Complete necrosis of hepatocellular carcinoma after preoperative portal vein embolization: a case report.

BACKGROUND: Hepatocellular carcinoma has a poor prognosis; few patients can undergo surgical curative treatment according to Barcelona Clinic Liver Cancer guidelines. Progress in surgical techniques has led to operations for more patients outside these guidelines. Our case shows a patient with intermediate stage hepatocellular carcinoma presenting a good outcome after curative treatment. CASE PRESENTATION: We report the case of an 80-year-old Moroccan man, who was positive for hepatitis c virus, presenting an intermediate stage hepatocellular carcinoma (three lesions between 20 and 60 mm). He presented a complete tumor necrosis after portal vein embolization and achieved 24-month disease-free survival after surgery. CONCLUSIONS: Perioperative care in liver surgery and multidisciplinary discussion can help to extend indications for liver resection for hepatocellular carcinoma outside European Association for the Study of the Liver/American Association for the Study of Liver Diseases recommendations and offer a curative approach to selected patients with intermediate and advanced stage hepatocellular carcinoma.

Anterior ischemic optic neuropathy complicating interferon alpha and ribavirin therapy in patients with chronic hepatitisC.

Ophthalmological complications with interferon therapy are rare, usually mild and reversible, and do not require the withdrawal of antiviral treatment. Anterior ischemic optic neuropathy is an uncommon complication of interferon treatment. From January 1998 to December 2007, three patients developed anterior ischemic optic neuropathy during antiviral treatment, with a favourable course after interferon was discontinued. Periodic Ophthalmological examinations, including visual acuity and fundus examinations should be performed before starting and during treatment, particularly in patients with vascular risk factors. Antiviral therapy should be stopped immediately if severe ophthalmologic complications occur.

Thyroid disorders during interferon alpha therapy in 625 patients with chronic hepatitis C: a prospective cohort study.

AIM: to report the prevalence, risk factors, management and long-term outcome of thyroid disorders caused by INFalpha in patients with chronic hepatitis C. PATIENTS AND METHODS: From January 1991 to December 2004, 625 patients with chronic hepatitis C underwent INFalpha therapy. TSH assay was normal and antithyroperoxidase antibodies (anti-TPO) was performed before onset antiviral treatment; then TSH was performed every 2 months in all patients during therapy, and every 3 months after treatment. RESULTS: 58 patients developed thyroid disorder (8.9%). Mean age was 50.6+/-13 years; sex ratio: 1 M/2 F; the anti-TPO antibodies were positive before onset antiviral treatment in 9 patients (13.8%). 26 patients developed hypothyroidism (44.8%), 9 patients developed hyperthyroidism (15.5%) and among them 3 cases of Grave's disease. Biphasic thyroiditis occurred in 21 patients (36.2%), anti-TPO increase during treatment in 2 patients (3.5%) without hypothyroidism. The dysthyroidism was more frequent in risk in female gender (p<0.05) and in the group with positive antiTPO antibodies before treatment (p<0.02). CONCLUSION: Female gender and positive antiTPO antibodies are the predictive factors of development of the thyroid dysfunction during INFalpha therapy.

[Hepatitis C and diabetes mellitus: effect of diabetes on the course of the liver disease]. / Hépatite virale C et diabète: influence du diabète sur l'évolution de l'hépatopathie.

UNLABELLED: The prevalence of diabetes mellitus is higher in chronic hepatitis C than in hepatitis B, even without cirrhosis. OBJECTIVE: To study the host, specific viral factors associated with diabetes mellitus and the influence of diabetes mellitus on the intensity of steatosis and the severity of fibrosis. MATERIAL AND METHODS: The following data were collected in a cohort of 1249 patients with chronic hepatitis C established between December 1991 and June 2004: age, gender, body mass index (BMI). None of the patients were under treatment for their liver disease. Serum transaminase level and hepatitis C serology with search for viral RNA, viral load and genotype were obtained. The Metavir score, iron overload using the Perls score (0-4) and steatosis class (0-3) were determined on liver biopsies. RESULTS: Mean patient age was 52.5+/-10 years (56% male). Mean BMI was 24.6+/-24 kg/m2. Forty-three patients (17.2%) presented diabetes mellitus. The mean duration of their diabetes was 8.9 years. Genotype 1 predominated (60.4%) and mean viral load was 7.7x10(6) eq.v/ml. Steatosis was present in 69.7% of the diabetic patients versus 17% of the non-diabetic patients. Grade 2 fibrosis (F2) was observed in 32.5% of diabetic patients versus 29% in non-diabetic patients and F3, F4 in 73% of the diabetic patients versus 57% of the non-diabetic patients. Comparison between diabetic and non-diabetic patients demonstrated an absence of statistically significant difference (at 5%) between the groups for gender, viral load and genotype. Diabetic persons were older (58.7 years against 51 years) and liver biopsy revealed steatosis and fibrosis (F3, F4) more often in diabetic patients (69.7% versus 49.5%). CONCLUSION: These findings suggest that steatosis could favor progression of fibrosis in diabetics with chronic hepatitis C.

