[Computed tomography-based virtual colonoscopy: an examination useful for the choice of the surgical management of colorectal endometriosis]. / Coloscanner à l'air avec coloscopie virtuelle: arguments dans le choix du traitement chirurgical des endométrioses colorectales.

OBJECTIVE: To evaluate the use of computed tomography-based virtual colonoscopy in the preoperative assessment of colorectal endometriosis. PATIENTS AND METHODS: We included in the study consecutive women undergoing surgical management of deep infiltrating endometriosis from August 2009 to April 2010, whose colorectal involvement had been assessed by magnetic resonance imaging (MRI) and rectal endoscopic sonography (RES). Prior to surgical procedure, a computed tomography-based virtual coloscopy was performed. Computed tomography was performed by insufflating air into the distal rectum, along with an intravenous injection of contrast agent. Then, 3D reconstruction of pictures was carried out, to allow visualization of the lumen of the rectum and the colon. Data provided by virtual colonoscopy were compared to those given by other imaging techniques and surgical exploration. RESULTS: Twenty-seven patients were included in the study: 7 women underwent colorectal segmental resection, 2 full thickness excision, 15 shaving, while in 3 of them no digestive surgical step was performed. Virtual colonoscopy provided the measurement of the length and the diameter of colorectal stenosis due to infiltrating nodule through rectal and sigmoid wall, which was presenting as an endoluminal indentation. The number of patients presenting with endometriotic nodules arising on the rectum, sigmoid colon, or both of them, were respectively 13, 7 and 7. Ovarian endometriomas were responsible for extrinsic compression leading to digestive tract stenosis in nine cases. The number of lesions and their height reported to the anus were accurately assessed in 24 women out of 27 (sensitivity of 88%). The origin of the digestive tract stenosis, i.e. either infiltrating endometriotic nodules or extrinsic compression due to ovarian endometriomas, was accurately assessed in all cases, by combining information provided by virtual colonoscopy, IRM, RES and transvaginal ultrasonography. CONCLUSION: Computed tomography-based virtual colonoscopy provides useful information about the degree and the height of digestive tract stenosis due to colorectal endometriosis. In our opinion, this information is of major interest to argue the choice of shaving or full thickness excision of nodules in a majority of women presenting with colorectal endometriosis.

[Functional MR urography in children]. / Uro-IRM fonctionnelle chez l'enfant.

MR Urography (MRU) provides both morphologic and functional information without radiation exposure. It enables the assessment of split renal function, excretion, and quantification of obstruction. MRU is thus complementary to ultrasonography in the assessment of pre- and post-natal obstructive uropathies in children. If available, MRU should be definitely preferred to intravenous urography.

[Treatment of thoracolumbar junction burst fractures (Magerl A3) by balloon kyphoplasty: anatomic study]. / Traitement des burst fractures (Magerl A3) de la charnière thoracolombaire par cyphoplastie à ballonnets: étude anatomique.

PURPOSE OF THE STUDY: Balloon kyphoplasty is a not widely used method for the treatment of vertebral burst fractures with displacement of the posterior wall. The purpose of this study was to measure the posterior height of the vertebral body and the posttraumatic canal surface area before and after balloon kyphoplasty for the treatment of burst fractures (Magerl A3). MATERIAL AND METHODS: This anatomic study was conducted on ten experimental burst fractures of the thoracolumar junction prepared on cadaver specimens. The surface area of the canal and the height of the posterior wall were measured by computed tomography before and after balloon kyphoplasty. These two variables were then compared with search for correlation. RESULTS: The posttraumatic canal surface area increased significantly after kyphoplasty (p=0.02). Gain in posterior height was not significant and there was no correlation between the two variables. Cement leakage into the canal was not observed. DISCUSSION: It is known that balloon kyphoplasty can re-establish anterior height and correct for the posttraumatic kyphosis in patients with compression fractures of osteoporotic vertebrae. The present cadaver study shows that when the posterior wall is displaced posteriorly, balloon expansion does not exaggerate the wall displacement. On the contrary, the posttraumatic canal surface area is increased due to the ligamentotaxis effect. CONCLUSION: Balloon kyphoplasty could be an alternative to posterior instrumentation for burst fractures without associated neurological deficit, even if the posterior wall is damaged. This technique can be used to reduce and stabilize the fracture while sparing the adjacent levels and limiting the risk inherent with an extensive surgical approach.

