[A rare cause of acute abdominal pain].
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Abdomen, Acute↗
Biomedical subjects
A Hamy
Publications and source records attributed to A Hamy.
[Mangafodipir trisodium-enhanced magnetic resonance cholangiography for detection of bile leaks].
PURPOSE: To assess the value of contrast-enhanced magnetic resonance cholangiography with Teslascan perfusion for the detection and localization of trauma-induced and postoperative bile leaks. MATERIALS AND METHODS: Between October 2002 and December 2004, 7 patients with suspected bile duct leaks after trauma (n = 2) or surgery (n = 5) requiring morphological evaluation were included. MRI examination included single shot fast spin- echo T2 weighted and gradient echo T1 weighted images prior to and 112 minutes in average after IV administration of mangafodipir trisodium. The results of contrast enhanced MR cholangiography were correlated to surgery (n = 3), clinical course (n = 3) and percutaneous drainage (n = 1). RESULTS: Mangafodipir trisodium-enhanced imaging showed extravasated Teslascan in collections in 6 patients (86%) whereas the combination of T2 weighted images and mangafodipir trisodium enhanced images revealed biliary collections in 7 patients (100%). The fistula between bile duct and collection was visualized in 4 patients (57%) before mangafodipir trisodium perfusion and in 3 patients (43%) after injection. In one patient the fistula was visible only after injection. Combination of both pre- and post injection MR correctly depicted the origin of bile leak in 5 cases (71%). CONCLUSION: Mangafodipir trisodium-enhanced magnetic resonance cholangiography is a non invasive technique that can successfully detect the presence of bile duct leaks. The combination of T2 weighted MR cholangiography and mangafodipir trisodium-enhanced T1 weighted MR cholangiography increases the sensitivity in detection and localization of the site of bile leak.
Abdominal Injuries↗
[Hepatoid adenocarcinoma of the stomach. A case report].
Hepatoid adenocarcinoma of the stomach is a very rare tumor with a poor prognosis. Lymph nodes involvement and/or liver metastases are frequently observed. Diagnosis should be pointed out if elevated serum level of alpha-fetoprotein (AFP) is detected with gastric tumor. Histologically, the tumor is an adenocarcinoma of intestinal type including foci of hepatoïd differenciation. Immunohistochemistry is positive for alpha-1-antitrypsin and alpha-1-antichymotripsin, and for AFP. We report a case of a 66 year-old man presenting an advanced stage of hepatoid adenocarcinoma of the stomach, treated by gastrectomy followed by chemotherapy. The patient died four months after the surgery because of progressing liver metastatic disease.
Adenocarcinoma↗
Percutaneous cholecystostomy for high-risk patients with acute cholecystitis.
BACKGROUND: Cholecystectomy remains the best treatment for acute cholecystitis but may cause high morbidity and mortality in critically ill or elderly patients. METHODS: From October 1995 to March 2004, percutaneous cholecystostomy was performed in 65 patients with acute cholecystitis. The mean age was 78 years (range, 45-95). All patients were American Society of Anesthesiologists (ASA) class III (n = 51) or ASA IV (n = 14). RESULTS: Percutaneous cholecystostomy was technically successful in 63 patients (97%) with no attributable mortality or major complications. In two patients, bile drainage was inefficient, requiring emergency laparoscopic cholecystectomy. One patient developed necrotic cholecystitis and died. The 30-day mortality rate was 13.8% (n = 9); eight patients died of respiratory or cardiac complications related to comorbidities. Mean drainage time was 18 days (range, 9-60). Postoperative length of hospital stay was 15 days (range, 7-30). Early and delayed cholecystitis occurred in six and five patients, respectively. During follow-up (mean, 20.4 months), five patients died of their underlying medical condition at 5, 6, 8, 12, and 14 months, respectively. In this study, delayed elective cholecystectomy was performed in 10 patients (15.3%). CONCLUSIONS: Percutaneous cholecystostomy is a valuable and effective procedure without mortality and with a low morbidity. Whenever possible, percutaneous cholecystostomy should be followed by laparoscopic cholecystectomy.
Acute Disease↗
Clinical spectrum and surgical approach of adult intussusceptions: a multicentric study.
