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2.
Rev Mal Respir ; 30(9): 780-4, 2013 Nov.
Artigo em Francês | MEDLINE | ID: mdl-24267769

RESUMO

INTRODUCTION: Respiratory infections due to Mycoplasma pneumoniae are typically mild and subacute. We report the case of a 40-year-old man hospitalized for acute respiratory distress in the context of an acute infection with Mycoplasma pneumoniae. Radiological and pulmonary function test were consistent with an acute infectious bronchiolitis. CASE REPORT: The patient presented with isolated respiratory failure with profound hypoxemia requiring oxygen delivered at high concentration by face mask. The CT appearance of the lesions corresponded to a spread of bilateral micro-connected pulmonary nodules (a "tree-in-bud" pattern) associated with obstructive ventilatory disorder. The only pathogen identified by PCR on BAL and serology was Mycoplasma pneumoniae. The evolution was favorable with antibiotic therapy combined with corticosteroids. CONCLUSION: Mycoplasma pneumoniae may be responsible for severe respiratory illness in the form of bronchiolitis. In the setting of severe acute community pneumoniae antibiotic treatment which is also effective against Mycoplasma pneumonia should be considered. In this case, corticosteroids may be an effective adjunct by their action on the small airways.


Assuntos
Pneumonia por Mycoplasma/diagnóstico , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/microbiologia , Doença Aguda , Adulto , Humanos , Masculino , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/complicações
5.
Rev Mal Respir ; 16(2): 210-3, 1999 Apr.
Artigo em Francês | MEDLINE | ID: mdl-10339766

RESUMO

Leiomyosarcomas are extremely rare tumors which develop from smooth muscle, usually in the esophagus and large vessels (inferior vena cava, pulmonary artery, and superior vena cava). In very rare cases, leiomyosarcomas develop from small vessels in the soft tissue of the mediastinum. Clinical expression of mediastinal leiomyosarcomas (dysphagia, dysphonia) is related to their large size and the subsequent compression of mediastinal structures. At pathology examination, the gross aspect is one of a single cell tumor. Microscopically, the tumor may be highly undifferentiated making it necessary to use specific immune markers (actin and desmin) or ultra-structural analysis to establish the diagnosis. Treatment of localized tumors is based on surgical excision, either alone or in combination with radiotherapy of the mediastinum. Chemotherapy, generally dexorubicin, is indicated in case of metastatic dissemination, but outcome remains uncertain. As for all soft tissue sarcomas, the prognosis of mediastinal leiomyosarcoma depends on the size of the tumor, its histological structure and its resectability.


Assuntos
Carcinoma/patologia , Leiomiossarcoma/patologia , Neoplasias do Mediastino/patologia , Antineoplásicos/uso terapêutico , Carcinoma/tratamento farmacológico , Doxorrubicina/uso terapêutico , Humanos , Leiomiossarcoma/tratamento farmacológico , Masculino , Neoplasias do Mediastino/tratamento farmacológico , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico
6.
J Mal Vasc ; 23(1): 67-70, 1998 Feb.
Artigo em Francês | MEDLINE | ID: mdl-9551356

RESUMO

We report an original case of giant cell arteritis, revealed by abdominal aortic arteritis on CT-scan, which was performed because the patient presented with a biological inflammatory syndrome. Course was favorable with steroid therapy. CT-scan, one month later, demonstrated a stable appearance of both regular and concentric thickening of the abdominal aortic wall. Aortic involvement is rare and occurs late in the course of giant cell arteritis. Usually clinical and biological manifestations of aortitis associated with giant cell arteritis either absent or non specific, leading to diagnostic difficulties. Furthermore, aortic giant cell arteritis is a major cause of morbidity and mortality. Gravity of aortic impairment is mainly linked to the risk of development of aneurysm and/or acute dissection. A search for aortic involvement should therefore routinely be carried out, once a year, in patients with giant cell arteritis, particularly a complete vascular clinical examination and a chest X-ray. Finally, our case report suggests that non invasive methods, notably CT-scan, may serve as a helpful test in diagnosis and follow-up of aortic giant cell arteritis.


