[Neuromeningeal tuberculosis: the contribution of genetic amplification to diagnosis]. / Tuberculose neuro-méningée: apport de la méthode par amplification génique dans le diagnostic.

Neurological manifestations of tuberculosis are rare, especially in immunocompetent subjects. The heterogeneity of clinical and radiological features induces frequently a delay for diagnosis. The aim of the study was to describe clinical and radiological presentation of 11 cases of neuro-tuberculosis and to evaluate clinical outcome. We performed clinical, CSF, MRI and outcome evaluation in all patients. We also performed a mycobacterium analysis by polymerase chain reaction (PCR). Patients were 6 men and 5 women with a mean age of 45.4 years. Clinical presentations were meningeal symptoms in 9 cases and focal manifestations in 4 cases. CSF was abnormal in 82 p.cent of cases (protein increase in 73 p.cent, pleiocytosis in 73 p.cent, hypoglycorrhachia in 45 p.cent and hypochlorrhachia in 36 p.cent). The best diagnostic test was PCR (positive in 45 p.cent of cases). CSF cultures were positive in only 2 cases (18 p.cent). Only 2 patients had chest involvement. MRI was abnormal in 64 p.cent of cases showing pseudo-tumor, arachnoiditis, vascular lesions or medullar involvement. Outcome was good in all cases but two (one patient died and one patient had paraplegia possibly related to late diagnosis). Neurological manifestations of tuberculosis are extremely various in terms of clinical and radiological presentation. The best diagnostic test seems to be tuberculosis PCR. Outcome is frequently favorable if late diagnosis is avoided.

Correlation between computed tomography and gross anatomy of the suspensory ligament of the ovary.

To assess the morphology of the suspensory ligament of the ovary on CT scan examination, an anatomic study of the suspensory ligament of the ovary was performed to demonstrate its morphology on CT and to facilitate the visualization of the ovaries. Twelve female cadavers were studied after intravascular injection of latex (venous: 2, arterial: 6, arterio-venous: 4). We first observed all the pelvises after their transection. Six dissections were then made to obtain optimal anatomic correlations on the content and relations of the infundibulo-pelvic ligament. The arterial opacifications were poor compared with to the good quality of the venous or arteriovenous opacifications. An upright correlation between CT slices and the anatomic study was made. This radio-anatomic study emphazises the importance of the veins, which really support the suspensory ligament of the ovary, as opposed to the involution of the arteries. This study points out the link between the infundibulo-pelvic ligament above and the utero-ovarian below, then with the superficial uterine vv. All these structures were well analyzed on CT and during the anatomic studies. A very well developed periovarian venous plexus which frequently concealed the ovaries was demonstrated. Some anatomic variations which were invisible on the CT scan examinations were displayed. The visualization of the suspensory ligament of the ovary should facilitate the visualization of the ovaries and could optimize the search for lymphadenopathies originating from ovarian cancers.

Anatomic approach to the parametrium: value of computed tomographic in vitro study compared to dissection.

The aim of this study is to describe the morphology of the normal parametrium by correlating the slices obtained with computed tomography of 12 female cadavers studies after intravascular injection of latex with the dissection findings in 6 of the these patients. the upper limit, represented by the isthmus was defined by the uterine a. and/or a superficial uterine v. and/or the coronary v. (Charpy). The lower limit corresponded to the insertion of the levator ani mm. at the junction of the middle and inferior thirds of the vagina. The paracervical and paravaginal tissues above the levator ani m. and medial to the pelvic fascia covering these muscles were perfectly visualized. The posterior limit, formed by the lateral ligament of the rectum and/or the sacrouterine ligaments, and the anterior limit determined by the umbilico-vesical fascia were more difficult to demonstrate. In this study the parametrium appeared as a highly vascular and essentially venous connective structure with a variable morphology dependent on the uterine position.

Computed tomographic follow-up study of 21 cases of nonoperatively treated cervical intervertebral soft disc herniation.

The authors studied the natural evolution of cervical soft disc herniations in 21 patients with cervical radiculopathy that was successfully treated with conservative therapy only. The first computed tomography (CT) examination was performed during the acute phase of the radiculopathy, and the second performed from 1 to 30 months after healing. The initial CT allowed classification of the herniations according to size: nine were considered small, seven medium, and five large. Comparison with follow-up scans showed that five of the herniations decreased between 0 and 35%, six decreased between 35 and 75% and ten decreased between 75 and 100%. The largest herniations were those that had the greatest tendency to decrease in size. This tendency could be secondary to the herniation breaking through the outer fibers of the anulus and entering the epidural space.

