[Exceptional association of bilateral popliteal aneurysm with an abdominal aortic aneurysm in Marfan syndrome]. / Association exceptionnelle d'un anévrysme poplité bilatéral et d'un anévrysme de l'aorte abdominale au cours d'un syndrome de Marfan.

Marfan syndrome is an autosomal dominant disorder with rheumatoid, ophthalmological, neurological, cutaneous and cardiovascular manifestations. Aneurysmal lesions affecting both the abdominal aorta and the peripheral arteries are not often described in the literature. We report a case associating a bilateral popliteal aneurysm and an aneurysm of the infra-renal abdominal aorta.

[Results of FDG-PET scanning in the pre-operative staging of broncho-pulmonary tumors]. / Résultats de la TEP [18F]-FDG dans la stadification préopératoire des tumeurs pulmonaires.

BACKGROUND: Positron emission tomography (PET) with [18F]fluorodeoxyglucose (FDG) has recently established itself as an important imaging strategy in the management of respectable non-small cell bronchial carcinoma (NSCLC). In this study we report our experience of the impact of FDG-PET in the pre-operative assessment of NSCLC. METHODS: In a single centre retrospective study between 01 January 2000 and 31 Dec 2002, 108 FDGPET scans were performed during the preoperative assessment of histologically proven or strongly suspected NSCLC. RESULTS: The sensitivity, specificity and accuracy of FDG-PET for the characterization of a parenchymatous opacity were 96%, 71% and 92% respectively (4 false negatives, 5 false positives). The sensitivity, specificity and accuracy for mediastinal node involvement were 62%, 94% and 84% respectively (10 false negatives and 4 false positives). The sensitivity, specificity and accuracy for the characterization of adrenal nodules were 88%, 100% and 97% (1 false negative) and for satellite pulmonary nodules 50%, 75% and 64% (2 false negatives and 3 false positives). CONCLUSION: FDG-PET is a useful imaging modality in the pre-operative management of NSCLC but is limited particularly in the characterization of lesions less than 10 mm in diameter and in the evaluation of mediastinal lymph nodes.

[Pseudotumoral lipid pneumopathies. Apropos of six cases]. / Pneumopathies lipidiques pseudo-tumorales. A propos de six observations.

In cases of localised pneumonia due to oil aspiration, the diagnosis may be difficult and is often assessed by thoracotomy. Six cases of lung paraffinoma are reported. The lesion, localised in the lower lobe in five patients out of six, was discovered on screening chest x-rays. In two cases, two lesions were observed in the same patient. All six patients underwent lung resection. Diagnosis was made on histologic examination showing foreign body reactions against oil. Oil aspiration was due to oily nose drops in one patient and to the use of paraffin oil on a tracheostomy in two others. The preoperative diagnosis may be suspected on bronchial lavage CT scan and MRI. When the diagnosis is strongly suspected, thoracotomy can be avoided as in some cases withdrawal of the medication can be followed by progressive resolution of the radiological signs.

Type IV Ehlers-Danlos syndrome with isolated arterial involvement.

Ehlers-Danlos syndrome is a connective tissue disorder characterized by skin hyperelasticity and friability, hyperextensible small articulations, vascular fragility, and ocular and visceral symptoms. Ten types of Ehlers-Danlos syndrome have been described to date. Type IV is characterized by isolated arterial involvement with the risk of rupture, making diagnosis difficult. A 25-year-old man was operated on for a ruptured left and then right iliac artery and once again for a hepatic artery aneurysm within a nine month period. The diagnosis of Ehlers-Danlos syndrome was based on clinical and histopathologic findings. An asymptomatic iliac artery aneurysm was found in the patient's 23-year-old brother.

[Rupture of the diaphragm of late manifestation]. / Les ruptures du diaphragme de révélation tardive.

Twenty one cases of delayed diagnosis of ruptured diaphragm caused by closed trauma are reported: 14 on the left side and 7 on the right side. The clinical signs and the modes of presentation are non-specific. Although the history of thoraco-abdominal trauma and the chest x-ray are sufficient to establish the diagnosis of rupture of the left hemidiaphragm, they can only suggest the diagnosis in cases of righ-sided rupture. The mechanism of rupture is more often due to sudden reflex contraction of the diaphragm against a closed glottis than to excessive abdominal pressure caused by the trauma. Diaphragmatic rupture due to closed trauma causes large tears exposing the patient to a low risk of strangulation of intestinal structures in contrast with ruptures due to a penetrating injury, which causes small tears. The diaphragmatic domes must be systematically explored during laparotomy or thoracotomy performed for thoraco-abdominal trauma.

Aseptic periprosthetic fluid collection: a late complication of Dacron arterial bypass.

Fluid collection encompassing an arterial prosthesis often leads one to suspect graft infection. Four cases of aseptic seroma occurring three to five years after insertion of knitted Dacron implants for bypass are reported. The collection was serohematic in three cases, puriform in the other. Repeated bacteriological investigations did not reveal any growth and laboratory tests did not demonstrate any signs of infection. The following pathophysiologic hypotheses have been advanced: modification of the permeability of the prosthetic wall, immunoallergic reaction to the graft, and aging hematoma. The role played by anticoagulant is debatable. Management by needle aspiration or drainage failed. Multiple recurrences led to prosthetic replacement in three cases. Treatment consists of replacing the graft by one of a different fabric. These collections must be distinguished from postoperative lymphoceles, anastomotic false aneurysms, hematomas and infections.

[Assay of plasma hCG. Our experience with the diagnosis of extra-uterine pregnancies. Apropos of 45 cases]. / Dosage de hCG plasmatiques. Notre expérience dans le diagnostic des grossesses extra-utérines. A propos de 45 observations.

Two groups of patients who were admitted to hospital with a possible diagnosis of ectopic pregnancy were compared. The levels of HCG in the plasma were obtained as an emergency in the first group (45 cases). The levels were not obtained in the second group (34 cases). Only those cases in the first group where the assays had shown the presence of HCG underwent laparoscopy: 12 laparoscopies revealed 7 extra-uterine pregnancies. In the second group, on the other hand, all 34 patients had laparoscopy; only 8 extra-uterine pregnancies were discovered by this method. Because of this study we found that when HCG assays were carried out there was no false positive or negative. When we wanted to rule out an L.H. peak in a doubtful case the assay was repeated. The comparison between the two groups underlines the importance of carrying out the assay: it avoids useless laparoscopies but it also shortens the length of stay in hospital.