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Objective: The authors report their experience with extracorporeal lithotripsy in 30 patients with calcific tendinosis of the rotator cuff., Materials and Method: This technique is based upon the utilization of high-energy shockwaves (6000 shocks in 3 sessions Day 1, D8, D30) under continuous ultrasound localization of the lesion (EPOS Ultra1). Calcification were evaluated at plain film, US and CT to characterize their length and features., Results: Complete or partial resorption of calcifying deposits within 2 months and one year was observed in 27.5% and 25% of cases respectively. Clinical improvement results are encouraging at two months (50%), but reduced at one year (28.5%), consistent with the rate of resorption of calcifications., Conclusion: This painful, long, and expensive technique seems to be disappointing in the treatment of the calcific tendinosis.

Purpose: To identify and classify the different types of bony changes of the condyles in patients with disorders of the temporomandibular joint (TMJ)., Materials and Methods: Since 1993, we have imaged over 600 patients with 0.5T MR unit by using gradient-echo T1-weighted sequences in the sagittal and coronal planes., Results: We will first describe the appearance of the normal TMJ. Then, we will introduce the concept of "Condylo-diskal disunion" using a three grade classification system. We will then describe three patterns of condylar changes: adaptive remodeling, either anterior or more frequently posterior, degenerative lesions with subchondral sclerosis, erosive lesions due to synovial hyperplasia., Conclusion: Using a 0.5T MR unit, a GRE T1 sequence is useful to identify lesions of the disk and detect bony changes. In addition, the tissues posterior to the disk can also be assessed on postcontrast images.

Like the anterosuperior subracromial conflict, the coracotrochineal or anteromedial conflict of the shoulder is a groove pathology. In a series of 340 patients who had an arthroscan of the shoulder, including 245 with a conflict syndrome (70%), we observed an anteromedial conflict in 12 cases (8.5%) of the 140 patients with an intact cuff and 52 cases (50%) in 102 patients with an injured cuff. The frequency of the anteromedial conflict appears to be proportional to the degree of cuff injury. We described the signs of the trochin suggesting the anterior musculotendinous structures (subscapsular tendon and/or long biceps tendon) are involved and conclude that the anteromedial conflict is often misdiagnosed. It would appear to be a frequent complication of cuff injury (mechanical theory) which the surgeon should take into consideration when repairing cuff injury.

Multiple pancreatic metastasis of small cell lung cancer. Pancreatic metastasis of small cell lung cancer are unusual, in spite of their fast evolution. The authors describe a case of small cell lung cancer with multiple pancreatic metastasis showed by echography and confirmed by ultrasonic guided biopsy.

Diagnostic value of radiologic examinations was assessed in a homogeneous series of 130 cases of neurinoma of acoustic nerve seen over the last 10 years. Radiologic exploration is conceived and used at the present time for two purposes. Firstly, it enables selection of patients with suspected acoustic nerve neurinoma. Radiotomography appears to be currently an accessory examination because of the discriminative performance of early auditory evoked potentials tests on the brain stem. Secondly, radiology is necessary for confirmation of diagnosis. Visualization of the tumoral syndrome can be obtained only by a scan or possibly opaque or gas meatocisternography.

Three methods of diagnostic imaging : bi-dimensional ultrasonography, scanography and 111Indium-labelled platelet scintigraphy were compared in 61 patients to detect left intraventricular thrombotic lesions, in order to determine their respective diagnostic values.

One hundred patients suffering from haematological diseases were explored by whole body scanning. The diagnosis was a lymphoma in the majority of cases (77). Analytical study of the images obtained was made on the basis of the various sections made systematically in the protocol of the study. Scanning proved to be of particular value in the thorax in the study of pleural and juxta-pleural lesions. In the abdomen, study of the liver, spleen and retro-peritoneal space benefited from the use of this means of investigation. Supra-mesocolic sections were felt to be of the greatest value, making it possible to demonstrate lymphadenopathies not revealed by lymphography. Scanning, perfectly harmless, provides a valuable contribution in determining the extent of lymphoma spread and facilitates the therapeutic surveillance of haematological disorders.

