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At least 19 recordsLinked to original sources
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

Splenic and portal venous obstruction in chronic pancreatitis. A prospective longitudinal study of a medical-surgical series of 266 patients.

The aim of this study was a prospective search for splenoportal venous obstruction (SPVO) in a medical-surgical series of 266 patients with chronic pancreatitis who were followed up a mean time of 8.2 years. SPVO was systematically searched for using ultrasonography and then confirmed by angiography or computed tomography. SPVO was found in 35 patients (13.2%) but was symptomatic in only two. Initial obstruction involved the splenic vein in 22 patients, the portal vein in 10, and the superior mesenteric vein in three. Since venous obstruction extended from the splenic to the portal vein in five patients, the prevalence of portal obstruction was 5.6% (15/266). Acute pancreatitis and pseudocysts were the probable cause of SPVO in 91.4% of our cases. Half the cases of splenic venous obstruction were related to pseudocysts of the caudal pancreas. Esophageal varices were found in two patients and gastric varices in four at the time of diagnosis and during follow-up. At the end of follow-up, 12 patients had undergone splenopancreatectomy (N = 11) or splenectomy (N = 1). Only one patient was operated on for massive esophageal variceal bleeding, and another patient died due to intractable colic variceal bleeding. In four of six patients operated on with portal vein obstruction, surgery was difficult due to venous collaterals. Ten patients were not operated on and 13 patients operated on were not treated for SPVO. The mean follow-up after diagnosis of SPVO for these final 23 patients was 28.9 months. None of these patients bled.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
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↗
PubMed1991

Giant hemangioma of the liver with pain, fever, and abnormal liver tests. Report of two cases.

In conclusion, we report the cases of two patients with large hemangiomas of the liver, abdominal pain, increased ESR and fibrinogen, increased serum alkaline phosphatase and gamma-glutamyltransferase activity, and normal white blood cell counts. Clinical and biochemical abnormalities disappeared after surgical resection. Increased ESR and fibrinogen are probably related to thrombosis within the tumor. This mode of presentation may suggest a diagnosis of hepatocellular carcinoma.

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

Cholangitis associated with cholecystitis in patients with acquired immunodeficiency syndrome.

Four patients with acquired immunodeficiency syndrome developed severe abdominal pain and fever due to acute acalculous cholecystitis. In all patients, preoperative laboratory data showed elevation of alkaline phosphatase and gamma-glutamyltransferase levels. Endoscopic or intraoperative cholangiography showed signs of intrahepatic and extrahepatic cholangitis. Cholecystectomy was performed and prompt relief of symptoms was achieved in all patients; no postoperative complication was observed. One patient did not develop any recurrence during an 18-month period of follow-up; two patients died 2 and 3 months after the operation. One patient developed recurrent abdominal pain and cholestasis 4 months after the operation, with dilatation of the common bile duct and papillary stenosis due to progression of cholangitis. These observations suggest that cholangitis is frequently associated with cholecystitis in patients with the acquired immunodeficiency syndrome. Its pathogenesis is not known.

Acquired Immunodeficiency Syndrome↗
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↗
PubMed1990

Membranous obstruction of the inferior vena cava and hepatocellular carcinoma in a Caribbean patient.

Membranous obstruction of the inferior vena cava has been reported mainly in South Africa, Japan, and India; in 20-40% of patients the disease is complicated by hepatocellular carcinoma. We report a case of membranous obstruction of the inferior vena cava with hepatocellular carcinoma in a 43-year-old Caribbean man of Indian origin. The Caribbean islands may constitute another geographical area where the population is at risk for the development of membranous obstruction of the inferior vena cava and subsequent hepatocellular carcinoma.

Adult↗
PubMed1990

CT of malignant anal canal tumors.

Radiation therapy of malignant neoplasms of the anal canal has promising results in the majority of patients if the disease is limited at initial diagnosis. Computed tomography (CT), especially when performed with contrast material injected intravenously, is valuable in the pre- and posttreatment assessment of the anorectal musculature and perirectal nodes. The authors review the anatomy of the anorectal area and their experience with CT evaluation of anal canal cancer in a series of 26 patients. They also discuss their experience with treatment of this cancer in a series of 48 patients.

Anal Canal↗
PubMed1990

Staging of esophageal carcinoma: comparison of results with endoscopic sonography and CT.

