Fotemustine (S 10036) in the intra-arterial treatment of liver metastasis from malignant melanoma. A phase II Study.

Fotemustine is a new nitrosourea which has shown some efficacy on disseminated malignant melanoma (DMM) (24.2% response rate (RR) among 153 patients in a Phase II trial) but little activity on hepatic metastasis (8.8% RR). In order to improve those poor results, hepatic intra-arterial infusion (HIAI) of fotemustine was performed. After two years, thirteen patients, all in good general condition, were evaluable. Seven were pretreated and six had extrahepatic metastasis on entry into the study. All patients had a surgically implanted intra-arterial catheter. The induction cycle consisted of 100 mg/m2/week for 3-4 weeks, followed by 5 weeks rest and maintenance therapy of 100 mg/m2 every 3 weeks for stabilized or responding patients. Two complete responses (CR) (72+ and 145+ weeks) and six partial responses (PR) (7-18.5 weeks) were observed. The hepatic RR reached 61.5%. A RR of 42.8% was registered on preexisting EHM (one CR and one PR on cerebral lesions). Nevertheless, this treatment is limited by the high progression rate of 46.1% in extrahepatic disease. Toxicity was mainly hematologic (grade III-IV), comprising 36% neutropenia and 15% thrombopenia. Hepatic intra-arterial infusion of fotemustine is efficient therapy for liver metastases of DMM, but combination schedules (IV + HIA) are warranted.

[Magnetic resonance angiography: fields of exploration, main indications and limitations]. / L'angiographie par résonance magnétique: domaines d'exploration, principales indications et limites.

Magnetic resonance angiography (MRA) has become a widely accepted technique with regards to the other available noninvasive techniques in the diagnosis of vascular disease. This paper proposes a review of the different indications of this technique in arterial and venous diseases. Among several MRA pulse sequences, the most frequently used until today consisted of a time-of-flight technique which provided angiograms without any injection of intravascular contrast medium. It required to be performed in a plane perpendicular to the main axis of the vessel to be optimal. New techniques, such as contrast medium bolus-enhanced acquisitions allow examination of vascular segments in a plane parallel to their course (coronal for the aorta and lower limb arteries). An increasing number of clinical applications has raised since the implementation of MRA techniques on MR devices; some of them are widely accepted, whereas some others remain under the scope of extensive validation. With a high level of accuracy in grading carotid artery stenosis, MRA is now routinely used in cerebral arterial occlusive diseases and has in part replaced contrast angiography. MRA of the venous system of the brain plays a major role in the diagnosis and follow up of dural venous thrombosis. Other vascular brain diseases, such as vascular malformations, yet have limited uses. Carotid artery dissections are fairly demonstrated with MRA, which can be used for diagnosis as well as for follow-up. The accuracy of MRA in the diagnosis of venous thrombosis of the cervical/mediastinal veins has been reported as high as 100%. Moreover, MRA allows a precise assessment of collateral vessels in case of complete cervical/mediastinal venous thrombosis.

[X-ray computed tomography of lumbosacral roots and primary hypertrophic neuritis (Dejerine-Sottas disease)]. / Scanner X des racines lombo-sacrées et névrite hypertrophique primitive (maladie de Dejerine-Sottas).

CT without contrast of lumbosacral nerve roots was performed in 13 patients with peroneal atrophy and 28 control subjects. Two series of 5 mm serial sections parallel to the plane of the disk were examined at the L4-L5 and L5-S1 levels, and the transverse diameter of the S1 nerve roots measured at the lower part of the lateral recess. Results showed frank bilateral, grossly symmetrical hypertrophy of lumbosacral roots in 8 of the 13 patients. This hypertrophy involved all roots examined (L4, L5, S1), except in one case where only S1 roots were involved. Hypertrophy was often more marked on the distal part of the roots and on spinal nerves, contrasting with the sometimes normal or only slightly altered appearance of the nerve roots emerging from the dural sac. In these 8 cases, the diameter of the S1 nerve roots was 8 to 18 mm, in contrast to a mean of 3.5 +/- 1 mm in the 28 controls. CT scan images were normal in the remaining 5 patients. The presence of a CT image of nerve hypertrophy was in all cases associated with a marked fall in nerve conduction rate (median nerve motor conduction rate less than 25 msec-1), and a decrease in number of myelinated fibers with numerous onion bulbs. In contrast, the absence of CT nerve hypertrophy could not predict the results of electrophysiological and histological examinations.

