Biomedical subjects
Publications and source records attributed to H Dahan.
Renal angiomyolipomas are renal hamartomas. They are usually found incidentally, presenting as well-defined echogenic masses on sonography and fat containing tumors on CT and MRI. We report a case of angiomyolipoma with sonographic and CT evidence of extension to the renal vein and inferior vena cava.
Fatty tumors of the uterus are rare. Most reported cases have been of the mixed type, consisting of smooth muscle and mature adipose tissue. We present the first case of a pure lipoma with pathologic correlation in which a preoperative diagnosis was made by magnetic resonance imaging.
This study had several purposes: to define cytomorphological features of thyroid cells that might be modified by alcohol fixation; to optimize May-Grünwald-Giemsa (MGG) staining on ThinPrep(R) (TP; Cytyc Inc., Bexborough, MA, USA) slides and to compare the diagnostic accuracy of slides prepared by a liquid-based method with those obtained by conventional technique. This study included 120 cases of ultrasound-guided fine needle aspiration (FNA) of the thyroid and 55 FNAs performed on surgically resected thyroid specimens. Histological control was available in 80 cases. In the first group of 120 FNAs, a split-sample technique was used for the TP. Three screenings were performed: first, an individual screening of the conventional smears (CS) and of the TP, a second screening to compare cells observed on the TP with the histological control and a third screening to assess the previously defined diagnostic criteria. Twenty-seven TP cases (22%) were considered unsatisfactory for diagnosis compared with 10 in CS (8%). The high rate of unsatisfactory cases with TP is likely to be due to the use of the split-sample technique. The sensitivity was 94% for CS and 81% for TP. The specificity was 67% and 60% for CS and TP, respectively. Two occult papillary carcinomas were missed by both methods. As for the MGG staining, the modified technique used for TP resulted in the same quality as the standard procedure. Conversely, TP did however induce uncommon morphological features. In this study, sensitivity and specificity levels are higher for CS than for TP; the difference may be explained by the fact that the methanol fixative used for TP induces some cytological alterations, especially in oncocytic tumours and lymphocytic thyroïditis.
Splenic injury following colonoscopy is rare and, to our knowledge, 18 cases only have been reported so far in the literature. The presumed mechanisms for splenic injury during colonoscopy are direct trauma to the spleen or excessive traction of the splenocolic ligament this latter mechanism being due to decreased mobility between the spleen and the colon secondary to adhesions. Splenomegaly or underlying splenic disease are two conditions which are considered to be predisposing factors to splenic injury. We report one case of splenic rupture which was due to colonoscopy in the absence of any underlying splenic disease. This case was diagnosed and monitored by computed tomography, thus avoiding unnecessary splenectomy.
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OBJECTIVE: To evaluate the results of combination of D-Dimer test and simple clinical model for the diagnosis of deep vein thrombosis (DVT). MATERIALS AND METHODS: Inclusion: clinical suspicion of DVT. Non inclusion criteria were Clinical model performed by the referring physician included probability varying from high to low. D-Dimer test was performed by five different rapid techniques. Standard of reference was Doppler ultrasonography (DU) performed by a senior radiologist. RESULTS: Eight hundred and fifty-four DU were performed on a 14 months time period, including 206 suspicion of pulmonary embolism, 109 postoperative time period, 120 non-included or excluded patients, 278 incomplete observations, 141 complete observations. DVT was present in 33 cases and absent in the other 108 cases (prevalence 23%). Sensitivity and negative predictive value of the five tests were between 82 and 97% and 90 et 97%. The most sensitive test had a specificity of 36% and a positive predictive value of 32%. Combination of clinical model and D-Dimer test did not improve the diagnostic accuracy. CONCLUSION: None of the test evaluated in the present study, even when combined with the clinical model results, did allow the exclusion of DVT.
