Vector-apodizing phase plate coronagraph: design, current performance, and future development [Invited].

Over the last decade, the vector-apodizing phase plate (vAPP) coronagraph has been developed from concept to on-sky application in many high-contrast imaging systems on 8 m class telescopes. The vAPP is a geometric-phase patterned coronagraph that is inherently broadband, and its manufacturing is enabled only by direct-write technology for liquid-crystal patterns. The vAPP generates two coronagraphic point spread functions (PSFs) that cancel starlight on opposite sides of the PSF and have opposite circular polarization states. The efficiency, that is, the amount of light in these PSFs, depends on the retardance offset from a half-wave of the liquid-crystal retarder. Using different liquid-crystal recipes to tune the retardance, different vAPPs operate with high efficiencies (${\gt}96\%$) in the visible and thermal infrared (0.55 µm to 5 µm). Since 2015, seven vAPPs have been installed in a total of six different instruments, including Magellan/MagAO, Magellan/MagAO-X, Subaru/SCExAO, and LBT/LMIRcam. Using two integral field spectrographs installed on the latter two instruments, these vAPPs can provide low-resolution spectra (${\rm{R}} \sim 30$) between 1 µm and 5 µm. We review the design process, development, commissioning, on-sky performance, and first scientific results of all commissioned vAPPs. We report on the lessons learned and conclude with perspectives for future developments and applications.

[Epidemiology and associated factors with depression among people suffering from epilepsy: A transversal French study in a tertiary center]. / Épidémiologie et facteurs associés au syndrome dépressif chez les patients suivis au centre hospitalo-universitaire de Rennes pour une épilepsie.

OBJECTIVES: The occurrence of depression in people with epilepsy is almost twice as common as in the general population. Furthermore, depression is the first cause of lower quality of life among those patients. Which is why the main goal of this study was to assess the epidemiology of depression and its associated factors among the patients from the tertiary department of epileptology in Rennes. METHODS/RESULTS: The subjects were included prospectively and consecutively at the moment of their consultation or hospitalisation in the department. Personal data about the socio-economic status and the type of epilepsy was collected. The subjects filled validated self-assessment of depression (NDDIE), anxiety (GAD-7) and quality of life (QOLIE-10). Thanks to the NDDIE, the patients were divided into: "depressed" and "not depressed"; and the two groups were compared with univariate and multivariate models. Of the 322 patients followed-up in the department between the 17th of June and the 9th of September 2016 223 of them were included in the study. According to the NDDIE, 22.6% suffered from depression; according to the GAD-7, 46.4% suffered from anxiety. In the "depressed" group, 82% were not under anti-depressant medication. In the univariate model, depression was associated with: anxiety, suicidal ideations, lower quality of life, vague nervus stimulation treatment, anticonvulsant benzodiazepine medication or psychiatric medication, and last of all bitherapy or polytherapy antiepileptic medication compared to monotherapy. In the multivariate model, depression was significantly related to anxiety (OR: 8.86 [3.00; 26.19] p=0.0001), suicidal ideas (OR: 7.43 [2.93; 18.81] p<0.0001), anticonvulsant benzodiazepine medication (OR: 3.31 [1.16; 9.49] p=0.0255), and lower quality of life (OR: 1.09 [1.02; 1.17] p=0.0087). Generalised epilepsy was a protective factor with uni and multivariate models (OR: 0.34 [0.11; 1.00] p=0.0492). CONCLUSIONS: In the tertiary epileptic department of Rennes, more than 20% of patients with epilepsy suffered from depression during the inclusion period according to the NDDIE. Among those "depressed" subjects, fewer than one out of five seemed to receive proper psychiatric care. Which is why this study highlights the importance of interdisciplinary cooperation between neurologists and psychiatrists in order to aim at better management of epileptic patients as a whole.

Correction for patient sway in radiographic biplanar imaging for three-dimensional reconstruction of the spine: in vitro study of a new method.

