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Bouhnik Y, Le Berre C, Zappa M, Lewin M, Boudiaf M, Zagdanski AM, Frampas E, Oudjit A, Scotto B, Tissier M, Annet L, Aufort S, Yzet T, Cuilleron M, Baudin G, Abitbol V, Cosnes J, Bourreille A, Mary J, Dupas JL, Marteau P, Picon L, Pelletier AL, Altwegg R, Dewit O, Filippi J, Roblin X, Stéfanescu C. Development of a New Index to Assess Small Bowel Inflammation Severity in Crohn's Disease Using Magnetic Resonance Enterography. Crohns Colitis 360 2022; 4:otac004. [PMID: 36777552 PMCID: PMC9802414 DOI: 10.1093/crocol/otac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Indexed: 11/14/2022] Open
Abstract
Background The severity of small bowel (SB) inflammation in Crohn's disease (CD) patients is a key component of the therapeutic choice. We aimed to develop a SB-CD Magnetic Resonance Enterography (MRE) index of Inflammation Severity (CDMRIS). Methods Each gastroenterologist/radiologist pair in 13 centers selected MREs from 6 patients with SB-CD stratified on their perceived MRE inflammation severity. The 78 blinded MREs were allocated through balanced incomplete block design per severity stratum to these 13 pairs for rating the presence/severity of 13 preselected items for each SB 20-cm diseased segment. Global inflammation severity was evaluated using a 100-cm visual analog scale. Reproducibility of recorded items was evaluated. The CDMRIS was determined through linear mixed modeling as a combination of the numbers of segments with lesions highly correlated to global inflammation severity. Results Four hundred and forty-two readings were available. Global inflammation severity mean ± SD was 21.0 ± 16.2. The independent predictors explaining 54% of the global inflammation severity variance were the numbers of segments with T1 mild-moderate and severe intensity of enhancement, deep ulceration without fistula, comb sign, fistula, and abscess. Unbiased correlation between CDMRIS and global inflammation severity was 0.76. Conclusions The CDMRIS is now available to evaluate the severity of SB-CD inflammation. External validation and sensitivity-to-change are mandatory next steps.
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Affiliation(s)
- Yoram Bouhnik
- Service de gastro-entérologie-MICI, AP-HP, Hôpital Beaujon, Clichy, France
| | - Catherine Le Berre
- Institut des Maladies de l’Appareil Digestif, Nantes University Hospital, Nantes, France,Address correspondence to: Catherine Le Berre, MD, Institut des Maladies de l’Appareil Digestif, Nantes University Hospital, 1 place Alexis Ricordeau, 44093 Nantes Cedex 1, France ()
| | - Magaly Zappa
- Service de radiologie, AP-HP, Hôpital Beaujon, Clichy, France
| | - Maïté Lewin
- Service de radiologie, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Mourad Boudiaf
- Service de radiologie, AP-HP, Hôpital Cochin, Paris, France
| | | | - Eric Frampas
- Service central de radiologie et imagerie médicale, Nantes University Hospital, Nantes, France
| | - Ammar Oudjit
- Service de radiologie, AP-HP, Hôpital Cochin, Paris, France
| | - Béatrice Scotto
- Service de radiologie, University Hospital of Tours, Tours, France
| | - Muriel Tissier
- Service de radiologie, AP-HP, Hôpital Bichat, Paris, France
| | - Laurence Annet
- Medical Imaging Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - Sophie Aufort
- Service de radiologie, Clinique du Parc, Castelnau Le Lez, France
| | - Thierry Yzet
- Service de radiologie digestive, University Hospital of Amiens-Picardie, Hôpital Sud, Amiens, France
| | - Muriel Cuilleron
- Service de radiologie, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Guillaume Baudin
- Service d’imagerie diagnostique et interventionnelle, Hôpital de L’Archet, Nice, France
| | - Vered Abitbol
- Service d’hépato-gastro-entérologie, AP-HP, Hôpital Cochin, Paris, France
| | - Jacques Cosnes
- Service de gastroentérologie, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - Arnaud Bourreille
