Successful laparoscopic management of a hepatic abscess caused by a fish bone.

BACKGROUND: Hepatic abscess is a rare condition but comes with heavy consequences if not diagnosed and managed properly. Early detection of this pathology is challenging because of the variety and lack of specificity of symptoms but is necessary for accurate management. CASE REPORT: We report a case of pyogenic liver abscess secondary to the migration of an ingested fish bone in a 74-year-old female. We used laparoscopic surgery to drain the abscess, remove the foreign body responsible and look for the perforation site. Parenteral antibiotherapy was added to the surgical treatment. CONCLUSION: Early diagnosis of hepatic abscess caused by the migration of a foreign body remains a challenge. In our opinion, laparoscopic surgery associated with antibiotics is the safest and most effective therapeutic option.

[Glioma in a patient with multiple sclerosis]. / Gliome chez une patiente atteinte de sclérose en plaques.

The simultaneous occurrence of multiple sclerosis and a primary brain neoplasm is exceptional: only 32 cases have been reported in the literature. We report the case of a 30-year-old woman with multiple sclerosis proven for 10 years who developed a grade II astrocytoma revealed by MRI. At the pathology examination, there was no cellular continuity with areas of demyelinized white matter. Unlike the hypothesis put forward in certain publications describing this association that argue for an induction link between these two entities, our case did not demonstrate any spatial or temporal relationship suggestive a common cause.

Malignant peritoneal mesothelioma.

A case of malignant peritoneal mesothelioma is described. The diagnosis was established by immunohistological studies after CT-guided percutaneous puncture of a small intraabdominal nodule. The clinical and radiological signs were non-specific. Survival period was short because of the absence of curative treatment.

The density, contour, and thickness of the pancreas in diabetics: CT findings in 57 patients.

Insulin has a trophic effect on pancreatic acinar tissue, so the pancreas might be expected to atrophy in persons who have diabetes. Accordingly, we analyzed the density, contour (smooth or lobulated), and thickness of the pancreas on CT scans of diabetic patients and compared the results with those in control subjects. The prevalence of pancreatic lobulation (incisurae deeper than 2 mm) and its correlation with age in diabetic and control subjects were determined. The thickness of the pancreas was measured at three levels (head, body, tail). Three groups of diabetic patients were examined: 20 insulin-dependent patients, 25 patients not treated with nor dependent on insulin, and 12 patients treated with but not dependent on insulin. A control group included 57 nondiabetic patients. The ages of the control subjects were similar to those of the diabetic patients. The statistical significance of the differences between groups of diabetic patients and control subjects was estimated by using Student's t test for the values of density and thickness and the chi 2-test for the prevalence of pancreatic lobulation. The density of the pancreas in diabetic patients and control subjects was not statistically different. Diabetic patients had increased lobulation of the pancreas. All parts of the pancreas tended to be smaller in diabetic patients, but the degree of reduction varied. It was modest in the patients not treated with insulin, pronounced in insulin-dependent patients, and intermediate in non-insulin-dependent, insulin-treated patients. Moreover, the size of the body was significantly reduced in all three groups, whereas the size of the pancreatic head was preserved in patients not treated with insulin. In conclusion, CT of the pancreas shows that although density in diabetic patients is normal, lobulation is increased. Reduction in size involves the body of the pancreas more than other parts of the gland and is more pronounced in insulin-treated diabetic patients. CT of the pancreas might be useful to predict which diabetic patients will require insulin therapy.

[Imaging evaluation of an alobar holoprosencephaly with cyclopia]. / Bilan radiologique d'une holoprosencéphalie alobaire avec cyclopie.

A case of an alobar holoprosencephaly with cyclopia diagnosed by prenatal ultrasound is reported. At 23 weeks of gestation, abortion was performed. The holoprosencephalic aborted foetus was studied as completely as possible. Skull X-rays, cranial computed tomography, and magnetic resonance images are discussed and compared with the necropsy findings.

Contributory aspects of MRI in the evaluation of basal encephaloceles.

Basal encephaloceles are rare pathologies which belong to the now well-defined complex called median cleft face syndrome. This entity includes median craniofacial dysraphism associated to a varying degree with optic tract pathology, dysfunctioning of the hypothalamus-hypophysis axis, agenesis of the corpus callosum and basal encephalocele. The latter is that virtually constant element for which surgery is frequently requested. Owing to the large number of surgical failures (especially in the transsphenoidal type) medical imaging for the evaluation of malformative damages must be very accurate. Until recently, the techniques available, such as standard radiography, conventional tomography, gas encephalography, carotid arteriography and computerized tomography with or without metrizamide cisternography, were either too invasive or too inaccurate. MRI is the technique which provides the best images of prolapsed meninges, brain regions or ventricles, as well as of the anatomical rapport between the hypophysis, the optic tract and the limbic system.