BACKGROUND: Three-dimensional (3D) reconstructions of the spine in the upright position are classically obtained using two-dimensional, non-simultaneous radiographic imaging. However, a subject's sway between exposures induces inaccuracy in the 3D reconstructions. PURPOSE: To evaluate the impact of patient sway between successive radiographic exposures, and to test if 3D reconstruction accuracy can be improved by a corrective method with simultaneous Moire-X-ray imaging. MATERIAL AND METHODS: Using a calibrated deformable phantom perceptible by both techniques (Moire and X-ray), the 3D positional and rotational vertebral data from 3D reconstructions with and without the corrective procedure were compared to the corresponding data of computed tomography (CT) scans, considered as a reference. All were expressed in the global axis system, as defined by the Scoliosis Research Society. RESULTS: When a sagittal sway of 10 degrees occurred between successive biplanar X-rays, the accuracy of the 3D reconstruction without correction was 8.8 mm for the anteroposterior vertebral locations and 6.4 degrees for the sagittal orientations. When the corrective method was applied, the accuracy was improved to 1.3 mm and 1.5 degrees , respectively. CONCLUSION: 3D accuracy improved significantly by using the corrective method, whatever the subject's sway. This technique is reliable for clinical appraisal of the spine, if the subject's sway does not exceed 10 degrees . For greater sway, improvement persists, but a risk of lack of accuracy exists.

Coraco- or costoclavicular paraosteoarthropathies in patients with severe central neurological disorders.

BACKGROUND: Paraosteoarthropathy (POA) is a frequent disabling orthopedic complication after severe central neurological impairment. The hip is the most frequently affected joint (32.1%) followed by the elbow and the shoulder (25%). PURPOSE: To evaluate coraco- and costoclavicular paraosteoarthropathy in patients with severe central neurological disorders. MATERIAL AND METHODS: We report a series of five consecutive patients with severe central neurological disorders who developed a POA of the clavicular region (coracoclavicular or costoclavicular POA). Every patient underwent a clinical, radiological, and computed tomographic (CT) examination of the shoulder region. RESULTS: Four patients had a history of traumatic brain injury (TBI), and one an acute disseminated encephalomyelitis (ADEM). They developed POA of the clavicular region, although not around the glenohumeral joint. The patients complained of shoulder pain and of moderate limitation of movements. Radiological and CT examinations showed the presence of a bony formation in the coracoclavicular space in four cases and extending from the clavicle to the first rib around the costoclavicular joint in one case. CONCLUSION: In patients with severe brain lesions suffering from shoulder pain and moderate limitation of joint movements, POAs of the clavicular region are rare but should be considered.

[MRI of intra-abdominal fat and HIV-associated lipodystrophy: a case review]. / IRM du tissu adipeux abdominal et lipodystrophie VIH, étude cas-témoin.

PURPOSE: To characterize intra-abdominal adipose tissue changes in HIV patients with clinical lipodystrophy using a reproducible imaging technique. Materials and methods. 89 HIV patients with clinical lipodystrophy were included. A single axial T1W image was acquired at the mid L4 vertebral level. Two radiologists measured subcutaneous (SAT) and visceral (VAT) adipose tissues using a semi-automated method. Measurements were compared to a matched population (race, sex, age and BMI). RESULTS: Measurements of abdominal adipose tissue on MRI are reproducible. Three clinical types of lipodystrophy are described in males with increased visceral (VAT) and reduced subcutaneous (SAT) adipose tissues compared to control subjects. Two clinical types of lipodystrophy are described in females with increased visceral (VAT) and unchanged subcutaneous (SAT) adipose tissues. CONCLUSION: MRI with comparison between HIV patients and normal control subjects is a reproducible method to characterize adipose tissue changes of lipodystrophy and evaluate its severity. Evaluation of a adipose tissue distribution in a large control population would be helpful to the study of metabolic disorders.

Ankylosing neurogenic myositis ossificans of the hip. An enhanced volumetric CT study.

Neurogenic myositis ossificans is a disabling condition affecting the large joints of patients with severe post-traumatic impairment of the central nervous system. It can result in ankylosis of the joint and vascular or neural compression. Surgery may be hazardous with potential haemorrhage, neurovascular injury, iatrogenic fracture and osteochondral injury. We undertook pre-operative volumetric CT assessment of 45 ankylosed hips with neurogenic myositis ossificans which required surgery. Helical CT with intravenous contrast, combined with two- and three-dimensional surface reconstructions, was the only pre-operative imaging procedure. This gave good differentiation of the heterotopic bone from the adjacent vessels. We established that early surgery, within 24 months of injury, was neither complicated by peri-operative fracture nor by the early recurrence of neurogenic myositis ossificans. Surgical delay was associated with a loss of joint space and a greater degree of bone demineralisation. Enhanced volumetric CT is an excellent method for the pre-operative assessment of neurogenic myositis ossificans and correlates well with the operative findings.

