Role of CT in the acute nontraumatic abdomen.

The diagnostic workup of the acute abdomen always begins with a precise clinical history, a complete physical examination, and careful reading of plain films. Commonly performed additional imaging studies include contrast examination and, more recently, ultrasound. CT offers the advantage of allowing a comprehensive diagnostic evaluation of both solid and hollow viscera in neoplastic as well as in inflammatory and vascular disorders.

[The use of high resolution x-ray computed tomography in the diagnosis of hypersensitivity pneumopathy to gold salts. Apropos of a case]. / Apport de la tomodensitométrie HR dans le diagnostic de la pneumopathie d'hypersensibilité aux sels d'or. A propos d'un cas.

A hypersensitivity pneumonia is rare during gold therapy. The underlying mechanism is immunological in origin, of Gell and Coombs Type IV. As there are numerous possible pulmonary disorders during the course of inflammatory rheumatism treated with gold, the early detection is vital, in order to prevent progress to fibrosis. In parallel with broncho-alveolar lavage to look for a T8 lymphocytic alveolitis, which is very suggestive, high resolution computed tomography has a place in the early diagnosis, to characterise the lesions, to aid in an aetiological diagnosis, and also to assess progress on treatment. The authors present a case of pneumonitis induced by gold with visible interstitial lesions on computed tomography, accompanied by significant bronchial distortion and bronchiectasis suggestive of fixed lesions. These lesions partially regressed following steroid therapy; the diagnostic and prognostic role for high resolution computer tomography was discussed.

Tubal sterilization by selective catheterization in an animal model.

RATIONAL AND OBJECTIVES: The feasibility of tubal occlusion by selective salpingography was tested in an animal model; three novel occluding materials also were tested for this application. METHODS: Unilateral selective salpingography was performed in three groups of six rabbits; fallopian tubes were embolized with ethanol (group 1), a hydrogel (group 2), or an occluding emulsion (Ethibloc, Laboratoire Princeps, Neuilly sur Seine, France) (group 3). Animals were killed 2 days or 30 days after the procedure, according to randomization; tubal patency and histologic modifications were evaluated. RESULTS: Selective tubal catheterization was obtained in 100% of the cases. In group 1, no satisfactory occlusion was obtained; in group 2, 65% of the tubes were occluded with little histologic damage; in group 3, 80% of the tubes were occluded, but significant inflammation and tissue necrosis were noted. CONCLUSION: Selective salpingography proved a suitable method for gaining access to the fallopian tube and allowed selective injection of occluding materials. More research is needed to determine a suitable occluding material, focusing on biocompatibility and on long-term efficacy.

PIP: Unilateral selective salpingography was performed in 3 groups of 6 rabbits. 4-6 month old, virgin New Zealand White female rabbits were used with a mean weight of 4.4 kg. The fallopian tubes were embolized with ethanol (group 1); a viscous radiopaque solution which solidifies rapidly after injection to produce a biocompatible and inert hydrogel (group 2); or an occluding emulsion (a radiopaque heterogeneous alcoholic solution of zein, poppy seed oil, propylene glycol, and sodium amidotrizoate from Ethibloc, Laboratoire Princeps, Neuilly sur Seine, France) (group 3). Animals were killed 2 days or 30 days after the procedure, according to randomization; and tubal patency and histologic modifications were evaluated. Selective tubal catheterization was possible in all 18 cases, in 12 cases on the right side (66%), in 6 cases on the left side (33%); in 11 cases with a 5F catheter (61%), in 7 cases with a 2.5F catheter (39%). In group 1, no satisfactory occlusion was obtained; in group 2, 65% of the tubes were occluded with little histologic damage; and in group 3, 80% of the tubes were occluded, but significant inflammation and tissue necrosis were noted. The fallopian tubes were selectively catheterized over variable lengths: over 10 mm in 5 rabbits (28%), between 5 and 10 mm in 4 rabbits (22%), and between 1 and 5 mm in 9 rabbits (50%). Before injection of the occluding materials, all the catheterized tubes were patent. Mean volume of occluding material injected was 0.36 mL in group 1, 0.30 mL in group 2, and 0.83 mL in group 3. The ethanol injected reached the peritoneum in all 6 rabbits. The gel was injected an average length of 11 mm in the tube, while the emulsion opacified all the volume of the tubes with a peritoneal spill of emulsion in 3 of 6 cases. Reflux of occluding material into the uterus was noted in 1 of 6 rabbits in group 1, in 4 of 6 rabbits in group 2, in 3 of 6 rabbits in group 3. Selective salpingography proved a suitable method and allowed selective injection of occluding materials.

Fallopian tube recanalization by selective salpingography: an alternative to more invasive techniques?

Selective salpingography was used in a total of 64 patients, engaged in evaluation for infertility and in whom standard hysterograms showed no tubal passage of contrast medium. Fallopian tube catheterization was successful in 92% of the cases; a peritoneal spill of contrast medium was obtained in 74% of the cases by manual injection. Recanalization of an obstructed oviduct was successful in 61% of the cases. Thus, after the procedure, 82% of the patients had at least one patent tube. We conclude that selective tubal catheterization, and recanalization when needed, should be included in the therapeutic procedures for tubal infertility, prior to in-vitro fertilization or tubal microsurgery.