Controlled trial of wireless capsule endoscopy versus push enteroscopy: control not yet perfect.
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Adult↗
Biomedical subjects
S Siles
Publications and source records attributed to S Siles.
Metaiodobenzylguanidine assessment of metastatic neuroblastoma: observer dependency and chemosensitivity evaluation. The SFOP Group.
BACKGROUND: In children over 1 year of age with metastatic neuroblastoma, clearance of metaiodobenzylguanidine (MIBG) skeletal uptake after four courses of induction chemotherapy is one of the most powerful prognostic factors. How subjective is quantification of MIBG uptake, and can earlier MIBG scintigraphy separate good and bad responders? PROCEDURE: The data from 47 patients who received uniform induction therapy were reviewed. A novel scoring system of MIBG update intensity was proposed. Initial, intermediate (after two courses), and final (after four courses) intensities were scored (0 to 21 points) independently by six different observers. The initial global score and the relative score (calculated by dividing the global score after two courses by the initial score) were compared to the final score. Good responders were those who scored 0 at final MIBG. RESULTS: Between two observers, the correlation coefficient for the global score was superior to 0.80, in nine of ten comparisons established between observers 1-5. The initial score did not predict the final score insofar as only nine of fourteen patients with low initial scores were good responders. The relative score also failed to predict outcome; only six of ten patients with favorable relative score (i.e., <20%), were good responders. CONCLUSIONS: This scoring system is reliable and may be used in multicentric trials. However, both initial and relative scores failed to predict final outcome. Thus, intermediate MIBG may be omitted during induction therapy assessment.
3-Iodobenzylguanidine↗
Analysis of the predictive value of clinical data in patients with suspected colonic disease.
OBJECTIVE: To develop guidelines for predicting colonic disease on the basis of clinical parameters. EXPERIMENTAL DESIGN: A prospective study of the clinical data prior to colonoscopy. On the basis of the endoscopic findings, the patients were divided into three diagnostic groups: absence of significant disease, significant benign disease and malignant disease. The patient population was divided randomly into two subgroups. The clinical data from one of them was used to build a database which, using Bayes' theorem, was compared with the variables from the other subgroup to predict the diagnosis for each patient. PATIENTS: A total of 336 patients (170 males and 166 females; mean age: 58 years; range: 15 to 87 years) were evaluated. RESULTS: When the endoscopic findings were grouped on the basis of their clinical importance, 211 patients (63%) belonged to the group without significant disease, 60 patients (18%) had significant benign disease and 65 (19%) presented a neoplastic disease. Of the 21 variables selected for use in the database, 6 showed statistically significant differences in terms of the absence or presence of malignant disease: age, absence of previous similar episodes, weight loss, rectal bleeding, lack of improvement and the presence of a mass on digital rectal examination. The predictive model differentiated patients with neoplasm from those without malignant disease, but was not capable of identifying differences among the latter. The model was useful for assessing the risk of malignant disease for each patient. CONCLUSIONS: The predictive model obtained is a useful tool for establishing the diagnosis and the priority in the performance of colonoscopy.
Adolescent↗
Acute transplant artery thrombosis induced by angiotensin-converting inhibitor in a patient with renovascular hypertension.
Acute renal failure due to angiotensin-converting enzyme inhibitors (ACEI) usually results from a marked fall in renal perfusion pressure in patients with renovascular disease. We report herein one case of acute kidney transplant artery thrombosis in a patient with renovascular hypertension. The thrombosis occurred immediately after a single dose of ACEI for evaluation of a renal transplant artery stenosis by renal scintigraphy. The dramatic fall of arterial pressure observed in our patient probably played an important role in the thrombosis. The risk of the administration of a single dose of ACEI coupled with renal scintigraphy in diagnosing renovascular hypertension is stressed.
Adult↗
Comparison by SPECT of renal scars after extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy.
