Mycotic aneurysm of renal graft artery: diagnosis by ultrasonography.

Mycotic aneurysm of the renal graft artery is rarely detected before its rupture. Diagnosis up to now relied on arteriography. We report on a patient whose preoperative diagnosis was made by ultrasonography. Recent progress with this noninvasive procedure should allow earlier recognition of this life-threatening complication.

The critical level of cadmium in human renal cortex: a reevaluation.

The previously published estimate (160 ppm) of the critical level of renal cortical cadmium (Cd) (Roels et al., Environ. Res., 26 (1981) 217-240) has been reassessed after the depth of the left kidney was measured in each worker by echography. The correction introduced for kidney depth demonstrates that the critical liver cadmium level of 30 ppm corresponds to a corrected critical level of cadmium in renal cortex of 216 ppm. This critical cadmium level in renal cortex (CdKc) protects probably more than 90% of male workers from developing Cd-induced renal dysfunction.

Vessels around the ureteropelvic junction: significance and imaging by conventional radiology.

We studied the influence of vessels crossing the ureteropelvic junction and of the grade of hydronephrosis in 86 patients who underwent endoureteropyelotomy. With a follow-up ranging from 1 to 12 years, the presence of crossing vessels had a significant negative influence on the outcome and recurrence rate of the procedure. The success rate was 82% when no vessels were present but only 33% when crossing vessels were documented. In 13 of 15 failures (87%), a crossing vessel was found at open pyeloplasty. The degree of hydronephrosis was a less potent detrimental factor, with an 81% success rate in low-grade and 54% in high-grade hydronephrosis. The best results (90% success) were obtained in patients with no crossing vessels and low-grade hydronephrosis and the worst (30% success) in those with high-grade hydronephrosis in the presence of crossing vessels. Selection of patients according to those prognostic factors is recommended. Conventional intravenous urographic imaging techniques proved insufficient, and only angiography provided diagnostic accuracy; less-invasive methods are desirable.

[Percutaneous drainage of infected abdominal collections. Guiding principles and results]. / Drainage percutané des collections abdominales infectées. Technique de guidage et résultats.

The authors report their results with percutaneous drainage of 29 abdominal abscesses in 28 patients. Two types of catheters were used: the pigtail angio-catheter and the trocar-catheter. CT scan and ultrasonography were the diagnostic technics used to localize the majority of these collections (20). Seventeen abscesses (58.6%) were cured by this drainage technique. Surgical drainage was necessary in 10 patients (34.4%). Six patients died: 4 of those had surgical drainage and 2 percutaneous drainage only. The cause of death in all cases was multiple organ failure secondary to a virulent noncontrolled infection. Analysis of the results uncovers 3 poor indications for percutaneous drainage: the digestive fistulous tract abscess, acute necrotic pancreatitis with secondary infection and the multi-loculated abscess. The best results are obtained in the case with a hepatic or left subdiaphragmatic abscess. No serious complication was related to the technique itself.

Early diagnosis of acute intestinal ischaemia: contribution of colour Doppler sonography.

The aim of this study was to evaluate the contribution of colour Doppler sonography in the diagnosis of acute intestinal ischaemia. In a two years experience, all patients admitted for acute abdominal pain in our emergency department were evaluated with colour Doppler sonography of the abdomen. The final diagnosis based on clinical evolution, endoscopic or surgical findings and further radiological investigations was compared to the sonographic results. Therapy and final outcome of the patients with acute intestinal ischaemia were also evaluated. In twenty-one patients a final diagnosis of acute intestinal ischaemia (mesenteric ischaemia (n = 13) and ischaemic colitis (n = 8)) was made. Intestinal ischaemia was correctly diagnosed by initial clinical and biological data and further confirmed by sonography in eight cases (mesenteric ischaemia (n = 2) and ischaemic colitis (n = 6)). Eleven other cases were detected by suggestive colour Doppler sonography features (mesenteric ischaemic (n = 10) and ischaemic colitis (n = 1)). Sixteen of the 21 patients had a final favourable outcome (mesenteric ischaemia (10/ 13) and ischaemic colitis (6/8)). We conclude that sonography has a place in the diagnosis of acute intestinal ischaemia and has to be integrated in the diagnostic algorithm of this acute condition. By this way, this diagnosis may be suspected earlier and may allow a prompt and adapted treatment with possible improvement in survival rate.

[Digital angiography of the renal arteries by an intravenous route. A simplified technic]. / L'angiographie numérique des artères rénales par voie intraveineuse. Technique simplifiée.

Of the 1,000 patients addressed to us for intravenous digital angiography (IVDA) of the renal arteries for arterial hypertension, for control of the artery of a transplanted kidney or for preoperative check-up prior to transplantation of a kidney, 738 were examined by a simplified technique. Compared to the standard practice this method simply consists of a manual injection of a standard ionic contrast medium via an antecubital vein punctured with a large catheter needle (caliber 14 G), without preparatory injection of an intestinal antispasmodic. This method has produced a satisfactory arterial opacification in 96% of the cases. The advantages and disadvantages of the technique are discussed. Of the 262 remaining patients, 250 were also examined by the peripheral venous mode, but the technique had to be modified in at least one of its aspects for one reason or another. Only 12 patients were not examined by the peripheral venous mode (7 puncture failures, 4 permanent venous accesses already installed). The IVDA simplified technique appears to be reliable for detecting reno-vascular arterial hypertension and with certain limitations, for the control of kidney grafts. With regard to the preoperative check-up before kidney transplantation, IVDA still does not seem a suitable replacement for the traditional method of angiography.

[Erratic course of bilateral renal angiomyolipomas]. / Evolution erratique d'angiomyolipomes rénaux bilatéraux.