[Glomus tumor of the leg: a case report]. / A propos d'une tumeur glomique de la jambe.

Glomus tumor is an uncommon benign neuromyoarterial tumor. It most frequently involves the fingers, and only rarely involves other sites. The clinical, imaging and therapeutic considerations regarding a glomangioma of the leg in a 65-year-old-man are reviewed.

[Erosive pustulosis of the scalp: 3 cases]. / Pustulose érosive du cuir chevelu: 3 cas.

BACKGROUND: Erosive pustulosis of the scalp is a rare entity of unknown etiology mainly affecting elderly people. It is often triggered by local trauma and features chronic pustules of the scalp evolving toward scarring alopecia. Its treatment is not yet codified. OBSERVATIONS: Two patients (66 and 87 years old) presented with crusted and erosive pustules of the scalp following surgical removal of actinic keratosis and total skin graft. In a third patient, similar lesions appeared after hair grafting. Clinical features were consistent with the clinical pattern of erosive pustulosis of the scalp. In all three patients, oral zinc gluconate in combination with topical steroids associated resulted in significant improvement. CONCLUSION: An association of topical steroids and oral zinc gluconate might be an interesting therapeutic option in this chronic, often disabling affection.

[Imaging of urinary Candida bezoars]. / Imagerie des bézoards candidosiques urinaires.

OBJECTIVES: To describe the renewed interest in Candida infections in general and urinary tract infections in particular, due to a recrudescence of immunodepressed patients and a better knowledge of their clinical and radiological manifestations. MATERIAL AND METHODS: The authors report 2 cases of Candida bezoars diagnosed by IVU, ultrasonography and CT scan in two insulin-dependent diabetics. RESULTS: The first case presented with right renal involvement, in the form of delayed renal secretion on IVU with the presence of a pelvic filling defect, dilatation of the upper tract cavities on ultrasonography with a dilated renal pelvis occupied by an echogenic formation with no posterior acoustic shadow. CT showed a slightly heterogeneous low-density lesion with no contrast enhancement. The second case presented with right pelvic and vesical involvement. The diagnosis of urinary candidiasis was confirmed, in the first case, by the presence of whitish lumps on catheterization, for which analysis and culture were in favour of candidiasis and, in the second case, by direct examination and urine culture. Treatment with amphotericin B led to improvement followed by disappearance of the signs in both cases. CONCLUSION: In addition to laboratory examinations, noninvasive imaging techniques, mainly ultrasonography and CT, but also percutaneous aspiration, constitute a decisive element in the diagnostic and therapeutic management of urinary candidiasis.

[Apropos of a case of acute pancreatitis revealing cystic dilatation of the common bile duct]. / A propos d'un cas de pancréatite aiguë révélant une dilatation kystique du cholédoque.

Dilatation of the common bile duct is rarely caused by cystic formations. Though the pathogenesis is uncertain, congenital disorders have been suggested. Most cases are observed in small children (80% female predominance) with only 20% of the cases reported in adults. Clinical signs vary. Recurrent acute pancreatitis has been reported but is rare. New imaging techniques using CT-scan cholangiography and sometimes MR cholangiography have greatly improved the diagnostic approach. MR of the bile ducts is a recent noninvasive technique enabling an analysis of the biliopancreatic ducts without contrast injection into the bile. To our knowledge, cystic dilatation of the common bile duct has not been previously reported in the literature. We report an interesting case in a 25-year-old woman who developed an episode of acute pancreatitis during the post partum period. We describe the clinical aspects and the different imaging findings, including magnetic resonance cholangiography results.

[Rare cause of ischemic cerebrovascular infarct in a young patient: cardiac hydatic cyst]. / Cause rare d'accident vasculaire cérébral ischémique chez le sujet jeune: le kyste hydatique cardiaque.

