[Bilio-digestive fistula with an unusual etiology]

On the basis of one case, the authors give the highlights on the various clinicopathological features of malignant gastric perforations. While medical imaging does not seem to contribute much in the positive diagnosis of such complications, it does remain essential to establish the local extension of the tumour process and thus to allow a better therapeutic management.

[Primary malignant fibrous histiocytoma of the lung]

On the basis of one personal case, the various clinicopathological features of primary malignant fibrous histiocytoma of the lung are summed up. This tumor, which has a nonspecific radiological appearance, most often appears as a large peripheral pulmonary opacity, for which the prognosis is guarded and the positive diagnosis based on surgical exeresis or biopsy.

New autosomal recessive chondrodysplasia--pseudohermaphrodism syndrome

Two siblings with a previously undescribed syndrome are presented. They both have severe dwarfism, antenatal in origin, with generalized chondrodysplasia, severe microcephaly with cerebellar vermis hypoplasia, a hypoplastic iris and a papillous coloboma (Coloboma of the optic disc). The first sibling has a 46,XY karyotype despite normal female internal and external genitalia. She has moderate mental retardation. Gestation of the second sibling was interrupted after antenatal diagnosis. The fetus was 46,XX and very similar to the first case.

Nilutamide pneumonitis: a report on eight patients

BACKGROUND

Nilutamide is a new, specific synthetic antiandrogen, released in several countries for the treatment of metastatic carcinoma of the prostate. Eight patients at the University Medical Centre at Dijon and affiliated referring hospitals developed reversible pulmonary opacities and respiratory symptoms while taking the drug.

METHODS

Records of eight patients who developed new, otherwise unexplained chest opacities while taking nilutamide were reviewed. In each patient a careful aetiological search was made for other environmental or endogenous causes. Six patients underwent bronchoalveolar lavage, and lavage fluid was cultured. Corticosteroids were not given, unless gas exchange was compromised (two patients).

RESULTS

The eight patients (all male) had had carcinoma of the prostate diagnosed on average 10.2 months earlier. All had improved with nilutamide, with a dramatic decrease of prostate specific antigen levels. Seven had received nilutamide at the recommended dosage of 150 mg/day, and one had received twice that amount. Treatment had lasted on average 113 (range 10-225) days, and the mean cumulated exposure was 21.8 (3-38) grams. The chest radiographs showed bilateral infiltrates, with no consistent topographic predilection. A restrictive lung defect was present in six patients and hypoxia in all (mean arterial oxygen tension (PaO2) 6.6 kPa). Bronchoalveolar lavage showed lymphocytosis in four patients and neutrophilia in two. The outcome was favourable in all patients after they had stopped nilutamide only (five patients), with corticosteroids (two patients) or a simple reduction of nilutamide from 300 to 150 mg/day (one patient). Recovery was associated with improvement of pulmonary function and PaO2.

CONCLUSION

Nilutamide is associated with interstitial pneumonitis in about 1% of patients and appears reversible.

[Primary sarcoma of the pulmonary artery]

On the basis of one personal case of leiomyosarcoma, the various anatomicoclinical features of sarcomas of the pulmonary artery are summed up. They most often produce a picture of severe pulmonary embolism that is resistant to all treatments; the lesion most often is a hilar mass without any associated bronchoscopic abnormality. Angiograms are not always easily interpreted, and the modern imaging techniques (ultrasound, computed tomography, and above all MRI) can best lead to the preoperative diagnosis, although this lesion is unfrequent.

[A radiologic image to be recognized in patients with thoracic injury: the retroligamentary pneumatocele]

A 17-year-old female patient had a road traffic accident. She suffered from a minor head injury, and a right pneumothorax which had to be drained. However, when admitted, an unusual picture was found on the chest film. It was a left para-mediastinal shadow with a fluid level, its greater axis being vertical. She underwent a computerised tomographic chest scan. This picture was seen to be in the left costo-vertebral gutter, and in contact with an area of pulmonary contusion in the left posterior basal segment. Another smaller similar picture was discovered on the right side. These were interpreted as being infrapleural pneumatoceles on the mediastinal surface of the lower pulmonary lobes. The patient recovered spontaneously. In fact, these effusions of air and blood can be seen in other areas in the chest (mediastinum, pleura, lung); these are discussed.

[Renal hyperechogenicity associated with an obstructive urologic disease in the newborn infant. A case]

A newborn infant exhibited bilateral hydronephrosis induced by uretero-pelvic junction syndrome (U.J.S.), pathological renal hyperechogenicity, and renal dysplasia at histology. Renal hyperechogenicity rapidly improved after curative surgery of the U.J.S. and therefore could not relate to dysplasia which is irreversible. The diagnostic value of renal hyperechogenicity is discussed.

[Transfontanellar echography in the early detection of traumatic subdural hematoma in the infant. Apropos of a case]

About one case of skull injury in a infant, brain ultrasonography potency is underlined. This technic allowed to diagnose a subdural hematoma which was inapparent clinically and by complementary investigations.

