El esquema de biopsia transrectal puede predecir la gradación histológica incorrecta del cáncer de próstata

Objective

To identify factors that might explain why a prostate with a Gleason score (GS) <7 in the biopsy specimen can turn out to have a GS ≥7 in the surgical specimen.

Material and methods

We compared the GS of biopsy specimens with the GS of surgical specimens in 185 patients who underwent surgery for prostate cancer. We calculated the sensitivity, specificity, and predictive values for the GS of the biopsy specimens. We used Cohen's kappa to determine the degree of concordance between a GS of <7 and ≥7 for the biopsy specimen and the surgical specimen. Age, a family history of prostate cancer, total prostate-specific antigen (tPSA), digital rectal examination, prostate structure and volume, and the number of biopsy cores (biopsy scheme) were analyzed using multivariable logistic regression.

Results

Histological study of biopsy specimens yielded high sensitivity (98%) but low specificity (49%) for GS ≤6 and low sensitivity (35, 26%) and high specificity (93, 99%) for GS=7 and GS ≥7, respectively. Cohen's kappa for the GS from the biopsy and surgical specimens was 0.43 (95% CI=30-56%). The biopsy scheme was the only predictor of discordance in the GS between the two techniques. Among the other variables included in the model, only tPSA showed a slightly significant association. Taking a scheme with less than 7 cores as a reference, we found no difference with 8 to 9 cores but we did find a difference with 10 to 11 cores and with 12 or more cores, with a prevalence ratio of 0.138 (95% CI=0.030-0.513) and 0.277 (95% CI=0.091-0.806), respectively.

Conclusion

The GS of the biopsy depends on the scheme. This factor must be taken into account when choosing a treatment option in patients with low tumor grade in biopsy specimens.     

Cribado de cáncer de mama. Estado actual

The currently available scientific evidence attests that mammographic screening and quality treatment have been able to reduce mortality attributable to breast cancer. Although screening is not without risks, population-based screening has clear advantages over opportunistic detection. Following the Council of the European Union's “Recommendations on cancer screening”, all the regional Autonomous Communities in Spain have screening programs that, in general, follow the same guidelines. The “European guidelines for quality assurance in breast cancer screening and diagnosis” serve as a reference that provides an overview of all aspects of screening. To achieve the foreseen objectives for the reduction of the morbidity and mortality attributable to breast cancer, screening programs must fulfill the established quality criteria and guarantee that patients have access to the best treatment options.     

Los elementos decorativos ambientales en el Área de Imagen Médica mejoran la percepción de agradabilidad del paciente

Objectives

To evaluate the sensation of pleasantness perceived by patients attended in the radiology department in response to decorative elements hung on the walls in the waiting rooms and in the hallways of the imaging area.

Material and methods

The material resources comprised works of art in the form of “magic windows” representing scenes from nature installed on the ceilings and walls of the waiting area and hallways of the imaging area. Patients were given a brief questionnaire with general data and questions (sadness-cheerfulness, coldness-warmth, darkness-light, and pessimism-optimism) about their perception of the decorative elements.

Results

Of the 150 questionnaires collected, 142 were filled out correctly. The overall health of these patients was good in 84 (56%), not bad in 58 (39%), and poor in 8 (5%). The idea seemed very good to 70 patients (47%), good to 58 (39%), not bad to 8 (5%), indifferent to 11 (7%), bad to 1 (1%), and very bad to 2 (1%). As far a patients’ mobility, 119 patients (79%) walked into the department, 18 (12%) were wheeled in on beds, and 13 (9%) needed wheelchairs.

Conclusions

We found a high level of satisfaction with the decorative elements.     

Coronariografía mediante tomografía computarizada con sincronización prospectiva. Comparación de la calidad de imagen y dosis de radiación con equipos de 128 detectores de fuente única y doble fuente

Objective

To compare the image quality and radiation dose in a group of patients undergoing coronary CT angiography using a 128-slice dual source helical CT scanner with high pitch alto and prospective acquisition with those in a group of patients with similar clinical characteristics undergoing coronary CT angiography using a 128-slice single-source CT scanner with prospective sequential acquisition.

