Reversible parkinsonism with normal beta-CIT-SPECT in patients exposed to sodium valproate

After reports of reversible parkinsonism and cognitive impairment with sodium valproate (VPA), the authors examined 50 consecutive patients taking VPA and 20 patients taking carbamazepine. Three patients taking VPA exhibited unequivocal parkinsonism with Unified Parkinson Disease Rating Scale scores >30. VPA was withdrawn from two patients with improvement of symptoms. Reduction in VPA dosage in the third patient produced no improvement. beta-CIT-SPECT scans were normal, suggesting dopaminergic neuronal loss is not the underlying mechanism.     

Explosive growth of uterine leiomyomas and carcinologic ovarian risk in a non-menopausal patient with BRCA1-BRCA2 mutation treated by tamoxifen

OBJECTIVE: To report the case of significant growth of a myoma in a premenopausal woman with a suspicion of BRCA1 and BRCA2 mutation, treated by tamoxifen for a hormonodependent breast cancer and to point out the carcinologic ovarian risks with a mutation BRCA1-BRCA2 in this context. Case. Four months after surgical treatment, chemotherapy and the beginning of tamoxifen, an explosive growth of the abdomen justified pelvic echography and laparoscopy confirming the diagnosis of uterine myoma. A polymyomectomy by laparotomy was performed. CONCLUSION: Use of tamoxifen in premenopausal woman with subjacent gynecological pathologies, whether BRCA1-BRCA2 mutation is present or not can prove to be delicate. A regular clinical and echographic monitoring is necessary.     

External auditory canal cholesteatoma: clinical and imaging spectrum

BACKGROUND AND PURPOSE: Cholesteatoma is an inflammatory lesion of the temporal bone that uncommonly involves the external auditory canal (EAC). In this large case series, we aimed to define its imaging features and to determine the characteristics most important to its clinical management. METHODS: Thirteen cases of EAC cholesteatoma (EACC) were retrospectively reviewed. Clinical data were reviewed for the history, presentation, and physical examination findings. High-resolution temporal bone CT scans were examined for a soft-tissue mass in the EAC, erosion of adjacent bone, and bone fragments in the mass. The middle ear cavity, mastoid, facial nerve canal, and tegmen tympani were evaluated for involvement. RESULTS: Patients presented with otorrhea, otalgia, or hearing loss. Eight cases were spontaneous, and five were postsurgical or post-traumatic. CT imaging in all 13 cases showed a soft-tissue mass with adjacent bone erosion. Intramural bone fragments were identified in seven cases. This mass most often arose inferiorly (n = 8) or posteriorly (n = 8), but it was circumferential in two cases. We noted middle ear extension (n = 5), mastoid involvement (n = 4), facial canal erosion (n = 2), and tegmen tympani dehiscence (n = 1). CONCLUSION: Temporal bone CT shows EACC as a soft-tissue mass within the EAC, with adjacent bone erosion. Bone fragments may be present within the mass. The cholesteatoma may extend into the mastoid or middle ear, or it may involve the facial nerve canal or tegmen tympani. Recognition of this entity and its possible extension is important because it may influence clinical management.     

Influence of gravity on radiographic contrast material-based measurements of regional blood flow distribution

RATIONALE AND OBJECTIVES: Radiographic measurement of regional blood flow distribution in the lungs is potentially biased because the contrast material used to track flow is denser than blood. The authors performed this study to evaluate the effect of gravity on flow estimates by using an experimental test phantom and numeric simulations. MATERIALS AND METHODS: Cross-sectionally uniform boluses of radiopaque contrast material were delivered at the upstream end of a horizontal inlet tube connected to a downstream axisymmetric bifuration attached to collecting tubing spirals. The phantom was imaged by using both planar angiography and dynamic multi-detector row computed tomography (CT) during the passage of the bolus through the phantom. The images were analyzed to determine the relative amounts of contrast material traveling through the top and bottom branches of the bifurcation by using varying Reynolds numbers and ratios of inlet tube volume to bolus volume. Numeric simulations of flow within a straight channeL with use of a dispersion operator intended to simulate settling of the bolus due to gravity, were performed under conditions representative of those in the experiments. RESULTS: When the plane of the bifurcation was vertical and actual flow through the two branches was equal, the fraction of contrast material passing through the downward-directed branch increased with decreasing Reynolds number and increasing inlet tube-bolus volume ratio. This occurred in both the experiments and the simulations. CONCLUSION: Because in the circulation Reynolds number decreases and pathway length increases with decreasing vessel diameter, the accuracy of regional flow measurements obtained with angiography or CT within the lungs may be limited by density differences between contrast material and blood.     

Macroscopic Quality Control Improves the Reliability of Blue Dye–Only Sentinel Lymph Node Biopsy in Breast Cancer

Background: One of the problems of sentinel lymph node (SLN) biopsy is the risk of false negatives. At the Institut Curie, to reduce the false-negative rate, we have developed a histological quality control of the SLN performed by blue dye alone, which consists of verification of the SLN blue stain by the pathologist.Methods: A total of 324 patients underwent an SLN biopsy procedure with patent blue dye only followed by an immediate axillary dissection. Initially, SLNs were checked to ensure that they were blue by macroscopic examination. Finally, a search for immunohistochemistry micrometastasis was performed.Results: In 277 (85.5%) of 324 patients, an SLN was identified by the surgeon. After standard examination, the false-negative rate was 11.1% (10 of 90). After macroscopic checking of the 197 negative SLNs, 167 of the 197 were confirmed blue, and there were 5 false negatives, which brought the false-negative rate down to 5.6% (5 of 90). Sixty SLNs out of the 167 confirmed blue SLNs were then proved to be immunohistochemically micrometastatic, and there were 3 false negatives, giving a final false-negative rate of 2.2% (2 of 90; P = .002).Conclusions: In this series, the procedure of pathologic analysis of the SLN has resulted in a significant reduction of the false-negative rate.