Assuntos
Aortite/diagnóstico , Idoso , Angiografia Digital , Aorta Abdominal/diagnóstico por imagem , Aortite/etiologia , Feminino , Humanos , Tomografia Computadorizada por Raios X
7.
Skeletal Radiol ; 26(7): 419-23, 1997 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-9259100

RESUMO

UNLABELLED: To evaluate the computed tomography (CT) findings of inflammatory lesions of the sternoclavicular joints (SCJ) in spondylarthropathies. DESIGN AND PATIENTS: CT scans of the SCJs were obtained in 23 patients (group 1) with inflammatory SCJ lesions in spondylarthropathies. These scans were reviewed by four readers and compared with the CT scans of 23 matched controls (group 2). Each reader had to complete a 27-item grid. RESULTS AND CONCLUSION: In the 23 patients of group 1, the mean number of observed signs was 5.3 +/- 4.2 higher (P < 0.01) than in the group of 23 matched controls (2.4 +/- 1.6). Four signs were more frequently observed (P < 0.05) in group 1: surrounded subchondral clavicular erosions and cysts, surrounded subchondral sternal cysts and sternal bone sclerosis. A cyst and/or an erosion was associated with hyperostosis and/or bone sclerosis in 9 of 23 patients in group 1. This association was not observed in group 2; the difference was significant (P < 0.001). A cyst and/or an erosive lesion was observed 18 times in group 1 versus 11 times in group 2; the difference was significant (P < 0.05). Conversely, signs of degenerative lesions (osteophytes, subchondral sclerosis, unevenness of joint surface) were no more frequently observed in controls than in group 1. This study emphasizes the diagnostic value of CT, in particular in the identification of inflammatory lesions, even when pre-existing degenerative disease is present.


Assuntos
Doenças da Coluna Vertebral/complicações , Articulação Esternoclavicular/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Artrite Psoriásica/complicações , Artrite Psoriásica/diagnóstico por imagem , Cistos Ósseos/complicações , Cistos Ósseos/diagnóstico por imagem , Feminino , Humanos , Hiperostose/diagnóstico por imagem , Artropatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Psoríase/complicações , Psoríase/diagnóstico por imagem , Esclerose , Sensibilidade e Especificidade , Doenças da Coluna Vertebral/diagnóstico por imagem , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico por imagem , Esterno/diagnóstico por imagem , Esterno/patologia
9.
J Mal Vasc ; 22(5): 322-5, 1997 Dec.
Artigo em Francês | MEDLINE | ID: mdl-9479602

RESUMO

If an association between venous thromboembolism and malignancy is now well established, there is no consensus about the investigations which should be performed to detect occult malignancy after deep vein thrombosis episode. We investigated the usefulness of systematic abdomino-pelvic ultrasonography in 148 consecutive patients older than 40 with deep vein thrombosis and or pulmonary embolism. Ultrasonography was abnormal in 8 patients (5.4%) and detected only 6 cancers. In 5 cases, clinical examination and laboratory tests were sufficient to suggest malignancy. Our results suggest that ultrasonography should not be systematically performed in patients with deep vein thrombosis. Decisions to performed additional diagnostic tests can be based on the finding of the initial clinical examination, that includes medical history, physical examination, routine laboratory tests and chest-x-ray.


Assuntos
Neoplasias/diagnóstico por imagem , Tromboflebite/diagnóstico por imagem , Abdome , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Tromboflebite/complicações , Ultrassonografia
11.
Acta Radiol ; 37(6): 950-3, 1996 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-8995472

