[Organized colorectal screening in French Community of Belgium and polyp surveillance]. / Le dépistage organisé du cancer colorectal en Communauté française de Belgique et surveillance des polypes.

Colorectal cancer is an important health care problem in Belgium and screening is now widely recommendend. The French Community has launched in March 2009, a campaign to build public and professional awareness of the importance of screening for colorectal cancer. With the goal of encouraging all persons age 50 to 74 to actively gain information and seek screening with the active participation of their house doctors, the campaign will work to clarify any myths or fears about screening options and ensure that the importance of screening and early detection will be understood. The program in the French Community propose guaiac-based fecal occult blood testing for average risk people and, in case of positivity a colonoscopy must be performed. A high quality colonoscopy should be offered first in case of significant personal and familial history of adenomas, colorectal cancer and some specific extracolonic neoplasia. Several strategies will be used to ensure follow up of this program and encourage wide participation of the population.

Transoral gastroplasty is safe, feasible, and induces significant weight loss in morbidly obese patients: results of the second human pilot study.

BACKGROUND AND STUDY AIMS: Bariatric surgical treatments have been proven to induce long-term weight loss in morbidly obese patients, but complications are relatively frequent. We recently reported a first human multicenter trial assessing the safety, feasibility, and weight loss results of the Transoral Gastroplasty (TOGA) system (Satiety Inc., Palo Alto, CA) at 6 months. Here we report the 6-month results of the second phase of the pilot trial with the TOGA system, with technical improvements to the device. PATIENTS AND METHODS: Patients met established criteria for bariatric surgery. The TOGA system, a set of transoral endoscopically guided staplers, was used to create a stapled restrictive pouch along the lesser curvature of the stomach. Follow-up was at 1 week and at 1, 3, and 6 months. At 3 months, re-treatment consisting in additional distal restrictions was allowed if necessary. RESULTS: Data were available for 11 patients in our center (7 female, mean age 44.2 years, mean body mass index 41.6). The procedure was completed safely in all patients. There were no serious adverse events. Mean excess weight loss was 19.2 %, 33.7 %, and 46.0 % at 1, 3, and 6 months, respectively. Average body mass index decreased from 41.6 before treatment to 33.1 at 6 months. Absolute mean weight loss was 9.9 kg, 17.5 kg, and 24.0 kg at 1, 3, and 6 months, respectively. A dramatic improvement in quality-of-life measures was observed in all patients. CONCLUSIONS: This second pilot trial confirmed the feasibility and safety of transoral gastroplasty. The early results and technical improvements reported in the present study are encouraging in terms of safety, early weight loss, and quality of life, and clearly allowed multicenter trials, which are planned to start soon.

A primary peritoneal pseudomyxoma peritonei arising from the Mullerian tissue: a case report.

A primary Pseudomyxoma Peritonei is uncommon. For a long time, ovaries, colon and appendix were proposed like a site origin of these enigmatic lesions. Recent publications show that the majority of cases are due to a rupture of appendicle adenoma. We report a case of a pseudomyxoma peritonei arising in an elderly patient with a previous medical history of appendectomy undergone in infancy. The pseudomyxoma was misdiagnosed as an abdominal abscess related to colitis. In our opinion, metaplasia of the Müllerian system is a possible source of a primary peritoneal pseudomyxoma.

Laparoscopic Nissen fundoplication after failure of Enteryx injection into the lower esophageal sphincter.

BACKGROUND: We investigated the feasibility, safety, and efficacy of laparoscopic antireflux surgery (LARS) after failure of Enteryx injection in the lower esophageal sphincter for the treatment of gastroesophageal reflux disease (GERD). METHODS: Four patients underwent LARS after failure of Enteryx injection. Particular care was taken during the procedure to identify unusual material or fibrosis. RESULTS: All patients underwent LARS successfully. In three patients, tight adhesions with fibrous tissues and black foreign material were observed around the esophagus. No complications occurred during the procedures. The postoperative period was uneventful and functional results were excellent. CONCLUSION: LARS following Enteryx injection is feasible. Careful dissection is mandatory to avoid operative complications. Both techniques may be considered as options for treating GERD.

Percutaneous drainage of subphrenic abscesses.

Forty subphrenic abscesses were drained percutaneously in 37 patients. These abscesses were subsequent to abdominal surgery (28 patients), biliary obstruction and/or fistula (six patients), trauma (two patients) or acute pancreatitis (one patient). The procedures were usually monitored by duplex sonography and fluoroscopy (35 out of 40 cases), with an angled subcostal approach to the subphrenic space in over 85% of the cases. Forty-three drainage catheters were inserted using the Seldinger method; 37 (86%) had a size of 12 F or more, 21 were 16 F in size. Only two out of 43 catheters were double-lumen sump drains. The clinical condition improved after insertion of the catheter in all 37 patients. Definitive successful drainage, defined as hospital discharge without complementary surgery, was achieved in 32 patients (87%), without major complications. A temporizing effect was obtained in three additional patients (8%) who underwent curative surgery for the underlying process after complete drainage of the abscess. Two patients died from multiple organ failure before their abscess healed. Considerations for successful drainage of subphrenic abscesses include a good knowledge of the subphrenic space anatomy, the use of large-bore drainage catheters and the recognition and correct management of underlying enteric, biliary or pancreatic fistulas.

Case report: colour Doppler demonstration of pseudoaneurysms complicating pancreatic pseudocysts.

The great morbidity and mortality associated with pseudoaneurysms complicating pancreatic pseudocysts stress the need for their early detection. The authors report the use of colour Doppler sonography in the detection of pseudoaneurysms within pancreatic pseudocysts, emphasizing not only the value of this modality in the initial diagnosis, but also its value in monitoring the success of transcatheter embolization. Colour Doppler should be used systematically in the evaluation of pancreatic pseudocysts.

