Postgranulomatous anetoderma associated with Takayasu's arteritis in a child.

Takayasu's arteritis (TA) is a rare chronic inflammatory arteriopathy affecting mainly the aorta and its branches. Many skin manifestations have been reported in association with this disease. Pyoderma gangrenosum and subcutaneous inflammatory lesions of the leg are the most frequent. We studied a boy with TA in whom a papular rash of the trunk preceded the onset of vascular symptoms by many years. Histologically, the lesions were superficial and consisted of middermal noncaseating tuberculoid granulomas, which progressed to atrophy and anetoderma because of elastic network disruption. Granulomas were also found in synovial tissue but not in a temporal artery biopsy specimen, which showed only intimal hyperplasia. Our observations suggest that vascular and skin lesions with elastic tissue may both result from a common granulomatous hypersensitivity process.

[Possibilities for surgical excision of diffuse hepatoblastomas. Contribution and limitations of chemotherapy]. / Possibilités d'exérèse chirurgicale dans les hépatoblastomes diffus. Apport et limites de la chimiothérapie.

Four children with major hepatoblastoma were treated with extensive surgical excision and chemotherapy. Two right lobectomies and two left extended hepatectomies were performed. The first patient only received postoperative chemotherapy. The others three had preoperative chemotherapy for unresectable hepatoblastoma. All these children exhibited an initial response with marked reduction in size of their primary tumor. The only child who died during operation had disease involving both lobes of the liver, inferior vena cava and lungs metastasis. The follow up of the three other children is 26 to 32 months. Two of them are free of all disease. The third had lung isolated metastasis removed and is actually free of disease with follow up of 32 months. Authors discuss chemotherapy interest and limits in major hepatoblastoma.

[Nephroblastoma with egg-shell peripheral calcifications. Apropos of 3 cases]. / Les néphroblastomes avec calcifications périphériques "en coque". A propos de 3 observations.

Three cases of nephroblastoma presented "egg-shell" peripheral calcifications of pseudocystic appearance of radiology. These peripheral lesions are compared with the more commonly reported central calcifications. Their pathology is unknown and they lack prognostic significance of any importance. As for all nephroblastomas the diagnosis is based on straight abdomen images, intravenous urography, ultrasound and computed tomography. Differential diagnosis is basically from renal adenocarcinoma in children, the latter often exhibiting similar calcifications, the distinction between the two types of tumor depending on age of onset. These calcified lesions are non-specific findings and various diagnoses are discussed.

[Circumscribed non-tuberculous osteomyelitis in children. Apropos of 31 cases]. / Les ostéomyélites circonscrites non tuberculeuses de l'enfant. A propos de 31 cas.

Over the last eight years (1975-1983) a total of 31 cases of circumscribed non-tuberculous osteomyelitis in children have been treated as against 21 cases of classical acute osteomyelitis, suggesting transformation of the mode of presentation of this disease. Lesions were located in the pelvis (8 cases), the calcaneum (3 cases) and the long bones (20 cases), the metaphysis being affected in the latter in 13 patients, the diaphysis in 4 and the epiphysis in three. Specific radiologic images for each location are defined. Clinical expression was subacute and signs of infection inconstant. Differential diagnosis is discussed in relation to each region involved, a positive diagnosis depending on clinical, biologic and radiologic findings, with the need for biopsy in case of doubt. The latter was necessary in 12 of the 31 children. Diagnosis was confirmed in all cases by the favorable outcome from treatment.

[Pelvic echographic data during normal and pathological development in girls]. / Données de l'échographie pelvienne au cours du développement normal et pathologique chez la fille.

From a population of 60 normal females divided in 4 groups of 15 according to age and puberty, standards of uterine length and ovarian volume as measured by ultrasonography were established. The length of the uterus increases moderately with age (mean: 26.4 mm under 2 years of age; 29.5 mm from 2 to 8 years; 36.5 mm from 8 to 12 years) and significantly with puberty (mean: 60 mm), as does the volume of the ovaries (mean: 0.98 cm3 from 8 to 12 years; 3.4 cm3 after puberty). These standards, confirming former data, allow a better understanding of ultrasonographic findings during pathologic growth in young females, such as precocious puberty, delayed puberty, hypopituitarism, or hyperandrogenism. Thus, this investigation may assume an important part in the diagnosis of disorders of puberty, as it is innocuous and may be repeated as often as necessary during the growth of young patients. As it is non invasive and inexpensive, it could be the first investigation in some of these indications.

