Arterial Spin-Labeling Perfusion Imaging in the Early Stage of Sturge-Weber Syndrome.

BACKGROUND AND PURPOSE: Sturge-Weber syndrome is a rare congenital neuro-oculo-cutaneous disorder. Although the principal mechanism of Sturge-Weber syndrome is characterized by a leptomeningeal vascular malformation, few data regarding perfusion abnormalities of the brain parenchyma are available. Therefore, the aim of this study was to assess the diagnostic performance of arterial spin-labeling perfusion imaging in the early stage of Sturge-Weber syndrome before 1 year of age until 3.5 years of age. We hypothesized that a leptomeningeal vascular malformation has very early hypoperfusion compared with controls with healthy brains. MATERIALS AND METHODS: We compared the CBF using arterial spin-labeling perfusion imaging performed at 3T MR imaging in the brain parenchymal regions juxtaposing the leptomeningeal vascular malformation in patients with Sturge-Weber syndrome (n = 16; 3.5 years of age or younger) with the corresponding areas in age-matched controls with healthy brains (n = 58). The analysis was performed following two complementary methods: a whole-brain voxel-based analysis and a visual ROI analysis focused on brain territory of the leptomeningeal vascular malformation. RESULTS: Whole-brain voxel-based comparison revealed a significant unilateral decrease in CBF localized in the affected cortices of patients with Sturge-Weber syndrome (P < .001). CBF values within the ROIs in patients with Sturge-Weber syndrome were lower than those in controls (in the whole cohort: median, 25 mL/100g/min, versus 44 mL/100g/min; P < .001). This finding was also observed in the group younger than 1 year of age, emphasizing the high sensitivity of arterial spin-labeling in this age window in which the diagnosis is difficult. CONCLUSIONS: Arterial spin-labeling perfusion imaging in the early stage of Sturge-Weber syndrome can help to diagnose the disease by depicting a cortical hypoperfusion juxtaposing the leptomeningeal vascular malformation.

CTA-Based Patient-Tailored Femoral or Radial Frontline Access Reduces the Rate of Catheterization Failure in Chronic Subdural Hematoma Embolization.

BACKGROUND AND PURPOSE: Chronic subdural hematoma embolization, an apparently simple procedure, can prove to be challenging because of the advanced age of the target population. The aim of this study was to compare 2 arterial-access strategies, femoral versus patient-tailored CTA-based frontline access selection, in chronic subdural hematoma embolization procedures. MATERIALS AND METHODS: This was a monocentric retrospective study. From the March 15, 2018, to the February 14, 2019 (period 1), frontline femoral access was used. Between February 15, 2019, and March 30, 2020 (period 2), the choice of the frontline access, femoral or radial, was based on the CTA recommended as part of the preoperative work-up during both above-mentioned periods. The primary end point was the rate of catheterization failure. The secondary end points were the rate of access site conversion and fluoroscopy duration. RESULTS: During the study period, 124 patients (with 143 chronic subdural hematomas) underwent an embolization procedure (mean age, 74 [SD, 13] years). Forty-eight chronic subdural hematomas (43 patients) were included during period 1 and were compared with 95 chronic subdural hematomas (81 patients) during period 2. During the first period, 5/48 (10%) chronic subdural hematoma embolizations were aborted due to failed catheterization, significantly more than during period 2 (1/95, 1%; P = .009). The rates of femoral-to-radial (P = .55) and total conversion (P = .86) did not differ between the 2 periods. No significant difference was found regarding the duration of fluoroscopy (P = .62). CONCLUSIONS: A CTA-based patient-tailored choice of frontline arterial access reduces the rate of catheterization failure in chronic subdural hematoma embolization procedures.

Pure flat epithelial atypia: is there a place for routine surgery?

PURPOSE: To determine whether it is appropriate to routinely undertake surgery if flat epithelial atypia (FEA) or pure flat epithelial atypia (pFEA) is found on large-core biopsy. PATIENTS AND METHODS: Between 2005 and 2010, 1678 large-core biopsy procedures were carried out, which led to 136 FEA sites being identified, 63 of which across 59 patients were pFEA (four patients had two sites of pFEA each). Forty-eight patients underwent further surgical excision, equating to 52 excised sites of pFEA. RESULTS: Of the 52 operated sites, there were 20 benign lesions (38%), 26 borderline lesions (56%), and three ductal carcinomas in situ (6%). The rate of histologic underestimation was put at 3.8%. Of the three cases that were underestimated, one was discarded because the definitive histology was not representative of the site from which microcalcifications had initially been taken. The other two cases that were underestimated were found in patients with an increased individual risk of breast cancer. CONCLUSION: In patients with no personal or first-degree family history of breast cancer, after complete or subtotal excision under radiology of the radiological lesion, and while excluding images fitting BI-RADS 5, annual monitoring may be offered as an alternative to surgical excision in view of the absence of underestimation found in our study.

Clinical utility and economic viability of a 3T MRI in an anti-cancer centre: The experience of the centre Oscar Lambret.

This paper will try and describe the installation of a 3T MRI in an anti-cancer centre. Functional sequences become indispensable in the assessment of targeted treatments. It is only possible to carry out these treatments on a routine basis in acceptable examination times with 3T. The technical constraints are overcome with third generation MRI and the improvement of the spatial resolution in examination times reduced by 30 to 50% increases patient comfort. Nevertheless, the financial constraints represent a major handicap. It is not possible to obtain an economic balance with rates based on the cost and depreciation of 1.5T imagers that are half the price.

