Biomedical subjects
Publications and source records attributed to D Thoumas.
Testicular cancer is the most common malignancy in young men and its incidence is increasing. The overall rate of cure can exceed 90% when management is optimal. Ultrasonography for diagnosis and thoraco-abdominal CT for staging are the optimal imaging modalities. In this paper we analyze technical parameters as well as findings and the strategy of examinations in testicular neoplasm.
INTRODUCTION: Renal infarction is a rare and often difficult diagnosis. The objective of this study was to demonstrate that contrast-enhanced spiral CT in patients presenting features of renal colic, can establish the diagnosis by confirming the presence of infarction of the renal parenchyma. MATERIAL AND METHODS: Over a 10-month period, the authors proposed the following decision flow-chart for all patients admitted with clinical features of renal colic: plain abdominal x-ray and first-line renal ultrasound, which, in the absence of a diagnosis (stones or dilatation of cavities), were completed by unenhanced spiral CT scan. When these examinations were normal, contrast-enhanced spiral CT scan was then performed. RESULTS: 300 patients were included in this study, and CT was performed in 40 cases. This management allowed the diagnosis of infarction of the renal parenchyma in three patients, who are described here. When unenhanced CT sections do not reveal any abnormality, contrast-enhanced sections are essential to visualize the infarcted zone, seen as a triangular low density lesion with clearly defined margins and a vascular topography. CONCLUSION: Contrast-enhanced spiral CT should now be considered to be the reference examination for the assessment of non-documented renal colic. This recent imaging modality should allow the diagnosis of a greater number of infarctions of the renal parenchyma, which formerly remained undiagnosed.
PURPOSE: To study color-doppler ultrasoundfeatures of testicular infarction caused by orchiepididymitis, a severe complication of orchiepididymitis. MATERIAL: and Methods. Five patients were included over a 2 year period. All presented with more than 24 hours of pain. A final diagnosis of testicular infarction caused by orchiepididymitis and color doppler ultrasound was available in all cases. RESULTS: All patients showed doppler ultrasound signs of testicular ischemia. Either vascularisation was not detectable or intratesticular resistive index was increased with a negative diastolic flow. Orchidectomy was performed in all patients. CONCLUSION: Color doppler examination of the scrotum should include measurement of intratesticular resistive index. An elevated RI can be suggestive of ischemia.
We report the case of a 77-year-old woman presenting with a jejunal intussusception as the primary symtom of metastatic renal cell carcinoma. Both lesions were demonstrated by abdominal CT which detected also pancreatic metastasis. This case emphasizes the significance of CT to diagnose intussusception and to characterize its cause.
Spermatic cord liposarcoma is a rare tumour, as only 60 cases have been reported in the literature. They represent 7% of all malignant spermatic cord tumours. The authors report a new case of spermatic cord liposarcoma unusual by its inflammatory and fibrotic features, occurring in an 83-year-old man in poor general health. Treatment consists of surgical resection as widely as possible. Adjuvant radiotherapy is sometimes effective on local recurrences. Despite the slow rate of progression of this tumour, prolonged surveillance is required due to the high risk of late recurrence.
PURPOSE: Pudendal neuralgia caused by nerve compression may be improved by surgical decompression of the pudendal nerve. This study was undertaken to determine if clinical symptoms, electrophysiological investigations, and the efficacy of preoperative pudendal nerve blocks could be used to predict the efficacy of surgery. METHODS: Twelve consecutive patients complaining of anal pain, genital pain, or both, exacerbated in the sitting position and unsuccessfully treated by analgesic drugs before referral were studied. In these 12 patients decompression of the pudendal nerve was performed after unsuccessful CT-guided injection of corticosteroids in the pudendal nerve at the ischial spine or after pain relapse following successful injections. Nineteen nerves were decompressed by surgery, and the compressed area was located between the sacrospinal and sacrotuberal ligaments for 18 nerves. RESULTS: Three months after surgery, four patients were totally relieved, and three were only partially improved. After 21 months of follow-up, three patients were cured, one was slightly improved, and eight remained in pain. In the three patients cured by surgery, pain completely disappeared for at least two weeks after a nerve block repeated twice before surgery, whereas pain relief was observed in only one of the nine other patients (P = 0.018). None of the three patients cured by surgery were being treated for depression, whereas six of the nine remaining patients were receiving antidepressants or were followed by a psychiatrist (P = 0.09). Results of surgery did not depend on other preoperative clinical or electrophysiological data. CONCLUSIONS: This preliminary study suggests that complete disappearance of pain for at least two weeks after a nerve block repeated twice before surgery may be the best criterion to predict success. Based on this criterion, surgery would have been performed in four patients in this study, of whom three would have been cured.
