Biomedical subjects
Publications and source records attributed to E Ponette.
A case of esophageal metastasis from a breast carcinoma is presented. Location was, as usual, midesophageal. The interval of time between breast carcinoma and the onset of esophageal symptoms was rather long. Barium swallow examination enabled correct diagnosis, whereas several series of superficial endoscopical biopsies were negative. Diagnosis was confirmed by deep endoscopical biopsy.
We reviewed the radiological documents and protocols of 196 cases of bile duct tumors examined over a period of 12 years: 20 of them (10.2%) presented with a polypoid endoluminal growth. The aim of this study was to provide a better knowledge about the radiological features of this less frequent kind of tumor. In these 20 cases, the correct diagnosis of bile duct lesion was provided in 100% by E.R.C.P., P.T.C., U.S. as well as C.T., and in 42% by arteriography. The correct diagnosis of tumor was made by E.R.C.P. in 86%, by P.T.C. in 88%, by U.S. in 61%, by C.T. in 63%, and by arteriography in 25%. A correct diagnosis of tumor could be reached in all cases by combination of several examination techniques. The anatomopathological diagnosis was: bile duct adenocarcinoma (7 cases), adenocarcinoma of the ampulla of Vater (4), villous adenoma of Vater's ampulla (2), cystadenoma (1), cystadenocarcinoma (1), hepatocellular carcinoma (1), apudoma (1), and metastases (3).
The case of a 75-year-old man with a history of hiatal hernia, who develops an acute gastric volvulus 17 days after a superior lobectomy of the left lung, is described. No similar cases were found in literature.
An abdominal ultrasound examination performed on two patients with abdominal pain showed segmental wall thickening of the colon that proved to be due to ischemic colitis. In one case, the typical "target lesion" was recognized. These findings could be confirmed with computed tomography, whereas a single contrast enema was unable to demonstrate the ischemic disease. In the second case, a typical five-layered structure of the bowel wall could be demonstrated. It is concluded that US can be useful in the early diagnosis of colonic ischemia.
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We report a patient who presented with recurrent right upper quadrant colics after a previous cholecystectomy. Radiological examination revealed the presence of a polypoid mass in the ileum caused by an anatomo-pathologically proven inflammatory fibroid polyp (IFP) in the ileum. Clinical and pathological aspects related to this rare benign lesion are discussed.
Anorectal ulceration eventually leading to rectal stenosis was observed in 10 patients who abused analgetic suppositories containing acetylsalicylic acid, acetaminophen, and codeine. Most patients were middle-aged women with a neurotic or psychiatric background. Perianal skin lesions were present in half of the patients. The endoscopic aspect of the sharply demarcated distal rectal lesions with squamous and transitional epithelium (anoderm) ascending from the anal canal was rather typical, but the appearances on biopsy were nonspecific. Possible pathophysiological mechanisms include mucosal prostaglandin depletion secondary to blockade of cyclooxygenase and shift to lipoxygenase products in the arachidonic acid cascade. Treatment options include drug cessation, topical steroids, and endoscopic dilation. Supporting psychological therapy often is necessary.
OBJECTIVE: To assess the immediate and long-term outcomes of elderly patients with acute complicated cholecystitis treated by percutaneous cholecystostomy. To assess the results of bile cultures obtained in this group of patients. DESIGN: Case series. SETTING: Tertiary care center. PATIENTS: Thirty-two patients, with a mean (+/- S.D.) age of 78 +/- 8 years (range, 58-92 years), and who presented with acute cholecystitis complicated by empyema formation. Sixty-six percent had associated disorders, which rendered them at high risk for surgical intervention. INTERVENTION: Percutaneous transhepatic catheter drainage of the gallbladder, with a mean drainage time of 20 days (range 0-84 days). In addition, endoscopic sphincterotomy with removal of common bile duct stones was performed in six patients and percutaneous aspiration of an associated liver abscess in four cases. RESULTS: Percutaneous cholecystostomy was followed by rapid regression of clinical symptoms and of radiologic abnormalities in all patients. Sixteen cases (50%) underwent elective cholecystectomy 1-12 weeks after cholecystostomy. One of them died of aspiration pneumonia, whereas 15 had no post-operative problems and were discharged 9 days (mean) after surgery. Forty-four percent (14/32) were considered inoperable: they remained completely free of biliary symptoms and died of unrelated illness (22%) after a mean follow-up of 6 months (range, 1-22 months) or are still alive (22%) with a mean follow-up of 15 months (range, 5-36 months). Bile cultures were positive in 75% of the patients. Escherichia coli, other aerobic Gram-negative micro-organisms, and anaerobic bacterial species accounted for 35% (16/46), 28% (13/46), and 20% (9/46) of the isolated bacteria, respectively. All aerobic Gram-negative species tested in vitro were susceptible to gentamicin and to temocillin. CONCLUSIONS: Percutaneous transhepatic cholecystostomy is a safe and effective procedure in the treatment of elderly high-risk patients with acute cholecystitis complicated by empyema formation. It can be followed by elective cholecystectomy, if possible, or by expectant conservative management in patients who are inoperable because of systemic disease.
