[Radiological picture and surveillance of nontraumatic aortic dissections of the descending aorta]

A retrospective study of 32 cases of acute dissecting aneurysms of the aorta forms the basis for further discussions on the role of arteriography. This is the only examination enabling full visceral investigation in type B dissecting aneurysms (affecting the descending aorta only) treated medically. The possible need for revascularization surgery will depend upon the results of this investigation, the type of arterial lesions affecting the visceral branches being determined by assessment of visibility of arteries in relation to the true and false lumen.

Bronchial artery occlusion for severe hemoptysis: use of isobutyl-2 cyanoacrylate

Isobutyl-2 cyanoacrylate (IBC) was used to embolize the bronchial arteries of 14 patients with severe hemoptysis. The site of bleeding was supplied by a bronchial artery from the aorta in 11 cases and from a right bronchointercostal trunk in three. IBC was injected after previous reduction of the blood flow in the artery by embolization with particles of dura mater. In all cases, bleeding stopped immediately after occlusion and no spinal cord complications were observed. The results indicate that IBC may be a valuable occluding agent in severe hemoptysis, since it produced virtually permanent occlusion of both the distal and proximal parts of the artery. In 13 patients, bleeding did not recur throughout follow-up periods of 2-17 months. In one patient, it recurred 12 months after embolization but stopped after occlusion of another bronchial artery with IBC. It should be noted, however, that immediately after embolization, five patients experienced violent transient retrosternal burning, and one patient experienced dysphagia and fever for 2 days. Since mediastinal ischemia cannot always be avoided, this procedure must be reserved for cases of severe hemoptysis for which surgical treatment is contraindicated.

[Intraspinal calcifications. Symptomatology. Pathologic value]

Calcifications in the spinal canal on plain films are not an unusual finding. The authors present 22 such cases. Identification and pathological value depend on the topography and morphology of these calcifications. The calcifications have been classified in three groups: anterior, median and posterior. The most common etiologies for the anterior ones were calcifications of the posterior longitudinal ligament and calcified discal hernias; meningiomas were the most common cause of the median calcifications; ligamentum flavum calcifications accounted for must of the posterior ones.

[Orthopedic radiology of the lower limbs. The two-dimensional "Complete Angles Lengths" technique (author's transl)]

The "Complete Angles Lengths (CAL)" is a new technique enabling geometrical definition of the lower limbs (angles and/or lengths) by the use of different reference points. Normal equipment can be employed, with or without radio control, and with ampliphotography if necessary. Localised orthoradiographs are performed through a fine metallic grid that can be made by the radiologist. Magnetic bands containing the programme for calculation are introduced into a packed calculator, and results are obtained automatically after feeding the measurements taken from the films into the machine. If the mode of employ is respected, the precision of the CAL is equal to or greater than that obtained with conventional methods.

[Involvement of the common bile duct in Hodgkin's disease : report of three cases (author's transl)]

The authors report 3 cases of extra-hepatic obstruction of the common bile duct in Hodgkin's disease, in one case due to lymph nodes compressing the hepatic pedicle, in the second case due to infiltration of the common bile duct alone, in the third case by a large Hodgkin tumour of the head of the pancreas. Although emphasizing the rareness of these cases of jaundice in Hodgkin's disease, they emphasize the necessity of exploring these patients in order to make a precise assessment of the lesions and thus choose the best treatment.

[Osteosclerotic myeloma. Report on three cases and review of the literature (author's transl)]

Three cases of osteosclerotic myeloma are reported. Clues for diagnosis are agarose gel electrophoresis and sclerotic bone biopsy. Review of 50 cases of literature points out frequency of peripheral neuropathy and Ig A type Immunoglobulin. Iliac crest biopsy shows thickening of bone structures and plasmocytosis in medullary spaces. Main X-Ray signs are mentioned and pathogenesis is discussed.

[Lower limb length measurement. Precision orthoradiographic methods (author's transl)]

The precision of the Bell-Thompson method for measuring lower limb length can be considerably improved by three simple additional procedures: estimating the distance between the anatomical plane and the examination table; marking the diaphragm opening area on the film; automatically correcting errors due to projection conicity and obliqueness of the segment measured by means of a programmable pocket calculator.

