[Magnetic resonance angiography of stents]. / Stents et angiographie par résonance magnétique.

PURPOSE: To understand the behavior of stents during contrast-enhanced magnetic resonance angiography (MRA). MATERIALS AND METHODS: Seven different types of stents are explored in vitro with spin echo (SE) T2 sequence and MRA sequences using classification of the intra-prothesis signal. Six patients with 11 different proximal stents are studied by Gadolinium enhanced MRA with the same classification. RESULTS: Stent material is not the only determinant of behavior. In this way, one stainless steel stent produced less intra-luminal hyposignal than a nitinol device. Nevertheless, only a nitinol stent did not alter the intra-prothesis signal and allowed an appreciation of patency, despite a decrease of diameter and presence of edge artifacts. CONCLUSION: Even if stent compatibility is well known with MRI, even with Gadolinium, cannot be used alone to depict stenosis or diameter reduction. Even patency based on the presence of a constant signal, cannot be confirmed routinely with confidence: indeed, only a single stent does not modify intra-arterial signal.

[The development of public health education: the Mauritius experience]. / Evolution de l'enseignement de la santé publique: l'expérience mauricienne.

A public course has been initiated in 1990 in Mauritius for covering the national growing needs of public health specialists. This training course was organized jointly by the Ministry of Health, the University of Bordeaux II and the French Cooperation. After 3 sessions dedicated specifically to the Mauritian physicians, the course has been re-designed for the needs of the other countries of the region. A feasibility study performed in 1994 in the countries of the Indian ocean region showed that during the past decade, the district level had become the focus point to integrate the health programs. This process has progressively transferred a wider and stronger part of the responsibilities from the central level to the district level and the survey showed that most of the health district managers were physicians that did not have the proper background for carrying such responsibilities. According to these results, a course curriculum was created by the Mauritian Ministry of Health and the University of Bordeaux II and submitted to various organisms supporting health program development in the region. This proposal was strongly supported by several agencies (the french Cooperation, Unicef, WHO, World Bank...) who agreed to sponsor candidates for that training course. The first session was organized in 1995, a second one in 1996. This training course is targeted to the medical doctors who are in charge of the management of health services at the district level. It is divided in two parts: A six-weeks intensive training course performed in Mauritius that include formal teaching and practical exercises in small groups for a total of 210 hours. The curriculum is mainly targeted on the various aspects of management as the management of health information (biostatistics epidemiology and computing), the management of human resources, financial resources and material resources. In addition to these main topics, there is an introduction to pedagogy, communication skills and applied research methodology. Following this six-weeks, training the students come back to work in their country and have 8 months to perform a thesis supervised by a local public health specialist. The subject of the thesis has to be closely related with one of the topic taught and should provide an obvious improvement for the public health situation in the district where this physician is acting. In 1995, 22 candidates attend to the course (13 from Madagascar, 4 from Mauritius, 3 from Comoros, 1 from Angola, 1 from Equatorial Guinea and 1 from Tchad), 19 had successively completed all the modules and got the diploma of public health delivered by the University of Bordeaux II. This diploma has been recognized as an equivalent to a master in public health in Mauritius. The evaluation of the courses-performed by the students, the teachers and the financial agencies gave a very positive results although the workload was considered as too important for a six-weeks training course. The recommendations of the 1995 session were included in the 1996 programs which is still on going for 23 candidates. The 97 session will probably extend the number of students up to 40, divided in 4 subgroups for practical exercises. In parallel to the course, a quarterly bulletin will be created and sent to the present and past candidates of this course in order to support a continuous medical education training program targeted to the district physicians.

[Study of atheromatous stenoses of carotid bifurcations by Doppler ultrasound, spiral angio-MRI, magnetic resonance angiography and comparison with arteriography]. / Etude des sténoses athéromateuses des bifurcations carotidiennes par écho-Doppler, angioscanner spiralé, angio-IRM et comparaison à l'artériographie.