Material and methods

We included 80 patients with heart rates ≤65 beats/min: 40 underwent sequential 128-slice single source CT with prospective synchronization and the other 40 underwent 128-slice dual source helical CT with high pitch and prospective synchronization. Two radiologists independently assessed the quality of the images of the coronary arteries on the 80 coronary CT angiograms: image quality was classified on a four-point scale in which 1 represented excellent and 4 deficient. The effective dose of radiation was also calculated.

Results

The clinical characteristics of the patients in the two groups were similar. The image quality obtained with dual source CT was significantly better than that obtained with single source CT (P=0.006). The mean effective dose of radiation in the group undergoing dual source CT was 36% lower than in the group undergoing single source CT (1.4±0.6 mSv vs. 2.2±0.9 mSv; P<0.01).

Conclusion

Although both sequential 128-slice single source CT with prospective acquisition and 128-slice dual source helical CT with high pitch and prospective acquisition provide good image quality and low effective doses of radiation, 128-slice dual source helical CT with prospective acquisition provides better image quality and results in a lower effective dose of radiation.     

Secuencia de disparo único eco de gradiente en fase y fase opuesta con preparación de la magnetización: descripción y optimización de la técnica con equipo de 1,5 T

Purpose

To implement in-phase and out-of-phase (IP/OP) techniques with Magnetization-Prepared Gradient Recalled Echo (MP-GRE) and to evaluate the feasibility and diagnostic image quality among pre and post-optimized MP-GRE sequences, including patients unable to cooperate with breath-hold requirements.

Materials and methods

Institutional review board approval with waiver of informed consent was obtained for this HIPAA-compliant retrospective study. Two groups of patients were included in the study, before and after optimization of MP-GRE parameters, with seventy-three (24 noncooperative/49 cooperative) and sixty-four (22 noncooperative/42 cooperative) consecutive patients, respectively. The motion-insensitive sequence used in this study was a single-shot 2D MP-GRE. Two radiologists qualitatively evaluated the sequences to identify the presence of phase cancellation artifact in OP images and to determine image quality, extent of artifacts (respiratory ghosting, bounce-point artifact, spatial misregistration and pixel graininess) and lesion conspicuity on the various sequences. The ability to visually detect liver steatosis and fatty adrenal adenomas was evaluated. Qualitative analyses were compared using the Wilcoxon and Mann-Whitney tests.

Results

There were statistically significant differences between all MP-GRE sequences concerning phase cancellation artifact (P<.0001) which was present in MP-GRE OP sequences and negligible to absent in the pre (IP₁) and post-optimized (IP₂) MP-GRE IP sequences, respectively, in all patients.Bounce point artifacts were significantly more pronounced in MP-GRE IP₁ (P<.0001). Spatial misregistration was slightly more prominent in noncooperative patients with MP-GRE IP₂ (P=.0027). MP-GRE OP and MP-GRE IP₂ showed significantly higher overall image quality (P<.0001).MP-GRE sequences subjectively identified hepatic steatosis (n=20) and adrenal adenomas (n=5) based on signal loss from IP to OP sequence.

Conclusion

Single shot IP/OP MP-GRE is feasible and allows motion resistant imaging with adequate diagnostic image quality. This technique is able to provide IP and OP information in patients unable to suspend respiration.     

Interval breast cancers: Absolute and proportional incidence and blinded review in a community mammographic screening program

Purpose

To evaluate the performance of the first years since the beginning of a mammographic population-based screening program.

