Detection of vascular complications in renal allografts with color Doppler flow imaging.

One hundred ninety-five color Doppler flow (CDF) examinations were performed in 146 renal allografts to assess the capabilities of this technique in detecting intra- or extrarenal vascular complications. Conventional angiography was also performed in 44 transplants. In the group of transplants with angiographic correlation, CDF sonography enabled correct identification of 30 of 34 vascular complications. CDF showed 10 of 11 significant stenoses of the renal artery or of one of its main branches. There were two false-positive renal artery stenoses (one normal artery and one 40% stenosis). Nine of nine renal artery thromboses and the single pseudoaneurysm were also identified. Within the parenchyma, CDF sonography demonstrated five of five segmental infarcts, two of two postbiopsy arteriovenous fistulas, and three of six segmental or interlobar artery stenoses. Measurement of peak systolic velocity showed a significant difference (P less than .05) between a group (n = 8) with significant stenosis of the renal artery or one of its main branches (mean, 215.2 cm/sec +/- 32) and a group (n = 14) without stenosis (mean, 99.2 cm/sec +/- 19).

MR imaging of foraminal and extraforaminal lumbar disk herniations.

Foraminal and extraforaminal disk herniations are less frequent than intraspinal herniations at the lumbar level and more difficult to diagnose. They are undetected by myelography and distinction between them and an enlarged nerve root may be difficult with CT. Thirty-three patients presenting with persistent radiculopathy and showing an image suggesting a far lateral disk herniation on CT at 34 disk levels were prospectively imaged with magnetic resonance (MR). In all cases the disk fragment was identified and its separation from the nerve root was possible. This separation was more readily visible on sagittal or angled coronal views. The exact location of the herniation in relation to the facet joints and the pedicles was best assessed with MR: Ten were purely intraforaminal, 8 extraforaminal, and 15 both. Cephalad migration was noted on the sagittal lateral facet plane in 71% of cases. Surgical correlations were available for 25 disks. Three were falsely positive for disk herniation. Enlarged foraminal veins were responsible for this appearance as confirmed by surgery in two of these. When a prediction of disruption of the lateral extension of the posterior longitudinal ligament was made, it was confirmed at surgery in 52% of cases because of extreme lateralization of the herniations.

Osteoid osteoma of the cervical spine. Misleading MR features about a case involving the uncinate process.

The authors studied the usefulness of MR imaging in the diagnosis of an osteoid osteoma occurring within the C4 left uncinate process. It was detected by scintigraphy and diagnosed by CT. On T2-weighted MR images the nidus showed a very low signal intensity with an increased signal within the adjacent end-plates. This pattern was misleading and more suggestive of degenerative disk disease.

[Angiography of hepatic angiomatosis in Rendu-Osler disease. Apropos of 3 cases]. / Angioscanner de l'angiomatose hépatique dans la maladie de Rendu-Osler. A propos de 3 cas.

The hepatic changes in hereditary hemorrhagic telangiectasia (Rendu Osler's disease) involve the extra- and intrahepatic vessels (enlarged hepatic artery, arteriovenous fistulas and inhomogeneous perfusion) and the hepatic parenchyma (fibrosis, telangiectasic cirrhosis). From three observations with liver involvement and imaged with angiography and dynamic CT, the authors emphasize on the role of the latter for detection of these changes, mostly arteriovenous fistulas.

[Tissue effects of extracorporeal lithotripsy on a model of experimental biliary calculi in dogs]. / Effets tissulaires de la lithotritie extracorporelle sur un modèle de lithiase biliaire expérimentale du chien.

Extracorporeal shock waves represent a new method to treat gallstones. This study was designed to evaluate: 1) the effectiveness of a recently available lithotripter (EDAP LT 01) for gallstone fragmentation; 2) adverse tissue reactions after treatment; 3) the optimum conditions for use of this apparatus in man. A human cholesterol stone was surgically implanted into the gallbladder of ten 20-25 kg mongrel dogs. One dog was used as a control. The other nine animals were divided into three groups (A, B and C). Two 60 min sessions of lithotripsy were carried out twice a week. Sonographic and CT examinations were performed 9 and 16 days after operation. The animals were killed 21 days after operation. Satisfactory fragmentation was obtained in 4 of the 9 animals, and in 2 dogs no stone fragments were detected. Fragments were found in the common bile duct in 5 dogs. In 2 animals a pathologic aspect of the papilla of Vater was observed. Marked hematoma was observed in the animals treated at 5 and 10 pulses/sec. In 5 cases, hematoma was observed in the gallbladder and in one case the gallbladder was ruptured. Hematoma was also noted in the hepatic vascular bed in 3 animals. Except for microscopic hemorrhagic lesions observed at the base of the right lung, no lesions were detected in any other organ. Shock waves produced by the EDAP LT 01 are effective for fragmentation of gallstones. However, in view of the tissue reactions observed at the higher pulse rates, the pulse rate should not exceed 2.5 pulses/s for use in man.

