Virtual colonoscopy using CT and MRI

PURPOSE: To evaluate experimentally and in patients the sensitivity and effective dose of virtual electron-beam tomography (EBT) colonoscopy for detecting small colon tumors and to compare the methods and results with virtual colonoscopy using spiral CT and MR imaging in a review of the literature. MATERIALS AND METHODS: Six polyps with diameters between 3 and 12 mm were created and randomly placed in resected pig colon. After distension with air, the pig colon was scanned with continuous volume scanning (CVS, 3 mm collimation) and a pitch of 0.4, 0.8 and 1.5. Twenty patients positive for the fecal blood test were examined after rectal CO2 insufflation and i.v. administration of 1 mg glucagon. A 13 s CVS scan was used to cover the entire colon within one breath-hold. 3D volume-rendered fly-throughs were evaluated by two independent radiologists. Effective dose equivalent was estimated using an Alderson phantom equipped with thermoluminescence dosimeters. RESULTS: In the tumor model, all polyps were detectable at a pitch of 1.5. A further reduction of the pitch ratio did not improve the conspicuity of the polyps. In patient studies, all tumors (n = 4) and polyps (n = 3) were correctly identified on 3D fly-throughs. Two false positive results were obtained. Effective dose equivalent was calculated at 3.2 mSv per scan. CONCLUSIONS: Our preliminary results indicate that virtual EBT colonoscopy holds promise for fast screening for colon polyps. The best technique for virtual colonoscopy (Spiral CT, EBT, MRI) has not yet been determined and the future role of virtual colonoscopy must still be defined.     

1,5 Tesla MRI in focal nodular hyperplasia. Review of the literature apropos of 7 cases

There are increasing reports of unusual clinical features and atypical courses of syphilis in patients with acquired immunodeficiency syndrome. Recently, we had the opportunity to study an HIV-positive female patient with strong manifestations of secondary syphilis. The case is discussed together with the implications of secondary syphilis in her concomitant ocular affliction. Moreover, we comment on the clinico-therapeutic controversies brought about by the association of infection with Treponema pallidum and HIV.     

Vernal keratoconjunctivitis in the child. Clinical and complementary study apropos of 22 cases

PURPOSE: Vernal kératoconjunctivitis was studied in a population of 22 children aged 3 to 14 years and followed up in an allergy and ophthalmology outpatient clinic. The role of allergy and the severity of inflammation where assessed by a systematic exploration, which combined a detailed allergy evaluation and blood and lacrimal sampling. MATERIALS AND METHODS: Allergy criteria chosen and recorded in 9 cases are: an increase of total IgE over the higher limit for the age, a positive skin prick test to one allergen, a positive serum specific IgE dosage (> 0.35 IU/mL) of specific IgE. Conjunctival allergy was present in 6 of the 9 children with a positive allergenic provocation test, or with a high local production of total IgE and a lacrimal/serum eosinophilic cationic protein ratio greater than one. RESULTS: Criteria used for supporting the IgE mediated hypersensitivity diagnosis are discussed: they have to be very strict to eliminate false positive results. Allergen involvement can only be evidenced by a specific provocation test. When evidenced as described, limbic or palpebral conjunctivitis had the same frequency. Lacrimal ICAM 1 levels seemed to be higher (p < 0.05) in the severe limbal forms (24.7 +/- 3 pg/mL) than in the palpebral ones (8.1 +/- 6.5 pg/mL). Interpretation of biological parameters evidencing conjunctival inflammation is more difficult. CONCLUSION: Allergic involvement in child vernal keratoconjunctivitis can only be assessed through a detailed evaluation, leading to a specialised ophthalmic and allergic management. A specific treatment can then be established, based on allergen eviction and possibly on specific immunotherapy (5 cases). H1 antihistamin treatments are dedicated only to children with a positive allergic evaluation.     

Current study of Cushing's syndrome, apropos of 3 cases

The authors describe three cases of Cushing' syndrome, due to nodular hyperplasia, simple hyperplasia and adenocarcinoma respectively, and the most useful approaches (dexamethasone, metopirona, insulinic hypoglycemia, cortisol rhythm, catheterism and assessment of urinary free cortisol) for diagnosis and etiology of Cushing's syndrome.     

Cervical ribs. Therapeutic deliberations apropos of 10 cases

The authors report ten cases of cervical ribs operated upon in 7 patients. The predominantly neurological symptoms and signs were associated with vascular problems in 3 cases, with intermittent compression of the sub-clavian vessels. Treatment consisted of resection of the cervical rib and the first rib via an extra-pleural axillary approach using the technique described by Roos. It gave 10 good results with a follow-up of 6 months to 3 years. The authors emphasise the fact that this pathology falls within the context of compressive syndromes of the root of the upper limb or thoracic outlet syndrome. Such a conception justifies associated resection of the first rib which should give better long term results than simple resection of the extra rib.     

