[Role of embolization in renal angiomyolipomas]. / Rôle de l'embolisation dans les angiomyolipomes du rein.

OBJECTIVE: The purpose of this study is to present the role of embolization in the treatment of renal angiomyolipoma (AML) in cases of hemorrhage and to prevent bleeding. METHODS: Over a period of 10 years, 35 AMLs in 34 patients, recruited in two medical centers, were treated with embolization: 16/35 AML were treated urgently to stop bleeding, and 19/35 AML had preventive embolization. Six patients were completely asymptomatic and 13 had a history of previous hematoma or flank pain. Catheterization was highly selective in all cases (coaxial microcatheter in 19 cases), and for embolization we used nonresorbable microparticles, coils, and alcohol. RESULTS: When patients presented with acute bleeding, embolization was efficient in 80% of cases; another embolization was necessary in two cases, and surgery in two others. In six of these cases, surgery was planned and done at a later date. When treatment was preventive, one embolization was necessary in 17 cases, and two embolizations per case were necessary in the other two. Over a period of 18 months of follow-up, we observed a 28% decrease in tumor volume; four patients were treated by surgery at a later date. CONCLUSION: Embolization is the technique of choice to treat a bleeding AML urgently. When preventive treatment is considered, in symptomatic or asymptomatic AML, embolization can be an alternative for surgery, but more data is needed to specify its proper place in the management of these tumors.

Diagnostic value of bronchoscopy, CT and transbronchial biopsies in diffuse pulmonary lymphangiomatosis: case report and review of the literature.

The authors present the case of a 48-year-old man with diffuse pulmonary lymphangiomatosis. This rare lymphatic disorder is characterized by proliferation of anastomosing lymphatic vessels varying in size. Clinical presentation and imaging findings are highly suggestive. Bronchoscopic examination of this patient showed, for the first time to our knowledge, vesicles disseminated throughout the bronchial tree. Histopathological examinations are necessary to differentiate lymphangiomatosis from lymphangiectasis. The diagnosis can be made by transbronchial biopsy without performing open lung biopsy which was, until now, considered necessary for diagnosis.

[The lower limb of elderly patients (venous and arterial diseases)]. / La jambe du sujet âgé (pathologie veineuse et ischémique).

Elderly patients frequently suffer from vascular pathologies of the leg. In these more fragile patients, diagnostic work-up must cause as little trauma as possible. The clinical status and morphological appearance of the vessels make vascular investigations sometimes difficult to perform in the elderly. With arterial pathology, vascular imaging relies on numerous non invasive techniques (Duplex scan and vascular imaging techniques by reconstruction: helical CT and magnetic resonance angiography). The clinical exam, the evolution stage of arterial disease and these non invasive investigations must allow to select the patients that should benefit from an arteriography, more or less associated to revascularization. With thrombo-embolic pathology, venography has now been replaced by venous duplex scan of the lower limbs irrespective of the underlying thrombotic etiology.

[40th ICAAC. Catheter-related septicemia]. / Au 40e ICAAC. Les septicémies sur cathéter.

A GROWING PROBLEM: Insertion or use of intravascular material is increasingly associated with septicemia. Septicemia occurs in 1 out of 1000 patients undergoing a non-surgical invasive cardiac procedure. The frequency of septicemia, particularly due to Gram-negative bacteria, is increasingly frequent in stem-cell graft recipients. PREVENTION MEASURES: Educational programs, for both patients and health givers, emphasizing the importance of aseptic can reduce the incidence of Gram-negative bacteria catheter-related septicemias.

[Spontaneous remission of cytomegalovirus retinitis in a patient infected with the human immunodeficiency virus]. / Rétinite à cytomégalovirus guérie spontanément chez un patient infecté par le virus de l'immunodéficience humaine.

BACKGROUND: We report a case of CMV retinitis cured in an AIDS patient after two months of regular HAART therapy without CMV medications. CASE REPORT: A 37-year-old patient (baseline CD4 count 47/ml) receiving HAART (2 NRTI and 1 IP) showed poor compliance and had increased his CD4 count for two months reaching 263/ml although HIV viral load remained high (71,840 copies/ml). His fundus was normal. He was evaluated 8 months after a period of loss to follow-up: his CD4 count was 65/ml, HIV viral load was 123,000 copies/ml, CMV serology for IgV and viruria were positive, viremia was negative, his fundus revealed a healed CMV retinitis. Six months later and without any CMV therapy, no relapse has been observed while regularly taking HAART medications. CONCLUSION: Few cases have been reported in which HAART therapy with good immune response and reduced HIV viral load lead to complete regression of CMV retinitis without specific CMV medication. This case suggests that, even with an uncontrolled HIV viral load, HAART via transient immune restoration may contribute to resolving CMV retinitis.

[Digital substraction angiography using gadolinium as contrast medium for patients with renal failure. A study of 15 patients]. / Angiographies digitalisées au gadolinium chez les sujets a haut risque rénal.

OBJECTIVES: To study the feasibility of IA-DSA for diagnostic or interventional purposes using gadolinium (Gd) as a contrast medium (CM) for patients with poor renal function. MATERIALS AND METHODS: This study is about 15 patients with renal insufficiency (creat. > 133 micromol/l) who needed IA-DSA for diagnostic or interventional purposes. Gd was used as a CM at a dose < or = 0.4 micromol/kg and a concentration > or = 75%. Serum creatinine level was evaluated before, at 24 h and 48 h after injection of Gd. An increase of creat. > or = 44 micromol/l was considered significant. Image quality was evaluated by two specialists. RESULTS: In 14/15 (93%) patients no significant elevation of the serum creat. level was noted. The images are of good to medium quality, the diagnostic or therapeutic purpose was however reached. Image quality depends on Gd concentration; the feasibility of the exam is limited by the quantity of Gd used and its dilution. The procedure is well tolerated without side effects. CONCLUSION: Gd allows arteriograms of adequate quality for diagnostic or therapeutic purposes without renal complications at doses used until now (0.4 micromol/kg). The procedure is easy to perform but only one region or organ can be studied in one procedure considering the relatively small volume of contrast allowed.