[Sinonasal cavities: CT imaging features of anatomical variants and surgical risk]. / Cavités sinusiennes de la face: aspect scanographique des variantes anatomiques et leur risque chirurgical.

Anatomical variants of the sinonasal cavities are common. About 15 major variants are described (nasal septal deviation is present in up to 62% of the population). Because the may lead to complications at the time of endovascular procedures or endoscopic sinonasal surgery (vascular, nervous, or osseous injury), there detection has medicolegal implications. Knowledge of anatomical variants by radiologists and ENT surgeons is thus required. We will describe these variants, their imaging features, frequency, implications and associated risk of potential complication.

3T MR imaging of postoperative recurrent middle ear cholesteatomas: value of periodically rotated overlapping parallel lines with enhanced reconstruction diffusion-weighted MR imaging.

BACKGROUND AND PURPOSE: MR diagnostic of postoperative recurrent cholesteatomas is difficult. Our purpose was to compare multishot fast spin-echo periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) diffusion-weighted MR imaging (DWI) with array spatial sensitivity encoding technique (ASSET) single-shot echo-planar DWI and late postgadolinium T1-weighted MR imaging for the detection of postoperative recurrent middle ear cholesteatomas with a 3T imaging unit. MATERIALS AND METHODS: Thirty-five patients with suggested postoperative recurrent middle ear cholesteatoma underwent 3T MR imaging with PROPELLER DWI, ASSET echo-planar DWI, and late postgadolinium T1-weighted MR imaging. Three radiologists (2 seniors, 1 fellow) analyzed unlabeled images for visualization of recurrence. Interobserver and intraobserver agreement was assessed by using the Cohen kappa statistic test. Sensitivity, specificity, and predictive value were assessed for the 3 observers. RESULTS: Nineteen recurrent cholesteatomas were diagnosed. PROPELLER interobserver agreement was very good (1, 0.89, 0.89) among the 3 observers. Intraobserver agreement between PROPELLER and T1-weighted imaging was very good to moderate (0.88, 0.57, 0.58). PROPELLER DWI provided less interobserver variability than other sequences, and the best sensitivity, specificity, and predictive value. CONCLUSIONS: On a 3T imaging unit, multishot fast spin-echo PROPELLER DWI allows an easier detection of postoperative recurrent middle ear cholesteatoma than T1-weighted imaging by reducing artifacts and by its better contrast. DWI with PROPELLER is diagnostically robust and accurate.

[A rare case of nasal and buccal obstruction in a child: the antrochoanal polyp of Killian]. / Un cas rare d'obstruction nasale et buccale chez l'enfant: le polype antrochoanal de Killian.

Nasal obstruction is a frequent symptom of consultation in paediatric otorhinolaryngology. Usually, adenoid hypertrophy is the cause. Sometimes the examination reveals the presence of polyps in the nose. The antrochoanal polyp of Killian is particularly frequent in childhood. The obstruction is usually unilateral, but the posterior extension of a bulky polyp to the oropharynx can cause a major discomfort, sometimes a respiratory distress. We report the observation of a 10-year-old patient presenting a bulky polyp of Killian, visible in the oropharynx and then discuss the features of this polyp in the literature.

[Combined transfacial and neurosurgical approach for the treatment of ethmoid cancers]. / Evaluation de la voie d'abord combinée transfaciale et neurochirurgicale dans le traitement des cancers de l'ethmoïde.

OBJECTIVES: The purpose of this work was to examine the indications for the combined transfacial and neurosurgical approach to ethmoid cancers. PATIENTS AND METHODS: Fifteen patients with ethmoid cancers underwent surgery via the combined approach between 1990 and 2000 at the Amiens University Hospital. The transfacial approach alone was reserved for elderly patients. RESULTS: The histological diagnosis was adenocarcinoma in 10 patients. There was one postoperative death. Mean follow-up was 45 months (range 3 - 129). Six patients died from local or metastatic recurrence. At last follow-up eight patients were disease free, two had local or metastatic recurrence. CONCLUSION: We compared systematic use of the combined approach for curative surgery with surgical strategies adopted by other teams. The combined approach is indicated for T3 or T4 tumors and for all other tumors with a posterior or superior extension. Anterior and unilateral tumors may be treated with the transfacial access alone. Limited tumors without extension to the orbit or cribiform plate may be managed endoscopically. The role of histological diagnosis and the choice of the surgical approach remain to be evaluated.

[Intraorbital infected cyst in the adult]. / Kyste intra-orbitaire surinfecté chez l'adulte.