Colonic angiodysplasia. Clinical, endoscopic, arteriographic signs and histopathological correlations.

The main clinical, endoscopic and radiographic findings in thirty documented cases of colonic angiodysplasia or vascular ectasia are described. We emphasise the association with colonic diverticulosis and cardiovascular pathology, describe the histological changes, summarize the present physiopathological hypothesis, and consider the various therapeutic approaches.

Foraminal epidural extra osseous cavernous hemangioma of the cervical spine: a case report.

STUDY DESIGN: A case report of purely epidural foraminal cervical cavernous angioma assessed by magnetic resonance imaging and diagnosed at pathologic study. OBJECTIVE: To illustrate a rare cause of cervical foraminal mass mimicking a schwannoma. SUMMARY OF BACKGROUND DATA: Several cases of epidural cavernous angioma have been reported. A purely epidural cavernous angioma in a cervical foramen has never been reported in the literature. METHOD: A 36-year-old man sought treatment for acute weakness in his right upper limb with radicular distribution. On magnetic resonance images, the lesion appeared as a foraminal mass with no bone invasion or hematic components. It enhanced after intravenous administration of Gadolinium. Pathologic study after surgery showed a typical cavernous angioma. RESULTS: The patient improved slightly after surgery. CONCLUSION: Clinical and radiologic presentation could be confusing in a purely foraminal epidural cervical cavernous hemangioma. Cavernous hemangioma must be known as a differential diagnosis of a foraminal schwannoma. Diagnosis of cavernous angioma is made easily on pathologic examination.

Zenker's diverticulum associated with multilevel cervical osteomyelitis.

STUDY DESIGN: A case report of cervical osteomyelitis possibly associated with a Zenker's diverticulum perforation. OBJECTIVES: To present clinical, radiologic, and surgical findings of a cervical osteomyelitis due to a Zenker's diverticulum perforation. SUMMARY OF BACKGROUND DATA: A 56-year-old patient was in an intensive care unit for a severe head injury. He was fed via a nasogastric tube. Four months later he developed a pyogenic cervical vertebral infection. METHODS: Plain films and magnetic resonance imaging showed a diffuse cervical osteomyelitis. Investigation of his dysphagia revealed a Zenker's diverticulum. RESULTS: After administration of antibiotics and surgical treatment of the diverticulum, the cervical infection resolved. Plain films and magnetic resonance imaging showed healing with vertebral fusion. CONCLUSIONS: Cervical osteomyelitis is uncommon. Only one case of direct contamination leading to cervical vertebral osteomyelitis after esophageal perforation has been previously described. Direct contamination of the prevertebral soft tissues by bacteria traveling through the fistula may have occurred. The development of vertebral osteomyelitis in this case is consistent with the hypothesis of direct contamination. Management relies on appropriate antimicrobial therapy and surgical management of the diverticulum. The association of Zenker's diverticulum with vertebral osteomyelitis and discitis is a unique, previously undescribed situation.

Epidural lipomatosis. Interest of magnetic resonance imaging in a weight-reduction treated case.

An obese patient with bilateral sciatic pain had epidural lipomatosis on magnetic resonance examination. Treatment that used a weight-reduction program eliminated the symptoms, and after magnetic resonance imaging, revealed reduction of the lipomatosis deposits.

Automated percutaneous lumbar discectomy versus chemonucleolysis in the treatment of sciatica. A randomized multicenter trial.

A randomized clinical trial was conducted to compare the results of automated percutaneous discectomy with those of chemonucleolysis in 141 patients with sciatica caused by a disk herniation; 69 underwent automated percutaneous discectomy and 72 were subjected to chemonucleolysis. The principle outcome was the overall assessment of the patient 6 months after treatment. Treatment was considered to be successful by 61% of the patients in the chemonucleolysis group compared with 44% in the automated percutaneous discectomy group. At 1-year follow-up, overall success rates were 66% in the chemonucleolysis group and 37% in the automated percutaneous group. Within 6 months of treatment, 7% of the patients in the chemonucleolysis group and 33% in the discectomy group underwent subsequent open surgery. The complication rates of both treatment groups were low, with the exception of a high rate of low-back pain in the chemonucleolysis group (42%). The results of this trial confirm previous controlled studies on chemonucleolysis and suggest that controlled studies should be carried out before automated percutaneous discectomy can be considered a useful intervention.

