Cardiac metastatic melanoma investigated by magnetic resonance imaging.

There is a high rate of cardiac involvement in malignant melanoma (MM), but such cardiac metastases are usually diagnosed late. This report describes four cases with different clinical presentations of MM cardiac involvement that were investigated by magnetic resonance imaging (MRI). The MM cardiac involvement was asymptomatic in one case, detected because of a superior vena cava syndrome in a second, and because a tamponade in the remaining two cases. MRI permitted the diagnosis of cardiac metastases of MM, which was not made by echocardiography in one case. By precisely detecting the extent of the tumors, MRI was a great help in management, especially when an isolated cardiac metastasis was suitable for surgical ablation (two cases). Because both clinical signs and transthoracic echocardiogram are not very sensitive for diagnosing MM myocardial involvement, MRI can help provide such a diagnosis and ensure better treatment-monitored decisions.

[Angiosarcoma of the aorta disclosed by intestinal metastasis]. / Angiosarcome de l'aorte révélé par une métastase intestinale.

The authors report a case of angiosarcoma of the descending thoracic aorta presenting with a metastasis of the small intestine. This is a very rare tumour in this localisation, two cases having been described among the 28 cases of aortic tumour reported in the literature.

[False aneurysm of the left ventricle. A sometimes late finding]. / Faux anévrisme du ventricule gauche. Une découverte parfois tardive.

Left ventricular pseudo-aneurysm is a rare complication of myocardial infarction, usually of the inferior wall. It is generally a sudden event due to rupture of the heart which is contained by the pericardium. The outcome is usually rapidly fatal by secondary rupture or adiastole. The authors report a case of pseudo-aneurysm of the left ventricle measuring 3.5 cm in diameter observed following a small inferior wall myocardial infraction in a diabetic patient with a history of inferior wall myocardial infarction 38 years previously. This case is interesting because of the silent character of the pseudo-aneurysm, very probably complicating the previous infarct.

[Angiosarcoma of the aorta revealed by an intestinal metastasis]. / Angiosarcome aortique révélé par une métastase intestinale.

We report a case of aortic endothelioma revealed by intestinal metastasis in a man who was admitted for severe anemia, left heart failure, and fatal ileo-mesenteric infarction. This is the 13th published case of aortic endothelioma, and the first case revealed by intestinal metastasis. It illustrates the value of the magnetic resonance imaging for the detection of an aortic tumor when intestinal angiosarcoma has been diagnosed. The surgical treatment could improve an otherwise very poor prognosis.

[Magnetic resonance imaging of lesions of the superficial plantar fasciitis]. / Imagerie par résonance magnétique des lésions de l'aponévrose plantaire superficielle.

MRI is an efficient imaging modality to establish the diagnosis of plantar fascia tear and plantar fasciitis. MRI allow to differentiate recent rupture from scar and fasciitis.

[Agenesis of the internal carotid artery: two cases report]. / Agénésie de l'artère carotide interne: à propos de deux cas.

The authors report two cases of agenesis of the internal carotid artery evaluated with MR angiography allows the diagnosis of the internal carotid artery agenesis and appreciates both the supply post.

[Role of MRI in pre-clinical breast lesions. Preliminary results]. / Place de l'IRM dans les lésions mammaires infra-cliniques. Résultats préliminaires.

The purpose of this study is to assess the value of MR imaging in nonpalpable breast tumors. Thirty-two women whose mammogram showed opacity, architectural distorsionor microcalcifications, underwent preoperative dynamic MR studies with quantitative evaluation of contrast enhancement. MR showed early contrast enhancement in 10/12 breast cancers (2 false-negative) and in 6/20 benign lesions (false-positive). Quantitative study of contrast enhancement does not allow clear differentiation between these lesions. Further studies are required to confirm these findings and purpose MR imaging for aid in detection of carcinomas. Multifocal sudden enhancements are possible in benign lesions and incite to limit MR to focal mammographic abnormalities.

[Toward a rational strategy in the treatment of postoperative bacterial endophthalmia]. / Vers une stratégie raisonnée du traitement des endophtalmies bactériennes post-opératoires.

