SMART syndrome: Classic transient symptoms leading to an unusual unfavorable outcome.

BACKGROUND: Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare complication of cerebral radiation therapy that usually presents>10 years after treatment as reversible paroxysmal episodes of neurological dysfunction associated with headaches. CASES: We report here on two cases of SMART syndrome in long-term survivors of high-grade glioma for whom neuropathological data were available. The course of the disease was unfavorable. Although the clinico-radiological picture of SMART syndrome clearly differs from classic cerebral radionecrosis, the gross neuropathological lesions observed in our two patients appeared to be similar to those described in focal radionecrosis. CONCLUSION: SMART syndrome may progress from a benign reversible form to a severe and eventually irreversible form. This severe course may also be confused with tumor progression, and lead to permanent disability and inadequate antitumor treatment. Clinicians should be aware of this latter atypical presentation.

Mathematical modeling of metabolism and hemodynamics.

We provide a mathematical study of a model of energy metabolism and hemodynamics of glioma allowing a better understanding of metabolic modifications leading to anaplastic transformation from low grade glioma. This mathematical analysis allows ultimately to unveil the solution to a viability problem which seems quite pertinent for applications to medecine.

[Growing teratoma syndrome]. / Le growing teratoma syndrome.

Growing teratoma syndrome (GTS) is a rare entity, characterized by enlarging masses of the retroperitoneum or other location occurring during or after systemic chemotherapy for the treatment of non-seminomatous germ cell of the testis (NSGCT). Three criteria define this syndrome: enlarging metastatic masses, normalized serum markers and no component of viable germ cell tumor in this mature teratoma. Prognostic is excellent after the resection of these masses, but this surgery has to be as much complete as possible. Surgical excision of large GTS lesions is technically challenging, a serious intraoperative complications may occur, that's why the treatment must not be delayed.

[Place of sclerotherapy in the treatment of chronic chyluria]. / Place de la sclérothérapie dans le traitement des chyluries chroniques.

Chyluria is rare. The parasite that causes filariasis is the most common cause while the non-parasitic causes is anecdotal. Medical treatment is often insufficient to treat cases of chronic chyluria for which the standard treatment is surgical lymphatic disconnection renovascular. However, sclerotherapy by instillation of a sclerosing agent kidney may represent an alternative to surgery. This technique has the advantage of being less invasive than surgery and has a proven efficacy in the literature.

[Venous infarction of the neonate]. / L'infarctus veineux hémorragique du nouveau-né

PURPOSE: To determine the imaging features of hemorrhagic infarction in neonates. PATIENTS AND METHODS: Retrospective study (1998-2008) of 19 children (17 premature and 2 term deliveries) with early lobar hyperechogenicity on transfontanel US (TFUS). Group I: 11 born infants with clinical as well as TFUS and MRI follow-up. Group II: 8 premature infants deceased within a week from multisystem pathology, with neuropathological study available in 3 cases. RESULTS: Group I (n=11): periventricular hyperechogenicity in a frontal (7), frontoparietal (2), parietooccipital (1) and temporoparietal (1) distribution with developing cavitary change (n=6). MRI showed a cortex sparing intraparenchymal hematoma. Group II (n=8): periventricular hyperechogenicity in a frontal (4), frontoparietal or parietal (3) and occipital (1) with developing cavitary change (3). Neuropathological examination showed characteristic lesions of venous hemorrhagic infarction. Clinical outcome was generally favorable for the surviving infants with contralateral motor deficit (n=5) non-correlated to the extent of the initial lesions. CONCLUSION: Venous hemorrhagic infarction mainly affetcs premature infants and typically involves the periventricular frontal white matter. Prognosis is generally favorable. It is thus important to differentiate this entity from asymmetrical cystic periventricular leukomalacia with much different prognosis.

[Risk from prenatal exposure to ionizing radiation]. / Risques liés à l'exposition d'une grossesse aux rayonnements ionisants.

Exposure to ionizing radiation during pregnancy always is a worrisome event. Knowledge of teratogenic and carcinogenic mechanisms based on reliable scientific data (ICRP 84) allows appropriate management of patients following exposure to ionizing radiation. Radiation exposure in the setting of diagnostic imaging studies is not associated with an increased risk of fetal malformation; however, the risk of childhood malignancy is minimally increased. This information must be provided to parents so they may reach an informed decision with regards to the outcome of the pregnancy. The analysis of the quality and quantity of exposure should be limited to imaging examinations where the abdomen was exposed. Management will be based on the type of exposure. Guidelines are provided for various exposure situations and all radiologists must be able to manage such situations.

[Detection of induced myocardial ischemia during stress cardiovascular magnetic resonance]. / Détection de l'ischémie myocardique par l'IRM myocardique de stress.

In the past decade, cardiovascular magnetic resonance (CMR) has evolved considerably. Its clinical applications enable the diagnosis and prognostic assessment of patients with ischemic heart disease. CMR is safe, with absence of any ionizing radiation, and offers the greatest information from a single test, allowing the assessment of myocardial morphology, myocardial function and viability. Stress-CMR can be used for detection and quantification of ischemia. This article analyses the technical approach, the limits and reviews the available literature about diagnostic performance of stress CMR testing and its results in the prognostication of cardiac patients. With further improvements in CMR techniques and the establishment of a standardized study protocol, stress-CMR will play a pivotal role in managing patients with ischemic heart disease.

[Diagnosis and therapeutic usefulness of ultrasonography in unusual gout]. / Intérêt de l'échographie ostéo-articulaire dans le diagnostic et le traitement des arthropathies goutteuses atypiques.

We report a 72-year-old patient who presented with a third metacarpo-phalangeal arthritis of unknown origin. Ultrasonography proved to be useful to the diagnosis of gout and to initiate therapy with allopurinol in the presence of erosions. This observation adds evidence to recent reports that using a specific semiology, ultrasonography could be useful to distinguish gout from pseudo-gout.

[Extradural spinal meningioma: case report]. / Méningiome rachidien extradural. A propos d'un cas et revue de la littérature.

OBJECTIVES: We report a case of purely extradural spinal meningioma and discuss the potential pitfalls in differential diagnosis. BACKGROUND: Spinal meningiomas account for 20-30% of all spinal neoplasms. Epidural meningiomas are infrequent intraspinal tumors that can be easily confused with malignant neoplasms or spinal schwannomas. CASE: A 62-year-old man with a previous history of malignant disease presented with back pain and weakness of the lower limbs. Magnetic resonance imaging revealed a well-enhanced T4 intraspinal lesion. The intraoperative histological examination showed a meningioma (confirmed by postoperative examination). Opening the dura mater confirmed the purely epidural location of the lesion. The postoperative course was uneventful with no recurrence 12 months after surgery. CONCLUSION: Purely extradural spinal meningiomas can mimic metastatic tumors or schwannomas. Intraoperative histology is mandatory for optimal surgical decision making.