Sclerotherapy using Surgiflo and alcohol: a new alternative for the treatment of aneurysmal bone cysts.

PURPOSE: This study aims to review the results of sclerotherapy using Surgiflo in addition to alcohol in primary aneurysmal bone cysts (ABC). METHODS: A total of 16 consecutive patients with histologically confirmed diagnosis of primary ABC were treated by percutaneous Surgiflo and alcohol injection at our institution. Clinical follow-up included the assessment of pain, swelling, limping and functional impairment. Radiological parameters included tumour volume, physis-cyst distance, thickness of cyst cortex, and presence of intracystic septations. Mean follow-up was 35,6 months (24-71 months). Treatment was considered successful when the cyst volume decreased by a minimum of 10%, the bone cortex became thicker, and the distance to physis increased. RESULTS: Mean age at presentation was 9.5 years (5.16-13.84 years). All ABC's were primary and all patients underwent a single Surgiflo and alcohol session except for two (12.5%) who required a second session. All patients had a good clinical result at final follow-up. Satisfactory cyst healing was achieved in 11 cases according to radiological parameters. Tumour volume decreased from a mean of 122 cm3 (111 to 133) before injection to 86 cm3 (76 to 96) at last follow-up (p < 0.01). Physis-cyst distance increased from a mean of 1 cm (0.1 to 2) to 2.1 cm (0.5 to 4) at last follow-up (p < 0.01). Cortical thickness improved from 1 mm (0.5 to 1.5) to 2 mm (1 to 3.5) at last follow-up (p < 0.01).There were no treatment related complications. Surgery was performed in one patient having a C3 vertebra ABC after developing quadriparesis due to tumour progression. CONCLUSION: Sclerotherapy using Surgiflo and alcohol may be used as an efficient, safe and minimally invasive alternative for the treatment of primary ABCs.

[Eating disorders in obese individuals--a psychiatric or internal medicine issue?]. / Poruchy príjmu potravy u obézních--problematika psychiatrická, nebo interní?

Many relations are connecting obesity and eating disorders--one disease is often modifying the other. Anorexia Nervosa and Bulimia Nervosa are mostly treated by psychiatrists. Internal medicine specialists are mostly involved only in complications (e.g. malnutrition, ion disorders). Obesity is mostly treated only by internists. Psychiatrists are only involved in some depressive patients. Obese patients with eating disorders are mostly not sent to psychiatric diagnostics. In this article an overview of eating disorder symptoms and classification is given--binge eating disorder, night eating syndrome and grazing. These symptoms are defined and possibilities of diagnosis and treatment are described.

Case report of a rare spontaneous superficial temporal artery aneurysm.

Unlike posttraumatic temporal artery aneurysm, spontaneous temporal artery aneurysm is an exceptional finding. We report the case of a 34-year-old woman with no history of previous trauma who presented a progressively enlarging right temporal lump. A CT scan revealed a 1.6 cm diameter aneurysm arising from the superficial temporal artery. The aneurysm was surgically resected. The postoperative course was uneventful. Histological examination revealed the presence of intima, media and adventitia.

[Complex anomaly of the origin of supraaortic vessels]. / Anomalie complexe de naissance des vaisseaux supra-aortiques.

We present a congenital variation of the origin of the supraaortic trunks discovered on an angioscan and described here for the first time in the literature. This variation combines a common carotid trunk, an arteria lusoria and an aberrant origin of the vertebral arteries, from the common carotid artery on the right side and from the aortic arch on the left. This complex anomaly is asymptomatic like most of the arterial variations but its detection is useful, even essential preoperatively, in order to adapt the intervention and limit potential complications.

[Transhepatic embolization of a hepatic artery aneurysm following laparoscopic cholecystectomy]. / Embolisation trans-hépatique d'un anévrisme de l'artère hépatique post-cholécystectomie laparoscopique.

