Case reports of medication-related osteonecrosis of the jaw (MRONJ) treated with uncultured stromal vascular fraction and L-PRF.

Medication-related osteonecrosis of the jaw (MRONJ) is a challenging affection, considering the absence of a "Gold Standard" treatment. Cell therapy and tissue engineering, using adipose-tissue stromal vascular fraction (SVF) containing mesenchymal stromal cells (MSC) and endothelial progenitor cells (EPC); and a scaffold with healing properties, l-platelet-rich fibrin (L-PRF), could be a therapeutic option. Two cases of MRONJ were treated by tissue engineering. The patients presented respectively a stage-II and a stage-III MRONJ. The protocol consists of SVF injection in the L-PRF applied on the cleaned bone. Patients are followed clinically and by medical imaging (MI) for 18 months. The buccal mucosa was closed within a month. No recurrence was observed during the follow-up. The MI highlighted bone formation. MSC and EPC presence, in the SVF, were confirmed by immunophenotyping. We report the preliminary results of MRONJ patients successfully treated with the association of autologous fresh L-PRF-SVF.

[Sonography of peripheral nerves--first part: upper limb]. / Echographie des nerfs périphériques--Première partie: membre supérieur.

At sonography, peripheral nerves have a fibrillar appearance, that is tape-like on longitudinal scans and ovoid on transverse scans. Nerves are composed by hypoechoic fascicules within a hyperechoic environment. Less subject to anisotropy and soft to the pressure of the probe, nerves lie between muscles, often with vessels, or within channels. Recent advances in sonographic technology allow accurate imaging of peripheral nerves of the upper and lower limbs, but adequate anatomical and clinical knowledge, as well as rigorous technique are mandatory. The purpose of this general review is to present, as clearly as possible, in two parts, the sonographic features of normal and pathological nerves of upper and lower limbs. This first part will discuss nerves of the upper limb.

[Imaging of the temporomandibular joint]. / L'imagerie de l'articulation temporo-mandibulaire.

A large number of imaging techniques are available nowadays to visualise the temporomandibular joint and surrounding structures. It is important that osseous structures as well as soft tissue can be shown. Transcranial images, conventional tomography, panoramic radiography and computed tomography (CT) are more suitable for viewing the osseous structures. The best techniques to evaluate the soft tissues are arthrography and especially magnetic resonance imaging (MR). The panoramic radiography is the technique of choice in the general practice and provides adequate screening images of the temporomandibular joints, mandible, maxilla, teeth and surrounding tissues. When the joint is suspected of developmental anomalies, neoplastic conditions or a condylar trauma, CT-images are necessary to depict the bony abnormalities. CT has a poor reliability in imaging the disk. For this reason, disk displacements of the temporomandibular joint are best shown with MR, although the clinician should be very restrictive in using MR-images. They are very expensive and are only useful to confirm an uncertain diagnosis, or if disc surgery is the treatment of choice. The anamnesis and the clinical investigation are still the most important elements in diagnosing craniomandibular dysfunction.

[Contribution of Doppler sonography in inflammatory pathology of the large bowels]. / Contribution de l'échographie Doppler dans la pathologie inflammatoire du tube digestif creux.

At the end of the eighties, Doppler equipment added to conventional ultrasonography a new dynamic dimension. On the basis of radiological (US, CT, barium studies), clinical, biological, surgical and/or pathological correlations in 30 cases, the following considerations were emphasized. In case of intestinal obstruction, viability of the obstructed segment is compromised when Doppler parietal flow remains undetectable. In Crohn's disease or ulcerative colitis, as well as in acute appendicitis, presence of Doppler parietal flow throughout the affected thickened segment indicates an acute condition; similarly, abnormally high mean portal velocity (30-48 cm/sec; normal: 15 +/- 7 cm/sec), and abnormally low resistive index in the superior mesenteric artery (0.58-0.78; normal: 0.908 = 0.026) are detected. In colonic diverticulitis, similar characteristics can be observed, but are subtle and usually predominant at the mesenteric side of the affected segment in moderate diverticulitis. These abnormal Doppler findings disappear with successful therapy.

[Magnetic resonance imaging in oral medicine. Principle indications and contra-indications]. / L'imagerie par résonance magnétique en odonto-stomatologie. Principes indications et contre-indications.

MRI is the most recent of diagnostic imaging possibilities. It completes the information provided by panoramic X-rays and scanner. The technique is based on proton excitation within an intense magnetic field and does not release any ionizing radiation, as opposed to conventional images (panoramic and CT scanner). This technique is harmless, provided that known and continuously updated contraindications be complied with. Its major advantages include imaging within different spatial planes without moving the patient and its excellent tissular discrimination capacities. The latter quality accounts for spontaneous visibility of the TMA disc. Currently, it is the golden standard in exploring painful TMAs (internal derangements).

Muscular actinomycosis in the back.

We present an unusual observation actinomycosis involving muscles of the back and probably of one thigh in a patient with pulmonary lesions. The patient was alcoholic and a heavy smoker and his teeth were in very poor repair. Opportunity is taken to review the literature on the rare cases of muscular actinomycosis.

Adipose tumors of soft tissues.

Thirteen patients with lipoma were examined at least with MRI, which revealed homogeneous and high signal lesions in both T1 and T2 WI sequences. On CT, these lesions were characterized by very negative density values. Sonography was useful to differentiate a lipoma from an old hematoma that share the same signal on MRI. Eighteen cases of biopsy proven liposarcomas were evaluated with at least two techniques. Tumor heterogeneity was the most important clue to malignancy. With CT, contrast injection was necessary because two cases out of eight appeared homogeneous on native examinations. Lobular pattern and large size are constant signs associated with liposarcoma. The correlation of imaging and histology classification was only successful with differentiated tumors. Angiography unspecifically reveals the malignancy of liposarcoma. MRI is better than CT to evaluate tumor expansion and to differentiate the mass from the surrounding tissue.

[The contribution of computerized tomography and MRI in the diagnosis of degenerative dementia]. / Apport de la TDM et de l'IRM au diagnostic des démences dégénératives.

CT and MRI are presently the most commonly used imaging techniques providing optimal visualisation of brain images. Normal aging is observed on CT and especially on MRI: these changes should be recognized and differentiated from pathological brain anomalies. The authors briefly describe changes demonstrated by CT and MRI in the most commonly encountered dementia: still emphasis is put on the fact that these anomalies are poorly specific and never pathognomonic. On the contrary, it must be prompted to perform CT and MRI in demented patients in order to rule out diseases curable by surgery such as normal pressure hydrocephaly, subdural hematoma, meningioma and so on especially well demonstrated by CT and MRI.