Particular location of a cardiac pacemaker lead

A dual-chamber pacemaker was implanted in a 69-year-old man. As far as the surgeon was concerned, there were no problems with implantation via a left subclavian transvenous route. The location of the leads seemed to be correct under the fluoroscope. Stimulation thresholds were correct. The chest radiograph was initially considered not revealing anomaly and the position of the electrodes was described as: "ends of leads appear to be correctly placed". On performing precise checks on the pacemaker, the ECG had the appearance of complete right bundle-branch block, during ventricular stimulation, a reason for fearing malpositioning in the left ventricle. The chest X-rays (A) were re-examined. On the lateral X-ray, the lower part of the ventricular lead has a first posterior small kink and is then distinctly directed anteriorly but its end remains clearly distant from the anterior surface. Was it still correctly positioned in the right ventricle? An ultrasound examination (B) was performed: the lead passed from the right atrium to the left atrium through the inter-atrial septum at the foramen ovale (arrow) then it penetrated the left ventricle through the mitral valve (arrow head). Despite the ambiguous appearance of the chest X-rays at the beginning, this lead was therefore malpositioned. A thoracic scan (C) was performed for another indication and also clearly showed the stimulation lead in the left atrium then the left ventricle

Pancreas serous cystadenoma: typical imaging aspect of a rare tumor

Abdominal ultrasonography performed in a 54-year-old woman suffering from dyspepsia revealed a large pancreatic mass (Fig. A). CT showed an 8 cm rounded shape pancreatic head mass, slightly lobulated, hypodense but of non pure hydric density at its edge (15- 20 UH) with a stellar-shaped calcified center (Fig. B). After iodine injection, multiple thin septa were visible forming multiple small lodges non-exceeding 2 cm diameter. Pancreatic head or body were not atrophic and main pancreatic duct size was < 3 mm

A new approach to the assessment of lumen visibility of coronary artery stent at various heart rates using 64-slice MDCT

Coronary artery stent lumen visibility was assessed as a function of cardiac movement and temporal resolution with an automated objective method using an anthropomorphic moving heart phantom. Nine different coronary stents filled with contrast fluid and surrounded by fat were scanned using 64-slice multi-detector computed tomography (MDCT) at 50–100 beats/min with the moving heart phantom. Image quality was assessed by measuring in-stent CT attenuation and by a dedicated tool in the longitudinal and axial plane. Images were scored by CT attenuation and lumen visibility and compared with theoretical scoring to analyse the effect of multi-segment reconstruction (MSR). An average increase in CT attenuation of 144 ± 59 HU and average diminished lumen visibility of 29 ± 12% was observed at higher heart rates in both planes. A negative correlation between image quality and heart rate was non-significant for the majority of measurements (P > 0.06). No improvement of image quality was observed in using MSR. In conclusion, in-stent CT attenuation increases and lumen visibility decreases at increasing heart rate. Results obtained with the automated tool show similar behaviour compared with attenuation measurements. Cardiac movement during data acquisition causes approximately twice as much blurring compared with the influence of temporal resolution on image quality

Cervical lymph node metastasis in adenoid cystic carcinoma of the larynx: a collective international review

Adenoid cystic carcinoma (AdCC) of the head and neck is a well-recognized pathologic entity that rarely occurs in the larynx. Although the 5-year locoregional control rates are high, distant metastasis has a tendency to appear more than 5 years post treatment. Because AdCC of the larynx is uncommon, it is difficult to standardize a treatment protocol. One of the controversial points is the decision whether or not to perform an elective neck dissection on these patients. Because there is contradictory information about this issue, we have critically reviewed the literature from 1912 to 2015 on all reported cases of AdCC of the larynx in order to clarify this issue. During the most recent period of our review (1991-2015) with a more exact diagnosis of the tumor histology, 142 cases were observed of AdCC of the larynx, of which 91 patients had data pertaining to lymph node status. Eleven of the 91 patients (12.1%) had nodal metastasis and, based on this low proportion of patients, routine elective neck dissection is therefore not recommended

