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Addeo P, de Mathelin P, De Marini P, Greget M, Bachellier P. Sequential Y 90 liver radioembolization and portal vein embolization: an additional strategy to downstage liver tumors and to enhance liver hypertrophy before major hepatectomies. Langenbecks Arch Surg 2023; 408:339. [PMID: 37639197 DOI: 10.1007/s00423-023-03083-0] [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: 04/29/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Yttrium (Y)90 liver radioembolization (TARE) induces both tumor downsizing and contralateral liver hypertrophy. In this study, we report the preliminary results of a sequential strategy combining Y90 radioembolization and portal vein embolization (PVE) before major right liver resections. METHODS We retrospectively reviewed clinical, radiological, and biological data of 5 consecutive patients undergoing Y90 TARE-PVE before major right liver resections. Comparison was made with patients undergoing PVE alone or liver venous deprivation (LVD) during the same period. RESULTS Between January 2019 and September 2022, five patients underwent sequential TARE-PVE. Type of resection included the following: right hepatectomy (n = 1), right hepatectomy + 1 (n = 2), and right hepatectomy + 1 + 4 (n = 2) with no postoperative mortality. Volumetric data showed a mean hypertrophy ratio of 30.4% after TARE and an additional 37.4% after sequential PVE. Patients undergoing sequential TARE-PVE had higher hypertrophy ratio (p = 0.02; p = 0.004), hypertrophy degree (p = 0.02; p < 0.0001), shorter time to normalize bilirubin (p = 0.04), and prothrombin time (p = 0.003; p < 0.0001) compared with patients receiving LVD or PVE. Time from diagnosis to surgery was statistically significant longer in patients undergoing sequential TARE-PVE compared with LVD or PVE (293.4 ± 169.1 vs 54.18 ±18.26 vs 58.62±13.15; p = 0.0008; p = <0.0001). CONCLUSIONS This preliminary report suggests that sequential PVE and TARE can represent a safe and an alternative strategy to downstage liver tumors and to enhance liver hypertrophy before major hepatectomies. When compared with PVE and LVD, sequential TARE/PVE takes longer times but achieves some advantages which warrant further evaluation in a larger setting.
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Affiliation(s)
- Pietro Addeo
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1, Avenue Molière, 67098, Strasbourg, France.
| | - Pierre de Mathelin
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1, Avenue Molière, 67098, Strasbourg, France
| | - Pierre De Marini
- Departement of Radiology, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Michel Greget
- Departement of Radiology, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Philippe Bachellier
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1, Avenue Molière, 67098, Strasbourg, France
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Calame P, Rostam M, d'Alteroche L, Malakhia A, Cervoni JP, Weil D, Martino VD, Sutter O, Greget M, Risson JR, Vionnet M, Bouvier A, Mokrane FZ, Ghelfi J, Papadopoulos P, Sangel C, Rodes A, Goupil J, Delabrousse E, Douane F, Loffroy R, Hebert T, Boizet A, Guerrab A, Raynaud N, Carbillet PQ, Dumas V, Velasco S, Lapuyade B, Pey MA, Boatta E, De Marini P, Cœur J, Verdot P. Left gastric vein embolization during TIPS placement for acute variceal bleeding has no effect on bleeding recurrence: Results of a multicenter study. Diagn Interv Imaging 2023; 104:248-257. [PMID: 36740536 DOI: 10.1016/j.diii.2023.01.005] [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: 10/28/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE The purpose of this study was to evaluate whether concomitant left gastric vein embolization (LGVE) during transjugular intrahepatic portosystemic shunt (TIPS) for acute variceal hemorrhage could reduce the risk of bleeding recurrence. MATERIAL AND METHOD A national multicenter observational study was conducted in 14 centers between January 2019 and December 2020. All cirrhotic patients who underwent TIPS placement for acute variceal bleeding were included. During TIPS procedure, size of left gastric vein (LGV), performance of LGVE, material used for LGVE and portosystemic pressure gradient (PPG) before and after TIPS placement were collected. A propensity score for the occurrence of LGVE was calculated to assess effect of LGVE on rebleeding recurrence at six weeks and one year. RESULTS A total of 356 patients were included (mean age 57.3 ± 10.8 [standard deviation] years; 283/356 [79%] men). Median follow-up was 11.2 months [interquartile range: 1.2, 13.3]. The main indication for TIPS was pre-emptive TIPS (162/356; 46%), rebleeding despite secondary prophylaxis (105/356; 29%), and salvage TIPS (89/356; 25%). Overall, 128/356 (36%) patients underwent LGVE during TIPS procedure. At six weeks and one year, rebleeding-free survival did not differ significantly between patients who underwent LGVE and those who did not (6/128 [5%] vs. 15/228 [7%] at six weeks, and 11/128 [5%] vs. 22/228 [7%] at one year, P = 0.622 and P = 0.889 respectively). A total of 55 pairs of patients were retained after propensity score matching. In patients without LGVE, the rebleeding rate was not different from those with LGVE (3/55 [5%] vs. 4/55 [7%], P > 0.99, and 5/55 [9%] vs. 6/55[11%], P > 0.99, at six weeks and one year respectively). Multivariable analysis identified PPG after TIPS placement as the only predictor of bleeding recurrence (hazard ratio = 1.09; 95% confidence interval: 1.02-1.18; P = 0.012). CONCLUSION In this multicenter national real-life study, we did not observe any benefit of concomitant LGVE during TIPS placement for acute variceal bleeding on bleeding recurrence rate.
