The management of asymptomatic carotid stenosis: Is there a benefit to operate elderly patients?

BACKGROUND: We present a retrospective study of a series of 40 patients over the age of 75 operated for an asymptomatic carotid stenosis. The results were evaluated during an average of 3 years of follow-up. MATERIAL AND METHOD: The study is retrospective and monocentric. The series includes 40 patients aged over 75 years and with an average age of 78.5 years (range 75-82). Patients underwent surgery for an asymptomatic carotid stenosis of more than 80%. The technique in all case was a carotid endarterectomy. RESULTS: There have been no postoperative deaths or neurological adverse events. During an average follow-up of 3 years, there was one death secondary to colon cancer. However, 5 patients were lost to follow-up. CONCLUSION: Carotid surgery in elderly patients may have a benefit. However, our study has shortcomings. It is retrospective and the patient cohort is reduced. A randomized, prospective study, comparing surgery or angioplasty with the best medical treatment, is necessary to choose the most effective and safest treatment to offer to an elderly patient with asymptomatic carotid stenosis.

Spectrum of temporal bone abnormalities in patients with Waardenburg syndrome and SOX10 mutations.

BACKGROUND AND PURPOSE: Waardenburg syndrome, characterized by deafness and pigmentation abnormalities, is clinically and genetically heterogeneous, consisting of 4 distinct subtypes and involving several genes. SOX10 mutations have been found both in types 2 and 4 Waardenburg syndrome and neurologic variants. The purpose of this study was to evaluate both the full spectrum and relative frequencies of inner ear malformations in these patients. MATERIALS AND METHODS: Fifteen patients with Waardenburg syndrome and different SOX10 mutations were studied retrospectively. Imaging was performed between February 2000 and March 2010 for cochlear implant work-up, diagnosis of hearing loss, and/or evaluation of neurologic impairment. Eleven patients had both CT and MR imaging examinations, 3 had MR imaging only, and 1 had CT only. RESULTS: Temporal bone abnormalities were bilateral. The most frequent pattern associated agenesis or hypoplasia of ≥1 semicircular canal, an enlarged vestibule, and a cochlea with a reduced size and occasionally an abnormal shape, but with normal partition in the 13/15 cases that could be analyzed. Three patients lacked a cochlear nerve, bilaterally in 2 patients. In addition, associated abnormalities were found when adequate MR imaging sequences were available: agenesis of the olfactory bulbs (7/8), hypoplastic or absent lacrimal glands (11/14), hypoplastic parotid glands (12/14), and white matter signal anomalies (7/13). CONCLUSIONS: In the appropriate clinical context, bilateral agenesis or hypoplasia of the semicircular canals or both, associated with an enlarged vestibule and a cochlear deformity, strongly suggests a diagnosis of Waardenburg syndrome linked to a SOX10 mutation.

[Imaging of child osteoarticular infections]. / Imagerie des infections ostéoarticulaires de l'enfant.

The diagnostic strategy in imaging osteoarticular infections is currently quite well codified. X-rays, always available in the emergency situation, are systematically taken. They can be usefully completed with sonography in accessible superficial locations, when looking for a puncturable abscess. MRI is not systematic but is widely used: In place of bone scintigraphy, when osteomyelitis is suspected with a normal x-ray and a clinical warning sign; In the acute period of certain deep topographies when looking for an abscess (pelvis, spinal cord); When growth cartilage is involved to evaluate the risk of epiphysiodesis; When there is resistance to treatment; In the chronic forms of osteomyelitis, for diagnosis and evaluating the extent of infection. The CT scanner has few indications: it is performed when looking for bone sequestrum in chronic forms and when MRI access is impossible in difficult anatomical sectors (spinal cord, pelvis, scapula). Scintigraphy is currently only performed when x-rays are normal and there are no clinical warning signs.

[Imaging aspects of sphenoid during development]. / Aspects en imagerie du sphénoïde au cours de la croissance.

To show the different steps of ossification and pneumatization of the sphenoid bone in children in order to emphasize normal anatomic variations. CT scanners and MRI studies of children up to 15 year old performed for various craniofacial conditions, without suspected involvement on cranial growth, are presented. The normal process of the ossification, of the closure of the synchondroses and of the pneumatization is demonstrated. Some examples of congenital abnormalities are also shown. The knowledge of these normal steps and variations is essential, in order to properly evaluate traumatic or congenital situations, but is also helpful for the diagnosis of bone dysplasias and bone marrow diseases (tumor or hematologic disorders).