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Introduction: The active surveillance (AS) of testicular tumors (seminoma and non-seminoma) is the most frequent management option in the stage I disease. Relapses generally occurred within the first 3 years and <5% appear after this time cut-off point is fulfilled. Therefore, the adherence is one of the most important pillars in the AS protocol. The aim of this study is to evaluate the adherence to the AS protocol in a community hospital and, in turn, evaluate the safety of it emphasizing in the relapse-free rate in patients with and without risk factors., Materials and Methods: A retrospective study of all the patients included in the AS protocol with seminoma tumors (ST) or non-seminoma tumors (NST) stage I was performed. Postoperative controls were performed according to the NCCN (National Comprehensive Cancer Network) recommendations. Different variables were taken into account, emphasizing in the risk factors: testicular tumor >4cm and the rete testis invasion in the ST, the linfovascular invasion and the percentage>40% of embrionary carcinoma in the NST. Adherence to the AS protocol was evaluated, focusing on those patients who lost it and what time it occurred., Results: A total of 64 patients were included. The median follow-up was 36 months (IC 21-48 months). 12 patients lost the follow-up during the protocol with a median follow-up of 27.5 months (IC 16-30 months). A 21.8% of patients entered in the AS protocol with some associated risk factor. Adherence follow-up was successful in the first year (96.8%) and decreased over time (92.2% at 24 months and 86.3% at 36 months)., Conclusion: We presented an important adherence to the AS protocol in patients with clinical stage I testicular cancer and in our series there no recurrences after 36 months of follow-up.

Anterior cruciate ligament (ACL) reconstruction with hamstring tendons has gained popularity in the past and is the most used type of graft in several national registries. It usually involves the harvest of both gracilis and semitendinosus tendons from the ipsilateral knee. More recently, the use of only 1 of the tendons (semitendinosus) in a tripled or quadrupled arrangement has been described, especially in an all-inside type of reconstruction. Having a thicker tendon with a quadrupled semitendinosus (ST), instead of double gracilis and ST enables to a have a graft with enough diameter to resemble more closely the native ACL and decreases the risk of graft rerupture. This Technical Note aims to present a way of reconstructing the ACL using a quadrupled ST graft, with suspensory cortical button in femur and interference screw in tibia, as an alternative to the all-inside technique., (© 2019 by the Arthroscopy Association of North America. Published by Elsevier.)

Introduction and Objectives: Nephron-sparing surgery (NSS) is the indication, provided it is feasible and meets the international treatment guidelines. One of the objectives of performing NSS is to reduce the ischemia time as much as possible. We propose a surgical technique for treating polar renal tumours and those larger than 4cm based on the principle of the technique described by Kim in 1964., Method: The technique performs a continuous circular suture on the base of the tumour, achieving compression of the renal pole without vascular clamping, facilitating haemostasis and avoiding the blind transfixion performed in Kim's original technique. We selected 28 patients for the implementation of the technique., Results: The patients' mean age was 56 years (30-69). The R.E.N.A.L. scores were as follows: 12 of low complexity, 12 of moderate complexity and 4 of high complexity. The mean surgical time was 109minutes (75-140), and the mean estimated blood loss was 120mL (50-300mL). No positive margins were identified, and no patients required blood transfusions. The mean stay was 3.7 days (2-6). There were no Clavien grade 2 or higher complications. There were 3 Clavien 1 complications (fever). The difference in glomerular filtration rate was -0.71mL/min/m 2 . The pathology was malignant in 26 cases, 19 of them clear-cell carcinomas. Two cases were reported as oncocytomas., Conclusion: The proposed technique showed acceptable results, with a low rate of complications in the patient group., (Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

The imaging work up of patients following trauma to the thorax and/or abdomen is dependent upon the hemodynamic and respiratory status. In patients with respiratory distress, management is based on a chest radiograph to detect pleural effusion or pneumothorax requiring immediate drainage. In patients with hemodynamic shock despite adequate resuscitation, FAST US may be the only imaging study performed, along with a chest radiograph, prior to laparotomy in the presence of hemoperitoneum. CT is the key to the management of patients with potentially severe trauma based on clinical findings and/or the nature of the trauma. CT analysis must be rigorous and exhaustive to detect lesions responsible for the clinical findings but also to identify dangerous lesions even if not currently symptomatic, such as contained isthmic aortic transection, bowel perforation or diaphragmatic injury. In patients with less severe trauma, the choice between chest radiographs and abdominal US, more economical, and with less radiation, and CT of the thorax and abdomen, more exhaustive and more accurate, will be discussed on a case by case analysis.

