Biomedical subjects
Publications and source records attributed to J Struyven.
Glans hyperemia after penile revascularization is a well known complication normally treated by surgery. However, this reintervention is often difficult due to local fibrosis. We report a case of successful embolization after supra-selective catheterization of the deep dorsal vein through the surgical anastomosis.
Corporeal veno-occlusive dysfunction is an important cause of organic impotence and is characterized by increased flow rates to create and to maintain erection during artificial erection produced by intracavernous saline infusion. Sixty-seven patients with this erectile insufficiency underwent penile ligature-resection of deep dorsal vein between 1982 and 1986, and were evaluated by nocturnal plethysmography, pharmacocavernometry as well as a questionnaire about their sexual life for long-term follow-up. The surgical procedure was controlled in the operating room by reduction of the erectile flow rates. Thirty-one patients were potent postoperatively and were able to have satisfactory intercourse. Results after resection were slightly better than after simple ligation of the deep dorsal vein. Four patients had penile glans insensibility resulting from the surgical dissection. There were 7 relapses several months after the procedure due to leakage through other deeper veins. Eight failures were due to additional psychogenic disorders or to neurologic disease not accurately diagnosed before the treatment because they all developed normal papaverine-induced erection after venous surgery while before it they only developed a slight tumescence. Reduction of the erectile flow rates within normal values was impossible during surgery in 3 patients. Eleven failures were due to concomitant arterial disease. Resection of the deep dorsal vein can restore penile erection in patients with cavernovenous leakage in about 50% of well-selected patients.
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The aims of the study were to determine the frequency of visualization of the normal transverse geniculate ligament (TGL) of the knee on lateral plain radiographs with magnetic resonance imaging (MRI) as a reference, and to determine features that make this ligament apparent on plain radiographs. 50 consecutive lateral plain radiographs and sagittal T1-weighted images of corresponding knees were evaluated prospectively. A TGL was considered visualized on plain radiographs when an opacity of soft-tissue density was apparent in the posterior part of the Hoffa's fat pad. The TGL was identified in 29 of the 50 (58%) sagittal MR images; a TGL was observed on the lateral plain radiographs of six patients (12%). Correlation with the MR images showed that, when visualized on plain radiographs, the ligament is at least 3 mm thick and completely surrounded by fat. Our study shows that the TGL is a normal variant that can be recognized frequently on lateral plain radiographs of the knee.
We retrospectively analyzed pre- and postoperative sonographic and medical records of 335 children who had surgical or endoscopic treatment at the ureterovesical junction, in order to determine normal and atypical sonographic appearances. Normal sonographic findings after ureteral reimplantation include thickening of the posterior bladder wall, pseudodiverticular sacculations, bladder asymmetry, and transitory hydroureteronephrosis. Short-term or persistent (lasting more than 1 month) hydroureteronephrosis, urinoma, hematoma, bladder lithiasis, and diverticula were abnormal findings, occurring in 17% of the patients. After partial ureteronephrectomies, visualization of the residual ureter on sonograms was not possible in cases without complications; in one patient, reflux of fluid dilated the residual ureter and made the ureter visible on sonograms. After endoscopic incisions, the masslike appearance of a collapsed ureterocele was observed. Submucosally injected Teflon always appeared as a curvilinear hyperechoic area with an acoustic shadow. Marked acute or persistent hydroureteronephrosis or ectopic intracavitary Teflon particles were observed in 2% of patients. Granuloma formation was considered likely in 5% of the patients when the area of injected Teflon material was longer than 12 mm on sonograms. Submucosally injected collagen appeared less echogenic than Teflon and showed no acoustic shadowing. The various normal sonographic appearances after treatment must be known in order to distinguish them from significant abnormalities. In patients with anatomic anomalies, such as short-term or persistent hydroureteronephrosis, urinoma, hematoma, and lithiasis, complementary uroradiologic examinations may be necessary to clarify the diagnosis.
Fourteen patients with prostatic carcinoma, benign prostatic hyperplasia, or chronic granulomatous prostatitis underwent gadolinium-DOTA enhanced magnetic resonance imaging of the prostate. Gadolinium-DOTA was administered intravenously in a dosage of 0.1 mmol/kg body weight. All studies were performed on a superconductive 1.5-T system. As compared to noncontrast T1- and T2-weighted images, Gd-DOTA enhanced T1-weighted images were useful in distinguishing malignant tumor from granulomatous prostatitis in one case, but were uncontributive to the differentiation between carcinoma and benign prostatic hyperplasia.
Because of its availability, ultrasound should be the preferred initial modality for the evaluation of palpable superficial masses. Most ultrasound units are equipped with high frequency probes that allow superficial focalization. The differential diagnosis of soft tissue masses and the sonographic features of some benign and malignant soft tissue lesions are reviewed in this article. After an initial ultrasound evaluation confirming the presence of a tumor, the need for and the role of other imaging modalities can be determined. In selected cases ultrasound may obviate the need for further imaging. MRI and CT should be reserved for cases in which sonography fails to establish a specific diagnosis or to demonstrate the limits of the soft tissue mass.
