Aneurysm in a persistent sciatic artery. Apropos of 2 cases

Persistent sciatic is a vascular malformation resulting in the embryo from the preferential growth of the ischiatic posterior axis remaining atrophic. We report here two cases of unilateral, complete and incompleted, persistent sciatic arteries, complicated by buttock aneurysm.     

Aneurysm of the membranous ventricular septum with ventricular septal defect, mitral and tricuspid insufficiency

Bile acids are known to promote colon carcinogenesis. However, there is one study showing that ursodeoxycholic acid (UDCA) supplemented in the diet at the concentration of 0.4% prevented azoxymethane-induced rat colon tumorigenesis. The aim of our study was to explore the inhibitory effect of a much smaller dose of UDCA on colon carcinogenesis in rats. One hundred 7-week-old F344 rats were given 2 mg of N-methylnitrosourea 3 times a week for 3 weeks by intrarectal instillation, and were fed a 0% (control), 0.4% or 0.08% UDCA-supplemented diet for the next 27 weeks. All the rats were killed and examined for tumor development at week 30. The tumor incidence and number were significantly lower and smaller, respectively, in the UDCA-fed rats than in the control rats: 40% and 36% vs. 68%; 0.5 +/- 0.1 (mean +/- SEM) and 0.4 +/- 0.1 vs. 1.0 +/- 0.2. All the tumors were located in the distal half of the colon and were plaque-shaped or polypoid, being well-differentiated adenocarcinomas restricted to the mucosa or submucosa. Bile acids in the feces and the blood obtained at weeks 20 and 30, respectively, were analyzed by HPLC. A significant increase of UDCA was confirmed in both the feces and the blood of the UDCA-fed rats compared with the control rats. The results suggest that the continuous feeding of a small dose of UDCA may prevent colon carcinogenesis.     

Carpometacarpal dislocations of the long fingers. Apropos of 26 cases with review of 20 cases

PURPOSE OF THE STUDY: A retrospective study reports the evolution of patients treated for dislocation of one or several of the four medial carpometacarpal joints. MATERIALS AND METHODS: In five of twenty-six patients, the dislocations were undiagnosed in emergency. Twenty-five dislocations were dorsal. A patient presented a divergent dislocation of the four medial metacarpals proximal ends. The mean age was 25-30 years. Twenty-six patients were treated: ten by closed reduction and sixteen by open reduction. Stabilization by oblique K-wire pining was used in twenty-four cases. Twenty patients were followed for an average of fourty-one months. Six patients were lost for follow-up. Two patients had an an ulnar nerve injury. In eighteen cases, dislocation was associated with avulsion fracture of the involved bone. Eleven fractures of the distal carpal row was reported. RESULTS: The results were assessed by the range of wrist and fingers motion, grip strength, pain and deformity. Three patients had a limited range of wrist motion, five patients had a limited range of fingers motion. Six patients had a loss of fourth and fifth carpometacarpal joint motion. Eight patients had an excellent grip strength. Four patients were pain free and fourteen had climatic pain, or after strenuous use of the hand. Eleven had no deformity or limited prominence and three a disabling deformity. Results were rated good in thirteen cases, fair in three and poor in four. DISCUSSION: Dislocation or fracture-dislocation of the carpometacarpal joints are uncommon injuries. The diagnosis can be easily missed. The authors recommend closed or open reduction but constant fixation by pins and immobilization in a plaster cast. In this study, the majority of results was good when no serious injuries were associated and when reductions were stabilized with k-wires. One out of four poor results had been treated by closed reduction without k-wires, the three others were due to associated injuries.     

Fast growing IB-IIB cancer of the uterine cervix. Apropos of 20 cases

Twenty cases of fast growing cancer of the uterine cervix (14 IB, three IIA, three IIB FIGO), the definition of which is specified, have been reviewed and compared to a cohort of 160 cases not having this feature, to assess their outcomes. In regard to fast growing carcinomas, the median age was 41 (25-50) years and the median follow-up 22 months (8-213) as compared to 54 years (27-79) and 80 months (5-199) for the reference cohort. The comparison of the two cohorts shows only a difference of breakdown which concerns the pelvic lymph nodes status (P < 0.05, chi 2). Thirteen deaths are reported in the fast growing series instead of 54 in the other series. The 5-year overall survival is respectively 34% (13-55) versus 74% (68-82), the loco-regional free survival 58% (33-84) versus 85% (79-81) (P < 0.001), the 5-year metastasis free survival 61% (38-84) versus 84% (78-90) (P = 0.004). This particular form needs a multidisciplinary approach, and the local regional treatment has to be intensified.     

