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Biomedical subjects

J L Dietemann

Publications and source records attributed to J L Dietemann.

At least 19 recordsLinked to original sources
PubMed1992

[Imaging in sciatica].

Sciatica being a benign disease its outcome is usually favourable, and paraclinical examinations should hold a modest role in its exploration, notably in the first painful episode. In reality, for multiple social, occupational and economic reasons imaging often intervenes at a very early stage of the condition. The role of standard radiography is to exclude non-discal diseases, and it should not need to be repeated in young adults. Computed tomography should be used only after a well-conducted treatment of six to eight weeks duration to demonstrate the responsible discal herniation and its morphological features in order to guide the therapeutic approach. Radiculography should no longer be performed as a first-line examination, but in about one out of ten cases it may be interesting to confirm an uncertain nerve root compression and, above all, to visualize in a standing up patient a container-contained maladjustment such as, for example, a vertebral canal stenosis. Magnetic resonance imaging, a rational, accurate and non-invasive method, unfortunately cannot be used as first-line examination due to its reduced accessibility in France.

Adult↗
PubMed1992

Neurofibromatosis with dural ectasia and bilateral symmetrical pedicular clefts: report of two cases.

We present two cases of bilateral, symmetrical pedicular clefts associated with dural ectasia in von Recklinghausen's disease (neurofibromatosis). In one case the pedicular cleft was at the T12 level, while in the other it was at L4, and was responsible for spondylolisthesis. Two hypotheses are advanced to explain the cleft: (1) a congenital, dysplastic osseous defect and (2) bilateral stress fractures related to thinning of the pedicle caused by dural ectasia.

Adult↗
PubMed1992

Contribution of MRI in supracardiac total anomalous pulmonary venous drainage.

A case of supracardiac total anomalous pulmonary venous drainage (TAPVD) in an infant aged 2 1/2 months is presented. Diagnosis was established non invasively by magnetic resonance image (MRI). Not only did MRI precisely depict the anomalous venous pathway but it moreover securely excluded pulmonary venous obstruction.

Echocardiography, Doppler↗
PubMed1992

CT, myelography and CT-myelography in the evaluation of common cervicobrachial neuralgia.

The CT technique used to explore intervertebral discs and foramina is described, as are the CT signs of nucleus pulposus (NP) herniation and cervical degenerative lesions. CT with intravenous contrast injection is the most efficient and easiest method to diagnose a radicular compression of discal or degenerative origin. The advent of high-resolution contrast CT will probably make obsolete the use of contrast media. CT measures the width of the vertebral canal, but it does not evaluate the repercussions on the spinal cord of compression caused by NP herniation or osteophytosis: only CT-myelography or, better, MRI can make this evaluation. Conventional CT scans are sometimes inadequate when exploration is hampered by superimposition of the shoulders (C6-C7 and more often C7-T1), when the scanner is of poor quality or when it is misused. Myelography and CT-myelography can then be utilized to resolve the problem posed by C7 or C8 cervicobrachial neuralgia (CBN). CT makes it possible to exclude most of the causes of non-discal CBN in the extradural spaces (e.g. bone tumour, neurinoma, vertebral vascular malformation, paravertebral expansive process, apical lung tumour). The search for an intradural cause (extra- or intramedullary tumour) rests on myelography, CT-myelography and MRI.

Adult↗
PubMed1992

CT and MRI of suprasellar lesions.

The authors report their experience of CT and MRI imaging in the study of suprasellar pathologies. The problems concerning the differential diagnosis between meningioma developed in the suprasellar region and pituitary tumour with suprasellar extension are discussed and illustrated; the demonstration of bone abnormalities (blistering, hyperostosis) is particularly useful for the diagnosis of presellar meningioma. The CT and MRI features of craniopharyngioma are compared; CT, of course, is more reliable than MRI in detecting calcifications; with both methods it may be difficult to visualize the cystic components. Glioma of the chiasma is readily diagnosed by MRI, provided the tumour is not too large. Non-thrombosed suprasellar aneurysms have typical features at CT and MRI. Cystic lesions are easily identified by MRI. The CT and MRI images of inflammatory lesions are not very typical.

