[Virtual colonoscopy with computerized tomography].
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Biomedical subjects
Publications and source records attributed to G Schmutz.
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Facial nerve intraparotid neuromas are rare. We report two cases with no facial paralysis. In the first case, the clinical protocol for the evaluation of a parotid mass did not suggest the intramastoid tumor extension. This extension was shown by CT and MRI and confirmed by gross and microscopic appearance. In the second case, no intrapretrous extension was observed with MRI. The diagnosis of neuroma was made during surgery. With a literature review, we discuss the diagnostic difficulties encountered in the investigation of parotid facial nerve tumors, emphasizing on the usefulness of CT and MRI in its diagnosis.
An increase in bone mineral content (BMC) as well as a decrease in the incidence of fracture of the proximal femur have been described in patients on thiazide diuretic treatment. A study was undertaken to assess, by means of dual X-ray absorptiometry, the effect of chronic low-dosage antihypertensive treatment with hydrochlorothiazide (HCT; < or = 25 mg daily) on lumbar vertebrae (representing the axial skeleton) and the nondominant radius (peripheral skeleton). Measurements were made on 27 women (mean age 63.8 +/- 8.2 years) and 23 men (65.9 +/- 9.5 years) and compared with a control group of 19 women (62 +/- 8.7 years) and 20 men (65.9 +/- 9.5 years) with minor surgical or dermatological lesions who had never taken HCT or other drugs with potential effects on mineral bone metabolism. In men who had been on HCT for more than 5 years, BMC of the lumbar vertebrae was higher by 10.3% and of the radius by 3.8% than among the controls (differences not significant). In women who had been on HCT for more than 5 years, the corresponding increases were 19.6% (P < 0.05) and 5.4% (not significant). Among those patients who had been on HCT for less than 5 years there were no significant differences compared with the control group. There were no significant differences between the groups relating as regards the proximal radius which, in contrast to the ultradistal radius, consists predominantly of cortical bone. -These data indicate that, while HCT has only a slight influence on BMC, it can be considered to have a desirable associated effect in the antihypertensive treatment of elderly patients.
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In this study, based on 600 cases of lumbar disc herniation treated by chemonucleolysis, the authors underline the importance of performing good discography and interpreting its results. A discographic classification of intervertebral disc deterioration is suggested. A CT-discographic study is reported and its results are compared with those of standard discography. On the basis of these studies, the authors have established methodological data concerning the efficacy of chemonucleolysis and its evaluation.
In the past few years, several studies have assessed the visualization of digestive diseases by ultrasound, but its clinical accuracy has been rarely defined. Thus we evaluated the contribution of sonographic examination as an initial diagnostic mean in the detection of colonic lesion. During a period of thirty six months (June 85-June 88) when we performed a standard sonographic abdominal examination, we utilized ultrasound to look for thickening or other modifications of the large bowel wall, if the clinical findings suggested a colonic disease. In these conditions we performed 453 US examinations. In our study, 363 cases were considered to be negative and the controls demonstrated colonic wall lesions in 24 cases. Thus the sensitivity was one of 77%. The sonographic examination was positive in 90 cases with 6 false positives. Thus our specificity reached 98.2% and the accuracy achieved was 93.3%. Thus sonographic examination appears to be a rapid, non invasive, mobile, mean of examining the abdominal cavity and also the large bowel in all patients. If this examination is negative, a colonic disease is possible since sensitivity is 77%. On the other hand, if the examination is positive, a colonic disease is very probable, since specificity reached 98.2%. The accuracy of US Colonic examination is 93.3% and with using abdominal plain film, theses percentages may be improved.
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We retrospectively analyzed the small bowel radiographies, performed by enteroclysis in 73 patients presenting a malabsorption disease. The etiology are: celiac disease (44 cases), abetalipoprotidemia (2 cases), Whipple's disease (7 cases), mastocytosis (1 case), amyloidosis (1 case), ischemia enteritis (4 cases), radiation injury (4 cases), lymphangiectasia (4 cases), Crohn's disease (4 cases) and NH lymphoma (2 cases). With enteroclysis, the radiological diagnosis of malabsorption disease is improved and it is able to differentiate malabsorption diseases based on radiological features: increased or decreased number of folds (celiac disease, mastocytosis, abetalipoprotidemia), nodularity of folds (Whipple's disease) and wall thickness (amyloidosis, lymphangiectasia, ischemic enteritis and radiation injury). It is no possible to differentiate NH lymphoma from Crohn's disease.
The authors report 83 cases of acute hepatitis secondary to non steroid anti-inflammatory drugs (NSAID), published in the literature. The NSAID in question are: niflumic acid, tolfenamic acid, diclofenac, fenoprofen, ibuprofen, indomethacin, naproxen, piroxicam, pirprofen and sulindac. Six deaths are directly ascribed to NSAID: although rare, these forms of hepatitis deserve therefore to be reported. They are usually mixed immuno-allergic forms of hepatitis (cytolytic as well as cholestatic). They often affect elderly women taking multiple medications. Monitoring of the liver function tests is necessary, during prolonged treatment with NSAID, especially during the first six months.