Normal and disrupted lumbar longitudinal ligaments: correlative MR and anatomic study.

The posterior and anterior longitudinal ligaments of the lumbar spine appear on magnetic resonance (MR) images as thin lines of very low signal intensity in all spin-echo sequences. They cover the periphery of the outer fibers of the anulus fibrosus on sagittal images. The lumbar spine of 17 patients with 19 disk herniations was prospectively evaluated with MR imaging, and these findings were correlated with surgical findings. At surgery the posterior ligament was found to be disrupted in eight cases and intact in 11. Absence of a low-signal peripheral line around the herniated nucleus pulposus (HNP) was the most reliable sign of ligament rupture (no false-negative or false-positive findings). The peripheral line appeared to be interrupted in four cases, two of which were falsely positive. The two false-positive cases were related to a chemical shift artifact between epidural fat and the HNP. Presence of a normal and continuous peripheral line outlining the HNP excluded ligament disruption. The overall sensitivity for detecting disruption was 100%, and the specificity was 78%.

[Intrarenal kinetics of Gd-DOTA in sequential MRI in rabbits. Reproducibility study]. / Cinétique intra-rénale du DOTA-Gd en IRM séquentielle chez le lapin. Etude de reproductibilité.

Ten normal rabbits and seven rabbits with experimental acute renal failure by tubular necrosis were studied with dynamic MR to evaluate the reproducibility of intrarenal kinetics of Gd-DOTA. Sequential spin-echo sequences with short TR (200 msec)/TE (26 msec) were used yielding a 29 sec acquisition time. A usual semi-quantitative analysis of intrarenal contrast demonstrated the reproducibility of some phases of the dynamic sequence in particular a drop in the signal within inner medulla between the third and the fourth minute after infusion. This effect, related to a high concentration of Gd-DOTA within the tubules was observed in 9 over 10 normal rabbits and in none of the rabbits with acute renal failure. The quantitative analysis calculation was based on relative signal intensity and contrast-to-noise ratio from the absolute signal intensity measure on regions-of-interest (ROI) on the cortex, outer medulla and inner medulla. No reproducibility of the variations with time of these parameters could be assessed. A great number of factors of variations or error, mainly during the measurements of signal intensity with ROI, could explain this lack of reproducibility. At the present, dynamic MR is therefore not able to quantitatively evaluate the renal function. Only a semi-quantitative estimation of tubular concentration can be deduced.

[Chronic volvulus of an ectopic spleen with subcapsular hematoma. CT x-ray aspect]. / Volvulus chronique d'une rate ectopique avec hématome sous-capsulaire. Aspect TDM.

The authors present a case of ectopic spleen complicated by chronic torsion and subcapsular haematoma in an asymptomatic patient. The value of ultrasonography and computed tomography in the diagnosis of these complications is discussed.

[Diagnostic and therapeutic angiography in severe retro- and subperitoneal hematomas]. / Angiographie diagnostique et thérapeutique dans les hématomes rétro et sous-péritonéaux graves.

This study of the value of arterial angiography was carried out in 22 patients with serious retroperitoneal hemorrhage. In the first instance, this investigation determines the number of hemorrhages, their sites and flows. Later on it can be used to evaluate the volume of the hemorrhage and its effect on vascularisation of the abdominal viscera so that an initial prognosis can be made. At a later stage it also provider valuable date when setting up an appropriate selective embolisation based on the number of sites involved.

[The lesser omentum. Normal aspect and tumor pathology in ultrasonography and x-ray computed tomography]. / Le petit épiploon. Aspect normal et pathologie tumorale en échographie et tomodensitométrie.

The lesser omentum is a peritoneal partition that can be divided into two portions: superior or gastrohepatic ligament and inferior or duodenohepatic ligament, although differentiation is sometimes difficult. Ultrasound and CT scan imaging allowed perfect definition of vascular and glandular elements contained in the omentum, and normal morphology is described. Masses developing between the two leaves of which it is constituted usually project in front of adjacent vascular structures and/or prolonged into the liver hilum, and a fatty layer separates them from large prevertebral vessels. These different guidelines allow them to be distinguished from retroperitoneal celiomesenteric adenopathies. These expansive processes are almost always of glandular origin secondary to primary digestive, retroperitoneal, pelvic and even bronchial tumors. In contrast, primary tumors are rare in this region.

[CY 222, a very low molecular weight heparin, in the curative treatment of deep venous thrombosis. Apropos of 95 cases. Clinical and phlebographic results]. / Le CY 222, Héparine de trés bas poids moléculaire dans le traitement curatif des thromboses veineuses profondes. A propos de 95 observations. Résultats cliniques et phlébographiques.

