Chronic sinusitis: the role of imaging.

In recent years, routine endoscopic examination of the nose and advances in medical imaging have led to a better understanding of the pathophysiology of chronic sinusitis and the development of "FESS". The CT san of the sinuses have superseded the conventional standard radiography in the evaluation of the paranasal sinuses as it offers more precise anatomic information to the surgeon on the complex anatomy of the sinus cavities and their drainage pathways, in particularly the ostiomeatal complex. The coronal plane is the best incidence because it most closely correlates with the surgical approach.

Allergy and sinusitis.

Nasal allergy is statistically related to inflammatory chronic sinusitis as a risk factor. But one question still remains unanswered: are the reactions and modifications observed in the sinuses after natural exposure to a nasal allergen or after nasal allergen challenge linked to an IgE mediated mechanism? Similarities in symptoms, eosinophils and mediators of inflammation in the mucosa have been found between allergic rhinitis and sinusitis. The same applies for the deposition of Major Basic Protein (MBP) and treatment results, especially when topical steroids are found.

[Unexpected origin of recurrent ascites: apropos of 2 cases].

The authors report the cases of two patients suffering from ascites attributed for several years to a non pericarditic aetiology. The first patient presented with a diagnosis of right cardiac failure secondary to a right myocardial infarction. Cardiac catheterisation, magnetic resonance imaging and transoesophageal echocardiogram allowed to establish the diagnosis.

Venous return by the paraumbilical and hepatic veins in case of superior vena cava obstruction.

Pseudolesion in segment IV of the liver is a well-known diagnostic pitfall during arterial portography or even spiral computed tomography (CT) of the liver. It has suggested that this pseudolesion is the result of an abnormality in subsegmental perfusion. We report a case of an early dense contrast enhancement of segment IV of the liver by epigastric and paraumbilical veins in a patient with a superior vena cava obstruction.

Systemic supply to a pulmonary arteriovenous malformation: potential explanation for recurrence.

A pregnant woman presented with hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) and a single pulmonary arteriovenous malformation (AVM) that had been embolized 5 years previously. Partly due to pregnancy, recanalization of the aneurysm occurred with subsequent hemoptysis. Despite successful therapeutic reembolization of the afferent pulmonary artery, hemoptysis recurred 5 days later.

Whipple's disease confined to the central nervous system.

We report a 49-year-old woman with a left parietal lesion, shown on CT and MRI as an isolated ring-enhancing mass. The diagnosis of cerebral Whipple's disease was made by brain biopsy; there were no gastrointestinal symptoms nor periodic-acid Schiff-positive inclusions in the jejunal mucosa. This case illustrates atypical Whipple's disease, confined exclusively to the central nervous system.

Dermatomyositis and bronchial squamous cell carcinoma: evidence for a true relationship.

The authors report a case of dermatomyositis (D.M) in a 57-year-old man, associated with a squamous cell bronchial carcinoma. The complete resolution of the dermatomyositis after radical resection of the bronchial tumor strongly suggested a paraneoplastic phenomenon.

Myositis ossificans of the chest wall.

We report the unusual case of a young man with progressive pain in the thoracic wall. The radionuclide bone scan revealed an increased uptake, and the bone roentgenogram, a calcified soft-tissue mass. Based on computed tomography findings, biopsy was avoided, and evolution was favourable for myositis ossificans.

Unusual presentation of papillary thyroid carcinoma: about two cases.

The papillary carcinoma is the most common cancer of thyroid but its presentation may be unexpected. In the first case, a 18-year-old girl complained of a painful enlargement of the right thyroid lobe. Upon the basis of a CT scan revealing punctuate calcifications suggesting psammoma bodies and a right-sided cold nodule on thyroid radioiodine scanning, the patient had a thyroidectomy.

[Pulmonary mycobacteriosis due to Mycobacterium xenopi" in-vitro sensitivity to classical antitubercular agents and clinical development].

Out of 11 patients suffering from Mycobacterium xenopi lung disease, 9 were treated with an empiric antituberculous triple chemotherapy until specific identification and antibiogram were available. Despite the important "in vitro" resistance to drugs, most of the patients improved; in the other patients, the impairment was always due to the underlying pathology. We conclude that the "in vivo" response of M.

Revascularization of the circumflex artery with the pedicled right internal thoracic artery: clinical functional and angiographic midterm results.

Retroaortic crossing of the pedicled right internal thoracic artery for revascularization of the circumflex artery used in combination with a pedicled left internal thoracic artery anastomosed to the left anterior descending artery and its branches is an attractive technique to achieve an extensive arterial revascularization of the left ventricle. However, there is a suspicion that pulling the right internal thoracic artery through the transverse sinus could compromise its blood flow capacity and patency. Between January 1990 and July 1994 this technique was applied in 256 patients (202 men, 54 women; average age 62 years, range 31 to 80 years).

