[Focused lithotripsy in the treatment of tendinosis calcarea of the shoulder: results at 2 months and one year]. / La lithotritie focalisée dans le traitement des tendinopathies calcifiantes de l'epaule. Résultats a 2 mois et un an.

OBJECTIVE: The authors report their experience with extracorporeal lithotripsy in 30 patients with calcific tendinosis of the rotator cuff. MATERIALS AND METHOD: This technique is based upon the utilization of high-energy shockwaves (6000 shocks in 3 sessions Day 1, D8, D30) under continuous ultrasound localization of the lesion (EPOS Ultra1). Calcification were evaluated at plain film, US and CT to characterize their length and features. RESULTS: Complete or partial resorption of calcifying deposits within 2 months and one year was observed in 27.5% and 25% of cases respectively. Clinical improvement results are encouraging at two months (50%), but reduced at one year (28.5%), consistent with the rate of resorption of calcifications. CONCLUSION: This painful, long, and expensive technique seems to be disappointing in the treatment of the calcific tendinosis.

[Posterior disk displacement of the temporomandibular joint. Apropos 2 cases]. / Déplacement discal postérieur de l'articulation temporo-mandibulaire. A propos de deux cas.

Posterior displacement of the temporo-mandibular joint disk is exceptional. The most typical clinical sign is sudden onset unilateral molar open bite. This lateral open bite is accompanied by a sensation of an intra-articular foreign body and more rarely by painful episodes. The joint sounds are not characteristic. Mouth opening is slightly limited. There is no consensus concerning treatment. Conservative treatment can be prescribed in cases with functional impairment. First line invasive techniques should be avoided.

[RMI of dysfunctional temporomandibular joint (TMJ). Value of gradient-echo T1 sequences in the evaluation of bony structures]. / IRM de l'articulation temporo-mandibulaire (ATM) dysfonctionnelle. Intérêt des séquences en écho de gradient pondéré T1 pour l'analyse des structures osseuses.

PURPOSE: To identify and classify the different types of bony changes of the condyles in patients with disorders of the temporomandibular joint (TMJ). MATERIALS AND METHODS: Since 1993, we have imaged over 600 patients with 0.5T MR unit by using gradient-echo T1-weighted sequences in the sagittal and coronal planes. RESULTS: We will first describe the appearance of the normal TMJ. Then, we will introduce the concept of "Condylo-diskal disunion" using a three grade classification system. We will then describe three patterns of condylar changes: adaptive remodeling, either anterior or more frequently posterior, degenerative lesions with subchondral sclerosis, erosive lesions due to synovial hyperplasia. CONCLUSION: Using a 0.5T MR unit, a GRE T1 sequence is useful to identify lesions of the disk and detect bony changes. In addition, the tissues posterior to the disk can also be assessed on postcontrast images.

[Coraco-trochineal conflict or anteromedial conflict of the shoulder. Contribution of arthroscanners]. / Le conflit coraco-trochinien ou conflit antéro-interne de l'épaule. Apport de l'arthroscanner.

Like the anterosuperior subracromial conflict, the coracotrochineal or anteromedial conflict of the shoulder is a groove pathology. In a series of 340 patients who had an arthroscan of the shoulder, including 245 with a conflict syndrome (70%), we observed an anteromedial conflict in 12 cases (8.5%) of the 140 patients with an intact cuff and 52 cases (50%) in 102 patients with an injured cuff. The frequency of the anteromedial conflict appears to be proportional to the degree of cuff injury. We described the signs of the trochin suggesting the anterior musculotendinous structures (subscapsular tendon and/or long biceps tendon) are involved and conclude that the anteromedial conflict is often misdiagnosed. It would appear to be a frequent complication of cuff injury (mechanical theory) which the surgeon should take into consideration when repairing cuff injury.

[Multiple pancreatic metastases of small-cell bronchogenic carcinoma]. / Métastases pancréatiques multiples d'un carcinome bronchique à petites cellules.

Multiple pancreatic metastasis of small cell lung cancer. Pancreatic metastasis of small cell lung cancer are unusual, in spite of their fast evolution. The authors describe a case of small cell lung cancer with multiple pancreatic metastasis showed by echography and confirmed by ultrasonic guided biopsy.

[Periungual capillaroscopy patterns in normal children]. / Etude des aspects capillaroscopiques péri-unguéaux chez l'enfant normal.

In children as well as in adults, capillaroscopy is an unsophisticated and non invasive technique which allows to investigate vascular acrosyndromes and systemic diseases. We have studied nailfold capillaroscopy patterns in 80 children without over vascular or systemic disease: pericapillary halos and haemorrhages increased with age and capillaries matured towards the typical hair pin structure seen in adults. The number of minor dystrophies increased with age and the venous subpapillary plexuses became less easily visible.

[Weismann-Netter and Stuhl disease. A review of the literature. Apropos of a case with uncommon radiologic signs]. / Maladie de Weismann-Netter et Stuhl. Revue de la littérature. A propos d'un cas avec signes radiologiques inhabituels.

Cases of Weismann-Netter and Stuhl disease reported in the literature usually involve stereotyped pictures characterized by the presence of tibio-fibular dysmorphism, most often the only abnormality. The authors present a current review of the literature on the basis of a new case of this tibio-fibular diaphyseal toxopachyosteosis.

