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Background: Iodinated and gadolinium-based contrast media (ICM; GBCM) induce immediate hypersensitivity (IH) reactions. Differentiating allergic from non-allergic IH is crucial; allergy contraindicates the culprit agent for life. We studied frequency of allergic IH among ICM or GBCM reactors., Methods: Patients were recruited in 31 hospitals between 2005 and 2009. Clinical symptoms, plasma histamine and tryptase concentrations and skin tests were recorded. Allergic IH was diagnosed by intradermal tests (IDT) with the culprit CM diluted 1:10, "potentially allergic" IH by positive IDT with pure CM, and non-allergic IH by negative IDT., Findings: Among 245 skin-tested patients (ICM = 209; GBCM = 36), allergic IH to ICM was identified in 41 (19.6%) and to GBCM in 10 (27.8%). Skin cross-reactivity was observed in 11 patients with ICM (26.8%) and 5 with GBCM (50%). Allergy frequency increased with clinical severity and histamine and tryptase concentrations (p < 0.0001). Cardiovascular signs were strongly associated with allergy. Non-allergic IH was observed in 152 patients (62%) (ICM:134; GBCM:18). Severity grade was lower (p < 0.0001) and reaction delay longer (11.6 vs 5.6 min; p < 0.001). Potentially allergic IH was diagnosed in 42 patients (17.1%) (ICM:34; GBCM:8). The delay, severity grade, and mediator release were intermediate between the two other groups., Interpretation: Allergic IH accounted for < 10% of cutaneous reactions, and > 50% of life-threatening ones. GBCM and ICM triggered comparable IH reactions in frequency and severity. Cross-reactivity was frequent, especially for GBCM. We propose considering skin testing with pure contrast agent, as it is more sensitive than the usual 1:10 dilution criteria.

The posterior inferior cerebellar artery (PICA) is known to be very variable, and some of its anatomical variations can explain ischemic complications that occur during endovascular treatment of aneurysms. The authors report two cases of anatomical variation of the PICA that they have called its double origin, one of which gave rise to an aneurysm. The first patient was a 36-year-old man who presented with a subarachnoid hemorrhage related to the rupture of a PICA aneurysm. The aneurysm was treated by the endovascular route. Selective and superselective studies showed that the PICA origin was low on the fourth segment of the vertebral artery (VA). The aneurysm was located on an anastomosis between the PICA and a small upper arterial branch originating from the VA. Embolization was performed through the small branch with no problem, but a lateral medullary infarct followed, probably due to occlusion of the perforating vessels. The same anatomical variation was incidentally discovered in the second patient. To the authors' knowledge, neither this anatomical variation of the PICA nor the aneurysm's topography have been previously described angiographically. This highlights the role of angiography in pretreatment evaluation of aneurysms especially when perforating vessels or small accessory branches that are poorly visualized on angiographic studies are concerned, as in the territory of the PICA. Anatomy is sometimes unpredictable, and the surgeon must be very careful when confronted with these variations because they are potentially dangerous for endovascular treatment.

Aim of the Study: To define the role of harmonic imaging in the study of biliary lithiasis., Subjects and Methods: We included 50 consecutive patients with suspected biliary lithiasis. Three independent observers compared results of harmonic imaging and conventional ultrasonography., Results: This study showed a better interobserver agreement with harmonic imaging for acoustic shadow (kappa=0.87 vs 0.68) and intra-hepatic biliary stones (kappa=0.79 vs 0.49). More stones and more lithiasic gallbladders were seen with harmonic imaging (27 vs 24) and visualization of gallbladder sludge and the acoustic shadow from stones (P=0.01) was better. Ultrasound examination appears to be easier and faster and the diagnosis is more certain with harmonic imaging than with conventional ultrasonography (P=0.005)., Conclusion: Harmonic imaging provides more information on biliary lithiasis and a more certain diagnosis.

A 48-year-old woman presented with a symptomatic right subclavian steal syndrome due to proximal subclavian artery stenosis. Anatomically the innominate artery was absent. Collateral circulation followed the vertebro-vertebral pathway with reversal of blood flow in the ipsilateral vertebral artery. There was also multiple dilated intervertebral collaterals and an associated saccular aneurysm on one of them. Surgical carotid-subclavian transposition permitted relief of clinical symptoms, disappearance of collateral circulation and subtotal regression of the aneurysm. This spontaneous evolution confirmed the role of high-flow in the pathogenesis of some aneurysms and the habitually good prognosis of flow-related aneurysms with correction of the cause. Arteriography still appears essential in diagnosis, pretherapeutic assessment and sometimes post-treatment evaluation in subclavian steal syndrome.

