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Biomedical subjects

V Vilgrain

Publications and source records attributed to V Vilgrain.

At least 19 recordsLinked to original sources
PubMed2006

Utility of staging laparoscopy in subsets of biliary cancers : laparoscopy is a powerful diagnostic tool in patients with intrahepatic and gallbladder carcinoma.

BACKGROUND: The aim of this study was to evaluate the utility of staging laparoscopy in patients with biliary cancers in the era of modern diagnostic imaging. METHODS: From September 2002 through August 2004, 39 consecutive patients with potentially resectable cholangiocarcinoma underwent preoperative staging laparoscopy before laparotomy. Preoperative imaging included ultrasonography and triphasic computed tomography for all patients and magnetic resonance cholangiography in 35 patients (90%). Final pathological diagnosis included 20 hilar cholangiocarcinomas (HC), 11 intrahepatic cholangiocarcinomas (IHC), and eight gallbladder carcinomas (GBC). RESULTS: During laparoscopy, unresectable disease was found in 14/39 patients (36%). The main causes of unresectability were peritoneal carcinomatosis (11/14) and liver metastases (5/14). At laparotomy, nine patients (37%) were found to have advanced disease precluding resection. Vascular invasion and nodal metastases were the main causes of unresectability during laparotomy (eight out of nine). In detecting peritoneal metastases and liver metastases, laparoscopy had an accuracy of 92 and 71%, respectively. All patients with vascular or nodal involvement were missed by laparoscopy. For prediction of unresectability disease, the yield and accuracy of laparoscopy were highest for GBC (62% yield and 83% accuracy), followed by IHC (36% yield and 67% accuracy) and HC (25% yield and 45% accuracy) CONCLUSION: Staging laparoscopy ensured that unnecessary laparotomy was not performed in 36% of patients with potentially resectable biliary carcinoma after extensive preoperative imaging. In patients with biliary carcinoma that appears resectable, staging laparoscopy allows detection of peritoneal and liver metastasis in one third of patients. Both vascular and lymph nodes invasions were not diagnosed by this procedure. Due to these limitations, laparoscopy is more useful in ruling out dissemination in GBC and IHC than in HC.

Adult↗
PubMed2006

Sequential arterial and portal vein embolizations before right hepatectomy in patients with cirrhosis and hepatocellular carcinoma.

BACKGROUND: Selective transarterial chemoembolization (TACE) and portal vein embolization (PVE) could improve the rate of hypertrophy of the future liver remnant (FLR) in patients with chronic liver disease. This study evaluated the feasibility and efficacy of this combined procedure. METHODS: Between November 1998 and October 2004, 36 patients with cirrhosis and hepatocellular carcinoma underwent right hepatectomy after PVE. Additional TACE preceded PVE by 3-4 weeks in 18 patients (TACE+PVE group) and the remaining 18 patients had PVE alone (PVE group). RESULTS: PVE was well tolerated in all patients. The mean increase in percentage FLR volume was significantly higher in the TACE+PVE group than in the PVE group (mean(s.d.) 12(5) versus 8(4) percent; P=0.022). The rate of hypertrophy was more than 10 percent in 12 patients in the TACE+PVE group and in five who had PVE alone (P=0.044). Duration of surgery, blood loss, incidence of liver failure and mortality (two patients in each group) were similar in the two groups. None of the 17 patients with an increase in FLR volume of more than 10 percent died, whereas there were four deaths among 19 patients with a smaller increase. The incidence of complete tumour necrosis was significantly higher in the TACE+PVE group (15 of 18 versus one of 18; P<0.001), with a higher 5-year disease-free survival rate (37 versus 19 percent; P=0.041). CONCLUSION: Sequential TACE and PVE before operation increases the rate of hypertrophy of the FLR and leads to a high rate of complete tumour necrosis associated with longer recurrence-free survival.

Aged↗
PubMed2006

[Isolated or multifocal segmental intrahepatic bile duct dilatation: management].

Segmentary dilatation of intrahepatic bile ducts are well depicted with ultrasound. Two groups of diseases could be differentiated by searching a liver mass: biliary diseases without any tumor or dilatation of biliary duct due to an adjacent liver mass. Inside these two groups, some diseases are frequent and other not. We will emphasize autoimmune cholangitis and (Low Phospholipid Associated Cholelithiasis) LPAC with MDR3 deficiency. Decisional trees are proposed.

