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Biomedical subjects

C Vallée

Publications and source records attributed to C Vallée.

At least 19 recordsLinked to original sources
PubMed2001

Zenker's diverticulum associated with multilevel cervical osteomyelitis.

STUDY DESIGN: A case report of cervical osteomyelitis possibly associated with a Zenker's diverticulum perforation. OBJECTIVES: To present clinical, radiologic, and surgical findings of a cervical osteomyelitis due to a Zenker's diverticulum perforation. SUMMARY OF BACKGROUND DATA: A 56-year-old patient was in an intensive care unit for a severe head injury. He was fed via a nasogastric tube. Four months later he developed a pyogenic cervical vertebral infection. METHODS: Plain films and magnetic resonance imaging showed a diffuse cervical osteomyelitis. Investigation of his dysphagia revealed a Zenker's diverticulum. RESULTS: After administration of antibiotics and surgical treatment of the diverticulum, the cervical infection resolved. Plain films and magnetic resonance imaging showed healing with vertebral fusion. CONCLUSIONS: Cervical osteomyelitis is uncommon. Only one case of direct contamination leading to cervical vertebral osteomyelitis after esophageal perforation has been previously described. Direct contamination of the prevertebral soft tissues by bacteria traveling through the fistula may have occurred. The development of vertebral osteomyelitis in this case is consistent with the hypothesis of direct contamination. Management relies on appropriate antimicrobial therapy and surgical management of the diverticulum. The association of Zenker's diverticulum with vertebral osteomyelitis and discitis is a unique, previously undescribed situation.

Anti-Infective Agents↗
PubMed2001

Bartonella henselae infection mimicking a splenic lymphoma.

We report a Bartonella henselae infection in a 40-y-old patient who presented with fever, weight loss, night sweats, elevated lactate dehydrogenase and multinodular splenomegaly with multiple abdominal lymphadenopathies. Splenic cat-scratch disease is an exceptional diagnosis in adults and can easily be mistaken for a splenic lymphoma, thereby leading to an unnecessary splenectomy.

Adult↗
PubMed2000

A longitudinal insufficiency fracture of the tibia in association with a healed chronic osteomyelitis.

Longitudinal stress fracture of the tibia often present with an atypical clinical presentation which can be mistaken for osseous tumor or osteomyelitis. We present a case of longitudinal stress fracture of the tibia which occurred in a patient with healed chronic osteomyelitis of the tibia. Magnetic resonance imaging failed to make the correct diagnosis. Accurate diagnosis was only obtained by helical CT which showed the longitudinal fracture line. Magnetic resonance imaging showed only non-specific signs of bone marrow edema, suggesting recurrence of osteomyelitis. Magnetic resonance imaging can be misleading in the absence of direct visualization of the fracture line.

Adult↗
PubMed2000

[Imaging-guided needle puncture, infiltration and lavage of rotator cuff calcifications. Retrospective evaluation of 50 cases of treated periarthritis].

PURPOSE: To evaluate mid term efficiency of imaging-guided needle puncture trituration and lavage (RPTL) in rotator cuff calcifications after failure of medical treatment. Materials and Methods. Fifty shoulders with rotator cuff calcifications (supra and infra-spinatus: 97%) from 42 patients, mean of 50.2 year old (M/F=10/32), were treated by RPTL. To establish a satisfaction score and potential undesirable effects, the follow-up was obtained by a telephone questionnaire after a median interval of 29.2 months. RESULTS: Eighty-eight percent of patients had excellent or very good results (cured: 62%, very improved: 26%). Four percent felt partially better and 8% failed but did not undergo surgery. No complication was noted. 41% suffered acute pain in the 24 hours following the procedure even though they were on nonsteroidal anti-inflammatory drug therapy (NSAID). CONCLUSION: These good results after more than two years support the promotion of this economical ambulatory treatment.

Adult↗
PubMed1999

Contribution of D-Dimer determination in the exclusion of deep venous thrombosis in spinal cord injury patients.