Computed tomography examinations of the liver, kidneys, and pancreas were conducted in 466 patients over a period of one year, and both adrenals were visualized in 94 p. cent of cases. The adrenals were investigated during examination of the posterior submediastinal space in certain types of cancer, and clinically silent adrenal metastases were demonstrated in 14 patients with bronchial or pancreatic cancer. When computed tomography is employed for specific investigation of the adrenals (22 cases), the technique varies (5 mm thick sections, "angioscan"), and results are comparable with those of early renal tomography, ultrasonography, and scintigraphy. Computed tomography provides clearer evidence of small tumors (less than 2 mm in diameter) and hyperplasia, and can provide images that are perfectly correlated with operative findings, but not always with the histology of the lesions. A method for exploring the adrenals radiologically, including the use of computed tomography, is proposed as a function of the biological nature and size of the tumors.

The use of early nephrotomography has added a supplementary functional dimension to intravenous urography films, made after the rapid injection of 60 ml of contrast media in the form of an embolus. This method enables the corticomedullary junction to be visualized in the nephrography, which is an important point in differential diagnosis. An analysis is made of the results obtained from early nephrotomographies in 50 patients with acute or chronic renal insufficiency. Satisfactory nephrographies were obtained in all cases and the position and size of the kidneys could be established. Certain nephrotomographic abnormalities appear more frequently during the course of some types of chronic nephropathies, and this can assist aetiological classification. The existence of dilated secretory cavities in the superior part of the kidney can be established very quickly. In this way it is possible to differentiate clearly between parenchymatous nephropathies and those due to obstruction, such as when oliguria or anuria is present. The presence of a persistent homogenous nephrography would evoke, under these same conditions, an acute medical nephropathy.

Specific computed tomography findings in Budd-Chiari's syndromes are described, based on an analysis of images from five cases. Recognition of these signs assists diagnosis when little evidence of the disease exists or when atypical images are produced. The performance of an angioscan and the study of the changes on repeated imaging provides essential data for liver exploration: on the one hand these emphasize or even unmask the lesions (peripheral multi-lacunar images in the obstructed territory), and on the other hand they assess possible lesions of the inferior vena cava as well as lack of filling of the hepatic veins. Furthermore, they assist avoidance of the trap of pseudo-metastatic images by the particular kinetic of the attenuation of contrasts and the systematization of the lesions. The typical appearance of the liver in Budd-Chiari's syndromes probably results from the conjunction of histopathologic and hemodynamic modifications, notably localized inversions of portal flow and particular by-pass pathways. Computed tomography can be included in exploratory procedures as a non-invasive method capable of confirming the diagnosis of Budd-Chiari's syndrome and of orientating vascular explorations essential for pre-operative evaluation.

On the basis of a series of 25 cases of closed recent trauma of the kidney examined by scanner, the authors analyzed the information provided by the method and its correspondence with the various lesions encountered. In the course of this study, the scanner appeared to be the method of investigation which, at the present time, offers the best information concerning the severity of parenchymatous damage, as well as the size, nature and course of the perirenal blood or urine collections. Such data being fundamental to therapeutic decisions, the place of the scanner is essential in the evaluation of renal trauma, and, in severe forms, should be performed immediately after the irreplaceable I.V. urography performed as an emergency.

The exploration of the lower urinary apparatus was carried out using a 105 mm ampliphotography system. 230 examinations were performed according to several techniques: descending and micturition cystography; urethrocystography or retrograde and voiding cystography; cystography with suprapublic puncture; and cystometrography. An analysis of the results enabled an evaluation of the method. The morphological study may appear inadequate if electronic enlargement is not employed. The dynamic study is excellent in the diagnosis of diseases of the neck and uretheral stenosis. The limits of the amplifier field should not lead to a failure to recognize a possible vesicoureteral reflux. A decrease in the exposure dose makes it a technique of choice in children on the condition that the rate of exposures is not excessive and electronic enlargement is not performed too frequently.

Gelatinous disease of the peritoneum, designated by Anglo-Saxon authors as peritoneal pseudomyxoma is a rare affection characterized by the presence in the peritoneal cavity of a mucoid substance corresponding to an acid mucopolysaccharide. It develops secondary to an acid mucopolysaccharide. It develops secondary to mucosecreting malignant tumors, particularly of ovarian or appendicular origin, and its capacity to provoke multiple recurrences makes it of fairly poor prognosis. Diagnosis has been improved by the availability of non-aggressive investigations such as ultrasound and particularly computed tomography imaging. Suggestive CT scan signs are hepatic scalloping and a partitioned intraperitoneal effusion. Follow up scans can give data on the course of the disease and detect any complications (renal and digestive lesions, intraperitoneal abscess).

Computed tomography is a recently introduced, nonaggressive method of radiological investigation that can contribute to the study of hepatic tumors. Information obtained by using a third generation apparatus in six cases of benign hepatic tumor is reported, and compared with operative findings in five cases. The principal aspects, common to both ultrasonography and computed tomography examinations, are compared within the context of the pathological findings. Computed tomography is of value as a complementary investigation to reduce any possible insufficiency of ultrasonography examinations or to supply supplementary information during pre-operative tests.