Some renal calculi are borderline indications for either extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL). Our purpose was to quantify by single photon emission computed tomography (SPECT) the parenchymal lesions of these two procedures to make the choice easier. The SPECT study was done before and 30 days after the stone treatment. The scan was carried out 10 hours after injection of 99mTc-DMSA using a GE400 rotative gamma camera, which data were reconstructed in three planes. The local uptake and scar of the treated area were evaluated in 22 patients with symptomatic kidney stones without previous treatment or renal failure. Twelve patients (mean stone size 12 x 9 mm) were treated on a piezoelectric (EDAP LT-01) lithotripter (mean shock wave number 3420), and ten patients (mean stone size 24 x 17 mm) were treated by PCNL (32F Amplatz sheath in a lower calix). There were no complications, and the stone-free rate at day 30 was 50% in both groups. In the ESWL group, all of the kidneys demonstrated a loss of local uptake, whereas 7 of the 10 in the PCNL group did so. In the ESWL group, 4 of the 12 kidneys had a local loss exceeding 4% but only 2 of 10 kidneys in the PCNL group. There were 7 scars in the treated area in the ESWL group and 6 in the PCNL group. Extracorporeal lithotripsy does not seem to be a nontraumatic procedure for the kidney. For stones that would require several sessions of ESWL, the use of PCNL must be preferred.
Cicatrix↗
[Pulmonary perfusion tomoscintigraphy in pulmonary embolism. Preliminary study].
Tomoscintigraphy, a method developed over 10 years ago, is little used nowadays for the evaluation of suspected pulmonary embolism. The authors report the results of a preliminary study of 10 patients hospitalised for this condition. Tomoscintigraphy was normal in 2 cases and abnormal in 8 cases. Seven of these 8 patients underwent pulmonary angiography which confirmed the diagnosis of pulmonary embolism in 6 cases. The small number of patients, however, did not allow measurement of the sensitivity and specificity. Tomoscintigraphy, repeated at the 8th day and at the first month, provides an assessment of therapeutic efficacy. Some improvement is observed in all cases from the first control but the amount varies from one subject to another. At one month, 3 of the 6 patients undergoing control tomoscintigraphy had hypoperfusion sequellae. The simplicity of pulmonary tomoscintigraphy makes it a useful investigation for emergency diagnosis and follow-up pulmonary embolism.
Aged↗
[Esophageal pseudoachalasia related to a neoplasm].
Differential diagnosis between idiopathic achalasia and esophageal pseudoachalasia is difficult to perform. One hundred and forty-four consecutive patients with a clinical diagnosis of primary esophageal motor disorder have been evaluated for pneumatic dilatation of the cardias. Of them, 6 (4.1%) have been finally diagnosed of esophageal pseudoachalasia with carcinoma of the cardias, although in four cases more than one biopsy procedure was needed to establish the diagnosis. The clinical data--higher age, shorter clinical history and higher weight loss--, the higher pressure of the lower esophageal sphincter and the failure of the dilatation suggested the diagnosis, but were uncertain findings. Esophageal biopsy is the only objective method to obtain a definitive diagnosis and should be performed in every patient with an esophageal motor disorder evaluated for dilatation of the cardias and, if negative, it should be repeated when malignancy is suggested by available data.
Aged↗
Value of MRI and MIBG-I123 scintigraphy in the diagnosis of spinal bone marrow involvement in neuroblastoma in children.
The results of MRI and MIBG scintigraphy performed on the spine of 14 children with neuroblastoma are reported. In 6 cases of diffuse spinal bone marrow tumor infiltration, diagnosis is easier with MIBG scintigraphy than with MRI. In 5 cases, MRI detected hyposignal of the vertebral body without any spinal abnormality on MIBG scintigraphy. A discussion of the reasons for negative MIBG scintigraphy is presented and in these 5 cases, it is suggested that a lateral view of MIBG scintigraphy and HMDP-Tc99m scintigraphy may be performed, even vertebral body biopsy in order to assess bone marrow tumoral infiltration.
3-Iodobenzylguanidine↗
[Adult celiac disease and hepatopathy].