RESUMO

PURPOSE: To assess the incidence of nephrotoxicity following i.v. injection of the iodinated low-osmolality contrast medium ioversol 300 (Optiray) in a geriatric population compared with a control group aged under 60 years, neither group presenting any associated risk factors. MATERIAL AND METHODS: CT with i.v. bolus injection of ioversol 300 mg I/ml was performed at a mean dose of 1.36+/-0.06 ml/kg (range 1-2 ml/kg b.w.) in 47 patients aged over 69 years. Serum creatinine level was measured and creatinine clearance was calculated at 24, 48 and 72 h after the examination, and compared to a reference serum creatinine value taken before CT. The findings were compared with a control group of 44 patients aged under 60 years. RESULTS: No significant increase in serum creatinine (+0.6 mmol/l) or in creatinine clearance (+0.7 ml/min) was found during the course of 3 days after the injection. Only one patient (aged 82) presented an increase of 25% in serum creatinine (109 mmol/l). CONCLUSION: The trial did not demonstrate any significant difference between the 2 groups, although the elderly patients had a subclinical renal impairment revealed by the decrease of the initial creatinine clearance. The use of low-osmolality ioversol makes it possible to perform examination with an iodinated contrast agent without increasing the incidence of nephrotoxicity in elderly subjects.


Assuntos
Meios de Contraste/efeitos adversos , Rim/efeitos dos fármacos , Ácidos Tri-Iodobenzoicos/efeitos adversos , Fatores Etários , Idoso , Creatinina/sangue , Humanos , Rim/fisiologia , Pessoa de Meia-Idade , Fatores de Risco , Tomografia Computadorizada por Raios X
12.
Skeletal Radiol ; 25(3): 237-41, 1996 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-8741058

RESUMO

OBJECTIVE: The objective of this work was to establish a reference population for the study of the sternoclavicular joint (SCJ). DESIGN: A prospective study of the SCJ was carried out by high-resolution computed tomography (CT). CT images were read by two radiologists and two rheumatologists using a pre-established grid (27 elementary signs). PATIENTS: Sixty healthy subjects, homogeneously distributed by sex and decade of life, from 20 to 80 years old, were studied. RESULTS AND CONCLUSIONS: The main results were the following: 98% of healthy subjects presented at least one sign; mean number of signs per subject was 2.4 +/- 1.9; mean number of signs was higher ( P < 0.005) in men (mean = 3.1 +/- 2.1) than in women (mean = 1.7 +/- 1.3); number of signs increased with age (P < 0.001). Some signs were very frequent: "ossification of the first costal cartilage" (88%), "Surrounded subchondral clavicular erosion" (27%). Some signs were significantly more frequent in the elderly: "sternal osteophyte" after the age of 70 (P < 0.01) and "meniscal calcification" (P < 0.01) and "sternal subchondral sclerosis" (P < 0.05) after the age of 60. The number of clavicular signs was greater than that of sternal signs (P < 0.001). These results can be used as references for the study of the SCJ.


Assuntos
Articulação Esternoclavicular/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças Ósseas/diagnóstico por imagem , Cartilagem/diagnóstico por imagem , Cartilagem Articular/diagnóstico por imagem , Clavícula/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/diagnóstico por imagem , Osteosclerose/diagnóstico por imagem , Estudos Prospectivos , Intensificação de Imagem Radiográfica , Costelas/diagnóstico por imagem , Fatores Sexuais , Esterno/diagnóstico por imagem
13.
Ann Rheum Dis ; 55(3): 177-80, 1996 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-8712880

RESUMO

OBJECTIVE: To test the hypothesis that pustulosis palmaris et plantaris and psoriatic arthritis (PsA) are two distinct diseases, and that the associated dermatoses are therefore also distinct diseases. METHODS: We prospectively performed clinical, radiological, biological, and bone scan investigations in 23 outpatients with pustolotic arthritis and 23 outpatients with PsA, matched by gender, age (+/- one year) and duration of arthritis (+/- two years). RESULTS: The anterior chest wall, especially the sternocostoclavicular joints, was more frequently involved in pustulotic arthritis than in PsA, both clinically (82% v 43%; p < 0.001) and radiologically (47% v 17%; p < 0.05). Sternocostoclavicular joints generally presented with erosive lesions in PsA, and with large ossifications in pustulotic arthritis. Peripheral joint involvement was mono- or oligoarticular, affecting proximal joints, in pustulotic arthritis (74% v 21%; p < 0.01), and polyarticular, involving small distal joints, in PsA (60% v 0%; p < 10(-4)), in which condition it was also more often erosive (43% v 8%; p < 0.01). The frequency of sacroiliitis and of spine involvement was similar in pustulotic arthritis and PsA. Biology and bone scan did not help distinguish between the two groups. CONCLUSIONS: Pustulotic arthritis and PsA are clinically and radiologically different, therefore pustulosis palmaris et plantaris and psoriasis are most probably distinct dermatological diseases.