The use of CT in the diagnosis and management of liver trauma is responsible for the shift from routine surgical versus non-surgical treatment in the management of traumatic liver injuries, even when they are of high grade. The main cause of complication and of death in liver trauma is related to vascular injury. The goal of this review focussed on the vascular complications of liver trauma is to describe the elementary lesions shown by CT in liver trauma including laceration, parenchymal hematoma and contusions, partial devascularisation, subcapsular hematomas, hemoperitoneum, active bleeding, pseudoaneurysm of the hepatic artery, bile leak, and periportal oedema, to illustrate the possible pitfalls in CT diagnosis of liver trauma and to underline the key-points which may absolutely be present in a CT report of liver trauma. Then we will remind the grading system based on the CT features and we will analyze the interest and limitations of such grading systems. Last we will discuss the diagnostic strategy at the early phase in patients with suspected liver trauma according to their clinical conditions and underline the conditions of arterial embolization, and then we will discuss the diagnosis strategy at the delayed phase according to the suspected complications.

Traumatic injuries to the knee are frequent (road or sports related accidents, falls in elderly people). The Ottawa knee rules are applied and dictate the need for additional evaluation. Some fractures are adequately assessed on plain radiographs alone whereas other fractures (tibial plateau fracture) require additional evaluation with CT. Some fractures may be occult: the significance of lipohemarthrosis (indirect sign of intra-articular fracture on the lateral radiograph with horizontal beam) must be known. Benign appearing avulsion fractures suggest the presence of underlying capsuloligamentous injuries requiring further evaluation with MRI. The imaging work-up of sprains is usually negative. MRI may show areas of bone contusion that further the understanding of the mechanism of injury, predict and confirm the presence of capsuloligamentous injuries. Angiography is performed to detect popliteal artery injuries after knee dislocation which is associated with a risk of ischemia.

Destruction in diabetic feet is secondary to neuropathy (peripheral and autonomic nervous system) in association with microangiopathy. The loss of sensation to pain and the static trouble lead to increase the pressure in some areas and predispose to pedal skin ulceration, the precursor of osteomyelitis. Plain radiography should be the first step in the evaluation for diagnosis and follow-up. The initial patterns are nonspecific but very rapid evolution associating osteolysis, osteosclerosis and fragmentation lead to the Charcot foot. When osteomyelitis is suspected, scintigraphy with labelled white blood cells and MRI are necessary to differentiate infection from neuropathy.

The authors report a case of unilateral primary adrenal lymphoma presenting with abdominal and dorsal pain. Primary lymphoma of the genitourinary tract, specifically adrenal localisation, is a rare disease. CT is the current best imaging modality for evaluating retroperitoneal masses and improving detection, characterization as well as assessing extension. Diagnosis is based on histology.

Purpose: To show that flow-independent venography that exploit the intrinsic MR properties of blood to isolate vessels from surrounding structures can be used for depiction of peripheral veins and for detection of deep venous thrombosis (DVT)., Materials and Methods: Sequence and parameters were first determined on a theoretical basis. The sequence was then optimized in volunteers (N = 4) for the depiction of the peripheral venous vessels. Qualitative evaluation of the normal venous anatomy was performed in five volunteers. The feasibility of diagnosing DVT of the calf with this method was evaluated with preliminary clinical studies., Results: Excellent depiction of the venous anatomy was achieved in all volunteers with the optimized technique. Very small venous structures, such as superficial, muscular, and perforator veins, were clearly depicted because of the high spatial and contrast resolution capacities of the sequences. In all six patients, DVT findings diagnosed by duplex sonography were also seen on MR venography., Conclusion: Venous anatomy mapping and detection of lower-limb DVT appear feasible using flow-independent MR venograms., (Copyright 2003 Wiley-Liss, Inc.)