Adult↗
PubMed2005

Endocrine pancreatic tumours and helical CT: contrast enhancement is correlated with microvascular density, histoprognostic factors and survival.

PURPOSE: To assess the role of contrast-enhanced helical CT in the evaluation of tumour vascularity in endocrine pancreatic tumours (EPTs), and to determine the predictive factors of malignancy of EPTs at helical CT with CT-histopathological correlation. MATERIALS AND METHODS: Thirty-seven consecutive patients with histopathologically proven EPTs underwent dual-phase helical CT. For each tumour detected, its density relative to the surrounding parenchyma was scored on the pancreatic phase using a 5-point scale. Radiological findings were correlated with histopathological (vessel density count) and clinical follow-up findings. RESULTS: Thirty of 37 patients had non-functioning EPTs and overall 44 tumours were detected by helical CT (mean size 38, range 5-100 mm). CT showed calcifications in 10 tumours. Calcifications were associated with well-differentiated carcinomas (90%, p = 0.02). Vascular density assessed by light microscopy was significantly correlated with tumour enhancement at the pancreatic phase (p = 0.0001). Poorly differentiated carcinomas were less vascularised than well-differentiated tumours and carcinomas (34 vs. 264 vessels/mm2, p = 0.0073). Tumour differentiation also correlated with tumour enhancement at the pancreatic phase (p = 0.0044, trend test): poorly differentiated carcinomas were hypoattenuating (71%) and isoattenuating or weakly hyperattenuating (29%), compared with well-differentiated carcinomas and tumours that were mainly moderately or strongly hyperattenuating (53%). In univariate analysis, poor tumoral differentiation, hepatic metastasis, high mitotic index, poor tumoral enhancement at the pancreatic phase and less vascularised tumours were correlated with decreased survival rate. CONCLUSION: Enhancement of EPT at CT is correlated with tumour vascularity assessed by light microscopy. Low-enhancing EPT at CT are correlated with poorly differentiated EPT and with a decrease in overall survival.

Adult↗
PubMed2005

[Intraductal papillary mucinous tumours of the pancreas: imaging features].

IPMTP is a pancreatic duct disease that can better be diagnosed due to advances in imaging techniques. This probably explains the recent increased frequency of this disease. Enlargement of the main pancreatic duct and/or branch ducts is a typical feature. CT and MRI with MRCP are useful for diagnosis. Features of malignant degeneration are better known. Preoperative staging is performed at CT. Differential diagnosis includes main pancreatic duct dilatation and pancreatic cysts. Recent papers indicate that isolated side branch IPMTP is less frequently malignant. Surgery is indicated in the presence of acute pancreatitis or suspicion of malignant degeneration. Imaging is useful for the follow up of patients with isolated side branch IPMTP. In this paper, the diagnostic, staging and malignant features of IPMTP will be reviewed.

Carcinoma, Pancreatic Ductal↗
PubMed2005

Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation.

BACKGROUND AND AIMS: Splanchnic vein thrombosis is a significant source of complications in candidates for liver transplantation. The aims of this study were: (a) to determine the prevalence of and risk factors for splanchnic vein thrombosis in cirrhotic patients awaiting transplantation and (b) to assess the usefulness of anticoagulation. METHODS: A total of 251 cirrhotic patients listed for transplantation were analysed. All underwent systematic screening for thrombosis with Doppler ultrasonography. During the second period of the study, all patients with thrombosis received anticoagulation up to transplantation while during the first period none had received anticoagulation. RESULTS: The incidence of splanchnic vein thrombosis at evaluation was 8.4%. Seventeen additional patients (7.4%) developed de novo thrombosis after evaluation. Independent risk factors for thrombosis were low platelet count (77.4 (36.3) v 111.6 (69.2) 10(9)/l; p = 0.001), a past history of variceal bleeding (47.4% v 29.1%; p = 0.003), and a prolonged interval from listing to transplantation (8.5 (6.8) v 4.8 (4.4) months; p = 0.002). The proportion of partial or complete recanalisation was significantly higher in those who received (8/19) than in those who did not receive (0/10, p = 0.002) anticoagulation. Survival was significantly lower in those who had complete portal vein thrombosis at the time of surgery (p = 0.04). CONCLUSION: These results support a systematic screening for splanchnic vein thrombosis in patients awaiting transplantation. They suggest that in these patients, anticoagulation is safe and has a significant impact on recanalisation as well as prevention of extension of thrombosis.