[Congenital toxoplasmosis and transfontanelle brain echography. Apropos of 8 cases observed in newborn infants and infants]. / Toxoplasmose congénitale et échographie encéphalique trans-fontanellaire. A propos de 8 cas observés chez des nouveau-nés et des nourrissons.

The undeniable value of brain ultrasound imaging in the detection of ventricular dilatation is emphasized, and a classification of intracranial calcifications proposed: hyperechogenic, nodular and irregular large images and those without a posterior shadow cone. Comparison between simple films and particularly computed tomography images was conducted in the cases studied.

[Superior tibial epiphyseal osteochondroma with intra-articular development. Apropos of 2 cases in children]. / Ostéochondrome épiphysaire tibial supérieur à développement intra-articulaire. A propos de deux cas chez 2 enfants.

Two cases of intra-articular development of an osteochondroma in the proximal epiphysis of the tibia are reported. The first case, a 3 year old boy, resulted in blocking of the knee. After resection of the mass the diagnosis was confirmed by pathology. The second patient, an 8 year old boy, had no symptoms and surgery was not performed, although ablation was required of an associated astragalian osteochondroma of tibiotarsal intra-articular development. Relations between these epiphyseal osteochondromata and hemimelic epiphyseal dysplasia and metachondromatosis are discussed.

[Echography and computed x-ray tomography in the diagnosis and surveillance of hepatoblastoma. Apropos of 5 cases]. / Apport de l'échographie et de la tomodensitométrie dans le diagnostic et la surveillance des hépatoblastomes. A propos de cinq observations.

Ultrasound imaging and CT scans were performed in a homogeneous group of five patients with hepatoblastoma. Effectiveness in determining characteristics of the tumor mass and its location and possible vascular extension were compared for the two exploratory methods. Findings suggest that these two examinations are useful and complementary for the diagnosis and follow up of hepatoblastoma.

[Wandering spleen. Apropos of a case in a 4-year-old girl]. / La rate errante. A propos d'une observation chez une enfant de 4 ans.

The case of a 4 year-old girl with ectopic spleen is reported. The diagnostic values of ultrasonography and scintigraphy are emphasized.

Multicystic dysplasia in the upper component of the complete duplex kidney.

Four cases of neonatal multicystic dysplasia involving the upper part of a complete duplex kidney are presented. This malformation, suspected on antenatal ultrasound examination, was confirmed by postnatal IVP and ultrasound. This emphasizes the need to perform an IVP when the diagnosis of multicystic kidney is suggested by ultrasound. Conservative surgery may then be achieved, as in three of the four cases.

An approach to the functional anatomy of the sacroiliac joints in vivo.

This first part of this paper is a review of the literature on the functional anatomy of the sacroiliac joint followed by a preliminary biomechanical study of the fresh post mortem pelvis. The latter was done in order to determine the coefficients of the screw matrix and the position of the instantaneous centers of rotation during the symmetrical movements of nutation and contranutation simulated in the biomechanics laboratory. The main part of this work deals with the spatial analysis in vivo of the relative displacements of the iliac bones with respect to the sacrum in the course of dissymmetrical movements of the pelvis. In the different phases of movement, the roentgenographic observation of the position of the bony components with respect to a three-dimensional orthonormal reference system required the use of material based on the principles of photogrammetry. This technique was used to achieve spatial reconstruction of the data recovered from a series of orthogonal x-ray films of the sacroiliac joints. Data retrieval was carried out on a digital table linked to a computer with a graphic terminal so that the information could be displayed in the form of rectangular coordinates of defined points on the bone. Owing to the limited amplitude of articular displacement, a statistical study was required to retrieve the coordinates from the projection of these points on the X-ray film with an estimated threshold of significance of 0.1 and an error of +/- 0.1 mm.(ABSTRACT TRUNCATED AT 250 WORDS)

[Congenital esophagotracheal fistulas in adults. Apropos of 2 cases]. / Fistules oeso-trachéales congénitales chez l'adulte. A propos de 2 cas.