We compared the results of endoscopic sonography and CT in the preoperative staging of 46 patients with esophageal carcinoma studied prospectively. All patients had surgery and 44 had pathologic examination of the mediastinal and celiac lymph nodes. The results of CT and endoscopic sonography were compared with surgical and pathologic findings. A total of 51 tumors were found in 46 patients. Sonographic estimation of tumor extension through the different layers of the esophagus was correct in 37 (73%) of all 51 tumors and in 22 (85%) of the 26 tumors in which the examination was complete. The echoendoscope (13-mm diameter) could not pass through the tumor in 23 cases (50%). Infiltration to adjacent organs was found in 15 cases at surgery. In four of these 15, the extension was detected by CT; in seven of the 15 cases, it was detected by sonography. False-negative determination of tumor extension occurred with endoscopic sonography in patients with stenotic tumor. There were no false-positive results with either CT or endoscopic sonography. For detection of mediastinal lymph-node involvement, the sensitivity of CT was 48%. The sensitivity of sonography was 50% if metastatic nodes unexplored by sonography were included, or 84% if only cases in which stenosis was passed were considered. Statistical comparison revealed that sonography was superior to CT for the detection of metastases to lymph nodes. CT and endoscopic sonography provide complementary information. When the echoendoscope can be maneuvered past the tumor, sonography can be used accurately to define extension through the layers of the esophagus, extension to the adjacent organs, and involvement of the lymph nodes. When the tumor cannot be passed by the echoendoscope, CT is superior to sonography for detection of mediastinal extension.

Adult↗
PubMed1989

[Diagnosis of disorders affecting hollow intra-abdominal organs].

Modern imaging methods, including ultrasonography, computerized tomography and magnetic resonance imaging, add considerably to the information provided by the classical exploratory methods for hollow intra-abdominal viscera. They evaluate the size of these viscera and especially their wall and they are particularly useful when the lesion is transparietal, submucosal or even sub-adventitial. They also detect abscesses originating in the gastrointestinal tract, measure the extent of tumoral expansion beyond the mucosa and reveal intra-abdominal abnormalities associated with the lesions. The new methods, therefore, are very useful and often indispensable as a complement to other methods used to explore the digestive tract.

Gastrointestinal Diseases↗
PubMed1989

Dopamine effects on diaphragmatic strength during acute respiratory failure in chronic obstructive pulmonary disease.

STUDY OBJECTIVE: To assess the effects of dopamine, which has an inotropic effect on the myocardium and increases renal and splanchnic blood flow, on diaphragmatic contraction. DESIGN AND PATIENTS: We studied the changes in transdiaphragmatic pressure during electrical bilateral supramaximal stimulation of the phrenic nerves in eight patients with chronic obstructive pulmonary disease during acute respiratory failure. In three patients, changes in diaphragmatic blood flow were also evaluated. METHODS: All patients were intubated and artificially ventilated. Stimulated transdiaphragmatic pressure, cardiac output, evaluated with a Swan Ganz catheter, and diaphragmatic blood flow, evaluated by timed volume collections of left phrenic venous effluent (a catheter was introduced into the right femoral vein and advanced into the left inferior phrenic vein) were measured before dopamine infusion, every 10 minutes after the onset of dopamine infusion (10 micrograms/kg body weight.min during 30 minutes) and 15 minutes after the end of dopamine infusion. Arterial blood gases and pH were measured before and at the end of dopamine infusion. MEASUREMENTS AND MAIN RESULTS: Arterial blood gases and pH were maintained within normal range by mechanical ventilation throughout the study. With dopamine infusion, heart rate increased by 17% (P less than 0.001) and cardiac output by 40% (P less than 0.001) on the average. The increase in cardiac output was accompanied by a marked increase in diaphragmatic blood flow (30% on the average) in the three patients in whom it was measured (P less than 0.001). Diaphragmatic strength also increased significantly during dopamine administration. Transdiaphragmatic pressure for an identical phrenic stimulation increased by 30% (P less than 0.001) on the average. The changes in cardiac output, diaphragmatic blood flow, and transdiaphragmatic pressure persisted throughout the infusion period; all values returned to control values 15 minutes after the end of dopamine administration. CONCLUSIONS: Dopamine has a potent effect on diaphragmatic strength generation and diaphragmatic blood flow in patients with chronic obstructive pulmonary disease during acute respiratory failure. It is possible to improve diaphragmatic contraction in these patients by administering pharmacologic agents that augment diaphragmatic blood flow.

Action Potentials↗
PubMed1989

Sonographic diagnosis of cholangitis in AIDS patients.

Eleven acquired immunodeficiency syndrome (AIDS) patients were initially evaluated by ultrasound of the liver because of biochemical evidence of cholestasis. Sonography was very useful for demonstrating dilatation and/or wall thickening of the common bile duct associated with dilated intrahepatic bile ducts. Periportal hypo- or hyperchoic areas were also visualized. In seven patients, gallbladder walls were thickened. In six patients, the diagnosis of cholangitis was confirmed by endoscopic retrograde cholangiography and/or histology. Cytomegalovirus infection or digestive tract cryptosporidiosis were often present and accounted for diarrhea in most patients. We believe the association of upper right quadrant pain and anicteric cholestasis in the course of AIDS is suggestive of cholangitis, but a disparity may exist between mild symptoms and sonographically demonstrated extensive biliary involvement.

Acquired Immunodeficiency Syndrome↗