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Michoud C, Erard D, Valette PJ, Bertrand G, Ponchon T, Milot L, Dumortier J. A biliary cast syndrome requiring liver transplantation: an original sequence. J Gastrointestin Liver Dis 2023; 32:565-566. [PMID: 38147616 DOI: 10.15403/jgld-5082] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/31/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Claire Michoud
- Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, Lyon, France. .
| | - Domitille Erard
- Hospices civils de Lyon, Hôpital de la Croix-Rousse, Service d'Hépatologie, Lyon.
| | - Pierre-Jean Valette
- Université Claude Bernard Lyon 1, Lyon; Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération de Radiologie, Lyon, France.
| | - Gaspard Bertrand
- Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, Lyon, France.
| | - Thierry Ponchon
- Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, Lyon; Université Claude Bernard Lyon 1, Lyon;.
| | - Laurent Milot
- Université Claude Bernard Lyon 1, Lyon; Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération de Radiologie, Lyon, France.
| | - Jerome Dumortier
- Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, Lyon; Université Claude Bernard Lyon 1, Lyon;.
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L'Huillier R, Dumortier J, Mastier C, Cayot B, Chambon C, Benech N, Stacoffe N, Valette PJ, Milot L. Robotic-assisted percutaneous irreversible electroporation for the treatment of hepatocellular carcinoma. Diagn Interv Imaging 2023; 104:615-617. [PMID: 37679270 DOI: 10.1016/j.diii.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Romain L'Huillier
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France; LabTAU - INSERM U1032, 69003 Lyon, France; The French Comprehensive Liver Center, Hospices Civils de Lyon, University of Lyon, 69004 Lyon, France
| | - Jérôme Dumortier
- The French Comprehensive Liver Center, Hospices Civils de Lyon, University of Lyon, 69004 Lyon, France; Department of Hepatology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
| | - Charles Mastier
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
| | - Benedicte Cayot
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
| | - Christine Chambon
- Department of Hepatology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
| | - Nicolas Benech
- Department of Hepatology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
| | - Nicolas Stacoffe
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, University of Lyon, 69495 Pierre-Bénite, France
| | - Pierre-Jean Valette
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
| | - Laurent Milot
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France; LabTAU - INSERM U1032, 69003 Lyon, France; The French Comprehensive Liver Center, Hospices Civils de Lyon, University of Lyon, 69004 Lyon, France.
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Guilhem A, Dupuis-Girod S, Espitia O, Rivière S, Seguier J, Kerjouan M, Lavigne C, Maillard H, Magro P, Alric L, Lipsker D, Parrot A, Leguy V, Vanlemmens C, Guibaud L, Vikkula M, Eyries M, Valette PJ, Giraud S. Seven cases of hereditary haemorrhagic telangiectasia-like hepatic vascular abnormalities associated with EPHB4 pathogenic variants. J Med Genet 2023; 60:905-909. [PMID: 36813543 DOI: 10.1136/jmg-2022-109107] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND EPHB4 loss of function is associated with type 2 capillary malformation-arteriovenous malformation syndrome, an autosomal dominant vascular disorder. The phenotype partially overlaps with hereditary haemorrhagic telangiectasia (HHT) due to epistaxis, telangiectases and cerebral arteriovenous malformations, but a similar liver involvement has never been described. METHODS Members of the French HHT network reported their cases of EPHB4 mutation identified after an initial suspicion of HHT. Clinical, radiological and genetic characteristics were analysed. RESULTS Among 21 patients with EPHB4, 15 had a liver imaging, including 7 with HHT-like abnormalities (2 female patients and 5 male patients, ages 43-69 years). Atypical epistaxis and telangiectases were noted in two cases each. They were significantly older than the eight patients with normal imaging (median: 51 vs 20 years, p<0.0006).The main hepatic artery was dilated in all the cases (diameter: 8-11 mm). Six patients had hepatic telangiectases. All kind of shunts were described (arteriosystemic: five patients, arterioportal: two patients, portosystemic: three patients). The overall liver appearance was considered as typical of HHT in six cases.Six EPHB4 variants were classified as pathogenic and one as likely pathogenic, with no specific hot spot. CONCLUSION EPHB4 loss-of-function variants can be associated with HHT-like hepatic abnormalities and should be tested for atypical HHT presentations.
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Affiliation(s)
- Alexandre Guilhem
- Service de Génétique, Centre de Référence pour la maladie de Rendu-Osler, CHU Lyon, Lyon, France
| | - Sophie Dupuis-Girod
- Service de Génétique, Centre de Référence pour la maladie de Rendu-Osler, CHU Lyon, Lyon, France
- Laboratory Biology of Cancer and Infection, CEA de Grenoble, Grenoble, France
| | - Olivier Espitia
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Sophie Rivière
- Médecine Interne et Maladies Multi-Organiques, CHU Montpellier, Montpellier, France
| | - Julie Seguier
- Département de Médecine Interne, Hôpital de la Timone, Marseille, France
| | | | | | - Hélène Maillard
- Service de Médecine Interne et Immunologie Clinique, CHU Lille, Lille, France
| | - Pascal Magro
- Service de Pneumologie, Hôpital Bretonneau, Tours, France
| | - Laurent Alric
- Médecine Interne, Département des Maladies Digestives, CHU Toulouse, Toulouse, France
| | - Dan Lipsker
- Clinique Dermatologique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Vanessa Leguy
- Service de Médecine Interne et Immunologie Clinique, CHU Dijon, Dijon, France
| | - Claire Vanlemmens
- Service Hépatologie et soins intensifs digestifs, CHU Besancon, Besancon, France
| | - Laurent Guibaud
- Service d'Imagerie Médicale Pédiatrique et Foetale, CHU Lyon, Lyon, France
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, Bruxelles, Belgium
| | - Melanie Eyries
- Genetics, Groupe Hospitalier Pitié-Salpétrière, AP-HP, Paris, France
| | | | - Sophie Giraud
- Service de Génétique, Centre de Référence pour la maladie de Rendu-Osler, CHU Lyon, Lyon, France
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Dumortier J, Gimonet H, Valette PJ, Cayot B. Venous hepatic aneurysms. Dig Liver Dis 2023:S1590-8658(23)00561-3. [PMID: 37088592 DOI: 10.1016/j.dld.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/07/2023] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023]
Affiliation(s)
- Jérôme Dumortier
- Department of Digestive Diseases, Hospices civils de Lyon, Edouard Herriot hospital, France; Claude Bernard Lyon 1 University, France.
| | - Hélène Gimonet
- Department of Digestive Radiology, Hospices civils de Lyon, Edouard Herriot hospital, Lyon, France
| | - Pierre-Jean Valette
- Claude Bernard Lyon 1 University, France; Department of Digestive Radiology, Hospices civils de Lyon, Edouard Herriot hospital, Lyon, France
| | - Bénédicte Cayot
- Department of Digestive Radiology, Hospices civils de Lyon, Edouard Herriot hospital, Lyon, France
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Dumortier J, Rebaudet H, Champagnac J, Valette PJ. Portal-hepatic venous shunt in a patient with trisomy 21. Clin Res Hepatol Gastroenterol 2023; 47:102122. [PMID: 37028487 DOI: 10.1016/j.clinre.2023.102122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 04/09/2023]
Affiliation(s)
- Jérôme Dumortier
- Hospices civils de Lyon, Edouard Herriot hospital, Department of Digestive Diseases, Lyon; Claude Bernard Lyon 1 University, Lyon.
| | | | | | - Pierre-Jean Valette
- Claude Bernard Lyon 1 University, Lyon; Hospices civils de Lyon, Edouard Herriot hospital, Department of Radiology, Lyon France
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Cayot B, Milot L, Valette PJ. Improved visualization of arterial supply of hepatic tumors during CT angiography using sublingual administration of glyceryl trinitrate. Diagn Interv Imaging 2023; 104:160-161. [PMID: 36283932 DOI: 10.1016/j.diii.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Bénédicte Cayot
- Body and VIR Radiology Department, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003 Lyon, France.
| | - Laurent Milot
- Body and VIR Radiology Department, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003 Lyon, France
| | - Pierre-Jean Valette
- Body and VIR Radiology Department, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003 Lyon, France
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Milot L, L'Huillier R, Dumortier J, Gérard L, Valette PJ. Robotic-assisted percutaneous microwave ablation of hepatocellular carcinoma. Diagn Interv Imaging 2023; 104:258-260. [PMID: 36792426 DOI: 10.1016/j.diii.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Laurent Milot
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France; Interventional Radiology Oncology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
| | - Romain L'Huillier
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France; Interventional Radiology Oncology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
| | - Jérôme Dumortier
- Department of Hepatology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
| | - Laura Gérard
- Interventional Radiology Oncology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
| | - Pierre-Jean Valette
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
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Couteaux V, Zhang C, Mulé S, Milot L, Valette PJ, Raynaud C, Vlachomitrou AS, Ciofolo-Veit C, Lawrance L, Belkouchi Y, Vilgrain V, Lewin M, Trillaud H, Hoeffel C, Laurent V, Ammari S, Morand E, Faucoz O, Tenenhaus A, Talbot H, Luciani A, Lassau N, Lazarus C. Synthetic MR image generation of macrotrabecular-massive hepatocellular carcinoma using generative adversarial networks. Diagn Interv Imaging 2023; 104:243-247. [PMID: 36681532 DOI: 10.1016/j.diii.2023.01.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of this study was to develop a method for generating synthetic MR images of macrotrabecular-massive hepatocellular carcinoma (MTM-HCC). MATERIALS AND METHODS A set of abdominal MR images including fat-saturated T1-weighted images obtained during the arterial and portal venous phases of enhancement and T2-weighted images of 91 patients with MTM-HCC, and another set of MR abdominal images from 67 other patients were used. Synthetic images were obtained using a 3-step pipeline that consisted in: (i), generating a synthetic MTM-HCC tumor on a neutral background; (ii), randomly selecting a background among the 67 patients and a position inside the liver; and (iii), merging the generated tumor in the background at the specified location. Synthetic images were qualitatively evaluated by three radiologists and quantitatively assessed using a mix of 1-nearest neighbor classifier metric and Fréchet inception distance. RESULTS A set of 1000 triplets of synthetic MTM-HCC images with consistent contrasts were successfully generated. Evaluation of selected synthetic images by three radiologists showed that the method gave realistic, consistent and diversified images. Qualitative and quantitative evaluation led to an overall score of 0.64. CONCLUSION This study shows the feasibility of generating realistic synthetic MR images with very few training data, by leveraging the wide availability of liver backgrounds. Further studies are needed to assess the added value of those synthetic images for automatic diagnosis of MTM-HCC.
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Affiliation(s)
| | - Cheng Zhang
- Philips Research France, 92150 Suresnes, France
| | - Sébastien Mulé
- Medical Imaging Department, AP-HP, Henri Mondor University Hospital, 94000 Créteil, France; INSERM, U955, Team 18, 94000 Créteil, France
| | - Laurent Milot
- Body and VIR Radiology Department, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003 Lyon, France
| | - Pierre-Jean Valette
- Body and VIR Radiology Department, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003 Lyon, France
| | | | | | | | - Littisha Lawrance
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France
| | - Younes Belkouchi
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; OPIS - Optimisation Imagerie et Santé, Université Paris-Saclay, Inria, CentraleSupélec, CVN - Centre de vision numérique, 91190 Gif-Sur-Yvette, France
| | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord-Val de Seine, Hôpital Beaujon, 92210 Clichy, France; Université Paris Cité, CRI INSERM, 75006 Paris, France
| | - Maité Lewin
- Department of Radiology, AP-HP Hôpital Paul Brousse, 94800 Villejuif, France; Faculté de Médecine, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - Hervé Trillaud
- CHU de Bordeaux, Department of Radiology, Université de Bordeaux, F-33000 Bordeaux, France
| | - Christine Hoeffel
- Department of Radiology, Reims University Hospital, 51092 Reims, France; CRESTIC, University of Reims Champagne-Ardenne, 51100 Reims, France
| | - Valérie Laurent
- Department of Radiology, Nancy University Hospital, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | - Samy Ammari
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, Université Paris-Saclay, 94800 Villejuif, France
| | - Eric Morand
- Centre National d'Etudes Spatiales, Centre Spatial de Toulouse, 31000 Toulouse, France
| | - Orphee Faucoz
- Centre National d'Etudes Spatiales, Centre Spatial de Toulouse, 31000 Toulouse, France
| | - Arthur Tenenhaus
- Université Paris-Saclay, Centrale Supélec, Laboratoire des Signaux et Systèmes, 91190 Gif-sur-Yvette, France
| | - Hugues Talbot
- OPIS - Optimisation Imagerie et Santé, Université Paris-Saclay, Inria, CentraleSupélec, CVN - Centre de vision numérique, 91190 Gif-Sur-Yvette, France
| | - Alain Luciani
- Medical Imaging Department, AP-HP, Henri Mondor University Hospital, 94000 Créteil, France; INSERM, U955, Team 18, 94000 Créteil, France
| | - Nathalie Lassau
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, Université Paris-Saclay, 94800 Villejuif, France
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Rivory J, Pioche M, Dumortier J, Lambin T, Lupu A, Ber CE, Valette PJ. Transesophageal endoscopic ultrasound-guided coil and cyanoacrylate treatment of challenging esophageal varices bleeding associated with CREST syndrome ulcerative esophagitis. Endoscopy 2022; 54:E761-E762. [PMID: 35523221 DOI: 10.1055/a-1814-4140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Jérôme Rivory
- Department of Endoscopy and Hepatogastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Mathieu Pioche
- Department of Endoscopy and Hepatogastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Jérôme Dumortier
- Department of Endoscopy and Hepatogastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Thomas Lambin
- Department of Endoscopy and Hepatogastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Alexandru Lupu
- Department of Endoscopy and Hepatogastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Charles-Eric Ber
- Department of Anesthesiology and Hepatogastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Pierre-Jean Valette
- Department of Radiology and Hepatogastroenterology, Edouard Herriot Hospital, Lyon, France
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Dumortier J, Guillaud O, Valette PJ, Partensky C, Paliard P, Boillot O, Erard D. Prophylactic sequential antibiotic therapy for recurrent liver/biliary sepsis. Clin Res Hepatol Gastroenterol 2022; 46:101979. [PMID: 35710040 DOI: 10.1016/j.clinre.2022.101979] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/30/2022] [Accepted: 06/13/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Recurrent liver/biliary sepsis are rare and can occur in different situations. Curative treatment of acute septic episodes is based on antibiotics. Nevertheless, recurrent sepsis can be life-threatening, and the treatment of the underlying disease could be complex, and eventually not possible. The aim of the present study was to report our experience on prophylactic sequential antibiotic therapy for recurrent liver/biliary sepsis in a large cohort of patients with long follow-up. METHODS All patients who received a prophylactic sequential antibiotic therapy for recurrent liver/biliary sepsis in our institution from 2005 to 2020 were included. Prophylactic sequential antibiotic therapy was based on per os antibiotics with expected antibacterial activity on digestive bacteria, mainly Gram-negative bacilli. The primary end-point was the reduction of the number of septic episodes to 1 or less episode per year, and not severe (not requiring hospitalization). RESULTS Were included 33 adult patients and the main initial disease/condition leading to prophylaxis was history of hepaticojejunostomy (78.8%). The majority of septic episodes required hospitalization (57.6%). First line prophylactic sequential antibiotic therapy was weekly ciprofloxacin in all cases. First line therapy was successful in the long-term in 19 patients (57.6%), with a median follow-up of 92 months (range: 25-206). Global efficacy (first-second-third lines) was 28/33 (84.8%). CONCLUSIONS The results of the present study with very long follow-up suggest that prophylactic sequential antibiotic therapy can successfully prevent recurrent liver/biliary sepsis with good tolerance.
