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Biomedical subjects

V Vilgrain

Publications and source records attributed to V Vilgrain.

At least 73 records · Page 4Linked to original sources
PubMed1996

Peritoneal carcinomatosis in patients with digestive endocrine tumors.

BACKGROUND: Peritoneal carcinomatosis (PC) in patients with digestive endocrine tumors (DET) is considered rare but its prevalence is unknown. The objectives of this study were to assess the prevalence and prognostic implications of PC in patients with various types of DET. METHODS: One hundred and sixteen consecutive patients with DET seen over a 3-year period were studied. Fifty-nine had gastrinomas, 30 had carcinoid tumors, and 27 had other types of endocrine tumors, mainly nonfunctioning ones. Diagnosis of PC was based on clinical symptoms (ascites and König's syndrome), findings of computed tomography scans that were performed at least yearly, and pathologic confirmation of tumor nodules or positive cytology in the peritoneal fluid. Factors associated with PC were investigated and the influence of PC on patients' survival was assessed. RESULTS: PC was found in 11 patients (overall PC prevalence: 10%; with 27% in patients with carcinoid tumors, 11% in those with nongastrinoma pancreatic endocrine tumors, and 0% in patients with gastrinomas). Nine of 11 patients with PC also had liver metastases. PC was metachronous to detection of the primary tumor in 7 of 11 patients, occurring 54 months (range, 23-273 months) after the diagnosis. In addition to the nature of the primary tumor, a greatest dimension of more than 5 cm was associated with the presence of PC in two of three patients with pancreatic endocrine tumors. In patients with carcinoid tumors, an ileal primary tumor occurred more frequently in patients with PC (87.5%) than in those without PC (50%). Prevalence of liver and other metastases was not significantly increased in patients with PC. Although five patients died of their disease, no deaths were related to PC. Actuarial survival rates at 5 years were 64% and 84% in patients with and without PC, respectively (P = not significant), whereas they were 73% and 93% in patients with and without liver metastases, respectively (P < 0.02). CONCLUSIONS: PC is not a rare event in the course of DET, especially in patients with carcinoid tumors. It did not occur in the patient population with gastrinomas, which are less often malignant but may also differ from the other types of DET by several cell characteristics. In contrast to liver metastases, PC is not associated with a significant decrease in life expectancy.

Actuarial Analysis↗
PubMed1996

Transjugular intrahepatic portosystemic shunts: comparison with paracentesis in patients with cirrhosis and refractory ascites: a randomized trial. French Group of Clinicians and a Group of Biologists.

BACKGROUND/AIMS: Transjugular intrahepatic portosystemic shunts reduce portal pressure and can control ascites in patients with cirrhosis. We carried out a controlled study to evaluate this procedure for the management of refractory ascites in patients with cirrhosis and to clarify its mechanism of action. METHODS: Twenty-five patients with refractory ascites were included in the trial; 13 were randomly assigned to shunts and 12 to paracentesis. Four patients in each group were Child-Pugh class C and the others were class B. Follow-up ranged from 9 to 34 months. Hemodynamic values, liver and renal tests and neurohumoral factors were measured before and at 4 months after inclusion. RESULTS: Shunts were successfully placed in 10 out of 13 patients. At 4 months, ascites had improved in all class B patients in the shunt group and in none of the patients in the paracentesis group (p < 0.05); ascites did not improve in any of the class C patients in either of the groups. At 2 years, the overall survival rate was 29 +/- 13% (mean +/- SE) in the shunt group and 56 +/- 17% in the paracentesis group (p < 0.05). In class B patients, there was no significant difference in mortality. At 4 months, portal pressure was significantly lower than before the shunt, while plasma levels of atrial natriuretic peptide were significantly higher and plasma levels of renin and norepinephrine significantly lower. CONCLUSIONS: In this trial, intrahepatic shunts were effective on refractory ascites in patients with cirrhosis. However, the overall survival rate was lower in shunted patients than in those treated with paracentesis. The efficacy of intrahepatic shunts on ascites was only observed in class B patients. Survival did not improve in class B patients, and decreased in class C patients compared to paracentesis. The efficacy of shunts on ascites might be due to neurohumoral factors which control natriuresis and depend on hepatic sinusoidal pressure.

