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Biomedical subjects

A Sibert

Publications and source records attributed to A Sibert.

At least 37 records · Page 2Linked to original sources
PubMed1993

Hepatic arterial chemoembolization in patients with liver metastases of endocrine tumors. A prospective phase II study in 24 patients.

BACKGROUND: Liver metastases of endocrine tumors are of major prognostic significance. The various therapeutic approaches have given disappointing results; however, locoregional treatment has allowed transient control of hepatic tumor growth. METHODS: Twenty-four patients with liver metastases of endocrine tumors (mainly carcinoid tumors [n = 18] and gastrinomas [n = 5]) were included in a Phase II study of hepatic arterial chemoembolization (CE). Metastases were bilateral in all patients and invaded more than 50% of the liver in 12. They were synchronous of the primary tumor in 62.5% of the patients. Seventeen patients had not responded to previous intravenous chemotherapy. CE courses were performed every 3 months using an emulsion of 10 ml of iodized oil and doxorubicin 50 mg/m2 injected into tumor vessels, followed by CE arterial occlusion with gelatin sponge particles. Seventy-one CE courses were performed in 23 patients; there was one technical failure. RESULTS: Among patients with carcinoid tumors, disappearance of diarrhea and/or flushing was observed in 8 of 11. Serotonin and/or its metabolite 5-hydroxyindoleacetic acid levels decreased by more than 50% in 57% of the patients. The size of liver metastases decreased by at least 50% in 6 of 18 patients, i.e., in 33% (range, 12-54%). Two had complete responses. The median duration of the responses was 14 months (range, 6-40). Among patients with noncarcinoid tumors, minor response or stabilization occurred in three of five patients. Major side effects were bleeding peptic ulcer (one patient) and oligoanuric renal failure (one patient). Abdominal pain, fever, and increases in hepatic enzyme levels were common and transient. CONCLUSIONS: These results suggest that CE is effective in patients with liver metastases of endocrine tumors, mainly in carcinoids. In the latter, CE allows control of the carcinoid syndrome and regression or stabilization of the liver tumors in 80% of patients.

Adult↗
PubMed1993

Hepatic metastases: detection with multisection FLASH MR imaging during gadolinium chelate-enhanced arterial portography.

PURPOSE: To determine the feasibility and sensitivity of multisection fast low-angle shot (FLASH) magnetic resonance (MR) imaging in the depiction of hepatic metastases. MATERIALS AND METHODS: The cases of 10 patients with 39 surgically proved hepatic metastases were prospectively evaluated. After unenhanced T1- and T2-weighted spin-echo (SE) and FLASH imaging, 4 mL of a 0.5 mol/L solution of a gadolinium chelate (tetraazacyclododecanetetraacetic acid) was injected into the superior mesenteric artery during FLASH imaging in a single breath-holding period. RESULTS: No side effects were noted. With multisection FLASH MR arterial portography, tumor-to-liver contrast-to-noise ratio (34.5 +/- 4.4) was significantly increased compared with unenhanced MR imaging. Sensitivity was 74% (29 of 39) for combined SE and multisection FLASH imaging and 95% (37 of 39) for multisection FLASH MR arterial portography (McNemar test, P < .02). CONCLUSION: Multisection FLASH MR arterial portography is a safe, feasible, and sensitive technique with which to detect hepatic metastases.

Adult↗
PubMed1992

[Benign tumors of the liver. Clinical and radiological data].

Cysts and haemangiomas, which are frequent benign tumours of the liver, must be separated from hepatic adenoma and focal nodular hyperplasia. The former are usually diagnosed by ultrasonography and/or computed tomography (CT), and they exceptionally require surgery. The latter, much rarer, are similar in that both occur in young women and have the same imaging characteristics: CT does not always show the sign that confirms the diagnosis of focal nodular hyperplasia (i.e. a central "scar" vascularized at CT-angiography); scintigraphy would provide the diagnosis, but it is at fault in 30 to 40% of the cases. Excluding a malignant tumour (hepatocellular carcinoma or fibrolamellar hepatocarcinoma) is sometimes difficult. Often more than a certainty, it is a collection of convergent clinical and radiological data that leads to the correct diagnosis.

Bile Duct Diseases↗
PubMed1992

Advantage of systematic random ultrasound-guided biopsies, measurement of serum prostate-specific antigen level and determination of prostate volume in the early diagnosis of prostate cancer.

