MRI in patients with chronic pubalgia: Is precise useful information provided to the surgeon? A case-control study.

BACKGROUND: Recent studies described that MRI is a good examination to assess damage in chronic athletic pubalgia (AP). However, to our knowledge, no studies focus on systematic correlation of precise tendon or parietal lesion in MRI with surgery and histological assessment. Therefore, we performed a case-control study to determine if MRI can precisely assess Adductor longus (AL) tendinopathy and parietal lesion, compared with surgery and histology. HYPOTHESIS: MRI can determine if AP comes from pubis symphysis, musculotendinous or inguinal orifice structures. MATERIALS/METHODS: Eighteen consecutive patients were enrolled from November 2011 to April 2013 for chronic AP. To constitute a control group, we also enrolled 18 asymptomatic men. All MRI were reviewed in consensus by 2 skeletal radiologists for pubic symphysis, musculotendinous, abdominal wall assessment and compared to surgery and histology findings. RESULTS: Regarding pubis symphysis, we found 4 symmetric bone marrow oedema (14%), 2 secondary cleft (7%) and 2 superior ligaments lesions (7%). For AL tendon, we mainly found 13 asymmetric bone marrow oedema (46%), 15 hyperaemia (54%). Regarding abdominal wall, the deep inguinal orifice size in the group of symptomatic athletes and the control group was respectively 27.3±6.4mm and 23.8±6.3mm. The correlation between MRI and surgery/histology was low: 20% for the AL tendon and 9% for the abdominal wall. If we chose the criteria "affected versus unaffected", this correlation became higher: 100% for AL tendon and 73% for the abdominal wall. CONCLUSION: MRI chronic athletic pubalgia concerns preferentially AL tendinopathy and deep inguinal canal dehiscence with high correlation to surgery/histology when only considering the item "affected versus unaffected" despite low correlation when we try to precisely grade these lesions. LEVEL OF EVIDENCE: III: case-control study.

Imaging of adductor-related groin pain.

Groin pain is a common condition in athletes and results from various causes. Osteitis pubis, adductor dysfunction, inguinal hernia, or a combination of all three entities, generally explains the onset of symptoms. Adductor longus tendinopathy is the main cause of adductor-related groin pain. It leads to a significant reduction of sports participation and can require surgical management. Diagnosis is based on ultrasonography and magnetic resonance imaging. Asymptomatic findings (tendinosis, calcifications, cortical erosions) are common in athletes and care should be taken when assessing groin pain. The most specific sign of tendinopathy is an intratendinous tear of the adductor longus.

Conservative treatment for postintubation tracheobronchial rupture.

BACKGROUND: Postintubation tracheobronchial rupture is usually responsible for unstable intraoperative or postoperative conditions, and its management is discussed. We insist on conservative treatment as a viable alternative after late diagnosis of postintubation tracheobronchial rupture. METHODS: We conducted a retrospective study including 14 consecutive patients treated between April 1981 and July 1998. RESULTS: Twelve tracheobronchial ruptures occurred after intubation for general surgery and two after thoracic surgery. In all cases, the tear consisted of a linear laceration of the posterior membranous wall of the tracheobronchial tree ranging from 2 to 6 cm. One death occurred in a very weak patient unfit to undergo a redo operation for surgical repair. Seven patients were treated conservatively and cured without sequelae. Six patients underwent surgical repair, of whom 2 were diagnosed and repaired intraoperatively. CONCLUSIONS: Aggressive surgical repair is not always mandatory after delayed diagnosis of iatrogenic tracheobronchial rupture. Conservative treatment must often be considered, except after lung resection.

[Chemotherapy of embryonal carcinoma of the testis with lymph node invasion and/or pulmonary metastases. Results of a VBP type protocol]. / Chimiothérapie des carcinomes embryonnaires du testicule avec envahissement ganglionnaire et/ou métastases pulmonaires. Résultats d'un protocole de type VBP.

Fourteen patients with histologically proven embryonal carcinoma of the testis with pulmonary metastasis (10 pts) or para-aortic nodal involvement (4 pts) were treated by a chemotherapy regimen including vinblastine, bleomycin and cisplatin. Extreme ages were 19 and 51 years with a median age of 32 years. Median duration of treatment was 6 months (6 cycles of chemotherapy) without maintenance treatment. After completion of chemotherapy, 6 patients in complete remission received para-aortic node irradiation (45 Grays in 25 fractions). One patient had a para-aortic node dissection, histologically negative. With a median follow-up of 47 months (maximum 92 months, minimum 12 months), eleven patients are in complete remission (78.6%). Three patients are dead from the disease, in spite of salvage chemotherapy. There were no toxic deaths. Disease-free actuarial survival is 74% at 4 years. Our results confirm the excellent therapeutic results of this chemotherapy regimen in embryonal carcinoma of the testis with pulmonary metastasis and/or para-aortic nodal involvement.

