Coping with the problems of diagnosis of acute colitis

AbstractAcute colitis is an acute condition of the colon. For the radiologist, it is mainly diagnosed during differential diagnosis of acute abdominal conditions. There are many causes of colitis and the degree of its severity varies. A CT scan is the best imaging examination for diagnosing it and also for analysing and characterising colitis. The topography, type of lesion and associated factors can often suggest a precise diagnosis but it is nevertheless essential to integrate these findings into the clinical context and take laboratory values into account. The use of endoscopy is still the rule where a doubt remains, or to obtain necessary histological evidence

Clinical characteristics and outcomes of patients with hepatic angiomyolipoma:A literature review

First reported in 1976, hepatic angiomyolipoma (HAML) is a rare mesenchymal liver tumor occurring mostly in middle-aged women. Diagnosis of the liver mass is often incidental on abdominal imaging due to the frequent absence of specific symptoms. Nearly 10% of HAMLs are associated with tuberous sclerosis complex. HAML contains variable proportions of blood vessels, smooth muscle cells and adipose tissue, which renders radiological diagnosis hazardous. Cells express positivity for HMB-45 and actin, thus these tumors are integrated into the group of perivascular epithelioid cell tumors. Typically, a HAML appears on magnetic resonance imaging (or computed tomography scan) as a hypervascular solid tumor with fatty areas and with washout, and can easily be misdiagnosed as other liver tumors, particularly hepatocellular carcinoma. The therapeutic strategy is not clearly defined, but surgical resection is indicated for symptomatic patients, for tumors showing an aggressive pattern (i.e., changes in size on imaging or high proliferation activity and atypical epithelioid pattern on liver biopsy), for large (> 5 cm) biopsy-proven HAML, and if doubts remain on imaging or histology. Conservative management may be justified in other conditions, since most cases follow a benign clinical course. In summary, the correct diagnosis of HAML is challenging on imaging and relies mainly on pathological findings

Segmentation d'images scanner X du foie par Max-Flow/Min-Cut

Dans le contexte d'une application médicale spécifique, le traitement mini-invasif des cancers primitifs du foie par ultrasons à haute intensités, notre étude porte sur une méthode de segmentation 3D semi-automatique rapide qui permet d'isoler le foie et les différents réseaux vasculaires hépatiques à partir de volumes acquis en scanner X. Cette méthode est caractérisée par une description du volume sous la forme d'un graphe où les poids des liens entre noeuds décrivent soit des degrés de similarité entre voxels de la même classe (approche région), soit des degrés de discontinuité d'un voxel par rapport à un voisin (approche contours). Ces différents poids sont définis après une première phase d'apprentissage interactive. L'algorithme de Max-Flow/Min-Cut est ensuite utilisé pour partitionner le volume en deux sous-ensembles représentatifs des classes

Bezoar-induced Small Bowel Obstruction

Purpose: The aim of this study was to observe the clinical features of a bezoar-induced small bowel obstruction and to in-vestigate the role of abdominal computed tomography (CT) in establishing the diagnosis. Methods: We retrospectively reviewed 20 cases of bezoar-induced small bowel obstruction in our hospital from 1996 to 2010. Results: Thirteen patients (65%) had a history of abdominal surgery. Nine patients (45%) were diagnosed with a bezoar before surgery, seven patients were diagnosed by using abdominal CT, and two patients were diagnosed with a small bowel series. Abdominal CT was performed in 15 patients, and the diagnostic accuracy was 47 % (7/15). Surgery revealed ten bezoars in the jejunum and 11 in the ileum. Two patients had bezoars found concurrently in the stomach. Spontaneous removal took place in two patients. An enterotomy and bezoar extraction was performed in 15 patients. Fragmentation and milking, a small bowel resection, and a Meckel’s diverticulectomy were performed in one patient each. Early operative treatment was possible (P = 0.036) once the bezoar had been diagnosed by using abdominal CT. There tended to be fewer postoperative complications in patients who were diagnosed with a bezoar by using abdominal CT, but the result was not statistically significant (P = 0.712). Conclusion: A preoperative diagnosis of bezoar-induced small bowel obstruction by using clinical features was difficult. Increased use of abdominal CT led to a more accurate diagnosis and to earlier surgery for bezoar-induced small bowel obstructions, thereby reducing the rate of complications

