[Doppler ultrasound and aortic regurgitation. Evaluation of the sensitivity and specificity of Doppler findings]. / Echo-Doppler artériel et insuffisance valvulaire aortique. Etude de la sensibilité et de la spécificité des signes.

PURPOSE: The purpose of this study was to determine the sensitivity and specificity of arterial Doppler findings of aortic regurgitation to assess if the amplitude of changes of Doppler tracings can accurately quantify the degree of regurgitation. PATIENTS AND METHODS: We analysed and compared the arterial Doppler tracings and echocardiograms of 250 patients. RESULTS: Even if the obvious pitfall of vascular stenoses is avoided, the global sensitivity of arterial Doppler findings for aortic regurgitation remains weak (30%). However, our study demonstrates that it can reach 100% if only significant AR (> or =2/4) is taken into account. Since the clear false-positive cases have been carefully excluded from the very start, the specificity of the classical criteria already proves excellent (above 95%). It will reach perfection if additional simple criteria gathered from the data mentioned in this study are considered. Quantifying precisely the degree of aortic regurgitation on the basis of arterial Doppler tracings is impossible. Nevertheless, we show that it is easy to identify significant AR (> or =2/4) that should be further assessed with echocardiography. CONCLUSION: Arterial Doppler sonography is unable to detect all cases of aortic regurgitation but those that are overlooked are not significant (1/4). If AR signs happen to be detected by arterial Doppler, the amplitude of the leak cannot be accurately determined based on tracing analysis. Yet, simple criteria will indicate whether it is important enough (> or =2/4) to require complementary echocardiogram, with well documented accuracy for morphological and hemodynamic evaluation.

Surveillance for hepatocellular carcinoma: compliance and results according to the aetiology of cirrhosis in a cohort of 141 patients.

Surveillance for early detection of hepatocarcinoma (HCC) in patients with cirrhosis is widely accepted. In a cohort of 141 patients with cirrhosis collected during the year 1995, we conducted a surveillance program by performing liver ultrasonography and blood alpha-foetoprotein measurement every 6 months. The median follow-up was 34 months. This study addressed to two questions: the compliance to the surveillance schedule according to the aetiology of cirrhosis and the results in terms of emergence of HCC and outcome. Aetiology of cirrhosis was alcohol-induced in 86 (61%), HCV-related in 30 (21%) and from other origins in 25 (18%). Compliance to the program schedule was good in patients with HCV-related cirrhosis (29/30--97%) and patients with cirrhosis of "other origins" (20/25--80%) but was poor in patients with alcoholic cirrhosis (45/86--52%). The lack of compliance was significantly linked to the failure to achieve alcohol abstinence. During follow-up, 6 HCC lesions were observed in 6 male patients with median age of 68 years. All 6 HCC were single nodule, less than 4 cm and accessible to percutaneous acetic acid injection. Nevertheless, the outcome was disappointing, four patients dying 3-15 months later (median: 8 months), two of them with extensive HCC. One of the two patients still alive developed extensive HCC, 36 months after percutaneous acetic acid injection.

[Continent urinary diversion and calculus]. / Dérivations urinaires continentes et lithiases.

The continent urinary diversion is the technique usually used to replace the urinary bladder after total cystectomy The formation of calculi in the pouch is a frequent late complication. We have treated successfully with extra corporeal wave shock lithotripsy (ESWL) two patients who have developed calculi in their pouch two years after realisation of an ileal urinary diversion (Indiana pouch). E.S.W.L. is a good and non invasive technique to cure those calculi with no danger for the continence of the pouch.

[Insidious growth of peritoneal cysts several years after pelvic surgery. Ultrasonographic and x-ray computed tomographic aspects]. / Croissance insidieuse des kystes péritonéaux plusieurs années après intervention pelvienne. Aspects tomodensitométriques et échographiques.

INTRODUCTION: The aim of the present study is to call the radiologist's attention to peritoneal cysts (PC) when making the diagnosis of cystic masses in patients with a history of long-standing abdominal surgery. MATERIAL AND METHODS: Four cases of histologically proven peritoneal cysts, discovered 2 to 21 years after abdominal surgery were studied with ultrasonography (US) and computed tomography (CT). The symptoms leading to the diagnosis of PC included abdominal pain, discomfort and palpable mass. RESULTS: On US and CT, the lesion of inflammatory origin appeared as a flaccid, septated and thin-walled cystic mass often mistaken for an ovarian lesion. Positive diagnosis of PC can be achieved at pathology examination by the identification of a mesothelial layer on the inner surface of the cyst. CONCLUSION: CT or US images showing a flaccid multiseptated thin-walled cystic mass in a patient who has a history of previous abdominal surgery should draw the radiologist's attention to the diagnosis of PC among other cystic tumors.