Brain Diseases↗
PubMed1991

Thoracic intradural arachnoid cyst: possible pitfalls with myelo-CT and MR.

A thoracic intradural arachnoid cyst presenting as an intradural extramedullary mass highly suggestive of psammoma on myelogram and myelo-CT is reported in a 34-year-old female. High densities of the cyst were related to collection of contrast media within the cyst. However MR examination of the thoracic spinal cord including sagittal T1 (without and with contrast) and T2 studies failed to demonstrate the mass. Lack of MR changes were related on one hand to the small size of the cyst and to the absence of mass effect on the spinal cord, and on the other hand to a CSF-like signal of the contents of the cyst. Only combination of myelography, myelo-CT and MR allows precise diagnosis of small intradural arachnoid cyst; however MR is the method of choice for evaluation of large intradural subarachnoid cysts.

Adult↗
PubMed1991

Evaluation of Blalock-Taussig shunts in newborns: value of oblique MRI planes.

Eight infants with systemic-pulmonary Blalock-Taussig shunts were evaluated by spin-echo ECG-gated MRI. Contrary to Echocardiography, MRI using coronal oblique projections successfully visualized all palliative shunts entirely in one single plane (including one carried out on a right aberrant subclavian artery). MRI allowed assessment of size, course and patency of the shunt, including pulmonary and subclavian insertion. The proximal portion of the pulmonary and subclavian arteries were also visualized. We conclude that MRI with axial scans completed by coronal oblique planes is a promising, non invasive method for imaging the anatomical features of Blalock-Taussig shunts.

Blood Vessel Prosthesis↗
PubMed1991

[Mannosidosis type II].

Four out of 7 siblings born of non-consanguineous parents have presented psychomotor retardation, macrocephaly and facial dysmorphism associated in 2 of them with thoraco-lumbar kyphosis and in one of them with recurrent pulmonary infections which had resulted in death. Chromatography of oligosaccharides displayed a characteristic mannosidosis profile. In addition, D-mannosidase activity was very low in leucocytes and fibroblasts. The father and mother showed no clinical abnormality and had no pathological urinary oligosaccharide excretion, but their leucocyte and fibroblast D-mannosidase activity was reduced. These cases give the authors an opportunity to describe the clinical and biochemical features of mannosidosis, which in its type II enables the patients to survive into adulthood, and to underline the value of D-mannosidase assays to detect subjects with this anomaly.

Adult↗
PubMed1991

[Cerebellar cavernous angioma, cervical dystonia and crossed cortical diaschisis].

On four occasions since 1978, this 53 year-old woman presented with a right hemicorporal hypotonia, symptomatic of a hemispheric cerebellar syndrome. In 1981, she experienced the progressive development of a cervical dystonia. CT scan and RM scan showed a cavernous angioma in the right cerebellar hemisphere. The 18F-2-fluoro-2-deoxy-glucose PET scan revealed a right cerebellar and a contralateral cortical and striatal hypometabolism. This crossed cerebello-cortical diaschisis can be interpreted as a functional interruption of the cerebello-cerebral pathways. This case raises the question of the role played by a cerebellar lesion in the development of a focal dystonia.

Cerebellar Neoplasms↗
PubMed1990

MR findings in mannosidosis.

MR findings are reported in three patients presenting mannosidosis. Among a family of 8 children, 4 presented typical clinical and biological abnormalities related to mannosidosis. Brain MR examinations including sagittal T1 and axial T2 sections were obtained in three patients of this family (one 25-year-old male, one 34-year-old female, and one 35-year-old female). MR scans demonstrate seven types of modifications: (1) brachycephaly, (2) thick calvaria, (3) verticalization of the chiasmatic sulcus, (4) poor pneumatization of the sphenoid body, (5) partial empty sella turcica (6) cerebellar atrophy, and (7) white matter signal modifications. High signal abnormalities involving the parieto-occipital white matter are identified on axial T2-weighted scans in the three patients and are probably related to demyelination and associated gliosis as described previously by several authors on specimens.

Adult↗
PubMed1990

Adrenoleukodystrophy. Value of contrast-enhanced MR imaging.

