Unresectable hepatocellular carcinoma: survival and prognostic factors after lipiodol chemoembolisation in 89 patients.

BACKGROUND: The majority of patients with hepatocellular carcinoma are not eligible for surgical radical treatment (resection or liver transplantation) and lipiodol chemoembolisation is an efficient alternative procedure in this indication. AIMS: To identify prognostic factors in patients treated with lipiodol chemoembolisation. PATIENTS AND METHODS: During 10 years, 89 consecutive patients with unresectable hepatocellular carcinoma underwent lipiodol chemoembolisation as a single treatment. There were 80 males and 9 females, with a median age of 65 years. Treatment consisted of one to six courses of hepatic intra-arterial lipiodol with doxorubicine and gelatin sponge. RESULTS: The median survival was 13 months with a 13.6% survival rate at 4 years. Univariate analysis showed that serum levels of albumin, bilirubin, alkaline phosphatase and alpha-fetoprotein, Child's class, tumour type, tumour size and intensity of lipiodol capture after the first course of lipiodol chemoembolisation were significant prognostic factors of survival. In the multivariate analysis, four parameters remained associated with a significantly better outcome: Child's class A, largest lesion<5 cm, uninodular tumour and intense lipiodol capture. CONCLUSIONS: While lipiodol chemoembolisation is associated with good results only in some patients, in the absence of lipiodol capture, it should be ruled out.

Endovascular Doppler guide wire in renal arteries. Correlation with angiography in 20 patients.

RATIONALE AND OBJECTIVES: To evaluate the feasibility of endovascular Doppler recording in renal arteries and to compare the reliability of Doppler parameters for detection of renal artery stenosis. METHODS: The authors examined 36 renal arteries in 20 patients with a 0.018" endovascular flow wire. Peak systolic velocity and the renal artery-to-aortic peak were measured in the main renal artery. From intrarenal waveforms, acceleration, acceleration time, and the renal resistive index were obtained. Spectral analysis with consensus scoring of early systolic peak was also performed. RESULTS: Twelve significantly stenosed renal arteries and 26 normal renal arteries were examined with the Doppler guide wire, without complications. Peak systolic velocity was the only parameter significantly different in renal artery stenosis (P = 0.037). Peak systolic velocity also differed significantly between hypertensive and normotensive patients. Tardus parvus was specific for severe renal artery stenosis. CONCLUSIONS: Endovascular Doppler is a safe and accurate method for the determination of velocity measurements and may be useful during percutaneous renal artery revascularization.

[General review of the value of hepatic MRI in the diagnosis and preoperative staging of liver metastasis from colon and rectum cancer]. / Intérêt de l'IRM hépatique dans le diagnostic et le bilan préopératoire des métastases hépatiques des cancers colo-rectaux.

Hepatic resection of secondary liver neoplasms is currently the only potentially curative therapy for patients with primary colorectal carcinoma. Long-term survival is closely related to stage, regardless of the number, size and distribution of liver lesions. Preoperative detection of liver metastases is crucial in patient staging and imaging techniques must be as accurate as possible to evaluate whether hepatic resection can be performed. Among the various strategies applied to the preoperative detection of liver metastases, CT with intra-arterial portography (CTAP) has been found to be the most sensitive technique. It is an invasive evaluation with a reported sensitivity ranging from 81 to 94% but with 6 to 15% of false-positive results. Recent studies demonstrate that MRI with superparamagnetic iron oxide has an equivalent sensitivity and specificity to CTAP. This paper reviews the technique of MRI, evaluates its sensitivity and specificity, and presents the advantages and draw backs of the technique.

Acute gastroduodenal peptic ulcer perforation: contrast-enhanced and thin-section spiral CT findings in 10 patients.