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Affiliation(s)
- Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-gastroentérologie, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France.
| | - Olivier Guillaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-gastroentérologie, Lyon, France
| | - Pierre-Jean Valette
- Université Claude Bernard Lyon 1, Lyon, France; Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Radiologie digestive, Lyon, France
| | - Christian Partensky
- Université Claude Bernard Lyon 1, Lyon, France; Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Chirurgie digestive, Lyon, France
| | - Pierre Paliard
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-gastroentérologie, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France
| | - Olivier Boillot
- Université Claude Bernard Lyon 1, Lyon, France; Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Chirurgie digestive, Lyon, France
| | - Domitille Erard
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service d'Hépato-gastroentérologie, Lyon, France
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Servais L, Boschetti G, Meunier C, Gay C, Cotte E, François Y, Rozieres A, Fontaine J, Cuminal L, Chauvenet M, Charlois AL, Isaac S, Traverse-Glehen A, Roblin X, Flourié B, Valette PJ, Nancey S. Intestinal Conventional Ultrasonography, Contrast-Enhanced Ultrasonography and Magnetic Resonance Enterography in Assessment of Crohn's Disease Activity: A Comparison with Surgical Histopathology Analysis. Dig Dis Sci 2022; 67:2492-2502. [PMID: 34052948 DOI: 10.1007/s10620-021-07074-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/15/2020] [Accepted: 05/24/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Contrast-enhanced ultrasonography (CEUS) is a potential interesting method for assessing accurately Crohn's disease (CD) activity. We compared the value of intestinal ultrasonography (US) coupled with contrast agent injection with that of magnetic resonance enterography (MRE) in the assessment of small bowel CD activity using surgical histopathology analysis as reference. METHODS Seventeen clinically active CD patients (14 women, mean age 33 years) requiring an ileal or ileocolonic resection were prospectively enrolled. All performed a MRE and a US coupled with contrast agent injection (CEUS) less than 8 weeks prior to surgery. Various imaging qualitative and quantitative parameters were recorded and their respective performance to detect disease activity, disease extension and presence of complications was compared to surgical histopathological analysis. RESULTS The median wall thickness measured by US differed significantly between patients with non-severely active CD (n = 5) and those with severely active CD (n = 12) [7.0 mm, IQR (6.5-9.5) vs 10.0 mm, IQR (8.0-12.0), respectively; p = 0.03]. A non-significant trend was found with MRE with a median wall thickness in severe active CD of 10.0 mm, IQR (8.0-13.7) compared with 8.0 mm, IQR (7.5-10.5) in non-severely active CD (p = 0.07). The area under the ROC curve (AUROC) of the wall thickness assessed by US and MRE to identify patients with or without severely active CD on surgical specimens were 0.85, 95% CI (0.64-1.04), p = 0.03 and 0.80, 95% CI (0.56-1.01), p = 0.07, respectively. Among the parameters derived from the time-intensity curve during CEUS, time to peak and rise time were the two most accurate markers [AUROC = 0.88, 95% CI (0.70-1.04), p = 0.02 and 0.86, 95% CI (0.68-1.04), p = 0.03] to detect patients with severely active CD assessed on surgical specimens. CONCLUSION The accuracy of intestinal CEUS is close to that of conventional US to detect disease activity. A thickened bowel and shortened time to peak and rise time were the most accurate to identify CD patients with severe histological disease activity.
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Affiliation(s)
- L Servais
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - G Boschetti
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.,INSERM U1111, International Center for Research in Infectiology, Lyon, France
| | - C Meunier
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.,INSERM U1111, International Center for Research in Infectiology, Lyon, France
| | - C Gay
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - E Cotte
- Department of Digestive Surgery, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Y François
- Department of Digestive Surgery, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - A Rozieres
- INSERM U1111, International Center for Research in Infectiology, Lyon, France
| | - J Fontaine
- Department of Pathology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - L Cuminal
- Department of Radiology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - M Chauvenet
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - A L Charlois
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - S Isaac
- Department of Pathology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - A Traverse-Glehen
- Department of Pathology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - X Roblin
- Department of Gastroenterology, CHU Saint-Etienne, Saint-Etienne, France
| | - B Flourié
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.,INSERM U1111, International Center for Research in Infectiology, Lyon, France
| | - P J Valette
- Department of Radiology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - S Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France. .,INSERM U1111, International Center for Research in Infectiology, Lyon, France.
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12
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Bertrand G, Rivory J, Robert M, Saurin JC, Pelascini É, Monneuse O, Gruner L, Poncet G, Valette PJ, Gimonet H, Rostain F, Ber CÉ, Bouffard Y, Boibieux A, Ciochina M, Landel V, Boyer H, Jacques J, Ponchon T, Pioche M. Digestive perforations related to endoscopy procedures: a local management charter based on local evidence and experts' opinion. Endosc Int Open 2022; 10:E328-E341. [PMID: 35433214 PMCID: PMC9010098 DOI: 10.1055/a-1783-8424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/28/2021] [Indexed: 11/06/2022] Open
Abstract
Background and study aims Perforations are a known adverse event of endoscopy procedures; a proposal for appropriate management should be available in each center as recommended by the European Society of Gastrointestinal Endoscopy. The objective of this study was to establish a charter for the management of endoscopic perforations, based on local evidence. Patients and methods Patients were included if they experienced partial or complete perforation during an endoscopic procedure between 2008 and 2018 (retrospectively until 2016, then prospectively). Perforations (size, location, closure) and management (imagery, antibiotics, surgery) were analyzed. Using these results, a panel of experts was asked to propose a consensual management charter. Results A total of 105 patients were included. Perforations occurred mainly during therapeutic procedures (91, 86.7%). Of the perforations, 78 (74.3 %) were diagnosed immediately and managed during the procedure; 69 of 78 (88.5 %) were successfully closed. Closures were more effective during therapeutic procedures (60 of 66, 90.9 %) than during diagnostic procedures (9 of 12, 75.0 %, P = 0.06). Endoscopic closure was effective for 37 of 38 perforations (97.4 %) < 0.5 cm, and for 26 of 34 perforations (76.5 %) ≥ 0.5 cm ( P < 0.05). For perforations < 0.5 cm, systematic computed tomography (CT) scan, antibiotics, or surgical evaluation did not improve the outcome. Four of 105 deaths (3.8 %) occurred after perforation, one of which was attributable to the perforation itself. Conclusions Detection and closure of perforations during endoscopic procedure had a better outcome compared to delayed perforations; perforations < 0.5 cm had a very good prognosis and CT scan, surgeon evaluation, or antibiotics are probably not necessary when the endoscopic closure is confidently performed. This work led to proposal of a local management charter.
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Affiliation(s)
- Gaspard Bertrand
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d’Hépato-gastroentérologie, Lyon, France
| | - Jérôme Rivory
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d’Hépato-gastroentérologie, Lyon, France
| | - Maud Robert
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Chirurgie Digestive Hépatobiliaire, Lyon, France
| | - Jean-Christophe Saurin
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d’Hépato-gastroentérologie, Lyon, France
| | - Élise Pelascini
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Chirurgie Digestive Hépatobiliaire, Lyon, France
| | - Olivier Monneuse
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Chirurgie Digestive d’Urgence, Lyon, France
| | - Laurent Gruner
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Chirurgie Digestive d’Urgence, Lyon, France
| | - Gilles Poncet
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Chirurgie Digestive Hépatobiliaire, Lyon, France
| | - Pierre-Jean Valette
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Radiologie, Lyon France
| | - Hélène Gimonet
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Radiologie, Lyon France
| | - Florian Rostain
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d’Hépato-gastroentérologie, Lyon, France
| | - Charles-Éric Ber
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d’Anesthésie, Section Endoscopie, Lyon, France
| | - Yves Bouffard
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d’Anesthésie, Section Endoscopie, Lyon, France
| | - André Boibieux
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Pathologies Infectieuses, Lyon, France
| | - Marina Ciochina
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d’Hépato-gastroentérologie, Lyon, France
| | - Verena Landel
- Hospices Civils de Lyon, Direction de la Recherche Clinique et de l’Innovation, Lyon, France
| | - Hélène Boyer
- Hospices Civils de Lyon, Direction de la Recherche Clinique et de l’Innovation, Lyon, France
| | - Jérémie Jacques
- Hôpital Dupuytren, Service de Gastroentérologie, Limoges, France
| | - Thierry Ponchon
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d’Hépato-gastroentérologie, Lyon, France,Hôpital Dupuytren, Service de Gastroentérologie, Limoges, France
| | - Mathieu Pioche
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d’Hépato-gastroentérologie, Lyon, France
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13
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Cayot B, Milot L, Nempont O, Vlachomitrou AS, Langlois-Jacques C, Dumortier J, Boillot O, Arnaud K, Barten TRM, Drenth JPH, Valette PJ. Polycystic liver: automatic segmentation using deep learning on CT is faster and as accurate compared to manual segmentation. Eur Radiol 2022; 32:4780-4790. [PMID: 35142898 DOI: 10.1007/s00330-022-08549-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to develop and investigate the performance of a deep learning model based on a convolutional neural network (CNN) for the automatic segmentation of polycystic livers at CT imaging. METHOD This retrospective study used CT images of polycystic livers. To develop the CNN, supervised training and validation phases were performed using 190 CT series. To assess performance, the test phase was performed using 41 CT series. Manual segmentation by an expert radiologist (Rad1a) served as reference for all comparisons. Intra-observer variability was determined by the same reader after 12 weeks (Rad1b), and inter-observer variability by a second reader (Rad2). The Dice similarity coefficient (DSC) evaluated overlap between segmentations. CNN performance was assessed using the concordance correlation coefficient (CCC) and the two-by-two difference between the CCCs; their confidence interval was estimated with bootstrap and Bland-Altman analyses. Liver segmentation time was automatically recorded for each method. RESULTS A total of 231 series from 129 CT examinations on 88 consecutive patients were collected. For the CNN, the DSC was 0.95 ± 0.03 and volume analyses yielded a CCC of 0.995 compared with reference. No statistical difference was observed in the CCC between CNN automatic segmentation and manual segmentations performed to evaluate inter-observer and intra-observer variability. While manual segmentation required 22.4 ± 10.4 min, central and graphics processing units took an average of 5.0 ± 2.1 s and 2.0 ± 1.4 s, respectively. CONCLUSION Compared with manual segmentation, automated segmentation of polycystic livers using a deep learning method achieved much faster segmentation with similar performance. KEY POINTS • Automatic volumetry of polycystic livers using artificial intelligence method allows much faster segmentation than expert manual segmentation with similar performance. • No statistical difference was observed between automatic segmentation, inter-observer variability, or intra-observer variability.
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Affiliation(s)
- Bénédicte Cayot
- Department of Medical Imaging, Hospices Civils de Lyon, University of Lyon, Lyon, France. .,Service d'imagerie médicale et interventionnelle, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France.
| | - Laurent Milot
- Service d'imagerie médicale et interventionnelle, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France.,Department of Medical Imaging, Edouard Herriot Hospital, Civil Hospices of Lyon, University of Lyon, Lyon, France
| | - Olivier Nempont
- Service d'imagerie médicale et interventionnelle, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France.,Philips France, 33 rue de Verdun, CS 60 055, Cedex 92156, Suresnes, France
| | - Anna S Vlachomitrou
- Service d'imagerie médicale et interventionnelle, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France.,Philips France, 33 rue de Verdun, CS 60 055, Cedex 92156, Suresnes, France
| | - Carole Langlois-Jacques
- Service d'imagerie médicale et interventionnelle, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France.,Unit of Biostatistics, Civil Hospices of Lyon, Lyon ,CNRS UMR5558, Laboratory of Biometry and Evolutionary Biology, Biostatistics-Health Team, Lyon, France
| | - Jérôme Dumortier
- Service d'imagerie médicale et interventionnelle, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France.,Department of Hepatology and Gastroenterology, Civil Hospices of Lyon, Edouard Herriot Hospital, Federation of Digestive Specialties, University of Lyon, Lyon, France.,University of Lyon, Lyon, France
| | - Olivier Boillot
- Service d'imagerie médicale et interventionnelle, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France.,University of Lyon, Lyon, France.,Department of Hepatobiliary-Pancreatic Surgery and Hepatology, Civil Hospices of Lyon, Edouard Herriot Hospital, University of Lyon, Lyon, France
| | - Karine Arnaud
- Service d'imagerie médicale et interventionnelle, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France.,Edouard Herriot Hospital, Civil Hospices of Lyon, Lyon, France
| | - Thijs R M Barten
- Service d'imagerie médicale et interventionnelle, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France.,Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joost P H Drenth
- Service d'imagerie médicale et interventionnelle, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France.,Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Pierre-Jean Valette
- Service d'imagerie médicale et interventionnelle, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France.,Department of Medical Imaging, Edouard Herriot Hospital, Civil Hospices of Lyon, University of Lyon, Lyon, France
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14
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Veyre F, Dumortier J, Radenne S, Valette PJ, Rode A, Erard-Poinsot D. Rare isolated spontaneous hepatic artery thrombosis in a non-transplant patient. Clin Res Hepatol Gastroenterol 2021; 45:101453. [PMID: 32958437 DOI: 10.1016/j.clinre.2020.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/01/2020] [Accepted: 05/07/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Florian Veyre
- Service d'hépato-gastroentérologie, hôpital de la Croix-Rousse, hospices civils de Lyon, Lyon, France; Université Claude-Bernard Lyon 1, domaine Rockefeller, Lyon, France.
