Ad Integrum Functional and Volumetric Recovery in Right Lobe Living Donors: Is It Really Complete 1 Year After Donor Hepatectomy?

The partial liver's ability to regenerate both as a graft and remnant justifies right lobe (RL) living donor liver transplantation. We studied (using biochemical and radiological parameters) the rate, extent of, and predictors of functional and volumetric recovery of the remnant left liver (RLL) during the first year in 91 consecutive RL donors. Recovery of normal liver function (prothrombin time [PT] ≥70% of normal and total bilirubin [TB] ≤20 µmol/L), liver volumetric recovery, and percentage RLL growth were analyzed. Normal liver function was regained by postoperative day's 7, 30, and 365 in 52%, 86%, and 96% donors, respectively. Similarly, mean liver volumetric recovery was 64%, 71%, and 85%; whereas the percentage liver growth was 85%, 105%, and 146%, respectively. Preoperative PT value (p = 0.01), RLL/total liver volume (TLV) ratio (p = 0.03), middle hepatic vein harvesting (p = 0.02), and postoperative peak TB (p < 0.01) were predictors of early functional recovery, whereas donor age (p = 0.03), RLL/TLV ratio (p = 0.004), and TLV/ body weight ratio (p = 0.02) predicted early volumetric recuperation. One-year post-RL donor hepatectomy, though functional recovery occurs in almost all (96%), donors had incomplete restoration (85%) of preoperative total liver volume. Modifiable predictors of regeneration could help in better and safer donor selection, while continuing to ensure successful recipient outcomes.

[Real-time contrast-enhanced ultrasound in the evaluation of focal liver lesions: diagnostic efficacy and economical issues from a French multicentric study]. / Echographie de contraste temps réel dans la prise en charge diagnostique des lésions nodulaires hépatiques: évaluation des performances diagnostiques et de l'impact économique sur une étude multicentrique française.

The recent introduction of high-end ultrasound equipment combined with recent contrast agents provides marked improvements in the characterization of focal liver lesions as previously reported by monocentric studies. The aim of the present study was to evaluate the diagnostic performance of Contrast-Enhanced Ultrasonography (CEUS) using SonoVue as well as its medico-economic value for characterization of focal liver lesions. These nodules were not characterized on previous CT or conventional sonography. This prospective multicentric study conducted in 15 French centres found diagnostic performances similar to those reported for CT and MRI, with a concordance rate of 84.5%, sensitivity greater than 80% and specificity greater than 90% for all types of lesions. Higher acceptance was found for CEUS compared to other imaging modalities. Economical assessment based on examination reimbursment and contrast agent cost showed a lower cost for contrast ultrasound versus CT and MRI. This French multicentric study confirmed the high diagnostic value of CEUS for focal liver lesion characterization and demonstrated a lower economical impact compared to other imaging modalities such as CT and MRI.

[Doppler ultrasonography in the study of the vascularization of the femur head in newborn infants]. / Etude en échographie Doppler de la vascularisation de la tête fémorale du nouveau-né.

PURPOSE: To establish the effectiveness of color Doppler and power Doppler ultrasound (US) in identifying the arterial supply of the femoral head in newborn. MATERIAL AND METHODS: Sixty normal hips in 30 newborns (mean age: 22 days) were imaged with a 7 MHz transducer. The presence and Doppler characteristics of flow in the branches of the inferior and superior arterial groups were documented according to the anatomic description of Lagrange and Dunoyer. RESULTS: The arterial flow within the chondroepiphysis from the inferior and superior branches was visualized in 100% and 91% cases, respectively. The transversal trochanter major incidence was the most adequate. Abduction without stress did not induce modification of the arterial supply. CONCLUSION: Visualization of femoral head vascularity with Power Doppler and color Doppler US is feasible and consistent in the majority of healthy neonates.

Prenatal MRI diagnosis of fetal cerebral tuberous sclerosis.

Tuberous sclerosis (TS) is an autosomal dominant phakomatosis. A high percentage of spontaneous mutations leads to the diagnosis of new cases in normal families. This diagnosis is suspected at antenatal ultrasound on the discovery of multiple cardiac tumors. Antenatal cerebral ultrasound shows a normal appearance in affected fetuses. Eight fetuses with multiple cardiac tumors were studied with antenatal MRI with, in five cases, an abnormal appearance showing hyperintense subependymal and cortical nodules on T1-weighted images. Among the three remaining patients MRI was non-contributive in one due to movement artefact, one had abnormal postnatal MRI consistent with TS and one had a normal postnatal and clinical examination. We conclude that MRI is a valuable tool in making the diagnosis of TS in fetuses with multiple cardiac tumors.

[Transient ischemic colitis. Diagnostic value of patchy epithelial atrophy]. / Les colites ischémiques transitoires. Valeur diagnostique de l'atrophie épithéliale en aires.

Microscopic findings, observed in 58 colonic biopsies, have been described by the authors during transient ischemic colitis. One of these lesions, closely associated with the diagnosis and named patchy tubular atrophy, was considered as a marker for ischemia. Patchy tubular atrophy was observed at the beginning of the disease, and was regularly associated with normal and necrotic areas. Three morphological aspects characterized this condition: --non secretory glandular crypts covered with rudimentary basophilic epithelium, --crypts regularly distributed in a geometrical pattern with intact connective spaces, --absence of interstitial inflammatory infiltrate, and presence of fibrinous thrombosis with extravasation of erythrocytes. This morphologic pattern was specific enough to rule ou the other inflammatory or trophic bowel diseases. Therefore patchy tubular atrophy, observed during transient ischemic colitis, was considered by authors as a distinct entity.