- Institut des Maladies de l’Appareil Digestif, Nantes University Hospital, Nantes, France
| | - Jean Yves Mary
- UMR-S-1153 Inserm, Denis Diderot-Paris 7 University, Hôpital Saint-Louis, Paris, France
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Pearson A, Dujardin P, d'Alteroche L, Patat F, Scotto B, Dujardin F, Bastard C, Miette V, Sandrin L, Remenieras J. Vibration controlled transient elastography for non‐invasive evaluation of liver steatosis. Med Phys 2022; 49:1507-1521. [PMID: 35094409 PMCID: PMC9401907 DOI: 10.1002/mp.15484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Arthur Pearson
- Radiology department University Hospital of Tours Tours 37000 France
- CIC Inserm 1415 University Hospital of Tours Tours 37000 France
| | | | - Louis d'Alteroche
- Hepatology department University Hospital of Tours Tours 37000 France
| | - Frédéric Patat
- Radiology department University Hospital of Tours Tours 37000 France
- CIC Inserm 1415 University Hospital of Tours Tours 37000 France
- UMR Inserm 1253, iBrain François Rabelais University of Tours Tours 37000 France
| | - Béatrice Scotto
- Radiology department University Hospital of Tours Tours 37000 France
| | - Fanny Dujardin
- Pathology department University Hospital of Tours Tours 37000 France
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Barbier L, Nault JC, Dujardin F, Scotto B, Besson M, de Muret A, Bourlier P, Zucman-Rossi J, Salamé E, Bacq Y. Natural history of liver adenomatosis: A long-term observational study. J Hepatol 2019; 71:1184-1192. [PMID: 31419515 DOI: 10.1016/j.jhep.2019.08.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/31/2019] [Accepted: 08/06/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Liver adenomatosis (LA) is characterized by the presence of at least 10 hepatocellular adenomas (HCAs), but the natural history of this rare liver disorder remains unclear. Thus, we aimed to reappraise the natural history and the risk of complications in a cohort of patients with at least 10 HCAs. METHODS We analyzed the natural history of 40 patients with LA, excluding glycogen storage disorders, in a monocentric cohort. Pathological examination was performed, with immunostaining and molecular biology carried out on surgical specimens or liver biopsies. RESULTS Forty patients (36 female) were included with a median follow-up of 10.6 (1.9-26.1) years. Six (15%) patients had familial LA, all with germline HNF1A mutations. Median age at diagnosis was 39 (9-55) years. Thirty-three (94%) women had a history of oral contraception, and 29 (81%) women had a pregnancy before LA diagnosis. Overall, thirty-seven (93%) patients underwent surgery at diagnosis. Classification of HCAs showed 46% of patients with HNF1A-mutated HCA, 31% with inflammatory HCA, 3% with sonic hedgehog HCA, 8% with unclassified HCA. Only 15% of the patients demonstrated a "mixed LA" with different HCA subtypes. Hepatic complications were identified in 7 patients: 1 patient (3%) died from recurrent hepatocellular carcinoma after liver transplantation; 6 (15%) had hemorrhages, of which 5 occurred at diagnosis, with 1 fatal case during pregnancy, and 2 occurred in male patients with familial LA. Four patients (10%) had repeated liver resections. Finally, 4 (10%) patients developed extrahepatic malignancies during follow-up. CONCLUSIONS The diversity in HCA subtypes, as well as the occurrence of bleeding and malignant transformation during long-term follow-up, underline the heterogeneous nature of LA, justifying close and specific management. In patients with germline HNF1A mutation, familial LA occurred equally frequently in males and females, with a higher rate of bleeding in male patients. LAY SUMMARY Liver adenomatosis is a rare disease characterized by the presence of 10 or more hepatocellular adenomas that may rarely be of genetic origin. Patients with liver adenomatosis have multiple adenomas of different subtypes, with a risk of bleeding and malignant transformation that justify a specific management and follow-up.