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Affiliation(s)
- Paul Calame
- Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France; EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, 25030, Besançon, France
| | - Mathieu Rostam
- Department of Radiology, CHU de Nantes, 44000, Nantes, France
| | | | - Alexandre Malakhia
- Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France; Department of Radiology, CHU Dijon-Bourgogne, 21079, Dijon, France
| | - Jean-Paul Cervoni
- Department of Hepatology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France
| | - Delphine Weil
- Department of Hepatology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France
| | - Vincent Di Martino
- Department of Hepatology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France
| | - Olivier Sutter
- Interventional Radiology Unit, Avicenne Hospital, Paris-Seine-Saint-Denis University Hospitals, Assistance-Publique Hopitaux de Paris, 93000, Bobigny, France
| | - Michel Greget
- Department of Radiology, Strasbourg University Hospital, 67200, Strasbourg, France
| | | | - Mathilde Vionnet
- Department of Radiology, CHU de Poitiers, 86000, Poitiers, France
| | - Antoine Bouvier
- Department of Radiology, University Hospital, 49100, Angers, France
| | - Fatima-Zohra Mokrane
- Department of Radiology, University of Toulouse III Paul Sabatier, 31062, Toulouse, France
| | - Julien Ghelfi
- Department of Radiology, University of Grenoble-Alpes, 38700, Grenoble, France
| | | | - Christian Sangel
- Department of Radiology, University of Grenoble-Alpes, 38700, Grenoble, France
| | - Agnes Rodes
- Department of Radiology, Hôpital de la Croix Rousse, Centre Hospitalier Universitaire de Lyon, 69004, Lyon, France
| | - Jean Goupil
- Department of Radiology, CHU de Nîmes, 30900, Nîmes, France
| | - Eric Delabrousse
- Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France; EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, 25030, Besançon, France
| | - Frederic Douane
- Department of Radiology, CHU de Nantes, 44000, Nantes, France
| | - Romaric Loffroy
- Department of Radiology, CHU Dijon-Bourgogne, 21079, Dijon, France
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- Club Francophone pour l'Étude de l'Hypertension Portale (CFEHTP)
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Rakotoarisoa L, Wagner C, Munch M, Renaud Picard B, Grenet D, Olland A, Greget M, Enescu I, Bouilloud F, Bonnette P, Guth A, Bosco D, Mercier C, Rabilloud M, Berney T, Yves Benhamou P, Massard G, Camilo C, Colin C, Arnold C, Kessler R, Kessler L. Feasibility and efficacy of combined pancreatic islet-lung transplantation in cystic fibrosis-related diabetes-PIM study: A multicenter phase 1-2 trial. Am J Transplant 2022; 22:1861-1872. [PMID: 35403818 PMCID: PMC9540675 DOI: 10.1111/ajt.17058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/21/2022] [Accepted: 04/04/2022] [Indexed: 01/25/2023]
Abstract
Cystic fibrosis-related diabetes (CFRD) is a common complication of cystic fibrosis (CF), and restoring metabolic control in these patients may improve their management after lung transplantation. In this multicenter, prospective, phase 1-2 trial, we evaluate the feasibility and metabolic efficacy of combined pancreatic islet-lung transplantation from a single donor in patients with CFRD, terminal respiratory failure, and poorly controlled diabetes. Islets were infused via the portal vein under local anesthesia, 1 week after lung transplantation. At 1 year, the primary outcome was transplant success as evaluated by a composite score including four parameters (weight, fasting glycemia, HbA1c, and insulin requirements). Ten participants (age: 24 years [17-31], diabetes duration: 8 years [4-12]) received a combined islet-lung transplant with 2892 IEQ/kg [2293-6185]. Transplant success was achieved in 7 out of 10 participants at 1-year post transplant. Fasting plasma C-peptide increased from 0.91 μg/L [0.56-1.29] to 1.15 μg/L [0.77-2.2], HbA1c decreased from 7.8% [6.5-8.3] (62 mmol/mol [48-67]) to 6.7% [5.5-8.0] (50 mmol/mol [37-64]), with 38% decrease in daily insulin doses. No complications related to the islet injection procedure were reported. In this pilot study, combined pancreatic islet-lung transplantation restored satisfactory metabolic control and pulmonary function in patients with CF, without increasing the morbidity of lung transplantation.
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Affiliation(s)
- Luc Rakotoarisoa
- Department of Endocrinology, Diabetes and NutritionStrasbourg University HospitalFrance,Inserm UMR 1260Regenerative NanomedicineStrasbourgFrance
| | - Clothilde Wagner
- Department of Endocrinology, Diabetes and NutritionStrasbourg University HospitalFrance
| | - Marion Munch
- Department of Endocrinology, Diabetes and NutritionStrasbourg University HospitalFrance
| | - Benjamin Renaud Picard
- Inserm UMR 1260Regenerative NanomedicineStrasbourgFrance,Department of PneumologyCystic Fibrosis CenterStrasbourg UniversityStrasbourgFrance
| | - Dominique Grenet
- Department of PneumologyCystic Fibrosis CenterHôpital FochSuresnesFrance
| | - Anne Olland
- Inserm UMR 1260Regenerative NanomedicineStrasbourgFrance,Department of Thoracic SurgeryStrasbourg University HospitalStrasbourgFrance
| | - Michel Greget
- Department of RadiologyStrasbourg University HospitalStrasbourgFrance
| | - Iulian Enescu
- Department of RadiologyStrasbourg University HospitalStrasbourgFrance
| | | | | | - Axel Guth
- Department of RadiologyHôpital FochSuresnesFrance
| | - Domenico Bosco
- Department of Surgery, Islet Isolation, and TransplantationGeneva University HospitalsGenevaSwitzerland
| | - Catherine Mercier
- Pôle Santé PubliqueService de Biostatistique et BioinformatiqueHospices Civils de Lyon, LyonFrance,Université de LyonLyonFrance,Université Lyon 1VilleurbanneFrance,Laboratoire de Biométrie et Biologie ÉvolutiveÉquipe Biostatistique‐SantéCNRSUMR 5558VilleurbanneFrance
| | - Muriel Rabilloud
- Pôle Santé PubliqueService de Biostatistique et BioinformatiqueHospices Civils de Lyon, LyonFrance,Université de LyonLyonFrance,Université Lyon 1VilleurbanneFrance,Laboratoire de Biométrie et Biologie ÉvolutiveÉquipe Biostatistique‐SantéCNRSUMR 5558VilleurbanneFrance
| | - Thierry Berney
- Department of Surgery, Islet Isolation, and TransplantationGeneva University HospitalsGenevaSwitzerland
| | - Pierre Yves Benhamou
- Department of Endocrinology, Diabetes and NutritionGrenoble University HospitalGrenobleFrance
| | - Gilbert Massard
- Inserm UMR 1260Regenerative NanomedicineStrasbourgFrance,Department of Thoracic SurgeryStrasbourg University HospitalStrasbourgFrance
| | - Coralie Camilo
- Pôle Santé PubliqueService de Biostatistique et BioinformatiqueHospices Civils de Lyon, LyonFrance,Université de LyonLyonFrance,Université Lyon 1VilleurbanneFrance,Laboratoire de Biométrie et Biologie ÉvolutiveÉquipe Biostatistique‐SantéCNRSUMR 5558VilleurbanneFrance
| | - Cyrille Colin
- Pôle Santé PubliqueService de Biostatistique et BioinformatiqueHospices Civils de Lyon, LyonFrance,Université de LyonLyonFrance,Université Lyon 1VilleurbanneFrance,Laboratoire de Biométrie et Biologie ÉvolutiveÉquipe Biostatistique‐SantéCNRSUMR 5558VilleurbanneFrance
| | - Cécile Arnold
- Department of Clinical ResearchStrasbourg University HospitalStrasbourgFrance
| | - Romain Kessler
- Inserm UMR 1260Regenerative NanomedicineStrasbourgFrance,Department of PneumologyCystic Fibrosis CenterStrasbourg UniversityStrasbourgFrance
| | - Laurence Kessler
- Department of Endocrinology, Diabetes and NutritionStrasbourg University HospitalFrance,Inserm UMR 1260Regenerative NanomedicineStrasbourgFrance
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Cazzato RL, Hubelé F, De Marini P, Ouvrard E, Salvadori J, Addeo P, Garnon J, Kurtz JE, Greget M, Mertz L, Goichot B, Gangi A, Imperiale A. Liver-Directed Therapy for Neuroendocrine Metastases: From Interventional Radiology to Nuclear Medicine Procedures. Cancers (Basel) 2021; 13:cancers13246368. [PMID: 34944988 PMCID: PMC8699378 DOI: 10.3390/cancers13246368] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 12/25/2022] Open
Abstract
Neuroendocrine neoplasms (NENs) are rare and heterogeneous epithelial tumors most commonly arising from the gastroenteropancreatic (GEP) system. GEP-NENs account for approximately 60% of all NENs, and the small intestine and pancreas represent two most common sites of primary tumor development. Approximately 80% of metastatic patients have secondary liver lesions, and in approximately 50% of patients, the liver is the only metastatic site. The therapeutic strategy depends on the degree of hepatic metastatic invasion, ranging from liver surgery or percutaneous ablation to palliative treatments to reduce both tumor volume and secretion. In patients with grade 1 and 2 NENs, locoregional nonsurgical treatments of liver metastases mainly include percutaneous ablation and endovascular treatments, targeting few or multiple hepatic metastases, respectively. In the present work, we provide a narrative review of the current knowledge on liver-directed therapy for metastasis treatment, including both interventional radiology procedures and nuclear medicine options in NEN patients, taking into account the patient clinical context and both the strengths and limitations of each modality.
