Biomedical subjects
Publications and source records attributed to J Masselot.
20 patients with a primary musculo skeletal tumor were investigated by MRI to assess the efficacy of Gd DOTA. The essential contribution is that it distinguishes the active parts of the lesion, intratumoral necrosis or sequelae cavities that do not take up the contrast medium. The injection does not allow for differentiation between tumor recurrence and treatment-induced inflammatory abnormality.
In a prospective study, patients undergoing abdominal cancer surgery were randomly allocated to receive either general anesthesia with fentanyl intravenously and postoperative analgesia with parenteral morphine (GA group) or general anesthesia combined with epidural bupivacaine and epidural morphine for postoperative pain relief (EP group). Analgesia was tested on a visual pain scale. Pulmonary complications were evaluated by clinical complications, blood gas analysis, x-ray film changes, and pulmonary volumes (vital capacity, forced expiratory volume in 1 second). Measurements were performed on the day before the operation and on the first 5 postoperative days. In the EP group the pain relief was significantly better on the first day (p less than 0.03). Whatever the criteria used, the rates of pulmonary complications were similar in the two groups: clinical complications 21% versus 26%, radiologic complications 50% versus 64% for GA and EP groups, respectively. Postoperative PaO2 and spirometric values were similar in the two groups. Postoperative epidural analgesia may improve the patient's comfort but does not decrease the incidence of pulmonary complications.
The authors try to specify the place of Tomodensitometry in utero-ovarian cancers. The examination technique presents no particularities: at best, the interval and the depth of the cuts must be selected. In cervical cancers, the poor appreciation on TDM of adnexal and vaginal involvement renders this examination unsuitable for staging. On the contrary, it is absolutely necessary in order to make the diagnosis of recurrences. In cancers of the body of the uterus, almost always operated on, TDM presents very little interest for the initial work-up except for patients who are difficult to examine or are going to undergo irradiation. As for ovarian tumors, TDM may be useful to detect intra-hepatic metastases before the first operation, to monitor patients undergoing chemotherapy: peritoneal carcinosis is inconstantly detected and TDM cannot replace a second look.
The risk of death after pleuro-pulmonary metastasis was studied on a sample of 55 patients treated for breast cancer between 1954 and 1978. The women treated by tamoxifen, aminoglutethimide, or radiotherapeutic castration, at the time of the appearance of their metastasis, had a significantly lower risk of death than the women treated by other methods, or who were left untreated. The characteristics of the initial tumor, the delay between the primary tumor and the metastasis, the rhythm of systematic chest X-rays, and the use of chemotherapy did not significantly decrease this risk. The management of controlled therapeutic trials is suggested to confirm these results.
We studied nine cases of endometrial carcinoma and twenty of cervix carcinoma. Correlation with histology is made after curietherapy in 8 cases of endometrial carcinoma. Tumor is not always seen and particularly when there is no mass effect on macroscopic examination. Myometrial invasion is not seen with accuracy: the interruption of "junctional zone" is not a good sign. The cervix tumors are well seen on T2 sequences before any treatment. There extra uterine extension is difficult to appreciate. The best results of RMI were in the follow-up after radiotherapy. Therefore it appears actually to us the best indication of RMI.
The authors have studied retrospectively, a group of 69 patients with primitive carcinoma of the ovary who underwent at most one CT examination following the first surgical treatment. In 26 out of these, CT was done within the three months following a second surgical operation. Peritoneal metastases were inconsistently seen (5 true positive, 9 true negative, 0 false positive, 9 false negative). The sensitivity is 36%, the specificity 100% and the accuracy 65%. The score is better in the detection of lymphatic, hepatic and intestinal metastases.
Forty-eight, computed tomography (CT) examinations undertaken in 30 patients with osteosarcoma of long bones were studied in detail, their diagnostic information being compared with that obtained from corresponding plain films. The latter were of more value in assessing peripheral bony involvement, by cortical extension and periosteal reaction, while the former, in general, permitted more accurate observation of extensions into adjacent soft tissues. Recognition of such extensions, however, was vitiated when they arose in relation to the proximal ends of the tibia, fibula, and humerus and when a haematoma had developed as a result of a biopsy. Plain films were also of more value in appreciation of response to chemotherapy. On the other hand CT is the only examination which permits a satisfactory study of intramedullary extensions of the tumour and in consequence is invaluable in determining the exact sites required for local resection. No cases of skip metastases were observed in our series, although similar appearances due to nutrient vessels or bony ridges, remote from the primary tumour, were noted on several occasions. Differentiation of these densities proved to be easy, particularly in the case of nutrient vessels when examination of the contralateral bone showed them to be symmetrical. Several authors have described the role of CT in the evaluation of local extensions. This paper reports the difficulties and errors encountered by us.
