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Anterior shoulder instability following traumatic dislocation in young adults is a common complication. The Latarjet procedure is the most widely used technique for treating this instability. It is based on coracoid abutment repair of the anterior edge of the glenoid. However, joint exposure during this surgical technique is often limited and makes it difficult to position the abutment. The purpose of this study was to evaluate the result of coracoid abutment procedure on functional outcome in the short and medium term. We assessed the positioning of the coracoid abutment on standard postoperative X-rays and the functional outcome according to Duplay score as well as the satisfaction rate in 70 patients. The average age of patients was 25 and a half years, the sex-ratio was nine, and the mean follow-up period was 6.5 years. Radiological examination showed that coracoid abutment was in subequatorial or non-flush position with respect to the anterior glenoid rim (too internal or protruding in intra-articular position) in 20% of cases. This group showed a drop in mean stability score by 7.68 points, in pain by 10.04 points and in Duplay’s overall score by 13.3 points as well as a significant increase in the level of glenohumeral arthrosis. This study highlights that coracoid abutment in subequatorial or non-flush position has deleterious effect on the functional outcome of the Latarjet procedure. [ABSTRACT FROM AUTHOR]

Intra-alveolar bleeding is a rare and severe medical emergency due to numerous causes. We report the clinical case of a patient who could contribute to extend the literature on this subject. The study included a 62-year old man, with a history of a trial fibrillation, under anti-vitamins K antagonist admitted with dyspnoea of sudden onset associated with haemoptysis and practising self-medication using non-steroidal anti-inflammatory drugs. X-rays and chest scan showed diffuse bilateral alveolar opacities. Haemostatic screening tests on admission showed non-coagulable INR. The diagnosis of intra-alveolar bleeding was clinically and radiologically suspected and then confirmed by bronchial endoscopy with broncho-alveolar lavage (BAL) which detected uniformly hemorrhagic liquid. Previous studies of similar complications occurring after anti-vitamins K antagonists assumption are rare. In conclusion, it seems very important to emphasize the interest of strict and optimal clinico-biological monitoring of patients treated in anti-vitamins K antagonists to avoid an overdose which could contribute to a life-threatening severe haemorrhagic event. [ABSTRACT FROM AUTHOR]

The article reports on innovation in the field of radiotherapy. Radiotherapy is one of the main modalities of locoregional cancer treatment that uses ionizing radiation to destroy the tumor. These radiations are in the majority of the cases beams of X-rays generated by a linear accelerator of particles.

Résumé Fabien Arcelin, médecin lyonnais, fut le thésard de Destot, l’un des pères de la radiologie française et le propre élève de son père, Adrien Arcelin, l’un des archéologues préhistoriens majeurs de notre pays, co-inventeur du site de la Roche-de-Solutré. Ainsi, radiologue à Lyon en semaine et archéologue en Bourgogne le week-end, Fabien Arcelin fit avancer ces deux disciplines avec le même brio. En archéologie, il découvrit les premières sépultures aurignaciennes. En radiologie, il examina près de 2000 cœurs avec l’orthodiagraphe de Destot pour déterminer le rapport cardiothoracique et laissa un ouvrage de référence sur l’utilisation des rayons X dans la détection des calculs rénaux. En radiothérapie, il marqua l’histoire de la discipline en réalisant le premier sondage adressé à ses collègues sur les effets secondaires de l’irradiation, base documentaire à l’origine de la mise en évidence de la radiosensibilité individuelle. En parallèle des essais de Regaud à l’institut Curie, il réalisa à Lyon les premières séries de radiothérapies. Fabien Arcelin, physician working in Lyon, pioneer of radiology and radiotherapy, was both mentored by Destot (one of the fathers of the French radiology for his thesis of medicine) and by his own father Adrien Arcelin (one of the two codiscoverers of the prehistorical site of the Roche-de-Solutré in Burgundy) for archeological works. Hence, radiologist in Lyon during the week and archeologist during the weekend, Fabien Arcelin made significant advances in both radiation research and archeology. He was notably the discoverer of the first tombs of Aurignacian men. In radiology, he examined about 2000 radiographic heart views with the Destot's orthodiagraph to assess the cardiothoracic ratio and wrote a reference book about the use of X-rays to detect kidney stones. He made the first survey about the secondary effects of radiotherapy, important database for pointing out individual radiosensitivity. In parallel to the radiotherapy trials of Regaud at Curie institute (Paris), he performed the first series of anticancer treatments in Lyon. [ABSTRACT FROM AUTHOR]