The authors report two cases of primary malignant melanoma. These primary neoplasms are exceptional on the GI tract. The diagnostical problems are discussed. The radiological features are a nodular lesion like an under-mucosa tumor.
Enteroclysis were practiced for 43 patients with radiation induced injuries of the small bowel. The radiological data revealed mucosal lesions in 23 cases, submucosa lesions in 21 cases, parietal thickening in 20 cases, mesenteric involvement in 32 cases. Narrowings and stenosis were present in 24 cases and dilated loops in 15 cases. Fistula formation existed in two cases. Twenty four patients were operated and the diagnosis of radiation enteritis was confirmed. In 12 cases, the enteroclysis succeed to a per os technique. The authors showed the superiority of the enteroclysis.
The authors report a new case of splenic artery congenital aneurysm. With regards to the surgical procedure, they insist on the necessity of a massive resection and remind a particular surgical procedure which allows to restore the colonic continuity with fittest conditions.
During 11 years, 14 cases of tuberculosis of the colon are radiographied. The clinical findings are not specific and the association with evolutive pulmonary tuberculosis is infrequent (28%). The radiological features are described: ulcerations (4 cases), ulcerations and hypertrophic features (3 cases) and hypertrophic features (7 cases). The involving sites are caecum and ileocecum in 6 cases, ascending colon in 3 cases, transverse colon in 2 cases, descending colon in 2 cases and recto-sigmoid in 2 cases. The differential diagnosis are segmental Crohn colitis and colonic carcinoma. Endoscopic examination with biopsy is a help to the diagnosis, but in 5 cases, it will be deficient. The diagnosis of colonic tuberculosis is setting only by surgical resections in 6 cases (43%) and 4 patients have been treated by medical treatment with success. No relapse appears in operated patients.
Cystic mediastinal lymphangiomas are rare benign uncommon slow-growing tumors. Seven cases of cystic mediastinal lymphangioma in adults are presented. In both cases a mediastinal opacity is evident on plain chest radiographs. Roentgen findings are not specific. The mass is noted to be non-pulsatile, and well circumscribed smooth-surfaced. There are no evidence of invasion to the neighboring structures and no calcification are seen within the lesions. In two patients, sonography examination confirmed the cystic nature of the mass. Four patients underwent computed tomography (CT) scan. Ct can offer considerable additional information: CT will show well circumscribed and uniform low density lesions without invasive characteristics. Attenuation values in CT scan cannot be considered conclusive for diagnosis in all cases, on the non contrast scan, attenuation varied between -49 to +27 UH, there was no contrast enhancement.
During seven years, 212 small bowel examinations are made on patients with suspected small bowel obstruction by barium infusion. We find all the main small bowel pathology: Crohn's disease (16.5%), carcinomatosis (14.6%), neoplasia (10.3%), vascular disease (17.8%), actinic enteritis (9.5%) and miscellanous (18%). The small bowel infusion is normal in 15%. Surgery is avoided in 51% of the cases. There is non complications associated with the examination but in 12% of the cases, the examination is unsuccessful.
The cases of two sisters with abetalipoproteinemia are reported. Both presented the complete clinical and biological features of the disease: ataxia, retinitis pigmentosa, lack of apolipoprotein B, chylomicrons, LDL and VLDL, reduced titers of serum cholesterol and triglycerides, acanthocytosis, very low levels of serum vitamin A and E. Abetalipoproteinemia is a rare autosomal inherited disease. It is usually revealed during early childhood by steatorrhea and failure to thrive; ataxia and retinitis pigmentosa appear later. The originality of these two cases stems from: 1) their late and fortuitous diagnosis: the first sister was investigated at the age of 42 after the discovery of a vitamin K induced coagulation disorder. The other sister was 39 when she was routinely examined as a family member; 2) the presence of constipation without any other suggestive digestive complaint. However, white discoloration of the duodenal mucosa seen at endoscopy and lipid droplets within the intestinal absorptive cells at biopsy were characteristic. Barium studies showed diffuse involvement of the small bowel which was displaced by an enlarged sigmoid. Treatment consists of administration of vitamin A and vitamin E which prevent or delay ocular and neurologic symptoms. Vitamin K is associated whenever necessary.
Thirty two patients with confirmed Crohn's disease were examined from october 1983 to may 1985 by ultrasound (42 examinations) and by Conventional Contrast Radiology (Barium Contrast Studies). The well-know "target" pattern is the most frequent feature (88%) which is characteristic of the thickening bowel wall. The thickening is more important for the small bowel wall than the large bowel wall. But the "target" pattern is not the single pattern of inflammation involving the bowel. We also find a "rosette" pattern. This third ring is hypo or hyperechogenic or more complex. Other infrequent features are noted: solid abdominal masses, distended loops, luminal narrowing, fistula and stiffness. Because sonography is noninvasive and simple to perform without radiation exposure, it must often be used as the initial diagnostic tool and as the follow-up test for young people.