Utilisation du laser CO2 dans le traitement endoscopique des diverticules pharyngo-œsophagiens de Zenker : Expérience à propos de 33 cas

Microendoscopic treatment of hypopharyngeal (Zenker's) diverticulum was performed in 31 patients during the period 1990-1995. The CO2 laser combined with the operating microscope has been used. 33 endoscopic procedures were performed (2 procedures were needed for 2 patients). The average age of the patients was 70.3 years (46-86 years). The average length of the general anesthesia was 48 minutes; the average length of the endoscopic procedure was 20 minutes. No major complication occurred for 32/33 cases (97%). Mediastinitis occurred for 1 case (3%) and was successfully treated by surgical and IV antibiotherapy. The average duration of hospitalization was 5 days (3-5 days) (patient with mediastinitis excluded): the average follow-up was 19 months (1-62 months). 28/31 patients (90.3%) were highly or fairly satisfied. Considering the external approach microendoscopic CO2 laser diverticulotomy offers comparable functional results. Moreover, this procedure is quick, requires a shorter hospitalization stay and is followed by a very low percentage of complications. Additionally, no visible scar is noted. Optimal management of Zenker's diverticulum remains controversial. However, we advocate that microendoscopic CO2 laser diverticulotomy should be considered as a first-line treatment option for patients with hypopharyngeal diverticulum

Traitement au laser CO2 du sulcus glottidis et du kyste épidermoïde. Technique et résultats.

The CO2-lasers of the new generation are equipped with milliwatts, super-pulse, small spot size (700 U or less). These technical improvements safe permit in resection of vocal fold benign lesions like polyps, nodules, or even sulcus glottidis. Our resection technique for sulcus glottidis and epidermoïd cysts is presented in 18 cases. If very strict rules of microsurgical treatment are respected, the functional results are as good as those with conventional techniques (93% of good results)

Using dual-detector helical CT angiography to detect deep venous thrombosis in patients with suspicion of pulmonary embolism: diagnostic value and additional findings.

OBJECTIVE: The purpose of this study was to assess the value of dual-slice helical CT angiography in detecting deep venous thrombosis in patients in whom acute pulmonary embolism was suspected and to describe the additional extrathoracic findings. SUBJECTS AND METHODS: Sixty-five consecutive patients were examined for suspected pulmonary embolism using helical CT of the chest (2.7-mm collimation; table speed, 7.5 mm/sec; 100-140 mL of contrast medium injected at a rate of 3 mL/sec) followed by CT of the lower limbs (6.5-mm collimation; table speed, 10 mm/sec) without any additional contrast medium injection. Sequential scanning of the abdomen was performed using 10-mm collimation and an interval of 40 mm. Color Doppler sonography of the lower limbs was done within 24 hr of CT by two radiologists who were unaware of CT findings. Results of CT venography were compared with those of Doppler sonography and with phlebography or repeated focalized sonography in cases of discrepancy. RESULTS: Twenty-two patients had pulmonary embolism revealed on chest CT. Sixteen patients had a deep venous thrombosis. Thirteen patients with pulmonary embolism had a deep venous thrombosis. Three patients with deep venous thrombosis had no pulmonary embolism. Sensitivity and specificity for diagnosing deep venous thrombosis with CT was 93% and 97%, respectively (kappa = 0.88). Additional extrathoracic findings were observed in four patients. CONCLUSION: Combined CT venography with dual-slice scanning is an accurate method to diagnose deep venous thrombosis that may reveal additional imaging findings in some patients with possible pulmonary embolism

Initial long-term results of collagen injection for vocal and laryngeal rehabilitation.

The records of 14 patients who have benefited from intralaryngeal injections of ZCI collagen for at least 3-4 years were reviewed. All patients still living were evaluated. Qualitative phonatory measurements included laryngostroboscopy and frequency voice analysis, while quantitative studies included maximum phonation times and phonatory quotients. The absence of both local and general inflammatory reactions was observed in these patients, confirming the excellent host tolerance of ZCI collagen and the stability of the functional results achieved