Paraganglioma of the cauda equina: MR findings. One case.

Paraganglioma of the filum terminale is a rare tumor but well described in the neurosurgery and pathology literature. Few MRI reports are mentioned. Paraganglioma, often misdiagnosed with ependymoma or schwannoma on MRI images, must be kept in mind, when a highly vascular lesion with serpentine vessels is observed.

[CMV and VZV encephalitis in AIDS]. / Encéphalites a CMV et VZV au cours du SIDA.

MATERIAL AND METHODS: Eighty patients were followed up prospectively. Histological correlation was obtained in 25 cases. All MRI examinations were performed on at 0.5 Tesla in T1-weighted sequences with and without gadolinium injection, and in axial or frontal T2-weighted spin echo sequences. Histological confirmation was obtained 30 days on average after the last MRI examination. Immunohistochemical stainings were performed in search of CMV, VZV, toxoplasma, HIV antigen and lymphoma. RESULTS: CMV meningoencephalitis was found in 6 cases. In 3 of these it was manifested by atrophy, either isolated or associated with high signal intensity punctiform areas. Histology detected cortical or subcortical microglial nodules. In 2 cases MRI displayed abnormalities of subependymal nodular signals without enhancement, associated with punctiform abnormalities of subcortical signals. Histology showed subependymal foci of necrosis and abnormalities of white matter. In one case, MRI showed a ventriculitis confirmed by histology. VZV meningoencephalitis was diagnosed in 2 cases. MRI displayed abnormal basal ganglia related to meningitis (n = 1). All abnormalities were confirmed at histology. CONCLUSION: Some images (ventriculitis, infarction in basal ganglia, abnormal subependymal signal) would suggest VZV and CMV encephalitis. Other images (abnormalities of punctiform signals or atrophy) are not specific.

[Immediate paper prints for publications and exhibits]. / Tirage papier immédiat pour publications et exhibits.

A simple method for immediate paper printing of documents with film illustrations uses a contact print of the mask of the original.

Phlebography with non-elaborate equipment. / La phlébographie du pauvre.

A simplified phlebocavographic technique is proposed, using a standard radiology table and two 30 x 90 cassettes with a screen. These are placed under the floating tray of the table, and are maintained in place with two corner pieces.

[Phlebography in recent injuries of the lower limbs. Its role in operative decisions]. / La phlébographie chez les traumatisés récents des membres inférieurs. Son rôle la décision opératoire.

67 patients were transferred to a traumatology centre within a mean period of 8 days following an accident in order to envisage treatment of their fractures. Routine pre-operative phlebography was undertaken in 37 patients. It detected the presence of thromboses in 46% of cases. Anticoagulant treatment was started immediately and the date of orthopaedic surgery delayed because of the risk of pulmonary embolism.

[Dynamic study of miction in patients with spinal cord injuries. Comparison with cystomanometry in 50 cases]. / Etude dynamique de la miction chez les traumatisés médullaires. Comparaison avec la cystomanométrie sur 50 cas.

Video recordings during radiodynamic studies of miction (ERDM) in 50 patients with spinal cord injuries produced images markedly superior in quality to permictional films in cases of dysuria. Correlation with cystosphincterometry (CSM) findings were good for normal cases. Dynamic studies were more effective than CSM for the neck, but less reliable for the detrusor and striated muscle on the condition than an electromyogram had been performed. In patients with complete spasticity the type of miction cannot be predicted from the level of the lesion.

[Ultrasonic diagnosis of non-palpable germinal tumors of the testis. Apropos of 2 cases]. / Diagnostic échographique des tumeurs germinales non palpables du testicule. A propos de deux cas.

The germ cell tumors are the most common type of testicular malignant tumors (90%). About 30% are revealed by metastasis usually into the retroperitoneum, with clinically normal testis. Ultrasound reveals a bright echogenic focus into the testis which is typical, considering the clinical presentation, for a regressed germ-cell tumor and guides the side of the orchidectomy which allows to suppress a still active tumoral tissue which will not be eradicated by chemotherapy. Two typical cases with sonographic guidance are reported herein and confronted with the cases previously described in the literature.