Traumatic pseudo-aneurysm and dissection of the thoracic aorta in the presence of an aberrant right subclavian artery: value of multi-slice helical CT.

A case of traumatic pseudo-aneurysm and dissection of the proximal descending thoracic aorta in association with an aberrant right subclavian artery and a common trunk for both common carotid arteries is presented. The diagnosis of this traumatic pseudo-aneurysm and dissection in association with these congenital anomalies by means of a multi-slice helical CT is discussed. To our knowledge, this is the first such case reported in the literature.

Pulmonary vein varix: diagnosis with multi-slice helical CT.

The diagnosis of a pulmonary vein varix with a recently introduced new CT technology, multi-slice helical CT, is discussed. The advantage of multi-slice helical CT lies in increased thin-slice coverage during a single breath hold, which is the predominant factor limiting scan time. This CT technique facilitates the diagnosis of vascular pulmonary pathology.

A semi-automated program for volume measurement in focal hepatic lesions: a first clinical experience.

The value of a semi-automated program for volumetric measurements was tested in 53 patients with liver lesions. Three different radiologists performed 10 measurements on a liver lesion in each patient. The variances of the measurements were calculated. There was no difference in intra- and interoperator variance of the measurements. If the diameter of the liver lesion exceeded the slice thickness, the different measurements became more reliable and more reproducible. The semi automation of the volume measurements makes its use in daily clinical practice possible. Volume measurement can be interesting in the follow-up and evaluation of the treatment on tumor reduction. However further and more thorough investigation is needed to test the clinical usefulness of the program.

[Predictive value of the hemogram for myelotoxicity induced by the association of carboplatin-fluorouracil on the 4th day of the therapeutic regimen]. / Valeur prédictive de l'hémogramme du 4e jour pour la myélotoxicité induite par l'association carboplatine-5-fluorouracile.

The aim of this study was to determine the value of haematological counts at the 4th day of a chemotherapy cycle, in order to foresee neutro and/or thrombocytopenia during the same chemotherapy cycle. One hundred and ten cycles of chemotherapeutic regimens with carboplatin (400 mg/m2, dl) and 5-fluorouracile (1 g/m2/d, by iv continuous infusion for 96 hours) every 3 weeks, were analyzed for 42 patients with locally advanced but non metastatic squamous cell carcinoma of head and neck, without prior chemotherapy. Lymphocyte counts were significantly decreased at the 4th day but normalized at the 8th day (P < 10(-6)). Decreases of lymphocyte and neutrophil counts at the 4th day were significantly correlated to grade > 2 neutropenia. The positive predictive value of lymphocyte or neutrophil counts is about 50% for some cut-off values but not high enough, with the schedule of chemotherapy in our study, to justify the systematic prophylactic therapy with haematopoietic growth factors.

[Randomized placebo trial of myeloprotection with goralatide in patients with squamous cell carcinoma of the upper respiratory and digestive tracts or esophagus, treated with a carboplatin-fluorouracil combination]. / Essai randomisé avec placebo de myéloprotection par le goralatide des patients présentant un carcinome épidermoïde des voies aérodigestives supérieures ou de l'oesophage, traités par l'association carboplatine-5 fluorouracile.

Eighty-four patients with locally advanced, non metastatic squamous cell carcinoma of head and neck or esophagus, were included in a multicentric double-blind randomized trial, comparing goralatide (12.5 or 62.5 micrograms/kg/day, d1-d4) to placebo, associated with carboplatin (400 mg/m2, d1) and 5-fluorouracile (1 g/m2/d continuous IV over 96 hours). Haematological toxicity was analysed on 221 cycles of chemotherapy. All but one patient were evaluable because of early death without haematological toxicity. No significant difference was observed for mean nadir of leukocytes, granulocytes, platelets counts and hemoglobin level. Duration of haematological toxicity was no significantly different for the two groups of patients. Anemia and lymphopenia were more frequent in the goralatide treated patients. Clinical and biological tolerability of goralatide was excellent.

Constructive interference in steady state-3DFT MR imaging of the inner ear and cerebellopontine angle.

PURPOSE: To assess the value of a three-dimensional Fourier transformation MR technique "CISS" (constructive interference in steady state) in imaging the inner ear. SUBJECTS: We studied 50 normal inner ears (40 axial, 10 coronal) and 10 pathologic inner ears in 60 patients. RESULTS: The cochlea, semicircular canals, and vestibulum were visualized in detail. Cranial nerve VII and the cochlear, superior vestibular, and inferior vestibular branch of cranial nerve VIII were identified in 90%, 94%, 80%, and 88% of the cases, respectively. A vascular loop was recognized inside the internal auditory canal in 6%, and in the porus in 30%, of the cases. The high signal of the cerebrospinal fluid and labyrinthine fluids (perilymph and endolymph) on the CISS images made excellent delineation of tumors in the cerebellopontine angle and internal canal possible and allowed detection of tumoral labyrinth involvement. The thin sections, high resolution of the images, and capability of producing multiplanar and three-dimensional reconstructions often offered additional information. CONCLUSIONS: The CISS sequence allows detailed study of the normal and pathologic inner ear and promises to be highly valuable in the demonstration of the vascular loop.

