Biomedical subjects
Publications and source records attributed to J C Bousquet.
A case of entrapment neuropathy of the inferior branch of the suprascapular nerve in the spinoglenoid notch is described. Ultrasonography and MRI examination showed a ganglion cyst in the spinoglenoid notch with an extension to the glenohumeral joint. The lesion was confirmed by surgical and pathological examination.
Primary systemic amyloidosis is a rare cause of vertebralcollapse. We describe a patient who presented multiplecollapsed vertebrae. Magnetic resonance imaging (MRI) demonstrated a diffuse bone marrow abnormality. A diffuse low signal throughout the vertebral bodies on T1 and T2 weighted spin-echo images were observed. A bone biopsy confirmed the suspected diagnosis of vertebral involvementby amyloid. MR imaging can be of interest to evaluate the bone spreading of a known amyloidosis and to help in the diagnosis of amyloidosis in the case of non traumatical vertebral fractures.
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The inventors of computed tomography were rewarded by the Nobel Prize for Medicine in 1979. This apparatus, now used routinely, is based on the physical principle of attenuation of x-rays combined with computerised calculation to generate a tomographic image of the human body. This article describes the components of computed tomography, the mode of acquisition, calculation and image reconstruction and the criteria of image quality and artefacts. Continuous rotation of the x-ray tube, now available on the latest machines, allows rapid 3D acquisition of raw data, largely eliminating movement artefacts, particularly those related to respiration. It is also possible to reconstitute images in a different plane from the plane of acquisition and to obtain 3D representations of the volume studied. The advantages and disadvantages of this recent technique are discussed.
OBJECTIVES: The aim of this study was to evaluate the prevalence and the clinical signification of non organ specific autoantibodies in chronic hepatitis C. METHODS: We studied retrospectively 158 consecutive patients (97 with chronic hepatitis C, 24 with chronic hepatitis B, 67 with alcoholic cirrhosis) and 100 blood-donors. RESULTS: The prevalence of anti-nuclear and anti-smooth muscle antibodies was lower in blood donors than in patients (P < 0.001), but was comparable among the 3 groups of patients. The anti-liver-kidney microsome type 1 antibodies were detected only in patients with chronic hepatitis C (6%). The serum gammaglobulin level was significantly higher in patients with hepatitis C and anti-nuclear antibody titers > or = 1/50. The anti-smooth muscle antibodies detected in patients with hepatitis C had no anti-actin specificity. The response to interferon was not related to the detection of non organ specific autoantibodies before treatment. CONCLUSION: Anti-nuclear or anti-smooth muscle antibodies are not characteristic of hepatitis C virus infection.
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Among all noninvasive techniques, high-resolution ultrasonography used alone has rarely been used for the diagnosis of thrombosis in the calf. Nineteen patients with suspected AVT were examined with ultrasonography and phlebography during 4 months. For each patient, a sonogram and a phlebogram were taken within less than 24 hours and interpreted independently. The sonographic exploration with a high-resolution (5 MHz) transducer covers all deep trunks and muscular veins (soleus or gastrocnemius muscles). The positivity criterion is the persistence of a hypoechogenic endoluminal image under moderate compression. According to the phlebographic data, 65% of the patients present with thrombosis. Ultrasonography has a sensitivity of 95% and a specificity of 99% for the study of the deep trunks. Ultrasonography screens more thromboses than phlebography (23 cases versus 17). On a whole, ultrasonography seems to be more sensitive than phlebography for the diagnosis of recent sural thrombosis.
Thirty-nine patients with liver tumors were examined using MRI at 0.5 T before and after intravenous bolus injection of either 0.1 mmol/kg (n = 18) or 0.2 mmol/kg (n = 21) of Gadolinium-Dota, using spin-echo T1-and T2-weighted sequences before injections and spin-echo or gradient-echo sequences after injection. When contrast-to-noise (C/N) data were normalized relative to time, optimal mean C/N was observed after gadolinium injection. However, subjective study and case-by-case C/N measurement showed better contrast for SE 2000/60 and CT with injection in 62% and 42% of cases, respectively.
Fotemustine is a new nitrosourea which has shown some efficacy on disseminated malignant melanoma (DMM) (24.2% response rate (RR) among 153 patients in a Phase II trial) but little activity on hepatic metastasis (8.8% RR). In order to improve those poor results, hepatic intra-arterial infusion (HIAI) of fotemustine was performed. After two years, thirteen patients, all in good general condition, were evaluable. Seven were pretreated and six had extrahepatic metastasis on entry into the study. All patients had a surgically implanted intra-arterial catheter. The induction cycle consisted of 100 mg/m2/week for 3-4 weeks, followed by 5 weeks rest and maintenance therapy of 100 mg/m2 every 3 weeks for stabilized or responding patients. Two complete responses (CR) (72+ and 145+ weeks) and six partial responses (PR) (7-18.5 weeks) were observed. The hepatic RR reached 61.5%. A RR of 42.8% was registered on preexisting EHM (one CR and one PR on cerebral lesions). Nevertheless, this treatment is limited by the high progression rate of 46.1% in extrahepatic disease. Toxicity was mainly hematologic (grade III-IV), comprising 36% neutropenia and 15% thrombopenia. Hepatic intra-arterial infusion of fotemustine is efficient therapy for liver metastases of DMM, but combination schedules (IV + HIA) are warranted.
