[Autoimmune and inflammatory pathologies associated with systemic scleroderma: Clinical, serological and prognostic profiles. Bi-centric retrospective series in the PACA region]

INTRODUCTION

Systemic sclerosis (SSc) is a rare auto-immune disease, affecting principally women between 40 and 60 years old. It is caracterised by a cutaneous and visceral fibrosis, an alteration of the microvascular network and the presence of autoantibodies. SSc can be associated with another connectivite tissue disease or to other autoimmune diseases, thus defining the overlap syndrome. The goal of our study is to describe these overlap syndromes.

METHODS

We have analysed the data of a retrospective and bicentrique cohort, from the internal medicine unit of Hôpital Nord in Marseille and from the internal medicine unit of the Hôpital Sainte-Anne in Toulon, of patients followed for a SSc between January 1st, 2019 and December 1st, 2021. We have collected clinical, imunological features, associated auto-immune and inflammatory diseases with its morbidity and mortality.

RESULTS

The cohort included 151 patients including 134 limited cutaneous SSc. Fifty-two (34.4%) patients presented at least one associated auto-immune or inflammatory disease. The association of two connectivite tissue diseases including SSc was found in 24 patients (15.9%), a third with Sjögren's syndrome and a third with autoimmune myositis. The principal associated disease to SSc was the autoimmune thyroiditis found in 17 patients (11.3%). The occurrence of complications (hospitalization, long-term oxygene therapy, death) was not significantly different depending on the existence or not of an overlap syndrom.

CONCLUSION

SSc is often associated with other autoimmune diseases. This interrelation between associated pathologies and SSc, modifying sometimes the evolution of SSc, enhances the need of a personalized follow-up.

Assessment of ventricular reconfiguration after third ventriculostomy: what does shape analysis provide in addition to volumetry?

PURPOSE

From neuroradiologic experience, it is evident that the adaptation of the ventricular system secondary to pathologic processes or surgery is not uniform. To describe changes entirely, one must consider, in particular, information about volume and shape. In this study, we address specifically the information encoded in the change of shape. To exemplify the technique, we used time-series MR imaging examinations of patients with surgically treated chronic or acute occlusive hydrocephalus.

METHODS

Preoperative and postoperative MR imaging at different time-steps was performed in 2 patients with occlusive hydrocephalus with a different time course of ventricular enlargement. The third and lateral ventricles were segmented with an automated classification scheme. Ventricular surfaces were binarized, mapped to a spheric coordinate system, and modeled by harmonic-basis functions. This approach allows simplification of the complex shape by stepwise filtering of the details that form the surface. The ventricles can be directly compared on the level of the simplified shape.

RESULTS

Although the relative volumetric change was comparable between patients, analysis of shape revealed notable regional differences in the pattern of adaptation. Comparing subacute and chronic hydrocephalus, the analysis reflected fundamental differences in the pattern of ventricular enlargement.

CONCLUSION

In addition to the mere volumetric description, this approach identifies regions that re-adjust differently to the altered pressure. The pattern of re-adaptation depends on the time course and history of the hydrocephalus. Furthermore, the different patterns of ventricular adaptation in patients with chronic or subacute hydrocephalus suggest a contiguity with properties of the surrounding parenchymal tissue.

[DS-1000--a new digital image intensifier film-screen system in thoracic diagnosis]

The characteristics of the DS-1000, a new digital imaging equipment, using an image-intensifier-video-system are described. The digital images are displayed on a monitor with 1024 x 1024 matrix, are stored on a hard disc and can be postprocessed with regard to gray-scale-level and recognition of details. The spatial resolution ist 1,1 Lp/mm, using the 47-cm-image-intensifier. The DS 1000 was employed for chest-examinations. The diagnostic accuracy of 70 selected cases with a great variety of pathologic conditions was verified in comparison to conventional chest films. There was no significant difference in the recognition of normal anatomic structures between the two imaging systems. Pathologic states with low contrast to the surrounding structures (mediastinal and hilar masses, airspace disease, pulmonary nodules) were displayed at least equivalent with the digital technique. The accuracy in recognizing pathologic states with the digital equipment as compared to the conventional technique was inferior for conditions requiring high spatial resolution (subtle interstitial infiltrations, septal lines, scars, subtle calcifications).

[Computed tomography of esophageal carcinoma. Correlation between computed tomographic and postoperative findings]

Between March, 1980 and January, 1984, computerized tomography (CT) was performed on 110 patients with proven esophageal carcinoma. In 26 patients, information obtained preoperatively by CT was compared with results of intraoperative exploration or histologic examination of resection specimen. Correlation analysis showed that accuracy of CT in assessing actual tumor size and mediastinal or abdominal lymph node involvement is rather limited, while correct results were obtained in between 84 and 100 per cent of patients as far as identification of invasion of adjacent organs is concerned. We thus advocate routine use of CT in the process of preoperative assessment of operability and staging.

[Computer or conventional tomography? Comparative studies in craniofacial fractures]

Both conventional tomography and computed tomography are usefully employed in examinations of facial and frontal skull base fractures. Whereas computed tomography offers an excellent high-resolution image, conventional tomography yields a better spatial representation. The advantages and limitations of these techniques in the diagnosis of facial and frontal skull base fractures are presented and discussed.

[Experience with the Hickman catheter in bone marrow transplantation and intensive cytostatic chemotherapy]

Long-Term indwelling right atrial (Hickman) catheters were placed in 37 patients undergoing bone marrow transplantation or intensive chemotherapy for acute leukemia and other malignancies. Blood sampling, application of blood products or intravenous drugs and parenteral nutrition were impressively facilitated. Parents were easily trained for catheter care at home. The median duration of function has been 85 (2-312) days. 7 catheters had to be changed because of dislocation - especially in smaller children - or fluid leakage. In 6 severely neutropenic patients bacteremia was observed which resolved without catheter removal. The cause of death in 9 children with functioning catheter was due to the underlying disease (graft rejection, relapse). The use of Hickman-catheters improved venous access and supportive care in children with acute leukemia or other malignancies at an acceptable complication rate.