Le méningiome kystique

Bien que les méningiomes soient des tumeurs intracrâniennes généralement solides et fermes, certaines sont associées à des kystes provoquant une confusion diagnostique avec les gliomes et les métastases. Une IRM préopératoire est plus utile que le scanner pour la planification chirurgicale appropriée. Selon Nauta, il existe quatre types de méningiomes kystiques. Dans le type 1 et 2, la tumeur ainsi que la composante kystique doivent être réséquées alors que dans le type 3 et 4 seule la tumeur est enlevée. Si les kystes intra-tumoraux ne sont pas reséqués, la récidive est hautement probable. La distinction entre le type 2 et 3 n'est pas évidente par l'imagerie IRM et il est parfois impossible de le faire en intra-opératoire. Dans ce cas, une exploration microchirurgicale avec biopsie devient nécessaire

Histoplasmosis peritonitis in an immunocompetent patient: case report

Abstract Histoplasmosis is a fungal infection most frequently seen in immunocompromised patients. It is endemic in Central and South America and in Africa. The infection is usually asymptomatic in a healthy individual. Extrapulmonary dissemination can be seen in immunocompromised hosts. Gastrointestinal manifestations frequently involve the terminal ileum and cecum, mimicking Crohn’s disease or malignancy. We describe the case of a 36-year-old healthy man from Cameroon, living in Switzerland for 13 years and without any medical nor surgical history, who presented peritonitis not responding to antibiotics. CT-scan showed bowel obstruction and signs of peritonitis. We opted for an explorative laparoscopy, which was converted to laparotomy with extensive adhesiolysis. Diagnostic of histoplasmosis was confirmed by histology and PCR analysis on biopsy. To our knowledge, this is the first described case of peritonitis as main outcome of a disseminated histoplasmosis involving the peritoneum in an immunocompetent patient

Tip malposition of peripherally inserted central catheters: a prospective randomized controlled trial to compare bedside insertion to fluoroscopically guided placement

Objective: Peripherally inserted central catheter (PICC) use continues to increase, leading to the development of a blind bedside technique (BST) for placement. The aim of our study was to compare the BST with the fluoroscopically guided technique (FGT), with specific regard to catheter tip position (CTP). Materials and methods: One hundred eighty patients were randomized to either the BST or the FGT. All procedures were done by the same interventional team and included postprocedural chest X-ray to assess CTP. Depending on the international guidelines for optimal CTP, patients were classified in three types: optimal, suboptimal not needing repositioning, and nonoptimal requiring additional repositioning procedures. Fisher's test was used for comparisons. Results: One hundred seventy-one PICCs were successful inserted. In the BST groups, 23.3% of placements were suboptimal and 30% nonoptimal, requiring repositioning. In the FGT group, 5.6% were suboptimal and 1.1% nonoptimal. Thus, suboptimal and nonoptimal CTP were significantly lower in the FGT group (p &lt; 0.001). Conclusion: Tip malposition rates are high when using blind BST, exposing the patient to an increased risk of deep venous thrombosis and catheter malfunction. Using the FGT or emerging technologies that could help tip positioning are recommended, especially for long-term indications. Key points: • Bedside and fluoroscopy guided techniques are commonly used for PICC placement. • Catheter malposition is the major technical issue with the bedside technique. • Catheter malposition occurred in 53% of patients with the bedside technique.</p

Comparison of MRI response evaluation methods in rectal cancer: a multicentre and multireader validation study

International audienceObjectives: To compare four previously published methods for rectal tumor response evaluation after chemoradiotherapy on MRI.Methods: Twenty-two radiologists (5 rectal MRI experts, 17 general/abdominal radiologists) retrospectively reviewed the post-chemoradiotherapy MRIs of 90 patients, scanned at 10 centers (with non-standardized protocols). They applied four response methods; two based on T2W-MRI only (MRI tumor regression grade (mrTRG); split-scar sign), and two based on T2W-MRI+DWI (modified-mrTRG; DWI-patterns). Image quality was graded using a 0-6-point score (including slice thickness and in-plane resolution; sequence angulation; DWI b-values, signal-to-noise, and artefacts); scores < 4 were classified below average. Mixed model linear regression was used to calculate average sensitivity/specificity/accuracy to predict a complete response (versus residual tumor) and assess the impact of reader experience and image quality. Group interobserver agreement (IOA) was calculated using Krippendorff's alpha. Readers were asked to indicate their preferred scoring method(s).Results: Average sensitivity/specificity/accuracy was 57%/64%/62% (mrTRG), 36%/79%/66% (split-scar), 40%/79%/67% (modified-mrTRG), and 37%/82%/68% (DWI-patterns); mrTRG showed higher sensitivity but lower specificity and accuracy (p < 0.001) compared to the other methods. IOA was lower for the split scar method (0.18 vs. 0.39-0.43). Higher reader experience had a significant positive effect on diagnostic performance and IOA (except for the split scar sign); below-average imaging quality had a significant negative effect on diagnostic performance. DWI pattern was selected as the preferred method by 73% of readers.Conclusions: Methods incorporating DWI showed the most favorable results when combining diagnostic performance, IOA, and reader preference. Reader experience and image quality clearly impacted diagnostic performance emphasizing the need for state-of-the-art imaging and dedicated radiologist training