[Hodgkin's disease revealed by an esophagotracheal fistula (author's transl)]

The authors report the first published case of an esophagotracheal fistula revealing the presence of Hodgkin's disease. Esophagotracheal fistula is a very rare complication of this disease, as only about twenty cases were found in the literature, but all these patients had known Hodgkin's disease and had received mediastinal irradiation. Radiotherapy has therefore an adjuvant role, but this case clearly illustrates that these fistulae are mainly the consequence of phenomena that are also extremely rare: necrotic adenopathies, esophageal and tracheal localizations. Biopsy was possibly negative in these cases because of the very necrotic nature of the lesions. The prognosis is poor.

[Selective arterial embolization for haemorrhages complicating hip surgery. One case (author's transl)]

In a patient undergoing re-operation on the hip, the severity and repetition of haemorrhages despite successive blood transfusions led to therapeutic angiography. Angiography of the renal artery pinpointed the bleeding areas: pools of extravasated blood were found along the distal branches of the superior gluteal artery and the ascending branch of the posterior circumflex artery. Selective catheterization and embolization of these two vessels resulted in complete and permanent haemostasis. Arterial embolization, already widely used for post-traumatic haemorrhages, can therefore be applied to the haemorrhagic complications of orthopedic surgery. Provided it is sufficiently selective, the risks of extensive necrosis are non-existent.

Portal hypertension, size of esophageal varices, and risk of gastrointestinal bleeding in alcoholic cirrhosis

We studied the relationship between the degree of portal hypertension measured by the gradient between wedged and free hepatic venous pressures, the size of esophageal varices, and the risk of gastrointestinal bleeding in a series of 100 unselected patients with alcoholic cirrhosis. The degree of portal hypertension was not different in patients with no visible, in those with small-sized, and in those with large-sized, esophageal varices. The degree of portal hypertension was not different in patients without and with gastrointestinal bleeding, whether the source of hemorrhage was ruptured varices or acute gastric erosions. The risk of gastrointestinal bleeding, whether due to ruptured varices or acute gastric erosions, was significantly higher in patients with large-sized, than in those with no visible or small-sized, esophageal varices. It is concluded that, in patients with alcoholic cirrhosis, (a) the degree of portal hypertension has no predictive value for the risk of gastrointestinal bleeding and (b) large-sized esophageal varices are associated with a high risk of occurrence or recurrence of gastrointestinal bleeding and could be taken into account for a better selection of patients for portacaval shunt.

[Unilateral pulmonary edema, pneumopericardium and bronchial cancer (author's transl)]

Carcinoma of the bronchus was detected following the onset of cardiac rhythm disorders, and a pneumopericardium with associated, radiologically detected, unilateral pulmonary edema. The tumor extended mainly around the bronchus and in the mediastinum, and a bronchopericardial fistula was present together with invasion of the left auricle and pulmonary veins. Pneumopericardium is a rare lesion and it is exceptional to observe it during the course of bronchial cancer. The relationships between unilateral interstitial edema and tumoral obstruction of the ipsilateral pulmonary veins are discussed.

[Panlobular emphysema. Value of radiology to assess the need for surgery (author's transl)]

Surgical decompression in 12 patients with panlobular emphysema and severe respiratory insufficiency, over the last 5 years, gave encouraging postoperative results. Preoperative radiological examination results were well correlated with findings during operation. Signs of thoracic distention and diffuse peripheral hypovascularization were noted in all cases. Furthermore, at least on the affected side, all patients showed avascular zones presenting as large bullae or as bullous zones extending over at least half of the hemothorax region, and compression signs affecting the lung parenchyma, the mediastinum, and the diaphragm. Radiological investigation is essential for assessing the need for operation, as it remains the only method which can demonstrate the part played by the bullae and the rest of the parenchyma in the alteration of respiratory function. Data can be obtained by standard radiological examinations with dynamic films on forced inspiration and expiration, and by computed tomography. However, pulmonary angiography gives a more precise evaluation of the vascularization of the remaining parenchyma, which is important when choosing the side to be operated upon, or that which should be operated upon first in cases of bilateral symmetrical lesions.