A retrospective study was performed in order to evaluate the prevalence of significant hepatic disease in patients with coeliac disease and its outcome after a gluten-free diet. Out of 46 patients with coeliac disease, 28 (60.87%) presented abnormal liver function test. These tests were normal after a gluten-free diet in 20 patients; one patient presented an acute B-virus hepatitis and in the remaining 7 patients a chronic liver disease was diagnosed (2 chronic persistent hepatitis, 1 chronic active hepatitis, 1 steatosis, 2 cirrhosis and 1 primary biliary cirrhosis). In conclusion, the high prevalence of significant hepatic disease in our patients with coeliac disease (15%) suggests an association between both disorders. Gluten-free diet does not modify the course of hepatic disease.
Adolescent↗
[Quantitative renal DMSA scintigraphy after extracorporeal lithotripsy].
This study reports the results of renal DMSA isotope scan before and after EDAP extracorporeal lithotripsy in 106 patients. An isotope scan was performed before lithotripsy and on the fourth day after lithotripsy and again on the 90th day when alterations were observed on the first post-lithotripsy scan. The assessment of any sequelae was based on the scale of colours of the spectrum, which revealed three types of modifications. The analysis of the results is divided into three periods according to the development in our lithotripsy technique: high firing rates had a success rate of only 40%, with renal scars on isotope scans in 2/3 of cases; low frequency firing rates had a 55% success rate and induced minor changes which were virtually always reversible; in contrast, low frequency firing rates during the 3rd period had a 60% success rate with scars on isotope scans in 1/3 of cases. These isotope scan modifications also depended on the site of the stone. In conclusion, lithotripsy definitely induces renal modifications. The renal parenchyma cannot remain indifferent to lithotripsy beyond a certain threshold. A homogeneous multicentre study with a common protocol is necessary to compare the various lithotriptors and to define cautious and coherent indications for each lithotriptor in the treatment of renal stones.
Humans↗
[Visual evoked potentials and attention processes in depression].
The study of the attention process during depression has been realized with the recording of visual evoked potential (VEP) by simple pattern reversal checkerboard and in sequences where a rare stimulus appears randomly, with or without task. The recordings obtained on fifty patients have been compared to the VEP obtained on fifteen reference subjects. The results indicate that some perturbations, characteristic of the depressive state, should happen at the both levels of attentional selection, early (P1 and N1 components) and late (P3 component). The responses of the depressive patients appear to reflect rather an intervention of automatic attention process.
Adult↗
[Value of various imaging technics in the diagnosis and follow-up of pulmonary metastases of thyroid cancer].
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Adult↗
[Contribution to the study of event-related potentials in depressed patients].
When we want to quantify an experimentation on an individual presenting behaviour troubles, the problem we are faced with is the relative inadequacy between the techniques that are used and the patient. The aim of this research is a study of the evolution of the differential analysis of power spectra and alteration in the repartition of VEP amplitudes on 18 depressed adults before and after antidepressive treatment. Control in healthy adult volunteers has been realised. The originality of the method used is in the analytical techniques and selected tests. It is difficult to state positively that VEP morphology represents a pertinent criterion in the study of the evolution of a depressed syndrome. But the results which are obtained show a similar evolution between VEP morphology and clinical criterion. This is in conformity with numerous present studies which consider VEP as a pertinent sign in a psychophysiological process.
Adult↗
An unexpected, benign cause of increased muscular uptake at bone scintigraphy.
Bone scintigraphy was performed in a healthy 30-year-old man because of post-traumatic heel pain. The scintigraphy displayed a bilateral increased uptake of 99mTc-MDP in the pectoral muscles and triceps brachii. Further extensive investigations including muscle biopsy were normal and excluded diagnoses such as polymyositis, myositis ossificans or amyloidosis. The abnormalities were in fact explained by physical exercise performed a few hours prior to the radionuclide scan. This was confirmed by the absence of these changes on a second bone scan performed 3 months later. This case shows that muscle exercise should be kept in mind as a cause of skeletal muscle uptake of bone-seeking agents, with the view to avoid unnecessary investigations.
Adult↗