Association of calcific rotator cuff tendinopathy with nephrolithiasis and/or cholelithiasis: A case-control study.

This study aimed to examine the association between calcific rotator cuff tendinopathy (RCT) and nephrolithiasis and/or cholelithiasis. A case-control study was conducted on patients diagnosed with RCT between June 2016 and June 2022. RCT was confirmed by ultrasound, and patients were divided into 2 groups: calcific RCT (case) and non-calcific RCT (control). Data were collected retrospectively from electronic medical records and completed by phone calls, looking for a history of nephrolithiasis and/or cholelithiasis; based on clinical features or incidental findings on abdominal and pelvic imaging. A total of 210 patients with RCT were included. Among the 95 cases of calcific RCT, 43 had a history of lithiasis (45.3%) against 23 (20%) from the non-calcific RCT group (P < .001); 21 patients suffered from nephrolithiasis (22.1%) and 26 had cholelithiasis (27.4%) versus 10 (8.7%) (P = .006) and 16 (13.9%) (P = .015) in the non-calcific RCT group, respectively. Logistic regression showed that the independent predictors of calcific RCT included a history of nephrolithiasis (OR, 4.38; 95% CI: 1.61-11.92, P = .004) and a history of cholelithiasis (OR, 3.83; 95% CI: 1.64-8.94, P = .002). In patients with calcific RCT, the occurrence of lithiasis was significantly associated in the bivariate analysis with higher age, body mass index, fasting blood sugar, and HbA1c (all with P < .05), but only with the presence of another site of calcific tendinopathy than the shoulder (OR, 3.11; 95% CI: 1.12-8.65, P = .03) in the multivariate analysis. Nephrolithiasis and/or cholelithiasis are associated with calcific RCT, and their presence predicts calcific RCT at least 3 times. Further research is required to determine the common risk factors and preventive measures against lithogenesis in patients with calcific RCT, nephrolithiasis, and cholelithiasis.

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OBJECTIVES: Musculoskeletal ultrasound has evolved throughout the last decade. This procedure allows accurate corticosteroid injections guidance. Precision is much higher than the infiltration performed blindly or under fluoro- scopy. The purpose of our approach is to describe our tech- nique in ultrasound-guided infiltration of the shoulder with an overview of the results. MATERIAL AND METHOD: 123 cases of ultrasound-guided infiltration of the shoulder were selected in our institution from July 2011 to June 2012. They are divided into sub-acromial sub-deltoid bursitis, biceps tenosynovitis, acromioclavicular osteoarthritis, adhesive capsulitis and cal- cific tendinosis lavage and aspiration. RESULTS: The infiltra- tion technique and the sonographic appearance in each con- dition are described. The rate of improvement is estimated between 70 and 80%. CONCLUSION: The ultrasound-guided infiltration provides an accurate and minimally invasive thera- peutic option before any surgery. Recovery and socio-profes- sional integration prove to be optimal and fast.

[Risk factors of pneumothorax and hemorrhage in lung biopsy: a single institution experience]. / Facteurs de risque du pneumothorax et de l'hémorragie associés a la biopsie pulmonaire: une expérience unicentrique.

OBJECTIVES: CT-guided transthoracic lung biopsy is widely used in pulmonary lesions diagnosis. This technique rarely entails severe complications such as pneumothorax and pulmonary hemorrhage which call for adequate candidates screening. The aim of our study is to statistically assess risk factors related to these two main complications, and determine the best diagnostic workup. MATERIALS AND METHODS: This retrospective study includes 110 patients who underwent CT-guided transthoracic biopsy of a pulmonary lesion. Rates of pneumothorax and pulmonary hemorrhage, as well as their severity, were evaluated, and a correlation with factors related to patients, lesions and biopsy technique were statistically analyzed. RESULTS: Higher rates of complications are significantly found with multiple punctures (pneumothorax risk multiplied by 7.4), longer intra-parenchymal needle tract (5 and 7% higher risk of pneumothorax and hemorrhage for every 1 mm increase in depth), and with smaller lesions (2 and 5% lower risk respectively for pneumothorax and hemorrhage for every 1 cm increase in lesion size). The presence of an interposing rib is associated with a higher rate of hemorrhage. CONCLUSION: Transthoracic lung biopsy is a minimally invasive technique. However, the presence of associated risk factors must lead to consider another diagnostic method.

Ultrasound as an adjunct to radiography in minor musculoskeletal pediatric trauma.

