[show abstract][hide abstract] ABSTRACT: Objectifs
L’objectif de cette étude a été d’analyser rétrospectivement l’efficacité et la morbidité de l’embolisation artérielle splénique pour hypersplénisme par hypertension portale (HTP), en fonction du volume de parenchyme splénique embolisé et de la nature de l’hypertension portale (HTP par bloc intrahépatique vs HTP segmentaire).
Patients et méthodes
Dix-sept patients ayant un hypersplénisme secondaire à une HTP (bloc intrahépatique, n = 14 ; HTP segmentaire, n = 3) traités par embolisation de l’artère splénique ont été inclus rétrospectivement. L’estimation du volume splénique embolisé était effectuée par TDM un mois après l’embolisation. Une évaluation clinique et la numération plaquettaire étaient réalisées à sept jours, un mois et six mois après l’embolisation.
Dans le groupe HTP par bloc intrahépatique, le volume moyen de parenchyme splénique embolisé représentait 63 % du volume splénique initial (extrêmes : 30 à 95 %). Le taux de plaquettes sanguin augmentait en moyenne de 232 % à six mois. Tous les patients ayant moins de 80 000 plaquettes/mL à six mois avaient un volume d’embolisation < 50 %. Dans le groupe HTP segmentaire, le volume moyen de parenchyme embolisé représentait 62 % du volume splénique initial (extrêmes : 20 à 95 %), la symptomatologie hémorragique a disparu chez tous ces patients, et le taux de plaquettes devenait supérieur à 80 000/mL. Six patients (6/17, 35 %) avaient des complications, deux mineures et quatre majeures : deux abcès spléniques, une détresse respiratoire avec décompensation ascitique et une pancréatite avec décompensation ascitique. Cinq des six complications étaient observées chez des patients ayant un volume de parenchyme splénique embolisé supérieur à 70 %.
Nos résultats montrent que l’embolisation splénique de plus de 50 % du parenchyme est efficace dans le traitement des hypersplénismes par hypertension portale, mais est associée à une morbidité non négligeable si elle dépasse 70 %.
Journal de Radiologie Diagnostique et Interventionnelle. 01/2012; 93(1):31–38.
[show abstract][hide abstract] ABSTRACT: The objective of this retrospective study was to analyze the efficacy and morbidity associated with splenic artery embolization for hypersplenism due to portal hypertension (PHT), as a function of the volume of the splenic parenchyma embolized and the type of PHT (due to intrahepatic block or segmental PHT).
This study retrospectively included 17 patients with hypersplenism secondary to PHT (intrahepatic block, n=14; segmental, n=3) treated by splenic artery embolization. The splenic volume embolized was estimated by computed tomography (CT) one month after embolization. A clinical assessment and platelet count took place at 7 days, 1 month and 6 months after the embolization.
In the group with PHT due to intrahepatic block, the mean volume of embolized splenic parenchyma was 63% of the initial volume (range: 30-95%). Six months later, the platelet level had increased by an average of 232%. All patients with fewer than 80,000 platelets/mL at 6 months had an embolization volume less than 50%. In the segmental PHT group, the mean volume of the embolized parenchyma was 62% of the initial volume (range: 20-95%), bleeding symptoms had disappeared in all patients, and the platelet level exceeded 80,000/mL. Six patients (6/17, 35%) had complications, two minor and four major: two splenic abscesses, one respiratory distress with ascites, and one pancreatitis with ascites. Five of the six complications were observed in patients with a volume of embolized splenic parenchyma more than 70%.
Our results show that splenic embolization of more than 50% of the parenchyma is effective in the treatment of hypersplenism due to PHT, but that when the embolized volume exceeds 70%, the procedure is associated with considerable morbidity.
Diagnostic and interventional imaging. 01/2012; 93(1):30-6.
[show abstract][hide abstract] ABSTRACT: Despites many limitations, liver biopsy remains the gold standard method for grading and staging liver biopsy. Several modalities have been developed for a non invasive assessment of liver diseases. Real-time elastography may constitute a true alternative to liver biopsy by providing an image of tissular elasticity distribution correlated to the fibrosis grade. In this paper, we investigate a new approach for the assessment of liver fibrosis by the classification of fibrosis morphometry. Multiresolution histogram, based on a combination of intensity and texture features, has been tested as feature space. Thus, the ability of such multiresolution histograms to discriminate fibrosis grade has been proven. The results have been tested on seventeen patients that underwent a real time elastography and FibroScan examination.
[show abstract][hide abstract] ABSTRACT: Intrahepatic cholestasis during pregnancy is a risk factor for prematurity, respiratory distress, fetal death in utero and exposure to meconium stained liquor. Treatment is based on ursodeoxycholic acid, which allows the pregnancy to continue until term. There is no consensus for labor induction criteria or for extraction of the fetus. We report a series of 10 patients who presented cholestasis during pregnancy and for whom we monitored the bile acid levels. These assays provided the means of confirming the diagnosis in patients suffering from pruritis. The threshold of 40μmoles/L could be a way of defining a group at risk of complications. Proper management for monitoring this pathology has not yet been properly established, but assay of the bile acids is an important element.
