Infiltration foraminale L5-S1 radioguidée dans le traitement de la lombosciatique S1

OBJECTIVE

To assess the efficacy of fluoroscopy guided L5-S1 transforaminal steroid injections for the treatment of S1 radiculopathy secondary to intervertebral disk disorder.

METHOD

41 patients were included: prospective study (20 patients) and retrospective study (21 patients). All patients suffered from S1 radiculopathy secondary to nerve root compression by intervertebral disk material, as demonstrated by lumbar spine CT. The patients underwent 2 fluoroscopy guided L5-S1 transforaminal injections of steroid (Hydrocotancyl 125 mg), at 8 days interval.

RESULTS

60% of patients showed significant improvement of their painful radiculopathy at day 8 (n:41), 60-67% at day 30 (n:41) and 67% at day 90 (n:18).

CONCLUSION

Fluoroscopy guided L5-S1 transforaminal injection showed good efficacy in the treatment of S1 radiculopathy.

[Infective dermatitis and recurrent strongyloidiasis in a child]

INTRODUCTION

Infective dermatitis is a chronic childhood dermatosis, associated with HTLV-1 infection. We report the observation of a young Haitian girl in French Guyana.

OBSERVATION

An 8 year-old girl presented recurring dermatosis on the scalp and armpits since she was 2 years old. The initial clinical examination showed the presence of centro-facial micro-papules, associated with a nasal pyodermatitis. A bacteriological culture isolated a Staphylococcus aureus. Phenotypic analysis did not indicate any production of exfoliatin or leucocidin. Serologic tests for HTLV1 were positive. In addition, the child presented recurring symptomatic anguillulosis, despite numerous antihelmintic treatments. A clinical and parasitological cure was obtained with a monthly treatment of ivermectin.

COMMENTS

This is the first case of infective dermatitis reported in french Guyana. The clinical analysis that led to this diagnosis showed a minor form of this dermatosis. The phenotypic analysis of the Staphylococcus aureus isolated from the cutaneous lesions did not indicate any factors of virulence habitually associated with pyodermatitis in Guyana. This is the first case of chronic digestive anguillulosis (a parasitic complaint usually associated with an adult HTLV-1 infection) associated with an infective dermatitis.

[Pulmonary nodules: dosimetric and clinical studies at low dose multidetector CT]

PURPOSE

To measure breast radiation dose from multidetector CT using three different low dose protocols and compare it to a standard two view chest examination. To compare the number of pulmonary nodules detected at low and standard dose.

MATERIALS AND METHODS

Thermoluminescent dosimetry was used to measure the absorbed dose on a phantom (Rando) and 10 patients. Then, we compared the standard dose to the low dose examinations. The Wilcoxon rank test and the kappa test were used to assess differences in the detection of nodules.

RESULTS

The absorbed dose of these low dose protocols correspond to the radiation dose for the acquisition of two to ten chest radiographs (two views). This study suggests that only the 30 mA protocol is sufficient for the detection of all pulmonary nodules; nodules smaller than 5 mm were overlooked at 10 mA.

CONCLUSION

A good image quality can be obtained with low dose protocols at multidetector CT (correspond to 2 to 10 chest radiographs).

[POEMS syndrome: imaging of skeletal manifestations, a study of 8 cases]

PURPOSE

To describe the imaging features of POEMS, and to compare our experience of 8 cases to a review of literature.

MATERIALS AND METHODS

This retrospective study included 8 patients (6 men, 2 women) with POEMS. Plain radiographs (8 patients), CT (6), MR (2) were performed.

RESULTS

Topographic localizations of POEMS were pelvis (7 cases), spine (5), femur (1), humerus (1), rib cage (1). Focal bone lesions, multiple (5 cases) or solitary (3 cases), were sclerotic in 4 cases, mixed lytic-sclerotic (lytic center and sclerotic rim) in 3 cases and one patient had an osteolytic lesion with sclerotic margins associated with many osteosclerotic lesions. Profilerative osseous changes were seen in 4 cases (pelvis, spine, tibia). MR imaging was performed in 2 patients: in one patient MR imaging revealed areas of low signal intensity on spin echo T1- and T2-weighted images in vertebral bodies, the other showed a lesion of low signal intensity on spin echo T1-weighted and high signal intensity on T2-weighted images in the ilium and adjacent soft tissue.

CONCLUSION

The imaging features commonly observed in POEMS syndrome are sclerotic and mixed lytic-sclerotic lesions, particularly in the pelvis and spine. Proliferative new bone formation is detected in 50%. MR imaging correlates with ostesclerotic or mixed lytic-sclerotic appearance.

[An assessment of low-dose high resolution CT in the detection of benign asbestos-related pleural abnormalities]

PURPOSE

To assess the reliability of low-dose high-resolution computed tomography (HRCT) in the detection of benign asbestos-related pleural abnormalities.

METHODS

Fourty-one patients exposed to asbestos were imaged on two occasions; the first time with conventional HRCT parameters: 140kVp, 220mAs; the second time with low-dose HRCT parameters: 120kVp, 60mAs.

RESULTS

The qualitative assessment dit not show any difference in the visibility of benign pleural abnormalities from one technique to the other in 98% cases.

CONCLUSION

The detection of pleural plaques and thickening did not vary with the two scanning protocols and, when compared with conventional HRCT, low-dose HRCT allows reduced radiation exposure by at least 76.5%, with an absorbed dose close to that delivered when using conventional chest radiography. Nevertheless, low-dose HRCT is a complementary study to helical acquisitions.

[Cross-sectional imaging of post endocarditis paravalvular myocardial abscesses of native mitral valves: 4 cases]

Four cases of submitral myocardial abscess imaged by CT or MRI following endocarditis are described. All cases occurred in fragile patients (diabetes mellitus, dialysis, severe cardiovascular diseases). An iatrogenic source was noted in one patient. Staphylococcus aureus was responsible in 2 patients. If subvalvular aortic abscesses are usually described, submitral myocardial abscesses are infrequent. In addition to transesophageal echocardiography, a technique superior to transthoracic echocardiography, CT and MRI may incidentally suggest the correct diagnosis. Both techniques provide useful morphological evaluation, information that can be used to optimize the timing for surgical repair.

[Solid pleural-based mass as initial manifestation of non-Hodgkin's lymphoma]

Subpleural involvement is a well-known site of advanced or recurrent lymphoma. But, to our knowledge, it has never been described as an initial manifestation of this disease. We report the case of a patient with solid subpleural mass revealing a non-Hodgkin's lymphoma.