UNLABELLED: Deep vein thrombosis (DVT) is a common complication of paraplegia despite prophylactic anticoagulant therapy. The diagnosis relies primarily on ultrasonography or phlebography; these investigations are difficult, expensive and can be time-consuming in paraplegic patients. STUDY DESIGN: To evaluate the usefulness of coagulation activation markers in excluding a diagnosis of DVT, D-Dimers, thrombin-antithrombin complexes, prothrombin fragments (F1+2) and activated factor VIIa. OBJECTIVES: To improve the diagnosis of deep venous thrombosis in paraplegic patients. SETTING: This collaborative work was done at Raymond Poincaré Hospital, Garches, France. METHODS: To evaluate the usefulness of coagulation activation markers in excluding a diagnosis of DVT, D-Dimers (D-Di), thrombin-antithrombin (TAT) complexes, prothrombin fragments (F1+2) and activated factor VIIa (FVIIa), were determined in a prospective study of 67 consecutive patients with paraplegia or tetraplegia. Doppler ultrasonography and/or phlebography of the lower limbs and D-Di, TAT, F1+2 level determination were systematically done in each patient at admission to our rehabilitation unit. RESULTS: Despite prophylactic low molecular weight heparin therapy, six of the 67 patients developed DVT diagnosed by radiologic explorations. D-Di levels measured by a reference ELISA (Asserachrom D-Di, Diagnostica Stago) or a new rapid automated turbidimetric test (STA-Liatest D-Di) were greater than 500 ng/ml in all DVT patients and in 40 non-DVT patients, of whom most had urinary tract infections, osteomas, or pressure sores. D-Di values were normal in only 21/67 patients (31%). The negative predictive value of D-Di in our study was 100% since all DVT patients had D-Di values greater than 500 ng/ml. TAT and F1+2 levels were not correlated with D-Di levels but also had a negative predictive value of 100%. Comparison of D-Di levels obtained using the two tests showed that results of the reference ELISA were closely correlated to those of the new rapid automated turbidimetric. TAT, F1+2, and factor VIIa are not useful for measuring hypercoagulability in paraplegic or tetraplegic patients since no rapid tests for determining these parameters are available. CONCLUSION: D-Di levels determined using an ELISA or a new rapid automated turbidimetric test have a good negative predictive value for DVT in paraplegic or tetraplegic patients and may reduce the need for Doppler ultrasonography and/or phlebography by 31%.

Adolescent↗
PubMed1999

Time dependence of iopamidol and iodixanol in arthrography of the knee.

PURPOSE: The safety and diagnostic efficacy of iodixanol (Visipaque) 270 mg I/ml was compared to that of iopamidol (Iopamiron) 300 mg I/ml in knee arthrography. MATERIAL AND METHODS: This trial was a bi-center double-blind trial including 128 patients (iodixanol/iopamidol 64/64 patients). Efficacy was evaluated by blinded grading of the diagnostic quality of the p.a. images taken 0, 12 and 25 min after contrast administration by the examining radiologist and later at a consensus evaluation by two experienced skeletal radiologists. Adverse events were recorded. RESULTS: No patient experienced any adverse event. The proportion of better images at both 12 and 25 min after injection was higher in the iodixanol group compared to the iopamidol group both by the examining radiologist and at the consensus evaluation. CONCLUSION: In the knee joint iodixanol is a safe contrast medium. The contrast effect of iodixanol lasted longer than that of iopamidol, which can be important when performing arthrography, especially CT arthrography, where the time between puncture and examination can be prolonged.

Arthrography↗
PubMed1998

Congenital muscular dystrophy: use of brain MR imaging findings to predict merosin deficiency.