Assuntos
Artrite Psoriásica/diagnóstico , Psoríase/diagnóstico , Artrografia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Coluna Vertebral/diagnóstico por imagem , Articulação Esternoclavicular/diagnóstico por imagem , Articulações Esternocostais/diagnóstico por imagem , Tomografia Computadorizada por Raios X
14.
Ann Rheum Dis ; 54(5): 375-8, 1995 May.
Artigo em Inglês | MEDLINE | ID: mdl-7794043

RESUMO

OBJECTIVE: To compare glucose metabolism in patients with vertebral hyperostosis (VH), with that in control patients. METHODS: We studied 50 patients aged 60 years or more who had VH according to Resnick's criteria, and 50 control patients without VH, matched for sex, age, weight and height. Plasma glucose was evaluated before and 120 minutes after ingestion of 75 g glucose. World Health Organisation criteria for diabetes mellitus (DM) were used. Radiographs of the pelvis and thoracic and lumbar spine were performed and read blind by two physicians. RESULTS: Statistical analysis showed no difference between cases and control patients for prevalence of DM, and plasma glucose at 0 and 120 minutes. CONCLUSION: These data suggest that glucoregulation in patients with VH does not differ from that in matched controls.


Assuntos
Diabetes Mellitus/metabolismo , Glucose/metabolismo , Hiperostose Esquelética Difusa Idiopática/metabolismo , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Complicações do Diabetes , Feminino , Teste de Tolerância a Glucose , Humanos , Hiperostose Esquelética Difusa Idiopática/complicações , Masculino , Pessoa de Meia-Idade
15.
Rev Rhum Ed Fr ; 60(3): 245-7, 1993 Mar.
Artigo em Francês | MEDLINE | ID: mdl-8293011

RESUMO

Imaging a 70 year old man with lymph node metastases from an adenocarcinoma developed cauda equina syndrome. The diagnosis of intradural metastatic disease was established on the basis of magnetic resonance imaging with gadolinium injection which visualized diffuse nodules in contact with the nerve roots.


Assuntos
Adenocarcinoma , Imageamento por Ressonância Magnética , Neoplasias da Medula Espinal/secundário , Idoso , Cauda Equina , Humanos , Masculino , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/etiologia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico
16.
Rev Mal Respir ; 10(4): 371-3, 1993.
Artigo em Francês | MEDLINE | ID: mdl-8235030

RESUMO

The authors report a case of a patient presenting with a bronchogenic mediastinal cyst, which presented as a super-infection of the cyst. The cyst was associated with malformation of the cervical vertebra, cardiovascular abnormalities and congenital deafness, placing this in the group of rare complex polymalformation syndrome with Klippel-Feil Syndrome. The authors also stress the value of computed tomography, and above all of nuclear magnetic resonance in the analysis of mediastinal tumours and in particular, of bronchogenic cysts.


Assuntos
Anormalidades Múltiplas/diagnóstico , Cisto Broncogênico/diagnóstico , Surdez/diagnóstico , Síndrome de Klippel-Feil/diagnóstico , Cisto Mediastínico/diagnóstico , Superinfecção/diagnóstico , Veia Cava Superior/anormalidades , Adulto , Cisto Broncogênico/complicações , Cisto Broncogênico/cirurgia , Surdez/complicações , Surdez/congênito , Diagnóstico Diferencial , Feminino , Humanos , Síndrome de Klippel-Feil/complicações , Imageamento por Ressonância Magnética , Cisto Mediastínico/complicações , Cisto Mediastínico/cirurgia , Superinfecção/complicações , Tomografia Computadorizada por Raios X
17.
Rev Prat ; 42(5): 569-72, 1992 Mar 01.
Artigo em Francês | MEDLINE | ID: mdl-1604183

RESUMO

The diagnosis of spinal stenosis can be strongly suspected when the following symptoms are present: limbs neuralgias with a poorly defined location, paresthesias in several dermatomas neurogenic intermittent claudication. Myelography coupled with scan yields the best information about morphology, levels of stenosis and narrowing factors, bone bridges ligaments and discal structures. If surgery is decided after failure of medical treatment to improve the patient's condition, the choice will be best guided by the myeloscan analysis.