Orbital dermoïd cyst is a rare tumour, whose pathogenesis remains unclear. This is a childhood pathology. It is usually located in the lateral orbit. This tumour is rarely observed during adulthood, and complications are often responsible for the symptomatology. We present a new case with late presentation and because of its variety, a review of the literature.

[Comparison of laryngoscopy and CT-scan results before partial laryngectomy]. / Comparaison des résultats de la laryngoscopie et du scanner avant laryngectomie partielle.

OBJECTIVES: Careful assessment of tumor extension is required before partial laryngectomy in order to ensure optimal carcinological safety. Laryngoscopy and CT-scan constitute the explorations of reference. We investigated the value of these two examinations and their association for the evaluation of glottic and supraglottic tumors. METHOD: We compared laryngoscopy and CT findings with those of the pathologic examination of the surgical specimen in a retrospective study of 57 patients. RESULTS: The results were presented by T-staging, then as a function of the laryngeal floor of the tumor and the anatomic localization. The laryngoscopy findings were most contributive for small tumors. Large spaces are better examined with the scanner. CONCLUSION: This study showed that the performance of laryngoscopy and CT-scan for the assessment of glottic and supraglottic tumors can be improved by a better knowledge of the limitations of each type of explorations for this type of assessment. CT-scan currently provides a better topographic assessment of the tumor than endoscopy; even higher performance can be expected with the advent of technological advances.

[Orthognathic surgery and stereolithographic models. A new technic of dental occlusion transfer]. / Chirurgie orthognathique et modèles stéréolithographiques. Nouvelle technique de transfert de l'occlusion dentaire.

Use of stereolithographic models in orthognathic surgery is limited by the difficult in considering the facial osteotomies and the dental occlusion at the same time. Different techniques allow the surgeon to perform the simulation using composite prototypes after including the dental casts on the models. These techniques require complex "stereotaxic" systems or a surgical approach before CT scanning in order to insert the reference screws. They cannot overcome the problem of mandibular movement during the CT session. Our technique is a simple way to include the dental casts in the stereolithographic model with high precision. This can easily be done in a maxillo-facial environment and does not require any further special knowledge other than that which can be aquired in a classical dental laboratory. The occlusion transfer is achieved with a silicon cast of the teeth and the bony structures of the sterolithographic model on which we include the plaster dental casts. The silicone cast of the dental occlusion can also be used to decrease the mandibular movement during CT scanning.

Visual memory for novel shapes: implicit coding without attention.

Implicit memory for novel shapes was explored with a negative priming paradigm. The results show that representations of shapes, formed in a single trial and without attention, can last without decrement across 200 intervening trials and with temporal delays of up to a month. No explicit memory of the shapes was available, either immediately or after a delay. There were consistent individual differences in the amount of negative priming shown, and some participants showed only facilitation. There was a trend toward increased facilitation across time, as if the memory of the shape survived longer than an "action tag" attached to it, which specified whether it should be attended or ignored. The results demonstrate a surprising combination of plasticity and permanence in the visual system and suggest that the roles of both attention and repetition may be to ensure voluntary retrievability rather than to form a lasting memory.

Costs and benefits of target activation and distractor inhibition in selective attention.

Three experiments examined the relative contributions of positive and negative priming in a selective attention task. A typical trial consisted of a briefly presented letter display containing a red target letter and a distractor letter of another color. This prime display was followed by another similar letter display (the probe). When the red target letters were identical in both displays, facilitation from identity repetition priming was obtained. When the unattended letter from the prime display became the probe target letter, response times were delayed, that is, a negative priming effect was found. Other combinations of target and distractor letters were manipulated to examine the relative influences of positive and negative priming. Results support the hypothesis that selective attention involves a selective inhibition mechanism and suggest that this inhibitory mechanism can be as influential as its excitatory counterpart.

Spontaneous portal venous gas in a patient with Crohn's ileocolitis.

In a 70-year-old man with Crohn's ileocolitis who presented with a sudden fever, ultrasound and computed tomographic (CT) examinations showed hepatic portal venous gas (HPVG). Abdominal plain film was normal. The course was benign with medical management. The authors review previous cases of portal vein gas in intestinal inflammatory diseases.

[Multiple duodenal lipomas. A x-ray computed tomographic diagnosis]. / Lipomes duodénaux multiples. Un diagnostic scanographique.