Two hundred and sixteen patients, presenting with a suspicious digital examination (stage T3 excluded) or a level of prostate-specific antigen (PSA) greater than or equal to 2.5 ng/ml, assessed by radioimmunoassay, underwent a transrectal ultrasound examination. Prostate volume was systematically calculated and correlated to PSA level. Biopsies were performed: (1) on suspicious peripheral hypoechoic areas; ultrasound-guided biopsies; (2) systematically on the 2 prostate lobes, whatever the result of transrectal ultrasound imaging:random systematic ultrasound-guided biopsies. In the 186 patients who had never undergone prostate surgery, ultrasound-guided biopsies showed 42 prostate cancers and random systematic ultrasound-guided biopsies showed 75; 14 of the 76 patients with normal digital rectal examination and transrectal ultrasound imaging had a prostate cancer. In the 30 patients who had previously undergone surgery for benign prostatic hypertrophy, random systematic ultrasound-guided biopsies showed 18 prostate cancers, 13% more than ultrasound-guided biopsies; 75% of patients with a serum PSA greater than 5 ng/ml had a prostate cancer. A very significant correlation was found between PSA level and prostatic volume (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Antigens, Neoplasm↗
PubMed1991

Prostate cancer in a 75-year-old man after four decades of testicular androgen deprivation.

In a 75-year-old patient referred for mild obstructive symptoms, physical examination revealed a clinically manifest T2B cancer of the prostate (CaP) involving the right lobe, and bilateral testicular atrophy (TA), right cryptorchidism with TA after orchiopexy at age 10, and left mumps orchitis with secondary atrophy at age 35). Since the age of 35, the patient had a limited sexual life and fathered no children. Transrectal ultrasonography demonstrated a small prostate (21 cm3) with a large hypoechoic zone in the right lobe, an isoechoic left lobe and no sign of capsular/seminal involvement. Three biopsies of the right lobe demonstrated a cancer (Gleason 4-3; score 7) of the right lobe, 3 biopsies of the left lobe showed an atrophic prostate with slight intra-acinar hyperplasia and moderate dysplasia. Morphometric studies showed these findings to be consistent with long-standing androgen deprivation. Serum prostate-specific antigen (PSA) was 8.7 ng/ml, whereas serum testicular androgens were within the castrate value (serum testosterone 0.2 ng/ml, dihydrotestosterone less than 0.05 ng/ml). Serum LH and adrenal androgens were within normal ranges. Bone scan was negative and NMR demonstrated no nodal enlargement. Considering the age of the patient, antiandrogen therapy was given (cyproterone acetate 50 mg t.i.d.). The patient reported marked improvement at 3 and 6 months of follow-up and PSA fell to 1 ng/ml at month 6. However, repeat rectal exams and ultrasonography showed no dramatic modification of the gland. The patient has since been lost to follow-up. Two conclusions may be drawn from this observation. Testicular androgen deprivation at age 35 although leading to prostatic atrophy does not prevent the development of CaP.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

[The correlation between the level of prostate-specific antigen and prostate gland volume in the early diagnosis of prostatic cancer].

One hundred and eighty six patients (Pts) presenting with either an abnormal per rectum examination (P.R. suggestive of prostatic cancer (P.Ca) (excluding stage T3) or a prostatic specific antigen (P.S.A.) level greater than or equal to 2.5 ng/ml (radioimmunoassay) were submitted to transrectal ultrasonography (T.R.U.) using a 7 MHz transducer. The prostatic volume (Vol.P) was systematically calculated during T.R.U. and correlated with the P.S.A. level. Six systematic multiple ultrasound-guided biopsies (S.M.U.B.) were performed in the 2 prostatic lobes (3 per lobe) regardless of the result of T.R.U. In the 111 patients in whom the S.M.U.B. were negative, a highly significant correlation (p < 0.001) was observed between the serum P.S.A. level (y) and the prostatic volume (Vol.P): y = (4.13 +/- 0.15 Vol.P) +/- 8.43. In the 75 Pts with P.Ca, the P.S.A./Vol.P correlation was significantly different (p < 0.05) from the straight line of regression with the previous standard deviation. A similar difference in correlation (p < 0.05) was observed in the sub-group of 14 Pts with P.Ca despite normal P.R. and T.R.U. These results suggest: 1) that there is a correlation between the Vol.P measured by T.R.U. and the P.S.A. level in patients with negative S.M.U.B. 2) that the absence of correlation is highly suspicious of P.Ca and requires S.M.U.B. 3) that there is a 15% incidence of P.Ca in the sub-group of Pts with normal P.R. and T.R.U. which are only detected by the raised P.S.A. not correlated with the volume of the prostate.

