[Severe hemoptysis in the onco-hematology patient]. / Hémoptysies sévères du patient d'onco-hématologie.

In France, even though it occurs only exceptionally in cases of hemopathy, severe hemoptysis in cancer is the leading cause of hemoptysis. Without adequate treatment, in-hospital mortality exceeds 60%, even reaching 100% at 6 months. The management of severe hemoptysis should be discussed with the oncologist. Aside from situations of threatening hemoptysis, in which bronchoscopy should be performed immediately, CT angiography is an essential means of localizing the bleeding and determining the causes and the vascular mechanisms involved. In more than 90% of cases, hemoptysis is linked to systemic bronchial or non-bronchial hypervascularization, whereas in fewer than 5%, it is associated with pulmonary arterial origin or, exceptionally, with damage to the alveolar-capillary barrier. The most severely ill patients must be treated in intensive care in centers equipped with interventional radiology, thoracic surgery and, ideally, with interventional bronchoscopy. Interventional radiology is the first-line symptomatic treatment. In over 80% of cases, bronchial arteriography with embolization allows immediate control. Emergency surgery should be avoided, as it is associated with significant mortality. Appropriate and adequate care reduces hospital mortality to 30%, enabling patients to benefit from the most recent, survival-prolonging treatments.

[Rapid outpatient diagnostic pathways for lung cancer: Evaluation after one year]. / Parcours de diagnostic rapide du cancer du poumon : évaluation à un an.

INTRODUCTION: The introduction of coordinated care pathways for lung cancer diagnosis and treatment is a complex process. The purpose of the French Cancer Plan 2014-2019 was to improve referral to treatment waiting times in people with suspected malignancy. The aim of this study was to assess a rapid outpatient diagnostic program for lung cancer established in 2016. METHOD: This retrospective study was carried out in the Pulmonology Department at Tenon Hospital, Paris, France between May 2016 and May 2017. RESULTS: During this period, 118 patients (60%) of patients in the pathway were diagnosed with lung cancer. The median waiting time to first consultation (D1) was 4 (2-7) days. The median waiting time between diagnosis and treatment decision (D4) was 4 (0-8) days. The median waiting time to the first treatment (D5) was 10 (4-15) days for chemotherapy and 27 (16-34) days for surgery. The median waiting time between the first abnormal chest X-ray and the first treatment (D6) was 49 days (34-70). CONCLUSION: Referral to treatment waiting times was consistent with international recommendations. Coordinating nurses improved care pathways in lung cancer patients.

Avaliação morfofuncional do enxerto de túnica albugínea suína na cistoplastia em ratos / Morpho-fuctional evaluation of porcine tunica albuginea as a graft for cystoplasty in rats

O objetivo deste trabalho é avaliar o uso da túnica albugínea suína na cistoplastia em ratos, avaliando funcionalidade, capacidade de reparação do órgão e possibilidades de complicações. Foram selecionados 30 ratos Wistar, machos, de seis meses de idade, divididos em: um grupo teste (TA), em que os animais receberam o enxerto de túnica albugínea suína após a cistectomia parcial e um grupo controle (C), em que os animais sofreram somente a cistectomia parcial. Os animais pertencentes a ambos os grupos foram divididos igualmente em subgrupos de cinco animais cada, que sofreram eutanásia em sete, 28 e 42 dias de pós-operatório. Foi realizada uma análise macroscópica e, posteriormente, uma análise histopatológica da região da ferida cirúrgica. Aos sete e 28 dias, os animais pertencentes ao grupo C e ao grupo TA apresentaram urotelização, regeneração da lâmina própria e da musculatura, porém o grupo TA apresentou menores sinais inflamatórios e maior organização tecidual, principalmente com relação à formação das fibras musculares. Aos 42 dias de pós-operatório, ambos os grupos já apresentavam características histológicas normais. Concluiu-se que o enxerto de túnica albugínea suína obteve sucesso na regeneração da bexiga de ratos, mantendo a funcionalidade do órgão, sem rejeição, e favorecendo a migração celular.(AU)

The aim of this study is to evaluate porcine tunica albuginea as a graft for cystoplasty in rats, regarding bladder function, capacity and possible complications. 30 male Wistar rats with six monthes of age have been selected and separated into two different groups: A test group (TA) in which the animals received a tunica albuginea graft after partial cystectomy and a control group (C) in which partial cystectomy was performed, followed by bladder suture. In each group the animals were euthanized at seven, 28 and 42 days after surgery. Macroscopic and Histological analysis have been performed. At seven and 28 days after surgery the samples from both groups had urothelial lining upon a lamina propria and smooth muscle fibers in regeneration process. However, the TA group showed less inflammatory signs and more organized structure, mainly regarding the smooth muscle formation. At 42 days after surgery all groups showed a bladder wall structure qualitatively identical to the normal tissue. We could conclude that tunica albuginea graft is able to maintain bladder function and support cellular migration without any kind of rejection.(AU)

[Imaging findings in neurocysticercosis]. / Neurocisticercosis. Hallazgos radiológicos.

