Biomedical subjects
Publications and source records attributed to B Dupas.
Cholestasis is due to abnormal biliary secretion, from hepatic or extra hepatic causes. The diagnostic strategy of anicteric cholestasis will be discussed, defining hepatic biologic abnormalities, and the role and sequence of imaging techniques based on clinical and biological findings. Main causes will be emphasized and illustrated with different radiological techniques (US, CT and MRI).
PURPOSE: To describe corneal and conjunctival epithelial changes in various ocular surface disorders with a new in vivo confocal microscope (Corneal HRT II module) and to compare these results with those obtained by immunohistology on impression cytology specimens. METHODS: In this study, we investigated 36 eyes of 18 patients with ocular surface diseases such as corneal epitheliopathy induced by ocular rosacea (five patients), keratoconjunctivitis sicca related to tear evaporative condition in Meibomian gland dysfunction (eight patients), or tear-deficient dry eye in Sjögren's syndrome (five patients). In vivo confocal microscopy imaging (Heidelberg Retina Tomograph II Rostock Cornea Module) and impression cytology of the cornea and/or conjunctiva were performed. The images were analyzed for epithelial cell morphology at nuclear and cytoplasmic levels, in the cornea and the conjunctiva, number of goblet cells and their possible presence within the corneal epithelium, corneoconjunctival junction at the limbus, and density and presence of inflammatory cells within both epithelia. RESULTS: Images obtained consisted of two-dimensional 400x400 microm optical sections oriented parallel to the surface of the eye and compared with impression cytology. Conjunctival and corneal epithelia showed dramatic changes in ocular surface disease. In keratoconjunctivitis sicca, we found squamous metaplasia, inflammatory cell infiltration, goblet cell depletion, as well as a nuclear snake-like chromatin pattern. In rosacea associated with corneal epitheliopathy, a corneal conjunctivalization (goblet cells together with conjunctival epithelial cells within the corneal epithelium layer) was found. The images provided by this technique are in excellent correlation with the findings using impression cytology. CONCLUSION: The HRT II in vivo confocal microscope facilitates the study of both central and peripheral ocular surface epithelia compared to first-generation confocal microscopy devices. In vivo confocal microscopy, showing corneal and conjunctival epithelial structures in the live eye at the cellular level, is likely to open up a new promising way to investigate ocular surface involvement in complex diseases, providing a new insight on corneal and conjunctival disorders in the future.
PURPOSE: To explore tumors of the limbus with a new in vivo confocal microscope and to compare the images to histology results. METHODS: We evaluated three tumors in three patients with the Heidelberg Retina Tomograph II, Rostock Cornea Module. A diagnostic and therapeutic excision with adjunctive cryotherapy was performed for each individual. Confocal microscopy was compared to histopathologic sections. RESULTS: Histology identified two dysplasias and one carcinoma in situ. The main pathological features were visible on our images: cytonuclear atypias, epithelial folds into an inflammatory and vascularized conjunctival stroma, fine vessels perpendicular to the surface, a clear limit with normal epithelium, papillomatous organization, and abnormal keratinization. CONCLUSION: Our preliminary study showed that this type of limbal tumor could be explored using in vivo confocal microscopy. We were not able to determine whether there was a microinvasion. This new method could be a diagnostic aid, especially for atypical lesions and for follow-up because of frequent recurrences. Other studies are necessary to confirm our hypothesis.
The purpose of this article is to describe potential complications following the most common image-guided (fluoroscopy, ultrasound or CT) percutaneous interventional procedures, both diagnostic and therapeutic, thoraco-abdominal and musculoskeletal, as well as to review risk factors and the best practice recommendations. Prior to any interventional procedure, it is necessary to ascertain the absence of any abnormality in coagulation, to secure enough time to explain the procedure to the patient, and to adhere to strict sterile technique. Indeed, infections and hemorrhagic complications are the principal causes of mortality and morbidity for all procedures. Following lung biopsy, CT scan detects an immediate pneumothorax in 30% of patients. Major complications following percutaneous liver biopsy occur within 3 to 6 hours. Following a percutaneous drainage, complications occur in less than 10% of cases. Following a radiofrequency thermal ablation of malignant tumors, the mortality rate is low (0,5 to 1,4%), infection and hemorrhage are the most frequent complications. While rare, septic arthritis is the main complication that can follow musculoskeletal procedures and is a cause of medical malpractice lawsuits brought by patients.