Adolescent↗
PubMed2003

[Multidetector CT and MRI of malignant liver tumors].

This chapter summarizes technical aspects of multidetector row helical CT and MR imaging of malignant liver tumors. Respective role of these examinations is shown in relation to the type of the tumors (hepatocellular carcinoma or liver metastases) and to the indications of imaging: diagnosis or pretreatment staging.

Aftercare↗
PubMed2002

[Acute clinical pancreatitis following selective transcatheter arterial chemoembolization of hepatocellular carcinoma].

Acute pancreatitis can complicate non-selective transcatheter arterial embolization of hepatocellular carcinoma with an incidence ranging from 1,7% (acute clinical pancreatitis) to 40% (biological pancreatitis). This complication is thought to be related to embolization of extrahepatic arterial collaterals. We report herein a case of acute clinical pancreatitis developing within 24 hours after a second course of selective transcatheter arterial chemo-embolization into the proper hepatic artery. Neither anatomical arterial variation nor particular risk factor for acute pancreatitis could be identified. This complication is unusual after selective arterial embolization. Because it may clinically mimick a postembolization syndrome, dosage of serum pancreatic enzymes should be performed systematically in case of abdominal pain following chemoembolization.

Acute Disease↗
PubMed2002

Management of spontaneous rupture of liver tumours.

Spontaneous ruptures of a liver tumour are often considered as a potentially life-threatening situation. The aim of the present study was to evaluate both clinical features and treatment in a subgroup of patients with ruptured liver tumours. From 1995 to 2000, 20 patients were referred to our centre for spontaneous rupture of a liver tumour associated with haemoperitoneum. Hepatocellular carcinoma (HCC) was present in 13 patients (11 men and 2 women) aged from 48 to 72 years (mean 62) and adenoma in 7 women aged from 23 to 52 years (mean 35). Although all patients experienced sudden abdominal pain and anaemia, shock at admission was present in 4 (20%) patients including 3 with HCC. In patients with HCC, severe liver insufficiency (Child-Pugh C) was present in 5 cases including the 3 shocked patients. No treatment was undertaken in 2 patients, transarterial embolization was performed in 9 cases and 5 patients underwent delayed resection. In hospital, mortality was observed in 3 (23%) patients, all of them had severe liver insufficiency. Long-term survival was observed in patients with good liver function who underwent resection. In patients with adenoma, shock at admission was observed in only 1 patient under anticoagulation treatment. Emergency resection was performed in 3 cases. A decrease of the tumour size was observed in patients who underwent delayed resection resulting in a lower rate of peri-operative transfusion. In conclusion, this study confirms that the majority of patients with ruptured liver tumours had no evidence of haemodynamic instability and therefore should be initially managed conservatively. In patients with single ruptured HCC associated with good liver function, long-term survival can be observed after liver resection. Delayed resection facilitated the operative procedure in patients with ruptured adenoma.

Aged↗
PubMed2002

[Liver anatomy: CT and MRI].

Computed tomography and magnetic resonance imaging are widely used tools to appreciate liver anatomy. Vascular and segmental anatomy are adequately appreciated with CT, while biliary anatomy is mainly seen with MR imaging. Basic principles of techniques and anatomical landmarks will be detailed.

Hepatic Veins↗
PubMed2002

[Liver and vascular abnormalities].

The liver is a parenchyma which contains many vessels. They are composed of two inflow vessels: the portal vein and the hepatic artery, and one outflow system represented by the hepatic veins. We will see in the chapter most of the abnormalities and their consequences due to decrease or an increase of the blood flow of these vessels. Many illustrations will be provided with a special focus on CT findings with multiphasic images.

Female↗
PubMed2001

MRI of unusual lesions in the internal auditory canal.