Materials and methods

Women aged 49–69 were invited biennially for two-view film-screen mammography and double reading without arbitration was performed. Interval cancers (ICs) from 2001 to 2006 were identified using screening archives, local pathology archives, and hospital discharge records. The proportional incidence of IC was determined considering breast cancers expected without screening. Three offsite radiologists experienced in breast cancer screening blindly evaluated mammograms prior to diagnosis, randomly mixed with negative mammograms (1:2 ratio). Cases unrecalled at review were considered as true ICs, those recalled by only one reviewer as minimal signs, and those recalled by two or three reviewers as missed cancers. T and N stage of the reviewed ICs were evaluated and compared.

Results

A total of 86,276 first level mammograms were performed. Mean recall rate was 6.8% at first and 4.6% at repeat screening. We had 476 screen-detected cancers and 145 ICs (10 of them ductal carcinomas in situ). Absolute incidence was 17 per 10,000 screening examinations. Invasive proportional incidence was 19% (44/234) in the first year, 39% (91/234) in the second year, and 29% (135/468) in the two-year interval. Of 145 ICs, 130 (90%) were reviewed mixed with 287 negative controls: 55% (71/130) resulted to be true ICs, 24% (31/130) minimal signs, and 22% (28/130) missed cancers. The rate of ICs diagnosed in the first year interval was 21% (15/71) for true ICs, 46% (13/28) for missed cancers, and 39% (12/31) for minimal signs, with a significant difference of true ICs rate compared to missed cancers rate (p = 0.012). A higher rate of T3 and T4 stages was found for missed cancers (18%, 5/28) compared to minimal signs (6%, 2/31) or true ICs (8%, 6/71), while the rate of N2 and N3 stage for both minimal signs (19%, 6/31) or missed cancers (25%, 7/28) was higher than that for true ICs (10%, 7/71), although all these differences were not significant (p ≥ 0.480).

Conclusion

These results showed the possibility to comply with European Community standards in the first years of a screening program implementation.     

Initial LDCT appearance of incident lung cancers in the ITALUNG trial

Objectives

To characterize early features of lung cancers detected with low-dose computed tomography (LDCT) screening.

Materials and methods

Two radiologists reviewed prior LDCTs in 20 incident cancers diagnosed at annual repeat screening rounds and 83 benign nodules observed in the ITALUNG trial.

Results

No abnormality was observed in 3 cancers. Focal abnormalities in prior LDCT were identified in 17(85%) cancers (14 adenocarcinomas; 14 stage I). Initial abnormalities were intra-pulmonary in 10, subpleural in 4 and perifissural in 3. Average mean diameter was 9 mm (range 4.5–18 mm). Nine exhibited solid, 4 part-solid and 4 non-solid density. The margins were smooth and regular in 5 cases, lobulated in 6, irregular with spiculations in 3 and blurred in 3. Ten (59%) initial focal abnormalities had a round or oval nodular shape, but 7(41%) had a non-nodular complex (n = 5) or “stripe-like” (n = 2) shape. Bronchus sign was observed in 3 cases and association with cystic airspace in 2 cases. Non-solid density, complex or “stripe-like” shape, bronchus sign and association with cystic airspace had a specificity higher than 90%, but positive predictive value of every feature of incident lung cancers was low (range 10.4–50%).

Conclusions

The vast majority of cancers diagnosed at annual repeat show corresponding focal lung abnormalities in prior LDCTs. Perifissural location and non-nodular shape do not exclude the possibility of early lung cancer. Since specificity of the early features of incident lung cancer is incomplete and their positive predictive value is low, all focal pulmonary abnormalities detected in screened subjects should be re-evaluated in subsequent LDCTs.     

Single reading with computer-aided detection performed by selected radiologists in a breast cancer screening program

Objectives

To assess the impact of shifting from a standard double reading plus arbitration protocol to a single reading by experienced radiologists assisted by computer-aided detection (CAD) in a breast cancer screening program.

Methods

This was a prospective study approved by the ethics committee. Data from 21,321 consecutive screening mammograms in incident rounds (2010–2012) were read following a single reading plus CAD protocol and compared with data from 47,462 consecutive screening mammograms in incident rounds (2004–2010) that were interpreted following a double reading plus arbitration protocol. For the single reading, radiologists were selected on the basis of the appraisement of their previous performance.