Fatigue in teriflunomide-treated patients with relapsing remitting multiple sclerosis in the real-world Teri-FAST study

BACKGROUND: Fatigue is a frequent and disabling symptom of multiple sclerosis (MS) often associated with impaired quality of life (QoL) in patients. Teriflunomide is a once-daily oral immunomodulator used for the treatment of relapsing remitting forms of MS. However, its effect on fatigue is not well known in real life practice. We evaluated the impact of teriflunomide on fatigue in patients with relapsing remitting MS (RRMS) after 2 years of treatment in the real-world Teri-FAST study. METHODS: Teri-FAST was a 2-year, prospective, observational study conducted in France in RRMS patients treated with teriflunomide 14 mg. Fatigue was assessed using the French version of the modified fatigue impact scale (EMIF-SEP). The primary endpoint was the change from baseline in EMIF-SEP score after 2 years of treatment. Secondary endpoints included evaluation of depression (Beck Depression Inventory [BDI]), health-related QoL (Two-Life Scale TLS-QoL 10), self-reported physical activity, and adverse events. RESULTS: 210 eligible patients were included in the study with a mean age of 45.4 years and a mean ± SD Expanded Disability Status Scale score of 1.76 ± 1.43 at baseline. About half (52.4%) of patients had no previous treatment for MS. In the 163 patients who completed at least 1 follow-up visit, the mean change in EMIF-SEP score at Year 2 was -1.54 (95% CI: -4.02, 0.94) indicating that fatigue remained stable. Similarly, there were no changes in depression level and QoL after 2 years of treatment. Physical activity slightly improved with 57% of patients reporting being physically active after 2 years as compared to 46% at baseline. The safety profile of teriflunomide was consistent with that seen during clinical development, and compliance with treatment was high. CONCLUSION: Fatigue scores remained stable in RRMS patients treated with teriflunomide 14 mg over 2 years in real-life setting. Teriflunomide did not negatively impact depression or QoL

Pathogenesis, diagnosis and management of pneumorrhachis

Pneumorrhachis (PR), the presence of intraspinal air, is an exceptional but eminent radiographic finding, accompanied by different aetiologies and possible pathways of air entry into the spinal canal. By reviewing the literature and analysing a personal case of traumatic cervical PR after head injury, we present current data regarding the pathoanatomy, clinical and radiological presentation, diagnosis and differential diagnosis and treatment modalities of patients with PR and associated pathologies to highlight this uncommon phenomenon and outline aetiology-based guidelines for the practical management of PR. Air within the spinal canal can be divided into primary and secondary PR, descriptively classified into extra- or intradural PR and aetiologically subsumed into iatrogenic, traumatic and nontraumatic PR. Intraspinal air is usually found isolated not only in the cervical, thoracic and, less frequently, the lumbosacral regions but can also be located in the entire spinal canal. PR is almost exceptional associated with further air distributions in the body. The pathogenesis and aetiologies of PR are multifold and can be a diagnostic challenge. The diagnostic procedure should include spinal CT, the imaging tool of choice. PR has to be differentiated from free intraspinal gas collections and the coexistence of air and gas within the spinal canal has to be considered differential diagnostically. PR usually represents an asymptomatic epiphenomenon but can also be symptomatic by itself as well as by its underlying pathology. The latter, although often severe, might be concealed and has to be examined carefully to enable adequate patient treatment. The management of PR has to be individualized and frequently requires a multidisciplinary regime

MRI for Noninvasive Thermometry

MRI was recognized for its potential use as a noninvasive in vivo thermometer 30 years ago. Today, the most popular application of MR thermometry is the guidance of thermal therapies for the treatment of cancer and other pathologies. These minimally invasive operations are routinely performed on patients who are not eligible for surgery in approximately 40 medical centers globally. The aim is to deliver or abduct thermal energy in order to cause local tissue necrosis or to sensitize a lesion to chemotherapy or radiotherapy without causing harm to the surrounding healthy tissue. Here we explain the principles of operation of MR thermometry and provide a critical review of the proposed methods, highlighting remaining fundamental and technical issues as well as recent progress. Emphasis is placed on hardware advances (RF receivers) for improved signal-to-noise ratio (SNR) which would lead to better accuracy, spatiotemporal resolution, and precise calibration. We conclude with a general outlook for the field

