[Dental implant news: from help to diagnosis to help to surgery]. / Nouveautés en implantologie: de l'aide au diagnostic à l'aide à la chirurgie.

Imaging has always been a part of dental implant procedures from its beginning. Initially, imaging was performed by dentists. The introduction of CT scan at the end of the seventies was revolutionary. Radiologists then played a major role in image generation and distribution. For the last two years, a revolution is occurring with the availability of "cone beam" CT machines in dental offices with implant planning software. The dentist can sometimes administer the entire delivery of care: choice of imaging technique, generation and distribution of imaging data, implant planning and treatment. The radiologist's role is now only conceivable as a specialist in dental imaging, attuned to the evolution of dental implant techniques.

[3D representation of skull and soft tissues. Usefulness in orthodontic and orthognathic surgery]. / Modélisation 3D du viscéro-crâne. Applications en orthodontie et chirurgie orthognatique.

Three D Modeling of the human face. The method combines the use of DICOM CT scan or cone beam data, anatomical informations and a mathematical tool, the axes of inertia, in order to create a 3D model for cephalometric analysis of the human face. The balance and symmetry of the model are stable enough to define normality for each individual, even when there are differences in ethnic and cultural origins. Imbalance and asymmetry characterize pathologies. Follow up shape and size of models allow growth prediction and modeling. An original statistical study of the 3D model variability using the "geometry morphometrics method" (GMM) is introduced. This 3D model is in the process of becoming an indispensable reference for all of those who are interested in studying the human face such as Orthodontists, Surgeons, Anatomists, Anthropologists and Forensic Medical Practitioners.

[Value of relative cerebral blood volume measurement using perfusion MRI in glioma management]. / Intérêt de la mesure du volume sanguin régional cérébral relatif par IRM de perfusion dans la prise en charge des gliomes.

INTRODUCTION: Neoangiogenesis is a critical feature that can differentiate high-grade from low-grade glioma. Conventional MR imaging does not assess this histological feature accurately. The goal of this study was to evaluate the gain in relative cerebral blood volume measurement using perfusion MRI in the management of cerebral gliomas. MATERIALS AND METHODS: Between 1998 and 2001, 32 histologically proven glial tumors were assessed by perfusion MRI using echoplanar imaging (EPI) and gradient-echo techniques. Relative cerebral blood volume (rCBV) was measured in all patients and compared to histological data. RESULTS: rCBV values were significantly correlated to histological grading in all 32 patients (P<0.001). Mean rCBV values were 8.74 (+/-3.79) for glioblastomas, 7.37 (+/-2.83) for anaplastic gliomas and 0.84 (+/-0.61) for low-grade gliomas. Mean rCBV values were significantly different between low- and high-grade gliomas, making it possible to determine a threshold (2.5-3) that can separate these two types of lesion. In determining the histological grading, rCBV was shown to be significantly more accurate than conventional MRI (P<0.005). CONCLUSION: Perfusion MRI using the EPI technique reliably assesses tumoral neoangiogenesis in gliomas preoperatively. The specificity and sensitivity of this technique make this radiological modality a valuable tool in the assessment of cerebral gliomas.

[The fat halo sign in the small intestine: diagnostic implications?]. / Le signe du halo graisseux iléal: quelle signification lui accorder?

The fat halo sign in the small intestine may sometimes be observed in patients with chronic inflammatory bowel diseases, but it can represent a normal finding that is possibly related to obesity. The authors report two cases showing these findings.

Lithium augmentation in venlafaxine non-responders: an open study.

Thirteen major depressive patients not responding to a 4-week venlafaxine 300 mg treatment were eligible for a 4-week open trial of lithium addition. Two patients had to stop lithium for a possible moderate serotonin syndrome and five patients became responders, including one dramatic response and two semi-rapid responses.

Functional MR imaging in assessment of language dominance in epileptic patients.

