Biomedical subjects
H Ducou le Pointe
Publications and source records attributed to H Ducou le Pointe.
[A painful mass of the thigh in a child].
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The fetal mandible: a 2D and 3D sonographic approach to the diagnosis of retrognathia and micrognathia.
OBJECTIVE: To define parameters that enable the objective diagnosis of anomalies of the position and/or size of the fetal mandible in utero. DESIGN: Fetuses at 18-28 gestational weeks were examined by two- and three-dimensional ultrasound. The study included normal fetuses and fetuses with syndromes associated with known mandible pathology: Pierre Robin sequence or complex (n = 8); hemifacial microsomia (Treacher-Collins syndrome, n = 3); postaxial acrofacial dysostosis (n = 1). Fetuses with Down syndrome (n = 8) and cleft lip and palate without Pierre Robin sequence or complex (n = 18) were also studied. Retrognathia was assessed through the measurement of the inferior facial angle, defined on a mid-sagittal view, by the crossing of: 1) the line orthogonal to the vertical part of the forehead at the level of the synostosis of the nasal bones (reference line); 2) the line joining the tip of the mentum and the anterior border of the more protruding lip (profile line). Micrognathia was assessed through the calculation of the mandible width/maxilla width ratio on axial views obtained at the alveolar level. Mandible and maxilla widths were measured 10 mm posteriorly to the anterior osteous border. RESULTS: In normal fetuses, the inferior facial angle was constant over the time span studied. The mean (standard deviation) value of the inferior facial angle was 65.5 (8.13) degree. Consequently, an inferior facial angle value below 49.2 degree (mean - 2 standard deviations) defined retrognathism. All the fetuses with syndromes associated with mandible pathology had inferior facial angle values below the cut-off value. Using 49.2 degree or the rounded-up value of 50 degree as a cut-off point, the inferior facial angle had a sensitivity of 1.0, a specificity of 0.989, a positive predictive value of 0.750 and a negative predictive value of 1.0 to predict retrognathia. In normal fetuses, the mandible width/maxilla width ratio was constant over the time interval studied. The mean (standard deviation) value was 1.017 (0.116). Consequently, a mandible width/maxilla width ratio < 0.785 defined micrognathism. Mandible width/maxilla width ratio values were below this cut-off point in eight and in the normal range in four fetuses with syndromes associated with mandible pathology. CONCLUSIONS: Retrognathia and micrognathia are conditions that can be separately assessed. The use of inferior facial angle and mandible width/maxilla width ratio should help sonographic recognition and characterization of fetal retrognathic and micrognathic mandibles in utero.
[Melanotic progonoma].
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[Radiologic case of the month. Fracture-dislocation of the humeral epiphysis removed from obstetrical origin].
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[Abdominal visceral lesions in battered child syndrome].
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Teleradiology.
According to the American College of Radiology, teleradiology is an electronic transmission of radiological images from one location to another for the purposes of interpretation or consultation. This article provides a historical perspective and discusses both solved and unsolved problems concerning the different elements of a teleradiology system (image acquisition, image transmission, image display, image compression). It concludes that teleradiology will in the future be a part of picture archiving and communication systems (PACS). Technical problems have for the most part been solved, with the exception of quality of gray-scale monitors. The characteristics of such a system depends on its goals.
[What is it? Congenital absence of the left pedicle of C7 vertebra].
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[A case of pulmonary mesenchymal hamartoma in a 9-year-old child].
This case of mesenchymatous hamartoma in a nine-year-old boy, was an incidental finding on a chest X ray. CT and MRI suggested the diagnosis showing a large (9 x 11 x 14 cm) mass developed in the right lower lung with sharp margins, without any sign of pulmonary or mediastinal compression. This lesion contained fatty areas on both CT and MRI. It showed no calcification. It enhanced slightly after IV contrast. On T2 WI, it appeared lobulated with low signal intensity septa. Presence of fatty tissues and lobulated margins were suggestive of the diagnosis of mesenchymatous hamartoma. A 1.2 kg mass was surgically removed. The tumor was attached to the right lower lobe by a small pedicle. Pathological examination disclosed fatty and connective tissues. This rare observation shows a good correlation between CT, MR, surgery and pathological examination.
[Gorham disease with prominent pleuropulmonary manifestation].
Gorham's disease usually manifests as diffuse osteolysis but may be complicated with pleural effusion. We describe the case of a 12 year-old boy who had repeated pleural effusions. Radiographs show a mediastinal widening and an interstitial syndrome related to hemolymphangiomatous involvement.
[Pediatric teleradiology: what is in the future?].
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[A case of intrapancreatic duodenal duplication communicating with the biliopancreatic channel].
Intestinal duplications are rare and are usually diagnosed in the first two years of infancy. They can occur at any level of the alimentary tract from the oral cavity to the anus. Duodenal duplication accounts for approximately 7% of all intestinal duplications. A previously healthy 4-year 6-month old boy was admitted with progressive increasing vomiting. Physical examination was normal, the serum amylase level was moderately increased. Upper gastrointestinal series showed an extrinsic compression defect of the proximal duodenum. Ultrasonography showed a 3 cm diameter cyst in the head of the pancreas. A duplication was suggested. Helical CT cholangiography showed a communication between duplication and the biliopancreatic common channel. The biliary tree was normal. Surgical resection of the intrapancreatic lesion was performed. Microscopic examination of the specimen revealed a duodenal duplication.