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High hematological toxicity has been observed with anti-carcinoembryonic antigen radioimmunotherapy (RIT) in medullary thyroid carcinoma (MTC), suggesting metastatic bone involvement (BI). This retrospective study evaluated the rate of BI in MTC patients enrolled in two phase-I/II RIT trials using anti-carcinoembryonic antigen x anti-diethylenetriamine pentaacetic acid bispecific antibodies and [(131)I]di-diethylenetriamine pentaacetic acid hapten. Thirty-five patients underwent bone scintigraphy, bone magnetic resonance imaging (MRI), and post-RIT immunoscintigraphy (IS). IS performed in MTC patients was compared with IS conducted in 12 metastatic colorectal carcinoma (CRC) patients. Quantitative analysis of bone uptake was performed in three MTC and three CRC patients. In the MTC group, bone scintigraphy detected BI in 56.6% of patients, MRI in 75.8%, and IS in 88.6%. BI was confirmed by undirected (random) bone marrow biopsy, by bone surgery, or by two positive imaging methods in 74.3% of the patients. Sensitivity per patient of bone scintigraphy, MRI, and IS were 72.7, 100, and 100%, respectively. In contrast, IS visualized BI in only 33.3% of CRC patients; bone uptake was lower in CRC than in MTC patients. Bone MRI combined with post-RIT IS disclosed a much higher BI rate in advanced MTC than previously reported in the literature.
PURPOSE: To show the advantages of the in vivo HRT2 confocal microscope corneal module for studying the superficial and peripheral corneal and conjunctival epithelia. MATERIAL AND METHODS: We examined 15 patients whose superficial cornea was healthy and ten patients with keratoconjunctivitis sicca and/or rosacea. Some conjunctival imprints where taken on patients with superficial ocular disease and examined by immunofluorescence. RESULTS: We found superficial corneal epithelial cells, corneoconjunctival Langerhans and dendritic cells, goblet cells, limbic epithelial junction, new blood vessels, as well as deeper corneal structures such as Bowman's membrane, keratocytes, corneal nerves, and endothelium. We also observed pathological corneal epithelium in keratoconjunctivitis sicca and substantial inflammatory and vascular changes in rosacea. In two cases of stem cell deficiency associated with rosacea, we observed goblet cells in the corneal epithelium. An interesting anatomical-clinical parallelism between in vivo confocal microscopy images and those obtained by ex vivo immunofluorescence was observed. DISCUSSION: Central corneal pictures after explorations by in vivo HRT2 confocal microscopy are similar to those obtained with standard confocal microscopy. But conjunctiva, peripheral cornea and limbus are better examined at the surface and at medium depth with the HRT2. Diagnosis and therapy of superficial corneoconjunctival and limbal diseases are therefore made easier in vivo.
PURPOSE: To describe blebs after filtering surgery with a new in vivo confocal microscope. METHODS: We retrospectively evaluated 20 filtering blebs of 17 patients after trabeculectomy or deep nonpenetrating sclerectomy. Ophthalmological examinations included slit-lamp examination, applanation tonometry and in vivo confocal microscopy imaging (Heidelberg Retina Tomograph II Rostock Cornea Module). Eyes were classified into three groups: filtering blebs (eight eyes), nonfiltering blebs that were encapsulated or flat (seven eyes) and filtering blebs with mitomycin C (five eyes). In vivo confocal microscopy images were compared to the morphological and functional aspects of filtering blebs. RESULTS: Filtering blebs had numerous intraepithelial microcysts, whereas nonfiltering blebs had none or few. However, few microcysts were seen in the encapsulated filtering blebs. The connective tissue of filtering blebs was arranged loosely, whereas it was dense in nonfiltering blebs. Filtering blebs with mitomycin C had numerous microcysts and loosely arranged subepithelial connective tissue. CONCLUSION: By evaluating filtering blebs at the cellular level, this original method is highly consistent with ex vivo histological examination. In vivo confocal microscopy constitutes a new promising way to understand the wound healing mechanism in filtering surgery.
