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Biomedical subjects

P Legmann

Publications and source records attributed to P Legmann.

At least 55 records · Page 3Linked to original sources
PubMed1994

[Biliary complications after liver transplantation. Contribution of imaging--percutaneous treatment].

Biliary complications are observed in 7 to 20% of orthotopic liver transplantations. Biliary strictures and fistulas are the commonest complications, usually at the site of anastomoses, or more rarely at a distance. The entire transplant biliary tract may be affected, particularly in the case of hepatic artery thrombosis. These lesions are due to multifactorial ischaemic phenomena. Mechanical complications can occur after insertion of a Kehr drain. Mucoceles of the cystic duct, responsible for extrinsic bile duct compression, are much less common. The diagnosis is based on medical imaging, as the clinical signs are often non-specific. Ultrasonography has limited sensitivity as a first-line examination. Opacification of the bile ducts is therefore essential at the slightest doubt, as it has a sensitivity of 100% and allow assessment of the lesions. Transhepatic cholangiography is preferable to retrograde opacification due to the risks infection. CT scan is useful in the case of fistula to assess fluid collections. Percutaneous treatment avoids the need for open surgery in about 1/3 of cases. Strictures can be dilated by means of inflatable balloons, via a percutaneous or retrograde approach. Intra-abdominal collections can be drained percutaneously.

Adult↗
PubMed1994

[Complications and liver transplantation: diagnostic strategy].

Liver transplantation is currently the treatment of choice for end-stage liver failure in children and adults. 670 liver transplantations were performed in France in 1990. The 2-year survival rate in adults is 65%. Significant progress in terms of survival has been achieved as a result of improvement of surgical techniques and postoperative surveillance, the development of effective immunosuppressant therapy and a better organization of donor organs. Surgical techniques depend on the recipient and the transplant available. Imaging is useful in pretransplantation assessment, but especially during the immediate and long-term follow-up to assess transplant vitality and to detect any complications, which are of four types: vascular, biliary, or related to rejection or infection. Postoperative surveillance of the transplant must be based on a diagnostic approach conducted according to the following optimal sequence: laboratory parameters, histological examination and imaging, performed systematically from the 1st day onwards, including examination of the hepatic parenchyma, bile ducts, hepatic vessels and search for effusions and collections. The role of imaging in the context of rejection is not so much to visualize of rejection, as to eliminate a vascular, biliary or even infectious cause for the altered laboratory parameters. In the context of surgical vascular, biliary, infectious or complex complications, the examination sequence always includes clinical and laboratory findings, histology, angiography in the context of vascular complications and CT scan to assess the vitality of the hepatic parenchyma and to identify any intrahepatic or perihepatic collections. Interventional radiology plays an important role in the treatment of these vascular, biliary and infectious complications and should be considered prior to any surgical revision.

Angiography↗
PubMed1993

Hepatic arterial chemoembolization in patients with liver metastases of endocrine tumors. A prospective phase II study in 24 patients.

BACKGROUND: Liver metastases of endocrine tumors are of major prognostic significance. The various therapeutic approaches have given disappointing results; however, locoregional treatment has allowed transient control of hepatic tumor growth. METHODS: Twenty-four patients with liver metastases of endocrine tumors (mainly carcinoid tumors [n = 18] and gastrinomas [n = 5]) were included in a Phase II study of hepatic arterial chemoembolization (CE). Metastases were bilateral in all patients and invaded more than 50% of the liver in 12. They were synchronous of the primary tumor in 62.5% of the patients. Seventeen patients had not responded to previous intravenous chemotherapy. CE courses were performed every 3 months using an emulsion of 10 ml of iodized oil and doxorubicin 50 mg/m2 injected into tumor vessels, followed by CE arterial occlusion with gelatin sponge particles. Seventy-one CE courses were performed in 23 patients; there was one technical failure. RESULTS: Among patients with carcinoid tumors, disappearance of diarrhea and/or flushing was observed in 8 of 11. Serotonin and/or its metabolite 5-hydroxyindoleacetic acid levels decreased by more than 50% in 57% of the patients. The size of liver metastases decreased by at least 50% in 6 of 18 patients, i.e., in 33% (range, 12-54%). Two had complete responses. The median duration of the responses was 14 months (range, 6-40). Among patients with noncarcinoid tumors, minor response or stabilization occurred in three of five patients. Major side effects were bleeding peptic ulcer (one patient) and oligoanuric renal failure (one patient). Abdominal pain, fever, and increases in hepatic enzyme levels were common and transient. CONCLUSIONS: These results suggest that CE is effective in patients with liver metastases of endocrine tumors, mainly in carcinoids. In the latter, CE allows control of the carcinoid syndrome and regression or stabilization of the liver tumors in 80% of patients.