Fibrothecomas of the ovary: CT and US findings.

OBJECTIVE: Fibrothecomas of the ovary are mesenchymal tumors representing 4-5% of all ovarian neoplasms. The purpose of this study is to describe a large series of CT findings in this type of tumor. MATERIALS AND METHODS: We reviewed retrospectively the CT examinations in 25 unilateral cases confirmed by surgery and pathology. Unenhanced and enhanced CT scans were performed in all cases and dynamic CT scans were performed in nine cases. These findings were compared to ultrasound in all cases. RESULTS: Computed tomography detected all but two small ovarian tumors (< 2 cm). Eighteen of 23 fibrothecomas were solid, with significant (> 10 HU) enhancement between precontrast and delayed CT scans. In all eight uncomplicated cases, nonincremental dynamic CT scan did not visualize arterial vessels; in seven of nine cases examined dynamically, early uptake of contrast material was visualized. Three of 23 fibrothecomas were partly cystic, partly solid. Two cases with torsion were mainly cystic with thickening and hemorrhage of the tube. CONCLUSION: In conclusion, 79% of ovarian fibrothecomas appeared as solid masses with delayed accumulation of contrast medium. On dynamic CT, the absence of arterial vessels and absence or slight early uptake of contrast enhancement could be useful findings for preoperative diagnosis. When partly or mainly cystic (21% of cases), ovarian fibrothecomas could not be easily differentiated from other ovarian masses.

Focal hyperdense areas in endometriomas: a characteristic finding on CT.

OBJECTIVE: To assess the value of a hyperdense focus seen on CT scans of endometrial cysts in the differential diagnosis of a lesion. MATERIALS AND METHODS: The preoperative CT scans of 328 patients with 410 ovarian masses (54 patients with 62 pathologically proved endometriomas and 274 patients with 348 pathologically proved other ovarian masses) were retrospectively reviewed in a random fashion without knowledge of the pathologic findings to determine whether a hyperdense focus was visible inside a cyst. RESULTS: In nine of 62 endometrial cysts (sensitivity, 15%), CT scans showed a hyperdense round or crescent-shaped focus, measuring 2 to 15 mm. This focus was located close to the inner border of the cyst in eight cases and in the central part of the cyst in one case. A hyperdense focus was not seen on CT scans of 348 other ovarian masses (specificity, 100%). An in vitro CT study of two specimens showed that this hyperdense area corresponded to a blood clot next to the inner wall of the cyst. This hyperdense area appeared as a nonspecific hyperechogenic focus on sonograms in five of nine cases and as a hypointense signal on T1- and/or T2-weighted MR images in four of five cases. CONCLUSION: The finding on CT scans of a hyperdense focus inside an ovarian cyst is suggestive of endometrioma and should help distinguish endometrioma from other pelvic masses.

[Canalicular stenoses complicating the insertion of lacrimal plugs. Incidence and mechanisms]. / Sténoses canaliculaires compliquant la pose de bouchons lacrymaux. Incidence et mécanismes.

Changes in canalicular permeability following the insertion of punctum plugs was studied. This occlusive method was used to treat dry eye syndrome in 43 patients over a period of 32 months. All had normal canalicular patency, confirmed on the day of implantation. One hundred and five large plugs were used (2.4 plugs per patient). Twenty seven (25.7%) impassable acquired canalicular stenoses were seen in 15 patients. The canalicular site of the 27 stenoses was the same: junction between the vertical and horizontal portions. Among the 27 stenoses: 4 plugs had disappeared at an unknown time, with follow-up probing taking place after a mean interval of 7.5 (months range: 1 to 15 months); 17 plugs had been expelled after being in place for an average of 5 months (range: 1 to 12 months; standard deviation 3.47), with follow-up examination taking place on average 12 months after insertion (range: 6 to 17 months; standard deviation 3.4); and 6 plugs were still in place after a mean of 7 months (range: 2 to 15 months; standard deviation 4.73) and the stenosis was discovered when they were removed. They were intact. These 6 Cases eliminate any possibility of intra-canalicular migration of the prosthesis--of all or part--of the prosthesis. Stenoses appeared to develop rapidly: 45% of cases were discovered during the first 3 months. 16/27 (59%) of stenoses were investigated a second time, 6 months later on average (range: 2 to 12 months): these 16 canaliculi all remained impassable.