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V Vilgrain

Publications and source records attributed to V Vilgrain.

At least 91 records · Page 5Linked to original sources
PubMed1994

Hepatic adenoma: MR findings in 51 pathologically proved lesions.

PURPOSE: To describe the magnetic resonance (MR) imaging features of hepatic adenoma and correlate these findings with histopathologic findings. MATERIALS AND METHODS: MR findings of 51 pathologically proved hepatic adenomas in 29 consecutive patients were retrospectively analyzed. T1- and T2-weighted spin-echo (SE) images were obtained in all patients, and contrast material-enhanced MR images were obtained in 16 patients. RESULTS: At pathologic analysis, a peripheral rim, observed in 16 (31%) hepatic adenomas, corresponded to pseudocapsule, and tumor heterogeneity, observed in 26 (51%) lesions, corresponded to hemorrhagic necrosis and peliosis. Hyperintensity on T1-weighted SE images was observed in 30 (59%) adenomas; 10 (67%) of 15 hepatic adenomas were hyperintense on contrast-enhanced gradient-echo images, and 13 (45%) of 29 were hyperintense on delayed contrast-enhanced T1-weighted SE images. CONCLUSION: Presence of a peripheral rim, heterogeneity, and hyperintensity are common features of hepatic adenoma.

Adenoma↗
PubMed1994

Budd-Chiari syndrome with extensive portal thrombosis: treatment with Senning's procedure.

A patient with Budd-Chiari syndrome and associated extensive portal thrombosis, precluding any kind of portosystemic shunt, was treated with Senning's procedure. This technique, which includes dorsocranial hepatic resection and direct hepatoatrial anastomosis under total vascular exclusion of the liver, resulted in prompt recovery from acute hepatic failure and esophageal bleeding. Peroperatively, the hemodynamic status was secured with a venous cavo-caval bypass. This observation suggests that Senning's procedure is strongly indicated in the case of Budd-Chiari syndrome with extensive portal thrombosis.

Adult↗
PubMed1994

[Cystadenoma of the liver. Clinical, radiological and anatomopathological study of 5 cases, one associated with cystadenocarcinoma].

We describe the clinical, radiological and pathological features of 5 cases of cystadenoma, one associated with cystadenocarcinoma. In 3 of these patients, the presence of thick wall, endoluminal buds and septations at imaging investigations was suggestive of the diagnosis of cystadenoma or cystadenocarcinoma. In 2 of these patients, these imaging features were lacking. In 2 of these patients, partial surgical resection was performed and was followed by recurrence of the tumor. In all cases, the diagnosis was confirmed by pathology examination of the resection specimen. In conclusion, this study shows that diagnosis of cystadenoma or cystadenocarcinoma may be very difficult because of the absence of suggestive imaging features in some cases, and confirms that complete resection of the tumor, allowing pathology confirmation, is needed for the optimal treatment of cystadenoma or cystadenocarcinoma.

Adult↗
PubMed1993

Resection of presumed benign liver tumours.

UNLABELLED: The surgical treatment of benign liver tumours (focal nodular hyperplasia (FNH) and hepatic adenoma) remains controversial. From 1984 to 1990, all 51 women aged below 50 years who presented with presumed benign liver tumours and without chronic liver disease underwent tumour resection. Preoperative assessment included liver tests, ultrasonography and dynamic computed tomography in all patients, plus angiography (n = 20), magnetic resonance imaging (n = 22) and technetium-sulphur colloid liver scintigraphy (n = 19). The aims of this study were to compare preoperative and final pathological diagnosis and determine whether surgical treatment was justified. Preoperative assessment suggested FNH in 18 patients and hepatic adenoma in 11. In 22 patients, the distinction between FNH and adenoma could not be determined before operation. Operative procedures included resection of one segment or less in 22 patients, two segments in 14 and three or more segments in 15. There was no postoperative death and no serious complication. The final diagnosis after pathological examination of resected specimens was FNH in 36 patients (71 per cent), including the 18 presumed before operation to have FNH, hepatic adenoma in 12 (24 per cent) and malignant lesions in three (6 per cent): hepatocellular carcinoma (HCC) arising in normal liver, fibrolamellar carcinoma, and adenoma containing areas of HCC in one patient each. IN CONCLUSION: (1) precise preoperative diagnosis of benign liver tumours remains difficult despite new imaging methods; (2) malignant liver tumours can go unrecognized; and (3) resection of all these lesions can be carried out safely. Resection of presumed benign liver tumours should be performed in young women when a preoperative diagnosis of FNH is not firmly established.