Adult↗
PubMed1993

Imaging and lung disease: uses and interpretation.

Diagnostic imaging has undergone a profound revolution since the first computed tomography (CT) unit was conceived in 1971; CT is now an integral part of daily practice in thoracic radiology, and has reached a relative technological maturity. Magnetic Resonance Imaging (MRI) has been introduced more recently. Technical difficulties still exist and are related to cardiac and respiratory motion. The storage-phosphor-based computed radiography system provides several advantages, including compensation for variations in exposure, but is still under evaluation especially in bedside radiography. Nevertheless careful plain film analysis still remains an important examination, and should be done before special procedures are taken to answer specific questions. Routine chest radiography is still the most frequent method of imaging employed today. Radiographic studies can suggest airway pathology such as atelectasis, endobronchial neoplasia or bronchiectasis, but CT provides a unique strategy for the localization and characterization of bronchial and pulmonary parenchymal disease. The most important role of CT is to determine, localize and characterize patterns within the pulmonary parenchyma, and correctly identify bronchiectasis even when bronchography is equivocal. In lung cancer, imaging has an important role in accurate staging with regard to the correct selection of patients and evaluation of prognosis. CT is one of the major tests used for staging. The staging system now adopted worldwide is based upon AJCC and ATS classification, and has two major components: anatomic extent of the disease (TNM) and cell types. The role of MRI with regard to lung cancer is not precisely determined. MRI can play a complementary role in the staging of lung cancer in cases of superior sulcus tumour; pericardial involvement, tumoral extension in subcarinal region and invasion of the superior vena cava. The radiologic detection of the solitary nodule is a difficult charge for the radiologist; CT provides the precise localization of the nodule and is reliable for analysing radiologic features such as calcification, cavitation, and spiculated borders. The problem remains of the discovery of an incidental benign pulmonary nodule in the patient with an extrathoracic malignancy, and often necessitates percutaneous biopsy under CT guidance. The evaluation of diffuse lung disease lies on pattern recognition. Chest radiography is the initial tool for diagnosis, high resolution CT (HRCT) can provide routine visualization of structures of less than 500 mu. HRCT can be useful in formulating a differential diagnosis with recognition of pattern and distribution of the disease.(ABSTRACT TRUNCATED AT 400 WORDS)

Bronchiectasis↗
PubMed1993

[Spontaneous unilateral adrenal gland hemorrhage and pregnancy].

Spontaneous unilateral haemorrhage of the adrenal gland during the third trimester of pregnancy is a rare event. The diagnosis may be suspected on the basis of echographic or MRI explorations. There is no sign of endocrine dysfunction. The pregnancy may be conducted to term when the diagnosis is probable but echographic monitoring shows the absence of further development. Only one analogous observation based on MRI diagnosis was found in the literature.

Adrenal Gland Diseases↗
PubMed1993

[Chylomediastinum after mediastinoscopy. Apropos of a case].

A mediastinal chylous effusion occurred in a young woman after a mediastinoscopy. This effusion healed rapidly with medical treatment. An understanding of the anatomy of these intra-thoracic/lymphatic channels explains that intra-thoracic chylous effusions may occur in case of incontinence of the lymphatic vessels which connect the tracheo-bronchial nodes to the thoracic duct in the mediastinum. This is very important following the surgical excision of a node because incontinent lymphatic vessels are directly sectioned. When the lymph nodes are biopsied in an enclosed cavity such as the mediastinum, the quantity of lymphoid tissue acts as an obstacle to reflux of the lymph which is thus less significant and more easily controlled.

Adolescent↗
PubMed1993

[Prognostic value of x-ray computed tomography in acute pancreatitis. Value of a new classification].