Results

Period 2010–2012 vs. period 2004–2010: Cancer detection rate (CDR): 6.1‰ (95% confidence interval: 5.1–7.2) vs. 5.25‰; Recall rate (RR): 7.02% (95% confidence interval: 6.7–7.4) vs. 7.24% (selected readers before arbitration) and vs. 3.94 (all readers after arbitration); Predictive positive value of recall: 8.69% vs. 13.32%. Average size of invasive cancers: 14.6 ± 9.5 mm vs. 14.3 ± 9.5 mm. Stage: 0 (22.3/26.1%); I (59.2/50.8%); II (19.2/17.1%); III (3.1/3.3%); IV (0/1.9%). Specialized breast radiologists performed better than general radiologists.

Conclusions

The cancer detection rate of the screening program improved using a single reading protocol by experienced radiologists assisted by CAD, at the cost of a moderate increase of the recall rate mainly related to the lack of arbitration.     

Hallazgos radiológicos en tomografía computarizada de los tumores carcinoides bronquiales típicos y atípicos

Objective

To define the CT findings for bronchial carcinoid tumors and to determine whether these findings enable these tumors to be classified as typical or atypical.

Material and methods

We reviewed the chest CT studies performed between 1 January 2001 and 31 December 2009 in patients at our hospital diagnosed with bronchial carcinoid tumors. The sample consisted of 52 patients (23 women and 29 men) with a mean age of 47 years (range 11-77 years). The 52 cases were classified as typical or atypical on the basis of the following radiological findings: size, location, focality, type of growth, calcifications, signs secondary to bronchial obstruction, and the presence of significant lymph node enlargement or metastases. These findings were then compared with the histological findings.

Results

Typical carcinoid tumors were the most prevalent (46 cases). The variables associated with atypical tumors were: male sex, advanced age at onset, and size > 3 cm. The accuracy of CT in classifying atypical tumors correctly increased with the number of variables indicative of atypical carcinoid tumors. A negative result for atypical nature made it possible to rule out an atypical carcinoid tumor in 95% of the cases.

Conclusion

CT is useful for defining and characterizing carcinoid tumors into typical or atypical, although a precise formula for differentiating between the two types remains to be defined.     

Qualités physiques requises pour la performance en sprint avec changements de directions types sports collectifs

Purpose

To explore qualities necessary to succeed in (swerve-sprinting) sprints with changes of direction.

Method

Two biometric measurements (body mass (MC); lean body mass (MM)) and three tests (20 m sprint two-point start 20 Da, 20 m swerve-sprint: 20Dc on track equipped with a force platform, and half squat) are carried out by nine players of team sports.

Results

The multiple linear regression shows that 44% of 20Dc performance are explained by relative maximum force (developed on the 20 Da) and the MM relative.

Conclusion

Coordination could represent 50% of unexplained 20Dc performance.     

Reproducibilidad y exactitud en la cuantificación morfométrica y mecánica del hueso trabecular a partir de imágenes de resonancia magnética de Tesla

Objective

We used an animal model to analyze the reproducibility and accuracy of certain biomarkers of bone image quality in comparison to a gold standard of computed microtomography (μCT).

Material and methods

We used magnetic resonance (MR) imaging and μCT to study the metaphyses of 5 sheep tibiae. The MR images (3 Teslas) were acquired with a T1-weighted gradient echo sequence and an isotropic spatial resolution of 180 μm. The μCT images were acquired using a scanner with a spatial resolution of 7.5 μm isotropic voxels. In the preparation of the images, we applied equalization, interpolation, and thresholding algorithms. In the quantitative analysis, we calculated the percentage of bone volume (BV/TV), the trabecular thickness (Tb.Th), the trabecular separation (Tb.Sp), the trabecular index (Tb.N), the 2 D fractal dimension (D^2D), the 3 D fractal dimension (D^3D), and the elastic module in the three spatial directions (Ex, Ey and Ez).