The value of functional MR Imaging (fMRI) in assessing language lateralization in epileptic patients candidate for surgical treatment is increasingly recognized. However few data are available for left-handed patients. Moreover determining factors for atypical dominance in patients investigated with contemporary imaging have not been reported. We studied 20 patients (14 males, 6 females; 9 right handed, 11 left handed) aged from 9 to 48 years, investigated for intractable partial epilepsy. Epileptic focus location was temporal in 14 cases, extratemporal in 6, and lateralized in the left hemisphere in 11/20. Hemispheric dominance for language was evaluated by both Wada test and fMRI using a silent word generation paradigm in all patients. Furthermore, a postictal speech test was performed in 15 patients. An fMRI language lateralization index was calculated from the number of activated pixels (Student's t test, P < 0.0001) in the right and left hemispheres. The Wada test showed a right hemispheric dominance in 8 patients (6 were left handed and 2 right handed) and a left hemispheric dominance in 12 patients (5 were left handed and 7 right handed). These results were concordant with clinical postictal examination in 11/15 patients (73%). Clinical status did not allow a conclusion about hemispheric dominance for the remaining 4 patients. FMRI was concordant with the Wada test in 19/20 cases. For one left-handed patient, fMRI showed bilateral activation, whereas the Wada test demonstrated a right hemispheric dominance. Right language lateralization was significantly correlated with left lateralized epilepsy (P < 0.05) but was not correlated with age at epilepsy onset, early brain injury (before 6 years), and lobar localization of epileptogenic focus. However the lack of a significant relationship between these factors and atypical language lateralization may be related to the small sample size.

[Contribution of perfusion magnetic resonance imaging in a patient with cerebral ganglioglioma]. / Intérêt de l'imagerie par résonance magnétique de perfusion. A propos d'un cas de gangliogliome cérébral.

A 48-year-old woman was admitted to the Neurosurgery Department for a large frontal lobe tumor revealed by partial seizures. The patient was conscious and alert. Neurological examination was normal. MRI study showed a right frontal lobe tumor compounded of an anterior solid mass strongly enhanced after gadolinium injection and a posterior voluminous cyst with important mass effect. The cerebral blood volume (CBV) map showed no area of elevated CBV within the tumor consistent with a low-grade tumor. The patient was operated on with a presumed diagnosis of anaplastic oligodendroglioma. Postoperative course was uneventful. Histopathological examination was consistent with a benign ganglioglioma. The patient did not undergo an additional treatment. One year later, the patient was healthy and neurological and neuropsychological examination were normal. MRI study did not show any recurrence. This case emphazises the relevance of perfusion MR imaging in the preoperative workup of glioneuronal and glial tumors.

[Morphological imagery of the occipital lobe]. / Imagerie morphologique du lobe occipital.

After reviewing the anatomical and functional aspects of the occipital lobe, the authors detail its gyral and sulcal anatomy using MRI in the three planes, with particular attention given to the localization of the calcarine fissure.

The AP diameter of the pelvis: a new criterion for continence in the exstrophy complex?

OBJECTIVE: Reconstructive surgery of bladder exstrophy remains a challenge. By using CT of the pelvis, we suggest a new pre- and post-operative investigative procedure to define the AP diameter (APD) as a predictive criterion for continence in this anomaly. PATIENTS AND METHODS: Three axial CT slices were selected in nine children with exstrophy who had undergone neonatal reconstructive surgery. The three levels selected were the first sacral plate, the mid acetabular plane and the superior pubic spine. We used combined slices to measure: APD = distance between the first sacral vertebra and the pubic symphysis. Pubic diastasis (PD). Three angles defined on the transverse plane of the first sacral vertebra--iliac wing angle, sacropubic angle and acetabular version. RESULTS: In exstrophy, the angles demonstrate opening of the iliac wings and the pubic ramus, and acetabular retroversion compared to controls. Comparisons between controls, continent and incontinent patients reveal that in continent patients, APD increases with growth and seems to be a predictive criterion for continence, independent of diastasis of the pubic symphysis. CONCLUSIONS: We believe that CT of the pelvis with measurements of the APD should be performed in all neonates with bladder exstrophy before reconstructive surgery and for better understanding of the malformation. The APD seems to be predictive and may be a major criterion for continence, independent of PD.

[Superficial bone metastases: report of two cases from colonic origin]. / Les métastases osseuses superficielles: à propos de deux cas d'origine colique.

Two cases of superficial bony metastases from colonic adenocarcinoma are reported. The plain film, CT and MR features are presented. The diagnostic imaging features and differential diagnosis are discussed. Superficial bony metastases are rare (2% of bony metastases) and only the characteristics of cortical bone vascularization allow to understand the superficial origin at the level of the cortex or subperiosteum. Magnetic resonance imaging is the modality of choice to characterize the tumor site and local extension. Diagnosis is suspected by clinical history and confirmed at biopsy.

[Delusional parasitosis or Ekbom's syndrome]. / Le délire de parasitose ou syndrome d'Ekbom.