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Affiliation(s)
- Roberto Luigi Cazzato
- Interventional Radiology, University Hospitals of Strasbourg, Strasbourg University, 67000 Strasbourg, France; (R.L.C.); (P.D.M.); (J.G.); (M.G.); (A.G.)
- Oncology, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg University, 67200 Strasbourg, France;
| | - Fabrice Hubelé
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), University Hospitals of Strasbourg, Strasbourg University, 67200 Strasbourg, France; (F.H.); (E.O.)
| | - Pierre De Marini
- Interventional Radiology, University Hospitals of Strasbourg, Strasbourg University, 67000 Strasbourg, France; (R.L.C.); (P.D.M.); (J.G.); (M.G.); (A.G.)
| | - Eric Ouvrard
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), University Hospitals of Strasbourg, Strasbourg University, 67200 Strasbourg, France; (F.H.); (E.O.)
| | - Julien Salvadori
- Radiophysics, Institut de Cancérologie de Strasbourg Europe (ICANS), 67200 Strasbourg, France;
| | - Pietro Addeo
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Hospitals of Strasbourg, 67200 Strasbourg, France;
| | - Julien Garnon
- Interventional Radiology, University Hospitals of Strasbourg, Strasbourg University, 67000 Strasbourg, France; (R.L.C.); (P.D.M.); (J.G.); (M.G.); (A.G.)
| | - Jean-Emmanuel Kurtz
- Oncology, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg University, 67200 Strasbourg, France;
| | - Michel Greget
- Interventional Radiology, University Hospitals of Strasbourg, Strasbourg University, 67000 Strasbourg, France; (R.L.C.); (P.D.M.); (J.G.); (M.G.); (A.G.)
| | - Luc Mertz
- Radiophysics, University Hospitals of Strasbourg, 67000 Strasbourg, France;
| | - Bernard Goichot
- Internal Medicine, Diabetes and Metabolic Disorders, University Hospitals of Strasbourg, Strasbourg University, 67200 Strasbourg, France;
| | - Afshin Gangi
- Interventional Radiology, University Hospitals of Strasbourg, Strasbourg University, 67000 Strasbourg, France; (R.L.C.); (P.D.M.); (J.G.); (M.G.); (A.G.)
- School of Biomedical Engineering and Imaging Science, King’s College London, Strand, London WC2R 2LS, UK
| | - Alessio Imperiale
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), University Hospitals of Strasbourg, Strasbourg University, 67200 Strasbourg, France; (F.H.); (E.O.)
- Molecular Imaging—DRHIM, IPHC, UMR 7178, CNRS/Unistra, 67037 Strasbourg, France
- Correspondence: ; Tel.: +33-3-68-76-74-48; Fax: +33-3-68-76-72-56
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5
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De Marini P, Greget M, Boatta E, Jahn C, Enescu I, Garnon J, Dalili D, Cazzato RL, Gangi A. Safety and technical efficacy of pre-operative embolization of head and neck paragangliomas: A 10-year mono-centric experience and systematic review. Clin Imaging 2021; 80:292-299. [PMID: 34467873 DOI: 10.1016/j.clinimag.2021.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/27/2021] [Revised: 07/26/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To retrospectively evaluate the safety and technical success of pre-operative embolization (POE) of head and neck paragangliomas (HNP) in a single-center cohort over a 10-year period, and to benchmark our results with those derived from a systematic analysis of the available literature. METHODS All consecutive HNP embolized between November 2010 and April 2020 were included and reviewed. In total, there were 27 HNP in 27 patients [8 (30%) males; 19 (70%) females; mean age 53 ± 16 years; range 30-86]. Embolization technique, total procedure time, dose area product (DAP), complications, rate of HNP devascularization, and technical success (i.e. ≥80% devascularization of the HNP) were recorded and analyzed. A systematic analysis on the safety and technical success of POE was then conducted according to the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Twenty-one (21/27; 78%) HNP were treated with an endovascular approach and 6/27 (22%) with a percutaneous or combined (endovascular/percutaneous) technique. Mean total procedure time and DAP were 108 ± 48 min (range 45-235) and 92.5 ± 61.3 Gy·cm2 (range 19.9-276.0), respectively. Two (2/27; 7%) complications (one minor, one major) were observed. Mean HNP devascularization was 88 ± 15% (range 23-100) with technical success achieved in 24/27 (89%) HNP. Literature analysis revealed a pooled rate of complication and technical success of 3.8% (95% CI: 0.5-8.8%) and 79.0% (95% CI: 63.6-91.6%), respectively. CONCLUSIONS POE of HNP is safe and results in extensive devascularization in the majority of treated tumors.
