[AA amyloidosis: a little-known complication of chronic leg ulcer]. / Amylose AA: une complication méconnue des ulcères chroniques de jambes.

INTRODUCTION: AA amyloidosis, secondary to inflammatory chronic diseases like rheumatoid arthritis, is often complicated by renal failure. Chronic inflammatory dermatoses constitute rare causes of AA amyloidosis. CASE-REPORT: We describe two cases of AA amyloidosis discovered after renal failure in patients presenting leg ulcers for several years. AL amyloidosis was suspected in both cases because of a history of monoclonal gammopathy in one patient and of plasmocytoma in the other. The diagnosis of AA amyloidosis was confirmed on renal histology through the detection of AA antibodies in amyloid deposits. No extrarenal amyloidosis was seen in either patient and there were no inflammatory diseases other than chronic leg ulcers. DISCUSSION: AA amyloidosis is caused by serum amyloid protein A (SAA), a reactive inflammatory protein. AA amyloidosis is thus caused by chronic inflammatory diseases, but only rarely by cutaneous inflammatory diseases. To our knowledge, the literature contains only seven other published cases of AA amyloidosis secondary to chronic leg ulcers. A review of the literature does not indicate whether cure of ulcers has any effect on the accompanying renal failure. We imagine that AA amyloidosis secondary to leg ulcer is in fact under-diagnosed. However, since the first specific treatment for AA amyloidosis is currently being evaluated by the Food and Drug Administration, it is essential that this serious complication of chronic leg ulcers be widely recognised.

[New possibilities to study biliary tree and gallbladder: functional magnetic resonance cholangiography contrast-enhanced with mangafodipir trisodium (Mn DPDP)]. / Les nouvelles possibilités d'exploration des voies biliaires en IRM: de l'imagerie morphologique à l'imagerie fonctionnelle avec perfusion de Mangafodipir Trisodium (Mn DPDP).

Mangafodipir trisodium (Teslascan) is a hepatobiliary contrast agent that provides noninvasive opacification of the bile ducts. Using this contrast medium combined with a T1-weighted gradient echo enhanced sequence provides functional imaging of the bile ducts. Second-intention MRI was obtained after the usual morphological study of the bile ducts using heavily T2-weighted sequences (SS-FSE Te eff long and SS FSE Te eff short). This method can detect many biliary duct anomalies: biliary leakage in the postoperative context, mapping of bile ducts and the gallbladder in the search for anatomical variants, analysis of biliodigestive or biliobiliary anastomoses, or a dynamic study of bile secretion and excretion. Opacification of the bile ducts has only been possible until now with invasive tests aggravated by a certain co-morbidity rate and their functional study using biliary scintigraphy limited by mediocre spatial resolution. This new possibility provides access not only to morphological imaging, but also to functional imaging with excellent spatial resolution.

[CT enteroclysis: a pictorial essay]. / L'enteroscanner: revue iconographique.

The objective of the CT-enteroclysis is to distend the entire small intestine equally and sufficiently using a nasojejunal probe and an enteroclysis catheter for administration of a neutral opacifying agent. Today this is the best radiological method available to explore the small intestine because of its good spatial resolution and the rapidity of the exam. It is a high-performance exam when searching for transmural and extramural pathologies, in particular small tumoral lesions. It remains less effective in the exploration of anomalies of the lumen's mucosal lining, contrary to videocapsule endoscopy and the double-balloon enteroscope. It has been recognized that the CT-enteroclysis is a high-performance examination that should replace the small-bowel follow-through exam. However, there are undeniable disadvantages: higher does of radiation, patient discomfort during placement of the enteroclysis catheter, false-positive results, long interpretation time, and the impossibility of exploring the endoluminal aspect of the intestinal mucosal lining. All radiologists should therefore become familiar with the problems involved with this exam and its signs and patterns, which are illustrated in this pictorial review.

[Liver and focal liver contrast: radiologic-pathologic correlation]. / Foie et contraste des lésions focales: corrélation radio-histologique.

Knowledge of the histological features of different components of a liver lesion greatly assists radiologists because it provides understanding of the correspondingimaging features. The imaging characteristics of lesions depend on variations of the extracellular architecture, mainly surrounding stromal tissue. Until histological imaging techniques become available, cellular analysis relies on optical microscopy and immunohistochemistry. Recent advances in imaging techniques now provide additional information on lesions due to improved spatial, temporal and contrast resolution. Correct interpretation of these imaging features should improve diagnosis.

[Lymphoepithelial cyst of the pancreas: a case report]. / Le kyste lympho-épithélial du pancréas: à propos d'un cas.

Lymphoepithelial cyst is a rare benign dysembryoplastic lesion of the pancreas, difficult to diagnose before surgery. The authors report the case of a 44 year old man with low left sided chest pain. CT-scan described a multilocular cystic tumor of the tail of the pancreas. The patient underwent a distal pancreatectomy with splenectomy. Histologic analysis led to the diagnosis of lymphoepithelial cyst of the pancreas. Through this observation, the authors stress the value of imaging in this benign entity that must be considered when evaluating a cystic pancreatic lesion because a different therapeutic approach may be required.

Opportunity 2000 in the National Health Service: a missed opportunity for women.

The NHS in 1991 launched an equality programme for women, setting eight goals to be achieved by 1994. Shows that at least some of the goals are not being met and suggests reasons falling into four categories. First is the NHS context, including trusts' autonomy which is incompatible with a national equality plan. Second, there is a failure of implementation. Third, the programme is inherently flawed: its business rationale is less than convincing to many health professionals who attach a high value to ethics, Fourth, the reasons for failure relate to all equality programmes for women, including a value system which sees the male career pattern as the norm. Concludes that movement towards equality for women in the NHS is only likely to be made if a different approach to goal setting is adopted.

Trade unions and local bargaining in the NHS.

Examines some effects of NHS Trusts moving away at varying speeds from complex national arrangements for determining terms and conditions towards local bargaining. Notes that while there has been some research into the extent and nature of this decentralization, the impact on trade unions has largely been ignored. This research suggests that, far from marginalizing stewards, senior managers have involved them in joint discussions. Although there has not been a renewal of local trade unionism, there has not been a decline, as membership has held up. Moreover, stewards have coped remarkably well with their enhanced roles, even though faced with the increasing and conflicting demands of their work and their union duties, compounded by problems in obtaining time off work because of lack of cover.