[Influence of palmar digital artery patency on neurological recovery of palmar digital nerve lesions]. / Influence de la perméabilité de l'artère digitale palmaire sur la récupération nerveuse dans les lésions des nerfs digitaux palmaires.

Should the palmar digital artery be repaired in the pedicular section of the finger? This repair is discussed in the case of a unilateral pedicular lesion on a vascularised finger, and often neglected in current surgical practice. The problem is knowing the role of a permeable artery in sensory recovery and cold intolerance. The author presents a retrospective study on palmar digital nerve reinnervation after section with or without palmar digital artery section. Artery permeability was studied by doppler ultrasonography. Forty nerves in 35 patients were studied after at least 3 years had passed. Twenty-five nerves were associated with a permeable artery, 15 with a non permeable artery. The functional result was evaluated with the Weber test (S2PD) and by the presence or absence of cold intolerance. This work demonstrates the statistically significant role of the palmar digital artery in sensitive recovery quality and cold intolerance appearance. Its permeability ensures a better sensitive result with an 8.84 mm S2PD versus 13.47 mm with a non permeable artery. The benefit of the systematic repair of palmar digital artery is thus demonstrated for the first time. This repair is all the more justified if local conditions are unfavorable, in particular in contuse wounds with associated lesions (tendinous or bone).

[Combined bipolar radiofrequency and cementoplasty of bone metastases]. / Radiofréquence bipolaire et cimentoplastie dans le traitement des métastases osseuses.

Bone metastases are the most common cause of pain in cancer patients. Pain management in cancer patients, often revealing the disease and always present at advanced stages, is an important and difficult task. Pain is not always properly controlled by high doses of specific medication, radiation therapy or chemotherapy. When these therapies do not provide adequate pain relief, percutaneous neurolysis, infiltrations, alcoholizations and cementoplasty may be considered. More recently RF ablation has been proposed. On weight-bearing bones, RF can be combined with acrylic cement injection. The authors present here this very effective new technique which is complementary to classical pain management techniques.

[Three-dimensional 3D modeling: First applications in radioanatomy and interventional radiology under CT guidance]. / Modélisation tridimensionnelle des vertèbres types: Premières applications en radioanatomie et radiologie interventionnelle sous guidage tomodensitométrique.

PURPOSE: To model vertebrae in 3D to improve radioanatomic knowledge of the spine with the vascular and nerve environment and simulate CT-guided interventions. METHOD AND MATERIALS: Vertebra acquisitions were made with multidetector CT. We developed segmentation software and specific viewer software using the Delphi programming environment. RESULTS: This segmentation software makes it possible to model 3D high-resolution segments of vertebrae and their environment from multidetector CT acquisitions. Then the specific viewer software provides multiplanar reconstructions of the CT volume and the possibility to select different 3D objects of interest. DISCUSSION: This software package improves radiologists' radioanatomic knowledge through a new 3D anatomy presentation. Furthermore, the possibility of inserting virtual 3D objects in the volume can simulate CT-guided intervention. CONCLUSION: The first volumetric radioanatomic software has been born. Furthermore, it simulates CT-guided intervention and consequently has the potential to facilitate learning interventions using CT guidance.

[Functional and sonographic shoulder assessment after Seidel nailing: a retrospective study of 29 cases]. / Evaluation fonctionnelle et échographique de l'épaule après enclouage de Seidel.

PURPOSE OF THE STUDY: Centromedullary nailing with a Seidel nail is a validated treatment for humeral shaft fractures which some teams have abandoned due to the injury caused to the rotator muscles. The purpose of this study is to assess shoulder function (Constant and DASH) after nailing procedures and to analyze sonographic findings. MATERIAL AND METHODS: Twenty-nine patients who underwent Seidel nailing between 1996 and 2002 were reviewed by an independent operator at 36 months follow-up on average (range 11-84 months). The sex-ratio was 1.64. Mean age at surgery was 41.5 years (range 17-81 years). The dominant side was involved in 17 cases. Fracture was caused by a traffic accident in 13 cases, a fall in 12, and a blunt injury in 4. The fracture was situated in the mid third of the shaft in 19 cases, the upper third in 3, the mid and lower third in 3 and mid and upper third in 3. Mean delay before surgery was 2.4 days. Initial complications were medioulnar palsy (n=1), complete brachial palsy (n=1), partial brachial palsy (n=1). There was one open Cauchoix I fracture. RESULTS: Bone healing was achieved in 27/29 patients at 3.5 months on average. Revision was required in nine patients. The Constant score was 69.1 (86.9% contralateral). The weighted Constant score was 81.7 and the DASH was 25. The Constant score was significantly better in patients aged less than 50 years and with transverse fractures. Sub-acromial space narrowing was observed in six patients at follow-up and only 9/28 sonographic examinations (32%) were normal; most shoulders presented transient healing lesions. DISCUSSION: This series was comparable with others regarding patient satisfaction, bone healing and complications, but was less satisfactory for the Constant score and time to healing. We have found that using a subjective function score (DASH) with an objective score (Constant) enables a better assessment of shoulder function. Like Gaullier, we consider that after cuff healing, anterograde nailing does not compromise shoulder function despite the injuries observed sonographically.

[Ganglion cyst rupture in the retro-femoral fat: a report of two cases]. / Rupture de kyste mucoïde dans la graisse rétro-fémorale: à propos de deux cas.