18 cases of bacterial endophthalmitis are reported. From bacteriological, epidemiological, pharmacokinetic data, we can propose a management of infectious endophthalmitis based on the two following rules: systematic intraocular fluid aspiration, on emergency, for stained smears (as real bacteriological extemporaneous investigations) and cultures; initial wide spectrum antibiotherapy with a quick adaptation to gram stain and culture identification. The antibiotics are selected according to their intraocular penetration, safety and spectrum. The intraocular bactericidal concentration requires the association of systemic, peri-ocular, and intraocular antibiotherapy, before the settlement of irreversible retinal lesions. By vitrectomy, the infected vitreous may be cleared, and intraocular drugs diffuse more easily.

[MRI symptomology in reflex sympathetic dystrophy of the foot]. / Séméiologie IRM de l'algodystrophie du pied.

PURPOSE: To describe the MRI findings of reflex sympathetic dystrophy of the foot and ankle. METHODS: Retrospective study of 50 patients with reflex sympathetic dystrophy of the foot (5 with the cold form, and 45 with the warm form) diagnosed based on clinical and scintigraphic findings. All patients underwent MR imaging. The MRI findings were correlated with the clinical and scintigraphic findings. RESULTS: Patients with the cold form of reflex sympathetic dystrophy had no abnormality of signal at MR imaging. All patients with the warm from of reflex sympathetic dystrophy showed periarticular marrow edema at MR, typically involving more than one bone (mean of 4). Other findings were inconstant: soft tissue edema, joint effusion, and rarely, subchondral band of low T1W signal intensity of unclear etiology. CONCLUSION: MR imaging, including fat-suppressed T2W or STIR images and noncontrast T1W images, is helpful in patients with the warm or acute form of reflex sympathetic dystrophy of the foot. In patients with the cold form, MR imaging is helpful to exclude another underlying etiology for the symptoms and identify patients with the warm form of the process.

[Comparison of magnetic resonance angiography with injection of gadolinium and conventional arteriography of the ilio-femoral arteries]. / Comparaison de l'angiographie par résonance magnétique avec injection de gadolinium et de l'artériographie conventionnelle des axes ilio-fémoraux.

Twenty-three patients underwent conventional arteriography and 3D contrast enhanced magnetic resonance angiography explorations. The study was limited to the iliofemoral arteries (13 segments for each patient). Each segment was classified as having 0-49%, 50-99% or 100% stenosis. Overall results were excellent with K = 0.822, sensitivity 92% and specificity 93%. Segment by segment analysis corroborated the overall results except for the internal iliac arteries and the deep femoral arteries, demonstrating the limitations of this technique in this series.

[Pneumococcal postoperative endophthalmitis]. / Endophtalmies post-opératoires à pneumocoques.

Three cases of pneumococcal endophthalmitis proven by paracentesis and direct bacteriologic evaluation were studied. Cultures were positive for pneumococcus in two the three cases. The fulminant course, and poor visual outcome emphasize the urgency of proper diagnosis by microscopic identification, and of intra-vitreal of injection of antibiotics sometimes associated with vitrectomy. Subconjunctival gentamicin commonly used in ophthalmologic surgery as prophylactic treatment, is often not effective against pneumococcus. It seems advisable to associate subconjunctival chloramphenicol with the gentamicin to help prevent this bacterial infection.

[MRI in post-traumatic cerebral fat embolism]. / IRM dans l'embolie graisseuse cérébrale post-traumatique.

We report two cases of posttrauma cerebral fat embolism evaluated with MRI. Due to sensitivity, MRI is the best examination for detecting focal abnormalities of the grey or white matter. MRI helps to make the diagnosis in atypical cases and allows assessment of both extension and course of the embolism.

[Disseminated tuberculosis of unusual locations]. / Tuberculose floride avec localisations rares.

We report a case of disseminated tuberculosis involving the middle ear, the central nervous system, the spine and the lung. The tuberculous epidural abscess and otomastoiditis don't have any specific imaging features. But their coexistence with an other tuberculous involvement might suggest their tuberculous nature. The epidural abscess may result from direct extension from otomastoiditis.