Purpose: To prospectively determine the accuracy of computed tomography (CT) in the detection of painful infection at the site of hip prosthesis before surgery., Materials and Methods: Helical CT examinations of hip prostheses were prospectively performed before surgery after a standard clinical and radiologic examination of 65 patients. CT scans and conventional radiographs were reviewed for periprosthetic bone abnormalities, and CT scans were reviewed for periprosthetic soft-tissue abnormalities (joint distention, fluid-filled bursae, and fluid collection in muscles and perimuscular fat). Patients subsequently underwent revision arthroplasty within 1 month, and infection was diagnosed in 12 (19%) patients., Results: Infection was detected clinically in 25% of patients. Periprosthetic bone abnormalities did not allow differentiation of infection from complications not related to sepsis, except for periostitis, with 100% specificity but only 16% sensitivity. Soft-tissue findings were accurate for detection of infection, with 100% sensitivity and 87% specificity. Fluid collection in muscles and perimuscular fat had a 100% positive predictive value, and absence of joint distention had a 96% negative predictive value., Conclusion: CT is accurate in the diagnosis of painful infection at the site of a hip prosthesis on the basis of soft-tissue findings, whereas periprosthetic bone abnormalities are not useful., (Copyright RSNA, 2002)

Purpose: Spontaneous blood echogenicity in vein ultrasound images may be a marker for an increased erythrocyte aggregability, but a reliable quantitative evaluation method is a prerequisite for its use in clinical studies. We compared a simple scoring system of blood echogenicity intensity and pattern, with automatic image analysis., Material and Methods: 157 femoral and popliteal vein digitized ultrasound sequences were reviewed by two independent observers who chose an image, delimited an area of interest (ROI), and graded blood echogenicity intensity and pattern, using a four class score. Each observer reviewed the images selected by the other, without and with ROI. The computer calculated first and second order parameters describing echo intensity and spatial organization., Results: Inter-observer reproducibility of subjective assessment was poor (Kappa<0.5), whereas the automatically calculated ROI average gray level intensity relatively to the whole image (tau(1)) effectively separated all grades of intensity. No parameter effectively separated patterns., Conclusion: Tau(1) is a simple parameter for the in vivo evaluation of blood echogenicity intensity. It should be evaluated in standardized conditions for clinical hemorheology studies in correlation with in vitro erythrocyte aggregation measurements.

Purpose: We studied pregnancy-induced changes in lower limb venous function., Methods: We used plethysmography and sonography to assess the changes in venous wall distensibility, saphenous vein diameters, and spontaneous blood flow echogenicity in the common femoral veins in 190 consecutive women during and after uncomplicated pregnancies (total of 409 examinations)., Results: The percentage of women with clinical symptoms and signs of venous insufficiency increased significantly during pregnancy. The mean diameters of the great and small saphenous veins also increased significantly, while occlusive venous plethysmography showed a decrease in parameters indicating vein distensibility. Spontaneous blood flow echogenicity in the common femoral veins was clearly visible or marked in 6% of cases during the first trimester of pregnancy, 63% during the second trimester, and 96% during the third trimester, versus 6% after delivery (p < 0.0001). The mean hematocrit decreased and the mean fibrinogen concentration increased during pregnancy., Conclusions: The increase in lower limb venous pressure seen during pregnancy leads to venous overdistention and worsens blood stasis. Decreased venous flow velocity and rheological alterations result in increased red cell aggregation, giving rise to spontaneous blood flow echogenicity. Spontaneous blood flow echogenicity is therefore a normal finding during pregnancy and should not be mistaken for venous thrombosis., (Copyright 2000 John Wiley & Sons, Inc.)

There have been many important analyses of prosthesis selection, techniques of implantation, and subpectoral or subglandular pockets, but only a few studies comparing and discussing the different approaches. The best incision must achieve a good and simple approach to the retromammary location, subpectoral or subglandular, preserving the anatomy to maintain the nerves and vessels responsible for the sensitivity and blood supply of the breast and avoiding cutting the ductus, and it must result in an inconspicuous scar. This article reports the authors' experience with the last 100 consecutive patients operated on with the triple-V transareolar technique based on the original reported by Ely. Follow-up took place over more than 2 years. The authors discuss the advantages and disadvantages of different incision placements.