Résumé Étienne Destot est un médecin d’origine bourguignonne qui bénéficia à Lyon, lors de ses études, de la qualité de l’enseignement et de la recherche des plus grands spécialistes du moment : Augagneur pour l’hygiène, Testut pour l’anatomie, Ollier pour la chirurgie, Lépine pour l’utilisation de l’électricité en médecine et les frères Lumière pour le développement technologique. Lors de ses expériences, il côtoya Despeignes, premier radiothérapeute de l’histoire, Regaud, pionnier de la radiobiologie, et Bouchacourt, chantre de la radiosensibilité individuelle. Moins de deux mois après la découverte des rayons X par Roentgen, il réalisa des clichés radiographiques qui furent à l’origine de nos connaissances actuelles en anatomie ostéoarticulaire et en traumatologie. Il créa également le premier service de radiologie en France dans la boutique désaffectée d’un bouquiniste où il laissa libre cours à son esprit de création. Si on compare son action avec celle de Béclère, il paraît évident qu’alors ce dernier a été le grand organisateur de la radiologie française, Destot en a été le grand « défricheur » : il est à l’origine de plusieurs innovations technologiques qui aboutirent à la stéréoscopie, à l’imagerie des corps internes ou à la mesure du rapport cardiothoracique. En revanche, il ne fut jamais convaincu des vertus thérapeutiques des rayons X, même s’il contribua largement au développement de tubes à rayons X. Martyr des radiations, mort en décembre 1918, en plein dévouement pour les blessés de la Grande Guerre, son nom est inscrit au monument aux morts d’Arc-et-Senans. Étienne Destot is a French physician from Burgundy who benefited, during his studies in Lyon, from the quality of teaching of the best specialists of the time: Augagneur for hygiene, Testut for anatomy, Ollier for surgery, Lépine for the medical applications of electricity and the Lumière brothers for the technological development. During its experiments, he met Despeignes, the first radiation oncologist, Regaud pioneer of radiobiology and Bouchacourt who pointed out individual radiosensitivity. Less than two months after the X-rays discovery by Roentgen, he produced one of the first French radiographic views that were at the origin of our current knowledge in bone and cartilage anatomy and traumatology. He funded the first department of radiology in France in a former library of the major hospital of Lyon, where he made a number of original advances. It appears obvious that, while Antoine Beclère was the great organizer of the French radiology, Destot was its pathfinder. Destot was at the origin of several technological advances that gave stereoscopy, internal organs imaging and quantification of the heart-thorax ratio. By contrast, he was not convinced of the therapeutic properties of X-rays even if he contributed to the technological development of X-ray tubes. Victim of radiations, exhausted, Destot died on December 1918, by helping the Great War victims. His name is written in a war tribute monument in Arc-et-Senans (Burgundy). [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: L’analyse fractale de l’os (Hmoyen) est un paramètre de texture reflétant la microarchitecture de l’os. L’appareil BMA™ (D3A™ Medical System, Orléans, France) est un appareil à rayons X de haute résolution qui permet l’analyse de la texture de l’os. Notre objectif était de mesurer l’Hmoyen chez les patients ayant une polyarthrite rhumatoïde au niveau des deuxième et troisième os métacarpiens à l’inclusion et après un an de suivi et d’évaluer la relation de l’Hmoyen avec les paramètres d’activité de la polyarthrite rhumatoïde. Méthodes: Les patients ayant une polyarthrite rhumatoïde répondant aux critères ACR furent inclus. Ils furent évalués pendant un an dans une étude prospective conduite à Maastricht. Pour cette sous-étude, l’activité de la maladie fut évaluée par la mesure de la VS, la CRP et le DAS28 effectués à chaque visite. La destruction osseuse fut évaluée par radiographie des mains et des pieds à l’inclusion et au bout d’un an. Les paramètres de texture osseuse furent évalués au niveau des deuxième et troisième têtes métacarpiennes sur la main gauche en utilisant l’appareil BMA™. Résultats: Cent soixante-cinq polyarthrites rhumatoïdes furent incluses dans cette étude. À l’inclusion, l’Hmoyen était corrélé négativement avec l’âge : r =–0,22 (p =0,013) et la vitesse de sédimentation r =0,16 (p =0,039). Nous n’avons pas constaté de corrélation significative entre l’Hmoyen et le score d’activité de la maladie, l’échelle visuelle d’activité de la maladie, la dose quotidienne de corticoïdes et la protéine C-réactive. Il y avait une augmentation significative de l’Hmoyen des deuxième et troisième métacarpiens au bout d’un an (1,6 et 1,3 %, p <0,01) sauf chez les patients ayant une érosion osseuse locale des deuxième et troisième métacarpiens. Conclusion: Le paramètre de texture osseuse Hmoyen est influencé par l’âge, inflammation et les érosions locales dans la polyarthrite rhumatoïde. [ABSTRACT FROM AUTHOR]

Résumé: Entre le 4 et le 23 juillet 1896, Victor Despeignes a effectué la première radiothérapie anticancéreuse validée par des publications et des faits pratiques incontestables. Toutefois, les événements et l’approche intellectuelle qui l’amena à réaliser ce traitement unique sont méconnues. Cette biographie inédite s’efforce de mieux connaître l’œuvre de Victor Despeignes, qui fut tout d’abord un médecin hygiéniste. La conjonction des idées pasteuriennes, de la découverte des rayons X et de l’aide technique probable des frères Lumière l’amena logiquement à irradier une tumeur cancéreuse. La vie de Victor Despeignes peut se découper en trois grandes parties : la période lyonnaise de 1866 à 1894 pendant laquelle il devint médecin et chercheur en parasitologie en travaillant sur la qualité des eaux de ville et la tuberculose ; la période passée à Buis-les-Baronnies (Drôme) puis aux Échelles (Savoie) de 1894 à 1907 pendant laquelle il fut simple médecin de canton et appliqua la première radiothérapie ; enfin la période chambérienne de 1907 à 1937, pendant laquelle il dirigea le bureau d’Hygiène de la ville de Chambéry en menant une action majeure en santé publique. [ABSTRACT FROM AUTHOR]

Abstract: Distal radius fractures remain the most frequent fractures in the adult. Associated osteoporosis increases morbidity risk (secondary displacement is the most frequent) and mortality risk (in women older than 60). Severity of the fracture and functional results are related to the bone mineral density. Anatomy has been recently revisited with better description of palmar and dorsal aspects in order to avoid material-related complications. Standard postero-anterior, lateral and oblique radiographs of the wrist show the fracture and the displacement. CT scan is warranted if conventional X-rays are insufficient to show the articular surface. The involvement of the metaphysis (comminution), the epiphysis (articular fracture) and the ulna is different in each case and each fracture is an association of these three components. The MEU classification describes the fracture with sufficient inter-observer reliability and intra-observer reproducibility to be a useful tool for treatment and prognosis. The PAF system is used to propose the most appropriate treatment for each patient. Anatomical reduction and stable fixation are associated with good functional results but in high demanding patients. [Copyright &y& Elsevier]

Summary: Accidental foreign body ingestion by children is not exceptional and occurs in most cases in children less than 5years old. The impact is not well known. We present the case of a 31-month-old boy affected by peritonitis caused by several bowel perforations after swallowing three magnets at different times. A single foreign body magnetic ingestion does not often cause trouble, but if the ingestions are spaced out, then consequential complications can occur. This is why, in case of stomachaches in a child less than 3years or a child with behavior problems, it is important to perform standard abdominal X-ray examination. [ABSTRACT FROM AUTHOR]

Abstract: Rhizarthrosis is a frequent disease, mostly observed in postmenopausal the women. It is localized in the trapezometacarpal joint, which is an instable joint, reinforced by strong ligamnts, and submit to high level of biomechanical stress. A reason why this joint is frequently affected by a degenerative process. The clinical diagnosis is easy in front of a pan localized at the base of the thumb. X Rays confirm the involvement of the TPZ joint and the extension to adjacent joints. The evolution is marked by a deformation of the thumb in Z or H, evolving over many years and which may lead to some functional impairment. The treatment consists in a nocturnal splint, analgesics, NSAIDs and local intraarticular injections of corticosteroids or hyaluronic acid preparations. However, the level of proofs needs to be better validated. In case of non-response to medical therapy, surgical procedure should be contemplated and consists in trapezectiomy of local prostheses. [Copyright &y& Elsevier]