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Affiliation(s)
- Louise Barbier
- Digestive Surgery and Liver Transplantation, Tours University Hospital, University of Tours, FHU SUPORT, Tours, France.
| | - Jean-Charles Nault
- Inserm UMR-1162, Génomique fonctionnelle des Tumeurs solides, Université Paris Descartes, Université Paris Diderot, Université Paris 13, Labex Immuno-Oncology, Paris, France; Liver Unit, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, APHP, Bondy, France
| | - Fanny Dujardin
- Pathology, Tours University Hospital, University of Tours, Tours, France
| | - Béatrice Scotto
- Radiology, Tours University Hospital, University of Tours, Tours, France
| | - Marie Besson
- Radiology, Tours University Hospital, University of Tours, Tours, France
| | - Anne de Muret
- Pathology, Tours University Hospital, University of Tours, Tours, France
| | - Pascal Bourlier
- Digestive Surgery and Liver Transplantation, Tours University Hospital, University of Tours, FHU SUPORT, Tours, France
| | - Jessica Zucman-Rossi
- Liver Unit, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, APHP, Bondy, France; Hôpital Européen Georges Pompidou, HEGP, F-75015, Assistance Publique-Hôpitaux de Paris, APHP, Paris, France
| | - Ephrem Salamé
- Digestive Surgery and Liver Transplantation, Tours University Hospital, University of Tours, FHU SUPORT, Tours, France
| | - Yannick Bacq
- Department of Hepatology and Gastroenterology, University Hospital of Tours, Tours, France
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Anon B, Scotto B, Bacq Y. Acute fatty liver of pregnancy simulating liver tumor. Clin Case Rep 2018; 6:230-231. [PMID: 29375874 PMCID: PMC5771878 DOI: 10.1002/ccr3.1293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 11/04/2017] [Accepted: 11/07/2017] [Indexed: 12/17/2022] Open
Abstract
Acute fatty liver of pregnancy (AFLP) is a rare liver disease unique to pregnancy that can lead to acute liver failure. Clinicians must have a high index of suspicion for AFLP because only early diagnosis and prompt delivery improve maternal and fetal prognosis.
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Affiliation(s)
- Benjamin Anon
- Department of Hepatology and Gastroenterology; University Hospital of Tours; Tours France
| | - Béatrice Scotto
- Department of Radiology; University Hospital of Tours; Tours France
| | - Yannick Bacq
- Department of Hepatology and Gastroenterology; University Hospital of Tours; Tours France
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Caruso F, Alessandri G, Cesana G, Castello G, Uccelli M, Ciccarese F, Giorgi R, Villa R, Scotto B, Olmi S. Laparoscopic pancreaticoduodenectomy for tumors of the head of pancreas; 10 cases for a single center experience. Eur Rev Med Pharmacol Sci 2017; 21:3745-3753. [PMID: 28975996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The tumors of the head of the pancreas are one of the leading causes of cancer-related death in Western countries. The current gold standard for these tumors is a Whipple procedure. This procedure did not change in its surgical steps since when it was initially introduced in 1935. More recently, a laparoscopic approach with similar outcomes has been described. The aim of this paper is to describe the laparoscopic surgical technique performed in our unit, reporting single center postoperative outcomes. PATIENTS AND METHODS From the 1st January 2013 to the 31st December 2015 a database was created. Data about patients who underwent a laparoscopic pancreaticoduodenectomy (LPD) were collected prospectively. All patients were preoperatively assessed with blood samples, tumor markers, CT chest abdomen and pelvis and/or MRI pancreas. Only patients with specific characteristics were considered eligible for an LPD: performance status 0, body mass index (BMI) less than 30 kg/m2, a small neoplastic lesion (< 3.5 cm) confined to the pancreas, the absence of infiltrated organs and/or blood vessels (T1 or T2). Postoperative data and complications were recorded and described according to the Clavien-Dindo classification and the international study group of pancreatic surgery definitions. RESULTS In a time interval of 36 months, 31 patients with an initially considered resectable pancreatic cancer were referred. 11 patients were found to have metastasis during the preoperative workout. Only 10 patients were considered eligible for a LPD. Six of them were men (60%). The mean BMI was 25.01 kg/m2 (19.6-29.8). 