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Affiliation(s)
- Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Michel Greget
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Emanuele Boatta
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Christine Jahn
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Iulian Enescu
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Oxford OX3 7LD, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
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Artzner T, Clere-Jehl R, Schenck M, Greget M, Merdji H, De Marini P, Tuzin N, Helms J, Meziani F. Spontaneous ilio-psoas hematomas complicating intensive care unit hospitalizations. PLoS One 2019; 14:e0211680. [PMID: 30794573 PMCID: PMC6386274 DOI: 10.1371/journal.pone.0211680] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 01/20/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Ilio-psoas hematoma is a potentially lethal condition that can arise during hospital stay. However, neither the incidence nor the prognosis of patients whose stay in intensive care units (ICU) is complicated by a iatrogenic ilio-psoas hematoma is known. METHODS A bicentric retrospective study was conducted to compile the patients who developed an ilio-psoas hematoma while they were hospitalized in ICU between January 2009 and December 2016. Their biometric characteristics, pre-existing conditions, the circumstances in which the hematoma was diagnosed, the treatments they received and their prognosis were recorded. RESULTS Forty patients were diagnosed with an ilio-psoas hematoma during their ICU stay. The incidence of this complication was 3.8 cases for 1000 admissions, taking into account only patients who stayed more than three days in ICU. The median age of patients was 74 years old and the median time between admission and the diagnosis of ilio-psoas hematoma was 12.6 days. A large proportion of them was obese (42.5%) and/or under dialysis (50%) prior to developing their hematoma. Ninety-five percent of the patients had heparin at prophylactic or therapeutic doses. Only 10% of them were above the therapeutic range of anticoagulation. The ICU mortality rate was of 50% following this complication (versus a general mortality rate of 22% for the patients without IPH over the same period of time). Patients with IPH that were complicated by disseminated intravascular coagulopathy had a significantly higher mortality rate than those with IPH and no disseminated intravascular coagulopathy (OR 6.91, 95% CI [1.28; 58.8], p = 0.04). CONCLUSION Age, anticoagulation, a high body mass index and dialysis seem to be risk factors of developing an ilio-psoas hematoma in ICU. Iatrogenic ilio-psoas hematomas complicated by disseminated intravascular coagulopathies are more at risk of leading to death. It is noteworthy that activated partial thromboplastin time above the therapeutic range was not a good predictor of developing a hematoma for patients who received unfractioned heparin therapy.
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Affiliation(s)
- Thierry Artzner
- Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux universitaires de Strasbourg, Service de Réanimation Médicale, Nouvel Hôpital Civil, Strasbourg, France
| | - Raphaël Clere-Jehl
- Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux universitaires de Strasbourg, Service de Réanimation Médicale, Nouvel Hôpital Civil, Strasbourg, France
- ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d’Immunologie et d’Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Malika Schenck
- Service de Réanimation Médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Michel Greget
- Service d’Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, France
| | - Hamid Merdji
- Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux universitaires de Strasbourg, Service de Réanimation Médicale, Nouvel Hôpital Civil, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | - Pierre De Marini
- Service d’Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, France
| | - Nicolas Tuzin
- Laboratoire de Biostatistique et d’Informatique Médicale, ICube UMR 7357, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Groupe Méthode en Recherche Clinique, Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julie Helms
- Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux universitaires de Strasbourg, Service de Réanimation Médicale, Nouvel Hôpital Civil, Strasbourg, France
- ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d’Immunologie et d’Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Ferhat Meziani
- Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux universitaires de Strasbourg, Service de Réanimation Médicale, Nouvel Hôpital Civil, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
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7
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Wagner C, Porzio M, Olland A, Reeb J, Greget M, Grenet D, Bouilloud F, Bonnette P, Berney T, Javelot Jacquelin C, Baltzinger P, Kessler R, Kessler L. WS19.6 Feasibility and efficacy of combined lung and pancreatic islet transplantation in Cystic Fibrosis-Related Diabetes: a pilot study. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30231-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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8
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Kling-Pillitteri L, Beck C, Roman M, Fonmartin K, Greget M, Kleinlogel S, Gonzalez M. Étude des RPS des médecins du Samu d’un CHU. ARCH MAL PROF ENVIRO 2017. [DOI: 10.1016/j.admp.2017.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Sportes A, Camus M, Greget M, Leblanc S, Coriat R, Hochberger J, Chaussade S, Grabar S, Prat F. Endoscopic ultrasound-guided hepaticogastrostomy versus percutaneous transhepatic drainage for malignant biliary obstruction after failed endoscopic retrograde cholangiopancreatography: a retrospective expertise-based study from two centers. Therap Adv Gastroenterol 2017; 10:483-493. [PMID: 28567118 PMCID: PMC5424875 DOI: 10.1177/1756283x17702096] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 02/23/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Percutaneous transhepatic biliary drainage (PTBD) is widely performed as a salvage procedure in patients with unresectable malignant obstruction of the common bile duct (CBD) after failed endoscopic retrograde cholangiopancreatography (ERCP) or in case of surgically altered anatomy. Endoscopic ultrasound-guided hepaticogastrostomy (EU-HGS) is a more recently introduced alternative to relieve malignant obstructive jaundice. The aim of this prospective observational study was to compare the outcome, efficacy and adverse events of EU-HGS and PTBD. METHODS From April 2012 to August 2015, consecutive patients with malignant CBD obstruction who underwent EU-HGS or PTBD in two tertiary-care referral centers were included. The primary endpoint was the clinical success rate. Secondary endpoints were technical success, overall survival, procedure-related adverse events, incidence of adverse events, and reintervention rate. RESULTS A total of 51 patients (EU-HGS, n = 31; PTBD, n = 20) were included. Median survival was 71 days (range 25-75th percentile; 30-95) for the EU-HGS group and 78 days (range 25-75th percentile; 42-108) for the PTBD group (p = 0.99). Technical success was achieved in all patients in both groups. Clinical success was achieved in 25 (86%) of 31 patients in the EU-HGS group and in 15 (83%) of 20 patients in the PTBD group (p = 0.88). There was no difference in adverse events rates between the two groups (EU-HGS: 16%; PTBD: 10%) (p = 0.69). Four deaths within 1 month (two hemorrhagic and two septic) were considered procedure related (two in the EU-HGS group and two in the PTBD group). Overall reintervention rate was significantly lower after EU-HGS (n = 2) than after PTBD (n = 21) (p = 0.0001). Length of hospital stay was shorter after EU-HGS (8 days versus 15 days; p = 0.002). CONCLUSIONS EU-HGS can be an effective and safe mini invasive-procedure alternative to PTBD, with similar success and adverse-event rates, but with lower rates of reintervention and length of hospitalization.