The purpose of this study was to report 30 cases of missed lung cancers and describe characteristics of each case. Reasons for misdiagnosis were analyzed from the report. Each radiograph was subsequently reviewed by a panel of two experts who quantified several parameters regarding image analysis and film quality. Lesions were not described in 67% of the cases and were misinterpreted as benign processes in 33% of cases. Comparison to previous chest radiographs and clinical information were seldom available on the report. Size of the lesions varied between 1 and 7 cm, location was primarily apical and paramediastinal, normal anatomy was highly or moderately complex in 87%, and distracting lesions were present in 63% of the cases. Image quality was considered perfect in 3 cases only. Among all the factors responsible for missed lung cancer, certain factors can be improved as film quality, comparison with previous radiographs, and better awareness of clinical information.
Filter placement within the inferior vena cava is performed to prevent pulmonary embolism in patients with contraindications or failure of anticoagulant therapy. Several complications of vena cava filters have been described. However, mechanical complications related to IVC filters may not be of any clinical significance. The purpose of this pictorial essay is to present the imaging features of complications related to inferior vena cava filter placement.
PURPOSE: To describe the imaging features of primary carcinoid tumors of the pancreas. Materials and Methods. The sonographic and computed tomographic examinations of six patients with pathologically proven primary carcinoid tumor of the pancreas were retrospectively reviewed. RESULTS: In all cases, sonography showed hypoechoic and well circumscribed tumors. CT scan demonstrated hypoattenuating tumors on noncontrast images, with variable enhancement on postcontrast images. Small tumors (less than 2cm in diameter) were homogeneous whereas larger tumors were heterogeneous with areas of cystic necrosis. In two cases, enlarged lymph nodes were found in association with ascitis. In one case, hepatic metastases were present. CONCLUSION: Primary carcinoid tumors of the pancreas display various and non specific imaging features. Small tumors are likely to be homogeneous and hypervascular whereas larger tumors are heterogeneous and hypovascular.
OBJECTIVE: The purpose of the present study was to determine the publication rate in Medline-indexed journals of papers originally presented at the Journées Françaises de Radiologie (JFR96). MATERIALS AND METHODS: Proceedings from the JFR 96 were reviewed by two observers in conference. A Medline search encompassing 1997-1999 was performed for the lead author of all abstracts of original papers. Publication year and the journal of publication were recorded. RESULTS: 456 oral presentations were analysed, 39 papers were subsequently published corresponding to a publication rate of 8.5%. 10 papers were published in Radiology, 4 in European Radiology and 4 in the Journal de Radiologie, the other 21 in other journals. Publication rate was significantly higher for two sessions: Research session (publication rate was 22%) and Bone and Joint session (publication rate was 16%). CONCLUSION: Less than 10% of abstracts presented at JFR 96 were subsequently published in Medline-indexed journals. This rate is lower than the publication rate of papers presented at other medical meetings.
We report a case of adenosarcoma arising in hepatic endometriosis. Both CT and MR scans demonstrated a huge heterogeneous mass containing septated, thick-walled cystic lesions. After enlarged right hepatectomy, the patient was asymptomatic with no abnormalities at liver and abdominal CT scan at 2-year follow-up.
PURPOSE: To prospectively evaluate the effectiveness and safety of selective embolization of the uterine arteries in the management of symptomatic uterine leiomyoma. MATERIALS AND METHODS: Eighty consecutive women (mean age, 44.7 years) with symptomatic uterine leiomyoma, none of whom desired future pregnancy, underwent superselective embolization of the uterine arteries with polyvinyl alcohol particles. In all women, arterial embolization was performed because of persistent, fibroid-related menorrhagia after failure of hormonal therapy. Follow-up consisted of office visits at 2, 6, 12, and 24 months and of ultrasonography at 2 and 6 months after the procedure. RESULTS: Bilateral embolization of the uterine arteries was performed in 76 women; unilateral embolization, in four women. Menorrhagia disappeared in 72 (90%) women. In five (6%) women (including three women with unilateral embolization), clinical improvement was not observed, and myomectomy was needed. In one woman with a large submucosal uterine leiomyoma, hysterectomy was needed because of septic uterine necrosis. Normal menstruation resumed in all but six women. Full-term pregnancy occurred in three women after the procedure. CONCLUSION: Superselective arterial embolization of the uterine arteries is an effective means of controlling symptomatic uterine leiomyoma. However, the ideal embolic regimen remains to be determined.