5 patients, who underwent to LPD did not have any comorbidities. An overall 50% of all patients were jaundice at the time of diagnosis with a mean bilirubin level of 181.3 µmol/L (119.7-307.8). All patients with a direct bilirubin greater than 250 µmol/L underwent a preoperative percutaneous biliary drainage. In the majority of the LPD performed (50%), the histology reported a pancreatic adenocarcinoma. Other postoperative histology described were: IPMN (20%), ampullar neoplasia (20%) and neuroendocrine tumor (10%). Neo-adjuvant chemotherapy was never considered indicated. The reported postoperative complications were: 1 anastomotic bleeding, 2 pancreatic fistula, 1 infected intra-abdominal collection and 1 delay gastric emptying. The pancreatic fistulas were considered grade A and grade B. One fatality after LPD occurred because of an uncontrollable, diffuse severe hemorrhagic gastritis associated with a GJ anastomosis bleeding in the POD 25. The mean hospital stay was 12.3 days (8-25). The mean operative time was 224 min (170-310). There were no intraoperative complications. The main intraoperative blood loss was 220 ml (180-400) and intraoperative blood transfusions were not required. The resection margins were negative (R0) in 100% of cases and the mean lymph nodes harvested were 24 (18-40). The LPD is still a not common practice. Our results are comparable with those reported in literature about the open technique. These remarkable surgical outcomes are probably related to the extremely careful preoperative patient selection performed. The indication for a laparoscopic vs. an open pancreaticoduodenectomy was based on a CT scan pancreas performed less than 30 days before the planned date of surgery and a careful preoperative assessment. A low complication rate and a relative short stay in hospital were associated to a good quality of life in the early postoperative period and an early referral for postoperative chemotherapy. Good clinical outcomes were associated with outstanding oncological results. CONCLUSIONS Laparoscopic pancreaticoduodenectomy is a feasible surgical procedure. Remarkable oncological and surgical outcomes can be achieved with a morbidity and mortality rate in line with the data reported by the large series of open procedures.
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Affiliation(s)
- F Caruso
- Laparoscopic Unit of Surgical Department of San Marco Hospital, Osio Sotto, Zingonia, BG, Italy.
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Scotto B, Spera E, Merola G, Di Simone D. Lynch II syndrome: a case report. BMC Geriatr 2011. [PMCID: PMC3194387 DOI: 10.1186/1471-2318-11-s1-a58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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7
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Benchellal ZA, Joseph-Reinette C, d'Altéroche L, Scotto B, Kraft K, Soro KG, Bacq Y. [Mirizzi syndrome mimicking a gallbladder carcinoma]. Presse Med 2009; 38:1191-3. [PMID: 19447579 DOI: 10.1016/j.lpm.2008.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 05/15/2008] [Accepted: 06/04/2008] [Indexed: 11/28/2022] Open
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de Brito P, Gomez M, Besson M, Scotto B, Huten N, Alison D. Frequency and epidemiology of primary epiploic appendagitis on computed tomography in adults with abdominal pain [in French]. Clin Imaging 2008. [DOI: 10.1016/j.clinimag.2008.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Acute fatty liver of pregnancy (AFLP) is a rare liver disease unique to pregnancy potentially fatal for both mother and child. Only a few cases of recurrence have been published. We report a new case. A 27-year-old primiparous patient presented a first episode of AFLP in 1991 at 37 week's gestation. Diagnosis was suspected because of vomiting, thrombocytopenia, and liver function tests abnormalities. It was confirmed by liver ultrasonography and abdominal computed tomography. Clinical and biological improvement was observed after caesarean delivery. Six years later, the woman began a second pregnancy. Liver function tests and complete blood count were regularly checked. At 30 weeks' gestation, recurrent AFLP occurred and caesarean section was performed. Again, diagnosis was confirmed by both ultrasonography and abdominal computed tomography. In 2006, the mother and the two girls, 15 and 8-year-old respectively, were in good health. The study of the HADHA gene, coding alpha subunit long chain 3-hydroxyacyl coenzyme A dehydrogenase (LCHAD) in the patient failed to find mutations, particularly the common mutation c.1528G>C (Glu474-Gln, p.E474Q). In conclusion, after an episode of AFLP, women should be clearly warned of the risk of recurrence and regularly monitored during the next pregnancy, even if the search of HADHA gene mutation is negative.
