[Hepatic hamartoma in adults. Apropos of a case documented by MRI]. / Hamartome hépatique de l'adulte. A propos d'un cas documenté par IRM.

A mixed hamartoma of the liver in a 39 year old man is reported. Abdominal ultrasound revealed a 4 cm inhomogeneous echogenic mass with acoustic shadowing. MRI T1 weighted images showed a inhomogeneous low intensity mass with lower gadolinium enhancement than normal liver, a moderate low signal intensity on proton density weighted images, and heterogeneous isosignal intensity on T2 weighted images. Peripheric calcifications were found on pathologic examination.

[Ultrasonography and tomodensitometry staging of kidney tumors: anatomo-radiologic correlations in 46 patients]. / Bilan d'extension TDM et IRM des tumeurs du rein: corrrélations anatomo-radiologiques chez 46 patients.

OBJECTIVE: To comparatively evaluate CT scan and MRI in the preoperative staging of renal tumours. METHODS: 46 patients with a solid renal tumour were investigated preoperatively by CT scan (n = 43) and MRI (n = 46), the results of which were compared with pathological data. RESULTS: MRI assessed capsular effraction with a sensitivity of 95.6% and a specificity of 52.1%, versus 95.2 and 40%, respectively, for CT scan. Three cases of perirenal extension were detected by MRI. The sensitivity of MRI was higher than that of CT scan for the demonstration of adenopathy (71.4% versus 57.1%) with specificities of 92.3 and 88.8%, respectively. Fourteen cases were associated with tumour extension into the proximal renal vein, which extended into the distal segment of this vein in 12 cases, into the inferior vena cava in 6 cases and as far as the right atrium in 2 cases. The performance of MRI was always better than that of CT scan in relation to venous segments of surgical interest (respective sensitivities of 70% and 83.33% in the distal renal vein and 66.6% and 83.33% in the inferior vena cava: and respective specificities of 84.8% and 97% in the distal renal vein and 91.8% and 97.5% in the inferior vena cava), provided the results of T1-weighted spin echo sequences and FLASH gradient echo sequences were assessed conjointly. CONCLUSION: These results lead us to now prefer MRI to CT scan for the preoperative staging of renal cancer, in the presence of a contraindication to iodinated contrast agent injection, very large tumours, and whenever venous extension is suspected on ultrasonography.

Percutaneous recanalization of recent renal artery occlusions: report of 10 cases.

PURPOSE: Percutaneous recanalization of renal artery occlusion was attempted in 10 patients. METHODS: All patients were hypertensive; before the procedure, the serum creatinine level was 80 mumol/L in one patient, ranged from 130-250 mumol/L in four patients, and was greater than 350 mumol/L in five, three of whom had anuria. Nine occlusions were thrombotic, one due to bilateral renal artery embolism. In four patients, percutaneous transluminal angioplasty of a contralateral renal artery occlusion was bilateral. In three patients, complementary local fibrinolysis was necessary. RESULTS: Three technical failures and one rethrombosis occurred after 24 h; in three of these cases the date of previous occlusion was unknown, whereas a relatively precise data was known for the seven other patients. One false aneurysm of the femoral artery was found 1 month after the procedure. One patient, after six technical successes, died 5 weeks after the procedure; follow-up for the other five was 6-36 months. Blood pressure was unchanged in four patients and improved in two. A significant and durable improvement of creatinine serum level (at least a 20% decrease) was observed in all six patients, usually after 1 month, thus enabling discontinuance of dialysis in three patients. CONCLUSION: Percutaneous recanalization should be proposed in cases of renal artery occlusion, especially to avoid terminal vascular azotemia and dialysis.

Local fibrinolysis for superior mesenteric artery thromboembolism.

A 66-year-old man with atrial fibrillation was referred soon after developing left lower limb and abdominal pain with rectal bleeding. An immediate flush aortogram showed embolic occlusion of the left distal superficial femoral artery and superior mesenteric artery (SMA), 3 cm from its ostium. Recombinant tissue plasminogen activator (rtPA) 40 mg was selectively instilled in the SMA in two boluses. Abdominal symptoms resolved within 48 h, and complete recanalization of the SMA was shown on angiography. Exploratory laparotomy after 72 h showed a normal small bowel and right colon, and was completed by femoropopliteal embolectomy. Six months later, the patient remained asymptomatic.