Results

The morphometric and mechanical quantification of trabecular bone by MR was very reproducible, with percentages of variation below 9% for all the parameters. Its accuracy compared to the gold standard (μCT) was high, with errors less than 15% for BV/TV, D^2D, D^3D, and E_appx, E_appy and E_appz.

Conclusions

Our experimental results in animals confirm that the parameters of BV/TV, D^2D, D^3D, and E_appx, E_appy and E_appz obtained by MR have excellent reproducibility and accuracy and can be used as imaging biomarkers for the quality of trabecular bone.     

Energía dual y angioTC de carótidas: calidad,eliminación de hueso y dosis de radiación de 80/140 kV frente a 100/140 kV

Objective

To study the differences in vascular image quality, bone subtraction, and dose of radiation of dual energy CT angiography of the supraaortic trunks using different tube voltages.

Material and methods

We reviewed the CT angiograms of the supraaortic trunks in 46 patients acquired with a 128-slice dual source CT scanner using two voltage protocols (80/140 kV and 100/140 kV). The “head bone removal” tool was used for postprocessing. We divided the arteries into 15 segments. In each segment, we evaluated the image quality of the vessels and the effectiveness of bone removal in multiplanar reconstructions (MPR) and in maximum intensity projections (MIP) with each protocol, analyzing the trabecular and cortical bones separately. We also evaluated the dose of radiation received.

Results

Of the 46 patients, 13 were studied using 80/140 kV and 33 with 100/140 kV. There were no significant differences between the two groups in age or sex. Image quality in four segments was better in the group examined with 100/140 kV. Cortical bone removal in MPR and MIP and trabecular bone removal in MIP were also better in the group examined with 100/140 kV. The dose of radiation received was significantly higher in the group examined with 100/140 kV (1.16 mSv with 80/140 kV vs. 1.59 mSv with 100/140 kV).

Conclusion

Using 100/140 kV increases the dose of radiation but improves the quality of the study of arterial segments and bone subtraction.     

Embolización selectiva como tratamiento de la hemorragia obstétrica

Objective

To describe cases of obstetric hemorrhage that have called for selective intra-arterial embolization and the different embolization techniques used. To assess the clinical outcomes and postprocedural fertility.

Material and methods

We studied 27 women with obstetric hemorrhage. In 24 patients, embolization was performed by catheterizing both uterine arteries and in 2 patients only one uterine artery was catheterized (pseudoaneurysm). The materials used for embolization consisted of Spongostan in 17/27, particles in 9/27, and coils in 1/27. Clinical follow-up included an analysis of early and late complications and of postprocedural fertility.

Results

Hemorrhage was classified as primary (25/27) or secondary (2/27).The cause of bleeding was vaginal delivery (20), cesarean sections (5), abortion (1), and cervical ectopic pregnancy (1).The initial technical success rate was 100% and the clinical success rate was 92.6% (25 of the 27 patients).Bleeding ceased and the outcome was satisfactory in 25 patients. During clinical follow-up ranging from one to seven years, 23 patients had normal menstruation and 6 patients completed 7 full-term pregnancies.

Conclusion

Intra-arterial embolization for obstetric hemorrhage leads to good outcomes and few complications and it preserves fertility.     

Técnicas de recanalización vertebrobasilar antes de la introducción de las endoprótesis recuperadoras: la reapertura no es sinónimo de buena evolución

Objectives

To evaluate the recanalization rate and clinical outcome three months after endovascular treatment for vertebrobasilar occlusion before the placement of stentrievers.

Material and methods

We reviewed all cases of basilar thrombosis treated with endovascular techniques at our center. We reviewed the clinical outcomes with the main objective of determining the recanalization rate and the secondary objective of evaluating the outcome using the modified Rankin scale (mRS) three months after treatment. We assessed clinical and angiographic variables and correlated them with outcome and complications.

