Role of the peritoneopleural pressure gradient in the genesis of hepatic hydrothorax. An isotopic study

SUMMARY

Hepatic hydrothorax is defined as the development of significant pleural effusion in a patient with cirrhosis without primary pulmonary or cardiac disease. This complication is seen in 4-10% of patients with cirrhosis. The pleural effusion is a result of a direct passage of ascitic fluid into the pleural cavity through a defect in the diaphragm. We report two patients with posthepatitis cirrhosis presenting with a significant pleural effusion. The peritoneopleural communication was demonstrated by peritoneal scintigraphy. The role of the peritoneopleural pressure gradient is discussed.

[Role of scintigraphic tests in upper urinary tract dilatation in children]

The diuresis renography has an important place in the management of upper urinary tract dilatation in children. This non-aggressive and low irradiant exploration is very helpful to determine if hydronephrosis is obstructive or not and to evaluate the renal function impairment. The protocol of exam must be particularly rigorous and interpretation should take into account physiopathological factors that influence provocated diuresis. A well patient hydration and if necessary a bladder catheter are required. The MAG-3 is the radiopharmaceutical of choice especially in newborn and infants. The furosemide administration at 20 minutes after radiotracer injection is the most commonly used protocol and is generally sufficient to classify the urinary dilatation. Equivocal cases and symptomatic forms can benefit from a modified protocol in which furosemide is administered 15 minutes before radiotracer injection (F-15). False positive tests may result from a marked dilatation or renal function reduction. The place of diuresis renography in management of neonatal hydronephrosis is controversial, particularly because of the dynamic and evolving nature of this pathology.

[What are the alternative criteria for fine needle aspiration biopsy of a thyroid nodule?]

OBJECTIVES

To identify the clinical and paraclinical factors of thyroid nodule malignancy (in absence of ultrasound-guided fine needle aspiration biopsy data).

PATIENTS AND METHODS

This retrospective study was conducted on a cohort of 282 patients admitted for management of a thyroid nodule disease. All patients had undergone surgery and the specimen had been analyzed anatomically and pathologically. Forty-four patients had malignant disease. Epidemiological, clinical, and paraclinical data, as well as the anatomical and pathological characteristics of the specimen were collected for each patient.

RESULTS

We showed that the epidemiological data (sex and age), the nodule's characteristics (consistency, irregularities of the edges and fixity to underlying structures, and size), the presence of adenopathies, signs of compression, and the presence of calcifications were the predictability criteria of malignant disease. However, the scintigraphic aspect, the echostructure, and the hormonal status were not significant.

CONCLUSION

This study underscores that a relevant clinical and paraclinical analysis remains highly contributive in the presurgical identification of factors predictive of malignancy of a thyroid nodule, notably in countries where technological tools are not always available.

[Transient rheological study of blood stored in a liquid state]

The rheological properties of blood stored in different conditions (in liquid state or as globular concentrates in the presence of the classical anticoagulant ACD or CPD solutions, or according to the SAG procedure) have beenn studied with a Couette viscosimeter. Apparent viscosity was measured at very low shear stress (0.05 s-1) as a function of the storage time. Furthemore the dynamic rheological parameters (thixotropy, viscoelasticity and rheofluidification) were determined. Blood viscosity increases strongly as a function of storage time, particularly on whole blood. Its variation is weaker on globular concentrates, particularly with SAG. Thixotropy, viscoelasticity and rheofluidification, on the contrary, are not strongly perturbated. These rheological modifications are closely related with the changaes occuring in the morphology and in the aggregation state of the stored red blood cells.

[Bone scan and prostate cancer]

Prostatic cancer has a great predilection for bone. The evaluation of its extension towards the skeleton is based on the bone scan, which has a better sensitivity than radiological examinations and clinical evaluation. Bone scan evaluation of the osseous extension, allowed a better comprehension of the mechanism of dissemination, the assumption of Batson appearing currently not very plausible. The importance of the osseous extension on the bone scan has a prognostic value; it constitutes one of the significant parameters of stratification in clinical trials. The indications of bone scan have been greatly modified since the introduction of prostate-specific antigen (PSA). At the initial assessment, the of bone scan should be indicated only if the rate of PSA exceeds 10-20 ng/mL, in the event of low grade tumor and pain. In the follow-up, the evolution of the PSA constitutes the major element of monitoring. After radical therapy, a rise in the PSA indicates bone scan, particularly if the level exceeds 10 ng/mL. In stage D2, routine bone scan is no longer indicated, except in phases II and III of the clinical trials.

[Papillary thyroid microcarcinoma presenting as cervical lymph node metastasis. Interest of tetrofosmin scintigraphy and lymph node thyroglobulin measurement]

PURPOSE OF THE STUDY

Thyroid microcarcinoma presenting as cervical lymph node metastasis is common and it is associated in most cases with the papillary variety. Diagnosis of lymph node metastases from a thyroid microcarcinoma is not always easy, because a thyroid nodule may not be palpable.

MATERIAL AND METHOD

In this work, the authors report two cases of papillary microcarcinoma presenting as cervical lymph adenopathy.

RESULTS

The diagnosis was made preoperatively by Tetrofosmin scintigraphy and thyroglobulin measurement in the lymph node.

CONCLUSION

Tetrofosmine scintigraphy is a performing exam but with a poor specificity. Lymph node thyroglobulin is a simple exam which is very sensitive and specific.

[Evaluation of the effect of Royat thermal gas in arteriopathy of the legs using thallium-201 muscular scintigraphy]

12 patients (group II) suffering from an arteriopathy of the lower limbs, stage II, were examined by thallium 201 muscular scanning. The aim of this study was to look for a possible muscular effect of Royat thermal gas injected subcutaneously. A preliminary study was conducted at rest, and consisted of recording the initial decay curve of thallium in the thighs and the study of the muscular fixation by different segments of the limbs, including the determination of the ratios of amounts fixed by the muscular and non-muscular zones. The results were compared with those obtained in 11 healthy subjects (group I) and no significant difference was noted between the two groups at rest. On the other hand, a considerable improvement of the fixation in the legs was observed after subcutaneous injection of thermal gas. The results are discussed in relation to the clinical and paraclinical data.