Adenoma↗
PubMed1993

MR imaging in intracystic hemorrhage of simple hepatic cysts.

Intracystic hemorrhage of simple hepatic cysts is one of the most frequent complications. Ultrasonography (US) and computed tomography (CT) may show abnormal findings and mimic other diseases. We describe magnetic resonance (MR) imaging in four patients with intracystic hemorrhage confirmed by surgery or percutaneous aspiration. In all cases the lesions were hyperintense on both T1- and T2-weighted sequences. In three of the four cases the signal was heterogeneous on T1-weighted sequences. Two cases of a thickened wall and one case of a fluid-fluid level were also observed. We suggest that MR imaging may be helpful to differentiate intracystic hemorrhage from other cystic lesions by showing high signal on T1- and T2-weighted sequences.

Aged↗
PubMed1993

Endoscopic ultrasonography in the diagnosis and staging of pancreatic adenocarcinoma. Results of a prospective study with comparison to ultrasonography and CT scan.

Endoscopic ultrasonography (EUS) was compared to ultrasonography (US) and CT scan (CT) in order to evaluate its role in the diagnosis and the locoregional spread assessment of pancreatic cancer. Sixty-four patients suspected of pancreatic cancer were studied prospectively, and the results of imaging techniques were compared to histology and surgical exploration. There were 49 cases of pancreatic adenocarcinoma, 11 of pancreatitis, 2 of common bile duct carcinoma, 1 lymphoma and 1 hepatocellular carcinoma with peripancreatic metastatic lymph nodes. EUS was significantly more accurate (91%) than CT (66%) and US (64%) for diagnosis of pancreatic cancer. EUS was able to image all 7 cancers less than 25 mm in diameter, US and CT only one. There were 4 false positives with EUS which were all cases of pseudotumorous pancreatitis. For detecting lymph node involvement, EUS was significantly more sensitive (62%) and accurate (74%) than US (8% and 37%) and CT (19% and 42%), respectively. Invaded lymph nodes adjacent to large tumors and micrometastatic involvement were responsible for this lack of sensitivity. EUS was significantly more sensitive (100%) than CT (71%) and US (17%) for detecting venous involvement. The specificity of EUS was lower (67%) because of duodenal bulb stenosis and large tumors. In conclusion, this prospective and comparative study confirms that EUS is an accurate tool for diagnosis and locoregional spread assessment of pancreatic cancer when performed in a reference center. EUS is of particular interest for small tumours. However, EUS does not enable differentiation of pseudotumorous pancreatitis from adenocarcinoma.

Adenocarcinoma↗
PubMed1993

Drainage after elective hepatic resection. A randomized trial.

OBJECTIVE: This prospective randomized study determined the influence of closed-suction drainage on the incidence of postoperative complications after elective hepatic resection. SUMMARY BACKGROUND DATA: Routine drainage is no longer advocated after several intra-abdominal surgical procedures. METHODS: A series of 81 patients who underwent elective hepatic resection were randomly allocated to either a nondrainage group (n = 39) and a drainage group with closed-suction drainage (n = 42). Indications for resection were 42 benign lesions and 39 malignant tumors, including 19 with cirrhosis. Major hepatic resection was performed in 25 patients and minor resection, in 56. All patients underwent ultrasonography with puncture for bacteriologic cultures of all fluid collections within the first 5 postoperative days. RESULTS: One patient died in each group. Ultrasonography found a significantly higher rate of subphrenic collections in the drainage group compared with the nondrainage group (respectively, 36% vs. 15%, p < 0.05). These collections were more frequently infected in the drainage group (n = 6) than in the nondrainage group (n = 2). After major liver resection, the rate of intra-abdominal postoperative complications (i.e., subphrenic fluid collections, hematomas, and bilomas) was similar between the two groups. CONCLUSIONS: Minor liver resection is safer without drainage. Major liver resection can be performed with or without abdominal drainage.