PURPOSE: To develop and evaluate a scale for assessment of the methodological quality for clinical investigations of radiologic studies. MATERIALS AND METHODS: A scale was developed that included methodological standards compiled from established sources for assessing the methodological quality of study designs in clinical research and characteristics related to biases commonly observed in clinical radiologic research. The scale was composed of 15 standards and was tested with the results of 96 studies on imaging of liver hemangioma. Interrater reliability was measured between two observers by using percentage agreement and kappa statistics. Interrater reliability between two observers for a composite quality index that encompassed the 15 standards was measured with the intraclass correlation coefficient. RESULTS: Agreement between the two observers was almost perfect (kappa value, 0.8-1.0) for 11 standards and substantial (kappa value, 0.74-0.78) for four standards. Agreement between the observers with regard to the composite quality index also was high (intraclass correlation coefficient r, 0.91 [95% CI: 0.87, 0.94]). CONCLUSION: The scale appears to be reliable for the assessment of methodological quality of clinical investigations of radiologic studies.
In 197 patients, uterine embolization with a single femoral approach and a single 5-F cobra catheter was successful in 362 of 394 (92%) uterine arteries. In six patients (12 arteries), distal embolization with a coaxial 3-F microcatheter was safer. In 10 patients with a life-threatening condition, embolization was performed at the anterior division of both internal iliac arteries. Bilateral selective embolization of the uterine arteries can be performed with a single catheter.
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OBJECTIVES: To evaluate the efficacy and safety of uterine embolization in the management of intractable post-partum hemorrhage. MATERIALS AND METHODS: From July 1994 to December 1997, 51 patients with severe primary (n = 37) or secondary (n = 14) post-partum hemorrhage were treated by arterial uterine embolization. In all cases, hemostatic uterine embolization was performed because of persistent hemorrhage despite adapted obstetrical measures and early introduction of uterotonic drugs. RESULTS: In case of immediate post-partum hemorrhage, primary and secondary success rates were 89% et 97% respectively. In one patient with placenta accreta, delayed hysterectomy was necessary. One patient died of associated cerebral hemorrhage while vaginal bleeding had stopped. The success rate reached 100% in case of secondary post-partum hemorrhage. CONCLUSION: Emergency arterial embolization is a safe and effective means of controlling severe post-partum hemorrhage after failure with medical treatment.
PURPOSE: To prospectively evaluate the efficacy and safety of emergency selective arterial embolization in the management of intractable primary postpartum hemorrhage. MATERIALS AND METHODS: Twenty-seven consecutively seen women with life-threatening primary postpartum hemorrhage underwent uterine embolization. In all cases, hemostatic embolization was performed because of intractable hemorrhage that could not be controlled with vaginal packing and administration of uterotonic drugs. The mean hemoglobin level before embolization was 7.48 g/dL +/- 2.39 (74.8 g/L +/- 23.9) (1 standard deviation). Hysterectomy performed in two patients before embolization failed to stop the bleeding. RESULTS: Angiography revealed extravasation in nine patients and spasm of the branches of the internal iliac artery in five. The procedure consisted of embolization of uterine (n = 46), vaginal (n = 5), or ovarian (n = 2) arteries or anterior division of internal iliac arteries (n = 8). Immediate disappearance or dramatic diminution of external bleeding was observed in all cases. Two patients needed repeated embolization the next day. No major complication related to embolization was found. In one patient with placenta accreta, delayed hysterectomy was necessary. Normal menstruation resumed in all women except the two who underwent hysterectomy. One woman became pregnant after embolization. CONCLUSION: Emergency arterial embolization is a safe and effective means of control of primary postpartum hemorrhage. The procedure obviates high-risk surgery and allows maintenance of reproductive ability.