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Affiliation(s)
- Adrien Sportes
- Gastroenterology Unit, Hôpital Cochin (AP-HP), University Paris Descartes, Paris, France
| | - Marine Camus
- Gastroenterology Unit, Hôpital Cochin (AP-HP), University Paris Descartes, Paris, France
| | - Michel Greget
- Interventional Radiology Unit CHRU Strasbourg, University of Strasbourg, France
| | - Sarah Leblanc
- Gastroenterology Unit, Hôpital Cochin (AP-HP), University Paris Descartes, Paris, France
| | - Romain Coriat
- Gastroenterology Unit, Hôpital Cochin (AP-HP), University Paris Descartes, Paris, France
| | - Jürgen Hochberger
- Gastroenterology Unit, Nouvel Hôpital Civil CHRU Strasbourg, University of Strasbourg, France
| | - Stanislas Chaussade
- Gastroenterology Unit, Hôpital Cochin (AP-HP), University Paris Descartes, Paris, France
| | - Sophie Grabar
- Biostatistics and Epidemiology, Hôtel Dieu (AP-HP), University Paris Descartes, Paris, France
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10
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Bilger A, Pottecher J, Greget M, Boudier E, Diemunsch P. Extensive pulmonary embolism after severe postpartum haemorrhage: management with an inferior vena cava filter. Int J Obstet Anesth 2014; 23:390-3. [DOI: 10.1016/j.ijoa.2014.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/18/2014] [Accepted: 06/08/2014] [Indexed: 11/28/2022]
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11
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Toti F, Bayle F, Berney T, Egelhofer H, Richard MJ, Greget M, Masson D, Zobairi F, Benhamou PY, Kessler L. Studies of circulating microparticle release in peripheral blood after pancreatic islet transplantation. Transplant Proc 2014; 43:3241-5. [PMID: 22099767 DOI: 10.1016/j.transproceed.2011.10.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The loss of graft function after intraportal islet transplantation is likely multifactorial involving allogeneic rejection, recurrent autoimmunity, graft exhaustion due to a marginally implanted islet mass, immunosuppressant toxicity, and impaired β-cell regeneration. Because early markers of the loss of β-cell mass or function are lacking, monitoring of islet function remains a challenging issue. We have reported herein monitoring of membrane procoagulant microparticles (MPs) as markers of cell stress in the plasma of three recipients with various clinical histories. Early kinetics of C-peptide and MPs followed identical patterns during the first weeks after transplantation; a major increase probably reflected processes related to cell infusion and islet engraftment. Importantly in the case of rejection, MPs and C-peptide showed opposite patterns. A fall in C-peptide was associated with enhanced insulin needs. Our results suggested that a peak in MP levels might indicate rejection with prognotic value. Treatment of the loss of islet function by a new islet infusion or steroid therapy returned MP and C-peptide levels to their baselines with concomitant restoration of islet function. In the patient with suspected acute cellular rejection, MPs also appeared to be sensors of immunosuppressive steroid therapy.
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Affiliation(s)
- F Toti
- Laboratory of Vascular Biology, Immunology and Hematology Institute, INSERM UMR 770, Faculty of Medicine, University of Strasbourg, Le Kremlin-Bicêtre, France
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12
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Kessler L, Greget M, Metivier AC, Moreau F, Armanet M, Santelmo N, Massard G, Berney T, Kessler R. Combined pancreatic islets-lung transplantation in cystic fibrosis-related diabetes: case reports. Transplant Proc 2011; 42:4338-40. [PMID: 21168694 DOI: 10.1016/j.transproceed.2010.09.121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED We report two cases of percutaneous portal embolization of pancreatic islets performed after double lung transplantation in cystic fibrosis (CF) patients using the pancreas of the same donor. CASE 1: A 19-year-old man with CF had insulin-dependent diabetes, which was poorly controlled despite an external insulin pump (96 IU/d): HbA(1c) = 9.8% and 1 to 3 hypoglycemic events per day. On October 29, 2007, he received a double lung graft because of chronic respiratory failure. For days after lung transplantation, 149,000 cultured IEQ (Islet EQuivalent) were injected by percutaneous intraportal infusion under local anesthesia. Immunosuppression consisted of steroids, cyclosporine, and azathioprine. Two years later, the forced expiratory volume (FEV) was 83%; C peptide level reached 1.4 μg/L, and the diabetes was satisfactorily controlled with an HbA(1c) of 7.5% and a decrease in insulin requirements to 30 U/d in the absence of hypoglycemic events. CASE 2: On July 10, 2006, a 32-year-old man with CF-related diabetes received a double lung graft because of chronic respiratory failure. Under multiple insulin injections, the HbA(1c) was 9.6% with numerous hypoglycemic events. On March 11, 2008, he again received a double lung graft because of persistent humoral rejection. Despite severe bleeding during the postoperative course, 234,000 IEQ were injected via the portal vein one week after lung transplantation. Immunosuppression consisted of steroids, tacrolimus, and mycophenolate mofetil. Eighteen months after the combined graft, the FEV was 52%; the plasma C-peptide reached 0.79 μg/L, the HbA(1c), 6% and the insulin requirements decreased to 55 U/d in the absence of hypoglycemic events. CONCLUSION Combined lung-islet transplantation for patients with CF-related diabetes improved pulmonary and metabolic function.
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Affiliation(s)
- L Kessler
- Service d’Endocrinologie, Diabète et Maladies Métaboliques, Hôpital Civil, 1, place de l’Hôpital, 67091-Strasbourg, France.
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13
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Kessler L, Bakopoulou S, Kessler R, Massard G, Santelmo N, Greget M, Moreau F, Helms O, Bosco D, Gasche-Soccal P, Morel P, Wolf P, Berney T. Combined pancreatic islet-lung transplantation: a novel approach to the treatment of end-stage cystic fibrosis. Am J Transplant 2010; 10:1707-12. [PMID: 20642693 DOI: 10.1111/j.1600-6143.2010.03143.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Patients with end-stage cystic fibrosis (CF) and severe CF-related diabetes (CFRD) may benefit from combined lung-pancreatic islet transplantation. In the present study, we report the long-term follow-up of four end-stage CF patients treated with combined bilateral lung and pancreatic islet transplantation from the same donor. All patients were C-peptide negative (<0.5 microg/L) and inadequately controlled despite intensive insulin treatment. One patient was transplanted with 4 019 +/- 490 islet equivalent/kg injected into the transverse colic vein using a surgical approach. In the remaining three patients, islets were cultured for 3-6 days and transplanted by percutaneous transhepatic catheterization of the portal vein. In all patients, islet allograft recovery was recognized by elevation in the plasma level of C-peptide (>0.5 microg/L). At 6 months after transplantation, one patient showed multiple episodes of acute lung transplant rejection and a progressive decline in pancreatic islet cell function. Three out of four patients experienced an improved control of glucose levels with a HbA1c of 5.2%, 7% and 6% respectively at 1.5, 2 and 15 years follow-up. Compared with the pretransplant period, there was a 50% reduction in mean daily insulin needs. Pulmonary function remained satisfactory in all patients. In conclusion, our cases series shows that combined bilateral lung and pancreatic islet transplantation may be a viable therapeutic option for patients with end-stage CF and CFRD.