We report a case of multiple and bilateral renal angiomyolipomas demonstrated and followed up by urography, sonography, and computed tomography during a period of 17 years. The diagnosis has been made by computed tomography. Follow-up examinations showed first a stability of the lesions, and afterwards, a rather fast increase of the volume of various masses, without symptoms, followed by a new period of stabilization.

[Chronic arterial mesenteric ischemia: Doppler color ultrasonography demonstration of collateral flow]. / Ischémie mésentérique chronique d'origine artérielle: mise en évidence de réseaux de vicariance par échographie Doppler couleur.

Two cases of atypical mesenteric ischemia where color Doppler US demonstration of the underlying arterial abnormality and collateral supply was possible are presented. Significant stenosis of the celiac axis and thrombosis of the SMA were clearly depicted, along with the presence of collateral arterial supply. Endovascular treatment was successful in both cases. These cases confirm the possibility of detecting collateral flow at Doppler imaging in patients with mesenteric ischemia, both for diagnosis of mesenteric ischemia and endovascular treatment planning.

[Value of echography in the diagnosis of acute intestinal occlusion]. / Intérêt de l'échographie dans le diagnostic de l'occlusion intestinale aiguë.

OBJECTIVE: The aim of our study was to assess the value of sonography in the diagnosis of acute intestinal occlusion. MATERIAL AND METHODS: Sonographic findings were reviewed in 50 cases of intestinal occlusion (39 small bowel and 11 colonic occlusions). The final diagnosis was based on surgical findings (n = 40) or clinical course and further imaging findings (n = 10). RESULTS: Occlusion was correctly detected with sonography in 48 cases (96%). The location was correctly established with sonography in 43 cases (86%). The precise cause was suggested with sonography in 21 cases (42%). COMMENTARY: These results confirm the value of sonography for the diagnosis of intestinal occlusion and the identification of its level and its cause.

[Follow-up of TIPS: evaluation of signs of dysfunction with Doppler ultrasonography]. / Suivi des TIPS: evaluation des signes de dysfonctionnement en echographie doppler.

PURPOSE: to assess the signs of TIPS dysfunction at Doppler sonography. MATERIALS AND METHODS: retrospective study of signs observed in 106 TIPS including 31 TIPS with dysfunction (portoauricular pressure gradient > 12 mmHg). RESULTS: the signs of TIPS dysfunction were a decrease in the mean velocity in the TIPS (for a velocity < 40 cm/sec, 90% sensitivity, 96%), a hepatopetal intrahepatic portal flow (on the right 90% sensitivity, 100% specificity, on the left 95% sensitivity, 92% specificity), a lack of cardiac modulation of the signal in the TIPS (93% sensitivity, 65% specificity), a hepatic vein flow reversal (30% sensitivity, 100% specificity), and, the only direct sign of stenosis, an increase of the mean velocity in the stenosis (42% sensitivity, 95% specificity for a velocity > or = 1 m/sec). CONCLUSION: the most sensitive Doppler signs of tips dysfunction are the indirect signs of stenosis.

[Ureteral lithiasis. Development of the therapeutic strategy and the place of endoscopic treatment]. / Lithiases urétérales. Evolution de la stratégie thérapeutique et place du traitement endoscopique.

In order to evaluate the impact of endourological techniques and extracorporeal lithotripsy on the management of ureteral calculi, we reviewed the charts of 838 patients requiring hospitalization for this pathology from 1982 till 1987. 314 patients were managed conservatively and 524 required intervention therapy: 52 with blind endoscopic techniques, 93 with open surgery, 122 with retrograde ureteroscopy, 168 with percutaneous extraction and 92 with ESWL. Evolution of the therapeutic strategy is discussed and our present approach to ureteral stone management is outlined.

[Lymphoceles after renal transplantation]. / Les lymphocèles après transplantation rénale.

Lymphocele following renal transplantation occurs in 1 to 10 p. cent of cases. Pathogenesis and symptomatology are discussed, based on findings in 8 cases. Diagnosis can usually be established by combining ultrasonography and intravenous urography. Asymptomatic lymphoceles require no treatment, but therapy is essential for those producing symptoms or venous or urinary compression. External drainage should be reserved for lymphoceles with spontaneous skin rupture: colloidal gold injections into the fistula orifice may assist drying up of lymphatic leakage. Intra-peritoneal marsupialization appears to be the most widely employed method in other cases, but recurrence is common when used alone. However it constitutes the treatment of choice, when combined with an epiploplasty.

Colour Doppler imaging of an ascending pharyngeal artery arising from the internal carotid artery.

We present two cases of an extracranial collateral of the internal carotid artery. The descriptions include Doppler recording and colour flow-mapping. The report underlines the epidemiological, embryological and anatomic features (including Doppler characteristics) of the variant, with a view to helping sonographers whenever the carotid examination proves difficult.

Percutaneous transhepatic venous sampling of the pancreas in localizing insulinomas.

Fourteen percutaneous transhepatic venous samplings of the pancreas were performed in 13 patients. Ten patients undergoing 11 samplings were operated, while 3 patients were not operated. Surgical intervention disclosed a single tumor in 8 patients, a double tumor in 1 patient and diffuse hyperplasia in 1 patient. The method allowed correct localization of 5 insulinomas and correct regionalizing of 4 insulinomas in 9 of 10 small tumoral lesions. In 1 double localization of the pancreatic body percutaneous venous sampling only detected 1 lesion. In 1 case of diffuse hyperplasia of the pancreatic tail, the venous sampling was suggestive for a tumor in the pancreatic tail. The method appears to be highly accurate in diagnosing and localizing insulinomas of the pancreas. However, a need persists for 3-dimensional localization of the lesions to facilitate enucleation. Intraoperative ultrasound could become the method of choice for localization of insulinomas.