Assuntos
Estenose Espinal/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mielografia , Estenose Espinal/patologia , Estenose Espinal/terapia , Tomografia Computadorizada por Raios X
18.
Presse Med ; 20(28): 1307-11, 1991 Sep 14.
Artigo em Francês | MEDLINE | ID: mdl-1833734

RESUMO

Between 1986 and 1989, we conducted a clinical, biochemical, radiological and scintigraphic prospective study of 15 patients (8 men, 7 women) with histologically proven palmoplantar pustulosis. In 70 percent of the cases the time interval between the first cutaneous and the first osteoarticular signs was 2 years. Anterior thoracic clinical manifestations were frequent. The joints and the numbers of patients involved were: sternoclavicular (12), manubriosternal (6), sternocostal (5), intervertebral (11), sacroiliac (6) and peripheral (10). Two patients had osteitis. The clinical, radiological and scintigraphic findings, as well as the distribution of these arthropathies over the anterior thorax (i.e. over a sternocostoclavicular complex with numerous ligaments), suggest a preference for entheses. Despite the absence of link with the HLA B27 antigen, the frequent association with pelvic and spinal lesions indicate that the articular disease of palmoplantar pustulosis is a spondyloarthropathy.


Assuntos
Osteoartrite/etiologia , Psoríase/complicações , Adolescente , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Feminino , Humanos , Masculino , Manúbrio/fisiopatologia , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Osteoartrite/tratamento farmacológico , Estudos Prospectivos , Radiografia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/tratamento farmacológico , Doenças da Medula Espinal/etiologia , Articulação Esternoclavicular/fisiopatologia , Esterno/fisiopatologia , Fatores de Tempo
19.
Arch Mal Coeur Vaiss ; 84(8): 1177-81, 1991 Aug.
Artigo em Francês | MEDLINE | ID: mdl-1835359

RESUMO

During a 30 months period, 70 patients (60-84 years old) underwent a renal artery angiographic investigation, either by combined intravenous angiography and pyelography, either by intravenous or intra-arterial digital angiography. Thirty-nine were males, 31 were females. All patients were hypertensive. Thirty-three had a normal renal function and 37 had a renal insufficiency arbitrarily definite as creatinine clearance lower than 60 ml/min (m = 33 +/- 15 ml/min). Eight aortic anevrysms were discovered. Thirteen patients (18.6%) had atherosclerotic renovascular disease. Criteria which led to undertake these investigations and results are listed in the following table. [table; see text] Transluminal percutaneous angioplasty and surgical treatment were performed 7 and 3 times respectively. In one case, nephrectomy was done. In all these patients but one, improvement of hypertension and/or renal function occurred. In patients with renal impairment, difference in size between the two kidneys detected by echography or plain abdominal X-rays were noted in 8 among the 9 patients with renovascular disease; six among them had proteinuria less than 0.5 g/day. In conclusion, in hypertensive patients older than 60, criteria for detection of renovascular disease are the same as in younger patients. When renal function is decreased, difference in size between the two kidneys requires an angiographic evaluation. Proteinuria does not exclude renovascular pathology.


Assuntos
Angiografia Digital , Hipertensão/diagnóstico por imagem , Obstrução da Artéria Renal/diagnóstico por imagem , Artéria Renal/diagnóstico por imagem , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão , Feminino , Humanos , Hipertensão/complicações , Hipertensão/terapia , Falência Renal Crônica/etiologia , Masculino , Pessoa de Meia-Idade , Proteinúria/etiologia , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/terapia , Estudos Retrospectivos
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