| | - Jérôme Dumortier
- Université Claude-Bernard Lyon 1, domaine Rockefeller, Lyon, France; Fédération des spécialités digestives, hôpital Édouard-Herriot, hospices civils de Lyon, Lyon, France
| | - Sylvie Radenne
- Service d'hépato-gastroentérologie, hôpital de la Croix-Rousse, hospices civils de Lyon, Lyon, France
| | - Pierre-Jean Valette
- Université Claude-Bernard Lyon 1, domaine Rockefeller, Lyon, France; Service de radiologie, hôpital Édouard-Herriot, hospices civils de Lyon, Lyon, France
| | - Agnès Rode
- Service de radiologie, hôpital de la Croix-Rousse, hospices civils de Lyon, Lyon, France
| | - Domitille Erard-Poinsot
- Service d'hépato-gastroentérologie, hôpital de la Croix-Rousse, hospices civils de Lyon, Lyon, France
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15
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Dumortier J, Erard-Poinsot D, Bosch A, Valette PJ. Diffuse Hepatic Arterioportal Fistulas After Liver Transplantation. EXP CLIN TRANSPLANT 2021; 19:1114-1115. [PMID: 34498554 DOI: 10.6002/ect.2021.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jérôme Dumortier
- From the Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Digestive Diseases, Lyon, France
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16
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Boillot O, Cayot B, Guillaud O, Crozet-Chaussin J, Hervieu V, Valette PJ, Dumortier J. Partial major hepatectomy with cyst fenestration for polycystic liver disease: Indications, short and long-term outcomes. Clin Res Hepatol Gastroenterol 2021; 45:101670. [PMID: 33722781 DOI: 10.1016/j.clinre.2021.101670] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/09/2020] [Revised: 02/18/2021] [Accepted: 02/26/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Symptomatic polycystic liver disease (PLD) with massive hepatomegaly represents a challenging surgical issue. In this work, we focused on early and long term outcomes after partial hepatectomy with cyst fenestration (PHCF) in selected patients. METHODS All patients who had PHCF for treatment of PLD between January 2003 and December 2019 in our center were included in this study. PHCF was undertaken if at least one hepatic section was relatively spared from PLD, afferent and efferent hepatic vasculature was patent, and liver function was maintained. RESULTS Twenty nine patients (25 women) with a mean age of 54.6 ± 9 years underwent PHCF. Major hepatectomy was performed in all cases with 4.3 ± 0.8 resected segments. Overall perioperative morbidity (Clavien ≥ II) and mortality rates were 41.4.6% and 13.8% respectively. Significant postoperative liver volume reduction was 52.8% within the first year and 55.5% thereafter. From preoperative evaluation, performance status (PS) normalized or improved in 84% of patients. After a mean follow-up time of 70.8 ± 65 months, overall patient survival was 82.7%. In univariate analysis, PS, initial liver volume, operative time and transfusion were associated with post-operative complications and PS, preoperative cyst infection, portal hypertension, transfusion, postoperative sepsis and persistent ascites were associated with mortality. CONCLUSIONS Our study confirms that in spite of significant morbidity rate, PHCF allows a massive reduction of liver volume in selected patients with symptomatic PLD and is highly and durably effective for the reduction of liver volume and improvement of quality of life.
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Affiliation(s)
- Olivier Boillot
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Pavillon D, 69437 Lyon Cedex 03, France; Université Claude Bernard Lyon 1, France.
| | - Bénédicte Cayot
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Pavillon D, 69437 Lyon Cedex 03, France
| | - Olivier Guillaud
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Pavillon D, 69437 Lyon Cedex 03, France; Ramsay Générale de Santé, Clinique de la Sauvegarde, Lyon, France
| | - Jessica Crozet-Chaussin
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Pavillon D, 69437 Lyon Cedex 03, France
| | - Valérie Hervieu
- Service d'anatomopathologie, Hôpital Femme Mère Enfant, Bron, France
| | - Pierre-Jean Valette
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Pavillon D, 69437 Lyon Cedex 03, France; Université Claude Bernard Lyon 1, France
| | - Jérôme Dumortier
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Pavillon D, 69437 Lyon Cedex 03, France; Université Claude Bernard Lyon 1, France
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17
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Gay-Chevallier S, de Mestier L, Perinel J, Forestier J, Hervieu V, Ruszniewski P, Millot I, Valette PJ, Pioche M, Lombard-Bohas C, Subtil F, Adham M, Walter T. Management and Prognosis of Localized Duodenal Neuroendocrine Neoplasms. Neuroendocrinology 2021; 111:718-727. [PMID: 32335556 DOI: 10.1159/000508102] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/21/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The characteristics, prognostic factors, and management of duodenal neuroendocrine neoplasms (dNEN) are ill-defined, given their rarity. Whether nonsurgical management might be appropriate for patients with nonmetastatic dNEN and a good prognosis, as is the case for pancreatic NEN (pNEN), is unknown. We aimed to describe the management and prognosis of nonmetastatic dNEN patients. METHODS All consecutive patients with nonmetastatic dNEN managed between 1981 and 2018 in 2 expert centers were included. Recurrence-free survival (RFS) and factors associated with recurrence were estimated. RESULTS A total of 145 patients with dNEN were included. Twenty-eight patients with sporadic, nonfunctioning, small (median 7 mm) dNEN underwent endoscopic resection, with a 5-year RFS rate of 89.4%. Local recurrence occurred in 2 patients, who underwent surgery with no new events. The 5-year RFS rate was 87.9% in patients who underwent surgery. Upon univariate analysis, age, size, Ki67 index, and lymph node involvement (LN+) were significantly associated with worse RFS for all dNEN treated (endoscopy/surgery); multivariate analysis found that age, size, and LN+ were associated with worse RFS. CONCLUSION Selected nonmetastatic dNEN had a favorable outcome, and a less invasive therapeutic strategy appeared more suitable than oncological surgery.
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Affiliation(s)
- Servane Gay-Chevallier
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Gastroentérologie et d'Oncologie Médicale, Lyon, France
| | - Louis de Mestier
- Service de Gastroentérologie et Pancréatologie, Hôpital Beaujon, Université de Paris, Clichy, France
| | - Julie Perinel
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Chirurgie Digestive, Lyon, France
- Université Lyon 1, Université de Lyon, Lyon, France
| | - Julien Forestier
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Gastroentérologie et d'Oncologie Médicale, Lyon, France
| | - Valérie Hervieu
- Université Lyon 1, Université de Lyon, Lyon, France
- Hospices Civils de Lyon, Service de Pathologie Multisite, Site EST, Centre de Biologie et de Pathologie Est, Bron, France
| | - Philippe Ruszniewski
- Service de Gastroentérologie et Pancréatologie, Hôpital Beaujon, Université de Paris, Clichy, France
| | - Ingrid Millot
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service d'anesthésie-Réanimation, Lyon, France
| | - Pierre-Jean Valette
- Université Lyon 1, Université de Lyon, Lyon, France
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Radiologie, Lyon, France
| | - Mathieu Pioche
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Gastroentérologie et d'Oncologie Médicale, Lyon, France
- Université Lyon 1, Université de Lyon, Lyon, France
| | - Catherine Lombard-Bohas
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Gastroentérologie et d'Oncologie Médicale, Lyon, France
| | - Fabien Subtil
- Université Lyon 1, Université de Lyon, Lyon, France
- Hospices Civils de Lyon, Service de Biostatistiques, Lyon, France
- CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France
| | - Mustapha Adham
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Chirurgie Digestive, Lyon, France
- Université Lyon 1, Université de Lyon, Lyon, France
| | - Thomas Walter
- Hospices Civils de Lyon, Hôpital Édouard Herriot, Service de Gastroentérologie et d'Oncologie Médicale, Lyon, France,
- Université Lyon 1, Université de Lyon, Lyon, France,
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18
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Dumortier J, Chambon-Augoyard C, Guillaud O, Pioche M, Rivory J, Valette PJ, Adham M, Ponchon T, Scoazec JY, Boillot O. Anastomotic bilio-biliary stricture after adult liver transplantation: A retrospective study over 20 years in a single center. Clin Res Hepatol Gastroenterol 2020; 44:564-571. [PMID: 31547998 DOI: 10.1016/j.clinre.2019.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/03/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Biliary complications are the main surgical complication after liver transplantation (LT). The aims of the present retrospective single center study were to describe anastomotic bilio-biliary strictures (ABS) in a large cohort of liver transplant recipients with long follow-up. METHODS All adult LT recipients who underwent a LT, with bilio-biliary anastomosis, between 1990 and 2010 in Edouard Herriot hospital, Lyon, France were included in the study. RESULTS The study population consisted in 783 patients (70.0% males), median age 50.5 years; main indication was alcohol-related liver disease (46.8%). The median follow-up after LT was 11.9 years (range 0-27 years). The overall incidence of anastomotic biliary complications was 9.7%: 50 patients developed an ABS (6.6%), after a median delay of 4.4 months (range 0.1-245.2) after LT and 32 (4.1%) developed biliary leakage after a median delay of 25 days (range 1-179). The actuarial risk of developing an ABS was 1.6% at 1-month, 2.7% at 3-months, 4.1% at 6-months, and 5.1%, 6.0%, 6.4%, 6.6%, 7.3% at 1-, 2-, 5-, 10- and 15-years, respectively. Univariate analysis disclosed that post-reperfusion syndrome and liver graft steatosis (≥30%) were significant risk factors for ABS. Multivariate analysis disclosed that graft steatosis (OR=6.262, 95%CI 1.936-20.257, P=0.002) and MELD score (OR=1.071, 95%CI 1.018-1.128, P=0.008) were significant risk factors for ABS. The first-line treatment of ABS consisted in endoscopic stenting for 44 patients (88.0%) and immediate success rate was 75.0%. Delayed recurrence of ABS occurred in 8/33 patients (24.0%). CONCLUSION Our results suggest that steatotic grafts should be used for recipients without severe liver failure to avoid ABS, and that endoscopic stenting of post-LT ABS leads to a high success rate, but is associated with a significant risk of recurrence.
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Affiliation(s)
- Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Unité de Transplantation hépatique, Lyon, France; Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-gastroentérologie, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France.
| | - Christine Chambon-Augoyard
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Unité de Transplantation hépatique, Lyon, France; Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-gastroentérologie, Lyon, France
| | - Olivier Guillaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Unité de Transplantation hépatique, Lyon, France; Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-gastroentérologie, Lyon, France
| | - Mathieu Pioche
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-gastroentérologie, Lyon, France
| | - Jérôme Rivory
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-gastroentérologie, Lyon, France
| | - Pierre-Jean Valette
- Université Claude Bernard Lyon 1, Lyon, France; Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Radiologie digestive, Lyon, France
| | - Mustapha Adham
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Unité de Transplantation hépatique, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France
| | - Thierry Ponchon
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-gastroentérologie, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France
| | - Jean-Yves Scoazec
- Université Claude Bernard Lyon 1, Lyon, France; Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Anatomie et Cytologie Pathologiques, Lyon, France
| | - Olivier Boillot
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Unité de Transplantation hépatique, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France
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Dumortier J, Lachaux A, Collardeau-Frachon S, Valette PJ. Hemorrhagic and necrotic adenoma associated with a congenital portosystemic shunt. Dig Liver Dis 2020; 52:920-921. [PMID: 32434737 DOI: 10.1016/j.dld.2020.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/08/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Jérôme Dumortier
- Hospices civils de Lyon, Edouard Herriot hospital, Department of Digestive Diseases, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France.
| | - Alain Lachaux
- Claude Bernard Lyon 1 University, Lyon, France; Hospices civils de Lyon, Femme-Mère-Enfant hospital, Department of Pediatry, Lyon, France
| | - Sophie Collardeau-Frachon
- Claude Bernard Lyon 1 University, Lyon, France; Hospices civils de Lyon, Edouard Herriot hospital, Department of Pathology, Lyon, France
| | - Pierre-Jean Valette
- Claude Bernard Lyon 1 University, Lyon, France; Hospices civils de Lyon, Edouard Herriot hospital, Department of Digestive Radiology, Lyon, France
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Bergère M, Erard-Poinsot D, Boillot O, Valette PJ, Guillaud O, Chambon-Augoyard C, Dumortier J. Portal vein thrombosis and liver cirrhosis: Long-term anticoagulation is effective and safe. Clin Res Hepatol Gastroenterol 2019; 43:395-402. [PMID: 30578107 DOI: 10.1016/j.clinre.2018.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 09/13/2018] [Revised: 10/18/2018] [Accepted: 11/19/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Portal vein thrombosis (PVT) is a common complication of liver cirrhosis. Anticoagulation therapy is efficient, but is associated with potentially severe side-effects, especially bleeding episodes. It is therefore still unclear which patients will benefit from anticoagulation, and for what duration. The aim of the present study was to retrospectively analyse our single centre experience on long-term anticoagulation in patients presenting a PVT, complicating cirrhosis. METHODS Data of 40 cirrhotic patients with PVT treated by anticoagulation therapy from June 2003 to May 2018 were collected. Regular imaging was performed to monitor the outcome of PVT. The hemorrhagic complications and the recurrence of the PVT after anticoagulation withdrawal were also analyzed. RESULTS The median follow-up under anticoagulation therapy was 33.7 months. Complete (57.5%) or partial (25.0%) recanalization of PVT was observed. Fifteen bleeding episodes (37.5%) occurred in our population, related to portal hypertension in 7 (46.7%). Eleven (73.3%) patients required hospitalization and eight (53.3%) required blood transfusion. No patient died from bleeding complication. Anticoagulation was stopped in 10 patients (25.0%), because of regression of PVT in 5 patients or a haemorrhagic episode in 5 patients. Among those 10 patients, 7 had a recurrence or extension of the initial PVT. CONCLUSIONS Our results confirm that anticoagulation allows a recanalization of PVT complicating cirrhosis in the majority of the cases, is associated with non-severe bleeding complications, and can be maintained for a long duration in order to avoid recurrence.
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Affiliation(s)
- Michel Bergère
- Fédération des spécialités digestives, hôpital Edouard-Herriot, hospices civils de Lyn, 69437 Lyon, France
| | - Domitille Erard-Poinsot
- Fédération des spécialités digestives, hôpital Edouard-Herriot, hospices civils de Lyn, 69437 Lyon, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France
| | - Olivier Boillot
- Fédération des spécialités digestives, hôpital Edouard-Herriot, hospices civils de Lyn, 69437 Lyon, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France
| | - Pierre-Jean Valette
- Fédération des spécialités digestives, hôpital Edouard-Herriot, hospices civils de Lyn, 69437 Lyon, France
| | - Olivier Guillaud
- Fédération des spécialités digestives, hôpital Edouard-Herriot, hospices civils de Lyn, 69437 Lyon, France
| | - Christine Chambon-Augoyard
- Fédération des spécialités digestives, hôpital Edouard-Herriot, hospices civils de Lyn, 69437 Lyon, France
| | - Jérôme Dumortier
- Fédération des spécialités digestives, hôpital Edouard-Herriot, hospices civils de Lyn, 69437 Lyon, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France.