Neuroimaging in alcoholism: CT and MRI results and clinical correlates

The objectives of our work are to develop methodologies capable of identifying the potential environmental health hazards of chemicals. These techniques are particularly useful when it is necessary to evaluate molecules that have not been synthesized as yet, or for which there is little or no toxicological information known. With the help of MULTICASE, an artificial intelligence program capable of uncovering the relationship between the presence of specific substructures in a molecule and its toxicity, and TOX II, a program capable of identifying the existence of such substructures in a new molecule, it is now possible to predict with a reasonable degree of certainty whether a new molecule will be toxic. TOX II will uncover any functionality previously found to be related to toxicity in any organic molecule. The evaluation is extensive and may include its automatically generated metabolites. The scope of TOX II is vast as more than 70 toxicological endpoints can be evaluated.     

Emphysematous cystitis: apropos of 2 cases

Emphysematous cystitis is a rare infectious disease of the lower urinary tract. Its reputedly serious prognosis is related to treatment failures revealing ignorance concerning its pathophysiological mechanisms. Two cases of this disease were seen in our department, both in diabetic men over the age of 70 years with a history of prostatism. They presented to the emergency department with complete urinary retention and alteration of the general state and fever. Urine culture isolated Klebsiella pneumoniae in both cases. Treatment consisted of bladder drainage associated with adapted antibiotic therapy and control of diabetes. A suprapubic prostatectomy was subsequently performed in one case and transurethral prostatic resection was performed in the other case. The prognosis of this disease depends on early diagnosis and rapid introduction of effective treatment.     

Improved clinical echo-planar MRI using spatial-spectral excitation

The feline immunodeficiency virus (FIV) model of vertical human immunodeficiency virus type 1 transmission was used to explore the timing and tissue tropisms associated with intrauterine lentivirus infection. Cats chronically infected with FIV-B-2542 and their cesarean-derived fetuses and placentas were assayed by polymerase chain reaction and coculture at defined gestational intervals. Prevalence of fetal FIV infection was 0 at 3 weeks, 5% at 5 weeks, 38% at 7 weeks, and 60% at 9 weeks (term). Fetal tissues exhibiting the highest viral tropism were blood mononuclear cells and brain (each containing virus in 60% of FIV-positive fetuses) and thymus (47%). Maternal hematologic and virus load markers did not vary substantially with gestational stage. Therefore, fetal and/or placental maturation may determine the timing of lentivirus transmission. FIV infection prevalence in term fetuses was equivalent to that seen previously in vaginally delivered offspring, suggesting that most vertical FIV transmission occurs late in utero rather than intrapartum.     

Inhalation burns: apropos of 198 cases. Incidence of laryngotracheal involvement

Inhalation burns and laryngotracheal involvement were studied in a retrospective series of 635 patients hospitalized for skin burns at the Center for Burn Treatment from January 1993 to January 1997. Inhalation burns were observed in 31.1% of the cases. Exclusive laryngeal involvement occurred in 19.6% of the inhalation burns. Both tracheobronchial and laryngeal burns were observed in 27.2%. Patients with inhalation burns also had facial burns (90.9%) and extensive (> 50%) or severe (UBS > 200) skin burns in 39.8% and 29.7% of the cases respectively. Mortality of skin burns was increased six-fold to 19.1% in patients who also had inhalation burns. Intubation was used alone in 60.1% and was followed by tracheotomy in 27.2%. The decision for tracheotomy was essentially based on the probable duration of ventilatory assistance. Tracheotomy was required in case of severe inhalation burns and the predictable duration of intubation was over 8 days. Laryngotracheal stenosis occurring after inhalation burns is complex and extensive, with great variability over time. Laryngotracheal calibration is indicated as first intention therapy.     

Gouty arthritis in women. The clinical picture in 13 newly diagnosed cases

The clinical characteristics and symptoms at the time of diagnosis in 13 women with crystal-proven gouty arthritis were reviewed in a retrospective study based on hospital records. Twelve patients were at the age of 60 or older (median 74 years). Tophaceous gout occurred in four, oligo- or polyarticular involvement in seven. Six patients had actual symptoms for two months or more, only one of these seemed to have had previous acute gouty attacks. The arthritis occurred evenly in the upper and lower extremities. Ten (77%) were in diuretic treatment, 12 (92%) had diseases associated with hyperuricaemia. Only nine (69%) had serum urate concentrations over the upper limit of normal range (0.35 mmol/l).