[show abstract][hide abstract] ABSTRACT: Aims
Embolization and chemoembolization are potential therapeutic options for liver metastases from a primary endocrine tumor in patients with a carcinoid syndrome. The aim of our study was to evaluate the clinical and morphological outcome, early and late after chemoembolization for procedures performed in our center from 1995 to 2004.
Patients and methods
This study involved 14 patients with carcinoid syndrome (eight men, six women, mean age: 60 years, range: 32 to 80) with liver metastasis from endocrine tumors: unresectable tumors unresponsive to medical treatments. For 12 patients, embolization was achieved with anthracyclines in Lipiodol® emulsion; simple embolization with coils and gelatin was used for two patients. Embolization was repeated at 1-month intervals: one procedure for eight patients, two for five patients and three for one patient. The morphological and clinical criteria of evaluation of OMS were used.
Technically, embolization was successful in all patients. Transient symptoms and minor complications occurred in four patients and one patient died from acute renal failure. At one month, assessment of the syndrome carcinoid showed: complete clinical response in six patients, improvement in two, static disease in three and progressive disease in three; morphologically the results were: one complete resolution, seven static disease and four progressive disease. Clinically, at last follow-up: eight patients had died, on average eight months after the first embolization; six patients survived, on average 21 months since the first embolization. Morphologically, the tumor progression persisted in all patients.
In accordance with the data of the literature, embolization and chemoembolization appear to be effective for liver metastasis, improving quality-of-life at least temporarily, for patients with the carcinoid syndrome secondary to liver metastases from unresectable endocrine tumors. Our morphological results are less satisfactory than reported in the literature.
Feuillets De Radiologie - FEUILL RADIOL. 01/2010; 50(1):11-21.
[show abstract][hide abstract] ABSTRACT: In most cases, fibrolamellar hepatocellular carcinoma has specific and distinctive histopathological features that distinguish it from hepatocellular carcinoma. Magnetic resonance imaging can provide characteristic features to obtain a diagnosis of this entity. We report a case of fibrolamellar hepatocellular carcinoma with a radiological-pathological correlation in a 37 year-old man with chronic viral hepatitis B without cirrhosis who underwent right hepatectomy.
Gastroentérologie Clinique et Biologique 05/2009; 33(5):382-6. · 1.14 Impact Factor
[show abstract][hide abstract] ABSTRACT: In most cases, fibrolamellar hepatocellular carcinoma has specific and distinctive histopathological features that distinguish it from hepatocellular carcinoma. Magnetic resonance imaging can provide characteristic features to obtain a diagnosis of this entity. We report a case of fibrolamellar hepatocellular carcinoma with a radiological–pathological correlation in a 37 year-old man with chronic viral hepatitis B without cirrhosis who underwent right hepatectomy.
Gastroenterologie Clinique Et Biologique - GASTROEN CLIN BIOL. 01/2009; 33(5):382-386.
[show abstract][hide abstract] ABSTRACT: The FFCD 9402 multicentre phase III trial was designed to compare the effects of the combination of Transarterial Lipiodol Chemoembolisation (TACE) and tamoxifen with tamoxifen alone on overall survival and quality of life in the palliative treatment of hepatocellular carcinoma with cirrhosis. From 1995 to 2002, 138 patients were randomised between the two groups. One hundred and twenty three patients were eligible including 61 in the Tamoxifen group and 62 in the TACE group. Baseline characteristics were similar: Child-Pugh class A: 70%, alcoholic cirrhosis: 76%, Okuda stage I: 71%, multinodular tumour: 70% and segmental portal vein thrombosis: 10%. At 2years, the overall survival was 22% and 25% in the Tamoxifen and TACE groups (P=.68), respectively. Multivariate analysis identified four independent prognostic factors for survival: alpha-fetoprotein (AFP)>400ng/mL (P=.008), abdominal pain (P=.011), hepatomegaly (P=.023) and Child-Pugh score (P=.032). The Spitzer Index level assessing the quality of life during follow-up did not differ between the two groups (P=.70). Amongst patients with stage Okuda I, the 2-year overall survival was 28% in the Tamoxifen group and 32% in the TACE group (P=.58). In this subgroup, two prognostic factors were statistically significant for survival: AFP>400ng/mL (P=.004) and Spitzer Index (P=.013) as shown by multivariable analysis. In conclusion, this study suggests that TACE improves neither the survival nor the quality of life in patients with HCC and cirrhosis.
European Journal of Cancer 04/2008; 44(4):528-38. · 5.06 Impact Factor