[Rotatory anomaly of the lumbar spine from asymmetry of posterior articular facets (author's transl)]

Radiographs of the lumbar spine frequently demonstrate asymmetry of posterior articular facets, but this is asymptomatic in patients with good abdominal and lumbar muscles when the anomaly is only of a moderate degree. It can, however, cause rotatory instability of the subjacent vertebra leading to lumbago. It is then frequently associated with osteo-articular complications affecting the posterior arch, this being a logical consequence of a sequence of changes which can be explained by simple mechanical factors.

[Extramucosal parietal lesions of the sigmoid of different aetiologies in children: report on two cases (author's transl)]

Rare, atypical, extramucosal parietal lesions in the rectosigmoid regions were observed in two children. The first child, with Henoch-Schönlein purpura, developed an intramural haematoma, a complication rarely reported in the literature. The second child had a perivisceral abscess of probable adnexial origin, arising during the course of pelvic septicaemia.

[Angiectasis of the colon (Moore's type I angiodysplasia). One case (author's transl)]

A 60-year-old man had severe, recurrent rectal haemorrhages. Arteriography showed lesions suggestive of angiodysplasia located in the initial part of the ascending colon. Right-sided hemicolectomy was performed. Angiectasis of the colon is acquired and degenerative. It affects elderly people and is due to dilatation of the veins in the mucosa of the ascending colon. The lesions are usually too small to be detected by barium enema or colonoscopy, but arteriography of the superior mesenteric artery shows pathognomonic images. The only treatment is right-sided hemicolectomy.

[Humeral head necrosis during bismuth encephalopathy (author's transl)]

A further case of humeral head necrosis occurring in the course of a bismuth encephalopathy is reported. There was no apparent direct effect due to the bismuth as the lesion was quite different from those observed during typical bismuth osteopathy. The region affected by the bone lesion, its appearance, and the progressive anatomical and clinical changes noted are arguments in favour of a traumatic origin. The necrosis could be related to myoclonic movements which agitate the patients (usually elderly women) who are confined to bed because of the encephalopathy.

[Tuberculous trochanteritis : radiological diagnosis (author's transl)]

Based on four typical cases of tuberculous trochanteritis, the authors describe the clinical symptoms and signs, and radiological findings in this osteitis. An unusual feature of this affection is the usually slow progression of the anatomical changes, especially in vaccinated adults. Another peculiarity arises from the fact that this para-articular osteitis (which menaces the hip) is probably secondary to a bursitis of the gluteus medius. A history of tuberculosis infection facilitates the diagnosis, which must be confirmed by bacteriological or histological examinations before instituting medical treatment.

[Postoperative pseudo-diverticulum of the small intestine as a cause of digestive hemorrhage (author's transl)]

Investigations in a 38-year-old woman with recurrent digestive hemorrhages demonstrated the presence of two diverticular images close to each other at the end of the ileum. Operation revealed distention of two blind loops at either end of a laterolateral anastomosis of the small intestine. This type of surgical procedure, now abandoned, may produce local complications. A history of surgical treatment on the small intestine should suggest this possibility, and confirmation is obtained by radiological examination.

[Left intertracheo-oesophageal pulmonary artery (author's transl)]

The authors report on case of this vascular malformation in an infant aged eight months, and describe its most interesting features known at the present time: embryology, variability of radiological signs, differential diagnostic problems, and more particularly the indications for therapy, tracheobronchial malacia lesions playing an essential role in the prognosis.

[Twisted pedunculated pleuro-pericardial cyst (author's transl)]

An unusual case of a pleuro-pericardial cyst is reported. The mobile character of its shadow in thoracic chest x-rays and the sudden onset of the unilateral chest pain suggested that the cyst was pedunculated and twisted. This was confirmed by operation.

[Intra-uterine gestational age. The value of calcification of dental crowns (author's transl)]

Calcification in the first decidual molar tooth first appears at the 33-34th week of gestation; and the second at the 36-37th week. It is therefore a stable and precise index of gestational age. It can be estimated in over two-thirds of films of the intra-uterine contents chosen at random. The search for this sign can complement or take the place of looking for epiphyseal centres in the knee. It gives information about gestational age in pathological conditions where bony maturation is abnormal.

[Ureteral compression by an aneurysm of the hypogastric artery. Two cases (author's transl)]

Aorto-iliac aneurysms produce ureteric obstrucation by different mechanisms: deviation, compression and, above all, encirclement by peri-aneurysmal fibrosis. Whilst it is rare to find this as the cause for apparently primary ureteric obstruction, individuals with aorto-iliac aneumrysms quite often show evidence of ureteral abnormalities. The two cases presented illustrate these two possibilities. Routine pre-operative urography, or seven better a urographic phase of arteriography, is therefore suggested.