Arteriovenous fistulae complicating central venous catheterization: value of endovascular treatment based on a series of seven cases.

OBJECTIVES: To point out the usefulness and effication of endovascular treatment of arteriovenous fistulae complicating the insertion of central venous catheter. MATERIAL AND METHOD: Retrospective study of 7 cases treated between 1983 and 1993. The central venous catheterization had involved the right internal jugular vein in 5 cases and the right subclavian vein in 2 cases. RESULTS: Isolated endovascular therapy was performed in 5 cases. Surgery was necessary in 1 case to remove an hematoma. In another case, occlusion of a large AVF was performed during intraoperative endovascular temporary occlusion of the AVF. The choice of the occluding agent was primarily dictated by the hemodynamic and anatomical conditions (releasable balloons, coils). Vertebro-vertebral fistulae (3 cases) could be treated with patency of this vessel. No complications were encountered. CONCLUSION: Endovascular approach is a reliable and safe method to perform occlusion of post catheter AVF.

[Computerized tomography-guided needle biopsy for the diagnosis of pulmonary nodules: analysis of a series of 41 patients]. / Ponction à visée diagnostique de nodules pulmonaires sous repérage scanographique: analyse d'une série de 41 patients.

This study was aimed at assessing percutaneous biopsy under computerized tomography (CT) guidance, its results in terms of diagnostic value, factors contributing to its complications or success, and its indications. Results obtained from a series of 41 patients and data from previous clinical trials were compared. Patients who were not eligible due to either poor physical condition or a tumor that could not be reached were not included into the study. Various factors, ie, the tumor location, the size of the lesion, the distance between the lesion and the thoracic wall, and the type (histological and/or cytological) of samples, were analyzed. Results were evaluated according to the disease evolution or pathological findings. Tumoral cells were found in 23 samples. Eighteen samples were negative for malignancy, with eight benign lesions and ten false negative. Complications that occurred just after the biopsy were recorded. Failures and complication factors were analyzed and compared to those already described. CT-guided needle biopsy is an admitted alternative to thoracotomy, even for small nodules deeply located. The use of this technique should be discussed when fiberoptic endoscopy leads to negative results. Various tumors cannot be reached using CT-guided needle biopsy and this technique is more efficacious for bulky nodules. The thickness of lung parenchyma passed through does not seem to change the risk of pneumothorax. The use of laser guidance might help locate the tumor with more accuracy.

[Value of echography in a case of polyorchidism]. / Intérêt de l'échographie dans un cas de polyorchidisme.

We report a case of polyorchidism diagnosed by scrotal ultrasonography and confirmed by surgery. Sixty eight cases have been reported in the literature.

[Blunt injury of the larynx by hanging. X-ray computed tomographic aspect]. / Traumatisme fermé du larynx par pendaison. Aspect scanographique à propos d'un cas.

The closed laryngeal traumas by attempt of hanging are rarely studied by medical imaging. The lesions are evaluated by fiberoptic endoscopy and CT scan. We report a case of complicated lesions of the larynx with rupture of the cricothyroid membrane, diagnosed by CT scan and we discuss the usefulness of this technique.

[Multiple calcified cerebral metastases revealing bronchial adenocarcinoma. Apropos of a case]. / Métastases cérébrales calcifiées multiples révélatrices d'un adénocarcinome bronchique. A propos d'un cas.

Calcified brain metastases are rare. They are unique or multiple. The primary site is lung, breast, gastro-intestinal tract, uterine cervix, bone or may be unidentified. It corresponds pathologically to an adenocarcinoma, a sarcoma or to a squamous cell carcinoma. We report a case of multiple calcified brain metastases discovered before primary tumour (bronchial adenocarcinoma), raising the problem of differential diagnosis resolved by stereotaxic brain biopsy.

[Meningeal metastases of ovarian cancer. Contribution of imaging]. / Métastases méningées du cancer de l'ovaire. Apport de l'imagerie.

BACKGROUND: Secondary meningeal localizations are uncommon and may disclose reactivation of a malignant disease. Most meningeal metastases occur in breast cancer, exceptionally in primary ovarian cancer. CASE REPORT: We report 2 cases of secondary meningeal localizations of ovarian cancer. The diagnosis was clinical, supported by cerebrospinal fluid analysis and computed tomography and magnetic resonance imaging. DISCUSSION: Establishing the diagnosis of carcinomatous meningitis may be difficult. Clinical signs and biological data are not always conclusive. If spinal tap is contraindicated or negative, imaging, particularly magnetic resonance imaging is highly contributive in establishing the diagnosis of secondary localization. A precise evaluation of the invaded tissues is quite helpful in guiding therapeutic management based on chemotherapy, tumor resection or radiotherapy.

Prevalence and risk factors of bacteriuria in cirrhotic patients: a prospective case-control multicenter study in 244 patients.

BACKGROUND/AIMS: The prevalence and risks factors of bacteriuria in cirrhotics have not been assessed by case-control study, and there are conflicting data concerning the role of liver failure and of ascites. The aims of this study were: i) to evaluate the prevalence of bacteriuria in cirrhotics, ii) to search for associated factors, iii) to evaluate the role of bladder post-void residual volume, and iv) to test the sensitivity of isolated bacteria to norfloxacin. METHODS: The prevalence and risk factors of bacteriuria on admission were determined by a multicenter prospective case-control study. RESULTS: Two hundred and forty-four cirrhotic patients and 240 controls were studied. Bacteriuria was present in 38 patients (15.6%; IC 5%: 11%-20%) and 18 controls (7.5%; IC 5%: 4.2%-11%; p<0.001). By univariate analysis, female sex and ongoing diuretic treatment were associated with bacteriuria (p<0.0001 and p<0.04, respectively). Pugh's grade, ascites and bladder residual volume were not associated with bacteriuria. By multivariate analysis, female sex (p<0.0001) and Child-Pugh score (p<0.03) were predictors of bacteriuria. Sensitivity of bacteria to norfloxacin was observed in 94.7%; sterile urine cultures were noted in 95.2% of patients treated with this antibiotic. CONCLUSION: Bacteriuria is twice as frequent in cirrhotic patients as in matched controls, and there is a trend to association with female sex and liver insufficiency.