BACKGROUND: The preoperative diagnosis of adult intussusceptions (AIs) remains difficult, and the assessment of the radiological methods has been evaluated very little in the literature. The aim of this study was to evaluate the interest of the different imaging modalities for the preoperative diagnosis of AI and describe causes of AI. PATIENTS AND METHODS: Consecutive patients of 15 years and older with the postoperative diagnosis of intussusception from 1979 to 2004 were reviewed retrospectively for this multicentric study. Data concerning clinical considerations, morphological examinations, surgical procedure, histological conclusions, mortality rate and recurrence were analysed. RESULTS: Forty-four patients with documented intussusception were included. The mean age was 51 years (15-93 years). The preoperative diagnosis of intussusception was made in 52% of the cases. The sensitivities of the different radiological methods were abdominal ultrasounds (35%), upper gastrointestinal barium study (33%), abdominal computed tomography (CT) (58%) and barium enema (73%). An organic lesion was identified in 95% of the cases. There was 29 enteric and 15 colonic (including appendicular) intussusceptions. Thirty-seven percent of the enteric lesions were malignant, and a bit less than 50% of them were metastatic melanomas. The benign enteric lesions were Meckel's diverticulum and Peutz-Jeghers syndrome in half of the cases. Fifty-eight percent of the pure colonic lesions (excluding appendix) were malignant, and 85% of them were primary adenocarcinomas. The benign colonic lesions were lipomas in 80% of the cases. All patients, except one, had a surgical treatment, and 13 of them had a complete reduction of the intussusception before resection. The mortality rate was 16% and recurrence occurred in three patients; two of them had a Peutz-Jeghers syndrome. CONCLUSION: Intussusception rarely occurs in adults, but nearly half of their causes are malignant. The CT scan is a helpful examination for enteric intussusceptions whether barium enema seems to be the most performing method for colonic lesions. Surgery is the recommended treatment, with or without a primary reduction of the intussusception. During the surgical procedure, this reduction can lead to a more limited bowel resection.
Adolescent↗
Central neck dissection in the management of sporadic medullary thyroid microcarcinoma.
AIM: Treatment of medullary thyroid carcinoma (MTC) includes total thyroidectomy with at least bilateral central neck dissection. Systematic measurement of thyrocalcitonin (CT) levels in thyroid nodules allows for early diagnosis of MTC. As central neck dissection (CND) is associated with high morbidity, the aim of this study was to investigate the necessity of this procedure in the treatment of sporadic medullary thyroid microcarcinoma (S-mMTC). METHODS: Prospective multicentric study including 43 patients with sporadic micro-MTC who underwent CND between January 1991 and August 2001. RESULTS: 26 women and 17 men with sporadic micro-MTC, aged 28-87 (mean age was 58 years), without family history of multiple endocrine neoplasia, underwent surgery. Total thyroidectomy was performed in all patients and combined with 'picking' (n=7) or CND (n=36). Size of tumours ranged from 0.2 to 9mm (mean size was 4.1mm). Solitary (32/43 patients) and multiple S-mMTC lesions (11/43 patients) were seen. 601 lymph nodes from the 41 subclinical patients were analysed. Mean follow-up period for these patients was 32 months. No mutations in the RET oncogene were seen. CONCLUSION: As lymph node involvement is uncommon in S-mMTC, systematic CND is of questionable value.
Adult↗
[Bisegmentectomy 7-8: importance of preoperative diagnosis of a right inferior hepatic vein].
The extent of hepatic resection is often determined by the hepatic veins and their relation to the tumor. A need to transect the right hepatic vein at its entry into the vena cava indicates a need to remove the entire right posterior segment. About six cases, the aim of the study was to remind that under certain circumstances the posteroinferior area may be preserved. The circumstances which allow such preservation are the presence of a stout inferior right hepatic vein and the ability to recognize the presence of the vein in the preoperative staging. In patients with possible impaired hepatic function (cirrhosis, chemotherapy), preservation of hepatic parenchyma is an important consideration during resection for hepatic tumors.
Adult↗
Thyroglobulin monitoring after treatment of well-differentiated thyroid cancer.