[Villous adenoma of the duodenum. Apropos of a case]. / Adénome villeux du duodénum. A propos d'un cas.

We report a case of recurrent villous tumors (1989-1995) of the second duodenum. The diagnosis of these rare tumors was obtained by endoscopy. Risk of recurrence and degeneration raise the question of surgical or endoscopic treatment.

Acute inguinal pain associated with iliopectineal bursitis in four professional soccer players.

Four professional soccer players were investigated for acute or subacute pain in the inguinal region. Clinical tests were negative for an inguinal hernia or adductor tendinitis. Resisted hip flexion caused pain. MRI in these four patients showed the onset of iliopectineal bursitis, with signal abnormalities predominantly at the periphery of the psoas tendon in contact with the iliopectineal eminence. Ultrasound-guided steroid injection allowed the two players injected to continue their sporting activity. The two other players were treated by 3 and 7 days rest and oral anti-inflammatory treatment.

[Dynamics of infestation with gastrointestinal strongyles of moors grazed by sheep in the Mediterranean area]. / Dynamique de l'infestation par des strongles gastro-intestinaux de garrigues pâturées par des ovins en région méditerranéenne.

The dynamics of free-living stages of sheep Nematodes was studied. The kinetics of infective larvae population was established during 16 months by sampling grass and faeces every 2 wk on an area frequently used by ewes on 3 out of 4 paddocks grazed by a flock. The periods at high risk for animal infection were autumn and spring, the moors being sterilized during summer by the dryness. Teladorsagia circumcinta, Trichostrongylus vitrinus, Nematodirus filicollis and N. spathiger were the main species. Free-living populations were quantified during the grazing seasons on 2 out of the 5 paddocks grazed by a second flock. Herbage and faeces were sampled on 12 areas from each paddock. Deposited eggs on each area were calculated at each rotational cycle by coproscopy and by estimating the amount of faeces deposited on the ground. Faeces appeared to be the main reservoir of infective larvae during the dry periods of spring and autumn. With rainfall the larvae were liberated from faeces and the populations on herbage increased steeply. The distribution of larval populations on the moor were highly correlated to the distribution of the eggs deposited during the preceding grazing cycle.

[A study on 333 patients with adenocarcinoma of the endometrium treated by combined surgery and radiation therapy (author's transl)]. / Analyse de 333 cas de cancer de l'endomètre traités par association radiochirurgicale (1958-1978).

Three hundred and thirty-three consecutive patients with adenocarcinoma of the endometrium treated from 1958 to 1978 by combined surgery and radiation therapy or radiation therapy alone were reviewed. According to the FIGO staging system, there were 204 stage I, 40 stage II, 24 stage III and 20 stage IV. 40 cases of recurrences were also included in this study. The main parameters influencing survival were clinical staging, depth of myometrial invasion, histologic differentiation as well as the possibilities of radical surgery in these patients. Analysis of therapeutic results shows the superiority of pre-operative intra-cavitary irradiation followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy with an 80% actuarial survival at five years in stage I. Primary surgery followed by radiation therapy gives inferior results, particularly in stage II. Treatment by radiation therapy alone should be reserved for inoperable patients after careful evaluation and gives a 35% actuarial survival at five years. The incidence of serious therapeutic complications was 3,6 %. The early diagnosis of endometrial carcinoma by means of systematic endo-uterine explorations in post-menopausal bleeding and the elaboration of combined multi-modality protocol prior to any treatment should lead to a better cure rate for this cancer of increasing incidence.

[Hodgkin's disease and pregnancy]. / Maladie de Hodgkin et grossesse

The onset of pregnancy raises special problems during Hodgkin's disease and renders difficult full assessment of the extent of the disease. Furthermore acute exacerbations are fairly common, except in patients with a complete remission for more than two years. The critical period seems to be labour and the following weeks. In fact when pregnancy occurs during Hodgkin's disease, one may decide to interrupt it. However, if the patient has been in remission for more than two years, one may allow the pregnancy to continue. The decision will be taken in the light of each case. After pregnancy contraception should be advised in all women with Hodgkin's disease.