Biomedical subjects
Publications and source records attributed to R Sarrazin.
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Ten volunteers with a normal mediastinum were investigated by magnetic resonance using a 0.5 Tesla CGR imager with a supraconducting magnet. The reconstruction matrix consisted of a 256 X 256 grating for a field of the order of 420 mm, with a spatial resolution of 1.6 X 1.6 mm2. The sections, balanced in T1, were performed in synchronization with the ECG. The successive sagittal sections were correlated with sagittal sections made on a single embalmed frozen subject. The MRI and anatomic sections were made at 5 mm intervals and located in relation to the median sagittal plane of the mediastinum. Examples of structural variations, malformations or tumours studied in sagittal sections, and taken from investigation of over 170 patients, demonstrate the importance of this investigational technique.
In order to assess the value of nuclear magnetic imagery NMR in the diagnosis of the extent of bronchial cancers, 61 patients with operable bronchial carcinoma had both a CT scan and an NMR scan pre-operatively. Fifty one mediastinoscopies were performed. Twelve times there were mediastinal glandular enlargement. Ten times the thoracotomy was performed straight away. After pathological studies of the biopsy, 24 patients were N2, 25 N1, 12 N0; the sensibility of NMR to foresee lymph node invasions was 83% (specificity 70%), for CT scanning 75% (specificity 81%). Thirteen patients presented with a direct mediastinal or parietal invasion. The sensibility of detecting these invasions was only 38% for NMR (specificity 94.5%) and for CT scanning 54% (specificity 94.5%). There is little difference in the results and no statistical difference. This leads us to conclude that at present, NMR does not give more information than TDM in the diagnosis of operability in bronchial cancers.
This correlative study concerns the investigation of 22 mediastinal tumors by MRI and CT, subsequently verified by biopsies or surgery. It allows us to better define the technical aspects in the realization of MRI, including an assessment of the use of ECG gating. It also permits an appreciation of the respective performances of these 2 imaging methods: there is a good correlation between the two technics for both the positive and etiologic diagnosis of mediastinal tumors: in etiologic diagnosis, the same limitations were encountered with the two technics. However, MRI offers some advantages in the evaluation of tumoral extension. So, we suggest once a mediastinal mass has been shown using plain films, when available, MRI alone should be performed.
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Irrigraphie (segmental impedance plethysmography) is a reliable non invasive method for the positive and topographic diagnosis of arterial occlusive disease and for its prognosis (5, 8, 9, 12, 13). The method is based on pulse volume recordings at six different positions of the leg (from 1 = proximal to 6 = distal). The amplitude of the signal is related to heart rate and to the basic impedance of the segment of the leg. The diagnosis of aorto-iliac disease is proposed when the upper extremity index (I1MS) over the lower extremity proximal index (I1) ratio (ITA) is increased (greater than 1.4), or when the I1 value is lower than 1.9. The diagnosis of femoro-popliteal disease is proposed when there is a significant drop between I1 and the above knee index I3. However in a recent study we found that I1 value drops when there is a severe femoro-popliteal lesion. In this case, irrigraphie proposes erroneously the diagnosis of aorto-iliac and femoro-popliteal diseases. In order to improve the method, we thought that a new electrod position (I0) over the iliac region would give to irrigraphie a more reliable topography diagnosis possibility. In this study 32 patients were analysed with angiography and irrigraphy, and divided into 3 groups: group I = isolated iliac disease (19); group F = isolated femoral diseases (22); group IF = ilio-femoral diseases (12). We observe from the ROC analysis, that I0 has a sensitivity of 84% and a specificity of 86%, when the iliac lesions are isolated whereas I1 and ITA give a lower specificity (52%). However, when aorto-iliac lesions are combined with femoro-popliteal lesions the irrigraphie is a little less sensitive (71%). In conclusion I0 index is more reliable for the topographical diagnosis of obstructive disease of the iliac artery than I1 index and we suggest to replace I1 by I0 whenever it is possible.
A simplified panorama of the different formation phases of the upper respiratory system (larynx, trachea, main bronchi) is presented. Chronologic evolution of organogenesis in embryologic phase and fetal phase is emphasized. Post-natal growing is also described. A classification of malformations of the upper respiratory system is done, based on topographic data. The mechanism of genesis of the malformations remains of hypothetical value.