Vascular complications following laparoscopic cholecystectomy are less frequent but carry higher morbidity than bile ducts lesions. We report on a 19-year-old patient, who presented a ruptured pseudoaneurysm of the hepatic artery 2 months after laparoscopic cholecystectomy. This case illustrates the alternative of direct transhepatic puncture with exclusive glue embolization in case of endovascular access failure.

[Glue embolization of an unruptured ovarian aneurysm]. / Embolisation à la glu d'un anévrisme non rompu de l'artère ovarienne.

Ovarian artery aneurysms are extremely rare, only 17 cases having been published till now. They usually present with rupture during delivery or in the immediate post-partum. We report a case of asymptomatic, unruptured ovarian artery aneurysm in a 40-year-old woman. Diagnosis was achieved by computed tomography performed for an unrelated reason and confirmed by angiography. Transcatheter arterial embolization using coils and glue excluded the lesion. To the best of our knowledge, this is the first report of an asymptomatic ovarian artery aneurysm, diagnosed outside a context of rupture.

[Giant venous malformation of the tongue: the value of Surgiflo]. / Malformation veineuse géante de la langue: intérêt du surgiflo.

Cavernous hemangiomas are rare congenital venous malformations having propensity for the head and neck. These venous malformations, especially the large and intraoral ones, may cause severe symptoms requiring aggressive treatment. Today, the main treatment is based on sclerotherapy, associated or no with surgery. We report on a patient presenting an enormous venous malformation of the face and tongue, which was treated successfully in our department by embolization, sclerotherapy and maxillo-facial surgery, with a special focus on Surgiflo in our technique.

[Intradural vertebral dissection: case report and literature review]. / Dissection vertébrale intradurale: cas clinique et revue de la littérature.

Vertebro-basilar dissections represent a rare but severe cause of posterior vascular accident and constitute 3 to 7% of non-traumatic subarachnoid hemorrhage. Digital angiography is classically the standard method for diagnosing of arterial dissections but CT and MR angiography are recently widely used as non-invasive and accurate ways of diagnosis. We report a case of atypical subarachnoid hemorrhage, with focus on contribution of the different techniques.

[Non invasive imaging of bilateral vertebral arteries agenesis]. / Imagerie non invasive d'une agénésie bilatérale des artères vertébrales.

Imaging descriptions are lacking for vertebral artery variants reported in the anatomy literature. We report thus a variant of vertebral arteries discovered incidentally in a patient admitted for aortocoronary bypass. Doppler of the supra-aortic arches revealed the absence of cervical segments of both vertebral arteries. Transcranial doppler revealed the presence of intracranial segments of these arteries that continued in a normal basilar trunk. MR-angiography performed on a 3T machine confirmed the bilateral absence of cervical segments and the presence of normal intracranial segments arising from the occipital arteries, branches of the external carotid arteries. Embryologic analysis explains this variant by an involution of cervical segments and persistence of anastomoses between the external carotid system and the vertebrobasilar system that normally regresses during fetal life. This anastomosis enables irrigation of the intracranial vertebrobasilar system by the external carotid artery. The introduction of 3T MR-angiography has enabled better and more precise detection of vascular variants without invasive angiography.

[Left innominate artery arising from the ascending aorta in the absence of right innominate artery]. / Tronc artériel brachiocéphalique gauche naissant de l'aorte ascendante en l'absence de tronc artériel brachiocéphalique droit.

It is important to detect anatomic variants of the supraaortic trunks prior to cardiovascular surgery in order to adjust the surgical technique. We report here, an anatomic variant that was not described previously, detected on a chest multidetector CT and confirmed during surgery. This variant consists of a left innominate artery, arising from the ascending aorta before the right subclavian and common carotid arteries that arise separately from the aortic arch. It is important to notice the absence of associated cardiovascular malformations. We formulate a possible explanation of the described variant through an embryologic study of the vasculogenesis.

Comparisin of low energy breakfast based on special egg white spread product with a standard breakfast.