[Role of transrectal echography in the evaluation of male infertility. Apropos of 91 studies]. / Place de l'échographie transrectale dans le bilan d'infertilité masculine. A propos de 91 explorations.

Ninety-one infertile men with oligospermia and normal FSH serum level have been explored by transrectal ultrasound, biochemical sperm study and spermoculture. Ultrasound data concerning ejaculatory ducts, seminal vesicles and prostate distinguished images evocative of constitutive abnormalities (18 patients, whom sperm fructosis level was low in only one among 12) and images evocative of inflammatory processes (44 patients, whom limited correlations with biological datas were found). Transrectal ultrasound appears as a complement of biological data in infertile man evaluation, offering a better approach of vesiculo-deferentography's indication.

The anatomical basis for ultrasonography of the lateral pterygoid muscle and the infratemporal fossa.

The infratemporal fossa and its contents (particularly the pterygoid muscles) is a region difficult to explore, in spite of its importance in odontostomatological pathology. In order to reduce the indications that justify examination by computed tomography and magnetic resonance imaging, for reasons of economy of health, the authors describe by application of orientated anatomical slices the way in which ultrasonography can be performed. Only the posterior approach between the mandible laterally and the mastoid process medially provided consistently adequate exploration of the infratemporal fossa and the pterygoid muscles.

[Pattern of blood creatinine levels in 140 hypertensive patients after successful percutaneous transluminal angioplasty for renal artery stenosis]. / Evolution de la créatininémie chez 140 patients hypertendus après succès technique de l'angioplastie transluminale percutanée de sténoses de l'artère rénale.

Long term effects on creatinine serum level of successful percutaneous transluminal renal angioplasty were retrospectively studied in 140 patients. 3 groups were distinguished: the first one (80 patients) included unilateral renal angioplasties, with normal contralateral kidney and renal artery; the second group (35 patients) included bilateral renal angioplasties; the third group (25 patients) included solitary kidney renal artery angioplasties. In each group, subgroups were defined whether creatinine serum level was upper or lower than 130 mumol/l. Renal function was considered to be improved if serum creatinine was reduced by 20% or more, maintained if serum creatinine variations were below 20%, worsened if its increase was upper than 20%. Global complication rate was 4.9% (9 between 185 patients) of whom 1 (0.54%) needed a surgical revascularization. At the end of follow-up (mean between 4 and 10 months), subgroups improvement and stabilization rates varied between 67 and 100%, with the best scores in the second group (96.2 and 100%) and solitary kidney with renal insufficiency subgroup (77.25%).

[Revascularization of occluded renal arteries. A case]. / Utilité de la revascularisation des artères rénales occluses. Une observation.

After recent treatment with an angiotensin converting enzyme inhibitor, a 62-year old woman with diabetes, hyperlipidemia and hypertension was admitted for oliguric acute renal failure due to bilateral renal artery lesions (right stenosis and left thrombosis). Hemodialysis was instituted. Percutaneous transluminal angioplasty (PTA) of the right renal artery did not improve the patient's condition, whereas left renal PTA, three weeks after admission, restored diuresis and renal function, allowing hemodialysis to be discontinued. This case underlines the capacity of functional recovery after late recanalization of a totally occluded renal artery. The best outcome predictor is the development of a collateral circulation and the visualization of distal renal arteries at arteriography. The kidney can be recanalized by surgery or PTA.

[Percutaneous recanalization of renal arterial occlusion. Apropos of a case]. / Recanalisation percutanée des occlusions artérielles rénales. A propos d'un cas.

Percutaneous recanalization of a left occluded renal artery has been performed 10 days after percutaneous transluminal angioplasty of a controlateral renal stenosis. Improvement of the renal function is keeping normal 8 months after, although hypertension control is not very well. 26 case-reports have been found. These preliminary results are encouraging and suggest that this technique should be used against severe hypertension, especially if the kidney is functionnaly solitary, to avoid dialysis in patients with increased operative risk.