[Temporary vena caval filters: report on cohort of 72 patients in Grenoble, France]. / Filtres cave temporaires: suivi d'une cohorte de 72 patients au CHU de Grenoble.

Patients with a contra-indication for anticoagulation can benefit from temporary vena caval filters for protection against pulmonary embolism or recurrence. The filter can be removed secondarily, once the contra-indication is overcome, enabling better long-term outcome by reducing the risk of thrombotic and mechanic complications inherent in these devices. However, it has been shown in several studies that effective withdrawal rates were low and could be improved by the establishment of protocols and registries. We report a retrospective study of withdrawal in 72 patients in whom an ALN® vena caval filter was implanted at the Grenoble University Hospital over a period of three years with an intention for secondary retrieval. Seventy percent of the indications were related to the coexistence of thrombotic and hemorrhagic conditions. Fifty-five percent of filters were removed, the remaining 45% shared involved patients who died before retrieval (11%), those lost to follow-up (4%), technical failure of retrieval (6%), withdrawal technically unfeasible (3%), retrieval refused by patients (6%) and medical indications for continuing filtration (15%). Despite an effective follow-up of these patients and 91% success rate of withdrawal, nearly one out of two filters remains in place. A long-term follow-up of these patients is needed to learn more about the outcome of these filters.

Geometric alignment and chromatic calibration of serial radiographic images.

OBJECTIVE: To develop software for automated registration and intensity calibration of serial dental radiographs for the analysis of longitudinal changes in bone density. METHODS: Serial dental radiographs were acquired using a positioning device designed to minimize projection divergence. Each radiograph included an image of a standardized aluminium wedge. The radiographs were scanned on a flatbed scanner (AGFA Duo Scan) with a spatial resolution of 300 dpi, and pixel intensity coded in 16-bit grey scale. The intensity was calibrated using serial images of selected areas with defined thickness of the aluminium wedge. A robust B-splines multiresolution registration algorithm was implemented to overcome the acquisition misalignment. Radiographs, taken before and after periodontal therapy, were subtracted to assess bone density evolution. RESULTS: The intensity calibration decreased the maximum intensity variations between serial radiographs from 30+/-17% to 1+/-1% (mean+/-standard deviation), and improved the visual comparison between the radiographs. The registration stage allowed correcting the misalignment of the radiographs on the scanner screen and superimposing the radiography contents. The observed residual motion was about 0.02+/-0.01 mm. CONCLUSION: Very user-friendly software was developed. The manipulator needs to scan the radiographs only one time. The software performs all subsequent processing steps.

[Pseudoainhum in lamellar ichthyosis]. / Pseudoaïnhum au cours d'une ichtyose lamellaire.

INTRODUCTION: Pseudoainhum is an affection characterized by the appearance of a constricting band around a digit or limb which may lead to spontaneous amputation. There are various etiologies which can be either congenital or resulting from a concomitant disease. We report herein an original case which occurred during lamellar ichthyosis. CASE-REPORT: We present the case of a thirty-year-old woman affected by a severe form of lamellar ichthyosis who, in a few months, developed a pseudoainhum of the third left finger. Biological results were normal. X-rays of this finger showed distal resorption of the bone. The painful evolution and the absence of any conservative treatment compelled us to propose amputation of the third phalanx. DISCUSSION: Other cases of pseudoainhum have been observed in many disease responsible for vascular or neurological abnormalities. They can also result in physical traumatisms or be associated with many dermatoses, such as hereditary palmar and plantar keratodermas. As far as we know, this lesion has never been described during lamellar ichthyosis but could result in the keratinization disorders observed in this congenital ichthyosis.

[Lymphoma presenting as Sister Mary-Joseph's nodule]. / Nodule de soeur Marie-Joseph révélant un lymphome.

BACKGROUND: Cutaneous metastasis of the umbilicus is generally associated with intra-abdominal adenocarcinoma, rarely with a malignant hemopathy. CASE REPORT: We report a case of lymphoma presenting as Sister Mary-Joseph's nodule, in a 79-year-old man. Histology evidenced small-cell lymphoma. DISCUSSION: Umbilical metastasis is uncommon, most of these lesions arising from gastric adenocarcinoma. Only two cases of lymphoma, associated with an umbilical metastasis have been reported. This case opens the discussion on the fact that the umbilicus is generally not a site of metastatic spread of lymphomas.

["Buffalo hump" related to indinavir treatment]. / "Bosse de bison" associée à la prise d'indinavir.

BACKGROUND: Since 1997, new side effects like lipodystrophia have been described in HIV-1-infected patients treated with protease inhibitors. The evolution is not specified in the most reported cases. CASE REPORT: A 44-year-old man treated for HIV 1 infection developed a Buffalo hump 12 months after initiating a new treatment including indinavir-protease inhibitor (Crixivan). Ten months later, we observe neither other fat accumulation nor fat loss and significant metabolic disorders. DISCUSSION: Many publications emphasized the relationship that would exist between protease inhibitors therapy and the occurrence of lipodystrophia. Clinical features of this syndrome appear like an accumulation of fatty tissue anywhere on the trunk, or a fat loss on the limbs, the buttocks and the face. It is sometimes associated with metabolic disorders. The pathogenesis of these lipodystrophia is unclear. Larger studies have to be led to highlight the incidence of these lipodystrophia and their subsequent effects on the HIV-1 infection.

Parapharyngeal space tumors: the infratemporal fossa approach.

Tumors of the parapharyngeal space, although mostly benign in their histopathology, present a challenge to the surgeon due to the limited access. Multiple approaches have been described in the literature for the extirpation of these tumors. The usual anatomic division of the parapharyngeal space into prestyloid and poststyloid spaces does not help the clinician determine which approach to use for a specific tumor. We have reviewed our 10-year experience at the University of Zurich. The usual presentation of the patients and the histopathologic characteristics of their tumors are compared. The radiological evaluation of these patients, their perioperative course, and complications are analyzed. The different surgical techniques used to treat the 72 patients in our series are described, with a special emphasis on the infratemporal fossa approach. Furthermore, a clinical division of the parapharyngeal space in the superior-inferior axis is established. The usefulness of this classification in helping the surgeon to decide which surgical approach is the most suitable for a particular lesion is discussed.

Prenatal diagnosis of thalassemia and hemoglobinopathies in Switzerland.

During a 10-month period, 10 couples originating from Africa (3), the tropics (1) and the thalassemia-belt region (6), living in Switzerland, requested prenatal diagnosis of hemoglobinopathies. Hb SS (twice), Hb Bart's (Hydrops fetalis) and beta-thalassemia major were diagnosed either by gene mapping or by direct detection of the mutations in DNA amplified by the PCR procedure. Whenever it was possible to obtain fetal blood or tissue, diagnosis was confirmed. In one Vietnamese man, concomitant existence of alpha-thal 1 with beta-thalassemia resulted in an unusually high Hb level because of balanced alpha and beta globin synthesis. The 10 couples examined originated from 7 different countries and presented at least 7 different Hb pathologies. This variety of pathologies represents the main difficulty for prenatal diagnosis of hemoglobinopathies in a non-endemic country. A diagnostic approach to overcome this problem is developed.