Forty thoracic CT scans have been performed on 27 patients with micronodular lung metastases of differentiated thyroid carcinoma. Lung nodules were visualized in 14 out of 19 patients (78%) with functioning lung metastases, although their chest X rays were normal. However, only a small number of peripheral micronodules can be visualized by CT scan since the central micronodules remain undistinguishable from adjacent vessel structures. A close relationship has been found between the number of micronodules and the thyroglobulin (Tg) serum level. In patients previously treated by 131I for proven lung metastases and who had no uptake for several years, but in whom Tg remained detectable in the serum, CT scans have shown micronodules in 7 of the 13 patients with normal chest X rays. The present data suggest that these nodules are mainly a result of fibrosis. CT scanning appears to be an important complementary tool with regard to 131I whole body scintigraphies in the radiologic diagnosis of lung nodules and in the assessment of radioiodine therapy.
Six sacrococcygeal chordomas were studied with CT at the Institut Gustave-Roussy. Only one was examined at the time of the initial diagnosis and CT made a valuable contribution to this. In other cases, CT determined the possibility of initial surgical excision and the field of radiotherapy and helped make a reliable diagnosis of local recurrences. CT seems to be the best examination to use for the early diagnosis of chordomas and recurrences, which will perhaps help improve the prognosis of this serious disease.
Fourty nine patients having a prostatic carcinoma had a CT examination. CT should be used only if bone metastasis lack and if a curative treatment is possible. Study of local extension is misleading and ultrasound, especially transrectal, is a better method to appreciate the volume of the tumor. On the contrary, CT detects quite often nodes metastasis which will modify the treatment. If CT is negative, lymphangiogram must be done because it is a more precise method to evaluate the node structure. Percutaneous node biopsy may confirm node metastasis.
Sixty-one radiologic evaluations were performed on 32 patients with possible pulmonary metastases from osteosarcoma. CT scanning was performed 61 times; standard chest radiography, 58; tomography, 36; scintigraphy, 40; and tomoscintigraphy, 33. Using CT as a reference (positive or negative results only), the sensitivities of the other examinations were 57% (32% of total metastases) for standard radiography, 88% (48%) for tomography, 21% (5%) for scintigraphy, and 41% (8%) for tomoscintigraphy. Of the 193 metastases, 98 were subpleural and 95 were parenchymatous. Five patients had surgery and the others had follow-up. One false-positive CT scan was thus detected. The authors' current evaluation of patients with metastases from osteosarcoma includes chest radiography and CT; the other three examinations are performed only before surgery.
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Our study of 24 head and neck embryonic rhabdomyosarcomas in children confirms the substantial contribution of CT: -to the diagnosis, by showing the soft tissue mass, the bone destruction especially at the skull base, orbital walls and walls of the maxillary sinuses and intra-orbital or intra-cranial extension, -for the follow-up during treatment, it shows the efficacy of treatment, confirms the diagnosis of complete remission and contributes to an evaluation for recurrence.
A retrospective study was conducted involving all case reports of patients treated for uterine cervix cancer, and investigated by a CT scan for suspected or follow up of a recurrence between Jan. 1981 and Nov. 1982. CT scan findings are described and the value of the method assessed; it appears to be very effective for diagnosis of recurrence in lumbar aortic lymph nodes, since it was the only examination enabling positive diagnosis in 13 out of 15 cases. Its diagnosis value is less in pelvic tumor recurrence, directly accessible to clinical examination (3 diagnoses only out of 9 cases). The CT scan is a reliable exploratory procedure since only 4 examinations were normal of the 38 completed. Possible therapeutic applications are discussed.
Twenty-five patients with endometrial cancer of body of uterus were examined by CT before and after intravenous administration of contrast medium. Hypodensity was noted before injection and was accentuated after injection in 4 cases, was observed after injection only in 9 and was totally absent in 12 cases. Comparison of findings with results of examination of frozen specimens indicated lack of correlation between size of tumor and depth to which myometrium was invaded, and results of CT imaging.
Malignant fibrohistiocytoma (MFH) is one of the most frequent malignant tumours of soft tissues [6]. Its classification as a bone tumour, however, is relatively recent [1]. In addition to primary MFH in bone, the entity has been observed to occur as a secondary phenomenon, some cases having complicated pre-existing infarcts of bone [4]. This paper reports three cases of MFH of bone developing as a consequence of previous radiation therapy.
This paper reports two giant-cell tumours of bone of low-grade malignancy, both complicated by the development of pulmonary metastases in which the histological appearances were identical to those of the primary neoplasm. Ten similar cases in the literature are reviewed.