Unlabelled: Single-injection medial canthus periocular anesthesia is a promising regional anesthesia technique for ophthalmic surgery. The purpose of this computed tomography (CT) study was to confirm that this technique is an episcleral injection and to explain why it provides a good akinesia of the globe. Four fresh nonpreserved cadavers (eight eyes) were injected with fractioned various volumes of a contrast media using a previously described technique. For each injection and each eye, CT scans were performed in three planes of the space, and the site and spread of the injection was observed. We confirm that single-injection medial canthus periocular anesthesia is, in fact, an episcleral anesthesia, which explains the good sensory block of the globe. When larger volumes are injected, the contrast media spreads to the lids and extraocular muscle sheaths. We believe that this may explain why this technique provides good sensory and motor block of the globe and eyelids. This technique is a promising alternative to both retro- and peribulbar anesthesia., Implications: We describe medial canthus single-injection periocular anesthesia by a computed tomography injection study in eight human cadaver eyes. It was confirmed to be an episcleral injection. Akinesia of the eyeball is provided by spreading of the local anesthetic solution from the episcleral space to the rectus muscle sheaths.

Acute deep venous thrombosis of the lower limb is a common and threatening condition whose clinical diagnosis is known to be unreliable. Sonography has gradually superseded venography as the primary diagnostic procedure. A review of the medical literature shows that sonography offers a high level of sensitivity and specificity in symptomatic patients but suffers from a lack of sensitivity at the calf level and in asymptomatic patients. Technologic progress, as well as increased operator experience, may improve sensitivity. Nevertheless, several critical issues remain unresolved, such as the significance of free-floating thrombi, the usefulness of calf and bilateral examination, the criteria that are essential to the diagnosis, the risk of compression sonography, and sonography's role in the direct detection of venous emboli.

Most techniques used so far for the evaluation of diaphragm kinetics are either invasive (electromyography, fluoroscopy), or indirect (respiratory pressures, impedance plethysmography). The aim of this study was to determine whether assessment with ultrasound or fluoroscopy differed, and which technique appeared more suitable in the investigation of quantitative hemidiaphragmatic displacement. Six patients (3 female, 3 male, aged 29 to 40) without respiratory disease were studied during systematic X-Ray chest examination, spirometry, and abdominal sonography. The amplitude of the right diaphragm motion could be measured in all patients with M-mode sonography as well as with fluoroscopy. The vertical ascending motion of the diaphragm measured by M-mode sonography, reached 60% of its maximum amplitude at 50% of inspiratory capacity. There was a significant correlation between the maximum amplitude of diaphragm motion as measured by M-mode sonography (5.8 +/- 0.4 cm; r = 0.89; p = 0.019) or fluoroscopy (5.6 +/- 0.7 cm; r = 0.84; p = 0.036) and the inspiratory capacity (2.73 +/- 0.39 l). M-mode sonography has technical, quantitative and qualitative advantages over fluoroscopy and should be the method of choice in the investigation of suspected diaphragmatic movement disorder. When coupled with other techniques like spirometry, this technique could represent a useful adjunct to functional respiratory studies.

Conventional or digital chest radiographs are usually efficient for diagnosis of minor chest trauma. The primary modality for diagnostic evaluation of severe blunt chest trauma remains chest X-ray. Other imaging modalities especially CT have to be performed. The management of these patients is based upon clinical and initial radiographic findings.

