Diagnostic strategy for the assessment of axillary lymph node status in breast cancer.

The nodal status in breast cancer is a major prognostic factor in terms of survival. It also plays a role in the therapeutic decision-making process. Therefore, the evaluation of lymph node involvement in breast cancer is imperative in establishing a personalized treatment scheme. The sentinel lymph node procedure has proved successful for small breast tumors (T1-T2), limiting axillary lymphadenectomy and its side effects without changing overall survival. Even so, a substantial number of women must undergo axillary lymphadenectomy during a second surgery when the analysis of the sentinel node discloses major nodal involvement. Imaging can improve patient selection, especially those who appear eligible for immediate axillary lymphadenectomy. Ultrasound is able to depict morphological abnormalities in the lymph nodes such as cortical thickening, peripheral vascularization, hilar infiltration and loss of the kidney-shaped appearance of a normal node. When ultrasound is negative, the risk of massive nodal involvement is limited, thus allowing the oncologist to take an approach with the sentinel lymph node procedure. Magnetic resonance imaging (MRI) can also be useful in detecting pathological lymph nodes, particularly with diffusion-weighted MRI sequence.

[Diffusion-weighted MR imaging of the breast]. / Diffusion en IRM mammaire.

Diffusion-weighted imaging is helpful to further characterize lesions that remain indeterminate after morphological and dynamic MR evaluation. Suspicious lesions are hyperintense on diffusion-weighted images with corresponding low ADC values, indicating restricted diffusion and hypercellularity. Benign lesions and tumors responding to treatment usually have no diffusion restriction. ADC maps are useful for T2W hyperintense lesions that could mask the presence of restricted diffusion. Image fusion is sometimes needed to accurately localize enhancing lesions on ADC maps. For indeterminate lesions, a hypocellular appearance suggests a lower ACR category whereas the presence of restricted diffusion suggests a higher category.

[Diagnosis of a malignant lymph node]. / Le diagnostic d'un ganglion tumoral.

There are several imaging techniques, each with advantages and limitations. Standard or computed radiography is always useful. CT diagnosis of an enlarged lymph node is easy but it is very difficult to conclude about its reactive or metastatic nature: subtle signs can help. MRI has similar pitfalls but sometimes it may be possible to identify fibrotic scarred nodes. US with Doppler can evaluate the abnormal angioarchitecture of a metastatic lymph node. Sentinel lymph nodes are easily identified by nuclear medicine. CT-PET provides morphologic and metabolic information which increases the diagnostic accuracy. Imaging work-up strategies for selected malignancies are discussed.

[Acute pyelonephritis. Randomized multicenter double-blind study comparing ciprofloxacin with combined ciprofloxacin and tobramycin]. / Pyélonéphrite aiguë. Etude randomisée multicentrique en double insu comparant la ciprofloxacine à l'association ciprofloxacine et tobramycine.

OBJECTIVES: To investigate the effects of an intravenous injection of tobramycin (T) in female patients with acute uncomplicated pyelonephritis treated with ciprofloxacin (CIP) (500 mg bid per os). METHODS: It was a randomized, multicenter, double-blind study conducted in six departments of emergency medicine. The main exclusion criteria were: previous history of urinary tract malformation of lithiasis, a recent urological procedure, pregnancy, diabetes mellitus, immunodepression, or severe sepsis. The primary criteria for evaluation were: the percentage and rate of clinical recovery, as well as bacteriological efficacy. RESULTS: 118 women were enrolled, 60 in the tobramycin group and 58 in the placebo group. E. coli was the most commonly isolated organism; all organisms were susceptible to ciprofloxacin and tobramycin. Two women in the CIP + T group and four women in the CIP + P group failed to respond clinically. The recovery rate was similar in the two groups (96 and 93% respectively). CONCLUSION: Administration of a dose of tobramycin did not demonstrate its clinical benefit in treatment of acute uncomplicated pyelonephritis treated by oral ciprofloxacin.

[A case of lymph nodes involvement in malakoplakia of the bladder]. / Malakoplakie vésicale et ganglionnaire: à propos d'un cas.

This case illustrates the involvement of lymph nodes in a patient with histologically proven malakoplakia of the urinary bladder. The nodes appeared hyperdense at CT and hyperintense at MR.

[The replication and utilization of a new embalming instrument from an instrumentarium dating from the 30th dynasty of Egypt]. / Réplique et utilisation d'un nouvel instrument d'embaumement provenant d'un instrumentarium daté de la XXXe dynastie égyptienne.

