[A review of bone scintigraphy in metastases from urological malignancies in adults]. / Le point sur la scintigraphie osseuse dans les cancers urologiques de l'adulte.

Bone scintigraphy still is a first line examination to assess bone extension from urological cancers. Technological progress of note has been the arrival of gamma cameras associated with computed tomography with fusion imaging which increases the scintigraphy performance. Nevertheless, bone scintigraphy indications have decreased particularly for the initial assessment of prostate cancer over many years.

Neuroimaging features of spontaneous intracranial hypotension.

We reviewed the cranial MRI and radionuclide cisternograms of four adults with postural headache indicating spontaneous intracranial hypotension (SIH). All four underwent clinical and radiological follow-up. MRI showed diffuse, thin meningeal enhancement; bilateral subdural fluid collections; and morphological abnormalities secondary to "sagging" of the brain. Radionuclide cisternography revealed direct or indirect signs of leakage of cerebrospinal fluid (CSF) along the spinal axis, and the symptoms resolved after the leak treated by epidural injection of blood at a level indicated by the cisternogram. The diffuse meningeal enhancement decreased but persisted on follow-up MRI, although the patients were asymptomatic. All morphologic abnormalities resolved during 3-5 months follow-up.

Radionuclide cisternography in spontaneous intracranial hypotension.

We report a case of spontaneous intracranial hypotension (SIH) that was investigated using cranial MRI and radionuclide cisternography. Radionuclide imaging was remarkable, showing direct signs of diffuse asymmetric leakage and indirect signs of cerebrospinal fluid (CSF) hypotension consisting of slow CSF circulation to the convexity and rapid appearance of urinary bladder activity. The MRI appearance was also suggestive of SIH, with diffuse meningeal enhancement. Treatment with autologous blood injection at the level of the radionuclide spinal leakage was useful, resulting in disappearance of SIH symptoms.

[Evaluation of the right ventricular function for lung transplantation. Value of the electron beam scanner]. / Evaluation de la fonction ventriculaire droite en vue d'une transplantation pulmonaire. Intérêt du scanner par faisceau d'électrons.

Several invasive or not invasive technics were used to evaluate right ventricular insufficiency associated to severe chronic pulmonary insufficiency. But none of them were very accurate and now the use of EBT appears as a real improvement. We performed a prospective study with 50 patients waiting for a lung transplantation and we compared the values of right ventricular function obtained by EBT to those obtained by nuclear medicine and catheterism. Accuracy of EBT for left ventricule evaluation has already been proved. Stroke volumes calculated by EBT in right and left ventricules are similar and this constitutes a good validation of the method for right ventricule evaluation. Correlations with hemodynamic measurements are poor and nuclear medicine technics underestimate the ejection fraction. So, EBT is recommended for right ventricular study before and after lung transplantation.

[Renal effects of captopril in hypertension with renal artery stenosis. Comparison between Tc-99m-DTPA scintigraphy and clearance method]. / Effets rénaux du captopril dans l'hypertension avec sténose d'artère rénale. Comparaison entre scintigraphie au Tc-99m-DTPA et méthode des clairances.

In eleven hypertensive patients with renal artery stenosis, the acute renal effects of captopril were investigated using two methods: 1) the Tc99m-DTPA renography with determination of an index of renal perfusion (IP), an index of glomerular filtration (IF) and the ratio of these indices (F/P); 2) the renal hemodynamics obtained by the clearance method using a continuous infusion of I131-hippuran and I125-iothalamate for calculation of renal blood flow (RBF), glomerular filtration rate (GFR) and filtration fraction (FF). The studies were performed before and after captopril treatment. Patients were classified according to the acute response to captopril as responders (R; n = 6) and non responders (NR; n = 5). Results are as follows: (B: basal, C = captopril). (table; see text) These data confirm that captopril produced a significant decrease in F/P and FF in R whereas these indices did not change in NR; it was found that IF and GFR decreased in R whereas IF increased and GFR did not change in NR; a significant correlation was observed between delta IF and delta GFR in R (r = 0.834, p less than 0.05). These results indicate that 1) data obtained before and after captopril by renography and by clearance methods are in good correlation either in Ror in NR patients; 2) Captopril test including renography or renal hemodynamic measurements is useful for selection of R patients.