Abstract: Patent Foramen Ovale (PFO) is a normal fetal communication between right and left atria that persists after birth by about 30% in adults. It is discussed to be associated to potential clinical events, asking rational of such closure. Its correction throughout venous access can be attempted on four different indications: (1) secondary prevention of stroke or transient ischemic attack, (2) decompression illness, (3) migraine with aura, and (4) platypnea-orthodeoxia. The PFO closure procedure implies the double control of X-rays and ultrasound, and is relatively simple to perform, using various prostheses. In France, the place of percutaneous closure procedure is nowadays unclear since the Haute Autorité de santé currently suspended recommendations about the management after stroke. [Copyright &y& Elsevier]

Summary: Ectopic intrathoracic kidney is a very rare congenital anomaly, which is often asymptomatic and discovered incidentally on chest radiography. Diagnosis of this ectopia in the neonatal period is extremely rare. We report the case of a female infant admitted for mild respiratory distress at birth in relation with maternofetal infection in whom a right posterior opacity on chest x-ray was diagnosed as intrathoracic kidney by sonography and chest CT scan. Diaphragmatic hernia could not be confirmed at this stage. At 2 months, the presence of air blebs on chest x-ray performed for viral bronchiolitis confirmed an associated right Bochdalek hernia. The infant, although asymptomatic, underwent surgery. The intrathoracic kidney was reduced into the abdominal cavity at the time of surgery. The postoperative course was uneventful and renal function was normal. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Les objectifs étaient d’évaluer l’amélioration de la mesure du pincement de l’interligne articulaire (PIA) dans la coxarthrose, en fonction de l’expérience du lecteur. Méthodes: Cinquante radiographies de patients atteints de coxarthrose ont été extraites de la base de données de l’étude randomisée et contrôlée ECHODIAH. Chacune d’entre elles a été lue par deux lecteurs n’ayant pas le même degré d’expérience dans l’interprétation radiologique. Les reproductibilités intra-observateur et interobservateur ont été évaluées par le calcul de la plus petite différence détectable (SDD) et le coefficient de corrélation intraclasse (ICC). Résultats: Reproductibilité interobservateur : pour le lecteur expérimenté, il n’a pas été observé de changement significatif dans la SDD avec la répétition des mesures de PIA. Pour le lecteur junior, la SDD a diminué significativement de 0,90 à 0,65mm (p =0,002). Un plateau a été obtenu après lecture de 200 à 300 radiographies, avec une SDD proche de la SDD moyenne du lecteur expérimenté (0,67mm). Les ICCs étaient élevés (>0,88) pour les deux lecteurs. Reproductibilité interobservateur : aucune amélioration de la reproductibilité interobservateur n’a été observée avec la répétition des lectures du PIA (SDD=0,81mm). Les ICCs étaient élevés (>0,85). Conclusion: Cette étude démontre pour la première fois l’effet de l’apprentissage de la lecture du PIA dans la coxarthrose pour un lecteur inexpérimenté. Après avoir lu 200 à 300 radiographies, la reproductibilité intra observateur du lecteur inexpérimenté est équivalente à celle d’un lecteur entraîné. Cette étude suggère en outre que la SDD et l’ICC devraient être systématiquement rapportés dans les études (l’ICC seul étant insuffisant) sur la progression radiologique dans l’arthrose pour faciliter l’interprétation des résultats. [Copyright &y& Elsevier]

Abstract: Metacarpal tuberculosis is a very rare form of the disease; it represents 1% of all bone sites. The diagnosis is often difficult because of the non-specific nature of the clinical examination and X-rays. Specialised morphological investigations are a capital contribution, but histology is diagnostic. Specific chemotherapy, combined with a bony debridement, generally allows desiccation of the bacilli in the lesions and the fixation of bone lesions. We report a case with the intention of pointing out the rarity of this location, the difficulty of diagnosis that may be encountered, and to highlight the severity of bone lesions that are mainly due to their late diagnosis. [Copyright &y& Elsevier]

Abstract: Calcifiying tendinitis of the rotator cuff is a frequent reason of shoulder symptoms. Following the French Society of Arthroscopy, four types of calcifications have been described based on X-rays analysis. While types C or D are separate entities, calcifications with sharp edges (type A or B) may have different consistency from soft to tough and chalky. Ultrasonography allows assessing this consistency in addition to other information on tendon integrity and presence of a subacromial bursitis. Ultrasonography defines three types of calcifying tendinitis with or without posterior attenuation or with a shadow cone. Analysis of density by CT-scan and by needling suggests that the calcifying tendinitis without posterior attenuation is soft whereas those with a shadow cone are though and those with posterior attenuation have intermediate density. These observations may be helpful in therapeutic choice of calcifying tendinitis. [Copyright &y& Elsevier]

Abstract: Better evaluation of disease inflammatory activity and structural progression and research of predictive factors of bone erosion have led to improve monitoring of rheumatoid arthritis (RA) patients. Ultrasonography (US) and magnetic resonance imaging (MRI) are more sensitive than clinical examination to detect synovitis, and than X-rays to detect bone erosions. Their external validity, reliability and sensitivity to change are satisfactory in RA. While the Rheumatoid Arthritis MRI Score (RAMRIS) score in MRI has been validated and appears as the score of reference for MRI reading in RA, no US score has obtained consensus, even though several US scoring systems have been proposed. [Copyright &y& Elsevier]

Abstract: Radiography remains the cornerstone of diagnosis of the sacroiliac joints and spinal structural lesions in ankylosing spondylitis. Assessment and quantification of spinal chronic changes relies on radiography; the mSASSS, which is currently the most widely used score is reliable but lacks sensitivity to change. MRI is sensitive to inflammatory changes, and these lesions can be reliably quantified with detailed scoring systems. MRI based scoring systems for sacro-iliac joints and spinal inflammation are highly responsive, allowing assessment in therapeutic studies. There is currently no validated and reliable ultrasound scoring system for peripheral enthesitis. Technological evolution of radiography and MRI should improve the effectiveness and possibilities of the imaging scoring systems in ankylosing spondylitis. [Copyright &y& Elsevier]

