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The retain project (Radiological Examination Transfer on ATM Integrated Network) consisted in teleradiology trials focused on pediatric imaging between two university hospitals. Rennes (France) and Barcelona (Spain) using an integrated broadband communication network based on ATM (asynchronous transfer mode), as part of a European research program. The network used was a full 10 Mbits/s ATM network directly connected to local PACSs (medical imaging hospital networks). One important reason to explicitly consider ATM for medical imaging is that multimedia applications on such networks allow integration of digital data and person-to-person communication. The utility of broadband communication for teleradiology has been confirmed. High quality video and sound are important for both human communication and medical video transfer. The project led to guidelines regarding technical options still open to improvement.

The Waldmann's disease or intestinal lymphangiectasia is a rare disease. We observed a case which occurred in a 14 years old boy. The disease was discovered in the screening of an intermittent diarrhea. The diagnosis was suspected on biological signs of protein-losing enteropathy and the presence of lymphangiectasias seen during endoscopy. The lymphography was conclusive showing the abnormal opacification of the mesenteric region. The other examinations were also important to assert the idiopathic origin of the disease.

Objectifs Revoir la semiologie tomodensitometrique de la carcinose peritoneale secondaire des tumeurs digestives alors que les progres du traitement medical et chirurgical ont relance l’interet de leur detection. Materiels et methodes Les auteurs revoient la litterature et, a partir de cas cliniques des differentes tumeurs digestives, illustrent les aspects tomodensitometriques de la carcinose peritoneale (ascite, infiltration mesenterique, implants peritoneaux tumoraux, envahissement du grand epiploon). Resultats La connaissance de la tumeur initiale permet de rechercher des signes de dissemination de contiguite (dans les grades eleves, a l’exception des localisations ovariennes des linites gastriques ou dans les cancers colorectaux) ou au contraire une implantation a distance dans les tumeurs mucineuses de bas grade (pseudomyxoma peritonei) ou les tumeurs gastriques. La sensibilite de detection est faible (entre 24 et 37 %) et est amelioree par les reconstructions multiplanaires. Le couplage a la TEP permet d’augmenter sensibilite et specificite. Le scanner permet de guider des prelevements, de planifier la chirurgie et de suivre une chimiotherapie de reduction. Conclusion Dans les cancers digestifs, le scanner abdominal est un examen peu sensible mais assez specifique pour le diagnostic de carcinose peritoneale.

The paper starts by presenting the major PACS (Picture Archiving and Communication Systems) related concepts and highlights the medical motivations which resulted in PACS developments. The authors review some PACS experiments carried out during the last decade and draw the conclusions of these experiments; the experience of the University Hospital of Rennes is also briefly presented. Finally a discussion is engaged about the future of PACS and their position within the Hospital Information System. According to the authors, this process should not be confined within the small community of PACS specialists but should concern all actors of the hospital, namely medical staff involved in the production or utilisation of medical images, technical staff in charge of equipment and the Hospital Information System, and hospital administrators. Three major lines are proposed: the first one deals with the functional capacities of PACS and their adaptation to actual user needs; the second concerns the methodology required to set up such systems to ensure adequate integration within the HIS and the third concerns economic issues.

The authors report 6 cases of portal hypertension with gastrorenal shunt. This shunt did not arise from the left gastric vein, but from the splenic vein. Portal hypertension was related to alcoholic cirrhosis in 3 cases, to extensive portal thrombosis in 2 cases, and to nodular regenerative hyperplasia of the liver in one case. A gastrointestinal hemorrhage revealed portal hypertension and the liver disease in the 3 cases of alcoholic cirrhosis and complicated the course of the disease in the other cases. Hemorrhage was either massive and life-threatening or often recurred. It was related to a rupture of fundic varices in all cases. The fundic varices were not associated with esophageal varices in the 3 cases of cirrhosis. The degree of portal hypertension was above 20 mm Hg, as assessed by the portohepatic gradient (one case), or the pressure gradient between a tributary portal system vein and the inferior vena cava during laparotomy (5 cases). Definitive control of hemorrhage could not be achieved by endoscopic variceal sclerotherapy (2 cases) or percutaneous transhepatic embolization (one case). Portacaval shunt or splenectomy was performed in 5 cases. These findings suggest that spontaneous splenogastrorenal shunt is a clinical and hemodynamic entity which requires specific treatment when associated with gastric variceal bleeding.

We report a case of partial pancreatic agenesis in a 25-yr-old man with insulin-dependent diabetes who exhibited abdominal pains in relation to a calcifying chronic pancreatitis. An endoscopic retrograde pancreatography through the accessory papilla revealed an abnormal duct configuration thought to be consistent with an obstruction of the main duct. Ultrasonography and computerized tomography scanning could not identify any pancreatic tissue in the region of the body or tail. Another endoscopic investigation revealed the main papilla in the third part of the duodenum. The ducts of Santorini and Wirsung were identified. Santorini's duct was dilated and contained calculi. Wirsung's duct was nearly normal. The junction between the two ducts was slightly narrowed. After papillotomy of the accessory papilla, the patient's abdominal pains disappeared. This new case of congenital short pancreas is discussed in relation to four other cases reported in the English and French literature.