The aim of the study was to evaluate the presence of cerebral lesions in asymptomatic scuba divers and explain the causes of them: potential risk factors associating cardiovascular risk factors, low aerobic capacity, or characteristics of diving (maximum depth, ascent rate). Experienced scuba divers, over 40 years of age, without any decompression sickness (DCS) history were included. We studied 30 scuba divers (instructors) without any clinical symptoms. For all of them, we carried out a clinical examination with fatty body mass determination and we questioned them about their diving habits. A brain Magnetic Resonance imaging (MRI), an assessment of maximal oxygen uptake, glycemia, triglyceridemia, and cholesterolemia were systematically carried out. Cerebral spots of high intensity were found at 33 % in the scuba diving group and 30 % in the control group. In the diving group, abnormalities were related to unsafe scuba-diving or metabolic abnormalities. In our study, we did not find a significant relationship between the lesions of the central nervous system, and the age, depth of the dives, number of dives, and ergometric performances (maximal oxygen uptake, V.O (2max), serum level of blood lactate). Nevertheless, we found a significant relationship between the lesions of the central nervous system and ascent rate faster than 10 meters per minute (r = 0.57; p = 0.003) or presence of high level of cholesterolemia (r = 0.6; p = 0.001). We found concordant results using the Cochran's Test: meaningful link between the number of brain lesions and the speed of decompression (Uexp = 14 < Utable = 43; alpha = 0.05, p < 0.01). We concluded that hyperintensities can be explained by preformed nitrogen gas microbubbles and particularly in presence of cholesterol, when the ascent rate is up to 10 meters per minute. So, it was remarkable to note that asymptomatic patients practicing scuba diving either professionally or recreationally, presented lesions of the central nervous system. This survey permitted us to highlight in a population of professional divers, neurological and also cardiovascular abnormalities (ventricular arrhythmias); although none of them present any symptoms today. It seems therefore important to us to propose in the future, for a better prevention of neurological injuries, a systematic follow-up by maximal oxygen consumption measure, brain MRI, and cholesterolemia. In the same way, our results suggest a modification of the diving tables with a maximal decompression rate at 9 m . mn (-1).
The authors report the case of a 24 year old woman presenting with acute lower GI hemorrhage caused by a Meckel's diverticulum. Diagnosis was made by CT-enteroclysis and confirmed at surgery. This new imaging technique will be briefly described and compared to the other more traditional small bowel imaging techniques. The authors will then present the CT-enteroclysis imaging features of this congenital anomaly.
Hypothenar hammer syndrome is all the clinical ischemic secondary manifestations in a stenose even one occlusion of traumatic origin of the distal portion of the ulnar artery. Our objective was to underline anatomical substratum of this lesion and to emphasize the interest of the angio M.R.I. in the diagnosis of this syndrome. The radioanatomical study of the distal portion of the ulnar artery were on 10 fresh corpses of both sexes free of traumatic hurt of upperlimb. On 6 anatomical details injected with latex colored with red Congo, three were dissected to the fresh state to the anterior faces of the distal third of the forearm, the wrist and the palmar face of the hand. The three others were subjected to transverse anatomical cuts of carp after freezing. An arterial opacification by injection of lead minium with radioscopic control followed by a radiography in face incidence was realised on 12 upperlimb. The 3 modes of this anatomoradiographic analysis objectivized the nearness of the carpal distal segment of ulnar artery and the hook of the hamate bone. On 7 carps the ulnar artery passed in the balance of the hooked bone, in 5 cases it followed the radial hillside and in twice the artery was mediale. Four details were not exploited for quality reasons of injection or radiographic incidence. By the fact that the carpal portion of ulnar artery be situated in the sagittal plan of the hook or that it be medial or lateral it always passed near this osseous anvil. This anatomical arrangement objectivized well in a transversal plan by the angio magnetic resonance imagering predisposes this arterial segment to the parictal hurts of traumatic origin responsible of stenose in the long-term.