INTRODUCTION: Ekbom's syndrome or delusional parasitosis is a disorder in which the patient believes that he/she is infected by a parasite. Epidemiologic, nosologic, psychopathologic and therapeutic data can barely be interpreted, as delusional parasitosis has mostly been described in either isolated cases or small cohorts. An extensive literature review is recommended to better understand common features associated with this syndrome. EXEGESIS: Ekbom's syndrome is a chronic disorder that may occur at any age but is more common in the elderly, particularly in females. International classifications have included this syndrome in non-schizophrenic delusions. However, it has also been reported in schizophrenia, affective disorders, and organic or induced psychosis. Treatment is based on antipsychotic agents, psychotherapy, and cooperation between dermatologists and psychiatrists. CONCLUSION: Pimozide is currently the most effective treatment. It requires careful monitoring, as it has several adverse effects. For patients with concomitant depressive symptoms, the use of antidepressants is recommended.

[MRI symptomology in reflex sympathetic dystrophy of the foot]. / Séméiologie IRM de l'algodystrophie du pied.

PURPOSE: To describe the MRI findings of reflex sympathetic dystrophy of the foot and ankle. METHODS: Retrospective study of 50 patients with reflex sympathetic dystrophy of the foot (5 with the cold form, and 45 with the warm form) diagnosed based on clinical and scintigraphic findings. All patients underwent MR imaging. The MRI findings were correlated with the clinical and scintigraphic findings. RESULTS: Patients with the cold form of reflex sympathetic dystrophy had no abnormality of signal at MR imaging. All patients with the warm from of reflex sympathetic dystrophy showed periarticular marrow edema at MR, typically involving more than one bone (mean of 4). Other findings were inconstant: soft tissue edema, joint effusion, and rarely, subchondral band of low T1W signal intensity of unclear etiology. CONCLUSION: MR imaging, including fat-suppressed T2W or STIR images and noncontrast T1W images, is helpful in patients with the warm or acute form of reflex sympathetic dystrophy of the foot. In patients with the cold form, MR imaging is helpful to exclude another underlying etiology for the symptoms and identify patients with the warm form of the process.

[Value of magnetic resonance cholangiography in the diagnosis of common bile duct cystic dilation]. / Intérêt de la cholangio-IRM dans le diagnostic de la dilatation kystique du cholédoque.

BACKGROUND: Magnetic resonance cholangiography is a noninvasive method for exploring the biliary and pancreatic ducts. Allergic risk is reduced as no contrast agent is required and there is no risk of infectious contamination due to catheterism. Unlike endoscopic retrograde cholangiography which requires anesthesia, there is no risk of morbidity. We report one observation of Todani type Ia cystic dilation of the main bile duct explored preoperatively with MR-cholangiography. CASE REPORT: A 39-year-old woman complained of acute abdominal pain. Physical examination revealed jaundice and fever. MR-cholangiography gave the diagnosis of angiocholitis with cystic dilatation of the main bile duct (type Ia). Surgery was indicated. The procedure included a Y-loop hepato-jejunal anastomosis and cholecystectomy. The postoperative period was uneventful. Pathology reported a cystic formation with no signs of malignancy. DISCUSSION: Common manifestations of congenital cystic dilatation of the main bile duct are biliary pain, fever and jaundice. The MR-cholangiogram provides a map of the bile duct system directly with a noninvasive procedure. The map may be obtained in several planes to guide surgery. Indeed, since cholangiocarcinoma is found in numerous cases, surgery is a formal indication in patients with angiocholitis.

[Attempted suicide and menstrual cycle. An epidemiologic study]. / Tentatives de suicide et cycle menstruel. Etude épidémiologique.

Relations between suicidal behaviours and menstrual cycle have been studied by various authors with different methodologies, from which miscellaneous and contradictory results. We have taken this relation again, about suicide attempts admitted in Dijon's emergency department. Were recorded for each suicidal woman aged 15 to 49 their sociodemographical and gynecological characteristics. The same data were collected among women admitted in such circumstances for various pathologies except suicidal disorders. Cases and witnesses were distributed in an ideal cycle of 28 days with the method called cycle adjusting. Statistic analysis reveals a significant difference between cases and witnesses for pre-ovulatory period but don't resist to the maximum bias hypothesis. Finally, our study emphasizes without our knowing, for the population concerned, cases and witnesses alike, an increase hospital-going during pre-ovulatory period.

[Guignol or the comedian's paradox]. / Guignol ou le paradoxe du comédien.

Our study is based on a puppet theatre performed with a group of children aged from six to eight who were experiencing a neurotic context. Guignol's playing reveals anguishes and defensive mechanisms as well as, regarding the actors, the ability to experience the comedy with authenticity without forgetting it is imaginary. The puppet theatre has allowed us to progress in a therapeutic process while continuing diagnostic exploration.