CT plays an important role in the screening of complications of acute hemorrhagic pancreatitis. There are three classifications at present, one based on a bioclinical score (Ranson) and the other two consisting of gradual stages of severity and resorting to CT imaging (Balthazar and Hill). The authors report about a study on 34 cases of acute pancreatitis, including 10 that became complicated, to which they applied a new classification including the existence of glandular necrosis, the number of extrapancreatic streaks, related to Ranson's bioclinical score. This classification makes it possible to classify acute pancreatitis into three stages: a mild stage with a favorable outcome, a medium stage requiring close surveillance, and stage 3 involving a high (75%) risk of severe complications.

Acute Disease↗
PubMed1993

[Single-stage resection of at least 6 liver segments in cases of liver tumors].

Seven partial liver resections of at least six hepatic segments (five extended left hepatectomies, also called left trisegmentectomies, and two subtotal hepatectomies) were performed for tumor (of malignant nature in 6 cases). Six of seven patients were admitted for liver transplantation and one for liver resection. These procedures were performed under total vascular exclusion of the liver in six cases (with a veno-venous bypass in two cases) and with the Pringle maneuver in one case. Postoperative liver function was satisfactory in six cases whereas one patient died of hepatic failure on the tenth postoperative day. There was one bile duct stricture at eight months, after extended left hepatectomy. Four patients survived more than one year, three with hepatic tumor recurrence and one with distant metastases. Two patients were still alive, one after fourteen months with tumor recurrence in the liver, the other after seventeen months. In selected cases, partial hepatic resection of more than six segments can be performed for very large tumors. In cases of malignant tumors, a short period of survival with good quality of life can be offered to these patients.

Adult↗
PubMed1993

[Value of techniques of measurement of bone. Radiological methods and contribution of ultrasonics].

The current interest in bone mineral density measurements is related to the frequency, the morbidity and the cost of osteoporosis, which is considered to be a public health problem in developed countries. The main risk factor of osteoporotic fractures is the reduction of bone mineral density. This risk factor can be prevented by hormonal therapy in post-menopausal women. So it is of interest to develop the bone mineral density measurement methods, in osteoporotic bone areas or the entire skeleton (absorptiometry). But the interpretation of the result in term of individual fracture risk, the choice of the bone site to be examined, and the indication of the measurement are still being discussed. A new method of bone status evaluation is currently available: the broad band ultrasonic attenuation, which measures the attenuation of ultrasounds through the calcaneus bone. The device is portable, inexpensive and radiation free, and may give quantitative and qualitative assessment of bone. However, the normal values, the relation with the absorptiometry results and the contribution of this method in fracture risk evaluation are currently studied. Osteoporosis risk evaluation is an important point of health management in post-menopausal women and elderly people. Large prospective studies with the different methods are in progress.

Absorptiometry, Photon↗
PubMed1992

[Magnetic resonance imaging of malignant hepatic tumors in adults].

Recently, magnetic resonance imaging (MRI) had an important place in imaging techniques of malignant primitive tumors of the liver. For many authors, this technique appears as the reference modality for hepatic tumor evaluation. Nevertheless, MRI is considered to be primarily a problem-solving rather than a screening modality. This specific goal of this technique is due to a more precise characterization of the lesions compared to other imaging modalities. The authors, according to recent data in literature and their own experience, present MRI findings of the more frequent malignant hepatic tumors encountered in adult.

Adenoma, Bile Duct↗
PubMed1992

[Role of MRI in the diagnosis of endocrine tumors of the pancreas].

Eight patients affected with endocrine tumor of the pancreas were examined, within the same period of time, by MRI and CT. Results from those two examinations were similar for the detection of the primary tumor (succeeding to visualize the lesion 5 times out of 8) and the evaluation of locoregional and vascular extension. No tumor smaller than 3 cm was diagnosed by MRI. Most of cases the pancreatic tumor appeared as hypointense in T1 and hyperintense in T2 sequences. MRI was a little more efficient than CT for the detection of liver metastases. MRI seems to be an interesting method for the follow-up of those patients needing a regular and prolonged surveillance after primary tumor ablation.

Adenoma, Islet Cell↗
PubMed1991

Preoperative computed tomography for transhiatal esophagectomy.