To improve the validity of a timed creatinine clearance as a measure of glomerular filtration rate (GFR), we investigated whether a single 800-mg dose of oral cimetidine was sufficient to inhibit tubular secretion of creatinine (TScr). Forty-five 3-hour timed creatinine clearances (Clcr) with single 800-mg dose oral cimetidine (TCC) in 17 renal transplant recipients with marked renal function impairment (creatinine 2.0 to 7.1 mg/dL) were compared with simultaneous [125I]-iothalamate GFR (Cliothal). For comparison, 13 timed Clcr without cimetidine (TC), and 36 24-hour Clcr were performed. The TCC was the most accurate: the ratio (mean +/- SD) of TCC:Cliothal was 1.12 +/- 0.02, compared with 1.33 +/- 0.08 for Clcr:Cliothal and 1.53 +/- 1.02 for TC:Cliothal. The difference between Cliothal and TCC was small over the range of GFRs tested (mean +/- 2 SD), 0.9 +/- 2.5 mL/min/1.73 m2. The intraclass correlation (R) for within-subject reproducibility of the TCC in five subjects was 0.8 (95 percent CI; 0.5, 0.9), and in 11 subjects who had at least three GFR determinations over 24 weeks, the TCC was as responsive to change in GFR as Cliothal. There was an inverse relationship between fractional excretion of cimetidine and GFR (r2 = -0.70), suggesting increased tubular secretion of cimetidine with decreasing GFR. In conclusion, a single 800-mg oral dose of cimetidine was effective in inhibiting TScr such that the TCC was an accurate, reproducible, and responsive test of GFR.

During the first 72 hours of their lives, 420 neonates were checked for retinal hemorrhages and macular affection. The neonate's gestational age, birth weight, and Apgar scores and maternal data (nulliparty, fetal presentation, duration of labor and delivery, induction of labor and obstetric technique) were all recorded. In 81 cases (19.2%), retinal hemorrhages were found. No significant relation was established with any of the associated factors, except for a significantly lower frequency of hemorrhages in cases of cesarean delivery (p < 0.01) and a significantly longer expulsive phase in the group with hemorrhages (p < 0.05). In follow-up examination 3 to 4 months later, neither the infants with hemorrhages nor the control group presented alterations.

Spondylodiscitis due to Citrobacter diversus is rare. An unusual case of bifocal cervical spondylodiscitis following transurethral prostatectomy is reported. C. diversus was detected by urinary cultures and locally by intervertebral disc puncture. Satisfactory recovery occurred after treatment with imipenem and amikacin, and then imipenem alone. Citrobacter infections are still rare in adults but are increasing in immunocompromised patients and sometimes occur in healthy subjects following surgery.

Rational and Objectives: The feasibility of tubal occlusion by selective salpingography was tested in an animal model; three novel occluding materials also were tested for this application., Methods: Unilateral selective salpingography was performed in three groups of six rabbits; fallopian tubes were embolized with ethanol (group 1), a hydrogel (group 2), or an occluding emulsion (Ethibloc, Laboratoire Princeps, Neuilly sur Seine, France) (group 3). Animals were killed 2 days or 30 days after the procedure, according to randomization; tubal patency and histologic modifications were evaluated., Results: Selective tubal catheterization was obtained in 100% of the cases. In group 1, no satisfactory occlusion was obtained; in group 2, 65% of the tubes were occluded with little histologic damage; in group 3, 80% of the tubes were occluded, but significant inflammation and tissue necrosis were noted., Conclusion: Selective salpingography proved a suitable method for gaining access to the fallopian tube and allowed selective injection of occluding materials. More research is needed to determine a suitable occluding material, focusing on biocompatibility and on long-term efficacy.

We describe an additional case of focal myositis presenting as a painful pseudotumor of the lower leg. Surgical biopsy showed typical features of myositis; the disease improved spontaneously, without clinical or biological abnormalities. Focal myositis can remain a localized process, but in some cases it can become an authentic polymyositis. These generalized forms are associated early with elevated erythrocyte sedimentation rate and/or muscular enzymes.

Ovarian vein thrombophlebitis is a rare condition but may be underdiagnosed because it is sometimes asymptomatic. The authors report a case of left ovarian vein thrombophlebitis complicated by pulmonary embolism, which was diagnosed by phlebography and treated by local thrombolysis.