Ascites↗
PubMed1996

Prospective evaluation of endoscopic ultrasonography and microscopic examination of duodenal bile in the diagnosis of cholecystolithiasis in 45 patients with normal conventional ultrasonography.

The aim of this study was to prospectively evaluate endoscopic ultrasonography and microscopic examination of duodenal bile in the diagnosis of cholecystolithiasis not detected by conventional ultrasonography. Forty five consecutive patients (26 females, 19 males, mean age: 50 years) with suspected cholecystolithiasis and at least two normal transcutaneous ultrasonography examinations were included. Endoscopic ultrasonographic criteria for the diagnosis of cholecystolithiasis were the presence of stones with or without acoustic shadowing or sludge. Criteria of microscopic examination of bile were cholesterol or bilirubinate crystals or spheroliths. Thirty three patients underwent cholecystectomy and lithiasis was found in gall bladder bile in 24. Twelve patients who were not operated on and were followed up (median: 17 months), had no evidence of cholecystolithiasis. Endoscopic ultrasonography and duodenal bile examination were 96% and 67% sensitive, respectively (p < 0.03). The specificity was not different (86 and 91%, respectively). None of the 16 patients with negative results in both procedures had evidence of cholecystolithiasis. It was found that for the diagnosis of cholecystolithiasis in patients with normal conventional ultrasonography, the sensitivity of endoscopic ultrasonography is higher than that of microscopic examination of duodenal bile. If endoscopic ultrasonography and microscopic examination of duodenal bile are negative, the risk of underdiagnosing cholecystolithiasis is negligible.

Adult↗
PubMed1996

Calcification in focal nodular hyperplasia: a new problem for differentiation from fibrolamellar hepatocellular carcinoma.

PURPOSE: To describe calcification in focal nodular hyperplasia (FNH) of the liver, which poses a new problem for the differentiation of FNH from fibrolamellar hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Ultrasound, computed tomography, and magnetic resonance imaging findings of 357 FNH lesions diagnosed in the past 5 years in 295 patients (274 female, 21 male; aged 14-72 years) were retrospectively reviewed with emphasis on intralesional calcification. RESULTS: Calcifications were seen in five FNH lesions (1.4%) as small, solitary spots located centrally or peripherally within the lesions. Morphologic features of these calcifications were similar to those of calcifications in two of six fibrolamellar HCCs in the same period. CONCLUSION: Calcification in FNH is a rare and atypical finding that poses further difficulty for differentiation from fibrolamellar HCC.

Adult↗
PubMed1996

[Imaging of ciliated hepatic or biliary cysts. 4 cases].

Four patients with ciliated hepatic cysts, a rare and benign lesion, were examined between 1990 and 1994. Imaging features were compared to 12 previous cases. All lesions were revealed by US, and were hypoechoic in 3 cases, and anechoic in 1 case. All lesions were less than to 4 cm in diameter, and were well-defined, unilocular, isolated, and located in subcapsular areas, usually in the medial segment of the left lobe of the liver (3 cases). In one case, the cyst was found in the gallbladder wall. The lesions were low density on pre- and post-contrast CT scan (performed in 2 cases), strongly hyperintense on T2-weighted MR images (2 cases), and had a variable signal intensity on T1-weighted MR images. One patient underwent percutaneous guided biopsy but no diagnosis was obtained. None of the patients had preoperative diagnosis and all underwent surgery. Diagnosis was confirmed by histopathologic examination of the resected specimen. Ciliated hepatic cysts may be suspected in this study and in the literature. Diagnostic criteria are as follows: hypoechogenic mass less than 4 cm in diameter, located in the subcapsular area of the medial segment of the left lobe of the liver.

Adult↗
PubMed1996

[Imaging of peripheral cholangiocarcinoma. Comparison with pathological anatomy].