AIM: The aim of the study was to evaluate the influence of a new form of low calorie breakfast in comparison to standard low fat cheese breakfast. A special spread based on egg white was used (Energy content per 100 g: 319 kJ versus 802 kJ, fat content 1.15 g versus 15 g). Egg white derived products are widely used for weight reduction in Czech Republic. METHODS: 12 non-diabetic patients were included into the study (7 men and 5 women), mean age 38.5+/-10.7 years, and mean BMI 24.6 kg/m2. Standard breakfast was served first in a time interval of 1 week (Krajanka cheese) and after a week wash-out period low energy breakfast based on egg white was served for the same time. Glucose level, insulinaemia and C peptide were evaluated in 0, 60, 120 minute after breakfast. Psychological questionnaire was used to evaluate the taste and satiety. RESULTS: Standard breakfast: insulinaemia 6.3...34.6...11.0 IU, C peptide 0.6...1.6...1.0 pmol/l, glucose 5.0...5.4...4.8 mmol/I Low energy breakfast: insulinaemia 6.6...24.6...10.7 IU, C peptide 0.6...1.4...1.0 pmol/I, glucose 4.8...5.1...5.0 mmol/l. Paired t-test was used for evaluation. No difference in blood glucose level was found, borderline significances of insulinaemia in 60 minute (p= 0.056) and in C peptide (p= 0.089). Significant difference in decrease of insulinaemia between 60 and 120 minute (p=0.03) and borderline significant decrease in C peptide (p=0.055) shows shorter insulin secretion after low calorie breakfast and good insulin sensitivity in this group of lean subjects. Higher satiety and less-worthier taste were found using low energy breakfast. CONCLUSION: Low calorie breakfast induces lower and shorter insulin secretion and has a good metabolic effect in lean subjects. Testing in obese subjects will follow. Egg white derived low calorie products have a beneficial effect on insulin response without any difference in ingested carbohydrate quantity.

[Unusual variation of popliteal arterial branches: 4 axes by early division of the peroneal artery]. / Une variante anatomique inhabituelle des branches de l'artère poplitée: quatre axes jambiers par division précoce de l'artère péronière.

Embryonic development of arteries of the lower limb results from the union of dorsal and ventral systems, explaining many variations at different levels. Some of these are important to recognize during the radiological exam because they can affect therapeutic management. These variations are most often bilateral and symmetrical predominating at the popliteal and subpopliteal levels. Lippert classified them into three types: normal level of popliteal arterial branching, high division of popliteal artery, hypoplastic or aplastic branching with altered distal supply. The length of the tibioperoneal trunk may also vary, rarely measuring more than 5 cm. We report a case combining three variations, two of them previously described in the literature and the third one not yet reported: our patient presented four arteries due to early bifurcation of the peroneal artery.

Dural arteriovenous malformation: an unusual cause of trigeminal neuralgia.

Trigeminal neuralgia has been rarely reported in association with dural arteriovenous malformations (DAVMs). We describe a case of trigeminal neuralgia resulting from compression of the trigeminal nerve at its root entry zone by a large tentorial DAVM. Surgical interruption of the draining vein at its exit from the tentorium resulted in complete angiographic obliteration of the fistula with immediate resolution of the facial pain. We review the literature relevant to this topic and discuss the aetiology and pathophysiology of trigeminal neuralgia as well as the management of tentorial DAVMs.

Use of desmopressin as an alternative to corticotropin-releasing hormone during inferior petrosal sinus sampling in a child with Cushing's disease.