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Affiliation(s)
- L Kessler
- Department of Diabetology, University Hospital, University of Strasbourg, France.
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Nobili C, Lesevic V, Marzano E, Casnedi S, Greget M, Bachellier P, Pessaux P. [Primary pancreatic sarcoma with liver metastases: is there a place for radical surgery?]. ACTA ACUST UNITED AC 2010; 34:227-30. [PMID: 20133094 DOI: 10.1016/j.gcb.2009.09.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 09/17/2009] [Accepted: 09/20/2009] [Indexed: 10/19/2022]
Abstract
Pancreatic leiomyosarcomas are a rare neoplasm that accounts for 1/1000 of pancreatic cancers. In the literature, 23 cases of pancreatic leiomyosarcoma have been reported and the majority being diagnosed on autopsy. It has never been reported any radical curative surgery in presence of synchronous hepatic metastasis. We reported a case of a patient affected by a primitive pancreatic leiomyosarcoma with bilobar hepatic metastasis, who underwent distal splenopancreatectomy associated with the resection of multiple liver metastases.
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Affiliation(s)
- C Nobili
- Pôle de pathologies digestives et hépatiques et de la transplantation, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, université de Strasbourg, avenue Molière, 67200 Strasbourg, France
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15
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Giraudo G, Greget M, Oussoultzoglou E, Rosso E, Bachellier P, Jaeck D. Preoperative contralateral portal vein embolization before major hepatic resection is a safe and efficient procedure: a large single institution experience. Surgery 2008; 143:476-82. [PMID: 18374044 DOI: 10.1016/j.surg.2007.12.006] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2007] [Accepted: 12/24/2007] [Indexed: 12/16/2022]
Abstract
BACKGROUND The aim of this study was to report the results of preoperative contralateral portal vein embolization (PVE) performed in a single institution. METHODS Between January 1997 and March 2006, 146 patients requiring a right or extended right hepatectomy for primary or secondary liver tumors underwent contralateral PVE when the future remnant liver volume (FRL) was less than 30% of total liver. Liver volumes and hepatic function were evaluated before and after PVE. RESULTS Contralateral PVE was performed successfully in 145 patients. In one patient, the catheterization of the left portal branch failed. Complications occurred in 14 patients (10%) including a transitory fever (n = 9), a parenchymal hematoma (n = 1), a mild hemoperitoneum (n = 1), a mesenterico-portal venous thrombosis (n = 1), a pulmonary embolism (n = 1) and a systemic sepsis (n = 1). The prothrombin ratio and the platelet count were significantly lower 3 days after PVE. Insufficient hypertrophy of the FRL was observed in 8 patients, malignant disease progression in 15, and both insufficient hypertrophy and disease progression in 4. The hypertrophy rate of the FRL 4 to 8 weeks after PVE was 47.7 +/- 31.9%. Pathological type of the liver tumor, cirrhosis, diabetes mellitus, and chemotherapy did not affect the volume of the left liver hypertrophy. However, the time required to achieve an adequate liver hypertrophy was significantly shorter in patients with normal liver. One-hundred and fourteen patients (78.6%) subsequently underwent hepatic resection. CONCLUSIONS The results suggest that contralateral PVE is a safe and efficient procedure inducing adequate hypertrophy of the FRL before major liver resection.
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Affiliation(s)
- Giorgio Giraudo
- Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université Louis Pasteur Avenue Molière, Strasbourg, France
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16
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Khorsandi SE, Bachellier P, Weber JC, Greget M, Jaeck D, Zacharoulis D, Rountas C, Helmy S, Helmy A, Al-Waracky M, Salama H, Jiao L, Nicholls J, Davies AJ, Levicar N, Jensen S, Habib N. Minimally invasive and selective hydrodynamic gene therapy of liver segments in the pig and human. Cancer Gene Ther 2008; 15:225-30. [PMID: 18259214 DOI: 10.1038/sj.cgt.7701119] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This paper highlights our experience of the transfer of hydrodynamic gene therapy (HGT) from the large animal, the pig, into clinical practice. The modification of balloon catheters and the development of a minimally invasive technique to allow selective isolation of liver segments for HGT in the large animal and human are described. Finally, our preliminary results from a phase I clinical study of HGT for thrombopoietin (TPO) in cirrhotic patients with thrombocytopenia are discussed. Based on these provisional data, minimally invasive selective HGT of liver segments appears to be technically safe, but further work is required to optimize the efficiency of gene transfer in order to achieve clinical benefit.
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Affiliation(s)
- S E Khorsandi
- Faculty of Medicine, Imperial College London, London, UK
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Oussoultzoglou E, Bachellier P, Rosso E, Scurtu R, Lucescu I, Greget M, Jaeck D. Right portal vein embolization before right hepatectomy for unilobar colorectal liver metastases reduces the intrahepatic recurrence rate. Ann Surg 2006; 244:71-9. [PMID: 16794391 PMCID: PMC1570606 DOI: 10.1097/01.sla.0000217609.26178.35] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AIM To assess the effect of portal vein embolization (PVE) on intrahepatic recurrence rate after right hepatectomy for unilobar colorectal liver metastases (CLM). SUMMARY AND BACKGROUND Recent research suggests that CLM could spread retrogradely through the portal vein. PVE may reduce tumor shedding by the occlusion of distal portal branches. However, no study reported the clinical effect of PVE on intrahepatic recurrence after CLM resection. PATIENTS AND METHODS Between 1995 and 2003, 44 patients requiring a right hepatectomy for unilobar CLM were operated in our institution. Right hepatectomy was performed after PVE in 23 patients (group A) and without PVE in 21 (group B). Surgical outcome and site of recurrence were analyzed. RESULTS The postoperative mortality was nil. Overall morbidity and transitory liver failure rates were similar in groups A and B (43.4% and 17.3% vs. 33.3% and 14.2%, respectively). The 3- and 5-year overall survival rates did not differ in group A and B patients (61.2% and 43.7% vs. 49.7% and 35.5%, respectively; P = 0.862). The disease-free survival rate was similar in both groups. Thirty patients (68.2%) developed recurrences. Recurrences were intrahepatic in 22 patients (50%) and extrahepatic in 27 (61.3%). Intrahepatic recurrence rate was significantly lower in group A compared with group B (26.0% vs. 76.1% respectively; P < 0.001). PVE, number of CLM, and administration of neoadjuvant chemotherapy were independent prognostic factors for intrahepatic recurrences. CONCLUSION This study showed that PVE reduces intrahepatic recurrence rate after right hepatectomy for unilobar CLM.