Electrocardiographic changes in chest deformities. Apropos of 20 cases in black subjects

The objective of this study is to describe the electrocardiographic signs associated with certain chest deformities. This is a prospective, case-control study comparing 20 black subjects with chest deformity (11 cases of flat back syndrome, 5 cases of pigeon chest, 4 cases of funnel chest) with 20 age- and sex-matched healthy controls. Cardiac duplex ultrasound was performed for each individual to exclude associated heart disease. Atypical electrocardiographic signs were observed in 15 subjects with chest deformity versus only 3 in the control group. The anomalies observed consisted of signs of atrial or ventricular hypetrophy, right branch block, abnormalities of repolarization on the T wave or ST segment. Chest deformities are therefore associated with several electrical signs simulating most cardiac diseases. A good knowledge of these modifications should help to avoid the numerous diagnostic traps associated with these signs.     

The covering of radionecrosis in plastic surgery. Apropos of a series of 20 cases

Twenty radionecroses with various locations were operated on between 1982 and 1993 in the Plastic Surgery Department at Strasbourg. Flap covers were performed. The results and indications as a function of localization and of the size and quality of the structures involved was analyzed for these radio-induced lesions. A wide range of therapeutic option are available to the plastic surgeon who must chose the most reliable reconstruction technique after the most extensive exeresis possible. Muscle and pediculated musculo-cutaneous flaps are preferred due to their safety, their vascular, trophic and anti-infectious quality and their excellent capacity of coverage.     

Microsurgical reconstructions of the lower face, after projectile injuries. Value of fibular flaps. Apropos of 20 cases

Projectile trauma of the lower face causes major functional damage and disfigurement. Reconstruction with tissue flaps, after microsurgical revascularization to guarantee tissue vitality, can restore satisfactory mental function. We report 26 mental reconstructions, including 20 using free fibular flaps which, due to its vascular pedicle and length of the available bone, appears to be the best adapted for reconstruction of the lower face. When used with cutaneo-aponevrotic flaps, only one operation is needed.     

Cysts of the prostate. Apropos of 2 cases

An unusual case of nodular fasciitis, arising from the splenius muscle, is presented. This uncommon lesion is always benign, but a local spread in the surrounding muscular tissue is possible. Through a Literature review, the main pathological, clinical and therapeutic features are discussed.     

Urogenital tuberculosis. Apropos of 40 cases

The authors report a series of 40 cases of genitourinary tuberculosis diagnosed and treated in the department of urology "B" of Avicenne hospital over a 7-year period. The objective of this study is to define the various diagnostic and therapeutic aspects of this disease. The patients were predominantly males (62.5%) with a mean age of 40 years. 25% of cases reported a history of extra-urinary tuberculosis. The very polymorphous clinical presentation is dominated by signs of cystitis (45%). Intravenous urography is frequently suggestive of the diagnosis based on the appearance and multiplicity of the lesions. The radiological lesions most frequently encountered were silent kidney (19 cases) and small tuberculous bladder (11 cases). The definitive diagnosis was established by pathological examination in 38 cases (biopsies, operative specimens, prostatic resection chips) and/or by demonstration of AFB in 2 cases (urine, pus). Tuberculostatic treatment was administered to all patients, either alone (5 cases) or, more usually, in combination with surgical and/or endo-urological treatment (35 cases), reflecting the magnitude and severity of the destructive and scar lesions.     

Ankylosing gout. Apropos of 2 cases

The Miles assay for vascular permeability has high intra- and interassay coefficients of variation (CVs). Quantification, usually by dye extraction and spectrophotometry, is time consuming. In this study, quantification by this means was compared with image analysis using the Olympus CUE-2 Image Analyzer (version 4). The test substance was recombinant human vascular permeability factor (rhVPF). The quantification process took approximately 10 min with image analysis. Formamide extraction and spectrophotometry required 1 hr of preparation, 4-6 days of incubation, and 1 hr for filtration and spectrophotometry. Between assay CVs ranged from 0 to 30% for spectrophotometry, but were all < 10% for image analysis. The sensitivity (2SD above the negative control mean) of the image analysis approach was 64 +/- 25 ng/mL, whereas for spectrophotometry it was 65 +/- 29 ng/mL. Interanimal CVs for rhVPF at 200 and 1000 ng/mL were 15% and 26% when assessed by spectrophotometry and 7% and 22%, respectively, by image analysis. The R2 value for the correlation of image analysis with spectrophotometry was 81.4%. Test substances injected close to the spine evoked a greater permeability response than those injected laterally: at 200 ng/mL p = 0.005, at 1000 ng/mL p = 0.1 (unpaired t tests).     