In a 65-year-old man, upper endoscopy revealed several polypoid lesions into the duodenum, for which histologic examination of the biopsy specimens showed normal mucosa. CT studies demonstrated homogeneous fat density of these nodules, and thus were diagnostic of duodenal lipomas. The diagnosis was ultimately histologically confirmed by deeper peri-endoscopic biopsies. About this case and the some previously reported ones, the authors emphasize the interest of CT examination in this small bowel tumor.

[Carney's syndrome disclosed by hemoperitoneum]. / Syndrome de Carney révélé par un hémopéritoine.

The authors report a case of Carney's triad in a blood-group O woman who successively sustained a) at age 13, a multicentric gastric leiomyoblastoma revealed by an hemoperitoneum; b) 6 years later, a pulmonary chondroma diagnosed by chest standard roentgenogram and CT scan, associated with leiomyoblastoma recurrence and hepatic metastases; c) 10 years later, a juxta-carotid tumor of unknown (paraganglion?) origin. This patient is presently in good clinical condition, in spite of hepatic metastases known for 5 years. Based on this case and the 33 previously reported cases, the main features of this very unusual entity are analyzed.

[Cavernous lymphangioma of the liver. A report of 2 cases and review of the literature]. / Lymphangiome caverneux du foie. Etude de 2 cas et revue de la littérature.

The authors report 2 cases of hepatic lymphangioma observed in a 54-year-old woman, and in a 39-year-old man. These tumors were discovered upon ultrasound examination performed for jaundice due to viral hepatitis, and for abdominal right upper quadrant pain respectively. Computed tomography and angiography showed hypervascularized tumors. Diagnosis was established through surgical biopsy specimens. The clinical course was uneventful, during respectively the 9- and 3-year follow-up periods, respectively. From these and the 40 previously reported cases, the authors describe the different features of this unusual tumor.

[Spontaneous contained perforation of a hiatal hernia. A new equivalent of Boerhaave's syndrome]. / Perforation "spontanée" cloisonnée d'une hernie hiatale. Un nouvel équivalent du syndrome de Boerhaave.

The authors report the case of an alcoholic 49-year-old man hospitalized because of epigastric pain and hematemesis. Upper endoscopy showed a tear in a hiatus hernia (interpreted as a Mallory-Weiss lesion) and a bleeding duodenal ulcer. Upper barium examination performed 16 days later revealed a mediastinal collection communicating with the hiatus hernia. Retrospective evaluation of chest roentgenograms obtained at admission showed a limited mediastinal gas collection. With medical management, the collection progressively disappeared. From a theoretical point of view, this case illustrates Watts' theory on the effect of hiatus hernia on the site of postemetic injury. From a practical point of view, it confirms that conservative management is indicated in contained spontaneous perforations.

[The contribution of x-ray computed tomography in acute pancreatitis]. / Apport de la scanographie dans les pancréatites aiguës.

In acute pancreatitis. CT realize the best morphological examination not only for pancreas but also for extrapancreatic spread. However, ultrasonography is necessary for biliary lithiasis detection. Prognostic value of CT findings remains controversial and further studies are needed to clarify this problem. CT also permits to survey evolution and to detect eventual complications. Interventional CT, consisting in single-step needle aspiration or catheter drainage, allows in selected cases to avoid an unnecessary surgery.

Gastric leiomyoblastoma: diagnosis by CT and ultrasonography.

A case of gastric leiomyoblastoma is reported in a 57-year-old woman complaining of upper abdominal discomfort. Ultrasound and CT examinations discovered an epigastric mass, and ultrasound manoeuvers by multiple positioning allowed to refer it to a gastric origin. Definitive diagnosis was established by histological examination of the surgically removed tumor. The authors emphasize the interest of the radiological examinations, particularly ultrasound and CT, in this rare condition.

"Porcelain liver" appearance due to Glisson's capsule phleboliths.

A case of multiple Glisson's capsule phleboliths is reported in a 29-year-old-woman who had portal vein obstruction with spontaneous shunting resulting in hepatic siderosis and cirrhosis. The phleboliths were visible as multiple linear calcifications on plain film and computed tomography. Diagnosis was established by surgical liver biopsy. The potential mechanisms of this unique entity is discussed.

Thyroid carcinoma in two sisters with familial polyposis of the colon. Case reports and review of the literature.

Multicentric thyroid papillary carcinomas were present in two sisters with familial polyposis of the colon; in one the tumor was found at age 29 and in the other at 26 years of age, respectively 13 and 5 years after colectomy. This association is not fortuitous and should lead to regular examination of thyroid gland in patients with familial polyposis or in Gardner's syndrome patients. It might even be wise to search for adenomas of the colon in young patients with thyroid carcinoma.