Depuis la découverte des rayons X(RX) par Röntgen, en 1895, á nos jours, l’évolution technologique de la radiothérapie n’a cessé de s’accélérer. Cependant, la philosophie est toujours restée la même: délivrer une forte dose au volume cible tout en limitant la dose aux organes á risque. Depuis le début des années 1990, avec l’aveènement de la radiothérapie conformationnelle (RC3D), différentes techniques se sont développées. Certaines sont dérivées de la RC3D comme la RC3D avec modulation d’intensité, l’ arcthérapie, la Tomothérapie™ ou les techniques d’asservissement respiratoire. Dans le domaine de la radiothérapie stéréotaxique, le GammaKnife™ est utilisé depuis une vingtaine d’annes, alors que de nouveaux concepts basés sur une approche robotique de l’irradiation (CyberKnife™) sont á présent utilisés. Aux côtés de la radiothérapie externe, la curiethérapie de nouvelle génération a, elle aussi, pu bénéficier de progrès technologiques majeurs. Dans le domaine des ions lourds, l’hadronthérapie représente une technique adaptée á des situations cliniques complexes, notamment en pédiatrie. Nous présentons ici une analyse de l’évolution technologique de la radiothérapie. [ABSTRACT FROM AUTHOR]

Abstract: X-ray doses (delivered) to the patients during coronary angiography (CA) and percutaneous coronary intervention (PCI) show ability of one certain deterious effects and can be sometimes at very high level. According to the European directives, all the equipments allowing to make diagnostic and interventional procedure integrate a unit of measure of the Dose Area Product. This measure is associated in a linear way with the effective dose and allows to measure the stochastic risk, the indicator also of good practices. Stemming from general vascular rotational acquisition technology, the cardiac rotational angiography is potentially beneficial for the patients and the operators concerning the exposure in ionizing radiations. The purpose of this study is to measure retrospectively the various dominating indicators in the irradiation of the patients on a series of case realized from January, 2009 till May, 2009 further to the implementation of this technique of acquisition. The dose area product, the duration of fluoroscopy as well as the number of acquired images were measured after coronary angiogram at 250 consecutive patients between January, 2009 and May, 2009. The procedures were realized by four operators, using the femoral access. The dose area product, the durations of fluoroscopy as well as the number of images has been respectively of 39,3Gycm2 [4,7–210,65Gycm2], 8,4minutes [0,8–38minutes] and 575 frames [175–1427 frames] in standard coronary angiogram; 33,64Gycm2 [4,95–85,6Gycm2], 2,8minutes [1,1–26minutes], 503 frames [314–836 frames] in single rotational coronary angiogram; 24,26Gycm2 [5,74–51,1Gycm2], 3,9minutes [1,3–14minutes], 272 frames [127–429 frames] in double rotational coronary angiogram. In conclusion, the exposure of the patient to the X-rays, the practitioners and paramedical in interventional cardiology depends on the operator, on the fluoroscopy time and on the number of acquired images. The double rotational angiography is one of the solution to achieve these objectives. [Copyright &y& Elsevier]

Summary: Bone damage in the spectrum of chronic kidney disease – mineral and bone disorders (CKD-MBD) represents a daily challenge for pediatric nephrologists. A real measurement of bone mineral density (BMD) by Dual X-ray absorptiometry (DXA) is currently performed to evaluate bone mass in children. However this technique has some limitations. In 2000, the National Institute of Health (NIH) has defined new “quality” criteria for the diagnosis of osteoporosis in addition to a decreased bone mass. Bone strength actually integrates 2 issues: bone density and bone quality (i.e., micro architectural organization, bone turnover, mineralization and micro fractures). These “quality” criteria cannot be evaluated by DXA. Histomorphometry remains the gold standard to evaluate bone but it is rarely performed in clinical practice. New bone imaging techniques have thus been developed, leading to an improvement in bone assessment. They are particularly challenging in children, whose bones continually grow in size, shape and mass. [Copyright &y& Elsevier]

Abstract: Introduction: The purpose of this study was to compare fat-free mass (FFT) determined by 19 bio-electrical impedance analysis (BIA) prediction models against criterion estimates determined by dual-energy x-ray absorptiometry (DEXA) in a heterogeneous sample of healthy adults in order to determine the best one. Results: This study selects in 68 sujects the Houtkooper et al. equation for total sample (r 2 =0.9454, average difference within −0.69kg; limits of agreement –1.51kg to −0.13kg), women sample, body mass index (BMI)<25; 2530. Comparison selects Lohman equation for women aged 18–29 years. Lukaski et al. equation for men was selected at the best. Conclusion: Comparison with dual-energy X-ray absorptiometry selects Houtkooper et al. equation at the most accurate, and the more recent formulae proposed by Kyle et al. or Sun et al. are not superior. [Copyright &y& Elsevier]

Résumé: Objectifs: Étudier les effets d’une activité physique, le football, sur la relation entre concentrations hormonales et densité minérale osseuse (DMO) chez de jeunes joueurs de football tunisiens à différents stades de puberté. Méthodes: Deux groupes de 152 jeunes garçons (âge : 13,3±0,9 ans) participaient à cette étude : 91 joueurs de foot et 61 témoins non athlètes. La DMO et le contenu minéral osseux (CMO) étaient mesurés par absorptiométrie biphotonique aux rayons X (DXA). Les stades de puberté étaient évalués, et les concentrations sériques d’IGF-1, d’IGFBP-3, d’hormone de croissance (GH) et de testostérone totale étaient mesurées. Résultats: La DMO et le CMO pour l’organisme entier, le rachis lombaire, le col fémoral, le pelvis et les membres inférieurs étaient plus élevés chez les joueurs de football que chez les témoins (p <0,001). Les joueurs en puberté récente avaient aussi une DMO et un CMO totaux et des os porteurs supérieurs à leurs témoins (p <0,001). Cependant, il n’y avait de variabilité inter-individuelle liée à la puberté ni pour la DMO ni pour le CMO. Les joueurs pubescents avaient des taux hormonaux d’IGF-1 et d’IGFBP-3 supérieurs à leurs témoins (p <0,05). De plus, la DMO totale était significativement corrélée aux taux de GH, d’IGF-1 et d’IGFBP-3 (p <0,001) mais pas aux taux de testostérone. Conclusion: L’activité physique sportive comme le football est généralement associée à une amélioration de la masse osseuse, de façon particulièrement marquée à la puberté récente et avancée. Les relations entre les hormones de l’axe somatotrope et la DMO des footballeurs pourraient être liées au développement parallèle de ces deux paramètres au cours de la puberté. [Copyright &y& Elsevier]