PURPOSE: To evaluate Doppler ultrasound (US), Helical CT, Magnetic Resonance (MR) angiography in the detection of carotid bifurcation atherosclerotic disease and comparison with angiography. MATERIALS AND METHODS: After a Doppler US procedure, 56 carotid bifurcations were included (symptomatic stenosis greater than 60% or asymptomatic stenosis greater than 30%). Helical CT, MR angiography and selective arteriography were performed. Stenosis were measured with NASCET criteria. Sensitivity and specificity were calculated and compared to arteriographics findings for each procedure and each grade of stenosis. RESULTS: Helical CT and MR angiography had their best sensitivity in grade 3 (70-99%), 92%, 100% respectively, their specificity was identical (91%). All the occlusions were depicted by the three procedures. CONCLUSION: Association of Doppler US and MR angiography may replace in the future selective angiography in the evaluation of extracranial atherosclerotic disease. Arteriography would be performed only in case of discordance between these two procedures.

[Peritoneal mesothelioma. Contribution of MRI. Apropos of a case]. / Mésothéliome péritonéal. Apport de I'IRM. A propos d'un cas.

Peritoneal invasion by a malignant mesothelioma is less frequently encountered than pleural localization. We report a case of a double pleural and peritoneal localization. CT and MR may be suggestive, especially when pulmonary asbestosis is associated, but pathology (fine needle aspiration or surgical biopsy) is necessary to assess the diagnosis. When possible surgery is performed, with or without associated radiotherapy. Prognosis is nevertheless very poor.

[Malignant adrenocortical carcinoma with atypical aspect. Value of tomodensitometry and magnetic resonance imaging. Apropos of a case]. / Corticosurrénalome malin de présentation atypique. Intérêt du scanner et de l'IRM. A propos d'un cas.

A case of large and non-functioning malignant adrenal tumor is reported. It was discovered incidentally during a check-up ordered because of sciatic pain caused by an osteolytic lesion of the sacrum. This huge abdominal tumor was suspected to be an adrenal tumor one the basis of the CT and MR findings. Histological analysis of percutaneous biopsies were unable to define the site and etiology of these two masses. Only histo-pathological examination of the surgical specimen allowed the diagnosis of adrenal cortical carcinoma.

[Aneurysmal cyst of uncommon site. Apropos of a case. Contribution of MRI]. / Kyste anévrysmal de topographie inhabituelle. A propos d'un cas. Apport de I'IRM.

An aneurysmal bone cyst of fourth metacarpal which occurred in a 7-year-old girl was explored by MRI. MRI findings such as fluid-fluid levels were compared to literature. These levels are inconstant and not pathognomonic of aneurysmal bone cyst. They could occur within others bone tumors. Even if fluid-fluid levels are highly suggestive of aneurysmal bone cyst only pathological study asserts the diagnosis. MRI procedure might be a good procedure for post surgery follow up.

[Gallbladder duplication. Apropos of a case of echographic finding]. / Duplication vésiculaire. A propos d'un cas de découverte échographique.

Duplication of the gallbladder is a rare congenital anomaly, which must be depicted by sonography, although false positive and negative diagnosis could still be made. Usually abdominal sonography allows duplication diagnosis as reported in our case and a cholecystography may be performed to determine the type of the anomaly. When a surgical procedure needs to be performed, especially in case of coelioscopic technique, surgeon needs to know the exact anatomic type of the anomaly and the number of gallbladders he will find.

[Spontaneous rupture of the rectum. Contribution of CT scan. Apropos of a case]. / Rupture spontanée du rectum. Apport du scanner. A propos d'un cas.

We report a case of spontaneous rupture of the rectosigmoid junction demonstrated by surgical and histological examination. This rare complication of chronic constipation is difficult to confirm except in the case of the typical clinical presentation with lower abdominal pain after defaecation and evisceration of small intestine loops through the anus. No radiological procedure is usually performed except for plain abdominal radiograph, to demonstrate inconstant (retro)peritoneal emphysema. CT scan could detect free air outside of the rectosigmoid lumen, suggesting parietal rupture and allowing appropriate surgical treatment on the lower digestive tract.

[Intrarenal migration of two fractured struts of a vena cava filter]. / Migration intra-rénale de deux branches fracturées d'un filtre cave.

Filter complications are quite common. The most frequent are distal or proximal migration, angulation, vena cava thrombosis or perforation. We report one case of filter struts fracture and their migration in the right kidney. This complication could require a surgical procedure and demonstrates the importance of filter follow-up with regular abdominal plain X-rays and possibly CT scan and/or cavography.