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Dumortier J, Dupuis-Girod S, Valette PJ, Valent A, Guillaud O, Saurin JC, Hervieu V, Robinson P, Plauchu H, Paliard P, Boillot O, Scoazec JY. Recurrence of Hereditary Hemorrhagic Telangiectasia After Liver Transplantation: Clinical Implications and Physiopathological Insights. Hepatology 2019; 69:2232-2240. [PMID: 30549294 DOI: 10.1002/hep.30424] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/03/2018] [Indexed: 02/04/2023]
Abstract
Liver transplantation (LT) has been proposed as a curative treatment in hereditary hemorrhagic telangiectasia (HHT) with severe hepatic involvement. We provide a long-term evaluation of graft status after LT for HHT, with a focus on the risk of recurrence. The present study included all patients prospectively followed up after LT for HHT in the Lyon Liver Transplant Unit from 1993 to 2010, with a survival of more than 1 year. Protocol clinical, radiological, and histological examinations were performed at regular intervals. Fourteen patients were included (13 women and one man). Median age at LT was 52.5 years (range: 33.1-66.7). In eight patients (seven female), disease recurrence was diagnosed by abnormal radiological features, suggestive of microcirculatory disturbances. Typical vascular lesions, including telangiectasia, were demonstrated by liver biopsy in five of these patients. The median interval between LT and diagnosis of recurrence was 127 months (range: 74-184). The risk of recurrence increased over time; estimated cumulative risk was 47.9% at 15 years. Liver tissue analysis found the coexistence of an angiogenic process combined with endothelial microchimerism, as shown by the presence of vascular lining cells of recipient origin. Conclusion: The present data show that disease recurrence occurs, usually after a long delay, in a significant number of patients treated by LT for liver complications of HHT. This strongly supports the necessity of a lifelong follow-up and suggests that therapeutic strategy needs discussion and evaluation, especially of the role of potential adjuvant treatments to LT, such as antiangiogenic medications, when recurrent disease appears.
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Affiliation(s)
- Jérôme Dumortier
- Unité de Transplantation Hépatique, Hôpital Edouard Herriot, Hospices Civils de Lyon, and Université Claude Bernard Lyon 1, Lyon, France
| | - Sophie Dupuis-Girod
- Service de Génétique and Centre de Référence Pour la Maladie de Rendu-Osler, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - Pierre-Jean Valette
- Service de Radiologie Digestive, Hôpital Edouard Herriot, Hospices Civils de Lyon, and Université Claude Bernard Lyon 1, Lyon, France
| | - Alexander Valent
- Département de Biologie et Pathologie Médicales, Service de Pathologie Moléculaire, Gustave Roussy Cancer Campus, Villejuif, France
| | - Olivier Guillaud
- Unité de Transplantation Hépatique, Hôpital Edouard Herriot, Hospices Civils de Lyon, and Université Claude Bernard Lyon 1, Lyon, France
| | - Jean-Christophe Saurin
- Service d'Hépato-gastroentérologie, Hospices Civils de Lyon, Hôpital Edouard Herriot, and Université Claude Bernard Lyon 1, Lyon, France
| | - Valérie Hervieu
- Service Central d'Anatomie et Cytologie Pathologiques, Hôpital Edouard Herriot, Hospices Civils de Lyon, and Université Claude Bernard Lyon 1, Lyon, France
| | - Philip Robinson
- Direction de la Recherche Clinique et de l'Innovation, Hospices Civils de Lyon, Lyon, France
| | - Henri Plauchu
- Service de Génétique and Centre de Référence Pour la Maladie de Rendu-Osler, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - Pierre Paliard
- Service d'Hépato-gastroentérologie, Hospices Civils de Lyon, Hôpital Edouard Herriot, and Université Claude Bernard Lyon 1, Lyon, France
| | - Olivier Boillot
- Unité de Transplantation Hépatique, Hôpital Edouard Herriot, Hospices Civils de Lyon, and Université Claude Bernard Lyon 1, Lyon, France
| | - Jean-Yves Scoazec
- Département de Biologie et Pathologie Médicales, Service de Pathologie Moléculaire, Gustave Roussy Cancer Campus, Villejuif, France.,Service Central d'Anatomie et Cytologie Pathologiques, Hôpital Edouard Herriot, Hospices Civils de Lyon, and Université Claude Bernard Lyon 1, Lyon, France
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22
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Guiu B, Chevallier P, Assenat E, Barbier E, Merle P, Bouvier A, Dumortier J, Nguyen-Khac E, Gugenheim J, Rode A, Oberti F, Valette PJ, Yzet T, Chevallier O, Barbare JC, Latournerie M, Boulin M. Idarubicin-loaded Beads for Chemoembolization of Hepatocellular Carcinoma: The IDASPHERE II Single-Arm Phase II Trial. Radiology 2019; 291:801-808. [PMID: 31038408 DOI: 10.1148/radiol.2019182399] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background A prior in vitro study showed that idarubicin was the most cytotoxic agent for hepatocellular carcinoma (HCC) cell lines. Idarubicin-loaded beads for transarterial chemoembolization (TACE) were previously evaluated for the appropriate dose in a phase I dose-escalation study. Purpose To evaluate objective response rate (ORR), safety, and survival after TACE by using idarubicin-loaded beads for unresectable HCC. Materials and Methods This prospective single-arm phase II study was conducted between January 2015 and January 2017. Participants with unresectable HCC were included in the trial and underwent TACE with idarubicin-eluting beads. The primary end point was 6-month ORR assessed with independent central review by using modified Response Evaluation Criteria in Solid Tumors. Secondary end points were best ORR during the first 6 months, overall survival, progression-free survival, time to progression, and safety. A two-stage Fleming statistical design was used. Results Forty-six study participants (mean age, 71.2 years ± 10.2; six women and 40 men) were included; 44 participants underwent at least one TACE session. The 6-month ORR was 52% (23 of 44). The best ORR achieved was 68% (30 of 44). Fourteen of 44 (32%) participants underwent a curative treatment after TACE. Median progression-free survival, time to progression, and overall survival were 6.6 months, 9.5 months, and 18.6 months, respectively. TACE was discontinued for toxicity in four of 44 (9%) participants. The most frequent grade 3-4 adverse events were elevated aspartate aminotransferase (14 of 44, 32%), elevated γ-glutamyl transpeptidase (eight of 44, 18%), hyperbilirubinemia (seven of 44, 16%), elevated alanine aminotransferase (seven of 44, 16%), and pain (seven of 44, 16%). Conclusion Idarubicin-eluting beads showed a good safety profile and promising objective response rate and time to progression when used as part of a transarterial chemoembolization regimen for unresectable hepatocellular carcinoma. © RSNA, 2019 See also the editorial by Padia in this issue.
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Affiliation(s)
- Boris Guiu
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Patrick Chevallier
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Eric Assenat
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Emilie Barbier
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Philippe Merle
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Antoine Bouvier
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Jérôme Dumortier
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Eric Nguyen-Khac
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Jean Gugenheim
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Agnès Rode
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Frédéric Oberti
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Pierre-Jean Valette
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Thierry Yzet
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Olivier Chevallier
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Jean-Claude Barbare
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Marianne Latournerie
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Mathieu Boulin
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
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Kepenekian V, Muller A, Valette PJ, Rousset P, Chauvenet M, Phelip G, Walter T, Adham M, Glehen O, Passot G. Evaluation of a strategy using pretherapeutic fiducial marker placement to avoid missing liver metastases. BJS Open 2019; 3:344-353. [PMID: 31183451 PMCID: PMC6551408 DOI: 10.1002/bjs5.50140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/23/2018] [Accepted: 12/06/2018] [Indexed: 12/19/2022] Open
Abstract
Background Hepatic surgery is appropriate for selected patients with colorectal liver metastases (CRLM). Advances in chemotherapy have led to modification of management, particularly when metastases disappear. Treatment should address all initial CRLM sites based on pretherapeutic cross-sectional imaging. This study aimed to evaluate pretherapeutic fiducial marker placement to optimize CRLM treatment. Methods This pilot investigation included patients with CRLM who were considered for potentially curative treatment between 2009 and 2016. According to a multidisciplinary team decision, lesions smaller than 25 mm in diameter that were more than 10 mm deep in the hepatic parenchyma and located outside the field of a planned resection were marked. Complication rates and clinicopathological data were analysed. Results Some 76 metastases were marked in 43 patients among 217 patients with CRLM treated with curative intent. Of these, 23 marked CRLM (30 per cent), with a mean(s.d.) size of 11·0(3·4) mm, disappeared with preoperative chemotherapy. There were four complications associated with marking: two intrahepatic haematomas, one fiducial migration and one misplacement. After a median follow-up of 47·7 (range 18·1-144·9) months, no needle-track seeding was noted. Of four disappearing CRLM that were marked and resected, two presented with persistent active disease. Other missing lesions were treated with thermoablation. Conclusion Pretherapeutic fiducial marker placement appears useful for the curative management of CRLM.
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Affiliation(s)
- V Kepenekian
- Department of Digestive Surgery Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Lyon France
| | - A Muller
- Department of Radiology Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Lyon France
| | - P J Valette
- Department of Radiology Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Lyon France
| | - P Rousset
- Department of Radiology Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Lyon France
| | - M Chauvenet
- Department of Digestive Oncology Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Lyon France
| | - G Phelip
- Department of Digestive Oncology Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Lyon France
| | - T Walter
- Department of Medical Oncology Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon 1 University Lyon France
| | - M Adham
- Department of Digestive Surgery Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon 1 University Lyon France
| | - O Glehen
- Department of Digestive Surgery Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Lyon France
| | - G Passot
- Department of Digestive Surgery Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Lyon France
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Robelin P, Hadoux J, Forestier J, Planchard D, Hervieu V, Berdelou A, Scoazec JY, Valette PJ, Leboulleux S, Ducreux M, Lombard-Bohas C, Baudin E, Walter T. Characterization, Prognosis, and Treatment of Patients With Metastatic Lung Carcinoid Tumors. J Thorac Oncol 2019; 14:993-1002. [PMID: 30771520 DOI: 10.1016/j.jtho.2019.02.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/23/2019] [Accepted: 02/05/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Metastatic lung carcinoids (MLCs) remain poorly characterized and no prognostic stratification exists. METHODS We conducted a retrospective study including patients with MLCs in two European expert centers. The aims were to characterize these cases and to identify prognostic factors of survival and effectiveness of their treatments. RESULTS A total of 162 patients with MLC were included: 50% were women, and the median age was 61 years. Half of the patients had synchronous metastases, mainly located in the liver (75%), bone (42%), and lung (25%). According to WHO classification, MLCs were typical (28%), atypical (60%), or unspecified (12%). A functioning syndrome was observed in 43% of cases and an uptake at somatostatin receptor scintigraphy in 76% of cases. The 5-year overall survival rate was 60% and at 10 years this was 25%. In multivariate analysis, Eastern Cooperative Oncology Group performance status of 0-1 (hazard ratio [HR]: 5.81, 95% confidence interval [CI]: 2.10-16.11), uptake on SRS (HR: 0.38, 95% CI: 0.22-0.66), low serum chromogranin A (HR: 2.27, 95% CI: 1.36-3.81), and typical carcinoid (HR: 1.87, 95% CI: 1.26-2.78) were associated with better survival. According to Response Evaluation Criteria in Solid Tumors version 1.0, the highest objective response rates were obtained after radiofrequency ablation of metastases (86%), liver embolization (56%), peptide receptor radionuclide therapy (27%), and oxaliplatin-based chemotherapy (18%). CONCLUSIONS MLCs are characterized by a high frequency of atypical carcinoids, functioning syndrome, and liver/bone metastases. WHO classification, performance status, somatostatin receptor scintigraphy, and chromogranin A were associated with longer survival. Partial response was more frequent with locoregional therapies, peptide receptor radionuclide therapy, or oxaliplatin-based chemotherapy.
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Affiliation(s)
- Patrick Robelin
- Service d'Oncologie Médicale, Groupement Hospitalier Centre, Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France
| | - Julien Hadoux
- Service de Médecine Nucléaire et de Cancérologie Endocrinienne, Institut Gustave-Roussy, Villejuif, France
| | - Julien Forestier
- Service d'Oncologie Médicale, Groupement Hospitalier Centre, Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France
| | - David Planchard
- Service d'Oncologie Médicale, Institut Gustave-Roussy, Villejuif, France
| | - Valérie Hervieu
- Service Central d'Anatomie et Cytologie Pathologiques, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France
| | - Amandine Berdelou
- Service de Médecine Nucléaire et de Cancérologie Endocrinienne, Institut Gustave-Roussy, Villejuif, France
| | - Jean-Yves Scoazec
- Service de Biologie et Pathologie Médicales, Institut Gustave-Roussy, Villejuif, France; University of Paris-Sud, Kremlin-Bicêtre, France
| | - Pierre-Jean Valette
- University of Lyon, Lyon, France; Service d'Imagerie Médicale, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| | - Sophie Leboulleux
- Service de Médecine Nucléaire et de Cancérologie Endocrinienne, Institut Gustave-Roussy, Villejuif, France
| | - Michel Ducreux
- Service d'Oncologie Médicale, Institut Gustave-Roussy, Villejuif, France; University of Paris-Sud, Kremlin-Bicêtre, France
| | - Catherine Lombard-Bohas
- Service d'Oncologie Médicale, Groupement Hospitalier Centre, Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France
| | - Eric Baudin
- Service de Médecine Nucléaire et de Cancérologie Endocrinienne, Institut Gustave-Roussy, Villejuif, France
| | - Thomas Walter
- Service d'Oncologie Médicale, Groupement Hospitalier Centre, Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France.
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25
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Cazauran JB, Muller A, Hengy B, Valette PJ, Gruner L, Monneuse O. Preliminary Report of Percutaneous Cholecystostomy as Diagnosis and Treatment of Biliary Tract Trauma. World J Surg 2018; 42:3705-3714. [PMID: 29882101 DOI: 10.1007/s00268-018-4621-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 12/20/2022]
Abstract
BACKGROUND Biliary leak following severe blunt liver injuries is a complex problem becoming more frequent with improvements in non-operative management. Standard treatment requires main bile duct drainage usually performed by endoscopic sphincterotomy and stent placement. We report our experience with cholecystostomy as a first minimally invasive diagnostic and therapeutic approach. METHODS We performed a retrospective analysis of consecutive patients with post-traumatic biliary leak between 2006 and 2015. In the first period (2006-2010), biliary fistula was managed using perihepatic drainage and endoscopic, percutaneous or surgical main bile duct drainage. After 2010, cholecystostomy as an initial minimally invasive approach was performed. RESULTS Of 341 patients with blunt liver injury, 18 had a post-traumatic biliary leak. Ten patients received standard treatment and eight patients underwent cholecystostomy. The cholecystostomy (62.5%) and the standard treatment (80%) groups presented similar success rates as the first biliary drainage procedure (p = 0.41). Cholecystostomy presented no severe complications and resulted, when successful, in a bile flow rate inversion between the perihepatic drains and the gallbladder drain within a median [IQR] 4 days [1-7]. The median time for bile leak resolution was 26 days in the cholecystostomy group and 39 days in the standard treatment group (p = 0.09). No significant difference was found considering median duration of hospital stay (54 and 74 days, respectively, p = 0.37) or resuscitation stay (17.5 and 19.5 days, p = 0.59). CONCLUSION Cholecystostomy in non-operative management of biliary fistula after blunt liver injury could be an effective, simple and safe first-line procedure in the diagnostic and therapeutic approach of post-traumatic biliary tract injuries.