Following our researches on the technique of the priest embalmer in Ancient Egypt, we have copied this instrument and used it on a cadaver, which appears to be as efficacious in maintaining the buccal cavity wide open. Thus prepared, the priest was able to carry out the purification rites.

Popliteal artery pseudoaneurysm revealed by deep vein thrombosis after arthroscopic meniscectomy.

Arthroscopic knee surgery is a widely performed and relatively safe technique with few complications. We report a case of a young girl with a previously undescribed complication of arthroscopy consisting of the association of deep venous thrombosis and concomitant pseudoaneurysm of the popliteal artery.

Imaging findings in giant pseudotumoral paraesophageal varices.

We report a case of variceal changes of the azygos vein, hemiazygos vein, and paraesophageal collaterals presenting as bilateral posterior mediastinal masses in a patient with long-standing portal hypertension due to hepatosplenic schistosomiasis. The case is unusual because the varices were considerably larger than those usually encountered in portal hypertension. Dynamic CT allowed the diagnosis in demonstrating the vascular nature of these masses, which enhanced to the same degree as the other vessels. Noninvasive techniques, such as color Doppler sonography and MRI, may also be useful due to their multiplanar capabilities.

[Ethyl alcohol levels in the expiratory air vs blood alcohol levels. 204 cases in an emergency unit]. / Ethylométrie dans l'air expiré versus ethanolémie. 204 cas dans un service d'accueil et d'urgence.

OBJECTIVES: Twenty to forty percent of all patients admitted to the emergency ward are positive for blood alcohol. Devices which measure alcohol in expired breath have been increasingly used in these units. This study was conducted to compare the results of breath alcohol analyzers with the classical laboratory methods based on enzyme assay and gas phase chromatography. METHODS: All patients with suspected acute ethanol intoxication at admission to the emergency room were included if blood alcohol had been ordered (enzyme assay and gas phase chromatography). RESULTS: There were 204 patients (151 men (74%) and 53 women (26%); mean age 43 +/- 12.7 years, range 14-80). The coefficient of correlation between blood alcohol level determined by gas phase chromatography (GC) and breath alcohol was 0.96 (r2 = 0.92, p < 10(-4)). The coefficient of correlation between breath alcohol and blood alcohol level determined by enzyme assay was 0.96 (r2 = 0.92, p < 10(-4)). Comparing the coefficients of correlation GC/blood (r2 = 0.92) versus GC/enzyme assay (r2 = 0.96) demonstrated a statistically significant difference (p < 10(-3)). CONCLUSION: In our 204 patients, the breath alcohol analyzer gave 3 false positives and 3 false negatives (2.94%). Even though breath alcohol levels are 21.1% lower than the levels given by gas phase chromatography, it is an instantaneous nonaggressive method well correlated with classical blood tests. Nevertheless, this method could not be used in 19.6% of emergency patients due to physical impossibility or refusal, justifying laboratory tests.

Laser guidance system for CT-guided procedures.

In a phantom and in 37 patients, a simple laser guidance system for computed tomography (CT)-guided procedures used the software program of the CT scanner and a laser beam mounted on the CT gantry without need for additional software or components. The skin entry point and angulation of the target path were determined. Then the system projected the desired needle path (including compound angulation), allowing accurate needle placement in all cases, even in small lesions.

Anatomic study of the lumbar region applied to multiplanar imaging techniques: importance and use of oblique vertical sections.

This anatomic study of the lumbar region (as defined by Rouvière [11]) applied to multiplanar imaging techniques was carried out both in the cadaver and in vivo. The cadaver study (5 cases) consisted of anatomic sections (transverse, sagittal, frontal and oblique) and computerised three-dimensional reconstructions after CT studies on subjects injected with colored and radio-opaque latex. The in vivo study (4 cases) used MRI sections and three-dimensional ultrasound sections coupled with the pulsed doppler. The spatially referenced oblique vertical sections revealed the structures from unusual aspects, situating them amidst the retroperitoneal area with the maximum of topographic landmarks. The transposition of these results (obtained by sectional anatomy of the retroperitoneal region) to the new techniques of multiplanar formatting after MRI, ultrasound or CT data acquisition should optimise the investigation of certain retroperitoneal structures by specifying the ideal planes of section for each organ, while diminishing certain artefacts specific to acquisitions in the traditional planes of section. Oblique vertical sections seem eminently suitable for ultrasound location of the suprarenal compartments, study of the renal pedicles and topographic retroperitoneal location. This oblique vertical visualisation constitutes a fundamental resource for the development of video-monitored surgical procedures as it corresponds exactly to the axes of the access routes in percutaneous surgery of the kidney and the adjacent anatomic structures.