Adult↗
PubMed1993

[Endoscopic drainage of pseudocysts of the pancreas. Study of 26 cases].

Endoscopic drainage of pancreatic pseudocysts has been proposed for several years as an alternative to surgical treatment. We report the results of 26 endoscopic cystostomies of pancreatic pseudocysts (13 cystoduodenostomies, 13 cystogastrostomies) performed in two specialized centres, from 1985 to 1991. The patients were divided into 3 groups (I, II, III) according to the pseudocysts' clinical presentation. The opening of the collection into digestive lumen was achieved in 22 cases; there were 3 puncture failures and 1 cystostomy was not performed because of a prior haemorrhagic puncture. Pain relief was obtained rapidly after cystodigestive drainage in 13 out of the 14 symptomatic patients. Three complications required surgery: 1 bleeding after cystoduodenostomy, 1 perforation and 1 peritonitis after cystogastrostomies. Two of them occurred after recutting a cystostomy. Two pseudocyst surinfections healed with antibiotic therapy. No deaths occurred due to the procedure. Among the 18 long-term followed-up patients (average = 33 months), 4 required surgery for persistence or relapse of pseudocysts. The results were excellent for the 14 other patients without any difference between cystoduodenostomies and cystogastrostomies, neither between the I, II and III groups. Each of the 5 cases with a digestive lumen-pseudocyst cavity thickness above 1 cm (measured on 20 CT scans) failed: 1 puncture failure, 3 complications, 1 relapse.

Adult↗
PubMed1992

Focal nodular hyperplasia of the liver: MR imaging and pathologic correlation in 37 patients.

Thirty-seven patients with 48 lesions of focal nodular hyperplasia (FNH) underwent preoperative magnetic resonance (MR) examination and surgical resection. Sixteen lesions were imaged at 0.5 T with T1- and T2-weighted spin-echo sequences; 32 lesions were imaged at 2 T with T1-and T2-weighted spin-echo and gradient-recalled-echo sequences. Contrast material-enhanced MR imaging was performed in 20 lesions. MR imaging failed to depict six tumors that were less than 3 cm in diameter. Typical appearance was present in 18 of the 42 (43%) lesions seen at MR. Atypical lesion features included no scar (n = 15), hypointense scar on T2-weighted images (n = 7), pseudocapsule (n = 6), strong hyperintense lesion on T2-weighted images (n = 3), diffuse hyperintensity on T1-weighted images (n = 3), and heterogeneous lesion (n = 1). Comparison between findings at MR imaging and at histopathologic examination was performed in 38 lesions: There was good correlation between presence and size of the scar on both examinations. In 13 of 20 (65%) of the hyperintense scars on T2-weighted images, edema was prominent, whereas in five of the seven (71%) hypointense scars on T2-weighted images, edema was absent or low.

Adult↗
PubMed1992

US-guided percutaneous liver biopsy with plugging of the needle track: a prospective study in 72 high-risk patients.

The efficiency, accuracy, and safety of ultrasound-guided liver biopsy with plugging of the needle track were prospectively assessed in 72 patients at high risk for hemorrhage. Seventy-eight biopsy procedures were performed in 72 consecutive patients prospectively classified into four different groups on the basis of coagulation parameters. Sixty-two patients (86%) had severe or moderately severe coagulation disorders. Fifty-four biopsy procedures were performed in 50 patients with diffuse liver disease, and 24 were performed in 24 patients with focal liver lesions. The biopsy track was embolized with gelatin particles and thrombin. Biopsy specimens adequate for histologic diagnosis were obtained in 69 of the 72 patients (96%). In focal lesions, accuracy and sensitivity in the diagnosis of malignancy were 75% and 89%, respectively. Two serious bleeding complications (2.8%) were encountered in two of the patients with major coagulation disorders. Liver biopsy with plugging of the needle track is a practical technique and is a feasible alternative to the transjugular approach. Respective indications for both methods depend on the severity of coagulation disorders and the presence of focal lesions.

Adult↗
PubMed1992

[Prospective comparison between a clinical and biological score and ultrasonography for the diagnosis of benign or malignant hepatic lesions].