[Spiral cholangioscanners and tridimensional reconstructions of the biliary tract in children].
PURPOSE: endoscopic retrograde cholangiography may be difficult or unfeasible in children. It also may be complicated by acute pancreatitis. The purpose of this study was to determine the diagnostic contribution of spiral CT cholangiography in pediatric patients. SUBJECTS AND METHODS: seven patients, age ranging from 10 months to 13 years were explored without general anesthesia. Eight spiral CT cholangiographies were performed. The patients were suspected to have biliary or pancreatic lesions. Spiral CT was performed 60 minutes after slow infusion of iodipamide (Transbilix-Guerbet). The dose was correlated to the body surface. 3D reconstructions were done using the surface rendering or the MIP technique. RESULTS: biliary tract opacification and 3D reconstructions were considered of good quality in 6 out of 8 studies. It was normal in 2 cases. A duplication of the duodenum communicating with the choledocus was found in 1 case. Biliary lithiasis with a stone in the cystic duct was found in 1 case. Two choledocal cysts with bile ducts dilatation were diagnosed. A post operative biliary leak with bile ducts dilatation was found in one case. The spiral CT was not diagnostic in 2 patients: a case of choledocal cyst, the study was of poor quality due to inadequate sedation and a case of Caroli's disease with a high serum bilirubin level. Four patients had an endoscopic or a percutaneous cholangiography: to explore the pancreatic ducts (2 cases), poor CT study due to the inadequate sedation in 1 child, and the case of Caroli's disease. CONCLUSION: spiral CT is feasible even in young children. It should reduce the indications for endoscopic or percutaneous cholangiography. It has to be performed as the first examination in cases of biliary or pancreatic diseases when surgery is contemplated.
Blount's disease: magnetic resonance imaging.
To evaluate the information obtained by magnetic resonance (MR) imaging, the radiographic and MR investigations of nine patients treated for idiopathic tibia vara were reviewed in retrospect. There were six unilateral and three bilateral cases (12 tibiae). Initial radiographs of each patient were assigned a stage according to Catonné's classification. MR imaging was performed with a 0.5- or 1.5-T apparatus. Bony epiphyses were poorly developed in all cases. The cartilaginous component of the epiphyses compensated partially (6/12 cases) or completely (6/12 cases) for the collapse of the physes. In two cases an abnormal area was found between the medial meniscus and the cartilaginous portion of the epiphysis. An abnormally large medial meniscus was noted in four cases; an abnormal signal in the medial meniscus was seen in two cases. MR imaging has several advantages over plain film: it uses no ionizing radiation, it shows the shape of the ossified and cartilaginous epiphysis, and it demonstrates meniscal and physeal abnormalities. MR imaging may influence the choice of treatment.
[All digital radiology, is it acceptable today?].
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[Multilocular cyst of the kidney in a child. Value of MRI?].
We report one case of multilocular cyst of the kidney in one year and three months female infant who underwent echography, computed tomography and MRI before surgery. MR image accurately reflect the morphology of the tumor: the capsule is hypointense on T1-weighted images, the septa show moderate enhancement with intravenous contrast. Varied intensities from fluid in the visualised locules presumably represent different concentration of proteins. MR imaging features are highly suggestive but non pathognomonic of the disease. Positive diagnosis always require histology.
Soft tissue signal abnormality associated with eosinophilic granuloma. Correlation of MR imaging with pathologic findings.
Six patients with eosinophilic granuloma were studied retrospectively in order to correlate the MRI appearances with the pathology. Ages ranged from 2 years 6 months to 11 years. The bones involved were the humerus, ulna, radius, femur, clavicle and ilium. Plain films, MRI and pathology specimens were obtained. A lytic lesion with indistinct margins, endosteal erosions and periosteal reaction was seen in all cases on plain radiographs. Bone marrow signal was decreased on T1-weighted images and increased on T2-weighted images throughout the bony lesion in all cases. T2-weighted images showed extensive soft-tissue abnormalities suggesting inflammatory changes in four cases. In two cases abnormalities were limited. Extensive changes correlated histologically with an early phase lesion. Localized minor changes were associated with a mid-phase lesion. Inflammatory soft-tissue changes could be associated with eosinophilic granuloma. The size of the soft tissue mass correlated well with the activity of the bony lesion.
Legg-Perthes-Calvé disease: staging by MRI using gadolinium.
Twenty-one patients (26 hips) with typical signs of Legg-Perthes-Calvé (LPC) disease on plain radiographs were explored by MRI. Patients were imaged with a 0.5 T MR unit. Gadolinium-enhanced spin-echo MR images were obtained after nonenhanced T1-weighted (spin-echo) and T2*-weighted (gradient-echo) images. Four different areas were identified in the femoral epiphysis (necrosis, regenerative, cartilaginous and normal fatty bone tissue). The histological evolution of LPC is well described by Catterall and others. Comparing their descriptions with our MR findings, we suggest classification of LPC into five phases: necrosis: regeneration, reconstruction, reossification and sequelae.