[Sternal locations of Hodgkins disease. A report on two cases (author's transl)]

Two cases of sternal lesions of Hodgkin's disease are reported. Location of the disease process in the sternum is rarely encountered but may occur at any stage of the affection. They are isolated and initially presenting lesions in exceptional cases only. Diagnosis is therefore difficult in these cases, as illustrated by the description of the first patient. Clinical and radiological signs are not specific and histological findings not easy to interpret. The bone lesions, which are of the lytic or mixed type, are associated with swelling of the anterior and posterior sternal soft tissue. This latter observation strongly suggests that these lesions are caused by spread from existing anterior mediastinal adenopathies.

[Rupture of an atheromatous plaque in a non-ectatic sub-renal aorta without evidence of an infectious process (author's transl)]

The authors report a case of rupture of an atheromatous plaque in a non-ectatic sub-renal aorta without signs of aneurysm or evidence of an infectious process. Similar cases do not appear to have been reported.

[Computer tomography changes in multiple sclerosis (author's transl)]

An attempt is made to evaluate the semiological data supplied by computer tomography, following its use on several occasions in 4 patients with multiple sclerosis. Three known signs in the encephalic forms are defined: cerebral atrophy, low density plates of sclerosis that do not take up the contrast medium, and those that do. These localized lesions are distinguished by their frequent multiplicity, often periventricular location, and absence of a mass effect. The semiological value of these signs involves discussion on the poor results of statistical evaluation, the significance of histology examination results, which are still being studied, and more particularly the variability, the best evidence of which seems to be the beginning and/or the changes occurring in contrast medium uptake. To this major diagnostic argument can be added the discovery of multilocular lesions which are sometimes present without clinical manifestations. Computer tomography is an essential procedure for establishing the differential diagnosis of multiple sclerosis, avoiding numerous valueless arteriographies, is a fundamental method for early positive diagnosis, and perhaps an element for establishing prognosis.

[Determination of effective atomic number and electronic density by computed tomography with dual energies. Application to the thalamus (author's transl)]

The authors have studied seven thalamic hyperdense lesions of five patients in managing, at the same level, successively two scans with a computer tomograph at two different energies. After they recall their methodology of testing their C.T. and computations, they have found the effective atomic number and the electron density of these lesions. All (one Fahr disease and six old hemorrhages) have both high effective atomic number and electron density. They discuss the limits of this technic but they emphasize the great interest to see the chemical aspects of the structures observed in C.T.

[Radiological appearances in postoperative obstructions (author's transl)]

In the light of 9 cases, the authors study the varioud radiological appearances of postoperative obstructions. These may be early, before the restoration of intestinal transit, or secondary, during the days following the restoration of transit. The authors eliminate late postoperative obstructions from this study. There are various mechanisms of postoperative obstruction: organic obstructions may be due to an adhesion but also to agglutination or incarceration of intestinal loops. Functional obstructions most often accompany a localised area of inflammation. Mixed obstructions are a special feature of the postoperative period: agglutination of loops in contact with an area of inflammation. The authors emphasize the difficulty of radiological interpretation and the frequent disagreement between radiological and surgical findings.

[Use of cerebral computer tomography for the diagnosis of multiple sclerosis]