[Laparoscopic surgery of profund endometriosis with rectal affect]. / Chirurgia laparoscopica a endometriozei profunde cu atingere rectala.

OBJECTIVE: To present the principles of laparoscopic treatment for rectal endometriosis and to discuss possible postoperative outcomes. MATERIAL AND METHODS: Our series included women managed for rectal endometriosis during consecutive 20 months in the Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen--France. Patient's characteristics, symptoms, imaging examination results, surgical treatment and postoperative outcomes were all evaluated retrospectively. RESULTS: Sixteen patients presenting with rectal endometriosis were managed surgically, (mean age was 35.9 +/- 6.5 years). All women presented at least one severe painful symptom which was typical of a digestive involvement in 12 cases. MRI results suggested a rectal involvement in 14 cases, and endorectal ultrasound examination clearly showed rectal wall infiltration in all patients. The gynaecological stage of surgical treatment was carried out laparoscopically in 13 cases, and the digestive surgical stage in 7 cases. Two limited and 14 segmental rectal resections were performed. Transitory stoma was carried out in 9 women. The length of the surgical procedure depended on the number of endometriosis localizations with a median value of 6 h 30 min. Postoperative complications occurred in 6 women: 2 anastomosis stenosis, 1 anastomosis fistula, 1 abscess of the parietal wall and 1 bladder atonia. Complains of pain were completely or significantly improved in all cases. CONCLUSION: Surgical treatment for rectal endometriosis may be carried out laparoscopically. It should be reserved for women presenting with severe painful condition and may contribute to significant improvement. However, the balance of benefit and risks must also be assessed on a case to case basis prior to any decision for or against surgical treatment.

[Treating severe endometriosis by pregnancy: a risky business]. / Traitement de l'endométriose sévère par la grossesse: un pari risqué

We report the case of a young woman presenting with painful deep and rectal endometriosis. This condition had started long ago while the diagnosis had been delayed. Brutal colon occlusion followed the discontinuation of oral contraception. Left colectomy with terminal colostomy was carried out in emergency. The conservative surgical management of deep endometriosis was performed three months later. In women presenting deep endometriosis, the discontinuation of hormonal treatment in order to attempt a spontaneous pregnancy should not be recommended before undertaking a thorough endometriosis and fertility status investigation.

Dynamic MR urography in urinary tract obstruction: implementation and preliminary results.

BACKGROUND: Recent studies have demonstrated magnetic resonance (MR) capabilities in evaluating renal morphology and function in patients with urinary obstruction. The objective of this report is to support the introduction of dynamic MR renography on any MR equipment. METHODS: A custom-made device of vials filled with different concentrations of gadolinium was studied by combinations of T1-weighted gradient-echo sequences and coils. We compared the capabilities of two coils (phased array vs. standard body), the properties of dynamic sequences, and the effects of increasing concentrations of gadolinium on signal intensity. In a second section, we designed MR urography plug-ins of Image J (DICOM image software) for the analysis of dynamic studies. RESULTS: Optimized gradient-echo sequences acquired with a phased array body coil produced acceptable quality images with a linear relation between signal intensity and the lowest concentrations of gadolinium. In vitro measurements showed loss of linearity above 8 mmol/L. CONCLUSION: Theoretical calculation and data from the literature suggest that the gadolinium dose to the patient should not exceed one-fourth of the usual one (0.025 mmol/kg). Postprocessing using Image J software and the specifically designed plug-ins was validated. The collection of plug-ins is now available on the Internet.