Dual phase helical CT of a primary malignant fibrous histiocytoma of the right renal vein.

A case is reported of primary malignant fibrous histiocytoma of the right renal vein involving the ipsilateral kidney which showed early enhancement on dual phase helical CT. The correct diagnosis of a primary tumour of the renal vein involving the kidney was not made but in retrospect could have been achieved pre-operatively by considering several CT features.

[Cap polyposis: a rare syndrome]. / Cap polyposis: un syndrome rare.

We report a case of inflammatory cap polyposis of the colon, a rare syndrome, affecting the rectosigmoid. It was observed in a context of mucous diarrhea. Endoscopic and radiological features consisted of elevated and umbilicated nodular lesions. Histology revealed polypoid lesions containing elongated crypts with superficial abrasions, covered by inflammatory and fibrinoid material. Etiopathogenesis of this new syndrome is unknown.

Adenocarcinoma of the ileum. A case report, and review of the literature.

A 47-year-old female presented with intestinal occlusion and a lower abdominal mass. On laparotomy, a 10 cm diameter mass was discovered involving the ileum, jejunum, vagina and the bladder. Pathological studies conclusion was a primary adenocarcinoma of the ileum involving the jejunum. Small bowel carcinoma is rare. It occurs between sixty- and seventy-year-old equally in male and female. It presents most frequently in the duodenum, sometimes in the jejunum, and occasionally in the ileum. The symptoms are not specific and do not point to the diagnosis which must be made radiologically and endoscopically. Currently, for a minority of patients, surgical resection remains the only hope of cure. Palliative resections and bypass procedures can prevent occlusion or subocclusion.

Late liver metastases of small bowel leiomyoma. The difficulty in assessing malignancy in gastro-intestinal smooth muscle tumours.

Two cases of small bowel tumour, resected and considered as benign leiomyomas, are reported. Both developed late hepatic metastases, 6 and 8 years after surgery respectively, diagnosed as leiomyosarcoma. Emphasizing the difficulties in assessing malignancy of these tumours and considering local and far dissemination, a long-term follow-up is recommended after surgical resection.

[Preoperative evaluation of rectal cancer]. / Evaluation préopératoire du cancer du rectum.

For a patient with a rectal tumor, the preoperative staging should answer four questions: Is the rectal tumor unique? Is the patient operable? Are there distal metastases? What is the loco-regional extension? The loco-regional extension is well evaluated by the echo-endoscopy while the involvement of the surrounding organs is better assessed by CT-scan or resonance magnetic imaging.

[The medical imaging and radiology department]. / Le Service d'Imagerie Médicale et de Radiologie Interventionnelle.

Technological developments arising from research have affected the whole wide spectrum of medical endeavor and have made a very significant impact on clinical practice and especially on imaging sciences. Ultrasonography brought spectacular advances, but CT and MRI became important landmark techniques. A further important development, which greatly increased the involvement of radiologists in direct patient management, was the growth of interventional and therapeutic techniques, called interventional radiology. Some statistics: approximately 155,000 patients per year including 19,000 CT Scans, 10,000 MRI exams, 21,000 ultrasound examinations and 1,000 therapeutic procedures. Some research activities: CT quantification of pulmonary emphysema, respiratory mechanics, MR and CT angiography, antenatal diagnosis of congenital and genetic diseases of the fetus, quantification of portal haemodynamics, MR imaging of bile and pancreatic ducts, morphologic and functional imaging of the brain, radiology of bone trauma, MR characterization in hepatic lesions.

[Desmoid tumor and Gardner syndrome]. / Tumeur desmoïde et syndrome de Gardner.

A desmoid tumor was found in a patient with Gardner's syndrome. The tumor was visualized by CT before and after contrast injection, by radiographic examination of the small bowel, and by sonography. CT demonstrated a heterogeneous mass in the left lower abdomen with attenuation values ranging from 23 to 72 HU on native scans, enhancing to 123 up to 172 HU after injection of contrast medium. This examination also demonstrated the extent of the tumor and its exact dimensions. The radiographic examination of the small bowel completed the diagnosis and showed no involvement of the small bowel. This diagnosis was confirmed by laparotomy.

[Spiral tomodensitometry of pancreatic calcifications]. / Tomodensitométrie helicoïdale des calcifications pancréatiques.

Chronic pancreatitis is characterized by the formation of intraductal precipitates that may later grow and calcify, forming large stones. These calcified stones, representing almost all the calcifications visible in chronic pancreatitis, are located in the major pancreatic duct or in the secondary branches. During the past 10 years, new sophisticated endoscopic techniques have been developed to remove obstructing calculi from the main pancreatic duct. These techniques require an accurate evaluation of the location of the calculi, since calculi cannot be removed from secondary branches. Therefore, a new radiological approach has been developed, based on helicoidal scanning and multiplanar and tridimensional reconstructions of the calculi layout.

[Mucosecretory and papillary intraductal tumors of the pancreas: clinicopathological considerations and radiological aspects including computed tomography symptomatology]. / Tumeurs intracanalaires mucosecretantes et papillaires du pancreas: considerations clinico-pathologiques et aspects radiologiques comprenant la semiologie tomodensitometrique.

Intraductal papillary-mucinous tumor of the pancreas (IPMT) is an uncommon entity, defined as an intraductal papillary proliferation of mucin-producing epithelial cells. Since the original description of the disease by Ohhashi in 1982, the definition and the classification of the disease has remained confused until the recently published classification of the World Health Organisation (WHO). The purpose of this article is therefore to report the clinico-pathological features of IPMT according to the WHO classification, to illustrate the radiological features especially the computed tomographic signs and to discute of the treatment.