Biomedical subjects
Publications and source records attributed to M Benozio.
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.
BACKGROUND: This study evaluates the endosonographic patterns of the anal sphincter after sphincteroplasty to define specific postoperative findings and to identify factors related to clinical outcome after sphincter repair. METHODS: Thirty-one incontinent patients (29 women, two men; mean age = 57 years) who underwent surgical repair for an external sphincter defect were studied postoperatively by endosonography. Twenty patients were found to improve after surgery. RESULTS: Postoperative endosonograms showed specific images: direct visualization of the surgical process was represented by the "overlapping sign" in 17 cases and the "end-to-end suture" in four cases. These echographically favorable cases were associated with improvement after surgery in 18 of 21 patients (p < 0.005). Persistent defects were reduced in five patients and unchanged in five other patients and were associated with poor outcome in eight of 10 patients (p < 0.005). CONCLUSIONS: Postoperative endosonography of the external anal sphincter presented some specific endosonographic aspects. The association between anal endosonographic findings and clinical outcome suggests the use of this procedure to assess patients following sphincteroplasty.
A comparative study of 11 pneumonectomized patients was undertaken in order to evaluate the respective advantages and drawbacks of MRI and CT in post-operative follow-up. Nine patients were healthy at the time of the study and two presented with tumor recurrence. MR examination included 500/40 ms axial, and frontal 800/40-80 ms or 1300/60-120 ms nongated spin echo sequences. MRI was slightly more efficient in identifying vascular stump and main nodal stations, and detected better than CT tumoral and metastatic spread in cancer recurrences. It was as informative as CT in evaluating postpneumonectomy space and bronchial stump. It was noncontributory in the detection of calcifications. Although clips were visible with MRI, their location was less definite than with CT, a potential pitfall when radiotherapy is planned.
Magnetic resonance (MR) imaging of the chest was performed in nine patients who had undergone pneumonectomy, to evaluate postoperative chest anatomical changes. The main criterion of selection in this study was the absence of cancer recurrence at the time of the study and 6 months later (normal clinical, fiberoptical and cytological data and normal laboratory values). All the MR studies were compared with chest CT performed within 15 days after MR imaging. Postpneumonectomy space revealed in all cases a heterogeneous signal both on T1- and T2-weighted spin-echo sequences. Vascular and bronchial stumps were clearly delineated and surrounded by low signal areas, considered to be postoperative scars. Spatial involvement was well understood with frontal and axial views. Calcifications were poorly identified. Surgical clips were easily detected, but they were difficult to locate accurately. No adverse effects was reported, either in patients with or without surgical clips.
The accidental finding of a pseudotumoral para-aortic mass in a 60-year-old woman led to the performance of a fine needle aspiration (FNA) biopsy under ultrasonographic guidance. The milky aspirate was centrifuged and processed as a cell block. The examination of sections confirmed the lymphatic origin of the sample, but also revealed some unexpected parasitic structures. While a complete identification could not be made on a few sections, the morphologic and epidemiologic evidence suggested Dirofilaria repens. The mass was surgically removed and identified as an adenolymphocele, which appears to be a new localization of dirofilariasis in humans. This case emphasizes the utility of FNA in diagnosing such unexpected findings without the use for exploratory surgery.
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Arteriovenous communications are a rare but specific complication of in situ saphenous vein arterial bypass. In this bypass procedure, some collaterals of the saphenous vein may remain patent. In this report, a characteristic example illustrates this complication. Local and general manifestations secondary to the development of these fistulas must be prevented by complementary surgical or radiological obliteration.
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