[Doppler preoperative evaluation of the prevalence of functional abnormalities of palmar arches in children]. / Evaluation préopératoire par Doppler de la prévalence des anomalies fonctionnelles de l'arcade palmaire chez l'enfant.

Thromboembolic events and inadequate palmar collateral circulation are the two main mechanisms of hand ischaemia following radial artery cannulation. The latter cause may be detected in adults with Allen's test, which is difficult to perform and to interpret in children. Therefore we investigated preoperatively in children the permeability of palmar arches with doppler ultrasound, prior to radial artery cannulation. Thirty-five children (20 M/15 F), aged between 6 months and 14 years (mean = 4.2 years) were scheduled for doppler ultrasound study of their palmar arches before undergoing a major neurosurgical procedure. This study was performed with a 8 MHz directional doppler probe according to Marcillon's technique. Blood flow in superficial palmar arch and in pad of the thumb were identified. Alterations in flow caused by compression of the radial artery were noted. Results were expressed in qualitative terms: functional arch (normal doppler), moderately functional or non-functional arch (abnormal doppler). In the latter cases, the artery was not cannulated. An anomaly in one or both palmar arches was seen in 43% of children (95% confidence interval: 25-60%). The incidence was comparable on both sides (right: 34%; left: 31%) with a mean probability of 33% (95% confidence interval: 17-49%). The probability of a controlateral anomaly, when one hand was abnormal, reached 70%, e.g., twice that of the first hand (p < 0.01). This indicates a relatively low incidence of asymmetry (20%) and therefore a high incidence of a bilateral anomaly (23%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Deep phlebitis of the lower limbs. Diagnostic value of D-dimer assays]. / Phlébites profondes des membres inférieurs. Intérêt diagnostique du dosage des D-dimères.

D-dimers are specific fibrin degradation products which have been measured in plasma and used as a diagnostic test for deep vein thrombosis of the lower limbs. However, the results published so far have often been conflicting. We compared the results of D-dimer assays by the latex method (positivity threshold: 0.5 microgram/ml) in 3 groups of patients: 22 patients with clinically suspected thrombophlebitis confirmed by doppler ultrasound; 22 patients with clinically suspected thrombophlebitis not confirmed by doppler ultrasound; and 17 hospital patients with other diseases serving as controls. The sensitivity of a D-dimer concentration higher than 0.5 microgram/ml was 96 percent and its specificity 69 percent. In an internal medicine unit where the prevalence of thrombophlebitis was 50 percent, the positive predictive value of a D-dimer concentration higher than 0.5 microgram/ml was 81 percent, and its negative predictive value was 94 percent. Thus, because of its low specificity as compared with imaging methods the D-dimer assay test cannot be used to diagnose deep vein thrombosis, but as it has good sensitivity and is rapidly performed, safe and inexpensive it can be used as an emergency examination which, when negative, makes this diagnosis unlikely.

[Extracorporeal lithotripsy of gallbladder calculi. Tolerability, complications and early results]. / Lithotritie extracorporelle pour lithiase vésiculaire. Tolérance, complications et résultats précoces.

The purpose of this prospective study, conducted on 88 patients, was to assess the tolerance, efficiency and early complications due to a piezo-electric lithotriptor in the destruction of gallbladder stones. One hundred and sixty one sessions were performed in 82 patients. All patients had symptomatic, uncomplicated lithiasis, the diameter of which was less than, or equal to, 30 mm. All patients had less than 7 stones in a functional gallbladder. In 22 patients, the stones were calcified. Lithotripsies were carried out without anesthesia or premedication, except in an 8-year-old child who had to be anesthetized. In 3 cases it was impossible to visualize the gallstones and in 3 other patients, the procedure was discontinued because of abdominal pain. Following the procedure, biliary pain occurred in 20 per cent of the patients. One patient only had biliary colic with transient anicteric cholestasis. Clinical examination, sonography, biological tests were found to be normal in all other patients. Endoscopic sphincterotomy or emergency surgery was never required. Stones were found to be unaltered in 6 patients following 2 lithotripsy sessions. The 76 other patients had fragmentation of their stones. The free gallbladder rate was 15.8 per cent between 0 and 2 months, 24.6 per cent between 2 and 4 months and 51.3 per cent between 4 and 8 months. These results tend to show that the destruction of biliary stones by piezo-electric lithotriptor is efficient and well tolerated. As repeated routine examinations were always negative, the three-day hospitalisation period no longer seems necessary.

[Scintigraphic appearance and particular arteriographic aspects intrahepatic cholestasis]. / Foies de cholostases. Aspects scintigraphiques et artériographiques particuliers.

Based on one case history, it is reviewed here that prolonged cases of obstructive jaundice can take on deceiving appearences, and all the more so when they fall within the framework of a "biological gap". Extensive distension of the extra and intrahepatic bile ducts are at the basis of images with multiple, radiating hilar gaps on scintigraphy, and of "chicken nests" and "Swiss cheese" at hepatographic times in selective hepatic arteriography. These rather uncommon images should lead to a diagnosis of a surgical cholestatic liver.

[Echography and cerebral gammagraphy in craniofacial injuries]. / L'Echographie et la Gammagraphie Cérébrale dans les traumatismes cranio-faciaux

The authors review the aid provided and sometimes essential nature of echographic and isotopic studies in cranio-facial trauma when seeking neurological complications -in particular intracranial haematomas and cerebrospinal fluid fistulas. They describe the principles of each of these technics, their indications, performance and limitations. These examinations are simple, rapid and perfectly harmless but must be carried out in specialised departments, which limits their use.

[Scintigraphy of the choroid plexus (choroid plexography)]. / La scintigraphie des plexus choroïdes (Plexographie choroïdienne)

An increase concentration of pertechnate in the choroid plexus was demonstrated in 21 patients pretreated with tin pyrophosphate injected intravenously 24 hours before the examination. Using this technique, the choroid plexus are seen quite clearly, giving indirectly a picture of the intracerebral ventricles. A dynamic study was carried out in 12 patients, 3 of whom had abnormalities of the cerebrospinal fluid circulation demonstrated by isotope cisternography. The results obtained were characterised by a typical diphasic curve with variations in the pathological cases.

Technetium-99m labeling by means of stannous pyrophosphate: application to bleomycin and red blood cells.

A new technique of technetium labeling using stannous pyrophosphate instead of stannous chloride as reducing agent for pertechnetate has been applied to red blood cells and bleomycin. Results are so encouraging that this technique could be extended to other compounds capable of forming stable complexes with reduced technetium. No saline washes of red cells are necessary before or after the addition of pertechnetate. No purification step is performed after labeling of bleomycin.