We report the results of a retrospective evaluation of preoperative chest computed tomography (CT) in 50 consecutive patients with esophageal carcinoma confirmed surgically. Forty patients underwent transhiatal esophagectomy without thoracotomy. In ten cases, blunt dissection of the esophageal carcinoma was impossible because of involvement of an adjacent organ. Transhiatal esophagectomy carries lower morbidity and mortality rates than the standard thoracotomy procedure, although long-term survival is considered to be the same with either method. The overall sensitivity of CT in detecting involvement of an adjacent organ, thus contraindicating the transhiatal procedure, was 90%, with an overall specificity of 92%. The positive predictive value was 75%, and the negative predictive value 89%. The negative predictive value of CT for tracheobronchial invasion, the main surgical risk in the transhiatal procedure, was 90%. A negative preoperative CT appears to be a reliable indicator for patients undergoing transhiatal esophagectomy.

Adenocarcinoma↗
PubMed1990

[Rectal stenosis. A rare complication of chronic salpingitis caused by an intrauterine device].

The authors describe one case of rectal stenosis complicating chronic salpingitis in a patient carrying an intrauterine device. This observation is peculiar in that the inflammatory fibrous reaction is very intense, spreading all over the pelvis and forming a pseudotumoral mass sheathing the rectum. The clinical signs were mainly digestive, including a rectal syndrome: cramplike pelvic pain before defecation, tenesmus, constipation, abdominal pain and induration of the anterior aspect of the rectum observed during the clinical examination. Radiological examinations (barium enema, ultrasound, CT) show a tissue mass within the pelvis, with considerable thickening of the rectal wall. Ultrasound-guided biopsy in the pelvis yielded only nonspecific inflammatory signs with dominant fibrosis. The diagnosis of rectal stenosis caused by chronic salpingitis complicating the presence of an IUD was made only during surgery.

Adult↗
PubMed1989

[Diagnosis of glucagonoma. Value of scanning, echography and arteriography. Apropos of 2 cases and a review of the literature].

The authors report two cases of glucagonoma, a rare endocrine tumor of the pancreas, and describe the data currently found in literature. Glucagonoma is a single and usually large tumor, which develops in the alpha cells of the islets of Langerhans and evolves slowly. The combination of characteristic skin lesions, diabetes and weight loss should lead to searching for hyperglucagonemia and for the pancreatic tumor. The diagnosis is usually made rather late, average evolution is five years before diagnosis when it is detected. Imaging, in particular ultrasound and computed tomography (CT), proves to be necessary for the positive diagnosis of glucagonoma as it localizes the pancreatic mass and plays a role in local assessment, thus providing guidance for surgery. The role of imaging is also fundamental for the detection of metastases, which are the only sign of malignancy as no criterion of benignity is found for this tumor.

Adenoma, Islet Cell↗
PubMed1989

[Echographic study of gallbladder contraction: normal and pathologic aspects. Apropos of 115 patients].

The gallbladder volume was measured on abdominal ultrasonography in 115 patients consisting of three population groups, before and after ingestion of a fatty meal and/or intravenous administration of cholecystokinin. The variation in volume, estimated as a percentage, was used to assess gallbladder contraction. The first group, consisting of 40 normal individuals without gallstones or impaired gallbladder or hepatic function, can be considered to constitute a control group. In this population, gallbladder contraction exceeded 50% in every case. The second group consisted of 40 cases of acute cholecystitis, including 30 cases with acute gallstones and 10 cases of stone-free acute cholecystitis proven surgically (7 cases) or by guided aspiration (3 cases). Gallbladder contraction was less than 15% in every case. Lastly, a third group of 35 patients with uncomplicated gallstones discovered on routine ultrasonography, demonstrated gallbladder contraction of between 10 and 85%. In this last group, 12 patients with vague gastrointestinal symptoms and gallbladder contraction less than 15% were operated: the histological results demonstrated severe lesions of chronic gallstone cholecystitis. The authors believe that absent or weak gallbladder contraction after endogenous stimulation is a supplementary sign to be taken into consideration in a context suggestive of the diagnosis of acute stone-free cholecystitis and to suggest, in the presence of gastrointestinal symptoms not directly related to the gallbladder, the hypothesis of chronic gallstone cholecystitis.

Acute Disease↗