Thirty four patients with advanced renal insufficiency and after kidney transplantation have been prospectively studied using pulsed wave doppler. The doppler flows were evaluated using an index of resistance. The index of resistance varies proportionally with the peripheral resistances. This study showed in 14 patients without symptoms a mean index of resistance equal to 0.71 +/- 0.087. During acute rejection, the mean index of resistance increases to 0.91 +/- 0.12 (p less than 0.01). Seven patients with acute tubular necrosis and an index of resistance equal to 1 (p less than 0.01). There is no increase of the indices of resistance in patients with cytomegalovirus infection or with overdosed cyclosporin treatment. The pulsed wave doppler has a very good sensitivity to diagnose the acute rejection (90%) and acute tubular necrosis (100%) but cannot differentiate them. However, the repetition of systematic examinations allows the early diagnosis of acute rejection and the follow-up of the vascularization of anuric kidneys related to tubulopathy.
The magnetic resonance (MR) features of an adult nephroblastoma are presented. The MR appearance is correlated with ultrasound (US), computed tomographic (CT) and pathology. The tumor appeared heterogeneous with calcifications and areas of necrosis and hemorrhage. MR correctly staged the tumor.
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A case of Askin tumor has been diagnosed by thin needle punction, in a sixty seven years old man who had a prostatic cancer with bone metastasis. The TDM aspect is described and compared to the aspects already related in literature.
This prospective study was conducted in 34 consecutive renal transplant patients. Pulsed doppler was used to evaluate the peripheral resistance (PR) in the transplant vessels. Under normal conditions, the PR of the graft is low, resulting in a continuous diastolic blood flow. The intensity of this blood flow was evaluated by means of a resistance index (RI), Pourcelot's index, calculated as follows: RI = systolic peak - end-diastolic peak/systolic peak This study demonstrated values for RI of 0.71 +/- 0.087 in 14 totally asymptomatic patients. In 10 cases of acute rejection, the RI increased to 0.91 +/- 0.12. The 7 patients with acute tubular necrosis had an RI equal to 1. In patients with cytomegalovirus infection of suffering from cyclosporin overdose, the RI was not modified in relation to asymptomatic subjects. This study demonstrates the existence of a rise in the PR in cases of acute rejection and acute tubular necrosis with a sensitivity of 90% and 100% respectively for these two diagnoses. However, this method cannot be used to distinguish between acute rejection and acute tubular necrosis.
This observation illustrates how difficult it is to interpret the intravascular signal observed with MRI in cases of portal hypertension. A signal occupying the entire lumen of the portal trunk and branches can be seen, which is constantly observed in the axial as well as coronal planes in the 3 series studied. It is hypointense relative to the liver on T1-weighted images, hyperintense on T2-weighted images: this appearance therefore perfectly mimicks portal thrombosis. Ultrasound combined with pulsed Doppler demonstrates the stagnant blood within the patent portal system. This kind of artifact, which is produced by a very slow flow or even by the standstill of flow, is much more difficult to recognize than the common flow artifacts; the criteria put forward by various authors to distinguish between artifacts and thrombosis are of no avail in this case. Examinations must able to confirm or rule out portal thrombosis in the case of portal hypertension with deceleration of flow. In practice, ultrasound studies, combined with pulsed Doppler in the best cases, is therefore indicated as a first-intension technique.
The authors report a case of synovial cyst developed about the serous bursae of the psoas iliaca muscle. It occurred in a 82 years old woman with a severe degenerative arthritis after hip dysplasia. The cyst has been revealed by a compression syndrome of the iliaca vein. Diagnosis has been made by CT. Physiopathology, clinics, diagnosis and treatment of this rare affection complete this case.
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This observation illustrates the use of CT in the diagnosis of rectosigmoid hemangiomas and the assessment of their extension. The CT appearance of hemangiomas is very specific and therefore allows confirming a diagnosis that is often difficult to make with other radiological techniques and with endoscopy: phleboliths within the thickened rectal wall are a characteristic sign. CT is primarily required when radical surgery is contemplated due to disabling repeated proctorrhagia: it provides a better delineation of trans- and extraparietal hemangioma extension, knowing that adhesion (...).