Ganglion cysts are ubiquitous cystic lesions without synovial wall and inconstant communication with the articular cavity. The later must nonetheless always be carefully looked for. We report two cases of ganglion cyst rupture in the retrofemoral fat simulating phlebitis with thigh cellulitis. To the best of our knowledge, this has not been previously reported in the literature. Familiarity with this entity ensures adequate medical diagnosis and management, avoiding unnecessary imaging and laboratory work-up and inappropriate use of anticoagulant and antibiotic.

Axe fragment pulmonary embolism. Interest of enhanced multislice helical CT with cardiac synchronised acquisitions.

A case of pulmonary embolism by an axe fragment investigated with enhanced mdCT with cardiac synchronised acquisitions is described. The authors stress the advantages of the techniques versus angiography for the exploration of foreign body pulmonary artery embolism.

[Superior mesenteric artery syndrome: a cause of vomiting in children. Report of 3 cases]. / Syndrome de l'artère mésentérique supérieure: une cause à évoquer devant des vomissements isolés chez l'enfant. A propos de 3 observations.

Duodenal obstruction by Superior Mesenteric Artery (SMA) is a misdiagnosed vomiting syndrome in children. Several factors are involved, including rapid weight loss, rapid statural growth without weight augmentation. Diagnosis is suspected when an improvement is achieved by ventral decubitus and it is confirmed by plain films of the abdomen, GI study with barium and echography, measuring the aortomesenteric angle (inferior to 25-30 degrees ). Patients must at first be treated conservatively. Surgery is indicated for occlusive episodes with unsuccessful conservative therapy. The authors report 3 cases with different clinical presentation. However, all the patients presented important weight loss and vomiting.

[Value of the pubic tubercle as a CT reference point in groin hernias]. / Valeur de l'épine du pubis comme repère TDM des hernies de l'aine.

PURPOSE: To assess the value of the pubic tubercle as a CT reference point in diagnosing the different types of groin hernia before surgery in patients presenting with mechanical bowel obstruction. MATERIALS AND METHODS: Retrospective review of CT examinations performed for small bowel obstruction in our department during 2003. Twelve cases of groin hernia causing small bowel obstruction were included. All CT examinations were reviewed by 2 abdominal radiologists. The surgical report of all 12 included cases was reviewed for final diagnosis. RESULTS: Twelve cases of groin hernia causing small bowel obstruction were reviewed in our department during 2003. Eight cases corresponded to small bowel obstruction caused by inguinal hernia (4 direct and 4 indirect) and 4 to small bowel obstruction caused by femoral hernia. In each case, the diagnosis suggested at CT using the pubic tubercle as a reference point was surgically confirmed. CONCLUSION: The pubic tubercle is an excellent reference point at CT for diagnosing inguinal and femoral hernias. Preoperative diagnosis is important because it may change the choice of surgical procedure.

[Value of the small bowel feces sign at CT in adhesive small bowel obstruction]. / Le feces sign: valeur d'un signe TDM dans l'occlusion du grêle sur bride ou adhérences péritonéales.

PURPOSE: The purpose of this study is to describe the CT features of the small bowel feces sign and to determine its value as a positive criteria of non-severity in adhesive small bowel obstruction. MATERIALS AND METHODS: We performed a retrospective study of adhesive small bowel obstructions diagnosed by CT from January 2001 to December 2002. All CT examinations featuring a small bowel feces sign were included. Clinical follow-up was available for all included patients. RESULTS: Twenty patients were included in this study. Twelve patients underwent successful conservative treatment with nasogastric aspiration. Urgent laparotomy performed in 6 cases and delayed surgical intervention performed in 3 did not show ischemic complication. Surgical management always consisted in lysis of adhesions without intestinal resection. CONCLUSION: Recently described in the radiological literature, the small bowel feces sign appears to be the first criteria of non-severity in adhesive small bowel obstruction.

[Large bowel obstruction secondary to lumbar hernia following latissimus dorsi flap]. / Occlusion colique sur hernie lombaire secondaire à un prélèvement de lambeau du muscle grand dorsal: à propos d'un cas.

The authors report the case of a 46-year-old woman with large bowel obstruction secondary to lumbar hernia following latissimus dorsi flap. Diagnosis was made by CT. This paper describes the CT features of this rare pathology. A brief review of the literature is also presented.

Intradural disc herniation with cranial migration of an excluded fragment.

Intradural herniation is a rare complication of the intervertebral disc disease. The history and present clinical findings may suggest the diagnosis. Although the myelographic signs are well known, intradural hernias have seldom been illustrated by magnetic resonance imaging (MRI). We present the case of an intradural disc hernia with cranial migration of a sequestrated fragment illustrated by both myelography and MRI. To our knowledge, such a case has never been reported in the literature so far.

Multidetector ct diagnosis of jejunal perforation by a chicken bone.

We report a case of perforation of the proximal jejunum by a sharp chicken bone. This case emphasizes the effectiveness of multislice CT in complex abdominal situations thanks to its possibilities of multiplanar reconstructions obtained with thinner collimation and higher resolution.

[Fluid-fluid level in an intra-osseous ganglion cyst of the talus]. / Niveau liquide-liquide dans un kyste mucoïde intra-osseux du talus.

The author report a very rare case of fluid-fluid level in an intra-osseous ganglion cyst of the talus that was detected on CT and MR imaging. Pre-operative diagnosis was suggested by the presence of a communication between the talo-cuboid joint and the cyst, as shown at MR Arthrography.