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Affiliation(s)
- Yannick Bacq
- Service d'hépatogastroentérologie, Hôpital Trousseau, CHRU de Tours, Tours.
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de Brito P, Gomez M, Besson M, Scotto B, Huten N, Alison D. Fréquence et épidémiologiedescriptive de l’appendicite épiploïque primitive par l’exploration tomodensitométrique des douleurs abdominales de l’adulte. ACTA ACUST UNITED AC 2008; 89:235-43. [DOI: 10.1016/s0221-0363(08)70399-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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De Brito P, Gomez MA, Besson M, Scotto B, Alison D. [Mesenteric hematoma: Unusual complication of a long term oral anticoagulation therapy]. ACTA ACUST UNITED AC 2006; 131:529-32. [PMID: 16712769 DOI: 10.1016/j.anchir.2006.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2003] [Accepted: 03/29/2006] [Indexed: 10/24/2022]
Abstract
Authors report a case of a 77 years old man who developed a small bowel mesenteric hematoma as consequence of an unusual complication from a long term oral anticoagulation treatment. Computed tomoangiography helpfully suggests diagnosis of a mesenteric hematoma and refuts an organic cause as vascular anomalies, by an equivalent method to conventional angiography, noninvasely. In our case report, patient's deterioration justified an emergency surgery corroborating medical imager findings. Authors review the rare cases previously reported.
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Affiliation(s)
- P De Brito
- Service de radiologie adultes, hôpital Trousseau, CHRU de Tours, 37044 Tours cedex 9, France.
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Lefrou L, Godart B, de Muret A, Scotto B, Dorval E. Néomutation germinale du gène p53 chez une malade présentant un syndrome de Li-Fraumeni et un adénocarcinome du pancréas. ACTA ACUST UNITED AC 2006; 30:484-6. [PMID: 16633321 DOI: 10.1016/s0399-8320(06)73212-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Pancreatic injuries caused by blunt trauma are unusual but associated with a high morbidity and a high mortality because of a delay in diagnosis. Clinical and laboratory findings are non-specific. Accurate grading of blunt pancreatic injury with identification of pancreatic duct disruption helps to define practical treatment guidelines. Computed tomography does not allow direct visualization of the pancreatic duct and may result in low accuracy for the detection of ductal injury. Endoscopic retrograde pancreatography is the "gold standard" but invasive (3-5% complication rate, mainly pancreatitis) and may not be possible in up to 30% of patients, or requested after surgery. Endoscopic retrograde pancreatography may be used as a therapeutic modality (stenting of the main pancreatic duct). Magnetic resonance cholangiopancreatography is non invasive and preliminary results are promising. Magnetic resonance cholangiopancreatography detects pseudocysts, has multiplanar capability and complemented with conventional MR imaging allows evaluation of the pancreatic parenchyma.
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Affiliation(s)
- M-A Gomez
- Département de Radiologie Adultes Hôpital Trousseau, CHU de Tours, 37044 Tours.
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Affiliation(s)
- K Pautrat
- Service de Chirurgie Digestive et Endocrinienne, CHU Trousseau, F-37044 Tours, France
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Abstract
Acute gastric dilatation with necrosis is a rare and severe complication associated with anorexia nervosa, bulimia, and psychogenic polyphagia. The Authors report an unusual case without underlying psychiatric context. Gastric necrosis was suspected based on imaging findings (plain radiograph and computed tomography). The detection of these imaging signs in an appropriate clinical setting, even without underlying psychiatric context, is important to avoid any delay in diagnosis and reduce mortality.