Résumé: Objectifs: Étudier la morphologie du long ligament sacro-iliaque postérieur (LLSIP) et ses rapports avec les structures adjacentes dans la région sacro-iliaque postérieure et en tirer les éventuelles conclusions fonctionnelles. Méthodes: Pour cette étude histologique descriptive, nous avons prélevé en bloc la région sacro-iliaque postérieure de quatre cadavres. Les blocs ont été déminéralisés par immersion dans l’acide éthyl-diamine-tétra-acétique (EDTA) et le résultat vérifié par radiographie. Les blocs ainsi déminéralisés ont été préparés, puis coupés grâce à un microtome à chariot coulissant. Après coloration par hématoxyline-éosine, les coupes ont été montées sur des lames en verre, puis examinées au microscope optique. Résultats: Les deux extrémités du LLSIP constituent les zones d’ancrage osseux. Entre ces deux zones d’ancrage, le ligament est formé par la confluence de trois couches : l’aponévrose du muscle sacrolombaire, le fascia profond et l’aponévrose des fessiers. À la face profonde du fascia profond se trouve une couche de tissu adipeux et conjonctif lâche, qui contient les nerfs clunéaux moyens. Conclusions: La partie moyenne du LLSIP semble constituer une zone de passage pour les nerfs clunéaux moyens, qui émergent de la région sacrée postérieure pour pénétrer dans la fesse. Les résultats de notre étude histologique laissent penser que les douleurs souvent attribuées à l’articulation sacro-iliaque seraient dues dans certains cas à la compression des nerfs clunéaux moyens dans le LLSIP. [Copyright &y& Elsevier]

Summary: Oesophageal duplication is a rare form of digestive duplication. This congenital malformation can be asymptomatic or manifest itself through respiratory signs due to airway compression. We report 2 cases of oesophageal duplication discovered in the neonatal period. Case report: In both cases, symptoms were dominated by respiratory distress and vomiting. Diagnosis was confirmed by oesophageal contrast X-rays, which revealed a total tubular form in the 1st case and a cystic form in the 2nd case. Conclusion: Oesophageal duplication is a rare abnormality of benign nature, which can be revealed in neonatal period by a noisy compression picture. Diagnosis of this abnomaly should trigger a search for other digestive duplications, as well as associated malformations, in particular vertebral. [Copyright &y& Elsevier]

Abstract: Aim: Acute complete ruptures of the ulnar collateral ligament should be treated with surgical repair of the ligament. But diagnosis using ultrasound, dynamic X ray and magnetic resonance imaging are unable to diagnose surely the complete rupture. According to Rotella and Urpi if the radiograph shows no parallelism between the sesamoid bones and the metacarpal head, the injury of ulnar collateral ligament is total and complete and requires surgical reparation. The aim of this work was to verify the finding of Rotella and Urpi and the relationship between the lost of parallelism and the Stener lesion (interposition of adductor aponeurosis between the ruptured ulnar collateral ligament and its site of insertion on the base of the proximal phalanx). Material and methods: Embalmed anatomical specimens were used to systematically investigate and document the role played in joint stability by each of the anatomical elements. Each ligament was sectioned and instability documented. A retrospective radiological study was performed on 93 patients who had an history of injured ulnar collateral ligament of the thumb. Results: The anatomical study confirmed the result of Rotella and Urpi in showing that the loss of parallelism between the sesamoid bones and the metacarpal head was associated with complete rupture of ulbnar collateral ligement The clinical study showed that the lost of parallelism was associated with a Stener lesion (N =23). Conclusion: The association between the lost of parallelism of sesamoid bones and Stener lesion confirm that the rupture of all elements of the ulnar collateral ligament. This anatomical and clinical findings have to be confirmed by a prospective clinical study. [Copyright &y& Elsevier]

Abstract: Carpal morphology and orientation of carpal bones are usually studied on two-plane radiography. Those measurements depend on the incidence of X-ray and on the expertise of physician. A method that eliminates both should improve the accuracy of those measurements. The digital data from computed tomography scans can be use to describe carpal geometry. We defined biometric and angular parameters allowing the study of carpal morphology and bones orientation. From digital data from computed tomography scans software can obtain bone volume, inertia principal axis and volume of ellipsoid of inertia. Bone centroid location and principal axis orientation can be used to study bones orientation. 3D distances ratio between geometry centroid of carpal bones. The measurements allowed by this methodology are numerous. A study of a more consistent series of normal wrists will allow in the future for each quantitative parameter to define the normal range. A comparative study of normal wrists and pathology wrists should allow defining, for each pathology, the most judicious quantitative parameters. [Copyright &y& Elsevier]

Abstract: Objective: Our first experience of palmar plating for dorsally displaced distal radius fracture with locking compression plate showed good results. But ancillary tools was ineffective, so we report our early experience with the DRP 2,4™ device. Methods: Between January and October 2004, 22 patients (16 women, 6 men), mean age 56,8 years (age range: 24–77 years), underwent internal reduction and fixation using DRP 2.4™ by Henry''s approach. By AO classification there was 10 A3 and 12 C1 or C2 fracture. On pre operative X Ray, radial inclination was 13.9°, and dorsal tilt was 27°. Results: Seventeen patients were reviewed with mean follow-up of 11 months (5 to 17). On postoperative X Ray, radial inclination was 22,7° and palmar tilt was 2,1°. At 6 month radiological findings found no loss of postoperative reduction. According to SOFCOT''s criteria''s, we noticed 9 anatomical results and 8 moderate malunion. Clinical results (Green and O''Brien) showed 6 excellent, 7 good, 4 fair and no poor results. Mean DASH score was 13.5. Strength recovery was 82% of opposite side. Complications concerning 6 patients with, 4 reflex sympathetic dystrophy, and 2 screwdriver breakage during insertion. Discussion: Volar plating with DRP 2.4™ is an effective technique, but obtain anatomical reduction remind challenging for the surgeon. Conclusion: DRP 2.4™ volar plating is an effective treatment for dorsally displaced fracture. Controlled study with orthopaedic reduction and K Wire fixation are need for determining the place of each treatment. [Copyright &y& Elsevier]

In recent years, breast imaging has benefited from a number of new advances. The resulting new imaging methods mainly focus on the functional examination of tumours and aim to improve tumour detection and characterization, provide new prognosis criteria, and guide the therapeutic management of breast cancer. One of the most promising functional assessments — whether performed through the use of ultrasound, X-rays or MRI — is the analysis of tumour angiogenesis, which plays a major role in tumour development and metastatic potential. In this article, we discuss the major developments in functional imaging of the breast, including imaging methods such as X-rays, ultrasound, MRI and nuclear medicine. After a brief technology overview, we present the early clinical results and prospects of each of the techniques. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The French National Health Authority recommends systematic radiography before lumbar manipulation. However, current research shows radiography to have more disadvantages than advantages. For the cervical spine, in cases of complication following cervical manipulation, the lack of prior radiography is a fault, even if such x-ray results would have advised manipulation. To establish clear recommendations on this topic, we searched in the literature for complications of spinal manipulations that could have been prevented had preliminary radiography been performed to determine whether these complications were anticipated or not by the international guidelines. Material and Methods: Literature search. Results: For the lumbar and thoracic spine, the international guidelines are sufficient, except in cases of aneurysmal bone cyst, which can appear until the age of 25 years. For the cervical spine, despite a lack of data in the literature, prudence and medicolegal issues justify the performance of systematic radiography. Conclusion: The SOFMMOO recommends systematic radiography prior to cervical manipulation and in case of back or neck pain in patients of less than 25 years of age. In all other cases, the international guidelines provide sufficient recommendations. [Copyright &y& Elsevier]

