Biomedical subjects
Publications and source records attributed to Y Grumbach.
The syndrome of Maffucci is characterized by angioma association of the enchondromatose. It is a relatively rare syndrome. The lesions are evolutived. The treatment is surgical. His pronostic is marqued by high percentage of malign degenerescence.
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Mammography and breast ultrasonography are complementary examinations. The combination of the two examinations can provide an accurate diagnosis, which mammography alone is unable to do. Ultrasonography is particularly important in the examination of dense breasts, especially for the visualization of sonolucent or hypoechogenic formations. However, ultrasonography should not be performed alone, as it is unable to visualize microcalcifications. It can not be used as a screening test and it would be a professional error to perform only a clinical examination and ultrasonography, as a large number of diagnoses would be missed. Two essential points should be stressed: 30% of carcinomas have microcalcifications; amongst these 30%, many lesions are small and impalpable and they may not be seen on ultrasonography in a fatty breast. 40% of occult cancers are detected by the microcalcifications identified on mammography, which remains the key to breast investigations. Ultrasonography compensates for some of the deficiencies of radiography and can be very useful in dense breasts, in cystic or hypoechogenic structures. It can also be used to guide aspiration biopsy of non palpable lesions and for the pre-operative localization of impalpable lesions with abnormal echostructure, which are not visible on mammography.
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The authors review the various techniques of intravenous arteriography before an excretory urogram and discuss their role in the etiological diagnosis of hypertension. Detection of renovascular disease classically implied Seldinger arteriography, with its limited indications, because of side effects and cost. This classical approach should now be systematically replaced by the visualization of renal arteries during the intravenous pyelography procedure which appears to be a method more effective, as well as less expensive and hazardous. The pyelogram wash-out should still be performed when the visualization of the renal arteries is poor because of its value in the screening for renovascular hypertension. Furthermore, when a renal artery stenosis is clearly defined, the wash-out of the pyelogram should also be performed because of its prognostic value. As the classical approach for the etiological diagnosis of hypertension, this technique has limited indications. It is indicated in severe hypertension in the young, when medical treatment does not control blood pressure satisfactorily or when renal failure progresses rapidly. Furthermore, this technique allows a non traumatic follow up of operated or dilated stenoses.
1. The technique of combined intravenous renal arteriography and pyelography is described and results in 848 hypertensive patients are reported. 2. The procedure was tolerated better than Seldinger arteriography and the diagnostic accuracy for renal artery stenosis was 95%. 3. The prevalence of renovascular disease was 7%. 4. Cost-effectiveness calculations favour combined intravenous arteriography and pyelography rather than the usual approach based on assessment of the indications for Seldinger arteriography from clinical and urographic signs.
The cost of the systematic radiological examination of 100 hypertensive patients in the search of renovascular hypertension reaches 118 330 F, for the classical approach based on selecting the indications of the Seldinger arteriography on the urographic signs and even 164 950 F when these indications are broadened. The systematic examination of 100 hypertensives by the combined intravenous arteriography and pyelography costs 108 240 F when only one film is taken and 120 910 F when 6 films are taken. The effectiveness for the diagnosis of the 11 renovascular diseases present in 100 hypertensive patients, is measured by the recognition of 8.6-9.1 of them by the classical approach and 10.4-10.9 by the combined intravenous arteriography and pyelography. The effectiveness for the diagnosis of the 2,3 cases of renovascular hypertension present in 100 hypertensive patients is measured by the recognition of 1.8 -1.9 of them by the classical approach and 2.1-2.27 by the combined IV arteriography and pyelography. The cost of finding a patient with curable renovascular hypertension is respectively 51 543 F and 53 264 F with the routine intravenous arteriography according to the number of films and 65 738 and 86 815 F for the classical approach according to wether the indications of the Seldinger arteriography have purely urographic or also clinical basis. In conclusion, the combined intravenous renal arteriography and urography is a method more reliable and less expensive to diagnose renovascular disease and hypertension than the classical approach selecting the seldinger arteriography on the urographic and clinical data. Furthermore, this technic prevents arterial catheterism complications and allows a non traumatic follow-up of the non operated stenosis which may threaten the life of the kidney, as well as the operated or dilated ones.
A new radiological technique is described for opacification of the thoracic aorta in neonates and babies weighing less than 10 kg. The exploration method is described: injection of a contrast medium after retrograde carotid puncture, and increased endothoracic pressure. The results obtained in 21 babies aged from 3 to 157 weeks, and weighing 3.3 to 10 kg are discussed. Radiographic results were excellent in 17 cases, satisfactory in 3 cases, and only moderate in 1 case. The procedure was perfectly well tolerated, and enabled visualization of an arterial canal in 4 cases, stenosis of a Blalock-Taussig anastomosis in 1 case, aortic stenosis in 7 cases (2 tubular hypoptasias, 1 coarctation, 3 segmentary interruptions, 1 recoarctation), coronary-cardiac fistula in 1 case, and a normal aorta in 9 cases. The authors review the advantages, inconveniences, and risks of the other methods of opacification of the thoracic aorta in neonates and babies. They conclude that when right cardiac catheterization cannot give, in babies under 10 kg of weight, a satisfactory radiological assessment of the thoracic aorta in the following clinical conditions: coarctation syndrome, badly tolerated left-right shunt, or possible abnormality of the aortic arch or coronaries, the technique of opacification of the thoracic aorta by retrograde puncture of the common carotid is the best radiological method for establishing a definite diagnosis.
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A newborn boy presented with an acrocephaly characterized by a coronal craniosynostoses, open sagittal sutures and abnormally high and straight forehead. He was the only child of young, unrelated, healthy parents; there was no familial history of dysmorphy. Facial asymmetry was important and associated with posterior cleft palate, syndactylia of the tips and polydactylia of feet, due to a splitting of the first metatarsus. The child also had a congenital heart disease, like in half of the 15 published cases. In older children, mental retardation is usually observed, often associated with obesity and hypogonadism. Polydactylia permitted to exclude Apert's acrocephalosyndactylia in which there is a normal number of finger arms and which seems to be a dominant mutation, while the transmission of Carpenter's syndrome appears autosomal recessive, thus requiring restrictive genetic counselling.
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The authors report their experience about 2,422 examinations with double contrast radiography in the study of the gastric posterior wall. This technique is of great value in the detection, analysis and follow-up of gastric ulcerations. In 54 per cent of cases, the double contrast radiography showed endoscopically proven ulcerations, which where not recognized by standard barium meal technique. The diagnosis of the benign tumours of the posterior wall of the stomach has been also increased bay double contrast radiography. Thus, this technique is recommended for routine examination of the stomach.
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