Biopsy↗
PubMed1990

[The value of ultrasound-guided multiple systematic biopsies in the early diagnosis of cancer of the prostate].

Endorectal ultrasonography using a 7 mHZ probe was performed in 99 patients with a negative history for surgery of the prostate and either findings on rectal examination suggestive of cancer (T3 stage excluded) or a serum level of prostate-specific antigen of 2.5 mg/ml or more. A biopsy gun was used to harvest 1.5 centimetre long specimens. Ultrasound-guided biopsies were performed in peripheral hypoechogeneic areas; in addition, regardless of the result of the endorectal ultrasonography, routine multiple ultrasound-guided biopsies were performed in both lobes of the prostate (3 per lobe). Morbidity consisted in two cases of prostatitis (2%). Among the 99 patients, ultrasound guided biopsies found 16 carcinomas (16.1%), and routine multiple ultrasound-guided biopsies found 32 (32.3%) carcinomas. Four patients with normal results upon rectal examination and endorectal ultrasonography were found to have carcinoma of the prostate. These findings suggest that the morbidity of routine multiple ultrasound-guided biopsies is low; that routine multiple ultrasound-guided biopsies is more sensitive than ultrasound guided biopsies, with 16/99 (16%) additional carcinomas detected in this study and 56% of carcinomas among those patients with findings upon the rectal examination suggestive of malignant disease; and that routine multiple ultrasound-guided biopsies can allow the detection of carcinomas responsible for isolated elevation of prostate-specific antigen levels without anomalies of the rectal examination or endorectal ultrasonography (8% of the carcinomas in this study).

Antigens, Neoplasm↗
PubMed1990

[Treatment using an endo-urologic approach of stenoses following uretero-intestinal anastomosis].

Twenty-one strictures following uretero-digestive anastomoses were treated by percutaneous transrenal dilatation. In 20 cases, an Olbert type angioplasty balloon on a guidewire was used. Rigid coaxial dilators were used in one patient after failure of the preceding technique and an electroincision was performed prior to dilatation in the remaining case. Overall, percutaneous transrenal dilatation was successful in nine patients, whereas ten dilatations failed and two patients are undergoing continued modeling with a mean follow-up of 16 months (range 1-42 months). Success rates by type of anastomosis were as follows: Bricker 5/12; Coffey 1/4; enterocystoplasty 2/4 and ureteroileovesical anastomosis 1/1. The date of development of the stricture, duration of modeling, and caliber of the indwelling catheter were apparently without influence on results. Because morbidity is low with percutaneous transrenal dilatation, this technique is advocated as first-line treatment, with surgery being reserved to failures.

Adult↗
PubMed1989

[Treatment of urethral stenosis using Olbert's balloon dilatation angioplasty. Re-evaluation of the results].

Twenty-eight patients with an urethral stricture underwent Olbert's angioplasty balloon dilatation under local anaesthesia and fluoroscopic control. Four dilatations failed. Six were performed palliatively after failure of classical urethral catheterisation. Sixteen dilatations were performed curatively: thirteen patients developed a recurrent stricture after periods of between 3 days and 12 months. Three patients were cured. Our results suggest that angioplasty balloon dilatation is ineffective as a curative procedure and should be reserved for inoperable patients requiring and indwelling catheter, in whom classical catheterisation has failed.

Angioplasty, Balloon↗
PubMed1989

[Diagnosis of glucagonoma. Value of scanning, echography and arteriography. Apropos of 2 cases and a review of the literature].

The authors report two cases of glucagonoma, a rare endocrine tumor of the pancreas, and describe the data currently found in literature. Glucagonoma is a single and usually large tumor, which develops in the alpha cells of the islets of Langerhans and evolves slowly. The combination of characteristic skin lesions, diabetes and weight loss should lead to searching for hyperglucagonemia and for the pancreatic tumor. The diagnosis is usually made rather late, average evolution is five years before diagnosis when it is detected. Imaging, in particular ultrasound and computed tomography (CT), proves to be necessary for the positive diagnosis of glucagonoma as it localizes the pancreatic mass and plays a role in local assessment, thus providing guidance for surgery. The role of imaging is also fundamental for the detection of metastases, which are the only sign of malignancy as no criterion of benignity is found for this tumor.