[Diagnosis of a calcified intramural mass next to the posterior mitral valve: review of 4 cases]. / Diagnostic d'une masse calcifiée intrapariétale adjacente à la valve mitrale postérieure: à propos de 4 cas.

PURPOSE: Calcified intramural tumors next to the posterior mitral valve leaflet are rare. The purpose of this paper is to review the differential diagnosis of such lesions. PATIENTS AND METHODS: The CT and MR imaging features of 4 patients (2 males, 2 females) aged between 67 and 76 years with calcified mass at the base of the mitral valve annulus on echocardiogram are reviewed. RESULTS: From a list of potential diagnoses, the two suggested diagnoses include: post-traumatic calcified myocardial hematoma and liquefaction necrosis of mitral annular calcifications. The diagnostic imaging features are reviewed. CONCLUSION: Post-traumatic calcified myocardial hematoma and liquefaction necrosis of mitral annular calcifications may be difficult to diagnose but should be recognized bevause they require simple follow-up.

Photoresponsive viscosity and host-guest association in aqueous mixtures of poly-cyclodextrin with azobenzene-modified poly(acrylic)acid.

In aqueous solutions, beta-cyclodextrin (CD) and cyclodextrin-containing polymers (PolCD) associate with azobenzene-modified polyacrylate (AMP). Inclusion complexes in solution of CD (or PolCD) and AMP, and the viscosity of these mixtures, have been studied as a function of the composition of AMP and concentrations of samples. AMPs are random copolymers containing a low fraction of a light-responsive hydrophobic moieties (<10 mol % of 6-[4-alkylamido]phenylazobenzene acrylamide), and a charged hydrophilic unit, sodium acrylate. PolCDs are beta-cyclodextrin randomly conjugated with epichlorohydrin and fractionated to yield copolymers of average number of CD per chain equal to 50. In dilute solutions, the composition of complexes has been investigated by capillary electrophoresis and UV-vis spectrometry. Association between PolCD and AMP appears more complex than the conventional Benesi-Hildebrand scheme. We identified a tight (quantitative) binding regime followed by a gradual increase of the density of AMP-bound PolCD upon increasing the concentration of PolCD. At higher concentrations, the formation of large clusters has been characterized by the increase of viscosity by several decades. Light-triggered trans-conformation of the azobenzene moieties of AMPs leads to a marked photoswitch of viscosity. Reversible viscosity swings by up to 6-fold were achieved by alternative exposure to UV and visible lights. In contrast, the composition of PolCD/AMP complexes in dilute regime does not respond to light, though subtle modifications of the structures of complexes are reflected by variation of electrophoretic mobilities and UV spectra. The properties of interpolymer clusters and photoviscosity are accordingly the result of modification of the dynamics of association. In practice, the low concentration of photochrome makes it possible to obtain rapid responses in samples having a thickness of the order of cm. The data reported provide guidelines for the formulations of CD/polymer systems, specifically, viscosity enhancers, which should show promising developments in pharmaceuticals or cosmetics.

Maximal exercise and muscle energy metabolism after recovery from exercise hyperthermia syndrome.

Muscle energy metabolism was studied in 30 subjects after recovery from exercise hyperthermia syndrome (EHTS subjects) and 15 healthy men with identical physical activities. Blood lactate, free fatty acid (FFA), serum creatine kinase activity (CK), and glycerol and the temperature in the auditory duct (T(c)) and on the thumb pad (T(sk)) were measured at rest and during and after maximal exercise on a cycloergometer. The EHTS subjects had a limitation of physical performance, with lowered values for maximal oxygen uptake (VO(2max), P < 0.0005), maximal workload (P < 0.05), and ventilatory threshold (V(t), P < 0.0005). The discrepancy between high plasma concentrations of FFA and the lack of decrease in respiratory ratio (RR) suggests that, in EHTS subjects, a very active release of FFA was not balanced by a proportional increase in catabolism. The increased skin temperature was smaller in EHTS subjects (P < 0.05 at 180 and 200 W). At the end of exercise, auditory duct temperature increase was higher in EHTS subjects than in control subjects (P < 0.05). This study thus showed an impairment of muscle metabolism and an abnormality of thermoregulatory mechanisms. These results may provide insight into the underlying physiopathological disturbance.

Swan-Ganz catheter-related pulmonary valve infective endocarditis: a case report.

We report the case of a 29-year-old man with decompensated alcoholic cardiomyopathy who developed a Staphylococcal pulmonic valve infective endocarditis during hemodynamic monitoring, as a consequence of catheter-related bacteremia. As experimentally demonstrated, the damaging role of the pulmonary artery catheter on the endocardial surface plays a major role in the pathogenesis of related right-sided infective endocarditis. Occurrence of bacteremia in a catheterized patient should be considered as a high risk situation, and righ-heart infective endocarditis must be suspected whenever patient presents fever or bacteremia without obvious site of infection. Doppler echocardiography is the reference diagnosis procedure.

[Results of the use of a monoblock pin-plate in trochanteric fracture in elderly patients. Apropos of 100 cases]. / Résultats de l'utilisation du clou-plaque monobloc dans les fractures trochantériennes du vieillard. A propos de cent cas.

The authors report their experience of the systematic use of a monobloc pin-plate in fractures of the trochanteric region in the elderly. The review of a series of 100 cases with a mortality of 16% demonstrates that this technique ensures excellent results compared with other published series. The biomechanical reliability of the monobloc pin-plate allows immediate weight-bearing in all patients. The technical simplicity and the better preoperative preparation of elderly patients allows an improvement in the postoperative course and consequently in patient survival. This operative technique can be proposed routinely with no restrictions.