Biomedical subjects
Publications and source records attributed to E de Kerviler.
Arthroscopic knee surgery is a widely performed and relatively safe technique with few complications. We report a case of a young girl with a previously undescribed complication of arthroscopy consisting of the association of deep venous thrombosis and concomitant pseudoaneurysm of the popliteal artery.
We report a case of variceal changes of the azygos vein, hemiazygos vein, and paraesophageal collaterals presenting as bilateral posterior mediastinal masses in a patient with long-standing portal hypertension due to hepatosplenic schistosomiasis. The case is unusual because the varices were considerably larger than those usually encountered in portal hypertension. Dynamic CT allowed the diagnosis in demonstrating the vascular nature of these masses, which enhanced to the same degree as the other vessels. Noninvasive techniques, such as color Doppler sonography and MRI, may also be useful due to their multiplanar capabilities.
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A patient treated with fluoxetin for a manic depressive disorder developed pulmonary inflammatory nodules with noncaseating giant cell granulomas, interstitial pneumonia and non-necrotizing vasculitis, whilst remaining asymptomatic. A progressive resolution of pulmonary nodules occurred after withdrawal of the offending agent, and the chest radiograph returned to normal in 9 months. The diagnosis was assessed by an open lung biopsy.
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AIM: The aim of this study was to evaluate the ability of MRI to detect recurrent differentiated thyroid carcinomas developed in the neck or the upper mediastinum. RESULTS: MRI was performed in 25 patients, and was compared in 5 cases with surgery. In 20 cases it was compared with I-131 scintigraphy (100 mCi in 14 cases and 5 mCi in 6 cases). The sensibility, specificity and overall accuracy of MRI was respectively: 100%, 66.6%, 82.6%. COMMENTARY: MRI is a good technique to detect recurrent thyroid carcinomas. It is specially interesting to investigate patients with a biological suspicion of recurrence and a negative scintigraphy. Mediastinal localisations that cannot be detected by US can be detected by MRI.
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In McArdle's disease (myophosphorylase deficiency) exercise intolerance is generally attributed to a lack of glycogenolysis, which decreases energy production during exercise. Magnetic resonance imaging data have recently suggested an impairment of the increase in muscle perfusion during exercise in these patients. We have tested this hypothesis by direct measurement of local muscle perfusion increase. Increase in muscle perfusion was assessed by positron emission tomography with oxygen-15 labelled water in five patients with McArdle's disease and five age- and sex-matched healthy volunteers. Radioactivity was measured in both forearms before and after exercise of the right forearm. The exercise intensity was biochemically assessed by in vivo phosphorus-31 magnetic resonance spectroscopy. The estimated increase in muscle perfusion with exercise was 5.7+/-5.5-fold in the patients (range 1.5-12.8) and 22.3+/-12.0-fold in the healthy subjects (range 10.1-37) (P=0.022). The results show a significant impairment of increase in muscle perfusion with exercise in McArdle's disease. Thus patients may suffer not only from a direct lack of glycogenolysis but also from indirectly impaired vasodilation.
The aim of the study was to determine the role of pre-operative magnetic resonance imaging (MRI), with and without contrast enhancement, in patients with penile carcinoma. Nine patients with a penile cancer were studied. The staging of the tumours was performed by clinical examination, MRI and surgery, according to the TNM classification. Six patients had primary tumours, of clinical stage T1 (n = 1) and T2 (n = 5). Three other patients had been previously treated and presented with a local recurrence of clinical stage T2. Surface-coil MRI was performed at 0.5 T with T1 weighted sequences before and after gadolinium-DOTA, and T2 weighted sequences. MRI results were compared with the clinical and surgical findings. T1 weighted sequences did not clearly demonstrate the margins of the tumours. T2 weighted sequences were the more useful in five patients, whereas contrast enhanced T1 weighted sequences allowed better delineation of the lesions in only three patients. Therefore, an imaging protocol should include spin echo T2 weighted sequences. Clinical examination correctly staged six of nine tumours; MRI, seven of nine tumours and the combination of both examinations, eight of nine tumours. MRI provided good evaluation of tumoral invasion into the penile shaft.