Efficacy of a very low molecular weight heparin, CY 222, in the treatment of deep venous thrombosis of lower limbs was evaluated in a prospective clinical trial instituted in November 1984. CY 222 was administered as subcutaneous injections of 0.03 ml.kg-1 daily (750 anti-Xa U.kg-1.d-1) as 3 divided doses over a minimum of 10 days. Efficacy was rated as a function of clinical and phlebographic criteria. The group of 95 patients treated was a heterogenious one: 38% medical, 62% surgical, and 48% of the total group had partial interruption of vena cava previous to study. The period between first clinical manifestations of the deep thrombosis and therapy varied between one day and 3 months (mean: 1 1/2 days). Clinical symptomatology significantly and globally regressed in 88% of the patients. Comparisons between phlebographic findings at start and end of treatment are expressed using Arnesen's score (cf. table).

Selective embolization of symptomatic contralateral metastases in treatment of carcinoma of the kidney: report of 2 cases.

We report 2 cases of contralateral metastases secondary to renal carcinoma that had been treated with nephrectomy. Selective embolization was done in 1 case because hematuria did not respond to medical treatment. The lower two-thirds of the remaining kidney were embolized. The other patient presented with severe pain that was not relieved by medical treatment of radiotherapy and, therefore, selective embolization of the remaining kidney was performed. In both cases selective embolization conserved satisfactory renal function and nephrectomy was not necessary.

[Changes in angiographic recordings during reflux nephropathy (author's transl)]. / Evolution angiographique d'une néphropathie de reflux.

On one of the few occasions when it was possible to review angiographic recordings taken at five-year intervals, in a patient with reflux nephropathy, the authors use the results to emphasize that it is always very difficult to decide whether a small kidney, associated with reflux, is congenital or acquired. The reflux must in any case be corrected.

[Angiomyolipomas (hamartomas) of the kidney. Radiological study apropos of 2 cases. Review of the literature]. / Les angiomyolipomes (hamartomes) du rein. Etude radiologique à propos de 2 observations. Revue de la littérature.

Two patients with renal angiomyolipomas studied angiographically are reported:--A case of tuberous sclerosis with bilateral multiple lesions, renal, hepatic and adrenal;--An isolated lesion whose preoperative diagnosis allowed the excision of the tumor. A review of the literature from 1965 to 1977 identified 242 cases of which 177 were isolated angiomyolipomas. There were 54 cases associated with tuberous sclerosis and one with von Hippel-Lindau disease. The radiologic and especially the angiographic signs are illustrated, the hemorrhagic risks are stressed, and the diagnostic features of fetal renal hamartoma are described.

[Acute renal failure and aorto and ilio-caval fistulas. A report of two cases (author's transl)]. / Insuffisance rénale aiguë et fistules aorto et ilio-cave. A propos de deux observations.

A report of two cases of aorto-caval and ilio-caval A.V. fistulas, where the authors examine the mechanisms for anuria. The renal venous hypertension, which is due to the arteriovenous shunt, seems to be a determining factor in the occurrence of this unveiling complication, as shown by the roentgenological findings.

[Critical analysis of the arteriography of primary malignant tumors of the bones, on the occasion of 19 unedited cases]. / Analyse critique de l'artériographie des tumeurs malignes primitives des os á l'occasion de 19 observations inédites

From the analysis of a series of 62 unedited cases of arteriography of osseous tumors including 19 primary malignant tumors, it was confirmed that the majority of angiographic signs described as being characteristic of malignant tumors of the bones are not significant. They are found in benign tumors and in ordinary inflammatory phenomena: several cases of osteoid osteoma, myeloplax tumor or simply of osseous reconstruction permit one to make criticisms. On the other hand, one must endeavour to demonstrate, by means of a technique whose main elements are recalled, vascular abnormalities which are the only typical ones and which furthermore are found in "silent" tumors such as chondrosarcomas or fibrosarcomas. These vascular abnormalities are given in detail, and several examples of them are given.

[Critical analysis of angiography in renal traumatology (author's transl)]. / Analyse critique de l'angiographie en traumatologie rénale

From this analysis of a series of 39 cases of trauma submitted to angiography, it can once again be said that surgical indications and tactics are essentially determined by vascular involvment. Renal arteriography is therefore alone capable of answering two primordial questions: "Must surgery be undertaken and when operating, what surgical tactics to adopt". It must be preceded by full arteriography which enables one to evaluate associated lesions (spleen 15%), at the same time as it orientates selective arteriography. The I.V.P. is a correct means of approach but is only significant in 60% of cases. Abstention from radiological investigation as a primary requisite is unpardonable and can leave irreversible sequels. (10% of cases).

[Familial reno-vascular hypertension (author's transl)]. / Hypertension réno-vasculaire familiale

The authors report a case of hypertension due to dysplasia of the renal arteries in a young man, and found the same disease in siblings. Two sisters and one brother also had renal hypertension, whereas the other relatives were unaffected. Two similar cases found in the world literature, did not permit the authors to determine the cause of this disease. This case is reported in order to stimulate research and the discovery of new cases.