The pathogenesis of portal hypertension in patients with lymphoproliferative and myeloproliferative disorders is not fully understood. We investigated 20 patients with myeloproliferative disease and 47 patients with lymphoproliferative disease. Transvenous liver biopsies and hepatic vein pressure gradient measurements were performed in all patients, and portal vein blood flow was measured by pulsed Doppler sonography in 31 of these patients and in 22 normal volunteers. The hepatic vein pressure gradient was significantly higher in patients with hepatic infiltrates, fibrosis or both than in patients without hepatic lesions (8.3 +/- 5.0 mmHg vs. 4.1 +/- 2.3 mmHg; p < 0.01). Portal vein blood flow was significantly higher in patients with hematological disease than in normal volunteers (31.2 +/- 15.5 ml/min.kg vs. 14.2 +/- 4.6 ml/min.kg;p < 0.01). In 81.8% of patients with hepatic infiltrates, fibrosis or both and increased portal vein blood flow, the hepatic vein pressure gradient was greater than 6 mm Hg. Although we saw a significant correlation between splenic vein blood flow and portal vein blood flow (n = 20; p < 0.01), we found no significant correlation between splenic vein blood flow and hepatic vein pressure gradient or spleen size. Hepatic infiltration and fibrosis appear to be major determinants of increased hepatic vein pressure gradient, probably because they increase intrahepatic vascular resistance. The role of increased splenic blood flow is probably not determinant. However, because portal pressure was not measured directly in this study, the incidence of portal hypertension may have been underestimated.

Lipomatous hypertrophy of the interatrial septum is characterised by an accumulation of fatty tissue in the interatrial septum. The authors report three cases, one presenting with sinus tachycardia and the other two being chance findings. Echocardiography associated with cardiac computerised tomography or magnetic resonance imaging usually confirms the diagnosis. In half the cases, supraventricular arrhythmias and suggestive P wave abnormalities are observed on the electrocardiogram. The diagnostic value of transoesophageal echocardiography is emphasised; it demonstrates the massive forms which may obstruct flow from the superior vena cava into the right atrium. The authors observe a discrepancy between the prevalence of this condition in autopsy series (about 1%) and the small number of cases described at echocardiography, suggesting that the diagnosis is probably missed.

A 21-year-old male of Moroccan descent was admitted for inflammatory polyarthralgia and monoarthritis of the left knee. The patient reported a history of recurrent isolated aphthous ulcerations of the oral cavity. He was found to be positive for the HLA B5 antigen. The other investigations for Behçet's disease were negative. During hospitalization, headache responsible for insomnia developed. Neurologic evaluation was normal, as well as funduscopy and spinal tap findings. CT scan images were suggestive of cerebral thrombophlebitis. Magnetic resonance imaging (MRI) disclosed an old thrombosis of the right transverse sinus. Time-of-flight MRI (MRI with sequences adapted to the study of vessels) evidenced recent thrombophlebitis of the left transverse sinus. Cerebral angiography fully confirmed MRI findings. Treatment with a corticosteroid and an anticoagulant was successful. Final diagnosis was Behçet's disease. Subsequently, the patient developed additional features of the disease, including hypersensitivity to pinprick, retinal vasculitis, and erythema nodosum. This case is interesting for two reasons: cerebral thrombophlebitis in Behçet's disease can manifest as localized headache. It occurs in 6 to 13% of patients. Early diagnosis and treatment are essential; MRI features of cerebral thrombophlebitis were confirmed by the cerebral angiogram. MRI established that the thrombophlebitis was of recent onset. MRI may be appropriate as the initial investigation in patients with suspected cerebral thrombophlebitis.

After a pelvic trauma, in a 78 years old women, systematic radiograms showed a polycyclic mass in the left side of the pelvis. This finding was confirmed by B-mode ultrasound echography. The vaginal touch found a pulsatile and expanding mass. At surgery, the diagnosis of a fissuring aneurysm of the internal iliac artery was confirmed, and a curative treatment was undertaken. Reviewing the literature, the authors emphasize the diagnostic usefulness of rectal and vaginal touch, and the importance of an early diagnosis using noninvasive imaging techniques. Surgery is the only treatment for isolated internal iliac aneurysms.