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Affiliation(s)
- Elie Oussoultzoglou
- Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Strasbourg, France
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Bucher P, Mathe Z, Bosco D, Becker C, Kessler L, Greget M, Benhamou PY, Andres A, Oberholzer J, Buhler L, Morel P, Berney T. Morbidity associated with intraportal islet transplantation. Transplant Proc 2005; 36:1119-20. [PMID: 15194389 DOI: 10.1016/j.transproceed.2004.04.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [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: 02/08/2023]
Abstract
INTRODUCTION Complications associated with intraportal islet infusion have been reported. In this study, we analyzed the relationship between occurrence of complications and islet preparation characteristics/infusion technique. METHODS We reviewed all intraportal islet infusions from 1992 to 2003. RESULTS Sixteen islet autotransplantations were performed without infusion-related complications. The tissue volume injected was 13 +/- 11 mL with basal and peak portal pressures of 13 +/- 6 and 21 +/- 6 mm Hg. Seventy-seven intraportal islet allotransplantations were performed in 51 patients. Fifteen islet infusions were done by laparotomy during simultaneous islet/kidney transplantation without complication. Among 62 percutaneous transhepatic injections, nine complications (two portal branch thrombosis and seven intra-abdominal hemorrhages) were recorded. Rise in portal pressure was related to tissue volume injected (P <.05). Basal and peak portal pressures were 14 +/- 5 and 18 +/- 6 mm Hg in uncomplicated infusions, 14 +/- 9 and 18 +/- 9 mm Hg in the thrombosis group, and 13 +/- 7 and 18 +/- 5 mm Hg in the hemorrhage group (P >.05). Complications occurred only after percutaneous islet infusion (P <.03). CONCLUSIONS Procedure-related morbidity of intraportal islet infusion is low. Changes in portal pressure are related to volume of tissue injected but do not seem to be associated with the occurrence of complications. Percutaneous infusion is a minimally invasive procedure, but this advantage must be balanced by the higher rate of complications.
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Affiliation(s)
- P Bucher
- Department of Surgery, Cell Isolation and Transplantation Center, Geneva University Hospital, Geneva, Switzerland
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Jaeck D, Oussoultzoglou E, Rosso E, Greget M, Weber JC, Bachellier P. A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg 2004; 240:1037-49; discussion 1049-51. [PMID: 15570209 PMCID: PMC1356519 DOI: 10.1097/01.sla.0000145965.86383.89] [Citation(s) in RCA: 415] [Impact Index Per Article: 20.8] [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: 12/14/2022]
Abstract
OBJECTIVE To assess outcome after a 2-stage hepatectomy procedure (TSHP) combined with portal vein embolization (PVE) in the treatment of patients with unresectable multiple and bilobar colorectal liver metastases (MBCLM). BACKGROUND Patients with MBCLM are often considered for palliative chemotherapy only, due to too small future remnant liver (FRL). Recently, right hepatectomy with simultaneous left liver wedge resections after previous right PVE has been reported in a curative intent. However, the growth of metastatic nodules in FRL after PVE can be more rapid than that of the nontumoral remnant hepatic parenchyma. Therefore, metastases located in the FRL should be ideally resected before PVE. Then, a right (or extended right) hepatectomy can be safely performed during a second-stage hepatectomy. Therefore, we analyzed our experience with the use of TSHP combined with PVE in treatment of MBCLM. PATIENTS AND METHODS Between December 1996 and April 2003, 33 patients with unresectable MBCLM were selected for a TSHP. A right or an extended right hepatectomy was planned after treatment of left FRL metastases to achieve a curative resection. The first-stage hepatectomy consisted in a clearance of the left hemiliver by resection or radiofrequency destruction of metastases of the left FRL. Subsequently, a right PVE was performed to induce atrophy of the right hemiliver and hypertrophy of the left hemiliver. Finally, a second-stage hepatectomy was planned to resect the right liver metastases. RESULTS There was no operative mortality. Post-PVE morbidity was 18.1%; postoperative morbidity was 15.1% and 56.0% after first- and second-stage hepatectomy, respectively. TSHP could be achieved in 25 of 33 patients (75.7%). The 1- and 3-year survival rates were 70.0% and 54.4%, respectively, in the 25 patients in whom the TSHP was completed. CONCLUSIONS In selected patients with initially unresectable MBCLM, a TSHP combined with PVE can be achieved safely with long-term survival similar to that observed in patients with initially resectable liver metastases.
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Affiliation(s)
- Daniel Jaeck
- Centre de Chirurgie Viscérale et de Transplantation and Service de Radiologie I, Hôpital de Hautepierre, Avenue Molière, 67098 Strasbourg, France.
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Bucher P, Mathe Z, Bosco D, Becker C, Kessler L, Greget M, Benhamou PY, Andres A, Oberholzer J, Buhler L, Morel P, Berney T. MORBIDITY ASSOCIATED WITH INTRAPORTAL ISLET TRANSPLANTATION. Transplantation 2003. [DOI: 10.1097/00007890-200308271-00063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Perrin A, Wicky C, Vinzio S, Greget M, Filisetti D, Schneider F, Bachellier P, Goichot B, Schlienger J. La nouvelle bête des Vosges. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80652-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jaeck D, Bachellier P, Nakano H, Oussoultzoglou E, Weber JC, Wolf P, Greget M. One or two-stage hepatectomy combined with portal vein embolization for initially nonresectable colorectal liver metastases. Am J Surg 2003; 185:221-9. [PMID: 12620560 DOI: 10.1016/s0002-9610(02)01373-9] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.0] [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: 12/30/2022]
Abstract
BACKGROUND Portal vein embolization (PVE), proposed to induce contralateral hepatic hypertrophy before major hepatectomy, carries some negative side effects since growth rate of metastases in the future remnant liver (RL) can be more rapid than that of nontumoral liver parenchyma. Therefore, metastases in the RL should be ideally resected before PVE, and a major hepatectomy can then be performed after PVE in patients with multiple bilobar colorectal liver metastases (MBLM). The aim of this study was to assess feasibility and outcome in patients with initially unresectable colorectal liver metastases treated by a one- or two-stage hepatectomy procedure (TSHP) combined with PVE. PATIENTS AND METHODS From December 1996 to December 1999, 180 patients with colorectal liver metastases underwent hepatectomy. During the same period, 18 were initially considered as unresectable. TSHP combined with PVE was attempted for 7 patients (group A) among those with MBLM, and a one-stage hepatectomy after PVE was attempted in another group of 11 patients (group B) among those with non-MBLM. RESULTS Nonanatomical resections for left liver metastases were performed as a first stage without any complications in group A. A right hepatectomy (RH) was performed in 5 patients in group A (feasibility = 71%). In group B, 7 of the 11 patients underwent a RH or an extended RH after PVE (feasibility = 64%). Postoperative complications rate did not differ between group A and B. Mortality was nil. Three-year survival rate was 53% in group A and 100% in group B. CONCLUSIONS These results suggest that one- or two-stage hepatectomy combined with PVE can be applied safely to selected patients initially considered as unresectable. Three-year survival was similar to that observed in patients with initially resectable liver metastases.