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Affiliation(s)
- Jean-Baptiste Cazauran
- Département de Chirurgie d'Urgence et de Chirurgie Générale, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France
| | - Arnaud Muller
- Département d'Imagerie Médicale, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Baptiste Hengy
- Département de Réanimation chirurgicale, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Pierre-Jean Valette
- Département d'Imagerie Médicale, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Laurent Gruner
- Département de Chirurgie d'Urgence et de Chirurgie Générale, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France
| | - Olivier Monneuse
- Département de Chirurgie d'Urgence et de Chirurgie Générale, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France.
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26
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Nemeth A, Segrestin B, Leporq B, Seyssel K, Faraz K, Sauvinet V, Disse E, Valette PJ, Laville M, Ratiney H, Beuf O. 3D Chemical Shift-Encoded MRI for Volume and Composition Quantification of Abdominal Adipose Tissue During an Overfeeding Protocol in Healthy Volunteers. J Magn Reson Imaging 2018; 49:1587-1599. [PMID: 30328237 DOI: 10.1002/jmri.26532] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/14/2018] [Accepted: 09/14/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Overweight and obesity are major worldwide health concerns characterized by an abnormal accumulation of fat in adipose tissue (AT) and liver. PURPOSE To evaluate the volume and the fatty acid (FA) composition of the subcutaneous adipose tissue (SAT) and the visceral adipose tissue (VAT) and the fat content in the liver from 3D chemical-shift-encoded (CSE)-MRI acquisition, before and after a 31-day overfeeding protocol. STUDY TYPE Prospective and longitudinal study. SUBJECTS Twenty-one nonobese healthy male volunteers. FIELD STRENGTH/SEQUENCE A 3D spoiled-gradient multiple echo sequence and STEAM sequence were performed at 3T. ASSESSMENT AT volume was automatically segmented on CSE-MRI between L2 to L4 lumbar vertebrae and compared to the dual-energy X-ray absorptiometry (DEXA) measurement. CSE-MRI and MR spectroscopy (MRS) data were analyzed to assess the proton density fat fraction (PDFF) in the liver and the FA composition in SAT and VAT. Gas chromatography-mass spectrometry (GC-MS) analyses were performed on 13 SAT samples as a FA composition countermeasure. STATISTICAL TESTS Paired t-test, Pearson's correlation coefficient, and Bland-Altman plots were used to compare measurements. RESULTS SAT and VAT volumes significantly increased (P < 0.001). CSE-MRI and DEXA measurements were strongly correlated (r = 0.98, P < 0.001). PDFF significantly increased in the liver (+1.35, P = 0.002 for CSE-MRI, + 1.74, P = 0.002 for MRS). FA composition of SAT and VAT appeared to be consistent between localized-MRS and CSE-MRI (on whole segmented volume) measurements. A significant difference between SAT and VAT FA composition was found (P < 0.001 for CSE-MRI, P = 0.001 for MRS). MRS and CSE-MRI measurements of the FA composition were correlated with the GC-MS results (for ndb: rMRS/GC-MS = 0.83 P < 0.001, rCSE-MRI/GC-MS = 0.84, P = 0.001; for nmidb: rMRS/GC-MS = 0.74, P = 0.006, rCSE-MRI/GC-MS = 0.66, P = 0.020) DATA CONCLUSION: The follow-up of liver PDFF, volume, and FA composition of AT during an overfeeding diet was demonstrated through different methods. The CSE-MRI sequence associated with a dedicated postprocessing was found reliable for such quantification. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:1587-1599.
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Affiliation(s)
- Angeline Nemeth
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F69621, Lyon, France
| | - Bérénice Segrestin
- Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RA), Centre Hospitalier Lyon Sud, Pierre-Bénite, Lyon, France.,Institut National de la Santé et de la Recherche Médicale Unit 1060, CarMeN Laboratory, Lyon 1 University, Oullins, France
| | - Benjamin Leporq
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F69621, Lyon, France
| | - Kevin Seyssel
- Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Khuram Faraz
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F69621, Lyon, France
| | - Valérie Sauvinet
- Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RA), Centre Hospitalier Lyon Sud, Pierre-Bénite, Lyon, France
| | - Emmanuel Disse
- Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RA), Centre Hospitalier Lyon Sud, Pierre-Bénite, Lyon, France.,Institut National de la Santé et de la Recherche Médicale Unit 1060, CarMeN Laboratory, Lyon 1 University, Oullins, France
| | - Pierre-Jean Valette
- Hospices Civils de Lyon, Département d'imagerie digestive, CHU Edouard Herriot, Lyon, France
| | - Martine Laville
- Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RA), Centre Hospitalier Lyon Sud, Pierre-Bénite, Lyon, France.,Institut National de la Santé et de la Recherche Médicale Unit 1060, CarMeN Laboratory, Lyon 1 University, Oullins, France
| | - Hélène Ratiney
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F69621, Lyon, France
| | - Olivier Beuf
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F69621, Lyon, France
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Dumortier J, Valette PJ. Transjugular intrahepatic portosystemic shunt for alveolar echinococcosis of the liver and Budd-Chiari syndrome. Clin Res Hepatol Gastroenterol 2018; 42:e61-e62. [PMID: 29891417 DOI: 10.1016/j.clinre.2017.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/20/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Jérôme Dumortier
- Department of digestive diseases, Edouard-Herriot hospital, Hospices civils de Lyon, Lyon, France; Claude-Bernard Lyon 1 university, Lyon, France.
| | - Pierre-Jean Valette
- Claude-Bernard Lyon 1 university, Lyon, France; Department of digestive radiology, Edouard-Herriot hospital, Hospices civils de Lyon, Lyon, France
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28
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Pioche M, Ganne C, Gincul R, De Leusse A, Marsot J, Balique J, Fond A, Bretagnolle M, Henry L, Billaud Y, Malezieux R, Lapalus MG, Chambon-Augoyard C, Del Tedesco E, Scalone O, Montoy JC, Russias B, Detry A, Veniat F, Qiu J, Valette PJ, Taillandier A, Saurin JC, Tomczyk-Ferrero J, Gandilhon C, Vecchiato L, Soler-Michel P, Ponchon T. Colon capsule versus computed tomography colonography for colorectal cancer screening in patients with positive fecal occult blood test who refuse colonoscopy: a randomized trial. Endoscopy 2018; 50:761-769. [PMID: 29486502 DOI: 10.1055/s-0044-100721] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Some patients (10 % - 32 %) with a positive guaiac fecal occult blood test (gFOBT) do not undergo the recommended colonoscopy. The aim of this study was to compare video capsule endoscopy (VCE) and computed tomography colonography (CTC) in terms of participation rate and detection outcomes when offered to patients with a positive gFOBT who did not undergo the recommended colonoscopy. METHODS An invitation letter offering CTC or VCE was sent to selected patients after randomization. Acceptance of the proposed (or alternative) procedure and procedure results were recorded. Sample size was evaluated according to the hypothesis of a 13 % increase of participation with VCE. RESULTS A total of 756 patients were targeted. Following the invitation letter, 5.0 % (19/378) of patients underwent the proposed VCE and 7.4 % (28/378) underwent CTC, (P = 0.18). Following the letter, 9.8 % (37/378) of patients in the VCE group underwent a diagnostic procedure (19 VCE, 1 CTC, 17 colonoscopy) vs. 10.8 % in the CTC group (41/378: 28 CTC, 13 colonoscopy; P = 0.55). There were more potentially neoplastic lesions diagnosed in the VCE group than in the CTC group (12/20 [60.0 %] vs. 8/28 [28.6 %]; P = 0.04). Thus, 15/20 noninvasive procedures in the VCE group (19 VCE, 1 CTC; 75.0 %) vs. 10/28 in the CTC group (35.7 %; P = 0.01) resulted in a recommendation of further colonoscopy, but only 10/25 patients actually underwent this proposed colonoscopy. CONCLUSION Patients with a positive gFOBT result who do not undergo the recommended colonoscopy are difficult to recruit to the screening program and simply proposing an additional, less-invasive procedure, such as VCE or CTC, is not an effective strategy.ClinicalTrials.govNCT02558881TRIAL REGISTRATION: Randomized, controlled trial NCT02558881 at clinicaltrials.gov.
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Affiliation(s)
- Mathieu Pioche
- Hepatogastroenterology department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Lyon 1 University Claude Bernard, Lyon, France
| | - Christell Ganne
- Research and Medical Information Division, Hospices Civils de Lyon, Lyon, France
| | - Rodica Gincul
- Hepatogastroenterology department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Hepatogastroenterology Department, Mermoz Hospital, Lyon, France
| | | | | | | | - Alain Fond
- Radiology Department, Mermoz Hospital, Lyon, France
| | | | - Luc Henry
- Radiology Department, Clinique du Val d'Ouest, Lyon, France
| | - Yann Billaud
- Radiology Department, Clinique du Val d'Ouest, Lyon, France
| | - Romain Malezieux
- Radiology Department, Clinique du Parc, Saint-Priest en Jarez, France
| | - Marie-Georges Lapalus
- Hepatogastroenterology Department, Hôpital Privé de L'est Lyonnais, Saint-Priest, France
| | | | - Emilie Del Tedesco
- Hepatogastroenterology Department, University Hospital Saint-Etienne, Saint-Priest en Jarez, France
| | - Olivia Scalone
- Hepatogastroenterology Department, Nord Ouest Hospital, Villefranche-sur-Saône, France
| | | | - Benoit Russias
- Radiology Department, Clinique du Renaison, Roanne, France
| | - Antoine Detry
- Radiology Department, Clinique du Renaison, Roanne, France
| | | | - Jin Qiu
- Hepatogastroenterology Department, Public hospital, Roanne, France
| | - Pierre-Jean Valette
- Radiology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | - Jean-Christophe Saurin
- Hepatogastroenterology department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Lyon 1 University Claude Bernard, Lyon, France
| | | | - Clémentine Gandilhon
- Hepatogastroenterology department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Departmental Screening Management Association Rhône ADEMAS 69, Lyon, France
| | - Léa Vecchiato
- Departmental Screening Management Association Rhône ADEMAS 69, Lyon, France
| | | | - Thierry Ponchon
- Hepatogastroenterology department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
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Mastier C, Valette PJ, Adham M, Mabrut JY, Glehen O, Ponchon T, Rousset P, Rode A. Complex Biliary Leaks: Effectiveness of Percutaneous Radiological Treatment Compared to Simple Leaks in 101 Patients. Cardiovasc Intervent Radiol 2018; 41:1566-1572. [DOI: 10.1007/s00270-018-2005-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/29/2018] [Indexed: 12/27/2022]
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Joyon N, Dumortier J, Aline-Fardin A, Caramella C, Valette PJ, Blay JY, Scoazec JY, Dartigues P. Gastrointestinal stromal tumors (GIST) presenting in the liver: Diagnostic, prognostic and therapeutic issues. Clin Res Hepatol Gastroenterol 2018. [PMID: 28645742 DOI: 10.1016/j.clinre.2017.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Indexed: 02/07/2023]
Abstract
CONTEXT Extra-gastrointestinal stromal tumors (E-GIST) presenting in the liver are exceedingly rare and raise difficult diagnostic and therapeutic challenges. METHODS We report on two cases of liver E-GIST with different clinical presentations. We describe their clinical and imaging features, their histopathological and molecular characteristics, their treatment and their course. RESULTS The first case was that of a 56-year-old male presenting with a 10-cm liver mass; the initial diagnosis, made in 1986 from a biopsy sample, was leiomyosarcoma; liver transplantation was performed in 1987; no extra-hepatic tumor was found; the course was uneventful until 1999, when tumor recurrence was diagnosed along the initial biopsy route; after reevaluation of available material, the definitive pathological diagnosis was GIST; imatinib treatment resulted in major response; the patient died of end-stage kidney disease 22 years after the initial diagnosis and 9 years after tumor recurrence. The second case is that of a 59-year-old female presenting with a 23-cm abdominal mass connected to the liver; on biopsy, the tumor was diagnosed as epithelioid GIST with exon 11 KIT mutation; imatinib treatment resulted in stable disease. CONCLUSIONS The diagnosis of E-GIST must be for any sarcoma presenting in the liver and confirmed by immunohistochemical and molecular techniques. Treatment might require aggressive strategies, which can be successful despite apparently adverse histoprognostic factors.
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Affiliation(s)
- Natacha Joyon
- Département de Biologie et Pathologie Médicales, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - Jérôme Dumortier
- Unité de Transplantation hépatique, Hôpital Edouard-Herriot, Hospices Civils de Lyon, 69003 Lyon, France; Université Claude-Bernard Lyon 1, 69622 Villeurbanne, France
| | - Aude Aline-Fardin
- Service d'Anatomie Pathologique, CHU de Martinique-La-Meynard, 97261 Fort-de-France, France
| | - Caroline Caramella
- Département d'Imagerie Médicale, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - Pierre-Jean Valette
- Université Claude-Bernard Lyon 1, 69622 Villeurbanne, France; Service de Radiologie Digestive, Hôpital Edouard-Herriot, Hospices Civils de Lyon, 69003 Lyon, France
| | - Jean-Yves Blay
- Université Claude-Bernard Lyon 1, 69622 Villeurbanne, France; Département d'Oncologie Médicale, Centre Léon-Bérard, 69008 Lyon, France
| | - Jean-Yves Scoazec
- Département de Biologie et Pathologie Médicales, Gustave-Roussy Cancer Campus, 94805 Villejuif, France; Faculté de Médecine de Bicêtre, Université Paris Saclay, Université Paris Sud, 94270 Le Kremlin-Bicêtre, France.
| | - Peggy Dartigues
- Département de Biologie et Pathologie Médicales, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
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Banaste N, Rousset P, Mercier F, Rieussec C, Valette PJ, Glehen O, Passot G. Preoperative nutritional risk assessment in patients undergoing cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for colorectal carcinomatosis. Int J Hyperthermia 2017; 34:589-594. [PMID: 28828897 DOI: 10.1080/02656736.2017.1371342] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Malnutrition is associated with increased postoperative morbidity in colorectal surgery. This study aimed to determine if preoperative nutritional markers could predict postoperative outcomes for patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for peritoneal metastasis (PM) of colorectal origin. METHODS All patients who underwent a complete CRS-HIPEC for colorectal PM between January 2009 and December 2014 were evaluated. Preoperative clinical and biological nutritional factors, including Body Mass Index (BMI), preoperative albumin and prealbumin levels were analysed. Preoperative computed tomography was used to measure the cross-sectional surface of the visceral and subcutaneous adipose tissue, at the third lumbar vertebrae, to assess the abdominal fat composition. Skeletal muscle mass was measured to assess for sarcopenia. RESULTS Among 214 patients, 14 (6.5%) had a BMI ≥ 35 kg/m2, 90 (42%) were sarcopenic, 19 (9%) presented albumin <35 g/L and 2 (1%) had pre-albumin <20 mg/dL. Median values for visceral and subcutaneous fat surfaces were 99.2 cm2 and 198 cm2, respectively. Hypoalbuminemia was associated with worse overall survival (23 vs. 59 months, p = 0.015). The other nutritional factors did not impact overall or progression free survival after CRS-HIPEC for colorectal PM. In multivariate analysis, major post-operative complication and hypoalbuminemia were independently associated with decreased overall survival. CONCLUSIONS Hypoalbuminemia appears as a strong predictive factor for decreased overall survival in patients presenting PM of colorectal origin undergoing CRS-HIPEC.
