Postoperative assessment of cerebral blood flow in subarachnoid haemorrhage by means of 99mTc-HMPAO tomography.

Regional hypoperfusion is a very frequent complication of subarachnoid haemorrhage (SAH), being related to vasospasm in the majority of cases. Twenty-six patients who were admitted for SAH underwent follow-up with technetium-99m hexamethylpropylene amine oxime single photon emission tomography (SPECT) 3 and 8 days after surgery. Fifteen patients of these had one more examination 15 days after surgery. The degree of hypoperfusion was quantified using an index of asymmetry which allow the comparison of two symmetrical regions of interest (ROIs) on the transaxial slice which presented the greatest perfusion defect. Comparison of CT data, transcranial Doppler data and clinical signs with the perfusion as quantified by 99mTc-HMPAO SPECT indicates that a difference in counts of less than 10% between the two symmetrical ROIs is of no diagnostic value. Follow-up of the brain perfusion clearly shows that the most pronounced hypoperfusion was observed just after surgery, with progressive normalization at 8 and 15 days after surgery. 99mTc-HMPAO SPECT performed 8 days after surgery allows prediction of the clinical outcome. For these reasons, 99mTc-HMPAO SPECT, which is the only method for follow-up of cerebral perfusion in routine clinical practice, should be the first examination to be performed after surgery in patients with SAH.

[The contribution of color-coded Doppler in early vascular complications of kidney transplantation]. / Apport du Doppler à codage couleur dans les complications vasculaires précoces de la transplantation rénale.

Ultrasound techniques and radionuclide studies are very often used to assess vascularization of renal transplants. Although, in acute tubular necrosis or acute rejection, it is difficult to choose between these two techniques, in 3 recent cases of renal artery thrombosis, we conclude that color coded Doppler is preferable to nuclear medicine or duplex system to diagnose this form of thrombosis.

[Cerebral x-ray computed tomography and scintigraphy. Value of the combination of these investigative methods in ischemic pathology]. / Tomodensitométrie et scintigraphie cérébrales. Intérêt de l'association de ces investigations en pathologie ischémique.

In 15 patients with a recent ischaemic cerebral vascular accident computerized tomography (CT) of the brain was normal whereas scintigraphy, performed at the same time, clearly showed the ischaemic area. These discordant findings may be interpreted as false-negative CT results. Factors such as the time elapsed between the cerebral accident and the CT examination, and the use or non-use of an intravenous contrast injection are discussed. It seems that the key factor is the proximity of the ischaemic lesion to the surface of the brain: cortical necrosis is undetectable at CT but distinctly visible at scintigraphy.

[Treatment of urinary tract infections by dibekacin]. / Traitement des infections urinaries par la dibékacine.

In this cooperative trial, 181 patients with various urinary tract infections were treated by dibekacin, a new hemi-synthetic aminoglycoside. Clinical and bacteriological results confirm the efficacy of dibekacin in this indication. Local and systemic tolerance, and thus renal and cochleo-vestibular, were very satisfactory.

[Dibekacin in the treatment of septicemia]. / La dibékacine dans le traitement des septicémies.

During an open multicentric trial (17 centers), we have treated 62 septicemia by dibekacin, alone or associated with other antibacterial drugs. Taking into account the degree of severity of these patients, the results are considered satisfactory in 47 patients. 15 failures were noted (including 9 deaths). General and local tolerance were good, in spite of the duration of treatment.

[Diffuse hemangiomas of the skin and gastrointestinal tract. A case of blue rubber bleb naevus (author's transl)]. / Hémangiomatose disséminée de la peau et du tube digestif. Un cas de blue rubber bleb naevus.

The authors report the case of a 33-year-old patient with 109 skin hemangiomas of the blue rubber bleb naevus type, accompanied by angiomas of the mucosa of the gastrointestinal tract. Bleeding of the angiomas caused anemia. This case was apparently sporadic. The authors recall the clinical, histological and ultrastructural features of this rare disorder. Histology can help to differentiate BRBN from glomangioma.

[Thyroid nodules. A report on 320 cases (author's transl)]. / Les nodules thyroïdiens. Résultats de 320 observations.

An analytical study of 320 case reports of patients with one or more thyroid nodules, 246 of whom had been operated upon, revealed the presence of 32 cancers, 15 toxic nodules, and 195 inactive benign uni- or multilobular goitres. Complementary examinations (scintigraphy with technetium, thermography, ultrasonography) cannot definitely establish the benign nature of a nodule. As long as cytological examination after needle biopsy, which requires the services of a highly specialised cytologist, will not become a routine procedure, histological examination is essential for correct diagnosis. Any nodule should be excised, therefore, and the thyroid explored completely.

[Left ventricular function in coronary disease. Gamma cineangiocardiography at equilibrium with right atrial pacing and nitroglycerine]. / Etude de la fonction ventriculaire gauche chez le coronarien. Gamma-cinéangiocardiographie à l'équilibre sous stimulation auriculaire droite et nitroglycérine.

25 patients (2 normal and 23 coronary artery disease) were studied by 99m Tc gated blood pool scans at rest, with right atrial pacing, right atrial pacing and nitroglycerine, and finally nitroglycerine alone. Total and regional ejection fractions were measured and the induced and reversible asynergy with right atrial pacing and nitroglycerine was also assessed.

[Hashimoto's thyroiditis and monoclonal gammapathy (two cases) (author's transl)]. / Thyroïdite d'Hashimoto et gammapathie monoclonale. Deux observations.

The authors describe two cases of Hashimoto's thyroiditis with a monoclonal dysproteinemia (IgG lambda in one case and IgG kappa in the other). They show that the antithyroid activity (anti-microsomial in the first case, anti thyroglobulin in the second case) is not carried by the abnormal gammaglobulin. The two diseases, therefore, appear to be separate but can both be considered as the consequence of a particular immunological state.

[Hemodynamic and cartographic study of intravenous trinitrin in the acute stage of myocardial infarct]. / Etude hémodynamique et cartographique de la trinitrine intra-veineuse au stade aigu de l'infarctus du myocarde.

12 cases of acute myocardial infarction were prescribed intravenous trinitrin. Haemodynamically, the drug invariably affected the pre-load whether the haemodynamic state was normal (group I), or disturbed by left ventricular failure (group II). Myocardial function was only improved in cases with left ventricular failure. Mapping studies, performed to assess, at least theoretically, the degree of ischaemia, only showed a transient lowering of the ST elevation compared to a control group, and limitation of the ischaemic area around the myocardial necrosis could not be proved.