[Spiral scanners: principles and clinical prospects]. / Scanner hélicoïdal: principes et perspectives cliniques.

Helical computed tomography (CT) involves continuous patient shifting during X-ray source rotation and data acquisition. As a result, a volume data set is obtained in a short period of time. An entire examination can be completed in a single breath hold, without additional radiation exposure, optimizing enhancement with intravenous contrast material. By overcoming some of the constraints of conventional CT, helical CT has advanced prospects, including multiplanar reconstruction and CT angiography, as reviewed in this article. There are undergoing studies to confirm these preliminary findings: its clinical applications are currently evolving.

[Clinical imaging of osteo-condensed metastases]. / Imagerie clinique des métastases ostéocondensantes.

INTRODUCTION: Due to the occurrence of osteoblastic metastases in the course of various cancers, particularly in the course of prostate cancer, we are faced with diagnosis and follow-up issues different from those associated with lytic metastasis. We therefore analyzed the respective advantages of imaging techniques. CURRENT KNOWLEDGE AND KEY POINTS: Most of the time, osteoblastic metastases are evidenced by standard radiography. Due to its ability to demonstrate metastases localization, extent and signs, CT scan is not only of value when osteoblastic metastases are suspected but also for patient's follow-up. MRI provides further information in regard to both the lesion content and osteoblastic degree. Though MRI must be performed after all other imaging procedures, it is of value for multiplanar study of the whole spine. FUTURE PROSPECTS AND PROJECTS: Studies focusing on either the lesion content and volume or helical CT are in progress and aim at better monitoring follow-up, while the objective of dynamic MRI studies is to better analyze lesion content.

[Computerized tomography pelvimetry: recent advances]. / Lapelvimétrie par scanner: récentes évolutions.

We describe a new technique of pelvimetry by computerized tomography (CT), using multislice-CT. This new technique can provide measurements of the classical diameters and is able to bring new informations on anatomical aspect of the bony pelvis, especially of the superior strait, with images easier to understand by obstetricians and midwives. It is a simple technique to perform, without increasing cost. No additional irradiation is needed, but this point has to be confirmed by multicenter evaluation.

[Pelvimetry using x-ray computed tomography]. / Pelvimétrie par tomodensitométrie.

The accuracy and the low radiation dosage administered when tomodensitometry is carried out for pelvimetry has led us to specify the use of this technique in every day practice. We propose to make is still more reliable and to simplify it. We have correlated the measurements obtained on the ultrasound screen with those that have been obtained by measuring the dried pelvis and have sought ways of measuring directly the three fundamental diameters of the pelvis. We have achieved exact measurements within one millimeter. This very precise correlation has been reproduced when we examined skeletons using the tomodensitometer. Then, when we checked again the accuracy of these measurements, we used the method on pregnant women. We have taken two views and two slices: an AP view to study the contents of the uterus and the morphology of the upper strait; a profile view to measure the diameter between the promontory of the sacrum and posterior surface of the symphysis, and we have programmed the two following slices: a perpendicular slice at the level of the upper strait measuring directly the transverse median diameter; another slice at the level of the sciatic spines to measure directly the diameter between these spines. We present this method because it is very simple and absolutely precise and gives all the information that is necessary. The patient does not have to stay still for long and only has a small dose of irradiation. This procedure does not need the use of conversion tables, nor parallel rulers nor standardisation.

[Virtual endoscopy]. / L'endoscopie virtuelle.

After a brief definition of Virtual Endoscopy (VE), the authors, by a personal experience and literature analysis, present the results of this new method in several applications: tracheo-bronchial tree, vessels, colon, bladder, central nervous system; patients were referred by standard endoscopy, advantages and limits were studied. We underline the atraumatic feature of VE and superiority of fibroscopy. Terminology is assessed. To compare two methods, one recent, is not actually specially justified. "VE" development is an undeniably interesting challenge for standard endoscopy. Is is absolutely conceivable that in the next future, an important number of purely diagnostic exams will be carried on by virtual technics (J. F Rey).