AIMS: The prognosis for well-differentiated thyroid carcinomas is favourable after treatment, but the rate of recurrence is around 20%. Cervical ultrasonography, radio-iodine scans, and monitoring of serum thyroglobulin (Tg) levels allow these recurrences to be diagnosed. The management of patients with isolated elevated Tg levels is controversial in the presence of negative radio-iodine scans. METHODS: The records of 57 patients diagnosed with recurrence of well-differentiated thyroid cancer were reviewed. Serum Tg was not evaluated in 31 of these patients (group 1) and measured in the other 26 cases (group 2). RESULTS: Forty-three recurrence sites were found; four deposits in the thyroid bed and 39 cervical metastatic nodes, with an average of five nodes per patient. The radio-iodine scan was accurate in detecting 10/24 of cases, radiology in 9/17, and elevated Tg levels in 20/25. Thirteen patients with recurrences diagnosed on the basis of Tg levels had negative radio-iodine scans. After surgery, Tg levels were normal in 10 patients from group 1 and 16 patients from group 2 (p=0.0078). CONCLUSIONS: Elevated Tg levels are indicative of disease progression or recurrence in patients who have previously been operated on for well-differentiated thyroid cancer. Even when the radiological study or radio-iodine scan is normal, surgical re-exploration of the neck, with total thyroidectomy and lymphadenectomy, is advisable.
Adenocarcinoma, Follicular↗
Endoscopic sphincterotomy prior to laparoscopic cholecystectomy for the treatment of cholelithiasis.
BACKGROUND: We performed this study to assess the outcome of endoscopic retrograde cholangiography (ERC) before laparoscopic cholecystectomy (LC) for symptomatic gallbladder and suspected duct stones. METHODS: We performed prospective study of 310 patients with symptomatic gallstones and suspected choledocholithiasis managed by preoperative ERC with endoscopic extraction (ESE) and LC. The presence of one or more of the following criteria at hospital admission led to preoperative ERC because of suspected choledocholithiasis: jaundice for more than 72 h, ultrasonography measurement of the common bile duct > 8 mm, cholestasis, and acute biliary pancreatitis. RESULTS: ERC for suspected choledocholithiasis was performed in 310 patients. The rate of successful cannulation for ERC was 96.8%. Duct stones were found in 86%. Twelve patients had impacted duct stones cleared at open common duct exploration. The failure rate of ERC was 4.5%, and the rate of unnecessary ERC was 13.5%. LC was performed in 298 of 310 patients. Morbidity rates were 2.2% and 1.5% after ESE and LC, respectively. CONCLUSION: A total of 95.5% of patients with symptomatic gallbladder and ductal stones could be successfully managed by ERC prior to LC with a low morbidity rate.
Adolescent↗
Palliation of carcinoma of the rectum using the urologic resectoscope.
BACKGROUND: Thirty percent to 40% of patients with rectal cancer are not candidates for aggressive surgery because of distant metastases, extensive local tumor infiltration, poor general condition, or refusal of the patient. The aim of this study was to report the results of endoscopic transanal resection (ETAR) using a urologic resectoscope for the palliative treatment of rectal carcinoma. METHODS: This study included 46 consecutive patients who underwent ETAR for rectal adenocarcinoma between October 1992 and October 2000. All patients had histologically confirmed adenocarcinoma. None of the patients were candidates for curative surgery. A retrospective evaluation of the outcome of ETAR was performed. RESULTS: Forty-six consecutive patients (25 men and 21 women), with a median age of 84 years (range, 57-92 years), underwent 76 ETARs. Twenty-four patients (52%) had locally advanced rectal cancer with a tumor length of more than 5 cm. The tumor involved the anterior rectal wall in 52 ETARs. Seventeen patients (37%) required more than one procedure. Median operating time was 49 min (range, 15-120 min). The morbidity rate was 8% (n = 6); perforation of the rectum occurred in 1 patient (2%) during an iterative ETAR. The mortality rate was 2%. The median postoperative stay was 5.5 days (range, 3-16 days). Symptomatic relief was achieved in 87% of patients. Colostomy was performed in 8 cases, with a median interval of 7 months (range, 3-12 months) after the first ETAR and after a median of 2 ETARs (range, 1-3). The median survival time was 14 months (range, 0-62 months); 40 patients died. The survival rate at 1, 2, and 5 years was 54%, 31.6%, and 5%, respectively. CONCLUSION: ETAR is a simple, minimally invasive, and economic method that should be part of palliative treatment for patients with rectal carcinoma. ETAR is a useful addition to the surgeon's armamentarium in the multidisciplinary approach of advanced rectal cancer together with laser destruction, stent implantation, and external beam radiotherapy. All these treatments must be evaluated not only in term of lumen patency or stoma rate, but also from the quality of life standpoint.