Mirizzi syndrome and biliobiliary fistulas: roentgenologic appearance

Five cases of extrahepatic cholestasis caused by impaction of a voluminous gallstone in the neck of the gallbladder or the cystic duct are reported. The formation of a biliobiliary fistula is the rule. Percutaneous transhepatic cholangiography visualizes the fistulas and permits their classification into 2 groups: gallbladder to hepatic duct, and cystic to hepatic duct. Preoperative diagnosis permits the best resolutions of 2 problems encountered during surgery: (1) the tumor-like feature often produced by the cholecystitis can be ascribed to benign lithiasic etiology if the biliobiliary fistula is diagnosed in the preoperative phase; and (b) treatment by biliary plasty, which requires first opening the gallbladder and partial cholecystectomy, has to be achieved.

[Mycotic aortic aneurysms (author's transl)]

Mycotic aortic aneurysms were detected in four men aged between 47 and 73 years. The infective nature of the lesion was obvious in one case, while in the other three cases the diagnosis was suspected after radiological examination and confirmed by pathological and bacteriological investigations of the aneurysm wall. Radiological signs which suggest the presence of an infective aneurysm include rupture of the aneurysm, a rapidly progressing course, and unusual locations or morphology. Diagnosis is important as therapy differs from that of other types of aneurysm.

Long-term loss of Warren's shunt selectivity. Angiographic demonstration

Fifteen patients with a patent shunt after distal splenorenal shunt with gastrosplenic disconnection were prospectively studied by angiography three to 36 months after operation. In all patients a collateral circulation from the portomesenteric to the gastrosplenic system was developed through enlarged venous channels. In all patients the portal flow decreased, as suggested by the angiographically assessed degradation of the portal perfusion of the liver and/or the diminution of the diameter of the portal vein. In two patients the portal vein was thrombotic. We conclude that three months after operation distal splenorenal shunt with gastrosplenic disconnection is not hemodynamically different than portacaval laterolateral shunt.

Pulmonary involvement in Behcet disease

The radiologic appearance of pulmonary involvement in six cases of Behcet disease is described. Chest radiographs in five patients showed infiltrates and/or rounded opacities followed by excavation in two cases and by pleural rupture in one. Repeat chest films on four of these five patients 3 weeks to 9 months after diagnosis showed resolution of the infiltrates and the subpleural opacities. The other findings from chest radiography in three patients were rounded or lobulated opacities near the hila. Four of the six patients underwent pulmonary angiography, which in all cases showed wide-spread occlusions of pulmonary arteries, accompanied in three cases by segmental or lobular pulmonary artery aneurysms corresponding to the proximal opacities visible on the plain films. Two of the three patients who displayed pulmonary artery aneurysms died of massive hemoptysis 3 and 13 months after angiography. In the third patient, progress under medical treatment was favorable; chest film 10 months after treatment started showed complete resolution of the aneurysms. Repeat angiogram also showed partial recanalization of the occluded arteries.

[Meniscus and sequestrum images during pulmonary suppuration. A case of pulmonary gangrene (author's transl)]

Pulmonary gangrene, a rare form of suppurative lung lesion, is the result of bacterial infection associated with vascular thromboses. It is one of the few affections that produce a meniscus image delimiting the pulmonary sequestrum. A case is reported of a woman with pulmonary venous hypertension from mitral disease who developed gangrene limited to Fowler's segment. Recovery occurred after antibiotic therapy and percutaneous drainage.

[Static radiological measurements of lower limb deformities (author's transl)]

A new method is described which employs three angular components for complete definition of lower limb deformities. These three angles can be the three static angles observed in two large films, anteroposterior and profile, of the two lower limbs (flexion-recurvation, varus-valgus, axial rotation). A more precise definition of the deformity is the rotation of the oblique axis which transforms a normal lower limb (the other side if it is healthy) into a deformed one. In this concept, two angles determine the axis, another angle defining the rotation around this axis. The technique is described and the theory exposed, simple cases being able to be resolved by pure geometry, the matricial theory enabling data processing of other cases by means of a pocket calculator.