BACKGROUND: In at least 15 % of dilated urinary tracts, diuresis renography fails to assess the presence or absence of urinary obstruction. OBJECTIVE: To determine the shortcomings of (99 m)Tc-DTPA frusemide diuresis renography by reference to pressure flow studies. MATERIALS AND METHODS: Thirty-four patients, aged 1 month to 20 years, with questionable obstruction were evaluated by diuresis renography and pressure flow studies (the Whitaker test) as the reference method during the same short period of time. Discrepancies were analysed. RESULTS: In patients with type I or IIIa renographic response, pressure flow studies never led to any change in management. Poor function, major dilatation and prior surgery were found to be risk factors of inaccurately obstructive pattern (type II) on renography (n = 6). In patients with type IIIb response, pressure flow studies could show low-grade (n = 3) or intermittent obstruction (n = 2). Intermittent obstruction was also demonstrated in two patients with type II response. CONCLUSION: In patients with risk factors, type II response was sometimes inaccurate, and urodynamic evaluation showed absence of obstruction and led to conservative management. Type IIIb response should be considered equivocal rather than partially obstructive, and pressure flow studies could be considered in such patients.
PURPOSE: To evaluate the clinical and biologic safety of ultrasmall superparamagnetic iron oxide particles (AMI-227) as a contrast agent for magnetic resonance (MR) lymphography and to assess their efficacy for the differentiation of metastatic and benign nodes in patients with urologic and pelvic cancer. MATERIALS AND METHODS: Thirty adults suspected of having lymph node metastases underwent MR imaging before and 22-26 hours after intravenous infusion of AMI-227 (1.7 mg Fe/kg). Sixty histopathologically proved lymph nodes were analyzed on MR images, and 29 of these nodes were also analyzed quantitatively. RESULTS: AMI-227 was well tolerated with no major side effects. It allowed the detection of 10 additional nodes relative to those detected at MR imaging without AMI-227. None of the 27 metastatic nodes showed a decrease in signal intensity (SI) on AMI-227-enhanced images; nine of 27 metastatic nodes showed an increase in SI on T1-weighted images, probably resulting from altered capillary permeability in the tumor. A visually perceptible reduction in SI, indicating active AMI-227 uptake, was observed on postcontrast T2- and T2*-weighted images in 16 of 21 benign nodes. The SI ratio of benign nodes was lower than that of metastatic nodes on T2- and T2*-weighted images. The sensitivity of AMI-227-enhanced MR lymphography was 100%, and the specificity was 80%. CONCLUSION: AMI-227 is safe and may facilitate the differentiation of metastatic and benign nodes in patients with urologic and pelvic cancers.
Ureteric polyp is a benign lesion, and an uncommon cause of hydronephrosis in children. It is associated with intermittent lumbar pain and haematuria. The diagnosis is usually based on intravenous urography or retrograde urography. Treatment must be conservative and consists of simple resection of the polyp, associated with varying degrees of ureteric resection depending on the size of the lesion. No case of recurrence after treatment has been reported to date. The authors report a case in a 7-year-old boy and present a review of the literature.
Spontaneous bladder ruptures is the accepted term of bladder rupture not associated with trauma. This rare condition occurs when an obstacle to urinary outflow is associated with a diseased bladder wall. The diagnosis is usually made on the retrograde cystogram. We report two cases of atypical spontaneous bladder rupture with intravesical herniation of the small bowel. The diagnosis was not suspected clinically but was made on CT and MRI.
INTRODUCTION: The search for anatomical variants of the renal blood supply is an important element in the choice of surgical technique for the treatment of ureteropelvic junction syndrome. MATERIAL AND METHODS: Prospective study of 17 patients (mean age: 33 years), assessed by spiral CT with acquisition of overlapping thin sections during the arterial phase. The renal blood supply anatomical findings were then compared with operative findings in all patients. RESULTS: We observed a solitary renal artery in 8 cases, a lower pole pedicle crossing the junction in 9 cases and vascular abnormalities in 4 cases. All of these radiological findings were confirmed intraoperatively. Spiral CT, with rapid acquisition during the arterial phase and overlapping thin sections, allows accurate analysis of the renal blood supply. Axial sections are sufficient to provide the necessary anatomical information. Three dimensional reconstructions allow a better spatial visualization of the various structures. CONCLUSION: This examination allows visualization of a possible lower pole artery associated with UPJ syndrome, with identical accuracy to that of renal arteriography, but constitutes a less invasive and less expensive investigation.