Thermoablation ultrasonore hépatique appliquée par voie interstitielle percutanée sous guidage échographique et sous contrôle actif de température en IRM

A MR compatible interstitial US applicator was developed for percutaneous treatmentof hepatocellular carcinoma (HCC) under imaging control. This work was based on two experimentations : 1) In the first experimentation, performed in vivo on pig liver,macro-lésions corresponding to the fusion of several elementary lesions on 360° were realized percutaneously under echo-guidance. The macrolésions obtainedshowed a size similar to those obtained with RF in clinical practice. Moreover, in this study, the elementary lesions proved to be quite indifferent to the heat sink effect oflarge hepatic blood-vessels; 2) In the second experimentation, performed in vitro andin vivo on pig liver, MR temperature active control was obtained for the creation oflesions similar in size and aspect in all directions. This MR temperature active control appeared extremely interesting since the power applied and the time of application were very different according to the direction of the ultrasonic beam.Un applicateur ultrasonore interstitiel IRM compatible a été développé pour le traitement percutané du CHC sous contrôle de l'imagerie. Deux grands axes expérimentaux ont été abordés : 1) au cours d'une première expérimentation réalisée in vivo sur le foie de porc, des macro lésions correspondant à la fusion de lésions élémentaires par rotation du transducteur sur 360° ont pu être réalisées par voie percutanée sous contrôle échographique. Les macro lésions obtenues possédaient une taille voisine de celles obtenues en pratique clinique par la RF. De plus, les lésions élémentaires se montraient relativement indifférentes à l'effet de vol de chaleur ; 2) au cours d'une seconde expérimentation réalisée in vitro puis in vivo sur le foie de porc, un contrôle actif par IRM de température a pu être obtenu pour la création de lésions ultrasonores de taille et aspect similaires quelle que soit la direction du faisceau ultrasonore. Ce contrôle de température est apparu d'autant plus important que les puissances appliquées et du temps d'application pour l'obtention de lésions de taille similaire étaient extrêmement variables selon la direction du faisceau ultrasonore

Echo-guidance and MR temperature active control for interstitial US Ablation in liver

Un applicateur ultrasonore interstitiel IRM compatible a été développé pour le traitement percutané du CHC sous contrôle de l'imagerie. Deux grands axes expérimentaux ont été abordés : 1) au cours d'une première expérimentation réalisée in vivo sur le foie de porc, des macro lésions correspondant à la fusion de lésions élémentaires par rotation du transducteur sur 360° ont pu être réalisées par voie percutanée sous contrôle échographique. Les macro lésions obtenues possédaient une taille voisine de celles obtenues en pratique clinique par la RF. De plus, les lésions élémentaires se montraient relativement indifférentes à l'effet de vol de chaleur ; 2) au cours d'une seconde expérimentation réalisée in vitro puis in vivo sur le foie de porc, un contrôle actif par IRM de température a pu être obtenu pour la création de lésions ultrasonores de taille et aspect similaires quelle que soit la direction du faisceau ultrasonore. Ce contrôle de température est apparu d'autant plus important que les puissances appliquées et du temps d'application pour l'obtention de lésions de taille similaire étaient extrêmement variables selon la direction du faisceau ultrasonore.A MR compatible interstitial US applicator was developed for percutaneous treatmentof hepatocellular carcinoma (HCC) under imaging control. This work was based on two experimentations : 1) In the first experimentation, performed in vivo on pig liver,macro-lésions corresponding to the fusion of several elementary lesions on 360° were realized percutaneously under echo-guidance. The macrolésions obtainedshowed a size similar to those obtained with RF in clinical practice. Moreover, in this study, the elementary lesions proved to be quite indifferent to the heat sink effect oflarge hepatic blood-vessels; 2) In the second experimentation, performed in vitro andin vivo on pig liver, MR temperature active control was obtained for the creation oflesions similar in size and aspect in all directions. This MR temperature active control appeared extremely interesting since the power applied and the time of application were very different according to the direction of the ultrasonic beam

Rapport sur la décoration des écoles. Approuvé par la Société des écoles enfantines dans sa séance du 2 juillet 1887

Delabrousse Anna. Rapport sur la décoration des écoles. Approuvé par la Société des écoles enfantines dans sa séance du 2 juillet 1887. In: La revue pédagogique, tome 12, Janvier-Juin 1888. pp. 534-538