PURPOSE: To evaluate the brain magnetic resonance (MR) imaging findings in patients with the "classic" form of congenital muscular dystrophy (patients with normal intelligence) in relation to the absence of merosin, a recently identified molecular component in the basement membrane of muscle fiber. MATERIALS AND METHODS: Brain MR images in 15 patients (13 children, two adults) were reviewed and correlated with the patient's merosin status. Merosin was evaluated by means of immunocytochemical study of specimens from muscle biopsy. RESULTS: Nine patients had merosin deficiency. All patients had diffuse white matter alterations similar to those seen in cases of leukodystrophy. Periventricular and subcortical white matter were involved. The corpus callosum and internal capsule were spared. Follow-up MR images were available in two patients; changes were nonprogressive. White matter signal intensity was normal in the six patients with normal uniform labeling against merosin. Ventricular dilatation and cortical atrophy were observed in both groups. CONCLUSION: Diffuse white matter changes resembling those seen with leukodystrophy may be a valuable criterion for diagnosis of merosin deficiency in patients with classic congenital muscular dystrophy.

Adult↗
PubMed1997

Implementation of the Ottawa ankle rules in France. A multicenter randomized controlled trial.

OBJECTIVES: To assess the impact of the implementation of the Ottawa ankle rules on radiography requests in French hospitals during a 5-month intervention period and the impact of using posters alone to sustain the effect of the rules during a 5-month postintervention period. DESIGN: Multicenter randomized controlled trial preceded and followed by observational studies of radiological practices. SETTING: The emergency departments of 5 Paris university teaching hospitals of the Assistance Publique-Hôpitaux de Paris. PATIENTS: A total of 2218, 1911, and 851 patients-all aged 18 years and older-who were seen for acute ankle or midfoot injuries in emergency departments during preintervention, intervention, and postintervention periods, respectively. INTERVENTION: Implementation of the Ottawa ankle rules by emergency department physicians in the intervention hospitals (using meetings, posters, pocket cards, and data forms). During the postintervention period, posters alone were used to sustain the intervention effect. MAIN OUTCOME MEASURE: Percentage of patients for whom radiography was requested. RESULTS: During the preintervention period, 98% and 98.5% of patients were referred for radiography in the intervention and control groups, respectively. During the intervention period, the mean proportions of patients referred for radiography by physicians was 78.9% in the intervention group and 99% in the control group (P=.03). Between preintervention and intervention periods, a relative reduction of 22.4% (95% confidence interval [CI], 19.8%-24.9%) in radiography requests was observed in the intervention group, while requests increased by 0.5% (95% CI, 0%-1.4%) in the control group. During the postintervention period, the proportion of radiography requests in the intervention hospitals was lower than the proportion observed in the preintervention period (83.1% vs 98%). CONCLUSIONS: Implementation of the Ottawa ankle rules significantly reduced radiography requests in French hospitals. Using a minimal postintervention implementation strategy, the effect of this intervention decreased but persisted after it was discontinued.

Ankle Injuries↗
PubMed1995

C1-2 arthrography.

OBJECTIVE: To describe the technique of C1-2 arthrography and recommend it as a suitable treatment for pain due to C1-2 abnormalities. MATERIALS AND METHODS: One hundred patients with the following conditions were studied: cervical pain or neuralgia without radiographic changes (group 1, n = 23), osteoarthritis (group 2, n = 37), rheumatoid arthritis (group 3, n = 23), ankylosing spondylarthritis (group 4, n = 5) and diverse conditions (group 5, n = 12). The technique consists of lateral puncture of the posterior aspect of the C1-2 joint with a 20-gauge needle under fluoroscopic control, arthrography using 1 ml contrast medium, and a 1-ml long-acting steroid injection subsequently. RESULTS: The articular cavity has an anterior and a posterior recess. Sometimes the posterior recess is large. In 18% of cases the contralateral joint also opacifies. CONCLUSIONS: C1-2 arthrography appears to be an efficient and safe technique for the treatment of upper cervical pain due to C1-2 articular disorders.

Adolescent↗
PubMed1995

[CMV and VZV encephalitis in AIDS].