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Affiliation(s)
- M-A Gomez
- Département de Radiologie Adultes Hôpital Trousseau, CHU de Tours, 37044 Tours cedex.
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16
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Sobkeng Goufack E, Mammou S, Scotto B, De Muret A, Maakaroun A, Socie G, Bacq Y. Thrombose des veines hépatiques au cours d’un traitement par infliximab (Remicade®) révélant une hémoglobinurie paroxystique nocturne. ACTA ACUST UNITED AC 2004; 28:596-9. [PMID: 15243394 DOI: 10.1016/s0399-8320(04)95017-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We report the case of a 41-Year-old man presenting with hepatic vein thrombosis (Budd-Chiari syndrome) during Infliximab therapy for ankylosing spondylitis. The systematic work-up revealed paroxysmal nocturnal hemoglobinuria. One Year later the patient was receiving anticoagulation therapy and was in good condition. The role of Infliximab in the development of thrombosis in this patient with rare underlying thrombophilia is discussed.
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Affiliation(s)
- Enam Sobkeng Goufack
- Service d'Hépatogastroentérologie, Hôpital Trousseau, CHRU de Tours, 37044 Tours Cedex
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Gomez MA, Bretagnol F, Besson M, Scotto B, Roger R, Alison D. [Radiologic appearance of epiploic appendages and their complications]. J Radiol 2003; 84:1719-24. [PMID: 15022983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
A wide spectrum of pathologic processes can involve epiploic appendages, and primary epiploic appendagitis is the most frequent. Pathologic processes are today more frequently identified with the increased use of radiological assessment (ultrasound and computed tomography) of patients presenting with acute abdominal pain. Recognition of specific imaging abnormalities of complications enables the radiologist to make the diagnosis, thus allowing appropriate treatment.
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Affiliation(s)
- M A Gomez
- Département de Radiologie, Hôpital Trousseau, CHU Tours, 37044 Tours Cedex.
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Gomez MA, Besson M, Roger R, Scotto B, Alison D. Caractérisation des incidentalomes surrénaliens découverts sur tomodensitométrie, revue générale. ACTA ACUST UNITED AC 2003; 37:244-7. [PMID: 14606311 DOI: 10.1016/s0003-4401(03)00034-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The detection of an incidentaloma at abdominal Computed Tomography (CT), except CT features that permit a specific diagnosis (hemorrhage, myelolipoma or cyst), become a problem to differentiate adenomas from "non adenomas" (primary or secondary malignancy) incidentalomas. A density of ten Hounsfield units or less with a nonenhanced CT is a feature of benign incidentaloma (essentially lipid-rich adrenal adenomas). There are two limitations of this characterization: incidentalomas initially detected at enhanced CT and lipid-poor adrenal adenomas. The relative enhancement washout on enhanced CT, by using a threshold of 50% washout, permit then to characterized as adenomas or "non adenomas" incidentalomas on a 10-minute-delayed enhanced CT. Limitations of this characterization are only for benign pheochromocytomas and atypical adrenal cortical carcinomas.
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Affiliation(s)
- M A Gomez
- Département de radiologie, hôpital Trousseau, centre hospitalier universitaire Tours, 37044 Tours, France.
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Abstract
Primary epiploic appendicitis are considered to be a rare cause of acute abdomen. We reported 2 cases in which computed tomography CT suggested the diagnosis. Primary epiploic appendicitis shows characteristic CT findings that allow the diagnosis and follow-up. This entity resolves spontaneously and CT helps in avoiding unnecessary surgery.
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Affiliation(s)
- F Bretagnol
- Service de chirurgie digestive, CHU Trousseau, 37044 cedex, Tours, France
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21
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Gomez MA, Besson M, Roger R, Scotto B, Lange G, Alison D. [Enterolith ileus: a rare complication of small bowel diverticulosis]. J Radiol 2003; 84:326-8. [PMID: 12736594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
An elderly patient with subacute small bowel obstruction due to an enterolith that evolved within a small bowel diverticulum is reported. Presence of small bowel diverticulum is not rare. But small bowel obstruction secondary to an enterolith formed within a small bowel diverticulum is a rare complication. Enterolith ileus closely resembles gallstone ileus in its clinical presentation. Diagnosis can be established only by documenting the absence of aerobilia and the presence of small bowel abnormality causing stasis, like small bowel diverticulosis.
