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Biomedical subjects

D Mathieu

Publications and source records attributed to D Mathieu.

At least 73 records · Page 4Linked to original sources

Percutaneous management of pyogenic liver abscesses.

Twenty-four pyogenic liver abscesses have been treated during a six-year period percutaneously. Percutaneous management included percutaneous drainage and fine needle aspiration under ultrasound or CT scan guidance. Percutaneous management was successful in 92% of cases, and no further treatment was required in 91% of these. One patient died, giving a mortality rate of 4.1%. There were no complications related to this method. The authors conclude that percutaneous management of pyogenic liver abscesses should be attempted in all cases, since results compare favourably with surgical procedures.

Adolescent

[Management of large adrenal glands discovered incidentally].

Incidental adrenal tumors are more and more often discovered with development of the new radiological techniques (CT scan, sonography). In such an occurrence, the largest panel of adrenal hormones measurements is needed. In the absence of hormonal abnormality, no exam can help for the clinical decision-making. According to epidemiological findings, we propose to operate upon tumors larger than 6 cm and to repeat CT scans at 2, 6 and 18 months for tumors smaller than 6 cm which should be operated upon if an enlargement of the adrenal tumor is demonstrated by a control exam. This attitude relies upon the quite higher frequency of adrenal adenomas (more than 99% of non-functioning adrenal tumors) and the more important risk of malignant adrenal carcinoma in front of a huge tumor. It appears to be the right choice in a cost-effectiveness perspective.

Adrenal Gland Neoplasms

Pancreatic cystic neoplasms.

Cystic neoplasms are an uncommon group among pancreatic tumors. Because of advances in noninvasive diagnostic procedures, these lesions are more frequently detected and surgically treated. New pathological entities have been recently described with their own prognosis. 1. In a large number of cases, the imaging procedures can differentiate microcystic adenoma from mucinous cystadenoma, the more frequently encountered lesions. A well-defined mass with innumerable small cysts producing a honeycomb appearance with central stellate septae is suggestive of microcystic adenoma. A well-defined multilocular mass containing thin, straight or curvilinear septae with papillary projections and local thickening is suggestive of mucinous cystadenoma. 2. No sonographic or CT finding allows the differentiation between mucinous cystadenoma and cystadenocarcinoma, however; the imaging features depend on the grade of malignancy. 3. Thus, in the majority of cases of cystic lesions, fine needle aspiration with appropriate stains is recommended.

Biopsy, Needle

[Abscess of the spleen: diagnosis and treatment. Apropos of 12 cases].

Twelve cases of splenic abscess, seen at our hospital between January 1980 and June 1987, were reviewed retrospectively. The most common causes of splenic abscesses were subacute endocarditis and intra abdominal sepsis. Diagnosis was suspected on clinical grounds and was always confirmed by sonography and/or computerized tomography. Two patients were drained unsuccessfully under CT scan guidance and underwent splenectomy. The other patients were operated primarily. One patient developed a subphrenic abscess postoperatively. One patient died from intractable cardiac failure due to subacute endocarditis. The authors stress the role of CT scan in the diagnosis of splenic abscess and recommend early splenectomy in cases of failure of percutaneous drainage.

Abscess

[Tolerability of a new non-ionic contrast medium, iopromide in x-ray computed tomography. Comparison with ioxaglate 320 mgI/ml].

Three randomized prospective and comparative trials were conducted in 165 patients undergoing brain (80) and whole body (85) CT scans. The two products compared where a new non-ionic contrast medium iopromide 300 (brain) and 370 (whole body) and the ionic low osmolar contrast medium, ioxaglate 320. Imaging quality was not different but the tolerance of the non-ionic medium was significantly better (p less than 0.05).

Contrast Media

[Ultrasonographic and x-ray computed tomographic aspects of Mirizzi's syndrome].

The Mirizzi syndrome is due to common hepatic duct obstruction secondary to the impaction of a large gallstone in the neck of the gallbladder or the cystic duct. The sonographic and computed tomography features in 3 cases of Mirizzi syndrome are described and compared with percutaneous transhepatic cholangiography or endoscopic retrograde cholangiography findings. The Mirizzi syndrome was diagnosed preoperatively on sonography in 2 out of 3 cases and on plain computed tomography scans in all 3 cases. However pre or intraoperative visualization of the biliary tract is mandatory in suspected Mirizzi syndrome to detect the presence or absence of cholecystobiliary fistula, in order to adapt the operative strategy.

Adult

Hepatic vein involvement in hepatocellular carcinoma.