Parapharyngeal tumors. Apropos of 6 cases

Natural infections with the lancet fluke (Dicrocoelium dendriticum) were detected in a group of seven diseased or dead/euthanized South American Camelids (five Llamas, two Alpacas) from Switzerland and Southern Germany. Clinical findings in almost all the animals revealed an acute decline of general condition followed by recumbency, decreased body temperature and a varying degree of anaemia. Concurrently, all animals showed an average to poor nutritional status. All liver enzyme activities analysed in serum biochemistry conformed to the reference values and therefore offered no diagnostic clues for this disease. Necropsy however, disclosed major alterations in the liver in the form of cirrhosis, abscesses, granulomas, and a massive infestation with D. dendriticum. The coprological investigations performed at the outset of the examinations revealed eggs of the lancet fluke in only two animals. This suggests that clinical findings alone permit at best only a provisional diagnosis. Repeated coprologic follow-ups showed that the presence of eggs of D. dendriticum can be diagnosed accurately and that clinical signs appear with an excretion rate above 1000 eggs per gram faeces (EpG). In these cases, praziquantel in a single dose of 50 mg/kg per os was given. This treatment was well tolerated and achieved a quite acceptable 90% reduction of eggs in the faeces.     

Aneurysm of sinus of Valsalva dissecting into interventricular septum

PURPOSE: We developed an algorithm using unenhanced computerized tomography (CT) for the management of acute flank pain and suspected ureteral obstruction. MATERIALS AND METHODS: During a 25-month interval 417 patients with acute flank pain underwent unenhanced helical CT. The final diagnosis was confirmed by additional imaging or clinical followup. For all patients who underwent additional imaging studies the official dictated radiology reports were used to determine whether the studies were recommended based on CT findings. Cases requiring intervention were evaluated to determine whether additional imaging was performed before the procedure. Medical records were reviewed and/or patients were interviewed to document the course of therapy and long-term outcome. RESULTS: Unenhanced helical CT diagnosed ureteral stone disease with 95% sensitivity, 98% specificity and 97% accuracy. Of the 38 patients requiring intervention, including nephrostomy catheters in 18, lithotripsy in 3 and ureteroscopic stone extraction in 7, additional imaging (excretory urography) was performed in only 1. Additional imaging studies generated by CT were done in 3 cases in which the dictated reports were indeterminate for ureteral stones, including negative excretory urography in 2 and retrograde urography in 1. In 1 patient in whom CT misdiagnosed a ureteral stone unnecessary retrograde urography revealed the calcification to be a gonadal vein phlebolith. Seven patients with false-negative examinations reported spontaneous stone passage with no complications. CONCLUSIONS: Unenhanced helical CT accurately determines the presence or absence of ureterolithiasis in patients with acute flank pain. CT precisely identifies stone size and location. When ureterolithiasis is absent, other causes of acute flank pain can be identified. In most cases additional imaging is not required.     

Aspergillosis of the sphenoid sinus. Apropos of 4 cases

Aspergillosis of the sphenoid sinus is a rare entity. The authors report four cases of non invasive aspergillosis sinusitis, three isolated cases and one with nasal polyps. All cases were treated by functional endoscopic surgery. Good results were noted with a mean follow-up of 18 months. Frequency, clinical features, treatment, and etiopathogenesis of sphenoidal aspergillosis are discussed.     

Pneumatosis cystoides of the colon. Apropos of 7 cases

Seven cases of pneumatosis cystoides intestinalis affecting the colon (PKC) revealed 5 times by a nonspecific symtomatology and 2 times by an occlusion were reported. In three of the patients the disease was found as a primary idiopathic form free of clinical antecedents. In 4 of the patients the pneumatosis was found to be secondary to a pulmonary disease, a gastric ulcer, a connectivite of a corticotherapy. The PKC was generally diagnosed either by barium enema or by computed tomography and less frequently by colonoscopy with deep biopsy allowing differential diagnosis with colonic polyposis. The mechanism and etiology of the PKC were not fully understood. The illness is a benign condition that often responds to a conservative management--i.e. abstention, oxygenotherapy, diet or antibiotherapy- or exceptionally to surgical colonic resection in case of acute complication.