The authors present their experience of Computed Tomography in the staging of abdominal sub-diaphragmatic extension in 144 cases of malignant lymphoma of the lymph nodes (76 cases of Hodgkin's disease and 68 non-Hodgkin lymphomas). The method provides accurate information on sub-mesocolic lymph node involvement, particularly when hypertrophy is pronounced. It may also be used to assess supra-mesocolic extension of the disease, which is inaccessible to lymphography, and to study the size and, mainly, the structure of the liver and spleen tissues. Easy to perform reliable and non-invasive, the scanner constitutes a new and important means of assessing the extension, course and response to treatment of malignant lymphomas.

Although the classification of "Ullman's universal angiomatosis" has not yet been completely defined, the authors estimed it interesting to report an observation which may fall into this denomination. This observation concerns a generalized cavernous angiomatosis differing from hereditary hemorrhagic telangiectasia (Rendu-Osler type) with its conventional skin and mucous membrane manifestations and its visceral forms. The patient presented cutaneous and probably digestive generalized cavernomatosis related to blue rubber bleb naevus. In connection with this observation, the authors attempt to offer reasons in support of the distinctions which appear to exist between glomangiomatosis and glomangioma. This observation is also interesting from two other standpoints: 1. the striking lineal descent: in five generations, seven subjects presented identical angiomatoses; 2. the malignant transformation (angiosarcoma) of one of the cavernous elements.

Cases of Weismann-Netter and Stuhl disease reported in the literature usually involve stereotyped pictures characterized by the presence of tibio-fibular dysmorphism, most often the only abnormality. The authors present a current review of the literature on the basis of a new case of this tibio-fibular diaphyseal toxopachyosteosis.

The authors report the case of a six and a half year old girl, with extensive poikilodermatous condition and acrokeratosis, preceded by early blistering and light sensitivity. The sequence of cutaneous symptoms suggests the diagnosis of hereditary and bullous acrokeratotic poikiloderma of Weary and Kindler; forty-two cases have already been reported in the literature and our patient would better fit into Kindler's type. The original findings under electron microscopy and direct immunofluorescence (colloid bodies, IgM deposition) that are reported herein are discussed from a pathogenic point of view.

The purpose of this study was to determine the course of cutaneous immature angiomas in a population of 362 children examined in a pediatric dermatology unit from 1975 to 1982. 461 angiomas were observed in these patients: 110 were of the naevus flammaeus type (port wine stain) including 23 forehead salmon patches. 351 were immature angiomas (IA)--strawberry angiomas. 3.5 p. 100 of children were afflicted of two types of hemangiomas. Results concerning the 282 patients with 351 IA are detailed as followed: average follow-up: 2 years; sex-ratio M/S 1.9, most of them Caucasians. Prematurity (data obtained prospectively during 1982): 19 p. 100; clinical features: dermal: 253, subcutaneous: 35, mixed pattern 63; 2 IA or more were detected in 12 p. 100 of the patients; site: head and neck; 49 p. 100, trunk: 21 p. 100, upper limbs: 14.5 lower limbs: 12 p. 100, genitals 3.5 p. 100; maximal size during follow-up: less than 1 cm: 36 p. 100, between 1 and 3 cm: 43 p. 100, more than 3 cm; 21 p. 100; time of onset: 51 p. 100 were noted at birth, 35 p. 100 during the first month, 13 p. 100 after the first month. Course of untreated IA is shown in figure 1. At the end of follow-up, spontaneous evolution in 52 patients was judged; very good in 44 p. 100, good in 41 p. 100, poor or bad in 15 p. 100. Minor complications (ulceration, infection, bleeding) were observed in 12.8 p. 100. Functional impairment requiring therapy was present in 2/4 plantar IA, 3/30 eyelid IA, 3/3 IA with laryngeal involvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Results are reported of the use of new imaging methods, CT scan and magnetic resonance imaging, in 12 patients with algodystrophy of femoral head. During the early stages a CT scan can detect partial demineralizations, observed on MR images in sagittal sections. When the disease is installed the CT scan images show global demineralization, but the MR images with coupled T1-T2 study appear to be more pathognomonic (hyposignal extended in T1 with hypersignal in T2, associated with a more marked subchondral hyposignal in T1 as in T2) particularly in relation to the osteonecrosis of femoral head.