Aged↗
[The importance of lymph node dissection in medullary thyroid macrocarcinomas].
UNLABELLED: Medullary thyroid carcinoma (MTC) is often regarded as good medium-term forecast. The 5- and 10-years survival rates are, respectively, appraised at 78-85% and 70-78%. These rates take no care, however, of the fact that 50-56% of the patients keep a pathological calcitonine (CT) level giving evidence of an evolutive disease. The treatment is based on the total thyroidectomy and cervical lymphadectomy. This treatment remains often incomplete and the results of reintervention are disappointing. AIM OF THE STUDY: About 48 patients, we wanted to demonstrate the importance of a complete lymph node dissection performed in the neck as soon as possible. PATIENTS AND METHODS: Between 1979 and 2000, 48 patients were treated for macroMTC (size >1 cm). The duration of follow-up was of 1-29 years (mean 9.3 years). The complete (central and lateral) neck dissection was initially made only in 22 cases. The selected criterion to assess the result was the normalization of the basal CT level. RESULTS: The rate of node involvement was 66.6% if the complete lymphadectomies (n = 22), the secondary neck dissections (n = 15), the incomplete (n = 10) and not made lymphadectomies (n = 2) were gathered. In case of primary or secondary complete lymphadectomies, the rate of node involvement was 81%. The 22 primary complete lymphadectomies performed in 13 patients (59%) allowed to normalize the basal CT level and among 17 (77.2%) to decrease this rate over 90%. All the incomplete neck dissection failed in case of positive nodes. CONCLUSION: The frequency of node involvement in macroMTC is about 80%. It does not have a preferential territory and the bilaterality is frequent (28-49%): that justifies a bilateral complete neck dissection. Initial surgical treatment seems essential in regard to the rate of normalization of basal CT level, which is, when a first complete lymphadectomy is done and in case of iterative surgery, respectively 59 and 26.6%. A complete lymphadectomy is still too rarely carried out: 22 times (45.8%) in our own experience and from 14 to 42% in the literature.
Adult↗
[Small bowel diverticulitis: the role of CT].
The authors report a case of small bowel diverticulitis diagnosed by computed tomography. They describe the CT findings and review its advantages for diagnosis of this uncommon entity that is rarely suspected at physical examination.
Abdominal Pain↗
Laparoscopic liver resection of benign liver tumors.
OBJECTIVE: The objective of this study was to assess the feasibility, safety, and outcome of laparoscopic liver resection for benign liver tumors in a multicenter setting. BACKGROUND: Despite restrictive, tailored indications for resection in benign liver tumors, an increasing number of articles have been published concerning laparoscopic liver resection of these tumors. METHODS: A retrospective study was performed in 18 surgical centres in Europe regarding their experience with laparoscopic resection of benign liver tumors. Detailed standardized questionnaires were used that focused on patient's characteristics, clinical data, type and characteristics of the tumor, technical details of the operation, and early and late clinical outcome. RESULTS: From March 1992 to September 2000, 87 patients suffering from benign liver tumor were included in this study: 48 patients with focal nodular hyperplasia (55%), 17 patients with liver cell adenoma (21%), 13 patients with hemangioma (15%), 3 patients with hamartoma (3%), 3 patients with hydatid liver cysts (3%), 2 patients with adult polycystic liver disease (APLD) (2%), and 1 patient with liver cystadenoma (1%). The mean size of the tumor was 6 cm, and 95% of the tumors were located in the left liver lobe or in the anterior segments of the right liver. Liver procedures included 38 wedge resections, 25 segmentectomies, 21 bisegmentectomies (including 20 left lateral segmentectomies), and 3 major hepatectomies. There were 9 conversions to an open approach (10%) due to bleeding in 45% of the patients. Five patients (6%) received autologous blood transfusion. There was no postoperative mortality, and the postoperative complication rate was low (5%). The mean postoperative hospital stay was 5 days (range, 2-13 days). At a mean follow-up of 13 months (median, 10 months; range, 2-58 months), all patients are alive without disease recurrence, except for the 2 patients with APLD. CONCLUSIONS: Laparoscopic resection of benign liver tumors is feasible and safe for selected patients with small tumors located in the left lateral segments or in the anterior segments of the right liver. Despite the use of a laparoscopic approach, selective indications for resection of benign liver tumors should remain unchanged. When performed by expert liver and laparoscopic surgeons in selected patients and tumors, laparoscopic resection of benign liver tumor is a promising technique.