PURPOSE: To assess the value of ultrasound as an adjunct to radiography in minor musculoskeletal pediatric trauma. METHODS: Fifty children with 53 suspected fractures were referred for upper and/or lower limbs X-rays, followed by ultrasound. On radiography, we noted presence of fracture, of soft tissue thickening, or absence of any lesion. On ultrasound, we noted presence of fracture, of soft tissue lesion, or absence of lesions. RESULTS: A fracture was seen on both examinations in 25 patients with 28 fractures.In 4 patients where only soft tissue thickening was seen on radiography, ultrasound showed fracture in 1 patient, hematoma in 1 patient and was normal in 2 patients. In another patient with a doubtful diagnosis of fracture on radiography, ultrasound was normal. In 20 patients with normal X-rays, ultrasound showed fracture in 6 patients, hematoma in 7 patients and was normal in 7 patients. CONCLUSION: Ultrasound was helpful as an adjunct to radiography, it yielded additional bone (7/50 patients) and soft tissue (8/50 patients) diagnostic information in 30% of patients. However, ultrasound remains operator-dependent and can be used only in particular circumstances, especially in children with normal X-rays and a high index of clinical suspicion for an occult or subradiological fracture.

Originality of new imaging techniques in pediatric radiology.

Pediatric radiology is a specialty that combines the performances of imaging and radio-protection. It also has to deal with absence of cooperation and motion of the child which have limited for a long time many radiological applications. Technical advances with shorter acquisition time in CT and MRI, higher frequencies in ultrasound, and digitalization in conventional radiology have widened the indications especially with the new modalities. We present in this article the originalities and the benefits of current pediatric radiology and perform a historic review outlining its evolution.

[Neurological manifestations of Behcet's disease: 22 cases among 170 patients]. / Etude de 22 observations de neuroBehçet dans une série de 170 maladies de Behçet.

OBJECTIVES: To present neurological involvement in Behçet's disease, its prognosis and treatment. METHODS: Our study was retrospective and was done at Hotel-Dieu Hospital of Beirut between 1980 and 2005. All these patients fulfilled the International Study Group criteria for diagnosis of Behçet's disease. RESULTS: Neurological involvement was observed in 13% (22/170) of our patients and was more frequent in men (sex-ratio: 1,75). The mean age of onset for Behçet's disease and NeuroBehçet's syndrome was 26+/-6 and 30+/-8 years respectively. Central nervous system involvement was found in 21 patients and peripheral nervous system involvement in one. Meningoencephalitis and/or transverse myelitis were found in 57% (12/21) of cases (in association with brainstem syndrome in 2 of these cases), brainstem syndrome without meningoencephalitis in 5 cases, tumor-like syndrome in 2 cases, repetitive ischemic attacks in 1 case and cerebral venous thrombosis in one. Focal deficits were the major presenting signs (16 cases) and external oculomotor nerve paralysis was observed in 4 patients. In meningoencephalitis, the cerebrospinal fluid findings were lymphocytic pleocytosis and elevated protein level. CT Scan, performed in 6 patients, was normal in 33% of cases. MRI, performed in 9 patients, was abnormal in 6 and showed abnormal signals distributed over the brainstem and the thalamus in 4, a tumor-like lesion and thrombosis of the left lateral sinus one each. Corticosteroids were usually efficacious but, when used alone, relapse was observed in 31% of patients. One patient who had brainstem syndrome died within 18 months because of a delayed corticosteroid treatment. CONCLUSION: Within central neurological involvement in Behçet's disease, we can individualize 4 clinical aspects: meningoencephalitis (and/or myelitis), brainstem syndrome, tumor-like features and cerebral venous thrombosis. Abnormalities, observed on CT Scan and MRI, by their brainstem localization and their multiplicity, should evoke the diagnosis. Corticosteroids, when prescribed early, are useful and are associated with better prognosis; their association to immunosuppressant agents should be considered in the parenchymatous forms.

[The echocardiographic interpretation of musculoskeletal disease pathology in children]. / Intérêt de l'échographie dans les pathologies musculo-squelettiques en pédiatrie.

Osteoarticular ultrasound, a well established technique in adults, appears to be very useful also in children because of the non ossification of cartilaginous structures, the possibility to avoid sedation and irradiation, and hence the use of scanner and MRI will be reduced. This is a review of the clinical applications of musculoskeletal ultrasound in the pediatric population. Pictorial examples of cases collected between January 2003 and December 2006 of different pathologies encountered in Lebanon are displayed with a discussion of congenital malformations, traumatic lesions, inflammatory and infectious lesions, bone dystrophy and dysplasia, metabolic and tumoral lesions.

The multiple ultrasound patterns of ectopic pregnancy.

