[Fractures of the orbit floor. Advances in radiologic imagery].
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Biomedical subjects
Publications and source records attributed to F Veillon.
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The authors present a typical case of a traumatic internal carotid aneurysm rupture appearing 40 years after a blunt head trauma and surgically treated with success. The etiopathogenic and clinical aspects are reviewed and the important place of the angiography in diagnostic and therapeutical strategy is discussed.
We report for the first time, to our knowledge, MRI features which could differentiate noninvasively pulmonary infarction from pneumonia. Three subjects with angiographically proven pulmonary infarction showed high T1 weighted MRI signals located in the embolic territory. Three patients with pneumonia and one patient with emboli, but without infarction, did not have these T1 weighted images.
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After a previous analysis of African depressions in studies based on the use of D.S.M. III as a preliminary tool, the authors are now seeking to understand more directly the different ways for depressed Ivorians to express the lowering of self-esteem, as well as the various meanings of agitation observed among them. An attempt of nosographic classification, closely linked with local reality, has been extracted from this material by the authors.
Based on 5 personal cases, the authors conducted a study of sphenoid mucocele, based notably on the results of CAT-scanning. This is the key step in diagnosis. Indeed, it makes it possible to determine the origin of the mass, and its growth, and lysis or even consolidation of bone walls. Magnetic resonance should supply valuable information on the inflammatory nature of the mass, its relationship with the pituitary and chiasma, as well as the images on a sagittal section. The studies conducted to date in general show a different presentation of the tumors in comparison with mucoceles. Because of the latent character of mucoceles they are often diagnosed at a late stage on signs of local involvement.
Orbital fractures should be evaluated by CT in frontal and transverse planes. The significance of blow-out floor and medial wall fractures is discussed. Limitation of inferior rectus muscle mobility is thought to be a result of edema, enophthalmos, fat prolapse or scar tissue formation, rather than muscle incarceration. The consequent therapeutic attitude implies a rigorous preoperative exploration by CT or for some orbital floor fractures by MR.
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Pinning of fractures of the clavicle is easily and safely done by introducing the pin through the medial fragment. The pointed tip is embedded into the cortex of the lateral fragment and the inner end of the pin is bent at a right angle to fix it to the bone. Insertion is made with image intensification to avoid vascular damage and to guide the passage of the pin through the medial fragment without danger. Of 25 fractures treated in this way, only two, treated at the beginning of the series, required open reduction. No other immobilisation was necessary. All the fractures united uneventfully.
CAT scan by thin slices offers the possibility of evaluation of the bone structures of the ear and their contents. The progressively increasing availability of the scanner should make access much more routine for study of the ear, with a concomitant reduction in tomographies, inadequate in a large number of circumstances. The 4 main indications are chronic otitis with cholesteatoma, trauma, acoustic neuromas and malformations. The respective performances of tomography and CAT scan in each of these situations are discussed and an investigation strategy is suggested.
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The correcting action of tropatepine hydrochloride upon the extrapyramidal effects induced by neuroleptics has been studied in 32 acute psychotic states. A satisfying result has been obtained with daily doses of 10 to 20 mg in 30 cases (excellent results: 20, good results: 10 patients). The action upon dyskinetic crises is particularly good and quickly obtained, avoiding a recourse to an i.m. corrector in 7 cases out of 8. The akineto-hypertonic syndrome has been efficiently corrected in 18 cases out of 23. The hyperkinetic manifestations (akathisia, tasikinesia) reacted favourably in 8 cases out of 11, dysarthria in 7 cases out of 11. The lessening of tremor was less satisfying (8 cases out of 15); same thing for the dryness of the mouth (7 cases out of 16) and disorder of visual accomodation (6 cases out of 12). The clinical tolerance was excellent. With the used doses, we found neither inconvenient atropinic effect, nor disorder of the vigilance, nor pharmacodependence. The one daily administration of a 10 mg tablet turned out to be sufficient in 19 cases. This possibility of only one administration a day appeared to us as a great advantage.
Trauma of the ossicular chain is a frequent complication of temporal bone injury. Skull trauma from blows to the temporal, parietal, or occipital region (with or without fracture of the temporal bone) is the main cause of ossicular injury; other modes of injury are rare. Ossicular injury usually occurs as a dislocation, of which there are five types: incudostapedial joint separation, incudomalleolar joint separation, dislocation of the incus, dislocation of the malleoincudal complex, and stapediovestibular dislocation. Fracture of the malleus, incus, or stapes is uncommon. High-resolution computed tomography is the method of choice for evaluation of ossicular trauma. Joint separation and fracture of the stapes are seen on axial images; coronal images may aid visualization. Both axial and coronal images are needed for evaluation of a dislocated malleus or incus. Fracture of the malleus or incus is detected with axial or coronal images; reformatted images may also be useful.
Three-dimensional CT scan imaging obtained by using helicoidal CT scan provides the basis for an endoscopic exam said to be virtual since no invasive procedure is actually performed. Compared to optical endoscopy this easily accessible exam offers additional information especially for the analysis of the infraglottic and tracheal areas, which are two anatomically rigid segments. This property facilitates their three-dimensional reconstruction. Our study encompassed 6 patients presenting with a stenosis of the laryngotracheal tract. In 5 of them it was possible to correlate optical and virtual endoscopic imaging. Coupling both exams significantly improved the diagnostic investigation and facilitated the management of the disease. However, the real contribution of virtual endoscopy to the exploration of tumoral conditions still remains to be determined given the low degree of tissue resolution. As a consequence parietal and extraparietal lesional spreading is more accurately assessed by axial scan imaging.