BACKGROUND: To describe contrast-enhanced and thin-section spiral computed tomography (SCT) findings in patients with acute gastroduodenal peptic ulcer perforation (GPUP). METHODS: Abdominal SCTs in 10 patients with confirmed acute perforated gastroduodenal (GD) peptic ulcer were retrospectively reviewed. Patients were 24-76 years old (mean = 44 years); seven were men and three were women. Diagnosis of GD peptic ulcer was done by endoscopy or surgery. Eleven ulcers were identified, two in the antrum and nine in the duodenum. SCTs were obtained after intravenous contrast medium without oral administration. Slice thickness was 3 or 5 mm. CT findings were correlated with surgical (n = 5) or endoscopic (n = 5) findings. RESULTS: Eight patients had pneumoperitoneum. All patients had evidence of GD wall thickening and enhancement and inflammatory changes in perigastroduodenal soft tissues or organs. Discontinuity in the GD wall and/or tiny air bubbles in close proximity indicated the site of perforation in eight cases. CONCLUSIONS: Abdominal SCT enables diagnosis and location of GPUP. A well-controlled prospective study with a larger group is needed to determine the sensitivity and specificity of this technique.

Comparative assessment of digital and analog radiography: diagnostic accuracy, cost analysis and quality of care.

OBJECTIVE: The aim of this study was to compare digital and conventional radiography for diagnostic accuracy, direct costs, and quality of care. MATERIALS AND METHODS: Diagnostic accuracy was assessed by a critical review of the literature on sensitivity, specificity and ROC analysis of these imaging techniques and by a survey with a panel of radiologists. Direct costs and quality of care were evaluated with a before/after study of the implementation of digital radiography in a Department of Radiology in 'Hospices Civils de Lyon' (France). We included 292 patients and measured duration of examinations and direct costs of equipment, films, maintenance and depreciation. To evaluate any changes in working conditions and patient management, a questionnaire was filled out by the staff of the department. RESULTS: Diagnostic accuracy with digital radiography was equivalent to that of conventional radiography but there were wide variations depending on the type of examination. In 1993, although digital radiography resulted in savings of FF 18,000 including tax (US$ 3600) on film consumption for 1 year of examinations, there was a global additional cost of FF 253,000 (US$ 50,600) for maintenance and depreciation. Results showed a nonsignificant tendency to reduced procedure times for all examinations. Working conditions improved, including greater availability for the patient, improved safety, and increased job interest. CONCLUSION: Digital radiography can be introduced into a large hospital to improve patient and staff conditions, at a higher cost than analog radiography, and depending on the type of examinations performed by the radiology department.

[Portasystemic anastomosis by transjugular approach: treatment of active and refractory hemorrhage caused by rupture of esophageal varices. Results in 11 patients]. / Anastomose porto-systémique par voie transjugulaire: traitement de l'hémorragie par rupture de varices oesophagiennes active et réfractaire. Résultats chez 11 malades.

OBJECTIVE: The aim of this study was to assess the feasibility and efficacy of transjugular intrahepatic portosystemic shunts for refractory variceal bleeding, uncontrolled by sclerotherapy or endoscopic ligation. METHODS: 11 patients (mean age: 52 years) with cirrhosis admitted for refractory haemorrhage from ruptured oesophageal varices were included in this study. Eight patients were Child-Pugh class C. All patients were actively bleeding. RESULTS: All the procedures were successful. Variceal haemorrhage stopped within 24 h. There was no mortality during the procedure. Early complications such as rebleeding (18%) and thrombosis (18%) occurred. Thirty days mortality was 27%. Follow-up in the 8 surviving patients was 19.5 +/- 8 months. Three patients developed recurrent bleeding, from non-variceal sources in 2. In 4 surviving patients, occlusion of the shunt was treated with dilatation or insertion of a second stent. The incidence of hepatic encephalopathy was 25%. Five patients subsequently underwent liver transplantation. Among the 3 patients ineligible for transplantation, one died of hepatocellular carcinoma after 10 months. The 2 others were alive after 19 and 25 months, respectively. CONCLUSIONS: These results suggest that transjugular intrahepatic portosystemic shunt is a safe and effective procedure of portal decompression in patients with refractory variceal bleeding. Prospective trials comparing this percutaneous procedure and surgical treatment are required.