A 21-year-old man presented with a 10-year history of a malabsorption syndrome of moderate severity, splenomegaly, and recurrent respiratory infections. Investigations revealed total atrophy of the villi and primary agammaglobulinemia. A gluten-free diet was ineffective. In spite of the absence of lambliasis, treatment with metronidazole produced objective clinical improvement and biological signs of healing of the malabsorption syndrome, but no alteration in the agammaglobulinemia. The authors discuss the relationship between total villous atrophy and primary agammaglobulinemias and the mode of action of metronidazole.

Exploration of acoustic neurinoma, the most frequent benign tumor of posterior fossa, now includes magnetic resonance imaging, and an C.G.R. supraconductor apparatus (0.5 Tesla) has been in use since March 1986. This equipment provides high resolution frontal sections, not only of posterior fossa but of the two pontocerebellar angles and even the contents of the two IAC (thin, contiguous 4 mm sections in 256 x 256 matrix). A total of 43 patients were examined, 37 with surgically confirmed acoustic neurinoma and 2 with tumor recurrence. The neurinoma appears on the first echo as a hyposignal in relation to brain stem in sequences predominant in T1 and as a hypersignal in relation to peripontic CSF in sequences predominant in T2. Short sequences predominant in Tl (partial saturation or short ET and RT spin-echos) appear to be most effective for detection of acoustic neurinoma. Comparison of MRI and CT scan imaging showed that firstly, all cases detected by conventional scanography were correctly analyzed by MRI, with superiority for MRI for preoperative screening due to the frontal sections obtained without interference and, secondly, the non-invasive confirmation of diagnosis in doubtful or negative cases requiring computerized gaz meatocisternography. No false negative or false positive results were reported in our series or those documented in the literature using this new imaging technique, but high performance apparatus is necessary (thin sections ans powerful principal magnetic field of at least 0.5 resla). Improvements in this method could be obtained by the availability of more rapid programmes, the use of surface coils and the injection of paramagnetic substances (galodinium chelates) presently under study. NMR imaging is a reliable and non-invasive imaging method capable of replacing the scanner for study of acoustic neurinoma as soon as more apparatuses become available.

Effectiveness of modern imaging techniques were compared when used for diagnosis of the painful hip in adults, particularly the distinction between aseptic osteonecrosis and decalcifying osteodystrophy. Although a small number of patients were studied (5 cases of osteonecrosis and 5 of decalcification) the series was homogeneous (same investigator for each technique and identical equipment for each patient), and the different methods of investigation (conventional radiology, scintigraphy computed scanography CE 10,000 and 0.15 resistive NMR imaging) could be validly compared. NMR images were recorded in only 5 patients but evaluation involved findings during use of this method of hip investigation over a period of 8 months. Results of comparison of the different imaging methods in osteonecrosis and osteodystrophy of hip showed conventional radiology to be much less effective for diagnosis. Conventional bone scintigraphy appeared to provide a good diagnostic approach, while C.T. images appeared to be as effective or even more specific than scintigraphy for differential diagnosis of the two affections. The only uncertainty is based on the radiologic latency in early stage disease, probably able to be filled by a densitometry. The use of NMR imaging appears to be promising, since it provides data as early as scintigraphy and as specific as scanography, particularly in view of apparent discrimination between osteonecrosis and osteodystrophy of the hip with respect to measurement of relaxation parameters.