Results

We reviewed a total of 27 consecutive patients (mean age, 58.1 ± 15.5 y; median National Institutes of Health Stroke Scale (NIHSS), 21, interquartile range, 18-29; median Glasgow coma score (GCS) 7, interquartile range, 4-9.5). The mean time between the onset of symptoms and endovascular treatment was 26.3 ± 41.7 hours. Complete or partial recanalization was achieved in 23 (85.1%) patients. Three months after treatment, 16 (59.2%) had died and 6 (22.2%) had good outcome (mRS ≤ 2).

Conclusion

Endovascular treatment achieved a high rate of recanalization of occlusions of the basilar artery. Nevertheless, a high percentage of the patients did not have a good outcome. New materials might improve the prognosis in these patients.     

Previous imaging findings of breast cancers that occurred in combined screening negatives

Purpose

To retrospectively evaluate previous imaging findings of breast cancers that occurred in women whose combined screening using both mammography and ultrasonography was negative.

Materials and methods

A search of the institutional database identified 65 patients with breast cancers who had comparable previous negative screening mammography and ultrasonography (BI-RADS category 1 or 2) within 2 years. We classified each case as true or false negative. The previous imaging findings and the final outcome were analyzed.

Results

Among 65 cases, 42 (65%) were true negatives, 23 (35%) were false negatives. The abnormalities of false negatives were underestimated in 16 (70%) and unrecognized in 7 (30%). The findings were calcifications (n = 8) or a mass (n = 6) on mammography, a mass (n = 5) or a non-mass (n = 3) on ultrasonography and a density on mammography correlated with non-mass on ultrasonography (n = 1). Ductal carcinoma in situ among false and true negatives accounted for 5 (22%) and 7 (17%), respectively. Symptomatic cancers among false and true negatives were 6 (26%) and 13 (31%), respectively.

Conclusion

Breast cancers that rarely occurred in combined screening negatives are often retrospectively seen as minimal abnormalities on previous imaging studies.     

Características en tomografía computarizada de la isquemia cecal aislada

Objective

The aims of this review are to describe the main characteristics for the CT diagnosis of isolated caecal ischaemia (ICA) and give details of the differential diagnosis with other conditions with a similar clinical picture.

Material and methods

A retrospective study was conducted to review the CT findings of 4 patients diagnosed with ICA in our hospital. The parameters recorded to analyse their characteristics in the CT were: maximum thickness of the caecum wall, the appearance of the peri-caecum fat, presence of free fluid, signs of caecal or portal pneumatosis, the appearance of the caecal appendix, and general signs of the presence of vasculopathy.

Results

In all cases it was recorded that there was a thickening of the walls of the blind loop with an abrupt transition between the caecal wall and the walls of the ascending colon wall. In all cases the caecal thickening had a characteristic image in the central area. Signs of caecal pneumatosis were observed in two cases. All of them had an appendix with normal characteristics.

Conclusions

The combination of caecal wall thickening with oedematous characteristics, with no changes in the appendix, ileum and colon, suggest the diagnosis of caecal ischaemia, particularly with the presence of pneumatosis.     

Tratamiento endovascular de estenosis intracraneales sintomáticas: resultados a corto y largo plazo de un único centro

Objectives

We present the short- and long-term results of a series of patients with symptomatic intracranial arterial stenoses treated with angioplasty and stenting.

Material and methods

We reviewed patients with symptomatic intracranial stenoses greater than 50% who were treated with angioplasty, stenting, or both. We recorded demographic data and risk factors (hypertension, diabetes, dyslipemia, ischemic heart disease). We classified all lesions treated according to their location, degree of stenosis, and length. The degree of stenosis was classified as moderate (50%-70%) or severe (>70%). In the follow-up, we assessed cerebrovascular accidents, episodes of ischemic heart disease, and deaths in the first 30 days and in later follow-up.