[Algodystrophy of the femoral head. Contribution of new imaging methods]. / L'algodystrophie de la tête fémorale. Apport des nouvelles méthodes d'imagerie.

Results are reported of the use of new imaging methods, CT scan and magnetic resonance imaging, in 12 patients with algodystrophy of femoral head. During the early stages a CT scan can detect partial demineralizations, observed on MR images in sagittal sections. When the disease is installed the CT scan images show global demineralization, but the MR images with coupled T1-T2 study appear to be more pathognomonic (hyposignal extended in T1 with hypersignal in T2, associated with a more marked subchondral hyposignal in T1 as in T2) particularly in relation to the osteonecrosis of femoral head.

[Magnetic resonance imaging in the study of acoustic neurinoma]. / Apport de l'imagerie par résonance magnétique dans l'exploration du neurinome de l'acoustique.

Exploration of acoustic neurinoma, the most frequent benign tumor of posterior fossa, now includes magnetic resonance imaging, and an C.G.R. supraconductor apparatus (0.5 Tesla) has been in use since March 1986. This equipment provides high resolution frontal sections, not only of posterior fossa but of the two pontocerebellar angles and even the contents of the two IAC (thin, contiguous 4 mm sections in 256 x 256 matrix). A total of 43 patients were examined, 37 with surgically confirmed acoustic neurinoma and 2 with tumor recurrence. The neurinoma appears on the first echo as a hyposignal in relation to brain stem in sequences predominant in T1 and as a hypersignal in relation to peripontic CSF in sequences predominant in T2. Short sequences predominant in Tl (partial saturation or short ET and RT spin-echos) appear to be most effective for detection of acoustic neurinoma. Comparison of MRI and CT scan imaging showed that firstly, all cases detected by conventional scanography were correctly analyzed by MRI, with superiority for MRI for preoperative screening due to the frontal sections obtained without interference and, secondly, the non-invasive confirmation of diagnosis in doubtful or negative cases requiring computerized gaz meatocisternography. No false negative or false positive results were reported in our series or those documented in the literature using this new imaging technique, but high performance apparatus is necessary (thin sections ans powerful principal magnetic field of at least 0.5 resla). Improvements in this method could be obtained by the availability of more rapid programmes, the use of surface coils and the injection of paramagnetic substances (galodinium chelates) presently under study. NMR imaging is a reliable and non-invasive imaging method capable of replacing the scanner for study of acoustic neurinoma as soon as more apparatuses become available.

[Contribution of nuclear magnetic resonance in the neuro-otologic diagnosis of acoustic neuroma. Screening and evaluation of its extension]. / L'apport de l'I.R.M. dans le diagnostic neuro-otologique du neurinome de l'acoustique. Dépistage et bilan d'extension.

Forty patients with suspected tumoral syndrome of ponto-cerebellar angle were investigated by NMR imaging. The method proved to be reliable, less invasive (lack of irritation and absence of iodized contrast) and as rapid as CT scan imaging for the diagnosis of presence and extension of an VIIIth nerve neurinoma. It also allowed avoidance of computerized gas meatography during screening for intracanal neurinomas.

Comparison of two-dimensional echocardiography with scanography and indium-111 platelet scintigraphy in detection of intracardiac thrombi.

The authors compare three diagnostic-imaging methods (two-dimensional-echography, heart scans and indium-111 platelet scintigraphy) used in the detection of intracardiac thrombi in 82 patients. They attempt to define their respective diagnostic values in the presence of left ventricular and atrial thrombi.

[Hemorheologic study of different forms of vasomotor acrosyndromes]. / Etude hémorhéologique au cours des différentes formes d'acrosyndromes vasomoteurs.

Hemorheologic disorders are a frequent finding in circulating blood during vascular diseases (arterial disease of lower limb, cerebrovascular accidents). They participate in thrombogenesis and tissue ischemia production, and also in microcirculatory disturbances as shown by behavior in microvessels of red cells with decreased hereditary deformability (sickle cell anemia). Active alterations in erythrocyte rheology have also been demonstrated during vascular diseases in relation to inflammation: cell-protein inflammatory reaction, action of leukocytes. Therapy should be adapted for these microcirculatory disorders by suitable specific clinical trials.

[Detection of left intraventricular thromboses. Comparison of 2-dimensional ultrasonics with scanography and scintigraphy with indium 111-labeled platelets]. / La détection des thromboses intra-ventriculaires gauches. Confrontation de l'échographie bidimensionnelle à la scanographie et à la scintigraphie aux plaquettes marquées à l'indium 111.

Three methods of diagnostic imaging : bi-dimensional ultrasonography, scanography and 111Indium-labelled platelet scintigraphy were compared in 61 patients to detect left intraventricular thrombotic lesions, in order to determine their respective diagnostic values.

[Computed tomography in imaging in maxillofacial surgery]. / Apport de la tomodensitométrie dans l'imagerie en chirurgie maxillo-faciale.

The improved definition and good visualization of soft tissues provided by high resolution computed tomography imaging greatly exceeds results of conventional tomography investigations. It is irreplaceable for tumoral lesions, particularly of the facial region, when not only the tumor but its degree of extension are perfectly identified. In orbital injuries it is the only imaging procedure capable of visualizing the orbital contents and its relation with the fracture line.