Ultrafast MR imaging of the normal posterior fossa in fetuses

OBJECTIVE: The purpose of our study was to determine if a standard imaging protocol using ultrafast MR sequences could adequately reveal normal posterior fossa anatomy in fetuses and, if so, to document a template on MR imaging for normal posterior fossa development. MATERIALS AND METHODS: A retrospective review found 66 MR imaging studies of 63 fetuses, 16-39 weeks' gestation age (mean, 25 weeks' gestation), who were referred between June 1996 and May 1999 for evaluation of non-central nervous system anomalies revealed on prenatal sonography. All fetuses had normal brains and spines on prenatal sonography. The standard MR imaging protocol included axial, sagittal, and coronal half-Fourier acquisition single-shot turbo spin echo (HASTE); sagittal and coronal two-dimensional fast low-angle shot (FLASH); and axial turbo T1-weighted FLASH images through the fetal brain. Structures that we analyzed were the fourth ventricle, the cisterna magna, the vermis, the cerebellar hemispheres, and the brainstem. Using the HASTE sequences, we documented gestational age-specific signal intensity changes in the cerebellar hemispheres and the brainstem. RESULTS: The posterior fossa anatomy was sufficiently well defined to exclude abnormalities of the fourth ventricle and cerebellar vermis in all cases. Because of high T2-weighting, good contrast enhancement, and good signal-to-noise ratios, HASTE images provided the best anatomic definition of the posterior fossa. CONCLUSION: Normal posterior fossa anatomy can be adequately shown on ultrafast MR images, which can be helpful when prenatal sonography is equivocal.     

The potential role of various species of intermediate hosts of Schistosoma haematobium in Saudi Arabia

The potential role of 3 species of Bulinus in the transmission of Schistosoma haematobium in Saudi Arabia was assessed on the basis of their susceptibility to experimental infection, their geographical distribution and numbers, and the type of habitats in which they were found. B. truncatus, distributed mainly in the mid- and south-western regions, showed extremely low susceptibility to strains of S. haematobium from Yemen, Egypt and Sudan. The same species from one area in the north-west was refractory to a strain of the parasite from Yemen. In contrast, B. wrighti was very susceptible to infection but is found only in a few habitats far from human settlements, thus probably playing little part in the transmission of the disease. As B. beccarii is highly susceptible to the infection and is distributed widely, this snail is probably the main intermediate host of schistosomiasis in Saudi Arabia.     

The use of computed tomography scan in unstable hip reconstruction

Accurate femoral-acetabular relationship was not possible until the advent of the computed tomography scan. Computed tomography scan allows visualization and measurement of femoral torsion, femoral head contour, soft tissue and bony impingements on the femoral head, acetabular configuration and femoral-acetabular relationship.     

Experience with hepatic hemangioendothelioma in infancy and childhood

This report describes our experience with 16 infants and children with a mean age of 7 months and a median age of 6 weeks with hepatic hemangioendothelioma. Fifteen patients presented with hepatomegaly. Seven had congestive heart failure and four had associated cutaneous lesions. Although diagnosis was clinically evident in 15 of the 16 patients, arteriography and computerized tomography (CT) were diagnostic. A variety of treatment approaches were used including radiation, resection, systemic steroids, hepatic artery ligation, angiographic embolization, and various combinations of these modalities. The following information was gained from this experience. CT with enhancement is as specific a diagnostic tool as hepatic arteriography. Angiographic and CT appearances do not correlate with prognosis. Most patients can be treated successfully with steroids; those who do not respond should have other approaches tried such as embolization or ligation. The angiographic appearance determines whether embolization therapy is worthwhile, as we found that hemangioendotheliomatosis with portal as well as hepatic arterial supply will not respond to embolization. The survival rate in this series was 80%.     

Which patients with colorectal cancer are followed up by general practitioners? A population-based study.

The aim of the study was to assess the contribution of general practitioners in the surveillance of colorectal cancer, and to examine characteristics and survival of patients with routine general practitioner follow-up. This French registry-based study included 389 patients diagnosed with first colorectal cancer in 1998 and free of disease at least 6 months after curative surgery. For each physician involved, medical records were thoroughly reviewed to collect information about the clinical examinations and follow-up tests prescribed within 3 years after surgery or until death or detection of recurrence. Five-year vital status was obtained through registry records. The proportion of routine clinical examinations performed by general practitioners increased from 35% in the first year to 65% in the third year. Patients having undergone regular general practitioner routine examinations (> or =one examination every 6-month period) had significantly less advanced disease (odds ratio: 0.45; 95% confidence interval: 0.21-0.96), preoperative complications (odds ratio: 0.28; 95% confidence interval: 0.08-0.91) and routine examinations by gastroenterologists/oncologists (odds ratio: 0.37; 95% confidence interval: 0.14-0.98) compared with those without general practitioner examinations. Routine general practitioner follow-up had no influence on 3 and 5-year survival. General practitioners detected significantly more recurrences than specialists in patients over 75 and in those presenting symptoms. French general practitioners are widely involved in the surveillance of patients with early-stage colorectal cancer, without any unfavourable impact on the patient's survival. Some suggestions exist that continuing education in oncology may increase the implication of general practitioners in colorectal cancer surveillance.