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Purpose: To review the etiology, location, and morphology of pelvic collection as well as the technique and results of image guided drainage., Materials and Methods: From June 1996 to August 2002, we performed image guided drainage of pelvic fluid collections in 21 males and 21 females. In patients where a direct contact between the collection and the endocavitary probe was present, the drainage was performed either by transrectal or transvaginal approach using 10F, 12F, 14F or 16F catheters according to the viscosity of the fluid. When the patients were no longer septic, when drainage had stopped, the drains were removed at day 5. When a fistula was present, the drain was left in place until the fistula healed., Results: The most common location of pelvic collections was the cul-desac (43%). A total of 81% of pelvic abscesses were digestive in origin, either from the colon or appendix. Transrectal or transvaginal drainage was possible in 83% of cases. Mean follow-up was 41 months. No drainage related complication was recorded. In two patients with collections of clear fluid, a simple aspiration was performed without insertion of a drain. In the 40 other patients, a drainage catheter was inserted. Twenty-nine patients were cured after 15 days of drainage. Two patients had recurrent collections. Image guided drainage failed in five patients, and all underwent successful surgical management., Conclusion: Image guided drainage of pelvic collections is a safe and effective procedure. Failures were due to initially undiagnosed pathology requiring surgical treatment.

A new technique of electro-incision of ureteral stenoses and strictured uretero-enteric anastomoses is presented. Incision is performed with a papillotome, routinely used to achieve endoscopic retrograde sphincterotomy of the duodenal papilla. Group I: 7 ureteral stenoses were performed, on a dog model after surgical ligation of the lumbar ureter. Ten days later, through a percutaneous approach, the papillotome was placed through the stenosis, deflected, and cutting current was applied to incise the stenosis. The IVP performed one month later showed disappearance of the stenosis in 4 cases, a residual stenosis without obstacle in 2 cases and a residual stenosis with obstacle in one case. Group II: 7 strictured uretero-enteric anastomoses on 6 patients. After placement of a percutaneous nephrostomy, a wire guided papillotome was placed into the stenosis. Cutting current was then applied to cut the stenosis. A 18 F ureteral stent was subsequently placed for 8 weeks. Two patients have a patent anastomosis, 7 and 10 months after removal of the stent. One patient died from metastases of bladder tumor. The three remaining patients are still stented. An urinoma occurred in one patient the day following removal of the stent, and was surgically drained. This new technique which combines electro-incision and stenting with a large caliber stent may be proposed as an alternative to surgery or balloon dilatation for the treatment of strictured uretero-digestive anastomoses.

Unlabelled: 16 strictured uretero enteric anastomoses were dilated and stented for 4 months with a large size stent (18F in fifteen cases and 14F in one case). All the patients had undergone a radical cystoprostactectomy, had received radiotherapy prior to surgery. The length of the stenosis did not exceed 3 cm in all cases. All the stenoses occurred within 2 years following the removal all of the stent., Results: 6 cases (37%), have a patent anastomosis, 18 to 36 months following removal of the stent. Most of the recurrences occurred within six months following removal of the stent. We recommend a long term stenting with a large size stent to obtain long term patency of dilated anastomotic strictures.

A prospective study in 60 consecutive patients evaluated gain in quality of image using ECG servo-assistance during pulmonary digital subtraction angiography (PDSA). Two groups of 30 comparable patients were randomly allocated to examination with ECG servo-assistance or three images per second technique. Criteria for assessment of quality of image were defined and used to compare results. No significant difference were noted and ECG servo-assistance failed to improve images during PDSA.

A 24-year-old man presented clinically confirmed Behcet's disease. He developed thoracic pain accompanied by hemoptyses as a result of thromboses and aneurysm formation in the pulmonary artery. The presence of these aneurysms was suggested by perihilar images on standard radiography, and confirmed by pulmonary arteriography findings and results of histological examination of the operative specimen. Radiological and anatomical evidence of the presence of bronchial endarteritis lesions was also obtained.