Marchiafava-Bignami disease (MBD) is a rare complication of chronic alcoholism. The clinical features, X-ray, CT and MRI findings are well documented. However, functional brain imaging has not been used in cases of MBD. We used single-photon emission computed tomography (SPECT) to monitor the regional cerebral blood flow in a patient suffering from a acute form of MBD, from which he subsequently recovered. Several abnormalities were found. A more frequent use of functional brain imaging in MBD could improve our knowledge of pathogenesis and prognosis for MBD.

The authors report two cases of arteriovenous fistula due to spontaneous rupture of an aortic or iliac aneurysm into the iliocaval venous axis. This is a rare complication of atheromatous aneurysm (less than 4% of ruptured aneurysms), often difficult to diagnose as the clinical presentation may be obscure. Although aortography is the reference diagnostic investigation, color Doppler ultrasonography enabled visualisation of the arteriovenous communication and provided an accurate diagnosis in one recent case. Treatment of these aortocaval fistulae is always surgical. The prognosis and immediate operative mortality depend mainly on the presence of an associated retroperitoneal rupture.

The study involved 70 patients considered to be sterile and in whom hysterosalpingography showed no tubal passage. Selective catheterisation enabled opacification under pressure in more than 80 p. cent of cases, with perfect visualisation of the entire tubes and significant peritoneal passage. In the presence of obstructive stenosis, disobstruction-reacanalisation using a soft probe was attempted with success in more than one case out of two. Future perspectives of selective salpingography appear to be very large. This technique seems to have a large number of indications apart from transport problems: recanalisation, sterilisation, and tubal antibiotic sensitivity studies.

A special technique giving good quality front and lateral chest roentgenograms in emergencies with no danger for the critically ill patient is described. The system consisted of a double-drawer plate-holder: one was passed at the back of the thorax, the other then being perpendicular to it. Placing the patient on an X-ray transparent stretcher made the technique easier. Several people were required to gently move the patient while the plate-holder was put in place.

Two properties of the laser beam can be used in medicine: coagulating and sectionning. The possibility for the beam to reach its target through an optic fibre, adaptable to the broncho-fibroscope, enables its use in bronchology. Two patients with a malignant tracheo-bronchial tumour received this treatment. Results were encouraging. Some practical applications are proposed.

Five cases of lethal midline granuloma are evaluated with computed tomography. CT examination is indispensable to appreciate extension of facial lesions, and detect lymphoma often associated.

In order to evaluate the usefulness of B-mode ultrasonography in the diagnosis of deep vein thrombosis, a prospective study was performed on 145 patients. Each patient was examined with occlusive venous plethysmography, continuous wave Doppler, real-time B-mode ultrasonography, and radiographic contrast phlebography. The diagnostic sensitivity and specificity versus phlebography were 91 and 82.1 per cent, respectively, for plethysmography, 92 and 86.6 per cent for Doppler, and 94 and 100 per cent for B-mode sonographic scanning. The combined noninvasive approach reached a 96 per cent sensitivity. B-mode ultrasonography demonstrated a mass in eight cases, and showed a superficial venous thrombosis in four cases, among the 45 patients without deep vein thrombosis. B-mode ultrasonography, therefore, appears to be very useful in obtaining a better specificity and differential diagnosis.

The purpose of this study was to evaluate the usefulness of abdominal ultrasonic tomography, among other methods, to detect visceral lesions in multiple traumas of the abdomen. Forty-seven case-records of abdominal traumas observed over an 8-month period were selected. We used a real-time sectorial ultrasound scanner with a 3.5 MHz probe. Positive results were obtained in 11 patients who were operated upon. None of the 33 patients with negative results and only one of the 3 patients with doubtful results underwent surgery. We found that suggestive symptoms were compatible with the absence of any severe visceral lesion and, conversely, that patients with multiple traumas but little suggestive symptoms could present with one or several intra-abdominal lesions. Abdominal ultrasonic tomography can rapidly be performed and its indications are different from, but wider than, those of peritoneal lavage. It is a safe and reliable emergency examination which does not interfere with resuscitation procedures.

We report a case of a bilateral multifocal renal oncocytoma and describe the features of different radiographic techniques emphasising the value of magnetic resonance imaging. This benign tumor is rare. Its preoperative differential diagnosis with renal cell carcinoma is very difficult, especially as its surgical treatment should be conservative.