofemorography versus DSA: prospective evaluation]. / Aortofémorographie par résonance magnétique nucléaire versus artériographie conventionnelle: évaluation prospective.

PURPOSE: To determine how far MRA of lower limbs obviates the need for pre-therapeutic DSA. MATERIALS AND METHOD: Three-step 3-D gadolinium enhanced aortofemorography with a moving bed was prospectively compared to DSA in 49 consecutive patients (40 males, 9 females; age range 38-80 years; mean age 64 years). According to Leriche and Fontaine's clinical gradation of lower limb ischemia, 5 patients were graded I, 37 graded II, 4 graded III, and 3 graded IV. Two observers graded stenoses for DSA and three for MRA. Cohen's kappa statistics were used to evaluate interobserver variability using MRA, as well as to compare MRA to DSA. In addition, sensitivity, specificity, positive and negative predictive values of MRA for the assessment of stenosis superior to 80% were calculated by using DSA as a gold standard, respectively for arterial trunks above and below the level of the knees. RESULTS: Overall accuracy of MRA was 92%. Comparison of DSA and MRA yielded a kappa value of 0.87 (0.95 for arterial trunks located above the level of the knees and 0.75 below). Interobserver agreement was very good. Sensitivity, specificity, positive and negative predictive values of MRA for the diagnosis of > 80% stenosis were respectively 98, 98, 85 and 99% above the level of the knees and 87, 91, 77 and 96% below the knees. CONCLUSION: MRA can be considered as valuable technique for the evaluation of peripheral arterial obstructive disease, especially for stenosis located above the level of the knees.

[State of the art of pancreatic cancer imaging]. / Actualités en imagerie du cancer du pancréas.

Ultrasonography and CT-scanner remain the first choice nowadays concerning detection and preoperative work-up of pancreatic cancer. MRI offers interesting options for the detection of liver metastases, and high quality of ductal and vascular examination. Actually, while we await a larger diffusion of MR systems and radiological expertise this technique is preferentially indicated as a third-step procedure when ultrasonography and CT-scanner are normal despite a real suspicion. Otherwise, MRI permits with a single non-invasive examination a complete work-up useful to prepare palliative therapy in case of unresectable tumor.

[Carotid endarterectomy without arteriography: only dedicated to urgent procedures?]. / La thrombendarteriectomie carotidienne sans arteriographie, une procedure reservee aux seules indications urgentes?

Duplex examination is presently established as a safe non-invasive and accurate method of evaluating patients with extracranial cerebrovascular disease which usually provides complete information about the extent of carotid artery narrowing Arteriography, in this indication, is an invasive procedure with a total complication rate of 3-4% with 1% of permanent stroke. If it is currently accepted that in emergency conditions (ictus ingravescens, pre-occlusive plaque) or if iodinated contrast media are contraindicated, thrombendarteriectomy can be performed without arteriography it could be extended to most cases. The authors stress the criteria to increase the number of those patients, summarize the pre-requisites to achieve this goal, and comment on the future alternative position of MRA.

Computed tomography of thoracic aortic trauma.

During a 63-month period, 28 consecutive patients suspicious for injury of the thoracic aorta were examined by computed tomography (CT). Twelve aortic ruptures were evidenced; pseudoaneurysm and mediastinal haematoma in close contact with the aorta were present in 12 patients, marginal lucency in 9, marginal irregularity in 8 and intimal flap in 6. CT was falsely negative in 1 patient with injury of the left subclavian artery. Angiography and surgery confirmed the diagnosis in 7 patients, and surgery alone in 5 patients. CT had a sensitivity of 92% and a specificity of 100%. The need for angiography was obviated in 67% of patients. A radiologist with experience in trauma management, CT and angiography should perform both examinations.

[Radioscopy and radiography of the thorax. Birth and maturation of an ever-current technique]. / Radioscopie et radiographie du thorax. Naissance et maturation d'une technique toujours d'actualité.

There are three milestones in the history of thoracic radiology. Thoracic radiology started in 1897 when Williams developed thoracic fluoroscopy and introduced the basic concepts of roentgenologic interpretation. At the same time, the first chest films were performed allowing decisive improvement in the diagnosis of many chest diseases. Continuous technical improvement is responsible for the fact that, even today, the conventional chest film remains a highly accurate and frequently used imaging modality. A third milestone was the development of digital radiography and its use in the chest. Computerised tomography changed thoracic imaging dramatically; in a first step mainly as a tool to visualise soft tissue abnormalities and, later on, also as a modality to study lung disease. The recent development of the digital chest radiograph has again added new perspectives to the approach and diagnosis of chest disease.

[Pulmonary epithelioid hemangioendothelioma with hepatic secondary location]. / Hémangio-endothéliome épithélioïde pulmonaire à localisation hépatique secondaire.

Hepatic metastases secondary to a primary pulmonary epithelioid hemangioendothelioma are demonstrated in a patient after a follow-up of 11 years. Three years after diagnosis of metastases, the patient is in good general condition. MRI of hepatic epithelioid hemangioendothelioma is not specific and histologic confirmation is mandatory.

[Phrenic nerve paralysis complicating cervicofacial surgery]. / La paralysie phrénique compliquant la chirurgie cervico-faciale.

Radical neck dissection remains the keystone to lymph nodes control in modern Head and Neck Surgery. Like any major operation, it has inherent complications ranging from minor surgical complications such as wound infection to potentially life-threatening complications such as fistula or carotid rupture. We have observed two cases of surgical damage of the phrenic nerve following radical neck dissection. Transient or definitive phrenic nerve palsy after radical neck dissection has been previously reported. The physiopathology according to the age and the clinical implications of that rare complication are discussed.