Biomedical subjects
Publications and source records attributed to J Sahel.
Non-Hodgkin pancreatic lymphoma is a rare disease. Its diagnosis is difficult without histological examination. Ultrasonographic, computed tomodensitometric, and endoscopic retrograde cholangio-pancreatographic findings are not pathognomonic. The better prognosis of these tumors, compared to adenocarcinoma, and their sensitivity to chemotherapy, implies the need for pathologic examination of every pancreatic tumor.
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A two-month-old girl presented with a unilateral benign cystic medulloepithelioma from the ciliary body associated with bilateral retinal non-attachment. The authors discuss the histopathologic findings and the pathogenesis of the congenital retinal non-attachment: are these incidental occurrences or do they arise from a common pathogenetic mechanism?
The authors report the results of a retrospective study of 76 patients enucleated for a choroidal melanoma, in whom prognostic factors of survival were studied. The presence of metastasis at the time of diagnosis, the size of the tumor and the epithelioid cellular type are the most pejorative factors (though statistically not significant). A peak mortality can be observed between the second and the fourth year after enucleation. A predominance of the liver metastases is clearly established (75% of the metastases observed in our sample). We observed a majority of small tumors (40%) of spindle cell type (50%).
Cell cultures obtained from human uveal tumours have been used as experimental model to study the lethal effect consecutive to the neutron capture reaction on boron incorporated into cells as borophenylalanine. An irradiation with a neutron fluence of 6 x 10(9) n cm-2 reduced the number of viable cells by about 30%.
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A total of 55 pancreatic pseudocysts in 45 patients with acute pancreatitis were managed between 1980 and 1990. Six patients were managed conservatively with resolution of pseudocysts in 5 patients. All pancreatic pseudocysts that disappeared were smaller than 35 mm. CT or ultrasound-guided aspiration were performed in 26 patients with a morbidity rate of 5%. Nine among 21 patients (42%) who were initially treated by percutaneous puncture were definitively cured: all pseudocysts were smaller than 55 mm. Nine patients were managed by long-term percutaneous drainage: 3 minor complications occurred and in 7 patients, no other treatment was necessary even for large pseudocysts. Endoscopic cystoenterostomy was performed in 12 patients. Only 15 pseudocysts (27%) bulged into the digestive wall, mainly of the stomach. Three complications (following 2 cystogastrostomies) occurred and one patient died after endoscopic cystogastrostomy. In 7 patients (58%), no other treatment was necessary even for large pancreatic pseudocysts. Surgery was required in 13 patients but only 4 patients underwent surgery as primary treatment. One major complication occurred and one patient died. Percutaneous drainage and endoscopic cystoenterostomy when technically feasible, are effective treatments of pancreatic pseudocysts complicating acute pancreatitis.
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16 patients (14 males, 2 females, mean age: 59.2 years) underwent sonographic-guided ethanol injections as treatment for 23 hepatocellular carcinomas (HCC) complicating cirrhosis. All lesions were pathologically proven by sonographic-guided cytology. Tumor sizes ranged from 9 to 66 mm. Sterile 96% alcohol was injected with a 17.7 cm-long 22 gauge spinal needle at one week intervals. At each session, 8-50 ml was injected depending on the diameter of the tumor. We regarded as a "success" the negativation of the cytologies one, two and three months after the end of the treatment associated with normalization of alpha-fetoprotein levels and typical echographic and tomodensitometric changes. No serious complication was associated with the procedure. In the "Child A" group1, 6 of 7 tumors have been successfully treated, the largest measuring 66 mm. The seventh lesion is currently being treated. In the "Child B" group1 3 of 6 lesions have been successfully treated. No success has been obtained in the "Child C" group. Volumes of alcohol greater than previously reported may be useful for lesions larger than 40 mm. Percutaneous alcohol injections can be considered as an alternative to surgery even for lesions larger than 50 mm. Among 4 patients presenting with 11 liver metastases of colic and gastric adenocarcinoma and 1 patient with a small bowel carcinoid tumor, one remission with a follow-up of 5 months was observed.
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Celiac plexus block is usually performed under fluoroscopic or tomodensitometric guidance. We report on a new procedure using sonographic guidance. the patient lies in supine position. We use a real-time sonograph with a 3.5 MHz probe. On a transverse plane, the celiac axis is localized emerging from the aorta. Under local anesthesia, the tip of the spinal needle (177 mm, 22 g) is placed close to the aorta (about 5 mm) on both sides. 5 to 10 ml of 1% lidocaine, then 10 to 20 ml of absolute alcohol, are injected on each side. 21 patients (10 males, 11 females, mean age: 61.4) underwent the procedure. They presented with cancer of the pancreas in 14 cases, metastatic nodes from an extra-pancreatic tumor in 5 cases and chronic calcifying pancreatitis (CCP) in 2 cases. No pain relief was secured in 3 patients (14%). One of these presented with CCP, but endoscopic cystic diversion of a small cyst was successful in eradicating pain. Partial pain relief was secured in 5 cases (24%) and total pain relief in 13 cases (62%). No treatment-related complication was observed. We conclude that sonography is a simple and safe method of guidance in performing alcohol block of the celiac plexus. The anterior approach may prevent neurologic complications occurring with other methods of guidance using a posterior approach.
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Five cases of localized ectasiae of pancreatic ducts associated with epithelial mucinous metaplasia have been previously reported by Itai et al. (Radiology 1986; 161:697-700). During a 1-year period, we collected four new observations of patients presenting with recurrent attacks of pancreatic pain due to similar clusters of cystlike dilated ducts communicating with the main pancreatic duct and lined by a columnar epithelium interspersed with numerous goblet cells. Duct lumina were filled with mucous. Carcinoembryonic antigen levels were high in the pure pancreatic juice, but normal in the blood. Sonography and CT scan showed cystlike, intrapancreatic defects localized three times in the head of the pancreas and once in the body. Endoscopic retrograde cholangiopancreatography (ERCP) showed a huge dilation of some collateral ducts filled by radiolucent defects. The main pancreatic duct was dilated proximally to pathological ducts in three cases. Neither pancreatic stones nor exocrine insufficiency could be demonstrated 7 years after the clinical onset; one case presented with an in situ carcinoma. Since mucinous ductal ectasia is a precancerous state, surgery is mandatory. ERCP is probably the best method of diagnosis.
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Celiac plexus block is usually performed under fluoroscopic or tomodensitometric guidance. We report on a new procedure using sonographic guidance. The patient lies in supine position. We use a real-time sonograph (Kontron Sigma 1 AC) with a 3.5 MHz probe. On a transverse plane, the celiac axis is localized emerging from aorta. After local anesthesia, the tip of the spinal needle (177 mm, 22 G) is placed close to aorta (about 5 mm) on both sides. 10 to 15 ml of 1 per cent lidocaine then 10 to 15 ml of absolute alcohol are injected on each side. 21 patients (10 males, 11 females, mean age: 61) underwent the procedure. They presented with cancer of the pancreas in 14 cases, metastatic nodes in 3 cases, cholangiocarcinoma in 2 cases and chronic calcifying pancreatitis (CCP) in 2 cases. No pain relief occurred in 3 patients (14 per cent). On of those presented with CCP but the endoscopic cystic diversion of a small cyst was successful to eradicate pain. Partial pain relief occurred in 5 cases (24 per cent). Total pain relief was obtained in 13 cases (62 per cent). No complication related to the treatment was observed. Sonography is a simple and safe method of guidance to perform alcohol block of the celiac plexus. The anterior approach may prevent neurologic complications related to other methods of guidance.