Abstract: Diagnostic probability of community-acquired pneumonia (CAP) depends on data related to age and clinical and radiological findings. The critical evaluation of data in the literature leads to the following conclusions: 1) the prevalence of CAP in a given population with acute respiratory disease is 5% in outpatients and 10% in an emergency care unit. This could be as low as 2% in young people and even higher than 40% in hospitalized elderly patients; 2) the collection of clinical data is linked to the way the patient is examined and to the expertise of the clinician. The absolute lack of “vital signs” has a good negative predictive value in CAP; presence of unilateral crackles has a good positive predictive value; 3) there is a wide range of X-ray abnormalities: localized alveolar opacities; interstitial opacities, limited of diffused. The greatest radiological difficulties are encountered in old people with disorders including chronic respiratory or cardiac opacities and as a consequence of the high prevalence of bronchopneumonia episodes at this age; 4) among patients with lower respiratory tract (LRT) infections, the blood levels of leukocytes, CRP and procalcitonine are higher in CAP patients, mainly when their disease has a bacterial origin. Since you have not a threshold value reliably demonstrated in large populations with LRT infections or acute respiratory disease, presence or absence of these parameters could only be taken as a slight hint for a CAP diagnosis. [Copyright &y& Elsevier]

Abstract: Lower respiratory tract infection is easily suggested on clinical signs (cough and sputum) associated with fever. To discriminate between pneumonia and acute bronchitis is crucial because of the mortality associated with pneumonia and of its specific management. Chest X-ray is a key exam for the diagnosis and should be performed on the basis of validated clinical signs that are however of weak diagnostic value. Clinical as well as radiological signs cannot be reliably used to identify the causative germ. Sputum examination, the search for pneumococcal and legionella urinary antigens are of good diagnostic value. An associated COPD may lead to an acute respiratory failure. Acute exacerbation of chronic bronchitis results from various causes but infection is involved in about 50% of the cases, mostly viral and most often due to a rhinovirus. Viral infection can be associated to bacterial infection and the most frequently isolated germs are Streptococcus pneumoniae, Haemophilus influenzae, and B. catarrhalis. Severity assessment relies on the value of basal FEV1 that is often non available. Therefore Afssaps suggests using a dyspnea index to assess exacerbation severity. [Copyright &y& Elsevier]

Abstract: Objectives: To describe the necrotizing pneumonia in children, a severe affection which prevalence seems to increase; to review literature. Patients and methods: We report 4 cases of necrotizing pneumonia: symptoms, agents, diagnostic tools, treatment and long term evolution. Results: In 2 cases, pneumatoceles could be seen at chest X-ray. Two patients presented a deficiency of anti-pneumococcal antibodies. Three needed insertion of a pleural chest tube of whom 1 had a resection of a small piece of necrotic lung. Duration of hospitalisation is longer than in uncomplicated pneumonias. Conclusion: Necrotizing pneumonia is a severe affection. Diagnosis has to be made by lung CT. Long term evolution is excellent in pediatric population with serious management at hospital. [Copyright &y& Elsevier]

Abstract: In some cases, after preliminary clinical examination, medical imaging can provide indispensable complementary information for the care of young patients. Volume imaging using two- and three-dimensional reconstructions provides the most complete information possible. Problems involving the superposition of anatomical structures, which can occur with conventional X-rays, are a thing of the past, and this technique represents the future in this field. In high-density tissue such as bone or teeth, tomodensitometry is the preferred examination as it can give a three-dimensional approach to the study. However, because of the high radiation dose required, scanner is still a second intention examination. Development of digital volume tomography using NewTom system, designed for maxillofacial exploration, produces the same type of image for a very much reduced X-ray dose, and at low cost. Although the use of this new examining technique is developing rapidly in Europe and throughout the world since its recent introduction, France is lagging behind as to date there are only seven machines in the entire country. The main uses in children, illustrated by original clinical cases, relate to preoperative surgery planning, post-trauma diagnostic workups, orthodontic checkups, postoperative follow-up and TMJ examinations. The purpose of this article is to inform dental surgeons, paediatricians and doctors about this new medical imaging examination, which will most definitely have a place in the battery of diagnostic tools available to us. After weighing the advantages/risks involved, it should be possible to reduce the number of tomodensitometry exams in favour of this new examination technique in children according to the clinical examination data and diagnostic information required. [Copyright &y& Elsevier]

Abstract: The preferred assessment of bone biomechanical competence in vitro is by direct mechanical testing and in vivo by X-ray absorptiometry techniques. For more than 30 years investigators have been developing alternative techniques, by ultrasonic methods, aimed at providing (i) the elastic properties in vitro without the complications related the destructive character of mechanical testing and (ii) the evaluation of the fracture risk in vivo, taking benefit of the propagation of elastic wave which are inherently affected by both material and structural bone properties. The in vitro strategy includes the use of multiscale ultrasonic assessment for the combined evaluation of both the material (or intrinsic) and the structural elastic properties in various axes of symmetry. The in vivo approach involves the use of the different propagation modes (bulk wave, guided wave, surface wave) permitted by the ultrasonic approach. We will review the in vitro and clinical data on each ultrasonic approach and discuss potential areas of development in the field of quantitative bone assessment bone. [Copyright &y& Elsevier]