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Affiliation(s)
- Nathan Banaste
- a Department of Radiology , Hospices Civils de Lyon, Centre Hospitalier Lyon Sud , Pierre Bénite , France
| | - Pascal Rousset
- a Department of Radiology , Hospices Civils de Lyon, Centre Hospitalier Lyon Sud , Pierre Bénite , France.,b EMR 3738, Faculté de Médecine Lyon Sud, Université Lyon 1 , Lyon , France
| | - Frederic Mercier
- c Department of Surgical Oncology , Hospices Civils de Lyon, Centre Hospitalier Lyon Sud , Pierre Benite , France
| | - Clémentine Rieussec
- a Department of Radiology , Hospices Civils de Lyon, Centre Hospitalier Lyon Sud , Pierre Bénite , France
| | - Pierre-Jean Valette
- a Department of Radiology , Hospices Civils de Lyon, Centre Hospitalier Lyon Sud , Pierre Bénite , France.,b EMR 3738, Faculté de Médecine Lyon Sud, Université Lyon 1 , Lyon , France
| | - Olivier Glehen
- b EMR 3738, Faculté de Médecine Lyon Sud, Université Lyon 1 , Lyon , France.,c Department of Surgical Oncology , Hospices Civils de Lyon, Centre Hospitalier Lyon Sud , Pierre Benite , France
| | - Guillaume Passot
- b EMR 3738, Faculté de Médecine Lyon Sud, Université Lyon 1 , Lyon , France.,c Department of Surgical Oncology , Hospices Civils de Lyon, Centre Hospitalier Lyon Sud , Pierre Benite , France
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Abstract
OBJECTIVES The success of longitudinal sleeve gastrectomy (LSG) is perceived as being potentially limited by dilatation of the remaining gastric tube during the follow-up. The aim of this prospective study was to determine the incidence and the characteristics of sleeve dilatation during the first post-operative year. MATERIALS AND METHODS Gastric volumetry using 3D gastric computed tomography with gas expansion was performed in 54 successive subjects who underwent an LSG for morbid obesity at 3 and 12 months following surgery. Total gastric volume, volume of the gastric tube and the antrum, and diameter of the gastric tube were assessed after multiplanar reconstructions. An increase of at least 25 % of the total gastric volume was considered as sleeve dilatation. Percentage of excess BMI loss (%EBMIL) and daily caloric intakes were recorded during the first 18 months. RESULTS Sixty-one percent of the subjects experienced sleeve dilatation 1 year after surgery. The gastric tube was mainly involved in the sleeve dilatation process (+91 %). Sleeve dilatation occurred especially in subjects with smaller total gastric volume at baseline (189 vs 236 ml, p = 0.02). Daily caloric intake was similar between the groups at each point of the follow-up. No difference concerning %EBMIL was observed between the groups during the 18 months of follow-up. CONCLUSIONS Sleeve dilatation occurred in more than 50 % of the patients. Dilatation was not necessarily linked to an increase of daily caloric intake and insufficient weight loss during the first 18 months following surgery. Small LSG at baseline is at higher risk of dilatation.
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Blond E, Disse E, Cuerq C, Drai J, Valette PJ, Laville M, Thivolet C, Simon C, Caussy C. EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease in severely obese people: do they lead to over-referral? Diabetologia 2017; 60:1218-1222. [PMID: 28352941 DOI: 10.1007/s00125-017-4264-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/06/2017] [Indexed: 12/11/2022]
Abstract
AIMS/HYPOTHESIS We aimed to assess the application of the recent European Association for the Study of the Liver (EASL)-European Association for the Study of Diabetes (EASD)-European Association for the Study of Obesity (EASO) clinical practice guidelines for the management of non-alcoholic fatty liver disease (NAFLD) in severely obese individuals in routine clinical practice. METHODS We performed a single-centre retrospective observational study of 385 patients referred for severe obesity (BMI ≥ 35 kg/m2) to our Endocrinology, Diabetes and Nutrition department, between 1 November 2014 and 31 December 2015. The recent EASL-EASD-EASO clinical practice guidelines for the management of NAFLD were retrospectively applied to the cohort using, successively, the NAFLD fibrosis score (NFS) and a combination of the NFS and transient elastography (TE) measurement in a subgroup of individuals. RESULTS We identified 313 (81.3%) individuals with NAFLD in the cohort. The application of the EASL-EASD-EASO guidelines using NFS would lead to referral to a specialist for up to 289 individuals (75.1%) in the cohort. The combination of NFS and TE measurement reclassified 28 (25%) individuals from the medium/high risk group to low risk and would lead to the referral of 261 (67.7%) individuals to a specialist. These proportions appear to be excessive given the expected prevalence of advanced fibrosis and non-alcoholic steatohepatitis (NASH) of around 10% and 30%, respectively, in the severely obese population. CONCLUSIONS/INTERPRETATION This is the first study to assess the strategy proposed by the EASL-EASD-EASO clinical practice guidelines for the management of NAFLD in severely obese individuals. The retrospective application of the guidelines in a cohort representing the routine clinical practice in our department would lead to an excessive number of specialist referrals and would also lead to an unjustified increase in health costs. Biomarkers and specific strategy for the screening of NASH and advanced fibrosis in morbidly obese individuals are thus crucially needed and would help to improve the actual guidelines.
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Affiliation(s)
- Emilie Blond
- Biochemistry Department, Lyon Sud Hospital, Hospices Civils de Lyon, Claude-Bernard Lyon 1 University, Pierre Bénite, France
| | - Emmanuel Disse
- Department of Endocrinologie, Diabète, Nutrition, Centre Intégré de l'Obésité Rhône-Alpes, Fédération Hospitalo-Universitaire DO-iT, Lyon Sud Hospital, Hospices Civils de Lyon, Claude-Bernard Lyon 1 University, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France
- Laboratoire CarMeN, Unité Inserm U1060 - INRA 1235 - INSA-Lyon, Pierre Bénite, France
| | - Charlotte Cuerq
- Biochemistry Department, Lyon Sud Hospital, Hospices Civils de Lyon, Claude-Bernard Lyon 1 University, Pierre Bénite, France
| | - Jocelyne Drai
- Biochemistry Department, Lyon Sud Hospital, Hospices Civils de Lyon, Claude-Bernard Lyon 1 University, Pierre Bénite, France
| | - Pierre-Jean Valette
- Department of Radiology, E. Herriot University Hospital, Hospices Civils de Lyon, Claude-Bernard Lyon 1 University, Lyon, France
| | - Martine Laville
- Department of Endocrinologie, Diabète, Nutrition, Centre Intégré de l'Obésité Rhône-Alpes, Fédération Hospitalo-Universitaire DO-iT, Lyon Sud Hospital, Hospices Civils de Lyon, Claude-Bernard Lyon 1 University, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France
- Laboratoire CarMeN, Unité Inserm U1060 - INRA 1235 - INSA-Lyon, Pierre Bénite, France
| | - Charles Thivolet
- Department of Endocrinologie, Diabète, Nutrition, Centre Intégré de l'Obésité Rhône-Alpes, Fédération Hospitalo-Universitaire DO-iT, Lyon Sud Hospital, Hospices Civils de Lyon, Claude-Bernard Lyon 1 University, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France
- Laboratoire CarMeN, Unité Inserm U1060 - INRA 1235 - INSA-Lyon, Pierre Bénite, France
| | - Chantal Simon
- Department of Endocrinologie, Diabète, Nutrition, Centre Intégré de l'Obésité Rhône-Alpes, Fédération Hospitalo-Universitaire DO-iT, Lyon Sud Hospital, Hospices Civils de Lyon, Claude-Bernard Lyon 1 University, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France
- Laboratoire CarMeN, Unité Inserm U1060 - INRA 1235 - INSA-Lyon, Pierre Bénite, France
| | - Cyrielle Caussy
- Department of Endocrinologie, Diabète, Nutrition, Centre Intégré de l'Obésité Rhône-Alpes, Fédération Hospitalo-Universitaire DO-iT, Lyon Sud Hospital, Hospices Civils de Lyon, Claude-Bernard Lyon 1 University, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France.
- Laboratoire CarMeN, Unité Inserm U1060 - INRA 1235 - INSA-Lyon, Pierre Bénite, France.
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Ognong-Boulemo A, Dohan A, Hoeffel C, Stanek A, Golfier F, Glehen O, Valette PJ, Rousset P. Adnexal masses associated with peritoneal involvement: diagnosis with CT and MRI. Abdom Radiol (NY) 2017; 42:1975-1992. [PMID: 28315929 DOI: 10.1007/s00261-017-1089-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Given the unique intra-peritoneal anatomic location of the adnexa, tubo-ovarian diseases can commonly spread into the peritoneal cavity. Peritoneal seeding may occur in a spectrum of adnexal conditions including infectious diseases, endometriosis, and benign or malignant primary or secondary ovarian tumors. CT is usually the imaging modality on which the concomitant involvement of the peritoneum and the ovary is depicted. The first diagnosis to be considered by the radiologist is generally peritoneal carcinomatosis from ovarian cancer but other conditions cited above have also to be borne in mind and may be suggested on the basis of careful assessment of CT findings or on further MR findings. MRI may indeed help characterize the lesions in some cases. The purpose of this review is to describe the clinical and imaging patterns of peritoneal involvement that may be found in association with different ovarian lesions. Familiarity with these patterns and diagnoses will help the radiologist narrow the differential diagnosis and make an accurate diagnosis, thus facilitating patient management and avoiding unnecessary invasive treatment.
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Affiliation(s)
- Audrey Ognong-Boulemo
- Lyon 1 University, Villeurbanne, France
- Department of Radiology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Anthony Dohan
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France
| | - Christine Hoeffel
- Department of Radiology, Hôpitaux Universitaires de Reims, Reims, France
| | - Agatha Stanek
- Department of Radiology, McGill University Health Center, Montreal, QC, Canada
| | - François Golfier
- Lyon 1 University, Villeurbanne, France
- EMR 3738, Oullins, France
- Obstetric and Gynecologic Department, Centre Hospitalier Lyon Sud, HCL, Pierre Bénite, France
| | - Olivier Glehen
- Lyon 1 University, Villeurbanne, France
- EMR 3738, Oullins, France
- Department of Surgical Oncology, Centre Hospitalier Lyon Sud, HCL, Pierre-Bénite, France
| | - Pierre-Jean Valette
- Lyon 1 University, Villeurbanne, France
- Department of Radiology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
- EMR 3738, Oullins, France
| | - Pascal Rousset
- Lyon 1 University, Villeurbanne, France.
- Department of Radiology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
- EMR 3738, Oullins, France.
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35
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Dumortier J, Sicard A, Guillaud O, Valette PJ, Scoazec JY, Boillot O. Portal Vein Thrombosis and Nephrotic Syndrome After Liver Transplant. EXP CLIN TRANSPLANT 2017; 17:418-420. [PMID: 28589849 DOI: 10.6002/ect.2016.0259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite systemic thromboembolic complications being frequent, portal vein thrombosis is a rare complication of nephrotic syndrome. We report here a liver transplant recipient who presented a late extensive portal vein thrombosis related to nephrotic syndrome. During regular follow-up after liver transplant, the patient presented with diabetes, arterial hypertension, hypercholesterolemia, and progressive renal dysfunction. In addition, urine analysis showed isolated proteinuria, and the diagnosis of nephrotic syndrome was made 36 months after liver transplant. Sixty months after liver transplant, the patient presented with mild acute abdominal pain, and the diagnosis of portal vein thrombosis was made from a computed tomography scan. Other causes for portal vein thrombosis were excluded. Histologic examination of a liver biopsy disclosed only mild steatosis. Histologic examination of a kidney biopsy disclosed severe lesions, suggesting a multifactorial, advanced chronic nephropathy probably caused by nephroangiosclerosis, diabetes, and toxicity of calcineurin inhibitors. Anticoagulation therapy led to complete recanalization of the portal and splenic veins, which was maintained thereafter. In conclusion, the case we report here illustrates that portal vein thrombosis can occur after liver transplant in the context of nephrotic syndrome, complicating chronic kidney disease, which is a very frequent and multifactorial complication after liver transplant.
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Affiliation(s)
- Jérôme Dumortier
- From the Hospices Civils de Lyon, Hôpital Edouard Herriot, Unité de Transplantation Hépatique, and the Université Claude Bernard Lyon
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36
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Olesinski J, Mithieux F, Guillaud O, Hilleret MN, Lombard-Bohas C, Henry L, Boillot O, Walter T, Partensky C, Paliard P, Valette PJ, Vuillez JP, Borson-Chazot F, Scoazec JY, Dumortier J. Survival and prognostic factors after adjuvant 131iodine-labeled lipiodol for hepatocellular carcinoma: a retrospective analysis of 106 patients over 20 years. Ann Nucl Med 2017; 31:379-389. [PMID: 28342103 DOI: 10.1007/s12149-017-1165-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/14/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Hepatocellular carcinoma (HCC) has high recurrence rate after curative treatment. The aim of the present study was to report our experience with adjuvant use of 131I-lipiodol after curative treatment of HCC in terms of recurrence and survival in a large cohort of patients with a long follow-up. METHODS All patients treated with 131I-lipiodol after curative treatment of HCC in two French centers from 1991 to 2009 were included in a retrospective cohort study. RESULTS One hundred and six patients were included. The median (range) follow-up was 6 years (0.3-22). Forty-three patients (41%) had cirrhosis. Recurrence-free survival rates at 1, 2, 5, 10, and 20 years were 73, 57, 40, 30, and 14%, respectively. Cirrhosis was an independent predictive factor of recurrence [RR = 1.18, 95% CI (1.11-3.02), p = 0.019]. Overall, survival rates at 1, 2, 5, 10, and 20 years were 90, 83, 59, 37, and 23%, respectively. Prognostic factors were recurrence [RR = 2.73, 95% CI (1.35-5.54); p = 0.005], age over 60 years (RR = 1.91, 95% CI [1.02-3.61]; p = 0.044), and tumor number over 3 [RR = 3.31, 95% CI (1.25-8.77); p = 0.016]. CONCLUSION Our results suggest that the effect of 131I-lipiodol after curative treatment of HCC could be related to a beneficial impact on risk factors of early tumor recurrence. This could be evaluated in further studies using modern radioembolization methods.