Neurocysticercosis, caused by the larvae of Taenia solium, is the parasitic infection that most commonly involves the central nervous system in humans. Neurocysticercosis is endemic in practically all developing countries, and owing to globalization and immigration it is becoming more common in developed countries like those in western Europe. The most common clinical manifestations are epilepsy, focal neurologic signs, and intracranial hypertension. The imaging findings depend on the larval stage of Taenia solium, on the number and location of the parasites (parenchymal, subarachnoid, or intraventricular), as well as on the host's immune response (edema, gliosis, arachnoiditis) and on the development of secondary lesions (arteritis, infarcts, or hydrocephalus). The diagnosis of this parasitosis must be established on the basis of the clinical and radiological findings, especially in the appropriate epidemiological context, with the help of serological tests.

Neuroimaging findings in the initial phase of development of high grade cortical astrocytomas.

OBJECTIVES: To describe the neuroradiological characteristics of a series of high grade cortical astrocytomas in the initial phase of development and their pattern of growth during a short time period. MATERIAL AND METHODS: This was a retrospective observational study of the neuroradiological findings in six patients diagnosed with high grade astrocytoma. All presented with a new onset epileptic seizure and focal supratentorial cortical lesions. The diagnosis was established after a short period of clinical and radiological follow-up. RESULTS: Magnetic resonance imaging (MRI) detected a small cortical lesion that was hyperintense in T2-weighted sequences in all six patients. This lesion showed slight or moderate enhancement after the administration of a contrast agent in five patients. All six patients underwent follow-up MRI within six months of the initial MRI examination (mean 79 days). Follow-up MRI showed marked growth of the lesions in all cases, and the histological diagnosis of high grade astrocytoma (glioblastoma in five patients and anaplastic oligoastrocytoma in one) was established after surgical debulking. CONCLUSION: High grade astrocytomas originating in the supratentorial cortex can have an atypical neuroradiological presentation in the early stages. High grade astrocytoma should be included in the differential diagnosis of a cortical lesion that enhances slightly or moderately after the administration of contrast material in a patient with a new onset epileptic seizure.

Idiopathic inflammatory-demyelinating diseases of the central nervous system.

Idiopathic inflammatory-demyelinating diseases (IIDDs) include a broad spectrum of central nervous system disorders that can usually be differentiated on the basis of clinical, imaging, laboratory and pathological findings. However, there can be a considerable overlap between at least some of these disorders, leading to misdiagnoses or diagnostic uncertainty. The relapsing-remitting and secondary progressive forms of multiple sclerosis (MS) are the most common IIDDs. Other MS phenotypes include those with a progressive course from onset (primary progressive and progressive relapsing) or with a benign course continuing for years after onset (benign MS). Uncommon forms of IIDDs can be classified clinically into: (1) fulminant or acute IIDDs, such as the Marburg variant of MS, Baló's concentric sclerosis, Schilder's disease, and acute disseminated encephalomyelitis; (2) monosymptomatic IIDDs, such as those involving the spinal cord (transverse myelitis), optic nerve (optic neuritis) or brainstem and cerebellum; and (3) IIDDs with a restricted topographical distribution, including Devic's neuromyelitis optica, recurrent optic neuritis and relapsing transverse myelitis. Other forms of IIDD, which are classified clinically and radiologically as pseudotumoral, can have different forms of presentation and clinical courses. Although some of these uncommon IIDDs are variants of MS, others probably correspond to different entities. MR imaging of the brain and spine is the imaging technique of choice for diagnosing these disorders, and together with the clinical and laboratory findings can accurately classify them. Precise classification of these disorders may have relevant prognostic and treatment implications, and might be helpful in distinguishing them from tumoral or infectious lesions, avoiding unnecessary aggressive diagnostic or therapeutic procedures.

[Anatomic study of parapharyneal space]. / Estudio anatómico del espacio parafaríngeo.

The parapharyngeal space is considered the key space of the suprahioid neck, being essential to establish the origin and anatomic relations of the lesions of the profound neck. The descriptions of the fascial limits of the parapharyngeal space are variable in the litterature, reflecting some ambiguity in the manuals of anatomy and surgery. We have done a detailed study of this region, working on 5 cadavers, fixed in a solution of phenol and alcohol, and correlating the disection pieces with a radiologic study. The goal has been to improve our anatomic knowledge of the suprahioid neck, to be able to establish an anatomo-clinic-radiologic correlation of the lesions of this region, to be able to establish an differential diagnosis, predict possible ways of dissemination and facilitate the most proper surgical approach.

[Reversible leukoencephalopathy related to cyclosporin treatment]. / Leucoencefalopatía reversible relacionada con el tratamiento con ciclosporina.

INTRODUCTION: At the present time cyclosporin is the most commonly used immunodepressive drug for the prevention of transplant rejection. Although the mechanism by which cerebral dysfunction occurs is not well understood, it has been noted that the clinical and radiological characteristics of cyclosporin neurotoxicity, which may occur even when the blood levels of the drugs are within the therapeutic range, are very similar to those of hypertensive encephalopathy and also resolve when the blood pressure drops. CASE CLINIC: A 35 year old woman, treated with high doses of cyclosporin for a bone marrow transplant, presented with progressive headache, drowsiness, blurred vision and convulsions which coincided with a rapid rise in blood pressure. After antihypertensive treatment full recovery (of all symptoms) was seen. Neuro-radiological studies showed extensive changes in the white matter, mainly in the posterior cerebral regions that were not enhanced after contrast. The changes were compatible with oedema. A magnetic resonance study done two years later was completely normal. CONCLUSIONS: In this clinical report the aetiology and the clinical and radiological characteristics of the neurotoxicity due to cyclosporin are discussed.