Abstract: Scaphoid fractures are the most common carpal fracture, accounting for 70 à 80% of all fractures of the wrist. The diagnosis of acute fracture of the scaphoid still continues to be missed despite an increasing improvement of imaging techniques. In fact, these fractures are mainly neglected because of minimal early symptoms or quick resolution of initial symptoms. X-ray analysis of acute fractures is rather difficult because of the irregular shape of the scaphoid and its overlapping with other structures. In case of doubtfull or negative initial radiographic views, a technetium 99 bone scan or MR imaging should be consisidered. These fractures occuring in the young and most active members of our society represents a population that doesn''t have the patience for traditionnal immobilisation in cast. Thus patients whith undisplaced fractures for whom early return to work or sport is a primary concern, percutaneous repair with cannulated screw fixation using fluoroscopy and even aided with arthroscopy represents an increasing option. Nevertheless, in thoses cases, cast immobilisation should always be first considered. If percutaneous internal fixation is the first choice in proximal pole fractures or fractures seen with a delay, in the other cases, it can only be advocated if internal fixation will provide a stable reduction. There is little controversy for the treatment of displaced unstable scaphoid fractures. Open repair and internal fixation with a screw represents the golden standard. Complex displaced or dislocated fractures are often comminuted and associated with bony defect. Accurate reduction may need to perform a bone graft. The ligamentous injuries should also be carefully repaired . Evidence of associated cartilagenous lésions must be asessed with precision, as they always jeopardize the end result. [Copyright &y& Elsevier]

Abstract: Hemolymphangioma is a benign malformation of the lymphatic vessels. Cervical localisation is the most frequent. Mediastinal localisation is rare, but may be life-threatening because of airway compression. We report on a four-month-old boy who presented, in a context of epidemics, with clinical signs of acute bronchiolitis requiring mechanical ventilation for several days. Chest X-rays showed an important mediastinal mass with airways compression. Diagnosis was evoked on CT-scan aspects and confirmed by histology. Surgery allowed complete resolution, but dysphonia and oropharyngeal disorders persisted for several months. This rare congenital malformation is reviewed. [Copyright &y& Elsevier]

Hydatid cystic disease is still a significant clinical problem in endemic countries. Hydatid cysts are usually located in the liver and lung. Mediastinal hydatid disease is very rare. We present the case of a 16-year-old girl who has undergone surgery for pulmonary hydatic cyst at age of 12 years. She had pain in the right hemithorax with progressive dysphagie, dysphonea and dyspnoea. In the X-rays of the thorax a mediastinal enlargement was noted. The ultrasonography and MRI of the thorax show multiple cystic mass evocating recurrence of cystic disease. The treatment was surgical. Favourable evolution was noted. [Copyright &y& Elsevier]

Etiology of neonatal digestive obstruction are variable and dominated by malformations. Antenatal diagnosis is actually possible by ultrasonography and MRI. Imaging exploration of this neonatal digestive pathology is directed by prenatal context and clinical symptoms. Its based on abdomen radiography, digestive contrast exam and ultrasonography with Doppler. Abdomen radiography is essential for neonatal abdominal obstruction. Ultrasonography supply specific argument for etiological diagnosis. The aim of this study is to remind the contribution of the various methods of imaging in diagnosis of neonatal digestive pathology through a review of the literature. [Copyright &y& Elsevier]

In this paper, we present a simple method that allows, among other things, to determine the absorption coefficient of X-rays from reflectivity measurements. This method is applicable if the analysed material is deposited on a substrate denser than the material layer, so that the X-rays reflectivity spectra exhibit two well-resolved descents. In such cases, the amplitude of the first descent (characteristic of the material layer) is directly related to the linear absorption coefficient of the material constituting the layer. We have been able to clarify this relationship and apply it successfully for several cases of materials, especially amorphous carbon and silicon. Values of thus obtained mass absorption coefficients are in very good agreement with those tabulated in the literature.[Journal translation] [ABSTRACT FROM AUTHOR]

The article addresses the structural effects of solutions of lead nitrate on a suspended or compacted bentonite. A permeability increase is observed on compacted clay. Investigating the composition of output solution, using X-Rays Diffusion at Small Angles and Scanning Electron Microscopy, this permeability increase is explained from structural variations at nanometric (reduction of particle size) and micrometric scales (microfissuration of aggregates). To cite this article: N. Jozja et al., C. R. Geoscience 335 (2003). [Copyright &y& Elsevier]

We report the results of 13C MAS NMR and EPR measurements on Ba3C60 and Ba6C60 fullerides. Using high resolution NMR, we were able to identify an isotropic line around 156 ppm for Ba3C60 and a broad isotropic one with three components at 132, 134.6, 139.9 ppm for Ba6C60 compound. The latter line is consistent with orientationally ordered C60 molecules leading to three unequivalent carbon sites in agreement with X-ray studies. A strong diamagnetic shift was observed for the NMR line of Ba6C60 that is interpreted in terms of transition moment in an indirect gap system. EPR results confirm the insulating nature of both studied compounds. [Copyright &y& Elsevier]

The angiography object of this study concerns the vessels imagery by X-rays. The quality assurance here deals with a quality control protocol (receipt tests), that will constitute the basement of the future constancy tests, for a steady performance of equipment. By being committed in this step, the Lariboisière hospital conforms to regular demands in France (decree Nr 2001-1154 of 05/12/2001; prescription Nr 2001-270 of 28/03/2001). The experiment protocol is composed of tests concerning essentially: the control of acquisition chain, performances depending on quality parameters in angiography, and patient dosimetry. That protocol requiered the utilization of a Barracuda multimeter (RTI), a DSA phantom (Nuclear Associate), and others small equipments. Presented results concern a DSA system GEMS LC ADVANTX set up in 1991. They show that a perfected knowledge of the DSA phantom is necessary for a correct result analysis. One notes then the limits of perceptibility concerning spatial resolution, density and concentration; dosimetry values; etc. All these results must be reproducible in next constancy tests. [Copyright &y& Elsevier]

To initiate Intensity-Modulated Radiation Therapy (IMRT) in our department, theoretical cases were used as a training, to define methods of measurements and to verify the software by comparing results of calculation and measurement on a PMMA phantom. Irradiation was performed with 6 and 25 MV X-rays from a linear accelerator. For measurements, films and ionization chambers have been chosen. The comparison between calculations and measurements shows some discrepancies at the level of junctions and also in areas of low doses especially when many segments were used. These theoretical cases provide a first step on the way towards treatments with intensity modulation. [Copyright &y& Elsevier]

Stents are widely used to treat stenosis. Stent expansion is suspected to be an important factor of restenosis. The problem is that, in day to day practice, correct stent expansion is hard to assess. In X-ray images, stents are visible only with a low contrast. We propose to locate and detect them automatically in these images by applying dedicated algorithms. We characterize the problem of detecting stents in X-ray images as a crease detection problem. We compare classical image processing approaches. We propose two specific algorithms, one belonging to gray-level values methods and the other one based on adapted filtering. Comparison is made on the false detection results. Results have been tested on a hundred image database. In a second time, we propose a multilocal fuzzy algorithm to detect struts in a more accurate way. [Copyright &y& Elsevier]