Results

Between 2006 and 2010, we treated 26 patients (21 men and 5 women; age range, 44-79 years; mean age, 63 years) with 29 intracranial lesions. The endovascular procedure (angioplasty + stenting) was successfully performed in 23 cases (92.0%). In the first 30 days after the procedure, 3 (11.5%) patients had adverse effects of vascular origin: 1 stroke, 1 hemorrhage, and 1 death due to thrombosis of the stent. Long-term follow-up (5-46 months) in the 25 patients who survived more than 30 days detected no recurrence of symptoms.

Conclusion

Endovascular treatment of intracranial stenosis is technically feasible. Short-term complications are highly prevalent. No recurrence of symptoms was detected during long-term follow-up.     

A careful evaluation of scout CT lateral radiograph may prevent unreported vertebral fractures

Objectives

Our purpose was to review scout CT lateral radiographs to reveal osteoporotic vertebral fractures unreported by radiologists and to explore scout CT as a potential diagnostic tool in the detection of vertebral fractures.

Methods

We considered 500 patients (303 males, 197 females, age 64.6 ± 13.5 year-old). Our investigation was firstly focused on scout CT lateral images to detect vertebral fractures with a combined semiquantitative and quantitative diagnostic approach. Findings addressed to vertebral fracture were subsequently confirmed by multiplanar sagittal CT reconstructions. Whenever a vertebral fracture was discovered the radiologist report was read and a collection of patient anamnesis followed to understand whether fractures were already known.

Results

In 44/500 patients (8.8%) the evaluation on scout CT was incomplete or limited for patient/technical-based conditions, and 15 were excluded from the analysis. In 67/485 patients (13.8%) 99 vertebral fractures were detected. Among 67 fractured patients only 18 (26.9%) were previously diagnosed by radiologists. However, in the clinical history of 32 patients vertebral fractures were already known.

Conclusions

The perception and sensibility to vertebral fractures among radiologists are still poor when the assessment of the spine is not the aim of the examination. Short time spent for the evaluation of scout CT lateral radiographs could improve our accuracy.     

Historia natural de la hernia de disco lumbar. ¿Tiene el realce con gadolinio valor pronóstico?

Objectives

To evaluate the percentage of disc hernias that have disappeared after one year of follow-up and the time to disappearance. To determine whether gadolinium enhancement is useful for predicting whether the hernia will disappear. To analyze whether the pattern of enhancement can help predict whether the fragment will disappear.

Material and methods

This prospective study included 118 patients with acute symptoms of lumbosciatica and a herniated disc diagnosed by CT. In 72 patients, we performed gadolinium-enhanced MRI every 6 months for one year or until the herniation disappeared; we related the findings of protrusion, extrusion, and the enhancement pattern with the disappearance or persistence of herniated disc material. We analyzed the results with univariate and multivariate statistics.

Results

The 59% of the hernias disappeared within 1 year of follow-up and 66% disappeared within the first 8 months of follow-up. The 83% of the extruded hernias disappeared, and this was significant in the multivariate analysis (P<.005). The absence of enhancement was significantly associated with the persistence of the hernia in the univariate analysis. The enhancement pattern was not useful for predicting whether the hernia would disappear. Five hernias disappeared within the first two months.

Conclusions

A high percentage of disc hernias disappear. We found a significant association between extrusion and disappearance but no correlation between the pattern of gadolinium uptake and the disappearance of the hernia.     

Contribution à l’étude des effets d’un programme de réentraînement à l’effort sur les aptitudes physiques de patients atteints de bronchopneumopathie chronique obstructive

Aims

The purpose of this study was to evaluate the effect of a three-months’ training rehabilitation on the physical capacity of patients suffering from chronic obstructive pulmonary disease (COPD).

Methods

The aerobic and anaereobic capacity was evaluated in 36 patients (Stage 2) before and after a training rehabilitation period: (duration: three months, frequency: two sessions per week, intensity: 65% of aerobic threshold for 25 min, type: regular exercise on a bicycle).

Results

Training rehabilitation caused a statistically significant specific improvement of submaximal aerobic capacity and an increase of quadriceps and flexor of the fingers’ strength.