[Breast cancer: role of MRI in follow-up of cases treated]. / Cancer du sein : rôle de l'IRM dans le suivi des cas traités.

Conventional imaging (CI) for breast cancer includes mammography and ultrasound. Its limited efficiency is especially manifest for breast cancer follow-up after breast-conserving therapy (i.e. exclusive radiation therapy) and after breast implant. Lack of evidence for definitive diagnosis increases the number of invasive explorations. To improve the specificity of the diagnosis between recurrence or fibrosis, we describe the interest of new imaging (NI) techniques: post-contrast MRI, and MR angiography (MRA), realized in 1 exam. Between October 1993 and December 1994, 82 patients were eligible for these investigations. All patients had an history of conservative breast cancer treatment of breast implant following mastectomy. In all cases CI was not contributive for a precise diagnosis; therefore a biopsy was performed and confirmed the diagnosis of breast cancer. NI was done before biopsy and compared results are following. 19 more patients were evaluated for primary chemotherapeutic response, including a total of 101 patients. Regarding the follow-up of prosthesis and conservative treatment, the correlation with histological control was obtained in 95% with four false diagnoses due to confusion between retroprosthesis relapse and inflammation. Historadiologic correlation were close to 90% for the evaluation of primary chemotherapeutic response. Studies are ongoing to confirm those preliminary findings. Though expansive, these techniques might be cost-effective if they result in a substantial decrease of unnecessary surgical invasive procedures.

[Localized tracheobronchial amyloidosis. A new case studied with x-ray computed tomographic and nuclear magnetic resonance. Review of the literature]. / Amylose trachéo-bronchique localisée. Une nouvelle observation avec étude tomodensitométrique et en résonance magnétique nucléaire. Revue de la littérature.

We report a new case of localized primary tracheobronchial amyloidosis revealed by haemoptysis and effort dyspnea. The CT scan image was a homogeneous and circumferential thickening of the bronchial wall measuring 282 on the Hounsfield scale. At magnetic resonance imaging the amyloid substance was a slightly less intense than fat tissue in T1 and T2-weighted sequences. Treatment using Yag laser photoresection stabilized the lesions with one year follow-up. The review of the literature enables us to summarize the clinical, endoscopic, morphological, prognostic and therapeutic features of tracheobronchial amyloidosis, as well as pathogenic hypotheses and relationship with tracheobronchopathia osteoplastica.

[Facial rejuvenation and concentric malar lift: the FACE RECURVE concept]. / Rajeunissement facial et lifting malaire concentrique: le concept du FACE RECURVE.

Cell ageing is responsible for the increasingly creased appearance of our skin. The ageing of the structures of the face is attributed primarily to the effect of gravity on the tissues. The theory expounded below sets out to prove that the main and initial cause of this ageing is the repeated contractions of the mimic muscles. This concept attributes only a secondary role to gravity in the ageing process, which is initially brought about by muscular contractions. An MRI study recently made it possible to demonstrate the anterior convexity curve of the mimic muscles in the young subject. This curve is due to the existence at the back of these muscles of a deep fat pad. In the young subject, the extent of its convexity and its location give a specific, youthful character to the movements, in terms of direction and amplitude, of the facial muscles. With age, the muscle gradually straightens and shortens due to the repeated contractions that expel the underlying fat and increase the tonus at rest. The application of these new findings to the ageing of the face gives rise to new technical possibilities both in the field of medicine and aesthetic surgery. These new techniques have the same targets: segments of the mimic muscles (maintain over time a good muscular curve and a low tonus at rest) and the underlying fatty convexities. As far as medicine is concerned, the combination of botulinum toxin and filling has proved its worth. But two technical elements are new: the filling products must, at several points, be injected primarily behind the muscle to treat the depressions naturally and restore the initial curve of the overlying muscle. A very low number of units (a quarter to one unit) of botulinum toxin must be injected into certain muscles to diminish the tonus at rest of these muscles without diminishing their strength in maximum contraction. In surgery, new possibilities to treat premature ageing include procedures that combine segmentary muscular weakening, micro liposuctions and retromuscular reinjections. The advantage with regard to the medical procedures is greater stability over time and the greater precision of these muscular actions (one third of a muscle can be weakened for example) and the fat reinjections can be more stable. These procedures can be performed under local anesthesia. In cases of more advanced ageing, surgery offers new treatment possibilities that include, for the midface region, the concentric malar lift. It replaces, on the orbital rim, the sub-orbicularis oculi fat that has descended eccentrically as a result of the contractions of the orbicularis oculi muscle. The procedure, using the subperiosteal detachment plane, is therefore stable over time. At the same time, specific muscles are weakened. The aims of restoring fatty volumes and muscular tonuses are thus achieved. Similarly, in the neck, the platysma muscle is specifically weakened. Each area is studied in line with its specificities. For the first time, the skin tension of the facelift has no more to be maximum to treat the relief of the jawl line, of the palpebro malar groove and so on. The skin tension becomes moderate, just to remove the excess of skin. The relief is faded with the specific muscular and fatty action. The name of this new concept is Face Recurve.