OBJECTIVE: Peripheral cholangiocarcinoma is a rare malignant intrahepatic tumor which originates in the distal bile duct. Our purpose was to identify the imaging characteristics of peripheral cholangiocarcinoma and to establish a correlation with surgical and histopathologic findings. METHODS AND MATERIALS: The imaging data of 16 patients with proven cholangiocarcinoma were retrospectively reviewed by sonography in 13 cases, computed tomography in 13 cases, magnetic resonance imaging in 6 cases, and angiography in 10 cases and correlated with surgical and histopathologic findings. RESULTS: In most cases peripheral cholangiocarcinoma appeared as a single, large (> 10 cm), heterogeneous, and non encapsulated mass. On precontrast computed tomography, the lesions were mostly low density. Enhancement was moderate in the bolus phase and increased in the delayed scan. With magnetic resonance imaging, lesion signals were low intensity in T1-weighted images and variable intensity in T2-weighted images. On angiogram, lesions were often hypovascular. Associated features were frequently observed: portal encasement (69%), lobar atrophy or capsular retraction (43%), dilated intrahepatic bile ducts (30%), extension into the hepatic capsule (23%), and inferior vena cava extension (15%). Radiopathologic comparison showed that imaging modalities accurately identified vascular encasement, but underestimated extrahepatic tumor extension. CONCLUSION: In most cases, peripheral cholangiocarcinoma has a typical appearance which may be helpful in differentiating this disease from other intrahepatic tumors.

Adult↗
PubMed1996

[A rare cause of obstructive jaundice: peripancreatic pseudoaneurysm].

We report the case of a 54-year-old-man with alcoholic calcified chronic pancreatitis complicated by jaundice and abdominal pain. Investigations (Doppler ultrasonography examination and computed tomography scan) showed peripancreatic pseudoaneurysm of the posterior and inferior pancreatico-duodenal artery and a dilatation of the common bile duct. Selective embolization of the pseudoaneurysm resulted in rapid regression of both jaundice and abdominal pain. Common bile diet compression is a rare complication of peripancreatic pseudoaneurysm. Selective embolization seems to be the first line treatment in this indication.

Aneurysm, False↗
PubMed1996

[Hepatic angiomyolipoma simulating hepatocytic tumor. 3 cases].

Hepatic angiomyolipoma is a rare, benign, mesenchymal tumor. We report 3 cases of atypical angiomyolipomas simulating benign hepatic tumors in 3 women free of tuberous sclerosis (Bourneville's disease). Hepatic angiomyolipomas were solitary in 2 cases and multiple in one. At imaging, the 6 lesions were large (7 cm in mean diameter), mainly hypoechoic and heterogeneous. At CT, lesions did not contain fat and were hypervascular. At MR imaging, lesions were hypointense in 4 cases and isointense in one case on T1-weighted sequences, hyperintense and isointense on T2-weighted sequences in four and in one case respectively. Percutaneous biopsy, performed in 2 cases, did not provide a correct diagnosis. Histopathologic examination of the resected specimen showed angiomyolipomas with very low or lacking fat in all 3 patients. All lesions were positive with the HMB-45 antibody. In conclusion, hepatic angiomyolipoma with a low fat component may mimic other hepatic tumors. Diagnosis may be improved by using HMB-45 reactivity on the biopsy specimen.

Adenoma, Liver Cell↗
PubMed1995

Preoperative cyst fluid analysis is useful for the differential diagnosis of cystic lesions of the pancreas.

BACKGROUND/AIMS: It has been suggested that activity of pancreatic enzymes and concentrations of tumoral markers in cyst fluid may help to distinguish pseudocyst, serous, and mucinous cystadenomas. The aim of this study was to prospectively assess the reliability of preoperative biochemical and tumor marker analysis in cyst fluids obtained by fine-needle aspiration for pathological diagnosis. METHODS: Cyst fluid was obtained preoperatively by fine-needle aspiration, and biochemical and tumoral marker values were measured. The diagnosis of cystic tumors (7 serous cystadenomas and 12 mucinous tumors) was established by surgical specimen analysis. Thirty-one pancreatic pseudocysts complicating well-documented chronic pancreatitis were also studied. RESULTS: Carbohydrate antigen 19.9 levels of > 50,000 U/mL had a 75% sensitivity and a 90% specificity for distinguishing mucinous tumors from other cystic lesions. Carcinoembryonic antigen levels of < 5 ng/mL had a 100% sensitivity and an 86% specificity for distinguishing serous cystadenomas from other cystic lesions. Amylase levels of > 5000 U/mL had a 94% sensitivity and a 74% specificity for distinguishing pseudocysts from other cystic lesions. CONCLUSIONS: High carbohydrate antigen 19.9, low carcinoembryonic antigen, and high amylase levels in cyst fluid are very indicative of mucinous tumors, serous cystadenomas, and pseudocysts, respectively.