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Affiliation(s)
- Jonathan Olesinski
- Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, pavillon L, 69437, Lyon Cedex 03, France
| | - François Mithieux
- Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, pavillon L, 69437, Lyon Cedex 03, France
| | - Olivier Guillaud
- Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, pavillon L, 69437, Lyon Cedex 03, France
| | - Marie-Noëlle Hilleret
- Service d'hépato-gastro-entérologie, CHU de Grenoble, Hôpital A. Michallon, La Tronche, France
| | - Catherine Lombard-Bohas
- Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, pavillon L, 69437, Lyon Cedex 03, France
| | - Luc Henry
- Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, pavillon L, 69437, Lyon Cedex 03, France
| | - Olivier Boillot
- Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, pavillon L, 69437, Lyon Cedex 03, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Thomas Walter
- Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, pavillon L, 69437, Lyon Cedex 03, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Christian Partensky
- Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, pavillon L, 69437, Lyon Cedex 03, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Pierre Paliard
- Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, pavillon L, 69437, Lyon Cedex 03, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Pierre-Jean Valette
- Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, pavillon L, 69437, Lyon Cedex 03, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Jean-Philippe Vuillez
- Service de Médecine nucléaire, CHU de Grenoble, Hôpital A. Michallon, La Tronche, France.,Université Joseph Fourier, Grenoble, France
| | - Françoise Borson-Chazot
- Service de Médecine Nucléaire, Hospices civils de Lyon, Hôpital Cardiologique Louis Pradel, Lyon, France
| | - Jean-Yves Scoazec
- Université Claude Bernard Lyon 1, Lyon, France.,Service Central d'Anatomie et Cytologie Pathologiques, Hospices civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Jérôme Dumortier
- Hospices civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, pavillon L, 69437, Lyon Cedex 03, France. .,Service de Médecine nucléaire, CHU de Grenoble, Hôpital A. Michallon, La Tronche, France.
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37
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Normand G, Jolivot A, Rabeyrin M, Hervieu V, Valette PJ, Scoazec JY, Gougon JM, Juillard L, Dumortier J. Paraneoplastic fibrillary glomerulonephritis associated with intrahepatic cholangiocarcinoma: When diagnosis of a rare kidney disease leads to successful hepatic cancer treatment. Clin Res Hepatol Gastroenterol 2017; 41:e8-e11. [PMID: 27542513 DOI: 10.1016/j.clinre.2016.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 07/05/2016] [Accepted: 07/08/2016] [Indexed: 02/04/2023]
Abstract
A 50-year-old man presented with nephrotic syndrome. Electron microscopy analysis of a kidney biopsy specimen showed fibrillary glomerulonephritis, a rare glomerular disease, while histological analysis of a liver tumor biopsy confirmed an intrahepatic cholangiocarcinoma. The paraneoplastic nature of fibrillary glomerulonephritis is debated but after curative treatment of the hepatic nodule, remission of nephrotic syndrome was confirmed at 6-, 12- and 24-months follow-up. To our knowledge, this is the first description of a paraneoplastic fibrillary glomerulonephritis associated with a cholangiocarcinoma, supported by complete remission achieved following cancer treatment.
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Affiliation(s)
- Gabrielle Normand
- Service de néphrologie clinique, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
| | - Anne Jolivot
- Service de néphrologie clinique, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Maud Rabeyrin
- Service d'anatomopathologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Valérie Hervieu
- Service d'anatomopathologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | - Jean-Yves Scoazec
- Service de radiologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jean-Michel Gougon
- Service de radiologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Laurent Juillard
- Service de néphrologie clinique, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Dumortier
- Service d'hépato-gastro-entérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
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El-Madani M, Colomban O, Tod M, Maillet D, Peron J, Rodriguez-Lafrasse C, Badary OA, Valette PJ, Lefort T, Cassier P, El-Shenawy SM, El-Demerdash E, Hommel-Fontaine J, Guitton J, Gagnieu MC, Ibrahim BM, Barrois C, Freyer G, You B. EVESOR, a model-based, multiparameter, Phase I trial to optimize the benefit/toxicity ratio of everolimus and sorafenib. Future Oncol 2017; 13:679-693. [PMID: 28076966 DOI: 10.2217/fon-2016-0357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
AIM This novel multiparameter Phase I study aimed to optimize doses/dosing schedules of everolimus and sorafenib drug combination, based on modeling/simulation (NCT01932177). PATIENTS & METHODS About 26 patients with solid tumors were treated in four different dosing schedules. Everolimus once daily + sorafenib twice daily were given continuously in arms A and B, and intermittently in arms C (alternating every other week) and D (everolimus continuous and sorafenib 3 days on/4 days off). RESULTS Continuous schedules exhibited higher toxicity risks than intermittent schedules (64.1 vs 35.9%; p < 0.0001), and trends for lower disease control rates (80 vs 100%). No significant pharmacokinetic interaction was identified. CONCLUSION Feasibility of EVESOR trial is demonstrated. Intermittent schedules might provide better tolerance and efficacy than continuous schedules.
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Affiliation(s)
- Mévidette El-Madani
- Faculté de Médecine Lyon-Sud, Univ Lyon, Université de Lyon, Université Claude Bernard Lyon 1, EMR UCBL/HCL 3738, Lyon, France.,National Research Centre, Pharmacology Department, Cairo, Egypt
| | - Olivier Colomban
- Faculté de Médecine Lyon-Sud, Univ Lyon, Université de Lyon, Université Claude Bernard Lyon 1, EMR UCBL/HCL 3738, Lyon, France
| | - Michel Tod
- Faculté de Médecine Lyon-Sud, Univ Lyon, Université de Lyon, Université Claude Bernard Lyon 1, EMR UCBL/HCL 3738, Lyon, France
| | - Denis Maillet
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, Lyon, France
| | - Julien Peron
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, Lyon, France
| | - Claire Rodriguez-Lafrasse
- Faculté de Médecine Lyon-Sud, Univ Lyon, Université de Lyon, Université Claude Bernard Lyon 1, EMR UCBL/HCL 3738, Lyon, France.,Biochemistry & molecular biology department; Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Lyon, France
| | - Osama A Badary
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Pierre-Jean Valette
- Faculté de Médecine Lyon-Sud, Univ Lyon, Université de Lyon, Université Claude Bernard Lyon 1, EMR UCBL/HCL 3738, Lyon, France.,Radiology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Lyon, France
| | - Thibaud Lefort
- Faculté de Médecine Lyon-Sud, Univ Lyon, Université de Lyon, Université Claude Bernard Lyon 1, EMR UCBL/HCL 3738, Lyon, France.,Radiology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Lyon, France
| | | | | | - Ebtehal El-Demerdash
- Department of Pharmacology & Toxicology, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Juliette Hommel-Fontaine
- Faculté de Médecine Lyon-Sud, Univ Lyon, Université de Lyon, Université Claude Bernard Lyon 1, EMR UCBL/HCL 3738, Lyon, France.,Pathology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Lyon, France
| | - Jerome Guitton
- Faculté de Médecine Lyon-Sud, Univ Lyon, Université de Lyon, Université Claude Bernard Lyon 1, EMR UCBL/HCL 3738, Lyon, France
| | - Marie-Claude Gagnieu
- Biochemistry & molecular biology department; Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Lyon, France
| | | | - Catherine Barrois
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, Lyon, France
| | - Gilles Freyer
- Faculté de Médecine Lyon-Sud, Univ Lyon, Université de Lyon, Université Claude Bernard Lyon 1, EMR UCBL/HCL 3738, Lyon, France.,Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, Lyon, France
| | - Benoit You
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, Lyon, France
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Pioche M, Lépilliez V, Ciocîrlan M, Rivory J, Miaglia C, Hervieu V, Poncet G, Valette PJ, Saurin JC, Ponchon T. Endoscopic submucosal dissection with the Nestis ® jet injector system with a bifunctional catheter: first prospective clinical trial (NCT: 2012-A00272-41). Surg Endosc 2016; 30:5140-5146. [PMID: 26944726 DOI: 10.1007/s00464-016-4827-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 02/09/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Enki-2 water jet system (Nestis SAS®, Lyon, France) with dual injection and dissection capability significantly reduced ESD procedure time and perforation rates in animal studies. The study aim was to evaluate its efficacy and safety in patients with superficial neoplastic lesions. METHODS A prospective study including 18 patients with esophageal, gastric and rectal superficial neoplasms treated by ESD using Enki-2 was designed. RESULTS Eighteen lesions (6 esophageal, 3 gastric, 9 rectal, mean diameter 43.5 mm) in 17 patients (10 men, mean age 65.9) were included. The mean procedure time was 65.6 min. One patient needed clipping for an incomplete muscle tear during procedure; there were neither delayed bleedings nor perforation. The "en bloc" resection rate was 100 %, the R0 resection rate was 88.9 % (16/18 lesions), and the curative resection rate was 77.8 %. The 3-month disease-free rate was 92.3 % (12/13 patients, 13/14 lesions, 1 patient lost to follow-up). The 12-month disease-free rate was 69.2 % (9/13 patients, 10/14 lesions, 4 patients lost to follow-up). CONCLUSIONS ESD with Enki-2 water jet system is effective and safe for superficial neoplastic digestive lesions.
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Affiliation(s)
- Mathieu Pioche
- Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon Cedex, France.
- Nestis, Lyon, France.
- LabTau, Inserm U1032, Lyon Cedex, France.
| | - Vincent Lépilliez
- Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon Cedex, France
| | - Mihai Ciocîrlan
- Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon Cedex, France
- Fundeni Gastroenterology Clinic, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Jérôme Rivory
- Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon Cedex, France
| | - Clothilde Miaglia
- Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon Cedex, France
| | - Valérie Hervieu
- Pathology Department, Edouard Herriot Hospital, Lyon, France
| | - Gilles Poncet
- Visceral Surgery Department, Edouard Herriot Hospital, Lyon Cedex, France
| | - Pierre-Jean Valette
- Digestive Radiology Department, Edouard Herriot Hospital, Lyon Cedex, France
| | | | - Thierry Ponchon
- Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon Cedex, France
- LabTau, Inserm U1032, Lyon Cedex, France
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You B, El Madani M, Henin E, Tod M, Maillet D, Peron J, Calire RL, Valette PJ, Lefort T, Cassier P, Hommel-Fontaine J, Guitton J, Barrois C, Freyer G. EVESOR, the first model-based multi-parameter academic phase 1 trial meant to optimize the benefit/toxicity ratio of everolimus (EVE) and sorafenib (SOR) combination: Initial results. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.2532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Benoit You
- Institut de cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Lyon, France
| | - Mevidette El Madani
- National Research Centre, Pharmacology Department, Cairo, Egypt, Cairo, Egypt
| | | | - Michel Tod
- EMR 3738, Ciblage Thérapeutique en Oncologie, Faculté de Médecine et de Maïeutique Lyon-Sud Charles Mérieux, Université Claude Bernard Lyon1, Oullins, France
| | - Denis Maillet
- 2.Medical Oncology ; Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL) ; CITOHL ; Centre Hospitalier Lyon-Sud ; Lyon ; France, Lyon, France
| | | | - Rodriguez-Lafrasse Calire
- Biochemistry and Molecular Biology Department, Institut De Cancérologie Des Hospices Civils De Lyon (IC-HCL) ; Centre Hospitalier Lyon-Sud, Lyon, France
| | - Pierre-Jean Valette
- Radiology Department; Hospices Civils de Lyon; Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - Thibaud Lefort
- Radiology Department ; Hospices Civils de Lyon ; Centre Hospitalier Lyon-Sud ; Lyon ; France, Lyon, France
| | | | - Juliette Hommel-Fontaine
- Pathology Department ; Hospices Civils de Lyon ; Centre Hospitalier Lyon-Sud ; Lyon ; France, Lyon, France
| | - Jerome Guitton
- Pharmacokinetic Department; Hospices Civils de Lyon; Centre Hospitalier Lyon-Sud; Lyon; France, Pierre-Benite, France
| | - Catherine Barrois
- 2.Medical Oncology ; Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL) ; CITOHL ; Centre Hospitalier Lyon-Sud ; Lyon ; France, Lyon, France
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El-Madani M, Hénin E, Lefort T, Tod M, Freyer G, Cassier P, Valette PJ, Rodriguez-Lafrasse C, Berger F, Guitton J, Lachuer J, Slimane K, Barrois C, You B. Multiparameter Phase I trials: a tool for model-based development of targeted agent combinations--example of EVESOR trial. Future Oncol 2016; 11:1511-8. [PMID: 25963428 DOI: 10.2217/fon.15.49] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Optimal development of targeted drug combinations is one of the future challenges to be addressed. Computerization and mathematical models able to describe biological phenomena and to simulate the effects of changes in experimental conditions may help find solutions to this issue. We propose the concept of 'multiparameter trials', where biological, radiological and clinical data required for modeling purpose are collected and illustrated by the ongoing academic EVESOR trial. The objective of the model-based work would be the determination of the optimized doses and dosing schedules of everolimus and sorafenib, offering the maximization of the predicted modeled benefit/toxicity ratio in patients with solid tumors. It may embody the 'proof of concept' of model-based drug development of anticancer agent combinations.
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Robert M, Pasquer A, Pelascini E, Valette PJ, Gouillat C, Disse E. Impact of sleeve gastrectomy volumes on weight loss results: a prospective study. Surg Obes Relat Dis 2016; 12:1286-1291. [PMID: 27134194 DOI: 10.1016/j.soard.2016.01.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/24/2015] [Accepted: 01/22/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Causes of weight loss failure after sleeve gastrectomy (SG) are still controversial. The impact of the size of the sleeve continues to be debated. OBJECTIVE The aim of our study was to determine the impact of sleeve volumes assessed at 3 months using gastric computed tomography (CT) on weight loss at 18 months. SETTING University Hospital, France. METHODS Sixty-seven obese patients eligible for SG were prospectively evaluated. Sleeve volumes were assessed postsurgery using 3-dimensional gastric CT with gas at 3 months and weight loss outcomes recorded up to 18 months. The population was divided into 2 groups: the first tertile (n = 22) with the smallest gastric volume was defined as the "small sleeve" group (SSG) and the rest of the population (n = 45) was defined as the "without small sleeve" group (WSSG). RESULTS No patients were lost to follow-up. In the SSG, overall gastric volume was 133±7 mL versus 264±11 mL for the WSSG (P<.0001). Percentage excess body mass index loss (%EBMIL) during the first postoperative 18 months was significantly greater in the SSG compared with the WSSG (P = .04). Although the volume of the gastric tube was not correlated with weight loss (r =-.04, P = .78), there was a negative linear correlation between the volume of the antrum and the %EBMIL at 18 months (r =-.39, P = .005). A narrow gastric tube was also associated with a high digestive intolerance and reflux. CONCLUSION Our data suggest that performing the sleeve with a not-too-small bougie size and a radical antrectomy could improve weight loss and digestive tolerance.