Pathology of the membranous labyrinth: comparison of T1- and T2-weighted and gadolinium-enhanced spin-echo and 3DFT-CISS imaging.

PURPOSE: To assess the value of unenhanced T1-weighted images, T2-weighted images, gadolinium-enhanced T1-weighted images, and three-dimensional Fourier transformation-constructive interference in steady state (3DFT-CISS) images in depicting lesions of the membranous labyrinth. METHODS: Six patients were studied using 1-T MR; both enhanced (gadolinium-tetraazacyclododecane tetraacetic acid) and unenhanced images were obtained and different sequences compared to determine which provided the most information. RESULTS: A combination of gadolinium-enhanced T1-weighted and 3DFT-CISS images could depict all membranous labyrinth pathology. Unenhanced T1-weighted images were necessary to exclude spontaneous hyperintensity in the membranous labyrinth. Gadolinium-enhanced T1-weighted images were needed to detect enhancing pathology such as labyrinthitis and tumors inside the membranous labyrinth. In these cases, 3DFT-CISS images allowed immediate differentiation between inflammation and tumor. In temporal bone tumors involving the bony and membranous labyrinth, unenhanced and enhanced T1-weighted images often sufficed to suggest the correct diagnosis. Only 3DFT-CISS images were able to demonstrate small structures (as fistulas) and to help us confirm or rule out obliteration of the labyrinthine fluid spaces. 3DFT-CISS images were necessary to detect small congenital malformations of the membranous labyrinth when only MR was performed. Uncalcified obliteration of the labyrinth fluid spaces could be reliably detected only on 3DFT-CISS images. Here also gadolinium-enhanced T1-weighted images had to be obtained because enhancement of the soft tissues inside the membranous labyrinth had been observed. CONCLUSION: The CISS sequence and enhanced T1-weighted sequence formed the best sequence combination for diagnosis of membranous labyrinth lesions; additional, unenhanced T1-weighted images can help one differentiate labyrinthitis, proteinaceous fluid, subacute hemorrhage, or tumor inside the labyrinth.

[Retrospective study of 139 cases of epidermoid carcinoma of the upper respiratory and digestive tracts treated by induction chemotherapy with cisplatin-5FU. Influence of the result on the therapeutic protocol]. / Etude rétrospective de 139 carcinomes épidermoïdes des voies aéro-digestives supérieures (VADS) traités par chimothérapie d'induction cisplatyl-5FU. Influence du résultat sur le protocole thérapeutique.

A retrospective study of 139 untreated staged III and IV epidermoid carcinomas of the upper aero digestive tract is reported concerning oropharynx, oral cavity, hypopharynx and larynx, all of them received as a first treatment, chemotherapy using a five days course of Cisplatinium (20 mg/m2/D) and 5FU (1,000 mg/m2/D). The aim of the trial was to determine: a) a free of disease survival and a global survival rate's increase, b) a more conservative treatment. The results of chemotherapy were clinically evaluated in two groups: Responders (a total or a more than 50% response), and no responders. The results were: on the tumor site: 64% responders (25% total response)--more in smaller lesion; on the lymphatic nodes: 54% responders (more in N1-N2). The results vary in inverse ratio to the stage of the lesion; usually, 2 cycles of chemotherapy are used but in case of efficiency: 2 to 6 cycles are provided increasing to 20% the rate of the total responders; toxicity of the drugs was neligible: 6 cases, 3 of them were renal insufficiency. The global survival rate at 3 months reaches 56.7%. The median line of survival reaches 32 months in responders reverse 15 months (NR); but there are no significant difference between the two groups concerning the recurrences, or the metastasis. The local treatment (after chemotherapy) decided in the 137 patients was surgery, in 40 cases and radiotherapy, in 97 cases (conservative treatment; 80%).(ABSTRACT TRUNCATED AT 250 WORDS)

Denta Scan: CT software program used in the anatomic evaluation of the mandible and maxilla in the perspective of endosseous implant surgery.

A radiological technique, using a new CT software program for the evaluation of alveolar process height and width, is presented. Irradiation is kept within acceptable limits when this technique is used. Measurements obtained with this technique were compared with those obtained on panoramic radiographs in 40 "half-jaws" (21 maxillar and 19 mandibular). We found that new indications for implantation emerge in the mandibular region because 'Denta Scan' can sometimes show possibilities to place implants on the buccal side of the canal (2 of 19 mandibular cases) when no possibilities are present above the canal on both the panoramic radiographs and Denta Scan images. In the maxillar region Denta Scan avoids unnecessary interventions by demonstrating the insufficient width of the alveolar ridge, often missed on panoramic radiographs (4 of 21 maxillar cases). Moreover the use of Denta Scan allows the use of implants with optimal length and diameter (23 of the 40 cases), giving better long-term results.