BACKGROUND/PURPOSE: Extracorporeal photochemotherapy (ECP) has been proposed for the treatment of various auto- and allo-immune reactions. However, a standard ECP regimen did not significantly alter the course of chronic progressive multiple sclerosis (MS). We tested whether an intensive ECP treatment can affect the course of secondary chronic progressive form of MS. METHODS: Five patients free of immunosuppression were included. Soluble 8-MOP was added ex vivo to a mononuclear cell suspension obtained in a cell separator. This cellular suspension was then irradiated using an UVA irradiator and re-infused into the patient. ECP was performed once a week for 6 weeks and then, depending on clinical evaluation, for a maximum of 6 months, with 2-year follow-up after treatment discontinuation. Scoring was performed with the Kurzke scale and EDSS by a single independent neurologist. RESULTS: One patient was excluded because of recurrent attacks at the very beginning of treatment. Four patients completed the study: one exhibited clinical improvement and three remained stable during the first 6 months of treatment. However, all experienced relapse or worsening of the disease after discontinuation of ECP treatment. CONCLUSION: Our intensive ECP treatment only transiently alters the course of the severe secondary chronic progressive form of MS, with rebound after treatment discontinuation.
BACKGROUND: Percutaneous ethanol injection and hepatic resection are the most widely used curative therapeutic options for patients with compensated liver disease and small hepatocellular carcinoma. AIM: To compare percutaneous ethanol injection and hepatic resection in a selected group of consecutive French patients with a single hepatocellular carcinoma, smaller than or equal to 50 mm, in terms of survival, recurrence rate of malignancy and direct costs. METHODS: The analysis of two contemporary cohorts of Child-Pugh A or B patients with a single hepatocellular carcinoma of < or = 50 mm treated by percutaneous ethanol injection (n=55) or hepatic resection (n=50). RESULTS: Long-term survival was not significantly different between the two groups when the size of hepatocellular carcinoma was less than 30 mm. However, the survival of patients with hepatocellular carcinoma larger than 30 mm was higher after hepatic resection than after percutaneous ethanol injection (P=0.044). The cumulative direct costs were significantly higher in patients treated by hepatic resection than in those treated by percutaneous ethanol injection regardless of the tumour size. The calculated costs per month of survival in patients treated with percutaneous ethanol injection and hepatic resection were 999 vs. 3865 euros, respectively (P < 0.001). CONCLUSIONS: Percutaneous ethanol injection is more cost effective than hepatic resection in patients with a single hepatocellular carcinoma smaller than 30 mm. However, in patients with a larger tumour, long-term survival is higher after hepatic resection.
BACKGROUND: Radiofrequency coagulation (RFC) is being promoted as a novel technique with a low morbidity rate in the treatment of liver tumours. The purpose of this study was to assess critically the complication rates of RFC in centres with both large and limited initial experience, and to establish causes and possible means of prevention and treatment. METHODS: This is an exhaustive review of the world literature (articles and abstracts) up to 31 December 2001; 82 independent reports of RFC of liver tumours were analysed. RESULTS: In total, 3670 patients were treated with percutaneous, laparoscopic or open RFC. The mortality rate was 0.5 per cent. Complications occurred in 8.9 per cent: abdominal bleeding in 1.6 per cent, abdominal infection in 1.1 per cent, biliary tract damage in 1.0 per cent, liver failure in 0.8 per cent, pulmonary complications in 0.8 per cent, dispersive pad skin burn in 0.6 per cent, hepatic vascular damage in 0.6 per cent, visceral damage in 0.5 per cent, cardiac complications in 0.4 per cent, myoglobinaemia or myoglobinuria in 0.2 per cent, renal failure in 0.1 per cent, tumour seeding in 0.2 per cent, coagulopathy in 0.2 per cent, and hormonal complications in 0.1 per cent. The complication rate was 7.2, 9.5, 9.9 and 31.8 per cent after a percutaneous, laparoscopic, simple open and combined open approach respectively. The mortality rate was 0.5, 0, 0 and 4.5 per cent respectively. CONCLUSION: The morbidity and mortality of RFC, while low, is higher than previously assumed. With adequate knowledge, many complications are preventable.