The authors describe computer tomography findings in multiple sclerosis (MS)), and attempt an evaluation of the value of cerebral computer tomography for the diagnosis of this disease, especially those forms in which the clinical diagnosis is uncertain. A total of 33 patients, 15 men and 18 women, were studied. According to McAlpine's criteria, 21 patients had established MS, 2 were probably MS cases, and the other 10 were possible cases of the disease. The scanner used was an EMI 1010 apparatus giving 13 mm thick sections, with a matrix of 160 X 160. A contrast medium was injected systematically. Abnormal computer tomography results were noted in 28 of the 33 patients, including one or more low density areas in the white substance in 26 patients, taking up of the contrast medium after injection in 10 patients, and cerebral atrophy in 24 patients. Cases where only one of these anomalies was present are rare, and the various anomalies noted on computer tomography are usually associated in varying proportions. In most cases, the computer tomography findings were not related to any specific clinical picture. In cases of established MS, computer tomography can provide information on the extension and progression of the lesions at the time of examination. Out of the 12 cases in which clinical diagnosis was uncertain, 9 presented abnormal findings (low densities and/or taking up of contrast medium); the level of CSF gamma-globulins was normal in 4 of these 9 patients; visual evoked potentials were not altered in the 5 out of these 9 patients studied. In 3 patients with medullary signs, several low cerebral trunk and white substance of the cerebral hemispheres. When diagnosis is uncertain, cerebral computer tomography is the method of choice for demonstrating latent MS lesions of a certain type: it complements neurophysiological studies (visual, auditory, and somesthesic evoked potentials), used at the present time for the diagnosis of MS by exploration of the optic tracts and cerebral trunk.

[False tumor of the posterior mediastinum in a case of portal hypertension (author's transl)]

A man of 37 years of age developed portal hypertension which was observed on radiological examination as a mediastinal opacity having the appearance of a tumor. No oesophageal varices were seen on barium meal examination or by endoscopy. A smooth liver was seen during laparoscopy. Pre-operative hemodynamic studies showed that there was no sinus block. Thoracotomy revealed an aneurysm of the azygos veins. Exploratory laparotomy after coelio-mesenteric arteriography confirmed the diagnosis of diffuse nodular hyperplasia of the liver, cirrhosis, and portal hypertension. The findings in 16 cases of mediastinal opacity from portal hypertension reported in the published literature are discussed.

[Treatment of headache in neuro-radiological investigations (author's transl)]

The aim of this study was to try the efficiency of tiapridal in preventing headache during neuro-radiological procedures. In spite of indiscutable curative effect, this drug does not prove to be efficient in preventive effect. The authors described a new protocol using IV infusion at the end of the radiological procedure, followed by pills per os. No side effect was observed.

The danger of "yellow dyes" (tartrazine) to allergic subjects

Oral administration of 50 mg tartrazine to 122 patients with a variety of allergic disorders caused the following reactions: general weakness, heatwaves, palpitations, blurred vision, rhinorrhoea, feeling of suffocation, pruritus and urticaria. There was activation of the fibrinolytic pathway as shown by reduction of plasminogen with high pre-kallikrein and low kallikrein values. Reduction in complement activity (CH50) was seen in three out of sixteen reactions.

[Radiological exploration of the Budd-Chiari syndrome. Study of 13 cases]

Using 13 cases of Budd-Chiari syndrome, the authors describe their method of radiological investigation in order to reach a positive and sometimes aetiological diagnosis. Hepatic venous thrombosis can be confirmed only on the basis of findings at hepatic phlebography. Cavography, which precedes retrograde catheterisation of the hepatic veins, provides only presumptive evidence and sometimes reveals total thrombosis of the inferior vena cava. Coeliac and superior mesenteric, or even hyperselective hepatic arteriography, is of great value if there is inversion of the portal flow. Otherwise it only leads to a suspicion of the diagnosis, and makes it possible to determine the state of the portal trunk and to seek an aetiology.

[Is the presence of air in the small intestines pathological (author's transl)]

The authors examined 119 patients coming to the Radiological Department for various reasons excluding all abdominal pathology: road traffic accidents, rheumatological pain, oto-rhino-laryngological or ophthalmological causes. Two observers, working separately but comparing their results, concluded that there was air in the small intestines in 51 % of the patients, and that the presence of air in the small intestines was considerable in 6 % of the patients. The presence of air in the small intestines was noted in 40 % of outpatients and in 70 % of patients in bed.