[Osteolysis of the astragalus and retractile opacity of the right lung].
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Biomedical subjects
Publications and source records attributed to M Coulomb.
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We report the results of 82 needle biopsies of pulmonary nodules, using a fine screw needle. Owing to the very small diameter of the needle (0.8 mm), very few complications were observed (minor pneumothorax 13%, major pneumothorax 2.5%). The screw needle provided samples adequate for both cytological and histological examination. Forty-eight out of 53 cancers were diagnosed by this method (sensitivity 83%, specificity 100%).
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Computed tomography imaging in a patient with a pericardial effusion showed fluid collection in the superior recessus of pericardium confirmed by mediastinoscopy. Topographic and morphologic criteria and anatomic bases of the radiologic diagnosis are described, and emphasis placed on the fact that because of density variations in pericardial effusions the latter has to be added to the already long list of abnormal opacities of Barety's space.
The effects of static magnetic fields used in MR imaging at 0.5 Tesla have been studied on 15 different types of cardiac valves. The displacement of the valves was insignificant at 0.5 Tesla. No significant heating effects was observed with the standard sequences used in cardiac imaging. The image artefacts remain confined to the area immediately surrounding these different valves. It seems possible to perform MRI examinations on patient with the prosthetic heart valves without any risk.
In 76 patients the diagnosis of the mediastinal extension of a bronchial cancer, assessed by computed tomography (CT), was compared to histological specimens obtained by mediastinoscopy and surgery (58/76). The extension to mediastinal nodes was present in 26 subjects (34.2%) and yet was not recognised 15 times on CT. There were 15 false negatives (FN) and 3 false positives (FP). Sensitivity 43%, specificity 94%, predictive value for positives (VPP) 70%, predictive value for negatives (VPN) 75%. Extension was present in 18 patients. These were recognised 14 times by CT. There were no false positives. (Sensitivity 70%, specificity 100%, VPP 100%, VPN 94%). We conclude That CT is useful for diagnosing direct mediastinal extension and allows the juxta-hilar extension of the cancer to be assessed. CT has no place in the diagnosis of mediastinal gland involvement. Mediastinoscopy (5.2% FN; no FP) is better than TDM for the diagnosis of extension to the mediastinal nodes both for peripheral and central cancers.
A new method for exploring the lumbar spine by means of serial computed tomography sections is proposed, radio-anatomical appearances of the normal lumbar canal and its contents being described and illustrated.
Results of computed tomography before operation in 5 cases of dermoid cysts (mediastinal: 3; retroperitoneal: 1; ovarian: 1) are employed to assess the contribution of this technique, and to define its place in relation to other diagnostic radiological procedures (straight radiographs and ultrasonography). The CT scan enables three morphological types to be distinguished, and also supplies very precise data on the extension, limits, and relationships of the tumor. The effective place of this examination in the diagnosis of dermoid cysts depends upon two factors: data obtained from the straight radiograph and the initial site of the lesion. When the former supplies specific information, the only role of the CT scan and ultrasonography is to determine the precise extent of the tumor pre-operatively, the CT scan being superior to ultrasonography for this purpose. When straight radiographs do not reveal characteristic signs, the diagnostic assistance of the scanner appears to be irreplaceable, even in those abdominal or pelvic regions where ultrasonography is best conducted.
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Waldenström's macroglobulinemia was diagnosed in a patient suffering from recurrent lymphocytic pleurisy. Ultrastructural studies of the pleura showed the features of Lennert's lymphoplasmacytoid immunocytoma. Computerized assisted tomodensitometry revealed a retroperitoneal growth surrounding the right kidney and squeezing the thoracic lymphatic duct.
After a brief reminder of recent progress in radiological methods in the diagnosis of mediastinal disorders, the authors study the contribution of Computerised Axial Tomography (T.D.M.). The advantages of T.D.M. in mediastinal disease rest on two characteristics : the morphological study of the mediastinum is made easier by the display of transverse axial cuts with nothing superimposed; the density measurements can distinguish between opacities which would appear similar on conventional radiology. Three facts have been established by the authors : T.D.M. raises the diagnostic sensitivity of radiology; in distinguishing between fatty, watery, vascular and solid tumours, it increases aetiological specificity; it simplifies the diagnostic approach while increasing the efficiency of radiology and the importance of its role in therapeutic decisions. In a typical case where one has just discovered an abnormal mediastinal opacity (and in whom a gastro-intestinal primary has been excluded), T.D.M. should be the first examination after standard radiography, because its results determine the remaining investigation. T.D.M. is specially indicated in evaluating a myasthenic or when investigating an anomaly in the infero-posterior mediastinum. A few cases do not entirely fit in to this schema, because of a particular clinical or radiological situation such as : mediastinal adenopathy; the assessement of the extent of a bronchogenic carcinoma; anterior cardio-phrenic opacities. The examination of the hila again has its limits when the abnormal opacity is small as there are errors in the technique due to the effects of incomplete volume. Finally, there remains the improved cost-effectiveness of the radiological examination of the mediastinum with the rational use of T.D.M.
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Based on a homogeneous series of 40 cases of thoracic or abdominal oesophageal cancer, of which 23 had been confirmed by operation, the authors analyse the contribution of the CT scan to the diagnosis of the extension of the cancer, and evaluate the effects on therapy of this technique. Computed tomography supplies much more precise and complete details of possible cancer extension than any other pre-operative investigation. Conducted after radiological and endoscopic examination of the oesophagus, it supplies rapid, perfectly readable, irreplaceable information on local, regional, and metastatic spread of the cancer. This only slightly aggressive examination enables evaluation of the size of the tumour and its direct relationships, effective exploration of the mediastinal and coeliac glands regions, and detection of possible pleural, pulmonary, or hepatic metastases. Its role in the decision to operate is a considerable one: true assessment of of local, regional, or metastatic extension assists the surgeon in his choice of either curative or palliative therapy. Better still, it enables a route of approach to be decided as a function of data concerning possible extension, as well as the best surgical tactic. As a support for radiotherapy or chemotherapy for this type of cancer, computed tomography greatly assists follow-up supervision.
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The authors use this term to describe collections of fatty material in the tissues, circumscribed or not, which may cause permanent deformity of the mediastinum. This definition may not be based upon histological examinations but it is perfectly appropriate following the recent use of computer tomography (CAT) investigations. The authors base their comments on the study of 21 cases divisible into two groups of unequal size: in 5 cases, studied without using CAT, diagnosis was made during operation; in the 16 other cases it was made by CAT. The masses may be circumscribed or not, but mixed forms have been observed. Among the circumscribed masses. Those in the right cardiophrenic region appear to be the frequent and are observed mainly in women: a retrocardiac location implies than an associated hiatus hernia must be searched for; the mediastinoparietal reduplicated form being rarely seen. The spreading types are noted mainly in men and occur usually in the superior or median part of the mediastinum. These masses can be demonstrated and diagnosis simplified by the use of CAT, as it is a truly specific radiological examination which eliminates the use of tomography, pneumomediastinum, and angiography as diagnostic procedures. Surgical operation is no longer practiced for diagnostic purposes and can be avoided in very many cases.
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