In patients with the Zollinger-Ellison syndrome, which is either sporadic or integrated into multiple endocrine neoplasia type 1, accurate localization of all the tumours is difficult and may have therapeutic implications. In an attempt to improve this localization, somatostatin receptor scintigraphy using [111In-DTPA-D-Phe1]-octreotide was performed prospectively in 48 consecutive patients with the Zollinger-Ellison syndrome. Thirty of them had the sporadic type of this disease. Scintigraphic data were compared with data obtained by conventional imaging methods, and also, in 32 selected patients, with those obtained by endoscopic ultrasonography. Somatostatin receptor scintigraphy showed abnormal tracer uptake in 39 patients (81%), in whom it correctly identified 50 of the 60 tumoral sites (83%) previously localized by the other imaging methods. In 17 patients (35%) somatostatin receptor scintigraphy disclosed abnormal tracer uptake at 18 different tumoral sites: 14 were located in the abdomen, including four in the liver and eight in the duodenopancreatic area, and four outside the abdomen, including two in the mediastinum. Six of the ten tumoral sites which were not correctly identified by somatostatin receptor scintigraphy were located in the duodenopancreatic area. However, in the 20 patients for whom conventional techniques failed to visualize any tumour in the duodenopancreatic area, somatostatin receptor scintigraphy was positive in ten (50%) whereas endoscopic ultrasonography was only positive in five (25%). In our patients with the Zollinger-Ellison syndrome, somatostatin receptor scintigraphy appeared to be a useful new addition to the battery of tests used for tumour detection.
Two patients with eosinophilic endomyocardial disease related to peripheral T-cell lymphomas are reported. Both patients were free of cardiac symptoms at presentation and during follow-up. Routine two dimensional echocardiography revealed bi-apical ventricular obliteration, which was also seen on MR imaging. On the T1-weighted sequence, the thickened endocardium appeared with an isointense signal. Gadolinium DOTA provided an enhanced contrast of the internal part of the left ventricular wall. On T2-weighted sequence, a thin hypointense curvilinear structure drew a dividing line between the internal, endocardial, and the external, myocardial area. Left-ventricular systolic and diastolic functions remained unaltered during subsequent follow-up.
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Invasive aspergillosis is a life-threatening illness, whose diagnosis is difficult: clinical signs are indeed not specific, and biological and mycological exams are not always conclusive. Radiological exams are essential for the diagnosis of this disease allowing to start an early intensive appropriate therapy. According to the literature and to their own experience the authors report the main radiological patterns with emphasis on the pulmonary and cerebral affections.
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OBJECTIVE: Most metabolic myopathies (like glycogenoses and mitochondrial myopathies) are related to inborn errors of muscle energy metabolism and often present clinically as exercise intolerance (inability to sustain normal exercise). We investigated whether the previously observed absence of normal exercise-induced variation in the T2 of muscle in McArdle's disease (a metabolic myopathy caused by muscle phosphorylase deficiency) was specific for this disease and whether the variations in T2 could be used for screening patients suspected of having metabolic myopathy. SUBJECTS AND METHODS: Exercise-induced variations in proton MR signal and in intracellular pH were studied in the forearm flexor muscles of nine healthy subjects and 49 patients with exercise intolerance due to muscle pain, suggesting a metabolic myopathy. The relative increase in T2, delta T2/T2, was measured from MR spin-echo images before and after exercise. Phosphocreatine (used as a control of the degree of exercise) and intracellular pH were measured from phosphorus-31 spectra before and during exercise. The progressive 4.5-min handgrip exercise reached maximal exertion capability at the end of exercise and decreased phosphocreatine to less than 50% of its rest value. RESULTS: Variations in T2 and end-exercise pH were correlated. The nine healthy subjects showed a delta T2/T2 ranging from +19% to +44% (but little T1 variation). Ten patients with McArdle's disease showed only slight delta T2/T2 (0-10%). There was no overlap with values for healthy subjects, but there was some with values for other patients. Of the 21 subjects with a delta T2/T2 less than 19%, 19 had a metabolic myopathy. The other two had a congenital neuromuscular disorder (one central core disease, one nemaline myopathy) with type I fiber predominance (type I muscle fibers are characterized by a high oxidative metabolism and a low lactic acid production). CONCLUSION: The altered increase in T2 was sensitive but not specific for McArdle's disease. However, as variations in T2 reflect variations in pH, they seem to be specific for myopathies in which there is little exercise-induced decrease in pH (some metabolic myopathies and congenital neuromuscular disorders with type I fiber predominance) among patients in whom exercise intolerance is the main symptom. Our results suggest that MR imaging might be useful as a screening test for these diseases.