The authors report the case of a 28-year-old man in whom the diagnosis of hydatic cyst of the heart was strongly suspected on echocardiography and CT-scan and confirmed by surgery. The interest of this case is based the total clinical latency of this hydatic cyst discovered by echocardiography during a systematic checkup for cerebrovascular disorders. Echocardiography and spiral scanography with bidimensionnal reconstruction in coronal and sagittal planes allowed a rapid anatomic and topographic diagnosis. CT-scan also identified spread of echinococcosis and discovered a calcifield hydatid cyst of the liver and a multivesicular hydatid cyst of the left kidney.

[Rare cases of bladder tumors]. / A propos de cas rares de tumeurs de vessie.

Among epithelial tumors, squamous cell carcinomas represent only 3 to 7% of the cases in the temperate countries, but constitute the most frequent histologic kind in bilharzien endemic zones and 17% of intradiverticulars tumors. The adenocarcinoma is found most often in the bladder dome, representing only 0.3 to 3% of all bladder tumors. Invasive cancer in a neighboring organ (digestive tract, genital organs) must be eliminated. In most cases, combining ultrasonography and intravenous urography can be helpful for diagnosis of intradiverticular carcinoma or bladder dome tumor. Computed tomography and magnetic resonance images are the best methods for positive diagnosis and extension exploration for tumors of the dome and base of the bladder. In this work, we report a series of five cases of uncommon bladder carcinoma. Three of the cases were intradiverticular squamous cell tumors and two were adenocarcinoma of the bladder dome.

[MRI and bladder leiomyoma]. / IRM et léiomyome vésical.

Unlike epithelial tumors, connective tissue tumors are uncommon, representing only 3% of all bladder tumors. Leiomyoma of the bladder is the most frequent non-epithelial benign tumor of the bladder. Magnetic resonance imaging (MRI) is highly useful for diagnostic purposes and to determine the degree of extension. Only few reports of sonographic findings have been reported for leiomyoma of the bladder. The tumor usually develops within the bladder. Extravesicular formations have also been reported as well as a few intramural localizations. The characteristic feature is the absence of mucosal involvement. We analyzed the MRI findings in a case of leiomyoma of the bladder with intra and extravesicular development, inflammatory reaction of the bladder wall and uterine adherences in a woman with a past history of chronic cystitis. The role of diagnostic MRI is discussed.

[Leiomyosarcoma of the inferior vena cava and magnetic resonance imaging]. / Léiomyosarcome de la veine cave inférieure et imagerie par résonance magnétique nucléaire.

Venous leiomyosarcomas are rare and predominantly arise in the inferior vena cava (IVC). The clinical findings, often not very suggestive and nonspecific, sometimes precede the diagnosis by several years. According to the literature, leiomyosarcoma of the IVC generally occurs in middle-aged women. Modern imaging techniques, especially magnetic resonance imaging (MRI) can now establish the diagnosis of leiomyosarcoma of the IVC with a high probability and allow assessment of operability. The authors report a case of leiomyosarcoma of the IVC in a 24-year-old male patient, confirmed by intravenous biopsy. They present the MR features of this malignant tumour, rarely reported in the literature, and emphasize the value of this examination in the operability staging. The 3D imaging provided by MRI allows intra and extraluminal staging and involvement of adjacent organs. It also allows optimal evaluation of the effects on flow, circulatory slowing or thrombosis and, due to its high contrast resolution, it is more sensitive to distinguish clot from tumour nodule.

[Vascular involvements in Behçet disease. Based on 40 patient records]. / Les atteintes vasculaires de la maladie de Behçet. A propos de 40 dossiers.

The authors report about 40 cases of Behçet's disease with vascular involvement, i.e. 32% of a 125 case series. The results were marked by the high frequency of venous involvement (36 cases, including 28 thrombophlebitis of the deep trunks of the lower limbs) and the rarity of arterial involvement (6 cases). Arterial and venous involvements were associated in only 2 cases. Inferior vena caval thrombosis was recognized in 4 cases, including 3 with associated lower limb thrombosis. Superior vena caval thrombosis is found in 6 cases. Superior cavography has allowed demonstrating thrombosis and assessing its extent, to the innominate veins in all cases, to the subclavian veins in 3 cases, and to the axillary veins in 1 case. Cases of arterial involvement include 5 cases of pulmonary arterial aneurysm and 1 of upper limb arteritis affecting the humeral and cubital arteries. It has been revealed by hemoptysis in all cases. Angiography has allowed establishing the diagnosis of aneurysm in 4 cases (3 with partial thrombosis and 1 without thrombosis). CT revealed the diagnosis of completely thrombosed aneurysms not opacified by angiography in another case.