[Retro- and parapharyngeal abscess in children: predictive factors of medical treatment failure]. / Abcès rétro- et parapharyngés de l'enfant: facteurs prédictifs d'échec du traitement médical.

OBJECTIVE: To consider the predictive factors of failure after medical treatment (intravenous antibiotics) first initiated in children with retro- and parapharyngeal abscess, without life-threatening complications. PATIENTS AND METHODS: Retrospective study between 1998 and 2006 of 45 children treated at the Nantes University Hospital for a retro- and parapharyngeal abscess. RESULTS: Median age was 3.8 years. Thirty (66%) patients required surgical management. Significant predictive factors of failure of initial medical therapy were: patients under 3 years of age, symptoms more than 3 days before intravenous antibiotic therapy, leukocyte count higher than 22,000 per millimeter cube, hypodensity diameter greater than 20mm, and abscess demonstrated on CT scan. Previous antibiotic therapy at home was not significantly related to medical treatment failure. Broad-spectrum antibiotic therapy associations did not improve medical outcome. CONCLUSION: The predictive factors of failure after initial medical therapy for retro- and/or parapharyngeal abscess in children are underlined; these factors help determine the clinical approach.

[Vertebrovertebral arteriovenous fistula diagnosis and treatment: report of 8 cases and review of the literature]. / Diagnostic et traitement des fistules vertébrovertébrales. Revue de la littérature: à propos de 8 observations.

Vertebrovertebral Arteriovenous Fistula (V.V.A.V.F.) is a relatively rare entity. It may be an incidental finding or be detected in patients presenting with pulsatile tinnitus, cervical bruit, or vertebro-basilar insufficiency. It can be spontaneous but it most frequently is post-traumatic in etiology. The authors report 8 patients, 4 women and 4 men aged between 20 to 77 years, with 4 post-traumatic V.V.A.V.F. and 4 spontaneous V.V.A.V.F. that were seen over a 15 year period. Imaging work-up included Doppler US (n=4), MRI 9n=3) and angiography (n=8). Seven of 8 patients were treated successfully using an endovascular technique (5 with balloon occlusion, 1 with coil embolization and 1 using a mechanical maneuver), without complication or recurrence, except in one case. We compare our results with published reports from the literature and review the underlying pathology and management strategies of V.V.A.V.F.

[MR-angiography of the head and neck vessels: technical considerations and clinical indications]. / ARM des vaisseaux cervico-encéphaliques: technique, principales applications cliniques.

Magnetic resonance angiography (MRA) is a very valuable tool in the routine evaluation of patients with stroke syndrome. It provides powerful noninvasive imaging of the cervical and intracranial vessels allowing the detection and the diagnosis of vascular anomalies. MRA usefully supplements, during the same examination, the analysis by MRI of the cerebral parenchyma. We will describe the indications of the various techniques (MRA with and without injection of contrast media) and show the value, artifacts and limitations of MRA in atherosclerotic stenosis or occlusive disease and in arterial dissections. This noninvasive vascular assessment will depend on the initial therapeutic orientation. Within the framework of the hemorrhagic stroke, we will discuss the role and the interest of dynamic MR angiography in the tracking and control of intracranial aneurysms and also the contribution of this newer sequences with gadolinium injection in the detection of cerebral vascular malformations.

[Emergency imaging of cerebrovascular accidents]. / Imagerie des accidents vasculaires cerebraux en urgence.

Over the last 25 years, advances in neuroimaging have significantly changed the evaluation and management of acute stroke syndromes. In the seventies, computed tomography (CT) could differentiate between ischemic and hemorrhagic stroke. Magnetic resonance imaging (MRI) is nowadays the imaging modality of choice in the initial assessment of acute stroke. MRI images can better discriminate acute, subacute and chronic infarcts, differentiate venous from arterial infarcts, detect arterial dissection, stenosis or occlusion. Diffusion-weighted images are highly sensitive and specific to acute infarction and the combination with perfusion technique is suitable to define potentially reversible ischemia (area of cerebral "mismatch" which is thought to represent the so-called ischemic penumbra). This penumbra is a potential therapeutic target of valuable interest for the treating physician.

[Bisegmentectomy 7-8: importance of preoperative diagnosis of a right inferior hepatic vein]. / Bisegmentectomie 7-8: intérêt du repérage pré-opératoire d'une veine hépatique inférieure droite (VHID).

The extent of hepatic resection is often determined by the hepatic veins and their relation to the tumor. A need to transect the right hepatic vein at its entry into the vena cava indicates a need to remove the entire right posterior segment. About six cases, the aim of the study was to remind that under certain circumstances the posteroinferior area may be preserved. The circumstances which allow such preservation are the presence of a stout inferior right hepatic vein and the ability to recognize the presence of the vein in the preoperative staging. In patients with possible impaired hepatic function (cirrhosis, chemotherapy), preservation of hepatic parenchyma is an important consideration during resection for hepatic tumors.

[Meckel's diverticulum Diagnosed by CT-Enteroclysis]. / Diagnostic d'un diverticule de Meckel hémorragique par entéroscanner.

The authors report the case of a 24 year old woman presenting with acute lower GI hemorrhage caused by a Meckel's diverticulum. Diagnosis was made by CT-enteroclysis and confirmed at surgery. This new imaging technique will be briefly described and compared to the other more traditional small bowel imaging techniques. The authors will then present the CT-enteroclysis imaging features of this congenital anomaly.

¿Influye la población inmigrante en el Índice de Natalidad en Navarra? Datos preliminares del Hospital Virgen del Camino. Periodo agosto-diciembre 2000 / Does the immigrant population influence the birth rate in Navarra? Preliminary data of the "Virgen del Camino" Hospital. Period from August to December 2000

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