Cushing's syndrome (CS) is rare in children. Information on bilateral inferior petrosal sinus sampling (BIPSS) in children with CS is limited. In the procedure CRH is always used to stimulate ACTH values. In addition, growth failure is the main complication of pediatric CS, mainly due to a profound GH suppression that persists for a few months after cure of the disease. Early treatment with recombinant GH after CS cure may partly reverse this phenomenon. We report herein a case of Cushing's disease (CD) in a 7-yr-old child, presenting with severe growth failure. No pituitary adenoma was shown on magnetic resonance imaging and a BIPSS using desmopressin allowed the identification of a central to peripheral (C/P) gradient; however transphenoidal surgery (TSS) did not cure the disease thus requiring the performance of bilateral adrenalectomy. After cure of the disease, a partial catch up of the growth delay occurred without any GH treatment. Our case reinforces the fact that BIPSS can be performed safely in very young children with CD. It also suggests for the first time that the use of desmopressin during the procedure gives the same information as CRH, as well as confirming the fact that the success of TSS is poor in very young children. Finally, it suggests that growth failure in children with CS can be partially reversed after surgical cure of the disease without any GH treatment and that the high IGF-I observed during corticosteroid replacement therapy is due to a state of IGF-I resistance.

[Aberrant thyroidovertebral artery]. / Artère vertébrothyroïdienne aberrante.

Radiological documents are lacking for many descriptions of variants of vertebral and inferior thyroid arteries reported in the anatomic literature. We report two simultaneous variants, discovered incidentally during a catheterization procedure of the left vertebral artery in a patient admitted for arteriovenous malformation. The vertebral and inferior thyroid arteries arose from a common trunk, issuing directly from the aortic arch. Ipsilateral cervical arteries arose from the subclavian artery that gave no thyroid branch. This aspect was also well documented by Doppler ultrasound. We give an embryological analysis, which would explain these variants by lack of involution of specific arterial segments. More recently, multidetector CT has been found to be helpful in facilitating detection and study of vascular variants.

[Unusual location of a parathyroid adenoma: the carotid sheath]. / Localisation atypique d'un adénome parathyroïdien: la gaine carotidienne.

We report the imaging features of an occult parathyroid adenoma with unusual location in the carotid sheath. Our patient presented with primary hyperparathyroidism. Following negative neck ultrasound and scintigraphy, exploratory neck dissection with partial thyroidectomy was performed twice over a 2 day period without biological response. Cervical and mediastinal CT and MRI were performed with no result. Digital angiography showed a tumoral blush supplied by the left inferior thyroid artery and located in close contact with the carotid artery. Venous sampling of the neck confirmed the left location of the adenoma and a third surgical intervention found the adenoma embedded in the left carotid sheath. This is an unusual case of parathyroid adenoma that necessitated the use of several imaging techniques.

[Pseudoaneurysm of the abdominal aorta due to retroperitoneal lymph nodes, diagnosed by Doppler ultrasound and treated by embolization]. / Faux anévrysme de l'aorte abdominale naissant dans un magma ganglionnaire: diagnostic par écho doppler et traitement par embolisation.

OBJECTIVE: To report a case of pseudoaneurysm of the abdominal aorta due to retroperitoneal enlarged lymph nodes. MATERIALS AND METHODS: A 40 years old patient, with known sarcoma and metastatic retroperitoneal lymph nodes was referred for abdominal ultrasound because severe abdominal pain after defecation. RESULTS: The Doppler examination revealed magma of retroperitoneal lymph nodes surrounding the abdominal aorta inside of which a saccular collection of circulating blood, communicating with the aorta, was detected. The spectrum registered in the channel revealed a bidirectional flow compatible with a pseudoaneurysm. MR angiography confirmed the diagnosis. Successful occlusion was done by coil embolization. CONCLUSION: Pseudoaneurysms of the abdominal aorta are very rare. We report the first case of pseudoaneurysm arising in retroperitoneal lymph nodes. Diagnosis by Doppler ultrasound allowed a rapid treatment by embolization.

[Unusual variation of the splenic artery]. / Variante originale de l'artère splénique.

The authors describe an exceptional variation of the splenic artery found on a preoperative angiogram and confirmed after surgery on splenopancreatectomy specimens. Total duplication of the splenic artery is herein reported for the first time and suggest the need for a new classification of digestive arteries anomalies.