MATERIAL AND METHODS: Eighty patients were followed up prospectively. Histological correlation was obtained in 25 cases. All MRI examinations were performed on at 0.5 Tesla in T1-weighted sequences with and without gadolinium injection, and in axial or frontal T2-weighted spin echo sequences. Histological confirmation was obtained 30 days on average after the last MRI examination. Immunohistochemical stainings were performed in search of CMV, VZV, toxoplasma, HIV antigen and lymphoma. RESULTS: CMV meningoencephalitis was found in 6 cases. In 3 of these it was manifested by atrophy, either isolated or associated with high signal intensity punctiform areas. Histology detected cortical or subcortical microglial nodules. In 2 cases MRI displayed abnormalities of subependymal nodular signals without enhancement, associated with punctiform abnormalities of subcortical signals. Histology showed subependymal foci of necrosis and abnormalities of white matter. In one case, MRI showed a ventriculitis confirmed by histology. VZV meningoencephalitis was diagnosed in 2 cases. MRI displayed abnormal basal ganglia related to meningitis (n = 1). All abnormalities were confirmed at histology. CONCLUSION: Some images (ventriculitis, infarction in basal ganglia, abnormal subependymal signal) would suggest VZV and CMV encephalitis. Other images (abnormalities of punctiform signals or atrophy) are not specific.

AIDS-Related Opportunistic Infections↗
PubMed1995

[Imaging of osteosclerotic metastases].

Carcinomas of the prostate and breast are the most common sources of osteosclerotic metastases. The osteoblastic response is related to stromal bone formation and reactive bone formation. Purely osteosclerotic or mixed osteolytic-osteosclerotic lesions are encountered. Frequent differential diagnoses are enostoses and Paget's disease. The classical MRI pattern is a signal of low intensity on T1 and T2- weighted sequences, but some osteoblastic metastases have an inhomogenous signal. Evaluation of the response to treatment is difficult and requires confrontation with clinical and biological data.

Bone Neoplasms↗
PubMed1994

Longus colli has a postural function on cervical curvature.

To determine the postural role of longus colli (LC) and dorsal neck muscles, we have studied the relationship between their cross-sectional areas related to their force of contraction and the lordosis and the length of the cervical spine. This study was carried out in 36 healthy subjects. Muscle cross-sectional areas were measured by computerized tomography. The index of lordosis and the length of the cervical spine were measured on an X-ray profile. The cross-sectional area of LC was correlated to the lordosis index (R = -0.432, p < 0.02) whereas all the other parameters were not correlated. The authors conclude that LC counteracts the lordosis increment related to the weight of the head and to the contraction of the dorsal neck muscles. Postural functions of LC and postcervical muscles are complementary. They form a sleeve which encloses and stabilizes the cervical spine in all positions of the head.

Adult↗
PubMed1994

[MRI of the knee. Value of delayed sequences after intravenous injection of gadolinium].

A prospective study of delayed sequences after intravenous injection of gadolinium for knee MRI shows the similar results as from the literature: enhancement of synovial fluid after 30 minutes. Sixteen patients were studied mainly with gradient echo. This phenomenon improves the visualisation of the intraarticular structures like meniscus, cruciate ligaments, or cartilage. This study leads to use this technique in case of difficulties like postoperative intraarticular lesions.

Cartilage, Articular↗
PubMed1993

[Chemolysis of intravertebral disk hernia and spinal syndrome].

The authors report a 31 year old patient who underwent L5-S1 chemonucleolysis. The prenucleolysis discogram disclosed intravertebral discal displacement. Severe spinal symptoms and development of geodes in the endplates adjacent to the treated disk occurred after the procedure. This case suggests that intraosseous discal displacement may be a risk factor for postchymopapain nucleolysis discitis and may contraindicate chemonucleolysis.

Adult↗
PubMed1991

[Radiologic anatomy of the wrist].

Wrist imaging still relies first on plain X-Ray films, MRI allows excellent appreciation of the sculture of bones, ligaments, tendons and even nerves. C.T. is essentially useful in traumatology, while Wrist arthrography can be useful for detection of small ligament lesions.

Humans↗