Amylases↗
PubMed1995

[Hemoperitoneum caused by spontaneous rupture of hepatocellular carcinoma. Value and prognostic factors of hepatic artery embolization].

To assess efficiency and to determine prognostic factors in emergency embolization for intraperitoneal hemorrhage from hepatocellular carcinoma we retrospectively analyzed 12 consecutive procedures. In order to evaluate the extension of tumor thrombus in the intrahepatic portal system before embolization, a portal perfusion rate was defined as the relative patency of the segmental portal veins demonstrated at arteriography. Serum bilirubin level and portal perfusion rate were correlated with length of survival. Successful hemostasis was achieved in all patients. Mean length of survival was 149 days. Two patients are still alive 545 and 195 days, respectively, after the procedure. A significant correlation (p = 0.005) between portal perfusion rate and length of survival was obtained. There was no correlation between serum bilirubin level and prognosis. Emergency embolization is an effective treatment in patients with intraperitoneal hemorrhage from hepatocellular carcinoma. Prognosis depends of portal perfusion rate.

Aged↗
PubMed1995

[Diagnosis of cystadenomas and cystadenocarcinomas of the pancreas. Study of 35 cases].

OBJECTIVES: The aims of this study were to assess the circumstances of diagnosis and accuracy of imaging procedures in patients with cystic pancreatic tumours. METHODS: Thirty-five consecutive patients with cystic pancreatic tumours (serous cystadenomas: n = 19, mucinous cystadenomas: n = 9, cystadenocarcinomas: n = 7) were studied from 1988 to 1993. Respective diagnostic values of ultrasonography, endoscopic ultrasonography, CT scan and analysis of cyst fluid were evaluated. RESULTS: The circumstances of diagnosis were abdominal pain (74%), weight loss (23%), jaundice (8%), abdominal mass (6%), asymptomatic (6%). Initial diagnosis of cystadenoma was correctly made by ultrasonography, CT scan and endoscopic ultrasonography in 63%, 77% and 84%, and the type of cystadenoma was correctly diagnosed in 20%, 51% and 55%. A pseudocyst was falsely diagnosed in 28%, 12% and 3%, respectively. After blind review of CT scans and endoscopic ultrasonography records, the type of cystadenoma was correctly diagnosed in 82% by both procedures. Cytological examination of cyst fluid of 18 cystic tumours gave correct diagnosis in 10 cases with sufficient material. A low CEA (P < 0.002), Ca 19.9 (P < 0.003) and absence of mucins (P < 0.002) in cyst fluid was evocative of serous cystadenoma. CONCLUSIONS: Abdominal pain was the main circumstance of diagnosis in cases of pancreatic cystadenomas. The type of cystadenoma was correctly diagnosed in 82% by CT scan and endoscopic ultrasonography. Cytological examination, tumoural marker and mucin levels in cyst fluid were helpful for an accurate diagnosis of cystic tumours.

Adult↗
PubMed1994

The changing scene of hepatic vein thrombosis: recognition of asymptomatic cases.