A case of trabecular type of gallbladder duplication, a very rare congenital anomaly of the gallbladder, is reported. Diagnosis was made by endoscopic retrograde cholangiography and was confirmed by oral cholecystography. Sonography could not visualize the accessory gallbladder.
Although patients with peripheral arterial occlusive disease due to thromboangiitis obliterans (TAO) have been well characterized and the relationship of this disease to tobacco is stressed, little attention has been focused on its ability to involve the mesenteric vasculature and its ability to affect women. We report a rare case of a known TAO female patient who presented with abdominal pain due to inflammatory changes of the mesenteric vessels. The resulting small bowel ischemic changes and formation of intramural gas were demonstrated on a small bowel follow-through and a plain abdominal film. An angiography finally showed a superior mesenteric artery occlusion.
A patient is reported who developed acute pancreatitis complicated by pseudocyst formation immediately after the insertion of a self-expanding metallic biliary stent via the percutaneous route. The distal end of the stent was positioned into the duodenum. Endoscopists should be aware of this potential complication of metallic biliary stents.
The value of ultrasound (US) in determining the cause and site of biliary obstruction was critically evaluated and compared to endoscopic retrograde cholangiography (ERCP), in a prospective study performed on 120 consecutive patients. The final diagnosis was based on surgery, endoscopic retrograde cholangiography or a combination of other examinations. Ultrasound successfully differentiated obstructive from non obstructive jaundice in 96% of the patients, comparing well with the results ERCP. US correctly defined the cause of obstruction in 71% of the patients with ductal stones, in 90% of the patients with tumoural bile duct obstruction, but only in 59% of the patients with chronic pancreatitis.
We present two cases of acute colonic pseudo-obstruction, one complicated with perforation. Orthopedic surgery was the pathogenetic factor in both cases. Recovery was successful in both patients after appropriate treatment. The importance of conventional X-ray techniques, and more specially the plain X-ray of the abdomen, is stressed regarding early diagnosis and follow-up.
In a retrospective study of 143 patients with Zenker's diverticulum followed for a period of 20 years, we classified the diverticula into 4 categories (A, B, C and D) using Brombart's scheme as a basis; the difference between the first two categories, however, was made on the basis of a morphological-dynamic criterion rather than a purely morphological one. Furthermore, a quantitative index was introduced to define the size of the diverticulum. In two cases we noted a substantial increase in volume with the transition from category C to D after more than 3 years, but we were unable to demonstrate an evolution from category A to B, nor from B to C. Our study confirms, on a large scale, the presence of three possible pathogenetic mechanisms, as proposed earlier in the literature: decreased relaxation of the upper esophageal sphincter as the most frequent factor in all categories except category A, and delayed opening or early closing of this sphincter as less frequent factors. The good relaxation of the upper esophageal sphincter in our category A, the different sex ratio and the absence of evolution in this category suggest that category A does not necessarily evolve further.
Two patients with cirrhosis are presented who developed retrosternal pain and dysphagia immediately after sclerotherapy of esophageal varices. Extensive submucosal bleeding of the esophageal wall was demonstrated radiologically and endoscopically. Complete resolution occurred spontaneously and did not lead to residual complications such as strictures. Intramural hematoma of the esophagus is an unusual complication after endoscopic variceal sclerotherapy.
Double contrast is the best radiological technique for the detection of small esophageal cancer. Gastrografin is indicated when a blind mediastinal fistula is suspected; in cases of choking or suspicion of a fistula with the airways, a low osmotic hydrosoluble Iodium compound must be used. Conventional radiology and endoscopy are complementary techniques for the detection of esophageal cancer, as some lesions may be missed or misinterpreted by both. The need for endoscopic biopsy being incontestable for diagnostic confirmation and characterization, radiology presents some advantages over classic esophagoscopy for preoperative and the general pretherapeutic staging of esophageal carcinoma: assessment of topographical relation with the surrounding organs is possible and with the upper esophageal sphincter is easier; appreciation of tumoral extension along the longitudinal axis (tumor length, gastric invasion) remains mostly possible even in cases of severe stenosis; tumoral extension along the transverse axis (kinking, fistula) may be evaluated; detection of a second tumor or concomitant pathology distally from a stenosing tumor is mostly possible; moreover radiology is important before starting radiotherapy; and finally, previous radiology may reduce the (small) risk of endoscopic perforation. Radiology is indispensable or indicated in the posttherapeutic follow-up of esophageal carcinoma, as well after surgery as after endoscopic interventions, radiotherapy or chemotherapy.