Introduction: The extensor tenodesis is a direct dynamic tenodesis which is activated by wrist flexion due either to hand weight or flexor carpi radialis. This tenodesis is usually performed to the distal radius, but it is possible to fix EDC (extensor digitorum communis) to the retinaculum extensorum.Material and methods: Biomechanical study concerned 12 anatomical subjects (24 wrists). The biometric and radiological analysis of retinaculum displacement distalwards was made under low (1 kg) and moderate (6 kg) pulling. Surgical clips were placed on the proximal and distal limits of the retinaculum in order to study their positions on roentgenograms.Results: Average width of the retinaculum was 19 mm. Average movement under 1 kg drive was 6 mm and 8,6 mm under 6 kg drive. X–rays showed that the proximal border of the retinaculum was always located proximally to the wrist rotate centre, whatever the traction.Discussion: We found the same anatomical features described by different authors, except for the width of the retinaculum. Our study suggests that the retinaculum is strong enough to support a surgical tenodesis. [Copyright &y& Elsevier]

The extent to which radiographs of the hands and feet can contribute to the diagnosis of early rheumatoid arthritis (RA) has received little research attention. Yet, the workup for recent-onset inflammatory joint disease usually includes radiographs of the hands and feet. We reviewed the literature for data on the value of these radiographs for diagnosing early RA. We sought to determine whether radiographic changes in the hands and feet constitute a valid diagnostic criterion, i.e., show good discrimination, good reproducibility, and an ability to detect early disease. Furthermore, we evaluated whether the sensitivity, specificity, and positive and negative predictive values of these changes could be calculated from published data. Few cohort studies of early inflammatory joint disease have been published, and the data come mainly from studies in early RA. Among radiographic alterations described to date, erosions seem associated with the best reliability and discriminating power. Radiographic alterations are of limited sensitivity for early rheumatoid arthritis because they occur only after some time. Radiographs of the hands and feet are far easier to obtain than magnetic resonance imaging and ultrasonography, which seem promising but are still undergoing validation. [ABSTRACT FROM AUTHOR]

Introduction. – The finger clubbing is most of the time associated with cardiovascular and pulmonary diseases. Pachydermoperiostosis also known as osteodermopathic syndrome, an hereditary disorder, is a rare cause of finger clubbing which might be difficult to diagnose in an incomplete form.Exegesis. – We report a 36 years old black man presenting over many years polyarthralgias, broadning of fingers and clubbing of the fingers and toes extremities.This was mentionned on other family members. The physical examination was otherwise unremarkable. There were no skin thickening, no psoriasis-like and cardio-pulmonary disease features.These following exams were normal; Hemogram, fibrinogen, C reactive protein, rheumatoi¨d factor, serum calcium and phosphorus, thyroid hormones, growth hormone, chest X-ray, gastroduodenoscopy, electrocardiogram. The skeletal X-ray documented a widespread bone formation, a sacro-iliac osteosclerosis and interosseous ossifications beetwen tibias and fibulas.Conclusion. – Pachydermoperiostosis diagnosis was set up on 3 out of the 4 Borochowitz criteria. The absence of pachyderma defines this incomplete form. The osteoarticular manifestations lead mainly to differential diagnosis with the secondary hypertrophic osteoarthropathy and chronic inflammatory rheumatisms.The underlying pathogenic mechanism of this disease remains still unclear. [Copyright &y& Elsevier]

Cu-poor meneghinite from La Lauzie&grave;re Massif (Savoy, France) has the composition (electron microprobe) (in wt%): Pb 59.50, Sb 20.33, Bi 1.19, Cu 0.87, Ag 0.05, Fe 0.03, S 17.62, Se 0.05, Total 99.64. Its crystal structure (X-ray on a single crystal) was solved with R1=0.0506, wR2=0.1026, with an orthorhombic symmetry, space group Pnma, and a=24.080(5) A˚, b=4.1276(8) A˚, c=11.369(2) A˚, V=1130.0(4) A˚3, Z=4. Relatively to the model of Euler and Hellner (1960), this structure shows a significantly lower site occupancy factor for the tetrahedral Cu site (0.146 against 0.25). Among the five other metallic sites, Bi appears in the one with predominant Sb. Developed structural formula: Cu0.15Pb2(Pb0.53Sb0.47)(Pb0.46Sb0.54)(Sb0.75Pb0.19Bi0.06)S6; the reduced one: Cu0.58Pb12.72(Sb7.04Bi0.24)S24. The formation of such a Cu-poor variety seems to be related to specific paragenetic conditions (absence of coexisting galena), or to crystallochemical constraints (minor Bi). To cite this article: Y. Moe¨lo et al., C. R. Geoscience 334 (2002) 529–536. [Copyright &y& Elsevier]

Purpose. – Among neutropenic patients, diagnosis of invasive pulmonary aspergillosis is difficult. Computed tomographic scan, bronchoalveolar lavage and histology are considered invasive procedures, because they represent an infectious risk for these immunocompromised patients.Methods. – We describe the clinical and noninvasive paraclinical (X-rays, serology) signs of invasive pulmonary aspergillosis, from a retrospective study of 16 cases in a haematology unit.Results. – Outside of fever and chills, cough and polypnea are the earliest signs, followed by chest pain, dyspnea, lung auscultation changes, and haemoptysis. The sensitivity of each sign is higher than 56%. Before the onset of lung auscultation changes, the chest X-ray shows mainly unilateral alveolar infiltrates. Sensitivity of serology is weak (25%), but contributed to early diagnosis in 16.6% of cases.Conclusion. – A better knowledge of the invasive pulmonary aspergillosis clinical, radiological and serological signs could help the practician to prescribe an ‘invasive’ investigation (computed tomographic scan, bronchoalveolar lavage) to confirm the diagnosis of this fungal infection. [ABSTRACT FROM AUTHOR]

Summary: Intrathoracic appendicitis is an uncommon diagnosis. We report the case of a 6-year-old boy with elevated CRP and no fever, who complained of nonspecific abdominal pain. A diaphragmatic hernia was suspected on a chest X-ray and confirmed by an ultrasound examination. A multidetector CT scan revealed intrathoracic acute appendicitis associated with a right posterolateral Bochdalek hernia. Abdominal diseases associated with late-presenting congenital diaphragmatic hernia are often manifested by an atypical clinical presentation, which can be a source of delay or error in diagnosis. We recommend radiological exploration in the case of diaphragmatic hernia, even with subtle clinical findings in the search of associated gastrointestinal complications. [ABSTRACT FROM AUTHOR]