Adenoma, Islet Cell↗
PubMed1989

[Endoscopically "impassable" urethral stenosis. Catheterization under fluoroscopic guidance. Apropos of 11 cases].

In eleven patients with impassable urethral stenoses, we attempted retrograde catheterisation with an angiographic guide under fluoroscopic control. The stenosis was able to be negotiated with the guide in 10 cases (91% success). After dilatation by dilators (coaxial or rigid) or by Olbert's angioplasty balloon, we were able to introduce a Foley catheter into the bladder. The only failure was caused by a very marked separation of the two ends of the urethra due to trauma. This simple and effective method constitutes an alternative to immediate surgical treatment of endoscopically impassable urethral stenoses.

Fluoroscopy↗
PubMed1988

Hepatitis tuberculosis presenting as tumoral disease on ultrasonography.

Macronodular involvement of the liver is a rare manifestation of hepatitis tuberculosis. Two cases of this pseudotumoral form are reported on ultrasonography, demonstrating multiple hypoechoic nodules distributed throughout the liver. The authors state the difficulty in differentiating this form in its atypical presentation from lymphomatous or secondary malignancies. They stress the importance of the bacteriological and/or histological diagnosis which can be performed with fine-needle percutaneous biopsy under ultrasound guidance and which allows effective therapy.

Adult↗
PubMed1988

[Muscle metastases: ultrasonic and x-ray computerized tomographic aspects. Apropos of 9 cases].

Clinical, ultrasound and CT scan examinations were carried out in 9 patients with secondary muscle lesions. All muscles can be affected but there was a marked predominance of psoas lesions (6 of the 9 cases). Two contrasting clinical pictures are seen. Secondary muscle tumors can occur during evolution of a known treated cancer (5 of the 9 cases), revealed usually by large, rarely painful, mass. CT scan imaging shows a heterogeneous mass taking up contrast and often partially necrotic, the lesions appearing hypoechogenic or heterogeneous on ultrasound examination. Certain lesions can be totally necrotic. In some cases (4 of the 9 patients) the muscle metastases revealed the presence of a tumor. Symptomatology may be atypical and lead to a delay in diagnosis. Fine needle puncture biopsy can detect the secondary origin of the muscle lesion and also the primary tumor site (4 out of 9 cases), bronchopulmonary and colon cancer predominating. Images are however non-specific and in the absence of NMR imaging the muscle or lymph node metastases can be confused, although this has no practice consequences since treatment is identical.

Adult↗
PubMed1988

[X-ray computed tomography in acute pancreatitis].

Diagnostic imaging of acute pancreatitis has been revolutionized by the introduction of computed tomography (CT). The purpose of this report is to review the different CT findings of the disease. The authors emphasize the predictive value of the contrast enhanced CT. It seems to be the most reliable method for detecting the most severe forms of acute pancreatitis and their complications. Correlation of CT findings with clinical and biological prognostic signs allows an easier surgical management.

Abscess↗
PubMed1987

[Idiopathic spontaneous adrenal hematoma in adults: echography and x-ray computed tomography. Apropos of 5 cases].

The five patients presented with sudden lumbar pain, transient collapse, and a right hypochondrium palpable mass. The location and the type of the mass could be determined by ultrasonography which showed a septated heterogenous mass displacing the retroperitoneal fat anteriorly. Computed tomography showed in two cases tiny parietal calcifications and a spontaneous hyperdensity in one case. All the patients underwent surgery and no tumoral tissue could be found.

Adrenal Gland Diseases↗
PubMed1987

[Complications of the treatment of renal calculi by extracorporeal lithotripsy. Prospective evaluation of 80 treated kidneys].

The acute effects of extracorporeal shock wave lithotripsy (ESWL) on morphology and function of the kidney were prospectively evaluated by abdominal radiography, ultrasonography and contrast-enhanced computed tomography, in 80 treated kidneys. Two types of complications were demonstrated: 1. Obstruction of the ureter by stone fragments in 25% of cases. Relief procedures became necessary in 5 patients (6% of the 80 cases). 2. Limited injuries of the kidney and perirenal spaces in 44% of cases: parenchymatous abnormalities 17.5%; subcapsular hematoma 12.5%; perirenal fluid collection 24%. No treatment was necessary and morphologic abnormalities disappeared in one or two months post-ESWL. Severe ureteral obstruction after ESWL seems to be related to stone size. No definitive evidence that kidney's injury was related to the number of shock waves applied to the kidney was found.

Acute Disease↗