Rupture of an intra-abdominal varix in a patient with portal hypertension is a rare but severe cause of massive hemoperitoneum. The authors report the case of a patient with alcoholic cirrhosis that presented to the emergency department with hypovolemic shock. Imaging showed massive hemoperitoneum, severe portal hypertension and suggested the diagnosis of spontaneous rupture of an intra-abdominal varix, confirmed at laparotomy.
A rare abnormal biliary tract consisting in a double common bile duct with an ectopic biliary tree draining into the stomach is described. This congenital anomaly, associated with lithiasis in the ectopic duct, was detected for the first time on MR-cholangiopancreatography. Only 23 cases of abnormal biliary drainage into the stomach have been reported in the literature. Embryogenesis and potential risks, such as lithiasis in the ectopic duct and the development of gastric carcinoma, are discussed.
Several anterior and posterior methods are today available for stabilization of the cervical spine. Factors such as level and degree of instability, method of decompression, bone quality, length of fixation and safety factors influence the choice of method for a particular patient. The use of laminar hooks in the cervical spine has been restricted by fear of cord compression with the potential of tetraplegia. The aim of the present study was to assess the safety and determine the anatomical relation between hooks inserted in the cervical spinal canal and the dura and spinal cord. Thirteen cadavers from seven women and six men with no evidence of cervical spine disorder were included. The mean age was 81.3 years (range 65-101 years). The cervical spine was instrumented with cervical Compact Cotrel Dubousset hooks and rods. The effect of the hook on the dura was studied by myelography in nine cadavers. The deformation of the dural sac was quantified by measurement of the maximal width of the indentation of the contrast column at each level. A CT myelography scan was obtained in three cadavers. The ratio between the distance of maximal hook intrusion into the spinal canal and the canal diameter in the direction of the hook was calculated. The relation between inserted hooks and the spinal cord and dura was documented in a fresh cadaver studied with CT myelography. A hemilaminectomy was performed at all levels in three cadavers with direct visual inspection and photography of the hook sites before and after excision of the dura. A dural deformation of 2 mm or less, as observed by myelography, was found at four out of 77 (5%) hook sites. The deformation was caused by a supralaminar hook at C3, C6 and C7 and by an infralaminar hook at C6. The mean hook intrusion in the spinal canal, as observed on CT, was 27% (range 8-43) of the canal diameter. On visual inspection, 14 out of 18 hooks were in contact with the dura. After removal of the dura, two out of the 18 hooks in the same cadaver were in contact with the spinal cord. However, no deformation of the cord was observed. To our knowledge this is the first study systematically documenting the relation between hooks and the spinal cord in cadavers. In 95% of the hooks no deformation of the dural sac was observed and there was no evidence of spinal cord deformation. From an anatomical point of view, laminar hook instrumentation can be considered a safe procedure. The study shows, however, that hooks inserted in the cervical spine have a close anatomical relationship with the neuraxis, and at stenotic levels the use of other techniques is therefore recommended.
Gene transfer of the herpes simplex virus thymidine kinase (HSV-tk) gene sensitizes tumor cells to the toxic effect of ganciclovir (GCV). The toxic effect of GCV extends to nontransduced surrounding cells by a metabolic process known as the bystander effect. A distant bystander effect, which involves anatomically separated tumors, has been reported in vivo. Our aim was to evaluate and characterize such distant effect in a rat model of colorectal tumors implanted in the liver using adenovirus to carry the HSV-tk gene. Two colorectal tumors were implanted in two distinct liver lobes of the liver. One of the tumor was transduced with an adenoviral vector containing HSV-tk gene. The volumes of the tumors were monitored after GCV treatment. Implication of the immune system was studied histologically and after in vivo manipulations. After GCV administration, the nontransduced distant tumor regressed partially or completely in the experimental group. Immunohistochemical analysis revealed the presence of CD8+ lymphocytes in the distant lesion. HSV-tk/GCV-induced immune response against tumors was evidenced by an adoptive transfer assay (Winn assay) and the distant bystander effect was blunted after CD8+ lymphocytes depletion. However, the survival rates for treated animals were not improved. These findings demonstrate that an immune-mediated effective distant bystander effect can be obtained after limited adenoviral-mediated transfer of the HSV-tk gene.