[Echography in pyelocaliceal tumors]. / L'échographie dans les tumeurs pyélo-calicielles.

In a study of over 32 pyelocaliceal tumors greater than 1 cm in diameter, the authors review retrospectively the reports of the pyelographic and sonographic documents obtained in these patients before the definitive diagnosis was confirmed by the pathological examination. They observed that pyelography has a much greater diagnostic accuracy than does sonography: 31 confirmed (27) or suspected (4) tumors whereas only one tumor was overlooked (silent kidney) on pyelography and 12 diagnosed tumors, 15 overlooked and 5 diagnostic errors on ultrasonography. However, it should be noted that the results of ultrasonography are much better when the results of the intravenous pyelogram are known than when the latter is performed first. These results are supported by triple-blind re-reading of ultrasonographic documents of tumors of the excretory tract grouped with documents of normal kidneys presenting another disease of the sinus. The authors conclude that ultrasonography must be performed first whenever a tumor of the excretory tract is suspected (especially in case of hematuria) and that in this field, there are essentially two indications for ultrasonography: --To remove a stone (hyperechogenic with a cone of shadow) if there is a pyelocaliceal lacuna of unknown cause. --To establish that obstruction is due to a tumor, in the presence of a silent kidney.

Lymphography in the initial evaluation of endometrial carcinoma.

Two hundred eighty-eight patients with endometrial carcinoma underwent a bipedal lymphography. The proportion of positive lymphangiograms is related to the clinical stage, the histologic grade, and the depth of myometrial invasion. Lymphography is not a significant predictor of survival taking into account the other prognostic factors. A histological examination of the lymph nodes was carried out for 138 patients. Lymphography is not very sensitive but is highly specific, detecting only 50% of metastases with a false positive rate that is too high. It therefore is of little diagnostic and prognostic value for operable patients. It is, however, useful for the followup of lymph nodes of patients treated by radiation therapy.

[Value of magnetic resonance imaging of cancers of the uterine cervix and corpus. Preliminary study apropos of 9 cases of cancer of the corpus and 20 cases of cancer of the cervix]. / Intérêt de l'imagerie par résonance magnétique des cancers du col et du corps de l'utérus. Etude préliminaire à propos de 9 cas de cancer du corps et de 20 cas de cancer du col.

We studied nine cases of endometrial carcinoma and twenty of cervix carcinoma. Correlation with histology is made after curietherapy in 8 cases of endometrial carcinoma. Tumor is not always seen and particularly when there is no mass effect on macroscopic examination. Myometrial invasion is not seen with accuracy: the interruption of "junctional zone" is not a good sign. The cervix tumors are well seen on T2 sequences before any treatment. There extra uterine extension is difficult to appreciate. The best results of RMI were in the follow-up after radiotherapy. Therefore it appears actually to us the best indication of RMI.

[Computed tomography of uterine and ovarian cancer]. / La tomodensitométrie dans les cancers de l'utérus et de l'ovaire.

The authors try to specify the place of Tomodensitometry in utero-ovarian cancers. The examination technique presents no particularities: at best, the interval and the depth of the cuts must be selected. In cervical cancers, the poor appreciation on TDM of adnexal and vaginal involvement renders this examination unsuitable for staging. On the contrary, it is absolutely necessary in order to make the diagnosis of recurrences. In cancers of the body of the uterus, almost always operated on, TDM presents very little interest for the initial work-up except for patients who are difficult to examine or are going to undergo irradiation. As for ovarian tumors, TDM may be useful to detect intra-hepatic metastases before the first operation, to monitor patients undergoing chemotherapy: peritoneal carcinosis is inconstantly detected and TDM cannot replace a second look.

[Imaging of ureteral and pelvic diverticuli. Apropos of 49 cases]. / Les images diverticulaires de l'uretère et du bassinet. A propos de 49 cas.

A review of 49 cases of rare ureteral and pelvic diverticula enables certain clinical and radiologic conclusions to be drawn. Lesions were bifid ureters with blind branches (20 cases), single (8 cases) or multiple (10 cases) diverticula of ureter and pelvic diverticula (11 cases). As previously reported, ureteral diverticula produced few clinical signs whereas these were marked in pyelic lesions. Multiple diverticula are particularly difficult to detect, but diagnosis is the rule from radiologic appearances and is generally confirmed by results of therapy. Their pathogenesis is poorly understood, however, mainly due to lack of histologic data, but recent studies by Cochran suggest they are a particular from of ureteritis. The only debatable point is the frequent association of multiple diverticula with bladder tumor, described by Cochran and confirmed by the authors and unlikely to be the result of chance. Further studies are necessary to provide clarification.

[Cystic pyeloureteritis. Apropos of 40 cases]. / La pyélo-urétérite kystique. A propos de 40 cas.

A series of 40 cases of cystic pyeloureteritis (CPU) is reported, this affection being considered as rare since only about 150 cases have been described in the literature. The lesion is probably more prevalent than was once believed but many cases probably remain unrecognized because of the paucity of radiologic signs. Based on findings in these 40 patients, results of radiologic imaging are described, the technical precautions needed for its detection emphasized and differential diagnoses discussed, none of which presents insurmountable obstacles since these are more theoretical than real. Pathogenesis is thought to be an acquired particular form of urinary mucosa metaplasia associated with urinary tract lesions responsible for stasis or chronic inflammation. Treatment should be conservative because of the usual benign nature of the lesion, although exceptional but possible occlusion by the lesions necessitates a certain surveillance.

[Preoperative radiologic localization of nonpalpable breast lesions. Technics and value. Apropos of 33 cases]. / Localisation radiologique préopératoire des lésions mammaires non palpables. Techniques et intérêt. A propos de 33 cas.

The aim of pre-operative radiologic localization is to facilitate surgery by reducing operation time and by limiting the size of excision of a benign lesion. The detection technique, the so-called "crochet" method, is described and compared with others reported in the literature. Using this method, 33 nonpalpable lesions were detected over a 6 month period and 15% of these cases had malignant tumors.

[Diagnosis of "severe" renal insufficiency of unknown origin: value and respective roles of ultrasonography and intravenous urography (author's transl)]. / Intérêt et place respective de l'échographie et de l'urographie intraveineuse dans le diagnostic des insuffisances rénales "sévères" de cause inconnue.

A retrospective study in 46 patients hospitalised with severe renal insufficiency of unknown origin, and investigated by means of a straight x-ray of the urinary system followed by bilateral renal ultrasonography, emphasises the importance of the latter examination for establishing the medical or surgical origin of the affection. Intravenous urography, which carries certain risks and does not supply supplementary information, can sometimes be avoided, but it is essential when dilated cavities are seen on ultrasonography. In the absence of the latter sign it should be performed when there is clinical evidence of an obstruction, or when the kidneys are of normal size of enlarged, depending on the results of biological tests or the clinical history. The only contraindication to its use is when ultrasonography has shown two small kidneys with thin cavities resulting from an acute episode of a pre-existing chronic nephropathy.