Adolescent↗
[Locoregional recurrence of differentiated thyroid cancers: diagnosis-treatment].
AIM OF THE STUDY: To evaluate the improvement of the diagnosis and the treatment of local recurrences (LR) in patients with differentiated thyroid carcinoma. MATERIAL AND METHOD: Among a total of 57 patients, two groups were compared: group I: 31 patients operated on from 1974 to 1990; group II: 26 patients operated on from 1991 to 2000. In the group I, the diagnosis of the cervical recurrence was supported by imaging study (ultrasonography, tomodensitometry), in the group II by radioiodinescan and serum thyroglobuline (Tg) measurement. The main difference was the consideration of Tg measurement to detect the recurrence in the group II. A high level of Tg was the only abnormality for 9 patients of the group II. RESULTS: A nodal recurrence was respectively present in the group I and II in 88.8% and 92% of the cases. Re-operation consisting in thyroid totalisation and bilateral lymphadenectomy was respectively performed in 71% and 100% of the cases. Surgery associated with iodine 131 therapy was respectively the treatment for 45.1% and 88.4% of the cases. After a median follow up of 66.2 months; results of the group I were as follow: normal or undetectable Tg: 10 (33.3%), second or more cervical recurrences: 7, distant metastases: 11, death in relation to thyroid cancer: 11. After a median follow up of 36.3 months, results of the group II were as follow: normal or undetectable Tg: 17 (65.4%), second or more cervical recurrences: 6, distant metastasis: 5, death in relation to thyroid cancer: 1. The best results concerned patients with an isolated elevated Tg without anatomical location of the first LR. CONCLUSION: LR diagnosis is difficult and needs imaging study, radioiodine-scan and serum Tg determination together. Re-operation associated with radioiodine-therapy is the treatment of choice. Elevated serum Tg is suffisant to indicate re-operation even if no anatomical substrate is found. Iodine-radiotherapy alone is generally unable to obtain undetectable serum Tg.
Adolescent↗
[Parathyroid cyst. Report of ten cases].
AIM OF THE STUDY: To evaluate the characteristics of the parathyroid cysts (PC). PATIENTS AND METHOD: Ten patients with PC were included in this retrospective study. The PC were discovered as follows: cervical mass (n = 3), hyperparathyroidism (n = 3), incidentally during thyroid surgery (n = 3) and screening for obesity (n = 1). Intracystic parathormone determination was performed after fine needle aspiration in 2 cases. RESULTS: Mean cyst measurements were 27 mm (ext: 5-70 mm) to 22 mm (5-45 mm). Nine cysts were cervical (resection by cervicotomy), and one was mediastinal (resection by sternotomy). In addition to the resection of the PC, 3 adenomas, 1 hyperplasia of the parathyroid glands and 3 benign thyroid diseases were recognized and treated during the cervicotomies. CONCLUSION: The diagnosis of PC is not common and must be based primarily on the study of the cyst liquid obtained by percutaneous puncture (intracystic parathormone measurement).
Adenoma↗
[Intensive care unit hospitalization after colorectal surgery].