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Affiliation(s)
- M-A Gomez
- Département de Radiologie Adultes, Hôpital Trousseau, CHU de Tours.
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Gomez MA, Besson M, Roger R, Watteau N, Scotto B, Alison D. [Quid? Jejunal diverticulitis with intra-abdominal abscess and reactional jejunitis]. J Radiol 2003; 84:63-5. [PMID: 12645509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- M-A Gomez
- Département de Radiologie Adults Hôpital Trousseau, CHU de Tours.
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Gomez M, Scotto B, Roger R, Watteau N, Alison D. [Ischemic cholangitis after ligation of the hepatic artery: a case report]. J Radiol 2002; 83:736-8. [PMID: 12149591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
We report a case of ischemic cholangitis that occurred after ligation of the hepatic artery performed to remove a celiac neurofibroma. At seven weeks in a septic setting, the patient developed ischemic cholangitis. Ligation of the hepatic artery and dissection of the hepatic hilum to remove a neurofibroma have played a role in the development of ischemic cholangitis. Our case demonstrates that supplying peribiliary arteries are important for the biliary vascularization of the epithelium.
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Affiliation(s)
- Ma Gomez
- Département de Radiologie Adultes Hôpital Trousseau, CHU de Tours, 37044 Tours Cedex, France.
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Karsenti D, Bourlier P, Dorval E, Scotto B, Giraudeau B, Lanotte R, de Calan L, Mesny J, Lagarrigue F, Metman E. [Morbidity and mortality of acute pancreatitis. Prospective study in a French university hospital]. Presse Med 2002; 31:727-34. [PMID: 12148349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVE According to certain learned societies, acute pancreatitis mortality should not exceed 10%. The aim of our work was to review the etiology, severity and mortality of acute pancreatitis in a prospective series of patients admitted to a regional university hospital in France, using standardised collection of data assessing the medico-surgical habits in the management of acute pancreatitis. METHODS From February to September 1999, 86 patients (54 men and 32 women with a mean age of 58.5 years) were admitted for 88 episodes of acute pancreatitis. Data was collected from all the patients on admission and permitted measurement of the severity and prognosis scores and the study of the etiology, complications and management of the latter and the mortality with acute pancreatitis. RESULTS Ranson's score was a mean of 2.4. Balthazar's score was superior or equal to D in 45% of cases. The respective prevalence of lithiasis, alcoholism, tumors, others or undetermined was of 41%, 37.5%, 7%, 5.5% and 9%. Acute pancreatitis was severe (multi organ failure, pseudo-cyst, systemic or necrotic infection and occlusive syndrome) in 32% of cases. Complications were: infection (22%), pseudo-cyst (14%), pleural effusion (12.5%) and occlusive syndrome (3.5%). Fever of more than 38.5 degrees C was noted in more than half of the patients. The median duration of hospitalisation was of 11 days (range: 1-86 days). Global hospital mortality was of 13.6% (12/88), and of 43% (12/28) in cases of severe acute pancreatitis. Six deaths occurred within the first 8 days of acute pancreatitis, and 6 after 8 days. Seven deaths (59%) were due to multi organ failure, 4 (33%) to infectious causes and one to another cause. CONCLUSION The standardized collection of clinical and progressive data used in this study permitted assessment of the medico-surgical habits in a regional university hospital.
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Gomez M, Couthon A, Gilbert B, Watteau N, Roger R, Scotto B, Alison D. [Isolated gallbladder contusion following blunt trauma: a case report]. J Radiol 2002; 83:490-1. [PMID: 12045748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
We report a case of isolated gallbladder contusion with hemobilia. Isolated gallbladder injury following blunt trauma is rare and early diagnosis is difficult. However, ultrasonography and computed tomography are valuable for investigating gallbladder injuries.