Repeated bronchopneumopathies are the principal manifestation of congenital esophagotracheal fistulae detected at a late stage. Diagnosis is suggested by air distention of the esophagus on the thoracic image. Esophageal barium swallow examination in the standing position is usually negative: esophageal transit is too rapid, the diameter of the fistula is too small, and its ascending pathway does not allow filling by the contrast medium. Examinations should be conducted in precubitus, after the passage of an esophageal sound, employing barium sulphate as the contrast medium, and with a horizontal beam and profile projection. Kinetic exploration, employing ampliphotography is necessary. The fistula pathway is seen as a thin opaque line, oblique from above forwards, and pushing from the anterior surface of the esophagus to the posterior surface of the trachea. There is associated filling of the tracheobronchial tract.

[Contribution of ultrasonography to the study of retroperitoneal tumors in children (author's transl)]. / Apport de l'échographie dans l'étude des tumeurs rétro-péritonéales de l'enfant.

Ultrasonography investigations of retroperitoneal tumors in children were conducted in 25 cases: 11 nephroblastomas, 11 neuroblastomas, 2 ganglioneuromas, and 1 rhabdomyosarcoma. Ultrasonographic exploration of such tumors should include analysis of the mass: echostructure, limits, interfaces and dimensions, and analysis of its extension. The latter should determine the position in relation to the median line, the condition of the large vessels (inferior vena cava and aorta), the homolateral renal cavities and the contralateral kidney, and the presence or absence of glandular spread and hepatic metastases. The semiology of each of these elements is described and discussed, to determine their individual diagnostic value.

[Computed tomography examination of adrenal tumors in adults (author's transl)]. / Tomodensitométrie de la surrénale pathologique tumorale de l'adulte.

The results of computed tomography examination of adrenal tumors in 19 adults patients are reported. Diagnosis of an adenoma during Cushing's syndrome is possible, as well as detection of spread of an adrenal cortex tumor. Avascular pheochromocytoma and Conn's adenomas less than 1 cm in diameter, occurring during the course of hypertensive disease, can also be demonstrated. In cases of adrenal metastases, the main value of the CT scan is to enable precise stereotaxic biopsies to be conducted, and to allow modification of therapy as a function of results.

[Computer tomography for the detection of bladder tumors (author's transl)]. / Apport de la tomodensitométrie dans le bilan des tumeurs vésicales.

Computer tomography examinations were conducted during pre-treatment investigations in 30 patients with histologically-confirmed bladder cancer. Comparison of anatomical and radiological findings demonstrated that the C.T. scan supplied precise details on any extension of the lesion, enabling choice of therapy to be made in 90% of the cases. These results, which are confirmed by published reports, are discussed in relation to data supplied by other complementary examinations. The conclusion is that the C.T. scan should be employed systematically before starting treatment for bladder tumors.

Orbital syndromes--CT analysis of 100 cases.

100 cases of orbital syndromes, primary or secondary, are reviewed after CT analysis and compared with the results of plain and angiographic conventional examinations. First, the technique and normal results are described. Primary orbital syndromes (45 cases) originating in the orbit form three subgroups--tumors of the eyeball, tumors limited to the orbit and tumors of the orbit with bone lesions, with or without extra-orbital extension. Secondary orbital syndromes (55 cases) spreading to the orbit contain malignant tumors (36 cases) of which 25 are epitheliomas and benign tumors, the most frequent being meningiomas. For ocular and orbital tumors, CT allows the diagnosis of a mass and sometimes the pathological diagnosis (endocrine exophtalmos, inflammatory pseudotumors, varicose ophthalmic veins). For all other orbital tumors CT is important in determining the volume, relationships and extension, and does so better than carotid angiography or orbital phlebography. In secondary orbital syndromes, and particularly in facial malignant tumors and in meningiomas, CT is of great interest in the pretherapeutic evaluation of a tumor. It shows its volume and extension toward the face and orbital cavities, the pterygo-maxillary fossa (so important in determining the operability), the infra-temporal fossa and the endocranium, often without resorting to complementary investigational procedures which are much more aggressive. After histological diagnosis, CT allows the establishment of a therapeutic program.