OBJECTIVE: Intensive care units (ICU) support critically ill patients during the perioperative period. Few studies exist focusing on ICU hospitalisation after colorectal surgery. The objective of the study was to 1) detect predictive factors of mortality and length of stay in ICU after colorectal procedures, and 2) compare the autonomy status of the patients before and 30 days after their ICU stay. PATIENTS AND METHODS: This study followed a prospective non randomized cohort in our colorectal surgery unit. During a period of one year (January 1st to December 31th, 2000) 351 colorectal procedures were performed and 54 patients were admitted to ICU after surgery. For each patient, 37 parameters were collected on a standardized register. Predictive factors of mortality (30 days after the procedure) and ICU stay (up to 3 days) were studied by univariate and multivariate statistical analysis. Self autonomy before surgery and 30 days after was also investigated. RESULTS: "Multiple-intervention" was the only independent factor influencing mortality. Both "low autonomy status before surgery" and "pulmonary comorbidity" increased the length of stay. Regarding the 48 survivors, 45 (94%) recovered the same autonomy index as in the preoperative period 30 days after the procedure. CONCLUSION: This study highlights the poor predictive factors influencing mortality during or after ICU stay following colorectal surgery, and emphasizes two preoperative parameters increasing the length of stay up to 3 days. This should guide the informations given to the patients families. Finally, this study confirms the good quality of self-sufficiency after ICU stay even for a long time (over 3 days).
Adult↗
Percutaneous ethanol injection vs. resection in patients with small single hepatocellular carcinoma: a retrospective case-control study with cost analysis.
BACKGROUND: Percutaneous ethanol injection and hepatic resection are the most widely used curative therapeutic options for patients with compensated liver disease and small hepatocellular carcinoma. AIM: To compare percutaneous ethanol injection and hepatic resection in a selected group of consecutive French patients with a single hepatocellular carcinoma, smaller than or equal to 50 mm, in terms of survival, recurrence rate of malignancy and direct costs. METHODS: The analysis of two contemporary cohorts of Child-Pugh A or B patients with a single hepatocellular carcinoma of < or = 50 mm treated by percutaneous ethanol injection (n=55) or hepatic resection (n=50). RESULTS: Long-term survival was not significantly different between the two groups when the size of hepatocellular carcinoma was less than 30 mm. However, the survival of patients with hepatocellular carcinoma larger than 30 mm was higher after hepatic resection than after percutaneous ethanol injection (P=0.044). The cumulative direct costs were significantly higher in patients treated by hepatic resection than in those treated by percutaneous ethanol injection regardless of the tumour size. The calculated costs per month of survival in patients treated with percutaneous ethanol injection and hepatic resection were 999 vs. 3865 euros, respectively (P < 0.001). CONCLUSIONS: Percutaneous ethanol injection is more cost effective than hepatic resection in patients with a single hepatocellular carcinoma smaller than 30 mm. However, in patients with a larger tumour, long-term survival is higher after hepatic resection.
Aged↗
[Percutaneous drainage of perisigmoid abscesses of diverticular origin].
STUDY AIM: The aim of this multicentric retrospective study was to report the results on the percutaneous drainage of perisigmoid abscesses during acute sigmoid diverticulitis in 12 patients. PATIENTS AND METHOD: Between January 1993 and March 2000. 12 patients with a perisigmoid diverticular abscess were treated by antibiotic therapy and percutaneous drainage of the abscess. The patient population consisted of eight males and four females (mean age: 50.2 years). The diagnosis was established in two out of seven cases by enema, in four cases out of seven by abdominal ultrasonography, and in eight cases out of 11 by CT scan. Percutaneous drainage was carried out in all cases, and was guided by ultrasonography (n = 3) and CT scan (n = 9). The mean duration of drainage was 6.5 days. RESULTS: No drainage-associated complications were observed. Drainage combined with antibiotic treatment provided satisfactory results in ten out of 12 cases. Two cases of failure of the method occurred, and the patients involved were operated on day 4 and week 5 by colectomy with protective lateral ileostomy. There was an early recurrence of the abscess in three patients, who were treated by the Hartmann procedure in one case, and by one-stage colectomy in two cases. Five patients underwent a secondary one-stage colectomy. Two patients in whom no residual abscess was detected were not operated on at the time of the study. CONCLUSION: Percutaneous drainage of perisigmoid diverticular abscesses combined with antibiotic therapy provided efficient treatment in ten out of 12 cases. Secondary one-stage colectomy was performed in seven out of the eight patients requiring further surgery.
Abdominal Abscess↗