In its early stage adrenoleukodystrophy (ALD) is characterized by hypodensity at CT and signal abnormalities at RMI (low-intensity signal on T1-weighted sequences, high-intensity signal on T2-weighted sequences) in the white matter of the parieto-occipital region and the splenium of the corpus callosum. These CT and RMI abnormalities are suggestive of ALD in children with progressive alteration of the superior brain functions, but they are not specific of the disease. The authors present two cases of ALD and underline the almost pathognomonic value of contrast-enhanced ribbons found at the periphery of low-intensity signal plaques after gadolinium injection. These areas of blood-barrier disruption on a background of inflammation and active demyelination appear, on T2-weighted sequences, as ribbons of low-intensity signal within plaques of high-intensity signal. MRI is also superior to CT in detecting abnormalities located in the posterior fossa, notably lesions of the auditory fibres.

Adrenoleukodystrophy↗
PubMed1990

[Magnetic resonance imaging after a one-month interval of lesions of multiple sclerosis in 2 populations, one during an acute attack treated with methylprednisolone, the other stable with no treatment].

Changes in clinical symptoms and MRI lesions of multiple sclerosis (MS) were evaluated on two occasions, one month apart, in 30 patients. Seventeen patients (group 1) with acute exacerbation were treated with methylprednisolone in high, then decreasing doses during a total of 30 days. MRI examinations were performed before and at the end of treatment. The remaining 13 patients (group 2) had been clinically stable for more than 6 months and received no treatment; here again, MRI was performed at 30 days' interval. All patients in group 1 showed functional improvement. The MRI lesions remained stable in 7 of group 1 patients and in 4 of group 2 patients. In the remaining 19 patients (10 in group 1 and 9 in group 2), the number, size and location of MRI lesions were found to have changed over 1 month. There was no correlation between clinical changes and the modification observed at MRI. This study confirms that high-dose corticosteroids are effective, at least clinically, in acute exacerbations, but the main results are that MS is a continually evolving disease, that changes rapidly occur in the lesions observed at MRI and that corticosteroids do not seem to influence the course of MRI lesions. Our study also suggests that MRI is inadequate to evaluate the effectiveness of short-time treatments of MS.

Follow-Up Studies↗
PubMed1990

[Contribution of MRI to the topography of oculomotor disorders in multiple sclerosis].

Magnetic resonance imaging (MRI) was performed in 20 patients with multiple sclerosis and abnormal electro-oculographic examination. All but 2 patients showed MRI abnormalities in the infratentorial region: hypersignal on T2-weighted sequences and/or images of atrophy. Usually, each patient had multiple abnormalities, which could prevent anatomico-oculographic correlations. With oculomotor disorders of cerebellar origin, correlations between clinical findings and MRI images were satisfactory, but with disorders due to brainstem lesions correlations were not so good, as shown by the results in 9 patients with internuclear ophthalmoplegia.

Adult↗
PubMed1989

Computed tomography of lumbar apophyseal joint lipoma: report of three cases.

The authors report three cases of lumbar apophyseal joint lipoma located at the L4/L5 or L5/S1 level. CT scan makes the diagnosis easily possible; indeed erosive changes with enlargement of the upper portion of the lumbar articular joint and anterior displacement of the top of the superior facet are associated with intra-articular fatty densities. Clinical symptoms are rarely encountered and may be related to narrowing of the upper portion of the intervertebral foramen.

Adult↗
PubMed1989

Hypothalamic-pituitary region: computed tomography imaging.

High resolution CT with dynamic scanning, demonstrating the pituitary tuft, the pituitary enhancement and the related vascular structures, is of major benefit for the diagnosis of pituitary lesions. Perfection of examination techniques is essential for accurate application of the modality to detect subtle diagnostic signs. A good knowledge of normal anatomy and variants of the sella turcica and pituitary gland permits one to avoid most of the misdiagnoses. Since the CT findings are often non-specific to tissues, clinical endocrinological correlation is essential. The technique also allows consistent assessment of the extent of the disease to permit better treatment planning and effective follow-up of patients after therapy.

Cavernous Sinus↗