A retrospective review of the dynamic computed tomography (CT) and ultrasound scans from examinations of 134 patients with hepatocellular carcinoma was undertaken with emphasis on evaluation of hepatic vein involvement. Hepatic veins were involved in 8 patients (5.9%). Portal vein obstruction was associated in 7 of these cases. Sonography demonstrated hepatic vein involvement in 6 cases was considered within normal limits in 1 and failed to display hepatic veins in another. Dynamic CT was superior in depicting venous obstruction in all the cases by different signs including (a) hypodensity and enlargement of the vessel, (b) perivenous arterial hypervascularization surrounding the hypodense intraluminal region, and (c) hemokinetic changes in relation to the outflow obstruction. The frequency and significance of these CT signs are discussed and correlated in 2 patients with magnetic resonance imaging (MRI) data.

Adolescent

[Detection of heterogeneous Staphylococci by the Autobac system using a nafcillin disk].

Detection of Methicillin Resistant Staphylococcus aureus (MRSA) is still a problem for automated system users. Forty-nine strains were studied--two kinds of tests were performed: the first by using a 1.0 microgram nafcillin disk with the Autobac system, the second by testing an oxacillin disk by diffusion on Mueller-Hinton agar base complemented with natrium chloride incubated at 37 degrees C. Between the two tests, we observed a concordance for 87.8% of the strains. Six strains showed a discrepancy with the reference method. But for five of them, the Light Scattering Index (LSI) showed a decreasing sensibility near for the cut off. Whereas, only one strain is considered as susceptible. The 1.0 micrograms nafcillin disk allow better results than the 5.0 micrograms oxacillin disk in the automated system, Autobac.

Automation

E. coli infections of the lower urinary tract and their treatment by immunomodulation or combined immunomodulation and antigen therapy.

A model of infection by E. coli 022 of the lower urinary tract in the rat is described. The infection is characterized by the presence in the urine of a large number of E. coli (10(5)-10(7) bacteria per ml). There is pus formation in the urine. A few infected rats also exhibited prostate hypertrophy and the presence of ACB could be detected in some of the latter group. Treatment of the infected rats by the C. granulosum-derived immunomodulator P40, injected intravenously either as a single dose of 1 mg per rat 1 day after infection or as 2 fractionated doses of 0.5 mg 1 day and 3 days after infection resulted in sterilization of a significant number of urines. The interest of fractionating the dose of P40 is to reduce the incidence of prostate hypertrophy formation. Comparable results were obtained when P40 was given preventively to the rats either as a single dose 7 days before infection or as 2 fractionated doses 7 days and 1 day before infection. The association of a single preventive dose of 1 mg of P40 given 7 days before infection by administering a suspension of heat-killed E. coli 022, as a specific antigen, 1 day after infection permitted the sterilization of urines in all infected rats and prostate hypertrophy formation did not occur.

Adjuvants, Immunologic

Budd-Chiari syndrome: dynamic CT.

A retrospective multi-institutional study was carried out on a series of 38 patients with histologically proved Budd-Chiari syndrome: Five patients had acute disease, and 33 had subacute or chronic disease. All patients underwent dynamic CT scanning. Angiography was performed in 20 cases, inferior cavography in 22, and wedge-hepatic venography in 16. In all acute cases, CT showed global liver enlargement with diffuse hypodensity on plain scans and patchy enhancement after contrast material injection. Thrombosis of the three main hepatic veins was always demonstrated. In subacute or chronic disease, plain CT scans showed abnormalities of liver morphology and hypodensity either in atrophic areas (19 cases) or in the periphery of the liver (eight cases). With dynamic CT, patchy enhancement was present in 28 cases. Correlation with angiography in 15 cases revealed a normal portal blood flow in enhanced areas and an inversed portal blood flow in atrophic areas. Different morphologic and enhancement patterns on CT scans could be related to the direction of portal blood flow, which changes with different stages of Budd-Chiari syndrome.

Acute Disease

[Effects of vaccination in urinary infections caused by Escherichia coli in rats].

The preventive effects of the immunomodulator P40 on the experimental E. coli infection of the lower urinary tract of the rat have been reported previously. In the present paper are presented the results obtained with the aid of vaccination using the same experimental model of infection in the rat. Active specific immunization of the animals with a vaccine consisting of the same strain as that used for infecting the rats afforded significant protection toward the infection. It is concluded that such vaccines could also be used in humans, either alone or in combination with other therapies with the aim at preventing recurrencies or relapses of infections of the lower urinary tract which were resistant to antibiotherapy.

Animals