[The value of MRI in the management temporomandibular joint algo-dysfunctional syndromes. Preliminary study]. / Intérêt de l'I.R.M. dans la prise en charge d'un syndrome algo-dysfonctionnel des articulations temporo-mandibulaires (S.A.D.A.M.). Etude préliminaire.

The authors report their initial conclusions regarding the value of M.R.I. in the investigation of temporo-mandibular joint dysfunction. This examination was performed for all varieties of symptomatology: musculo-ligamentary, menisco-ligamentary or meniscal. A detailed examination technic is given. M.R.I. enables meniscal abnormalities to be demonstrated: morphological and positional abnormalities (reducible and irreducible anterior luxations) and structural abnormalities similar to those seen in meniscal pathology within the knee joint.

[Value of modern imagery in the study of coronoido-malar malformations. Apropos of 2 cases]. / Apport de l'imagerie moderne dans l'exploration des dysmorphoses coronoïdo-malaires. A propos de deux cas.

We report two cases of mechanical limitation of buccal opening. CT scanning of bone anomalies diagnosed on standard radiography allowed to define malformation of the coronoid piston on the one hand, and the temporo-malar groove on the other: a combination of Langenbeck's and Jacob's disease in one case and Langenbeck's disease in the other. Coronoidectomy, systematically bilateral, demonstrated these morphological anomalies together with formation of coronoido-malar neo-arthrosis.

Steroid-induced spinal epidural lipomatosis: CT survey.

A new case of spinal cord compression secondary to steroid-induced epidural lipomatosis is reported in a patient treated for dermatomyositis. Computed tomography was performed before the institution of steroid therapy, during spinal cord compression, and after effective surgical treatment. The development of epidural lipomatosis does not require a preexisting lipoma and may occur in a previously normal spine.

Virtual tracheo-bronchial endoscopy: educational and diagnostic value.

The use of Helical CT significantly improves image quality of examinations in a number of clinical settings. It is particularly suited to the study of the tracheo-bronchial tree as a result of new ways of image processing (developed by GEMS research) which can produce virtual endoscopic images without the use of an endoscope. We present our initial anatamo-radiological findings and their educational value as well as our thoughts on potential future clinical applications.

[Endometrial cancer: progress in the evaluation of locoregional extension by imaging techniques]. / Cancer de l'endomètre: progrès dans l'évaluation de l'extension locorégionale par l'imagerie.

In the evaluation of loco regional extension, MRI and ultrasound provide highly valuable information, with respect to the invasion of deep myometrium, which determines prognosis, being highly similar for the two techniques. This gives ultrasound techniques a role of primary intention for reasons of public health economics. MRI, however, improves the work-up of other types of loco regional extension, and CT scan remains an indispensable tool for evaluating overall lymph node involvement and visceral extension.

The clinical measurement of volumes using helical CT.

The object of this preliminary study is to evaluate the new techniques of measurement by helical CT which allow direct assessment of the volume of a lesion in clinical practice particularly by obtaining direct macroscopic anatomical correlation. Its primary application is anatomical, with measurement of the volumes of organs or anatomical structures, the clinical importance of which relates primarily to oncology. We present our initial results, including their applications and limits, before extending this study to a larger series so that it may be compared with other multicentre evaluations.