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Affiliation(s)
- Ma Gomez
- Département de Radiologie Adultes, CHU de Tours, 37044 Tours Cedex, France.
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Baulieu F, Bourlier P, Scotto B, Mor C, Eder V, Picon L, De Calan L, Dorval E, Pottier JM, Baulieu JL. The value of immunoscintigraphy in the detection of recurrent colorectal cancer. Nucl Med Commun 2001; 22:1295-304. [PMID: 11711899 DOI: 10.1097/00006231-200112000-00004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The aim of this prospective study was to determine whether anti-carcinoembryonic antigen (anti-CEA) scintigraphy is a useful additional technique in the diagnosis recurrence of colorectal cancer. Forty patients with suspected recurrence of colorectal cancer, underwent immunoscintigraphy (IS) and helical computed tomography (CT) in the 2 weeks before surgery. Surgical findings were used to evaluate the performance of the imaging techniques. Suspected areas on IS and CT were systematically explored. Helical CT was found to be superior to IS for the liver, the sensitivity and specificity of CT being 100% and 90%, respectively, vs 53% and 100% for IS. However, IS was better than CT for the detection of extra-hepatic abdominal recurrence: sensitivity and specificity of IS were 100 and 82% respectively vs 33 and 82% for CT. Seven cases of peritoneal carcinomatosis were overlooked by helical CT. Our results indicate that IS improves detection of extra-hepatic abdominal recurrence of colorectal cancer. Immunoscintigraphy is valuable as a guide to the treatment strategy and operative procedures.
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Affiliation(s)
- F Baulieu
- Department of Nuclear Medicine, University Hospital Trousseau, F37044-Chambray les Tours, France.
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Abstract
OBJECTIVE The aim of this retrospective study was to determine the risk factors of early complications after progressive pneumatic dilation for achalasia. METHODS Five hundred four dilations were performed in 237 consecutive achalasic patients between 1980 and 1994 with the same technique: low-pressure pneumatic dilation every other day with balloons of increasing diameter until success criteria were obtained (depending on manometric examination and esophageal x-ray transit performed 24 h after each dilation). Clinical, radiographical, endoscopical, and manometrical data as technical procedure characteristics for patients with perforations or other early complications were compared with those without complications. RESULTS We observed 15 complications (6% of patients): 7 perforations (3%), 3 asymptomatic esophageal mucosal tears, 4 esophageal hematomas, and 1 fever. Perforations occurred in 6 of 7 patients during the first dilation. The mean age was 68.5 yr in the group with complications versus 56.4 yr for the remainder (p < 0.05). Two deaths occurred in patients older than 90 yr. Instability of the balloon during dilations was noted in 8 of 15 cases of complications versus 57 of 222 patients (p < 0.05). No other data differed significantly. CONCLUSIONS This study showed a low prevalence of early complications using this progressive technique. Patients with hiatal hernia, esophageal diverticulum, or vigorous achalasia may safely undergo progressive pneumatic dilation. Only patients older than 90 yr should be referred for progressive pneumatic dilation with caution. Most of perforations arose during the first dilation, but there was no predictive pretherapeutic factor of perforation.
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Affiliation(s)
- E H Metman
- Service d'Hépato-gastroentérologie, Hôpital Trousseau, Tours, France
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Abstract
Precise delineation of vertebrobasilar ischemia by computed tomography (CT) appears difficult due to the numerous variations in distribution of the posterior fossa arterial supply. While pontine and upper brainstem infarctions can be readily demonstrated, medullary infarction remains beyond the scope of present CT scanners. CT findings in cases of basilar artery occlusion include bilateral pontine infarction or extensive brainstem ischemia, associated with cerebellar and posterior cerebral vascular damage. Demonstration of basilar artery occlusion using routine CT is only rarely achieved. In cerebellar ischemia, CT, in conjunction with clinical syndromes, helps in the recognition of the arterial territory involved. CT provides useful guidelines for the treatment of cerebellar stroke, leading to surgery in cases of massive cerebellar infarction.
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