OBJECTIVES: The contribution of ultrasonography to pretreatment morphological assessment of strictures of the anterior urethra and assessment of the risk of recurrence after internal urethrotomy. MATERIAL AND METHODS: 33 patients (16-89 years) operated by internal urethrotomy for stricture of the anterior urethra and followed for at least 6 months. Preoperative urethral ultrasonography, recording the number, length and degree of strictures and echostructure of the peristenotic fibrosis of the corpus spongiosium. RESULTS: Ultrasound visualization of all urethral strictures, with no false-positives and no false-negatives. 11 patients relapsed after a mean interval of 5.7 months (1-16 months), 22 patients did not present recurrence: mean interval: 15.5 months (6-36 months). Corpus spongiosum fibrosis associated with urethral stricture is isoechoic to the corpus spongiosum (19 cases) or hyperechoic to the corpus spongiosum (14 cases). No statistical correlation was observed between the echostructure of the fibrous tissue and the risk of recurrence after internal urethrotomy. CONCLUSION: Ultrasonography allows excellent analysis of the morphological characteristics of a stricture of the male anterior urethra. In our experience, and in contrast with the limited data of the literature, no correlation was observed between the echostructure of the peristenotic fibrosis and the risk of recurrence after internal urethrotomy.
OBJECTIVE: Spontaneous perirenal haematomas are relatively rare. The authors report 6 recent cases and try to propose a diagnostic and therapeutic strategy based on the aetiology. MATERIAL AND METHODS: From January 1993 to May 1995, 6 patients between the ages of 36 and 61 years were admitted to hospital for spontaneous perirenal haematoma, presenting in the form of acute lumbar pain associated, in one half of cases, with signs of internal bleeding. RESULTS: In each case, CT examination allowed precise assessment of the haematoma, but the aetiology was determined preoperatively in only 3 out of 6 patients, corresponding to a neoplastic lesion in each case (1 corticoadrenaloma, 1 adenocarcinoma, 1 angiomyolipoma). All patients were operated (3 radical nephrectomies, 2 haemostatic nephrectomies, 1 drainage of the haematoma with biopsies). No cause was found in 2 cases. CONCLUSION: Spontaneous perirenal haematomas essentially raise the problem of the aetiological diagnosis, but can sometimes be inadequate. Arteriography is useful when CT scan is negative or in the case of vascular disease. The therapeutic attitude, nephrectomy or conservative treatment remains controversial, but in view of the frequency of renal neoplastic lesions, the authors recommend nephrectomy at the slightest doubt concerning renal integrity. When no cause can be found, the assessment must be completed postoperatively with long-term, close surveillance, due to the risk of an undiagnosed neoplastic lesion.
We report a case of multiple and bilateral renal angiomyolipomas demonstrated and followed up by urography, sonography, and computed tomography during a period of 17 years. The diagnosis has been made by computed tomography. Follow-up examinations showed first a stability of the lesions, and afterwards, a rather fast increase of the volume of various masses, without symptoms, followed by a new period of stabilization.
A laparoscopic procedure used to achieve transperitoneal drainage of a lymphocele that developed three months after radical prostatectomy for prostate cancer is described. The lymphocele wall was resected through a peritoneal opening. After drainage of the lymphocele, a corner of the omentum was inserted into the cavity. Preoperative aspiration of the lymphocele and computed tomography allowed accurate evaluation of the relationships of the lymphocele with the blood vessels, urinary tract, and digestive tract. These investigations also ruled out an infection and established the diagnosis of lymphocele. Laparoscopic drainage has the same indications as conventional internal drainage and readily allows to perform the same procedures. As a conventional internal drainage and readily allows to perform the same procedures. As a simple procedure associated with low morbidity, laparoscopic drainage could be used as the first-line treatment for large, symptomatic, recurrent lymphoceles developing after pelvic surgery, in particular after extraperitoneal procedures such as radical prostatectomy, provided there is no infection, the lymphocele is readily accessible, and the surgeon is experienced in the use of laparoscopic techniques.
Radiology of the urinary tract has a great place in evaluating voiding dysfunction. The role of the radiologist is not limited to diagnosis of the sequelae of voiding dysfunction but he must provide information about causes, mechanisms and helps to provide a more accurate diagnosis. Projectional radiography (excretory urography, voiding cysto-urethrography) is still the best method of evaluation in spite of development of new imaging techniques (ultrasonography, computerized axial tomography, magnetic resonance imaging). Radiodynamic examination of the lower urinary tract is the best method of choice to study the complex functional problems involving those structures.
The authors report a case of extra-skeletal mesenchymal chondrosarcoma in a 22 year old man. This rare tumour developed along the nerve tracts (nerve roots, sciatic nerve and gluteal nerves) with contiguous involvement of muscles and three different bones (vertebra, sacrum, iliac bone). The nature of the tumour could only be determined by histological examination of a large fragment.
Chronic anoperineal pain without any apparent etiology may be caused by compression of the pudendal nerve. This presentation illustrates the course of the pudendal nerve and the technique of computed tomography-guided infiltration of the nerve.