One case of renal cortical necrosis is reported. The results of ultrasound and angiographic imaging and the relevant literature are reviewed. The examinations, particularly selective angiography, are of great interest in the diagnostic and in the etiology of this disease.
The authors report the fortuitous demonstration of an asymptomatic gossypiboma during the preoperative staging of a rectal carcinoma 13 years after abdominal surgery for perforated gastric ulcer. Ultrasonography disclosed a well-defined hypoechoic mass containing highly echogenic foci with a strong posterior shadow. The CT findings are reported, as well as the complementary aspects of sonography. Differential diagnosis from tumors of the lesser omentum is also presented.
A premature baby boy presented at birth with respiratory distress. A right lower lobe opacity was found on chest X-ray. Pulmonary sequestration was the diagnosis suggested by ultrasound. The size of the mass decreased on subsequent examinations. 4 months later X-rays and sonography failed to demonstrate any remaining mass. This case illustrates another example of involutive pathology and suggests that not all pulmonary sequestration-like anomalies should be operated on.
Visualization of the transverse geniculate ligament of the knee in four patients is described. This normal variant was seen on lateral plain radiographs as a small, rounded opacity surrounded by fatty tissue and located anterior to the knee joint. Magnetic resonance imaging helped confirm this image to be that of the transverse geniculate ligament.
A desmoid tumor was found in a patient with Gardner's syndrome. The tumor was visualized by CT before and after contrast injection, by radiographic examination of the small bowel, and by sonography. CT demonstrated a heterogeneous mass in the left lower abdomen with attenuation values ranging from 23 to 72 HU on native scans, enhancing to 123 up to 172 HU after injection of contrast medium. This examination also demonstrated the extent of the tumor and its exact dimensions. The radiographic examination of the small bowel completed the diagnosis and showed no involvement of the small bowel. This diagnosis was confirmed by laparotomy.
Computed tomography, ultrasonography and magnetic resonance imaging are currently used in stomatology and dentistry. These recent imaging modalities have suppressed or reduced classic examinations (by example: conventional tomography and sialography). Efficient, exact and fast, they improve the diagnostic capacities and optimize the choice of the treatments. After some technical considerations, their applications in various stomatology and dentistry problems are evoked.
Pseudoaneurysm and arteriovenous fistulae are classical but unusual complications of femoral catheterism. The use of large diameter catheters, heparinotherapy and fibrinolysis constitute risk factors. These local complications are becoming more frequent resulting from an increase in interventional techniques. Therefore, a non invasive management of these lesions becomes necessary. A simple manual percutaneous compression of the puncture site was successful as treatment of 3 arteriovenous fistulae and 4 of 7 pseudoaneurysms. That is the reason why the authors consider that this technique constitutes a good alternative of the surgical treatment.
Bronchial tumors that invade the mediastinum are not necessarily inoperable. Whether surgery is possible depends, among other things, on the extent of pulmonary artery invasion. The authors have studied the value of cardiac-gated MRI and compared it with CT and venous DSA for staging tumor invasion. CT demonstrated the areas of contact between tumor and mediastinum. The MRI planes were transverse and also in the main axis of the pulmonary arteries. Twenty-one patients were studied and in 16 the findings could be checked during surgery. In all cases the findings on MRI were confirmed. In eight patients MRI provided more information than CT and DSA combined and thereby showed its superiority for evaluating arterial invasion.
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Prostatic magnetic resonance images of 22 male volunteers less than 30 years old and with no known genito-urinary tract disease were obtained at 1.5 T. Normal anatomical features of the prostate were studied with spin-echo techniques. Different zones of the normal gland are shown by T2-weighted images: the anterior fibromuscular fascia, the central prostate, the peripheral prostate and the periurethral zone can be differentiated. The normal prostate gland is shown on T1-weighted images as a homogeneous appearance. It is important to recognize the normal zonal anatomy of the prostate since prostatic disorders arise in different anatomical zones.
Cysts of the prostate and seminal vesicles are confusing abnormalities because they are uncommon and their origin is uncertain. Several approaches to diagnosis have been used, most recently CT and transrectal sonography. In this study, we investigated the value of MR imaging in the diagnosis of six cases of prostatic cyst and five cases of cysts of the seminal vesicles. All patients were symptomatic. T1- and T2-weighted spin-echo images were obtained in all cases; pathologic confirmation was available in four patients. MR images were analyzed prospectively without knowledge of clinical data or the results of other imaging procedures. In all cases, low- and high-signal masses were observed on T1- and T2-weighted images, respectively. The cysts were unilocular with a sharply defined margin, ranging from 0.5 to 3.0 cm in diameter. The thin wall was of low signal intensity on T2-weighted images. Our experience suggests that MR imaging is useful in demonstrating the liquid content of prostatic and seminal-vesicle cysts and in establishing their size and location.