[Multiple proximal coronaro-pulmonary fistulae. Review of the literature apropos of a new case]. / Fistules coronaro-pulmonaires proximales multiples. Revue de la littérature à propos d'un nouveau cas.

The authors report a new case of multiple proximal coronaro-pulmonary fistula between right coronary arteries, anterior interventricular artery and the trunk of the pulmonary artery, in a 64 year-old female patient with chest pain and a continuous murmur located in the third left intercostal space. The coronary steal is demonstrated by a myocardial scintigraphy during stress with return to normal after surgical ligation. A review of the literature enabled to find 33 cases of this major congenital anomaly of the coronary arteries, defined as an abnormal communication between at least two main coronary vessels and the trunk of the pulmonary artery. This results in a left-right shunt, usually minor without any repercussions on the right cavities and pulmonary pressures. The entire clinical, electrocardiographic, radiological, sonographic, scintigraphic, haemodynamic and angiographic picture is reported for these 33 cases. A physiopathological discussion is proposed. The course of this disease is usually favorable (only one case of myocardial infarction was published, without cardiac failure. Osler's endocarditis or sudden death); this seems to authorize simple monitoring as a logical therapeutic approach except when a myocardial ischemia secondary to coronary steal is demonstrated, imposing a surgical correction.

[Alveolar microlithiasis. Non-invasive diagnosis using alveolar lavage and technetium scintigraphy]. / Micro-lithiase alvéolaire. Diagnostic non invasif par lavage alvéolaire et scintigraphie au technetium.

A new case report of alveolar micro-lithiasis shows the diagnostic interest of two non invasive explorations to affirm a radiologic suspicion. Technetium showed calcium in the lung. The broncho-alveolar lavage, realised with a big quantity of fluid, removed the microliths. These two technics together avoid pulmonary biopsy.

[Noninvasive diagnosis of alveolar microlithiasis by Tc99m-MDP scintigraphy and alveolar lavage]. / Diagnostic non invasif de la microlithiase alvéolaire par la scintigraphie aux Tc99m-MDP et le lavage alvéolaire.

In a new case of alveolar microlithiasis we report the diagnostic value of two non-invasive examinations. In agreement with the histo-chemical date, scintigraphy with technetium shows an abnormal pulmonary fixation as evidence of the presence of intra-pulmonary calcium. The demonstration of micro-lithiasis in the alveolar lavage liquid, which requires a particular technique, confirms the diagnosis and avoids an open lung biopsy.

[Contribution of data processing to hospital archives. Cardiological experience]. / Apport de l'informatique aux archives hospitalières. Expérience cardiologique.

Access to essential information characterising the clinical condition of a patient and the course of that condition is an advance which physicians have long expected from data Processing to meet a certain number of needs: follow up of the patient, organisation of medical secretariat, file selection, help to clinical thought, etc. This typically documentary activity raises a problem of data representation classically solved by the use of clinical information classified beforehand: questionnaires or nomenclatures. This article reports on the use of a truly medical language: REMEDE, a the end of one year's operation in a cardiac department; the automatic processing of 173 coronary angiographies shows the interest, efficiency and flexibility of such a system of automated hospital archives.

[Computer treatment of medical reports: example of the "Remède" system (author's transl)]. / Traitement par ordinateur des comptes rendus médicaux: l'exemple du système "Remède".

Physicians are mostly interested in medical text processing if they can directly interrogate the exact content of each text and not only keys leading to a more or less rough retrieval. Remede is a prototype of a medical documentary language using current medical terms and few syntactic rules. It allows to make reports directly processeable by computers. The paper presents the system runninr for one year in the Service of Cardiology-La Salpêtrière Hospital Paris.