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Affiliation(s)
- Daniel Jaeck
- Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Strasbourg, Avenue Molière, France.
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Jaeck D, Bachellier P, Weber JC, Oussoultzoglou E, Greget M. [Process in surgical exeresis of colorectal cancer liver metastases]. Bull Acad Natl Med 2003; 187:863-76; discussion 876-9. [PMID: 14979052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Liver resection is the only curative option offering long-term survival in patients with colorectal liver metastases (25 to 40% five-year survival). It can be achieved with low mortality and low morbidity. However, this surgical approach can be offered only for approximately 10 to 20% of patients with colorectal liver metastases. Therefore, 80 to 90% of patients are excluded from liver surgery and will receive palliative therapies. Recent advances have selected subgroups of patients presenting initially unresectable disease to achieve curative resection. These new multidisciplinary strategies were developed in order to increase safely the resecability in patients with initially non-resectable liver metastases and to improve treatment of recurrences in patients with isolated liver metastases either by repeat hepatectomies or local tumor destruction. These strategies offer the same survival than observed in patients with initially resectable liver metastases. Our series includes 438 patients operated on for colorectal liver metastases between 1987 and 2002. Overall mortality was 1.1%, morbidity was 26%. Actuarial 5-year and 10-year survival were respectively 29.6% and 20.1%.
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Affiliation(s)
- Daniel Jaeck
- Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Avenue Molière-67098 Strasbourg, France
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Abstract
Imaging of the window of the temporal bone has became an important tool in the analysis of hearing loss, vertigo, tinnitus in a context of trauma, malformation, otosclerosis, and chronic otitis media. A good knowledge of the anatomy and a good technical procedure are necessary for making an efficient diagnosis. The increased thickness of the footplate may be delineated in otosclerosis, chronic otitis media, malformation, when it is measured at 0.7 mm or more in horizontal computed tomography (CT) sections. The traumatic displacement of the stapes, particularly within the labyrinths, is easily diagnosed in horizontal CT section. Imaging of the round window is now very important for the detection of otosclerotic foci, congenital stenosis, and perilymphatic fistula with or without fracture. Magnetic resonance imaging (MRI) with the high-resolution T2 plays an important role in the detection of a small amount of fluid in the round window recess, confirming the traumatic perilymphatic fistula without fracture.
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Affiliation(s)
- F Veillon
- Department of Radiology 1, University Hospital of Strasbourg, France.
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Andrès E, Kaltenbach G, Goichot B, Lioure B, Greget M, Schlienger JL, Imler M. [Veno-occlusive disease of the liver and POEMS syndrome]. Presse Med 1999; 28:334-6. [PMID: 10083875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Veno-occlusive disease of the liver is a common cause of morbidity and mortality after chemotherapy and/or radiotherapy and bone marrow transplantation. Non thrombotic hepatic venous obstruction is characteristic, but pathogenesis of this disease remains unknown. CASE REPORT In june 1993, a 58-year-old man was treated by cyclophosphamide and steroid for a POEMS syndrome. In november 1996, he developed hepatalgia, edema, ascitis and jaundice. The diagnosis of hepatic veno-occlusive disease was obtained by hepatic biopsy. Refractory ascitis was treated by transjugular intrahepatic portosystemic shunt. Gradual improvement in clinical status was observed after this therapy. CONCLUSION This observation offers three original types of information: there has been no prior report of an association between veno-occlusive disease and POEMS syndrome, the role of low dose cyclophosphamide in hepatic veno-occlusive disease was certain, transjugular intrahepatic portosystemic shunt is an interesting therapy with one years remission.
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Affiliation(s)
- E Andrès
- Service de Médecine interne, Hôpital de Hautepierre, CHU de Strasbourg
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26
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Greget M, Veillon F, Ellero B, Tongio J, Wolf P. [Imaging of renal graft lymphomas. Apropos of 5 cases]. J Radiol 1997; 78:1153-1157. [PMID: 9499953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The occurrence of non-hodgkin's lymphoma is a classical complication after transplantation. The frequent localization near the graft is well established. We report 5 cases of lymphoma, arising from the renal graft, from a series of 648 transplantations (0.77%). The lesions appear as soft tissue masses, iso or hypoechoic with ultrasonography, soft tissue attenuation with CT and low attenuation after contrast medium. With MRI, we note isosignal in T1 and hyposignal in T2 weighted sequences. The involvement of renal parenchyma (n = 3) and the inclusion of the vessels in the masses (n = 2) are frequent. Excretory tract compression leading to obstruction is often associated (n = 3).
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Affiliation(s)
- M Greget
- Service de Radiologie I, Hôpital de Hautepierre, Strasbourg
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Abstract
The authors report the case of a 67-year old man, with no particular medical history, presenting a large swelling of the left thigh. Investigations conclude to metastases located in muscles of the left thigh and of the pelvis, secondary to an adenocarcinoma of presumed pancreatic origin. With reference to this case, features of muscular metastases are reviewed. Muscular metastases seldom occur during the course of a cancer and are exceptionally the first manifestation of a neoplastic process. They are usually described as a painful mass, but symptoms can be misleading and delay diagnosis. Images obtained by ultrasonography, tomodensitometry and magnetic resonance imaging are not specific and histological examination is necessary to confirm the diagnosis.
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Affiliation(s)
- A E Perrin
- Service de médecine interne, CHU Hautepierre, Strasbourg
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Greget M, Veillon F, Meyer C, Tongio J, Imler M. [Desmoid tumor in Gardner syndrome. Apropos of a case evaluated with echography, CT and MRI]. J Radiol 1994; 75:199-202. [PMID: 8176680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A case of desmoid abdominal tumor is reported. This is a rare benign tumor often found in association with Gardner's syndrome. The radiological features with ultrasonography, computed tomography and magnetic resonance imaging are presented. These explorations illustrate the infiltrating characteristics and the high potentially recurrence rate of desmoid tumor.
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Affiliation(s)
- M Greget
- Service de Radiologie, Hôpital de Hautepierre, Strasbourg
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