BACKGROUND/AIMS: Hepatic vein thrombosis is thought to be manifested by ascites, abdominal pain, and hepatomegaly, with a uniformly poor prognosis. However, new imaging techniques allow for the diagnosis of hepatic vein thrombosis in asymptomatic cases. The aim of our study was to re-evaluate symptoms and prognosis in patients with hepatic vein thrombosis. METHODS: Eighty-one patients with hepatic vein thrombosis were analyzed. Forty-seven patients were admitted from 1970 to June 1987 (group I, before Doppler ultrasonography and magnetic resonance imaging were introduced at our hospital) and 34 from July 1987 to June 1991 (group II). RESULTS: When comparing the two groups, age, sex ratio, and causes of hepatic vein thrombosis did not differ. Eight group II patients (asymptomatic patients) had no ascites, hepatomegaly, or abdominal pain. One major hepatic vein remained patent in 41% of group II patients, compared with 12% in group I (P < 0.05). Intrahepatic collaterals were seen in 79% of group II patients, compared with 21% of group I patients (P < 0.01). All asymptomatic patients had large intrahepatic and portasystemic collaterals. At 3 years, death occurred in 22% of group II patients and in 45% of group I patients. No asymptomatic patient died. CONCLUSIONS: Asymptomatic hepatic vein thrombosis is associated with the spontaneous development of large intrahepatic and portosystemic collaterals. In asymptomatic patients, prognosis at 3 years seems to be good, and surgical therapy may not be required.

Adult↗
PubMed1994

Diagnosis of choledocholithiasis by endoscopic ultrasonography.

BACKGROUND/AIMS: Endoscopic ultrasonography is a promising procedure for the diagnosis of extrahepatic cholestasis. Accuracy for the diagnosis of choledocholithiasis by ultrasonography and computed tomography were prospectively compared with endoscopic ultrasonography in 62 consecutive patients. METHODS: Final diagnosis was determined by endoscopic retrograde cholangiography with or without sphincterotomy or intraoperative cholangiography with or without choledochoscopy. All of the patients had abdominal ultrasonography, computed tomography, endoscopic ultrasonography, and either an endoscopic retrograde (n = 40) or intraoperative cholangiography (n = 32) performed. RESULTS: Choledocholithiasis was confirmed in 22 patients. Thirteen patients had a stone with a diameter < 1 cm, and 14 had a nonenlarged common bile duct. Endoscopic ultrasonography was more sensitive (97%) than ultrasonography (25%; P < 0.0001) and computed tomography (75%; P < 0.02). Specificity and positive predictive value were not significantly different. Negative predictive value of endoscopic ultrasonography (97%) was better than that of ultrasonography (56%; P < 0.0001) and computed tomography (78%; P < 0.02). Results were unchanged after six patients in whom the absence of choledocholithiasis was considered probable after follow-up were excluded. Endoscopic ultrasonography results did not depend on stone diameter or common bile duct dilatation. CONCLUSIONS: Endoscopic ultrasonography appears to be the best diagnostic tool for the diagnosis of choledocholithiasis compared with other noninvasive procedures.

Adult↗
PubMed1994

Adenomatous hyperplasia of the liver in a patient with congenital hepatic fibrosis.

We report the case of a 30-year-old man suffering from congenital hepatic fibrosis, who was treated at age 12 by splenorenal shunt for portal hypertension, and who developed numerous, large hepatic nodules. The patient underwent liver transplantation because of recurrent episodes of acute cholangitis and the presence of foci of dysplasia in the nodules. Histological examination of the surgical specimen showed adenomatous hyperplastic nodules with a few atypical foci in an otherwise fibrous but non-cirrhotic liver. Such lesions have not yet been described in congenital hepatic fibrosis. The respective roles of congenital hepatic fibrosis and splenorenal shunts in the development of these nodules are discussed.

Adult↗
PubMed1994

Biliary obstruction resulting from Strongyloides stercoralis infection. Report of a case.

Hepatobiliary manifestations of strongyloidiasis are rare. A case is described of biliary obstruction associated with the presence of Strongyloides stercoralis in the duodenal mucosa and 250 microns rhabditiform larvae in bile. Biliary obstruction resulted from papillary stenosis, which resolved after treatment with thiabendazole. It is proposed that papillary stenosis may be responsible for obstructive jaundice associated with Strongyloides stercoralis infection, and that strongyloidiasis should be added to the causes of papillary stenosis.

Adult↗