[Neurocysticercosis of spinal manifestation. Apropos of a case]. / Neurocysticercose à révélation spinale. A propos d'un cas.

A case of spinal extramedullary cysticercosis with location in basal cisterns is reported. It was revealed by a severe sciatalgia and studied with MR imaging which is precious for the diagnosis and the follow-up. Cerebral cisternal arachnoiditis is the main problem in this racemose form where long medical treatment is necessary.

[Ileocolic intussusception in adults. Apropos of a case caused by benign inflammatory polyp of the terminal ileum]. / Invagination iléo-colique de l'adulte. A propos d'un cas, secondaire à un polype inflammatoire bénin de l'iléon terminal.

A case of an adult intussusception secondary to a fibroid polyp of the terminal ileum is reported. Adult intussusceptions are observed rarely, usually caused by an organic lesion. The preoperative diagnosis is based on US patterns, target aspect and sandwich sign.

[Magnetic resonance imaging in the warm and cold forms of algodystrophy of the foot]. / L'imagerie par résonance magnétique dans les formes chaudes et froides de l'algodystrophie du pied.

PURPOSE: To report magnetic resonance imaging abnormalities in reflex sympathetic dystrophy of the foot. METHODS: Retrospective study of 22 algodystrophies of the foot, in warm phase in 17 cases, in cold phase in 5. RESULTS: Algodystrophy in warm phase: Bone medullary abnormalities were noted in 17 cases (decrease of signal intensity was found in T1 weighted images, increase of signal intensity in T2 weighted images, in T1 and T2 with fat-saturation, in T1 with gadolinium), located at the increased uptake technetium site in 16 cases. T1 and T2 weighted images with fat-saturation and T1 with fat-saturation after injection of gadolinium were pathological in all cases, T1 was normal in 2 cases. Soft tissues abnormalities were noted in 11 cases, joint effusion in 8 cases, synovial hypertrophy enhanced by gadolinium in 2 cases and a subchondral linear area of hypointense signal on T1 and T2 images was not present after gadolinium injection in 1 case. Six fractures were detected. Algodystrophy in cold phase: no bone edema, no synovial hypertrophy, no joint effusion, no soft tissues abnormalities, no fractures are detected. CONCLUSION: The results suggest that the MRI has a considerable value in diagnosis during the warm phase of reflex sympatetic dystrophy of the foot. The normal MRI findings during the cold phase could be important to understand its etiology.

[Principles of magnetic resonance angiography]. / Principes de l'angiographie par résonance magnétique.

Magnetic resonance angiography is a modality of functional imaging which can only be interpreted on the basis of a good understanding of vascular physiology and the physical principles of image acquisition. Magnetic resonance angiography is based on flow-related "artefacts". The oldest method is based on renewal of the image by proton flow: the flight time effect. Dephasing of the protons travelling in magnetic field gradients results in phase-contrast angiography. These two methods of angiography each have respective advantages and disadvantages: they are not mutually exclusive, but complementary.

Pharmacokinetics of aztreonam in the aqueous humour.

Fifteen patients awaiting cataract extraction were given a 2 g intravenous bolus injection of aztreonam. The mean aztreonam concentrations in the aqueous humour. 1, 2 and 4 h after the injection were 1.22, 1.46 and 2.22 mg/l, respectively.

Pefloxacin concentrations in human aqueous humour and lens.

In 20 patients undergoing cataract extraction, we measured pefloxacin concentrations in the eye. After a 1 h infusion of pefloxacin 400 mg iv, the mean pefloxacin concentrations 2, 6, 12 and 24 h post-infusion were 0.75, 1.45, 1.04 and 0.86 mg/l, respectively. The simultaneous mean pefloxacin concentrations in the lens were 0.09, 0.20, 0.26 and 0.43 mg/l, respectively. The adequate penetration of pefloxacin into uninfected aqueous humour and lens suggests that this antibiotic may be effective in the treatment of certain bacterial endophthalmic infections.