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Affiliation(s)
- Maud Robert
- Department of Digestive and Bariatric Surgery, E. Herriot University Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France.
| | - Arnaud Pasquer
- Department of Digestive and Bariatric Surgery, E. Herriot University Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Elise Pelascini
- Department of Digestive and Bariatric Surgery, E. Herriot University Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Pierre-Jean Valette
- Claude Bernard Lyon 1 University, Lyon, France; Department of Radiology, E. Herriot University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Christian Gouillat
- Department of Digestive and Bariatric Surgery, E. Herriot University Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Emmanuel Disse
- Claude Bernard Lyon 1 University, Lyon, France; Department of Endocrinology, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon, France
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Mohkam K, Passot G, Cotte E, Bakrin N, Gilly FN, Ledochowski S, Bernard L, Valette PJ, Glehen O, Rousset P. Resectability of Peritoneal Carcinomatosis: Learnings from a Prospective Cohort of 533 Consecutive Patients Selected for Cytoreductive Surgery. Ann Surg Oncol 2015; 23:1261-70. [DOI: 10.1245/s10434-015-5005-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Indexed: 12/27/2022]
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Hamel B, Guillaud O, Roman S, Vallin M, Pilleul F, Valette PJ, Henry L, Guibal A, Mion F, Dumortier J. Prognostic factors in patients with refractory ascites treated by transjugular intrahepatic porto-systemic shunt: From the liver to the kidney. Dig Liver Dis 2014; 46:1001-7. [PMID: 25096966 DOI: 10.1016/j.dld.2014.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 12/10/2013] [Revised: 06/24/2014] [Accepted: 06/30/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this retrospective study was to evaluate the prognostic value of different scores (including Child-Pugh and Model for End Stage Liver Diseases) in cirrhotic patients treated with transjugular intrahepatic porto-systemic shunt for refractory ascites. METHODS Overall, 111 patients with transjugular intrahepatic porto-systemic shunt insertion between January 1998 and July 2012 were included. RESULTS Survival rates (without transplantation) were 82.0% at 3 months, and 59.4% at 1 year. In addition to standard parameters, a new simple classification based on platelet count and glomerular filtration rate showed strong prognostic ability and could distinguish 3 groups of patients (Log-rank test, p<0.001): a "good-prognosis" group with platelet counts above 125×10(9)L(-1) and a glomerular filtration rate above 90 mL/min (1-year survival rate 92%), a "poor-prognosis" group with platelet counts below 125×10(9)L(-1) and a glomerular filtration rate below 90 mL/min (1-year survival rate 34.8%), and an "intermediate-prognosis" group (1-year survival rate 58.2%). Multivariate analysis showed a hazard ratio of 6.34 for the intermediate class and of 12.623 for the high class. CONCLUSIONS A new and simple classification including platelet count and glomerular filtration rate is highly predictive of survival in patients with refractory ascites treated with transjugular intrahepatic porto-systemic shunt and could be used to select patients for this procedure.
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Affiliation(s)
- Benjamin Hamel
- Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, France
| | - Olivier Guillaud
- Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, France
| | - Sabine Roman
- Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Mélanie Vallin
- Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, France
| | - Frank Pilleul
- Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Pierre-Jean Valette
- Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Luc Henry
- Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, France
| | - Aymeric Guibal
- Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, France
| | - François Mion
- Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Jérôme Dumortier
- Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, France; Claude Bernard Lyon 1 University, Lyon, France.
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Rousset P, Peyron N, Charlot M, Chateau F, Golfier F, Raudrant D, Cotte E, Isaac S, Réty F, Valette PJ. Bowel endometriosis: preoperative diagnostic accuracy of 3.0-T MR enterography--initial results. Radiology 2014; 273:117-24. [PMID: 24828001 DOI: 10.1148/radiol.14132803] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To prospectively determine the accuracy of 3.0-T magnetic resonance (MR) enterography in the preoperative assessment of deep infiltrating endometriosis (DIE) lesions located in the bowel above the rectosigmoid junction. MATERIALS AND METHODS Institutional review board approval for this study was obtained, and each patient gave written informed consent. Over 18 months, patients with known pelvic DIE who were scheduled for surgery were recruited. Consecutive patients suspected of having bowel endometriosis above the rectosigmoid junction underwent 3.0-T MR enterography. Two blinded readers independently performed a systematic analysis of nine bowel segments above the rectosigmoid junction. MR images were compared with surgical and pathologic findings. Efficacy parameters were calculated with 95% confidence intervals (CIs). Interobserver agreement was assessed with κ statistics. RESULTS Among the 43 patients enrolled in this study, 33 underwent surgery and were included in the final analyses. Sixteen (48%) patients had bowel DIE lesions located above the rectosigmoid junction at surgery and histopathologic examination. Twenty-six lesions were analyzed, including four ileal, two ileocecal, three cecal, three appendicular, and 14 sigmoid colon lesions. For the diagnosis of these lesions, MR imaging showed sensitivities of 92% (95% confidence interval [CI]: 81.7, 100) for reader 1 and 96% (95% CI: 87.1, 100) for reader 2 and specificities of 100% (95% CI: 98.8, 100) for both readers. The κ value was 0.97. CONCLUSION These results show 3.0-T MR enterography is accurate in the preoperative diagnosis and mapping of bowel DIE lesions located above the rectosigmoid junction. Online supplemental material is available for this article.
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Affiliation(s)
- Pascal Rousset
- From Lyon 1 Claude Bernard University, Lyon, France (P.R., N.P., F.G., D.R., E.C., P.J.V.); and Departments of Radiology (P.R., N.P., M.C., F.C., F.R., P.J.V.), Obstetrics and Gynecology (F.G., D.R.), Oncologic and General Surgery (E.C.), and Pathology (S.I.), Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France
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Dumortier J, Decullier E, Hilleret MN, Bin-Dorel S, Valette PJ, Boillot O, Partensky C, Letoublon C, Ducerf C, Leroy V, Vuillez JP, Borson-Chazot F. Adjuvant Intraarterial Lipiodol or ¹³¹I-Lipiodol After Curative Treatment of Hepatocellular Carcinoma: A Prospective Randomized Trial. J Nucl Med 2014; 55:877-83. [PMID: 24722530 DOI: 10.2967/jnumed.113.131367] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 11/06/2013] [Indexed: 01/27/2023] Open
Abstract
UNLABELLED The prevention of tumor recurrence after curative treatment of hepatocellular carcinoma (HCC) is unresolved. Postoperative intraarterial injection of (131)I-labeled lipiodol has been proposed as adjuvant treatment. The aim of this prospective randomized trial was to evaluate if a single dose of postoperative adjuvant intraarterial (131)I-lipiodol (vs. unlabeled lipiodol) could reduce the rate of intrahepatic recurrence at 2 y. METHODS Patients who underwent curative treatment for HCC and recovered within 6 wk were randomly assigned to receive a single 2,200-MBq (131)I-lipiodol dose or a single unlabeled lipiodol dose on a 1:1 basis. Recurrence-free and overall survival rates were analyzed. RESULTS Between June 2005 and February 2009, we included 58 patients (median age of 63 y [range, 23-85 y]): 29 received intraarterial (131)I-lipiodol and 29 received lipiodol adjuvant treatment. At 2 y after treatment, the rate of patients with intrahepatic recurrence was 28% in the (131)I-lipiodol group and 56% in the lipiodol group (P = 0.0449). The Kaplan-Meier analysis confirmed this result, with a 2-y recurrence-free survival in the (131)I-lipiodol and lipiodol groups of 73% and 45%, respectively (P = 0.0259). The 5-y recurrence-free survival rates in the (131)I-lipiodol and lipiodol groups were 40% and 0%, respectively (P = 0.0184). The overall and specific survivals were not significantly different between groups (P = 0.9378 and P = 0.1339, respectively). (131)I-lipiodol had no severe toxic effects. CONCLUSION After curative treatment of patients with HCC, one 2,200-MBq dose of intraarterial (131)I-lipiodol significantly decreased the rate of intrahepatic recurrence but failed to improve overall or specific survival.
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Affiliation(s)
- Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, Lyon, France Université Lyon 1, Lyon, France
| | - Evelyne Decullier
- Hospices Civils de Lyon, Unité de Recherche Clinique, Pôle IMER, Lyon, France EAM Santé Individu Société 4128, Lyon, France
| | - Marie-Noëlle Hilleret
- Service d'Hépato-Gastro-Entérologie, CHU de Grenoble, Hôpital A. Michallon, La Tronche, France
| | - Sylvie Bin-Dorel
- Hospices Civils de Lyon, Unité de Recherche Clinique, Pôle IMER, Lyon, France EAM Santé Individu Société 4128, Lyon, France
| | - Pierre-Jean Valette
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, Lyon, France Université Lyon 1, Lyon, France
| | - Olivier Boillot
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, Lyon, France Université Lyon 1, Lyon, France
| | - Christian Partensky
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, Lyon, France Université Lyon 1, Lyon, France
| | - Christian Letoublon
- Service de Chirurgie Digestive, CHU de Grenoble, Hôpital A. Michallon, La Tronche, France Université Joseph Fourier, Grenoble, France
| | - Christian Ducerf
- Université Lyon 1, Lyon, France Service de Chirurgie Digestive, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Lyon, France
| | - Vincent Leroy
- Service d'Hépato-Gastro-Entérologie, CHU de Grenoble, Hôpital A. Michallon, La Tronche, France Université Joseph Fourier, Grenoble, France
| | - Jean-Philippe Vuillez
- Université Joseph Fourier, Grenoble, France Service de Médecine Nucléaire, CHU de Grenoble, Hôpital A. Michallon, La Tronche, France; and
| | - Françoise Borson-Chazot
- Université Lyon 1, Lyon, France Service de Médecine Nucléaire, Hospices Civils de Lyon, Hôpital Cardiologique Louis Pradel, Bron, France
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Adham M, Chopin-Laly X, Lepilliez V, Gincul R, Valette PJ, Ponchon T. Pancreatic resection: Drain or no drain? Surgery 2013; 154:1069-77. [DOI: 10.1016/j.surg.2013.04.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 04/11/2013] [Indexed: 02/08/2023]
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Affiliation(s)
- Pierre-Jean Valette
- Department of Digestive Radiology, Pavilion H, Hôpital Edouard Herriot, Place d'Arsonval, 69003 Lyon, France.
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You B, Freyer G, Tod M, Rodriguez C, Cassier PA, Hommel-Fontaine J, Valette PJ, Guitton J, Henin E. Evesor: The first phase I trial combining multiple dose/dosing schedules—Pharmacodynamic assessments and mathematical modeling to optimize the benefit/toxicity ratio of everolimus and sorafenib association. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.tps2625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS2625 Background: In 2004, FDA declared the abandon rate of new oncology drugs was too high and new trial designs should be developed. The combination of everolimus (EVE) and sorafenib (SOR) is rational, and has been studied in 11 phase I studies, where approved monotherapy regimens have been used (EVE qd and SOR bid). Although promising efficacy outcomes were found, the combination may be abandoned due to metabolical and skin toxicity. The best doses and dosing schedules of EVE and SOR associated with the optimal benefit/toxicity ratio may be identified using mathematical modeling of data from an adequately designed multiparameter trial. Methods: This academic study is composed of 4 arms with different dosing schedules of EVE and SOR (qd; 1 week/2; 3 days-on …), and dose escalations. Patients with different tumor types potentially sensitive to the combination are enrolled. Multiparameter assessments include: pharmacokinetics (PK); pharmacodynamics (PD) with control of signaling pathway inhibition (ERK, AKT, S6K) in 2 tumor biopsies & repetitive PBMC assays; kinetics of circulating tumor DNA kinetics & angiogenesis markers; tumor angiogenesis changes using repeated DCE-ultrasounds; and radiological/clinical effects. These data enrich a translational multiscale model meant to quantify the relationships between drug dosing modalities, PK, PD, radiological and clinical effects, developed in parallel. The doses and dosing schedules of EVE and SOR which enable maximization of benefit/toxicity ratio (utility function) will be searched using simulations, and then tested. The protocol was approved by ethic committee in 2012. Two patients a month have been enrolled in 2 centers since January 2013. Expected results: Mathematical modeling of the relationships between dosing modalities; PK; PD; radiological and clinical effects based on the data from an adequately designed trial may help determine the optimal doses and dosing schedules of EVE and SOR (with the best benefit/toxicity ratio), and avoid the combination abandon. EVESOR study may embody the proof of concept of this new model-based trial design. Clinical trial information: 2012-002818-39.
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Affiliation(s)
- Benoit You
- Centre Hospitalier Lyon Sud; Hospices Civils de Lyon, Lyon, France
| | - Gilles Freyer
- Oncologie Médicale; Hospices Civils de Lyon; Centre Hospitalier Lyon-Sud, Lyon, France
| | - Michel Tod
- EMR 3738, Ciblage Thérapeutique en Oncologie, Faculté de Médecine et de Maïeutique Lyon-Sud Charles Mérieux, Université Claude Bernard Lyon1, Oullins, France
| | - Claire Rodriguez
- Université De Lyon; Université Claude Bernard Lyon 1; Faculté De Médecine Lyon-Sud; EMR Ucbl/Hcl 3738; Biochemistry and Molecular Biology Department; Hospices Civils De Lyon; Centre Hospitalier Lyon-Sud;, Pierre-Benite, France
| | | | - Juliette Hommel-Fontaine
- Pathology Department; Hospices Civils de Lyon; Centre Hospitalier Lyon-Sud; Lyon; Franc, Pierre-Benite, France
| | - Pierre-Jean Valette
- Radiology Department; Hospices Civils de Lyon; Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - Jerome Guitton
- Pharmacokinetic Department; Hospices Civils de Lyon; Centre Hospitalier Lyon-Sud; Lyon; France, Pierre-Benite, France
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Abstract
The majority of breast lesions in men are benign. Gynaecomastia is a very common condition in which hormonal changes cause male breasts to enlarge. Three radiological patterns of gynaecomastia have been described: nodular, dendritic, and diffuse glandular pattern. The main differential diagnosis is lipomastia, which is when adipose tissue deposits are found in the subcutaneous tissue. Male breast cancer is rare. The main risk factors are pathologies that cause hormonal imbalances, a history of chest irradiation, and a family history of breast cancer (particularly in families carrying a mutation of the gene BRCA2). Mammography usually shows a mass with no calcifications. Sonography is useful to investigate local disease spread, and for detecting any enlarged axillary lymph nodes. MRI is not currently indicated to investigate male breast cancer. Very often, the clinical examination alone is enough to distinguish benign lesions from malignant lesions. Imaging must not be automatically carried out, but rather it should be used when the diagnosis is clinically uncertain or when patients present risk factors for breast cancer, as well as for guiding biopsies and for assessing disease spread.
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Affiliation(s)
- M Charlot
- Medical Imaging Department, Lyon South General Hospital, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
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