[Obstruction of pulmonary arteries. Contribution of the scanner and MRI. Apropos of 10 cases]. / Obstruction des artères pulmonaires. Apport du scanner et de l'IRM. A propos de dix cas.

We present a retrospective study of ten patients presenting non specific clinical manifestations in whom the diagnosis of pulmonary embolism was documented by CT scan and/or MRI. Results of CT scan and/or MRI were compared to DSA bi-selective pulmonary angiography findings. In a large number of cases, CT scan and MRI allowed the detection of the obstruction within the right and left pulmonary arteries (RPA and LPA). Although these techniques did not permit the diagnosis of peripheral clots, pulmonary infarcts were usually depicted by these two procedures. CT scan and/or MRI could be performed as first-line investigations in case of atypical clinical symptoms because of their high relevance for proximal pulmonary artery obstruction, although these two non-invasive procedures cannot indicate the aetiology of the obstruction etiology.

[Thoracic extramedullary hematopoiesis. Apropos of a case]. / Hématopoïèse extra-médullaire thoracique. A propos d'une observation.

Extramedullary haematopoiesis is a compensatory response of bone marrow to abnormal haematopoietic tissue formation: the commonest etiology is thalassemia (generally intermedia). The thorax is a rare site and the posterior mediastinum is usually involved. CT scan completes standard chest radiology and allows fine needle aspiration to provide adequate cytologic material for the diagnosis of extramedullary haematopoiesis, especially when an intercurrent pathology is present and could involve paravertebral areas. Thoracotomy may be necessary in rare cases of complications.

[A survey of the prevalence of leprosy in 5 countries in central Africa]. / Enquêtes de prévalence de la lèpre dans 5 pays d'Afrique Centrale.

The authors report the results of national surveys conducted in 5 Central Africa states: Cameroon, Congo, Gabon, Equatorial Guinea and RCA. The method used was cluster sampling among random populations. Only adults (greater than 15 years of age) took part in the study. The prevalence rates were between 6 and 14 per thousand. They are markedly higher than the official data.

[Perforation of a loop of the small intestine by a Kim-Ray Greenfield endocaval filter. Report of a case]. / Perforation d'une anse grêle par u n filtre endocave de Kim-Ray Greenfield. A propos d'un cas.

Kim-Ray filter complications are usually benign, such as angulation or slight migration. We report and compare with the literature one case of vena cava perforation associated with a small bowel lesion. The follow-up with regular abdominal plain X-rays allows detection of filter angulation, the first step before vena cava perforation. Cavography or CT scan depicts this perforation. Complete or partial surgical removal of the filter may be necessary.

[Rapidly developing benign teratoma of the mediastinum in the adult]. / Tératome bénin du médiastin d'évolution rapide chez l'adulte.

Benign mediastinal teratomas are rare entities, representing 8 to 18% of all mediastinal tumors. Two cases of benign teratomas with a rapid growth suggesting malignancy are reported. CT and MR allowed precise characterization of the multi-tissue composition of the tumor (various CT densities were noted corresponding to adipose, cystic, calcified and hemorrhagic components), and definition of the extension of the process before surgical removal. The per-operative pathological analysis in one patient confirmed the benign nature of the lesion based on the absence of immature tissue, allowing complete surgical removal. The final pathological examination showing mucus secretion by bronchial glandular tissue and intra-tumoral hemorrhage may explain the rapid growth of this kind of lesion. The post-operative follow-up of these benign teratomas is favourable.

[Sampling surveys: an objective method of evaluating the prevalence of leprosy in an endemic zone]. / Les enquêtes par sondage: une méthode objective d'évaluation de la prévalence de la lèpre en zone d'endémie.

The authors submit a simplified sample survey methodology designed to evaluate prevalence rates of leprosy. The system proposed uses a cluster sampling technique. A cluster is a randomly selected group of households. In each household visited by the epidemiological teams all the inhabitants of the target-group are interviewed and examined. Various samples sizes are used (from 6500 to 12,000 peoples) according to the expected prevalence rate of the studied area. All the new cases detected through these surveys are notified to the National Departments in charge of leprosy programmes. Two surveys are already achieved (Equatorial Guinea, Cameroon), a third one in on the way.