Colour Doppler imaging of an ascending pharyngeal artery arising from the internal carotid artery.

We present two cases of an extracranial collateral of the internal carotid artery. The descriptions include Doppler recording and colour flow-mapping. The report underlines the epidemiological, embryological and anatomic features (including Doppler characteristics) of the variant, with a view to helping sonographers whenever the carotid examination proves difficult.

Screening for hepatocellular carcinoma: a regained enthusiasm due to new therapeutic options?

Screening for hepatocellular carcinoma arising in cirrhosis has been recommended for a long time. However, the results of this screening have been disappointing mainly because of poor health status and liver function in patients with cirrhosis. Indeed, when an hepatocellular carcinoma is discovered by screening, surgical resection can rarely be performed. Recently, percutaneous ethanol injection has emerged as an efficient and well acceptable therapeutic procedure. In this review, we report our personnal opinion on the regained interest for screening for hepatocellular carcinoma in the light of percutaneous ethanol injection.

The density, contour, and thickness of the pancreas in diabetics: CT findings in 57 patients.

Insulin has a trophic effect on pancreatic acinar tissue, so the pancreas might be expected to atrophy in persons who have diabetes. Accordingly, we analyzed the density, contour (smooth or lobulated), and thickness of the pancreas on CT scans of diabetic patients and compared the results with those in control subjects. The prevalence of pancreatic lobulation (incisurae deeper than 2 mm) and its correlation with age in diabetic and control subjects were determined. The thickness of the pancreas was measured at three levels (head, body, tail). Three groups of diabetic patients were examined: 20 insulin-dependent patients, 25 patients not treated with nor dependent on insulin, and 12 patients treated with but not dependent on insulin. A control group included 57 nondiabetic patients. The ages of the control subjects were similar to those of the diabetic patients. The statistical significance of the differences between groups of diabetic patients and control subjects was estimated by using Student's t test for the values of density and thickness and the chi 2-test for the prevalence of pancreatic lobulation. The density of the pancreas in diabetic patients and control subjects was not statistically different. Diabetic patients had increased lobulation of the pancreas. All parts of the pancreas tended to be smaller in diabetic patients, but the degree of reduction varied. It was modest in the patients not treated with insulin, pronounced in insulin-dependent patients, and intermediate in non-insulin-dependent, insulin-treated patients. Moreover, the size of the body was significantly reduced in all three groups, whereas the size of the pancreatic head was preserved in patients not treated with insulin. In conclusion, CT of the pancreas shows that although density in diabetic patients is normal, lobulation is increased. Reduction in size involves the body of the pancreas more than other parts of the gland and is more pronounced in insulin-treated diabetic patients. CT of the pancreas might be useful to predict which diabetic patients will require insulin therapy.

Klebsiella pneumoniae liver abscess with septic endophthalmitis. The role of computed tomography.

Klebsiella pneumoniae liver abscess associated with septic endophthalmitis is a rare observation. To our knowledge, only 10 cases have been reported in the international literature. We report a further case of complication occurring in an adult woman with hypothyroidism, and comment on the role of CT for the work-up.

[Pancreatitis and choledochal cyst]. / Pancréatite et kyste du cholédoque.

A six years old girl was rushed to hospital with an acute abdomen. Because of the age of the patient, the clinical examination and the usual biology we diagnose an acute appendicitis. The fortuitous measuring out of the pancreatic enzymology allows us to correct our first diagnostic into the one of pancreatitis with angiocholitis. The check-up shows a congenital choledochal cyst with an abnormality of the choledochus-Wirsung junction explaining the physiological pathology presented. The surgical operation was made up of an cystectomy with cholecystectomy and hepatico-jejunostomy according to an Y shaped loop from Roux. Pancreatitis diagnostic is unusual in childhood, there is a good reason to suspect in those circumstances the existence of a choledochal cyst.