The purpose of this study was to compare ultrasound with a clinical and biological score to differentiate benign and malignant liver lesions. The study was carried out prospectively in 100 consecutive patients with liver masses of unknown origin. The accuracy of ultrasound and the score was 84% and 76%, respectively (P = 0.02). Ultrasound and the score gave the same results for the diagnosis of hepatic lesions in 68% of cases. When both ultrasound and the score were in agreement, the prediction of malignancy was 94% ant that of benignity was 100% accurate. Although ultrasound was superior to the score in this series, it is interesting to calculate the score because of the higher predictive values when both methods are associated.

Adult↗
PubMed1991

Diagnosis of abdominal venous thrombosis by means of spin-echo and gradient-echo MR imaging: analysis with receiver operating characteristic curves.

The authors compared the accuracy of spin-echo (SE) and gradient-echo (GRE) magnetic resonance images in diagnosis of abdominal venous thrombosis. Images of 292 abdominal veins in 72 patients were reviewed in a blinded manner by three radiologists, with seven levels of confidence for diagnosis. Corroborative studies proved thrombosis (n = 95) and vessel patency (n = 197). Receiver operating characteristic (ROC) curves were constructed for SE images alone, GRE images alone, and SE and GRE images combined. At specificities of 90% and 95%, thrombi were identified with sensitivities, respectively, of 76% and 63% with SE images, 74% and 58% with GRE images, and 88% and 82% with combined SE and GRE images. The area under the ROC curve for SE and GRE images combined (0.958 +/- 0.011 [standard deviation]) was significantly larger (P less than .001) than that for SE images alone (0.913 +/- 0.018) and GRE images alone (0.921 +/- 0.016). It is concluded that combination of SE and GRE images significantly increases the accuracy of diagnosis of abdominal venous thrombosis.

Abdomen↗
PubMed1991

[Value of computed tomography and celiomesenteric angiography in assessing vascular involvement in cancer of the exocrine pancreas. Apropos of 31 cases].

The prediction of vascular involvement by computed tomography (CT) with intravenous bolus contrast medium enhancement was compared to that of angiography in 31 patients with pancreatic carcinoma. CT was performed in 29 patients, angiography in 18 patients, while 16 had both investigations. Results of both radiological investigations were reviewed and compared with surgical findings. Sensitivity and specificity of CT was 88 and 100 percent respectively. Sensitivity and specificity of angiography was 57 and 100 percent respectively. The four false-negative results of CT concerned the superior mesenteric and portal veins. The ten false-negative results of angiography concerned the superior mesenteric and portal veins in four cases, and the celiac and superior mesenteric arteries in six cases. Comparison of results of CT and angiography revealed that the two methods concurred in 12 patients, five without and seven with vascular involvement. In three other cases, CT detected more abnormal vessels than angiography. In another case, only CT demonstrated nonresectability. In conclusion, CT with enhancement seems to be more accurate than angiography in the prediction of vascular involvement of pancreatic carcinoma.

Adenocarcinoma↗
PubMed1990

Comparison between ultrasonographic signs and the degree of portal hypertension in patients with cirrhosis.

The sensitivity of ultrasonography (US) for the diagnosis of portal hypertension was assessed in 48 patients with known cirrhosis. These results were compared to the hemodynamic values obtained on the same day by hepatic vein catheterization. The sensitivity of US in detecting portal hypertension was about 40% considering either a greater than 13 mm diameter of the portal vein, or the lack of mild caliber variation of the superior mesenteric vein. The sensitivity was more than 80% considering the presence of portosystemic venous collaterals. Presence of numerous portosystemic shunts was significantly associated with high hepatic venous pressure gradients which reflected the severity of portal hypertension.

Female↗
PubMed1990

Cholangiographic appearance simulating sclerosing cholangitis in metastatic adenocarcinoma of the liver.

Three patients with liver metastases and clinical and biochemical signs of cholestasis are reported in this study. In the three patients, cholangiography showed shifted and stretched intrahepatic bile ducts and multifocal strictures simulating intrahepatic primary sclerosing cholangitis. In two patients, histological examination showed periductal fibrosis or inflammation. Hepatic metastases should be included among the conditions considered to simulate intrahepatic primary sclerosing cholangitis during cholangiography.

Adenocarcinoma↗