We report the MRI findings of six unusual lesions of the internal auditory canal: three haemangiomas, one lipoma, one metastasis and one traumatic neuroma. We compare the findings to those of 20 intracanalicular schwannomas. We noted the site and size of the tumour, its signal intensity, borders and the homogeneity of enhancement were studied on T1-weighted images before and after intravenous contrast medium and T2-weighted images. Most schwannomas were homogeneous lesions, isointense on T1- and T2-weighted images, and strongly enhancing. Spontaneous high signal on T1-weighted images, heterogeneous contrast enhancement and extranodular enhancement were helpful for recognising lesions other then schwannomas; site, size and signal on T2-weighted images were not. All the haemangiomas had a specific pattern of contrast enhancement, with an anterior core intensely enhancing portion and a posterior portion which enhanced moderately or not at all.

Adult↗
PubMed2001

Assessment of the benefits and risks of percutaneous biopsy before surgical resection of hepatocellular carcinoma.

BACKGROUND/AIMS: Because of a potential risk of needle tract seeding, the use of ultrasound (US)-guided biopsy for the diagnosis of hepatocellular carcinoma (HCC) is controversial. This study was aimed at determining the usefulness, accuracy and safety of this technique as well as the incidence of needle tract seeding. METHODS: From 1986 to 1996, 137 patients who underwent resection or transplantation for suspected HCC had US-guided biopsy before surgery. The analysis of the resected liver was compared to the results of biopsy. Patients were assessed with a mean follow up of 38 months. RESULTS: The diagnosis of HCC was established by biopsy in 122 patients (89%). Thirteen of the 15 patients with negative biopsy were shown to have HCC after surgery. The remaining two patients had non-malignant nodules. Sensitivity and accuracy of US-guided biopsy were 90 and 91%, respectively. Accuracy was significantly influenced by the location of the nodule but not by its size. Needle tract seeding occurred in two patients (1.6%). CONCLUSIONS: In this series, the incidence of needle tract seeding was less than 2% and no recurrence was observed after local excision. This risk should be balanced with the risk of deciding an aggressive treatment in a patient without malignancy. Patients with negative biopsy should undergo a second biopsy and/or repeated investigations by imaging techniques.

Adult↗
PubMed2001

Radiofrequency liver ablation: experimental comparative study of water-cooled versus expandable systems.

OBJECTIVE: We evaluate the uniformity and reproducibility of thermal lesion ablation and quantify the volume of tissue destruction and hemorrhage induced with two different commercially available radiofrequency ablation devices. MATERIALS AND METHODS: A four-array anchor expandable needle electrode and a triple-cluster cooled-tip needle electrode were used to induce lesions in three explanted calf livers and in vivo in eight swine livers. The sizes of the radiofrequency-induced lesions were macroscopically evaluated by measuring two perpendicular dimensions immediately after the experiment. Bleeding was evaluated by weighing gauze swabs used to dry the hemorrhage caused by electrode insertions. RESULTS: In explanted liver, the mean diameter of the radiofrequency-induced lesion was 5.3 +/- 0.7 cm for the cooled-tip needle and 3.7 +/- 0.4 cm for the expandable needle (p = 0.042), which correspond to approximate volumes of 65.35 +/- 26.22 cm(3) and 26.67 +/- 9.59 cm(3), respectively (p < 0.002). In vivo, the mean diameter was 3.7 +/- 0.4 cm for the cooled-tip needle and 3 +/- 0.4 cm for the expandable needle (p < 0.0001), which correspond to approximate volumes of 24.18 +/- 7.56 cm(3) and 11.16 +/- 3.65 cm(3), respectively (p < 0.0001). Blood loss attained a median value of 3.5 g for the cooled-tip needle and 2.6 g for the expandable needle; this difference was not statistically significant (p = 0.06). CONCLUSION: The cooled-tip needle induced significantly larger lesions than the expandable needle, but the lesions produced by the expandable needle are more reproducible, uniform, and spheric. The larger size of the lesions produced by the cooled-tip needle may be attributed to the higher maximum power used by the generator and the higher energy deposition, which is due to the cooling of the needle electrode.

Animals↗