Ultrasonographic findings in peptic ulcer: a report on 24 cases proven endoscopically.

A series of 24 patients is presented who had routine upper abdominal sonography for reason of atypical abdominal pain; in all cases the sonographically suggested diagnosis of a mucosal ulceration was proved by a following endoscopy. The ultrasonic findings were localized thickening of the gastric wall in combination with presence of liquid intragastrically in a fasting patient.

Herniography in adults: review and personal studies.

In 120 adults (87 men, 33 women) with suspicion of a hernia but with normal physical examination, herniography disclosed 125 positive findings correlated with the clinical manifestations. There were no false positive or false negative herniographic diagnoses among 25 patients who underwent surgery. Herniography is a useful examination to evaluate patients with an uncertain or normal physical examination and with clinical manifestations suggestive for hernia. This relatively simple technique and the use of a non-ionic contrast medium are well tolerated.

Giant angiomyolipoma with atypical arteriovenous shunting: CT and angiographic studies.

The advent of both ultrasound and computerized tomography made the pre-operative diagnosis of angiomyolipoma much easier. However, differentiation from retroperitoneal, perinephric space and especially intrarenal liposarcoma remains difficult or impossible. Angiographic findings are atypical and often do not allow differentiation from renal cell carcinoma. Early filling of the renal vein in renal cell carcinoma is sometimes used to distinguish renal cell carcinoma from angiomyolipoma. A case of a giant angiomyolipoma with arteriovenous shunting and early filling of the renal vein is described.

Growing bone cysts in long-term hemodialysis.

All patients with chronic renal failure undergoing hemodialysis for more than 10 years in the university hospitals of Leuven were selected for this study. The medical records and radiographs of these 21 patients were studied retrospectively. Skeletal surveys were examined for the presence and location of subchondral cysts. The predialysis films and the films taken after 5, 10, 15 and 20 years of dialysis were reviewed. Subchondral cysts that grew in size and number were found in the wrist, humeral head, hip, and patella. Accurate measurements were made of cysts in the wrist and compared with a control group. In the dialysis group, cystic involvement of the wrist was more common and the size and number of the cysts were larger. Soft tissue swelling was seen in the dialysis group but not in controls. Soft tissue swelling was assessed on shoulder radiographs by measuring the acromiohumeral distance (ACD) and in the knees by ultrasonic measurement of synovial thickness. In 11 patients synovial or bone biopsies or aspirated synovial fluid were available. All these patients had swollen joints and multiple subchondral periarticular cysts. Amyloid deposition was found in ten of these patients, and this proved to be composed of B2 microglobulins in seven.

[Dynamic MRI of temporomandibular joint: technique and application]. / L'IRM dynamique de l'articulation temporo-mandibulaire: technique et application.

Internal derangements or disk dysfunctions represent the most frequent pathology of the temporomandibular joint (TMJ). The radiological study of TMJ dysfunction was, for a long time, restricted to arthrography. More and more MR is used to study the TMJ, because MR, allows non-invasive visualisation of without the use of X-rays. Moreover a "dynamic" MR technique can be used to study disk movements during mouth opening. A lot of the internal derangement problems can be solved with this technique and arthrography can often be avoided. This dynamic MR technique is described and some cases are discussed.

[Palliative chemotherapy of epidermoid carcinoma of the upper respiratory and digestive tracts with a combination of carboplatin and 5-fluorouracil]. / Chimiothérapie palliative des carcinomes épidermoïdes des voies aéro-digestives supérieures par une association de carboplatine et de 5 fluoro-uracile.

One hundred and thirteen patients with advanced squamous cell cancer of the head and neck were entered into a multicenter trial. Median age was 54 yr (range: 33-74 yr). Median Karnofsky index was 70 (60-100). Thirty-five patients had had prior induction chemotherapy. The first schedule was carboplatin 300 mg/m2, dl and fluoro-uracil 1000 mg/m2/d administered in continuous IV infusion for 96 h every 4 weeks (group 1). The second schedule was carboplatin 350 mg/m2, dl and fluoro-uracil administered at the same dose every 3 weeks (group II). Median number of cycles was 3 (range: 1-16). Seven patients were not eligible. The response rate was 26% (95% confidence limits: 18-34). Nine patients had a complete response. The median duration of response was 6 months (2-16+). The response rates in the 2 groups were not statistically different (21 and 31%) but disease progression was more frequent in group I (61%) than in group II patients (25%). Six early deaths occurred, without sign of drug toxicity. Grade 2 hematological toxicity between or before any cycle was more frequent in group II patients, in particular for leucopenia (13 vs 42%, P less than 0.05). One death was related to granulopenia. Grade 2 or 3 gastric toxicity was observed in 43 patients. No other major toxicity was observed. In our study, combination therapy with carboplatin and fluoro-uracil was found to be moderately active but myelotoxic.

Vertebral artery dissection without ischemic events in the vertebro-basilar system.

A case of extracranial vertebral artery dissection is reported, presenting with headache and pulsatile tinnitus, without ischemic events in the vertebrobasilar system.