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Eighty-three patients with Hodgkin's disease were treated with a combination of chemotherapy and radiotherapy. 43 were included in protocol 1 (from january 1970 to january 1974) and 40 in protocol 2 (february 1974 to december 1977). In protocol 1, staging laparotomy was not systematically performed (20 cases). Treatment consisted of 2 intravenous injections in Vinblastine and total nodal irradiation. In protocol 2, laparotomy was systematic in patients over 50 (35 cases). Patients with stages 1 and II treated as mentioned above. Patients with stage III received two Mopp courses followed by total nodal irradiation. Patients older than 50 with stages I and II and poor prognosis factors received chemotherapy only. Laparotomy was associated with a 0% mortality rate and a 3,6% morbidity rate. No myelitis or pericarditis were observed. Herpes zoster occurred in 24% of the patients, pulmonary apex fibrosis in 6%, hypothyroiditis in 2,4%, and leucopenia in 3,6%. Two late infectious complications were fatal. No solid tumor was apparent. Acute leukemia and non-Hodgkin malignant lymphoma developed in two patients. Good tolerance, shortness of treatment, and remission rate, warrant the pursuit of protocol 2 in which systematic laparotomy for patients under 50 allows total nodal irradiation and therefore reduction of chemotherapy.
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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.
Two recently introduced impedance plethysmographic methods have been used in the etiologic diagnosis of 100 leg ulcers: the occlusive rheoplethysmography (RPO) and the irrigraphy. RPO investigates the venous part of the lower limb circulation and irrigraphy the arterial blood flow. These two quantitative methods associated with Doppler examination of venous system allow to point out the type and the topography of the vascular alterations. The value of rheoplethysmographic methods in etiological leg ulcers investigation is reported.
The authors present the report of their experience of 20 injections of the lymphatic system of the stomach during surgery by vital staining dye: 19 times by Pontamine sky blue 6 BX, 1 time by patent blue violet. The results of this study are analysed; the anatomical interest is specified. Nevertheless, this technique presents no surgical interest concerning the stomach, in spite of many authors' opinion.
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.
The case of a 5 month old female infant with respiratory problems since birth in the form of a recurrent right pneumonia, associated with slight pulmonary arterial hypertension. Persistence of a paramediastinal opacity suggestive of a right upper lobe atelectasis led to bronchography being performed which revealed a bronchus implanted into the right side of the trachea. At operation there were two abnormalities: --an azygos lobe represented by the apical segment of the right upper lobe; --a tracheal bronchus, apical segmental apical, ventilating this territory. Simple disenclavement of the parenchyla and pleuroplasty led to regression of the respiratory disturbances. The special feature of the case lay in the rarity of an azygos lobe ventilated by a tracheal bronchus. The azygos lobe results from an abnormality in the topography of the arch of the azygos vein which draws the parietal pleura with it, forming a mesoazygos. It is not a supernumary lobe. Abnormalities of bronchial implantation are located above all along the right side of the trachea (tracheal bronchi) and correspond in most instances to ectopic positioning of a segmental bronchus of the upper lobe, as in the present case.
The results of treatment of intermittent claudication by a physical training programmed during 30 to 45 days in a rehabilitation center, are assessed on 148 patients of whom 105 have followed a full program at first (32 cases) or after surgery (73 cases). Ankle pressures are not altered. Irrigraphy shows a significant increase of 10 to 14% of the proximal indexes. Walking distance is greatly increased. 13 patients had a walking distance of about 900 m at the beginning and 31 patients at the end of the course ("functional remission"). Out of 105 patients, 98 showed improvement, 4 remained unchanged and 3 slightly worsened. The appreciation of his own progress is a strong psychological stimulation for the patient, this helping him to accent his illness, and to fight the corrigible risk factors of atherosclerosis, all significantly reduced. The interpretation of the results is discussed and shows the importance of non-hemodynamic factors in the achieved progress. The programmed exercise training is one of the best non surgical symptomatic treatments of intermittent claudication.
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