Unusual pitfall of use of retrograde cardioplegia.

The use of retrograde cardioplegia can lead to several complications, mainly related to injuries during the cannulation of the coronary sinus. We herein present a case report of injury to the right coronary artery related to kinking due to the pursestring on the right atrium.

3D spiral CT of the tracheobronchial tree.

Objective: Because of intrinsic limitations of transverse cross-sectional imaging methods, CT sometimes is insufficient for adequate evaluation of complex tracheobronchial anomalies. This article describes a complementary 3D procedure specifically dedicated to the study of the tracheobronchial tree.

Materials And Methods: The procedure combines a specific spiral CT acquisition with 2 or 4 mm collimation, 3D surface rendering of the tracheobronchial aerial content, and double obliquity multiplanar reformats directly planned on the 3D virtual object.

[Pneumatosis cystoides intestinalis associated with Steinert disease].

We report the case of a 63-year-old patient suffering from myotonic dystrophy, complicated with respiratory insufficiency, who presented a pneumoperitoneum without sign of peritonitis. Diagnosis of pneumatosis cystoides coli was based on CT scan evidence. Given oxygenotherapy and antibiotherapy, the patient rapidly improved.

[Non-allergenic bronchial hyperreactivity and occupational agents].

The relationship between occupational asthma (OA) and non-specific bronchial responsiveness (NSBR) is reviewed. Natural or laboratory exposure to ubiquitous allergens can induce or increase NSBR. Reduction of exposure has an opposite effect.

Dyskinesia of the superior oesophageal sphincter: assessment and treatment.

Pharyngo-oesophageal dyskinesias present a common symptomatology associated with those difficulties in swallowing for which the radio-manometric assessment is well known. Radiology, nevertheless, with an overall analysis of deglutition and its iatrogenic complications, as well as manometry of the superior oesophageal sphincter (OSS) with its diversity of results, according to the material, techniques, age, sex and stress involved, has convinced us of the necessity for a supplementary dynamic examination. Electromyography (EMG), simultaneously by the inferior constrictor (IC) and cricopharyngeal (CP) muscles, analyses with precision the electric activity of these two muscles, as well as the pharyngosphincteral synchronism.

[Status of 3 years of hyperthyroidism treatment with iodine 131].

We analysed retrospectively the results obtained during 3 years in the treatment of thyrotoxicosis with 131-iodine. A group of 32 patients, including 21 Graves' diseases, 10 multinodular toxic goitres and 1 toxic adenoma has been collected. The therapeutic efficacy of one dose of radioiodine, assessed after 6 months was 100% in toxic multinodular goitres and 57% in Graves' diseases.

[Recurrent respiratory distress and idiopathic subglottic stenosis: what treatment?].

Background: Idiopathic subglottic stenosis is a rare cause of acute respiratory distress, that is difficult to treat (corticosteroids, tracheotomy).

Case Report: A nine-year-old boy presented with acute respiratory distress due to tracheal stenosis. The symptoms recurred after the endotracheal inflammatory membranes had been removed with forceps, despite 6-months of degressive corticotherapy.

[Value of flexible fiberoptic bronchoscopy under local anesthesia in infants].

From October 1991 through April 1992, 16 infants aged 5 to 25 months (mean age 14.3 months) underwent bronchoscopy with a flexible fiberoptic bronchoscope, under local anesthesia. The technique is described in detail.

[Study of a group of diabetic patients enrolled in the INAMI convention "Self-monitoring of blood glucose"].

We have studied the clinical characteristics of 126 insulin-treated diabetic patients, mainly type I subjects, who regularly performed during 18 months home glucose monitoring. The numbers of strips used each month was of 60 +/- 33 (mean +/- lSD). During the study period, HbA1C levels decreased from 8.

[Aging of heart function in man].

In normal subjects at rest neither heart rate nor ejection volume are influenced by age. The loss of elasticity of the great arteries, and in particular the aorta which becomes tortuous and wider, results in an increase of impedance at ejection. At systole time pressure rises in the whole cardiovascular system, so that the left ventricle is subjected to an increase of parietal tension to which it adapts itself by hypertrophy which normalizes this tension.

Focal necrosis of the ureter following CT-guided chemical sympathectomy.

Focal necrosis of the ureter was observed in our patient 7 days after CT-guided chemical sympathectomy. The injection of phenol was apparently rendered remote from the ureter and still caused ureteric necrosis. Ureteric injury may thus result following chemical sympathectomy, not from direct puncture of the ureter, but from unpredictable individual diffusion pathways.