Ectopic pregnancy (EP) has a variable and misleading clinical presentation contributing to the confusion with medical or other gynecological disorders. The rapid recourse to diagnostic methods, human chorionic gonadotropin (beta-hCG) titers and transvaginal ultrasonography, represents the best approach not only in the early diagnosis but also in the management and monitoring of patients with diagnosed EP. The purpose of this article is to provide a pictorial essay about EP and its multiple ultrasound (US) patterns. We present a large spectrum of EP aspects diagnosed on US and confirmed by pathology. We also review miscellaneous gynecologic diseases that may mimic EP on US. Although endovaginal US combined with quantitative (beta-hCG) analysis is an excellent tool for identifying EP, it may be normal sometimes in early pregnancies. Knowledge of all these patterns is helpful in establishing an early correct diagnosis, therefore leading to elective and conservative management in stable patients and preventing tubal rupture or substantial hemorrhage.

Spontaneous detorsion of the ovary: can it be diagnosed by MRI?

PURPOSE: To determine whether recent progress in imaging has made it possible to diagnose spontaneous detorsion, which is an accepted concept in the gynecological literature but until now has been a presumptive diagnosis that could not be confirmed because of the lack of imaging proof. MATERIALS AND METHODS: We searched for patients who had a diagnosis of spontaneous detorsion on MRI between January 2000 and January 2003, and selected only patients who met a selection of strict criteria, including mainly enlargement and hyperintensity of ovarian stroma on T2-weighted (T2W) images, clinical findings compatible with torsion and detorsion, and return of the stroma to normal size on follow-up examinations. Other signs of torsion, such as tubal thickening, were appreciated but not mandatory. Clinical follow-up for at least three years was available. RESULTS: Four patients met the study criteria. No stabilizing procedure was performed in the ovaries. One patient recurred and lost her ovary. CONCLUSION: The diagnosis of torsion followed by spontaneous detorsion was made with high probability in a selected number of patients. The clinical management of such patients remains a matter of debate. Laparoscopy with oophoropexy would be useful for young patients in whom close follow-up cannot be achieved.

Variable MR findings in ovarian functional hemorrhagic cysts.

PURPOSE: To describe the magnetic resonance (MR) findings in ovarian functional hemorrhagic cysts (FHC). MATERIALS AND METHODS: A total of 21 patients with 22 FHC, proven by follow-up ultrasound (US) in 11 women and surgery in 10 women, had US and MR examinations within 24 hours. The study was limited to cysts with obvious an echogenic pattern. All patients had T2-weighted fast spin echo (FSE), T1-weighted spin echo (SE), and T1-weighted SE fat-suppressed sequences. RESULTS: Four cysts (18%) were hypointense on T1-weighted-images without and with fat suppression, and hyperintense on T2-weighted-images. Five cysts (23%) were hypointense on T1-weighted images without and with fat suppression but heterogenous on T2-weighted images. Five cysts (23%) were hypointense on T1-weighted images but showed intermediate signal intensity on T1-weighted fat suppression images and heterogenous signal intensity on T2-weighted images. Two cysts (9%) were entirely intermediate on T1-weighted images. Five cysts (23%) displayed high signal intensity occupying less than 30% of the cystic content on T1-weighted images and one cyst (5%) displayed high signal intensity occupying more than 30% of the cystic content. CONCLUSION: Despite an obvious echogenic pattern on US, 64% of FHC were hypointense on T1-weighted images and 18% were also hyperintense on T2-weighted images. Only 36% demonstrated intermediate or high signal intensity on T1-weighted images.

Adnexal torsion: magnetic resonance findings in the viable adnexa with emphasis on stromal ovarian appearance.

PURPOSE: To evaluate ultrasound (US) and magnetic resonance (MR) findings in the viable twisted adnexa. MATERIALS AND METHODS: Ten patients underwent US and MR studies before surgical detorsion. Corrected cross-sectional area of the ovary was defined as cross-sectional area minus areas of cysts and follicles superior to 1 cm. On T2-weighted images, signal intensity of the stroma was graded as type 1 when it was equal to that of urine and type 2 when it was less than that of urine but markedly more than the contralateral side. RESULTS: The tube was twisted in six cases and the ovary in nine cases. All adnexa were viable. The largest ovarian cross-sectional area and the largest corrected ovarian cross-sectional area of the twisted ovary were significantly larger than those of the contralateral ovary (P = 0.043 for US; P = 0.012 and 0.017, respectively, for MR). These ovaries contained types 1 and 2 hyperintensity in six cases and only type 2 hyperintensity in three cases. Tubal thickening was seen on MR in five cases. CONCLUSION: Tubal thickening, enlargement of ovarian stroma as reflected by the corrected cross-sectional area, and hyperintensity of this stroma on T2-weighted images probably related to edema were useful findings in these viable torsions.