[Pylephlebitis in the course of diverticulitis]. / Pyléphlébites au cours des diverticulites.

Pylephlebitis or septic portal thrombophlebitis is a rare but serious condition which may occur following intra-abdominal sepsis from any source. Sigmoid diverticulitis is one of the most common sources. Modern imaging modalities, particularly CT, have increased the recognition of this condition. Standard treatment consists of anticoagulation plus antibiotic therapy to cover anaerobic and gram negative organisms. The duration of anticoagulation therapy remains controversial. Sigmoid colectomy may be required in cases of perforated diverticulitis or failure of medical therapy.

[Torsion of an epiploic appendage inside a Spigelian hernia: a first imaging case report]. / Torsion d'un appendice épiploïque au sein d'une hernie de Spigel: premier cas rapporté en imagerie.

We present the first case illustred in imaging of an epiploic appendage torsion inside a Spigelian hernia.

[Imaging of a thickened-wall gallbladder]. / Imagerie des épaississements de la paroi vésiculaire.

Thickening of the gallbladder wall may result from a large spectrum of pathological conditions, intrinsic as well as extrinsic to the biliary tract, and may have different appearances. Accurate diagnosis is usually established after a correlation of imaging findings, laboratory data and clinical history. US remains the initial imaging modality for the evaluation of acute right upper quadrant pain. CT and MRI are complementary to US and have an increasing role in assessing a thickened-wall gallbladder.

[Imaging of pancreatic adenocarcinoma]. / Imagerie de l'adénocarcinome du pancréas.

Pancreatic cancer remains the fourth most common cause of cancer death. Surgery remains the only option for cure. Accurate diagnosis and staging are essential for appropriate management of patients with pancreatic cancer. This paper reviews the state of the art for imaging modalities in the diagnosis and staging of pancreatic adenocarcinoma. The crucial role of CT has increased with the new generation of multidetector CT.

Relationship of antibodies to thyrotropin receptors and to thyroid ultrasonographic volume in euthyroid and hypothyroid patients with autoimmune thyroiditis.

It has been reported in hypothyroid patients with Hashimoto's thyroiditis and in patients with primary myxoedema that antibodies (Ab) to the TSH-receptor (R), which inhibit the thyroid gland, decrease both thyroid hormonogenesis and cell growth in vitro. We investigated, in 169 newly diagnosed patients with euthyroid (n = 83) or hypothyroid (n = 86) autoimmune thyroiditis, the relationship between thyroid autoimmunity expression and thyroid ultrasonographic volume or thyroid hormonal status. In patients positive for TSH-receptor (R) antibodies (Ab), negative correlations (P < 0.01) were found between TSH-R Ab levels and free T4 (FT4) values in a euthyroid (r = -0.63), as well as in a hypothyroid (r = -0.54) state, and between TSH-R Ab and total thyroid volume (TTV) values in an euthyroid (r = -0.62) as well as in a hypothyroid (r = -0.53) state. In contrast, no positive correlations were found between TSH levels and FT4 values or TTV levels in patients positive as well as negative for TSH-R Ab in an euthyroid or in a hypothyroid state. These data demonstrate in vivo, that, in contrast to TSH, TSH-R Abs are related to both thyroid hormonal production and volume in euthyroid or hypothyroid patients with autoimmune thyroiditis.

Testicular steroidogenesis in adult men with human chorionic gonadotropin-producing tumors.

There are few critical studies on plasma testosterone (T) and 17 beta-estradiol (E2) levels in men with hCG-producing tumors, and the results are contradictory. Plasma E2 levels are most often elevated, whereas plasma T values are high or in the normal range. We studied the plasma levels of such steroids and of delta 4 and delta 5 T precursors in adult men with intact hCG-producing tumors to evaluate the relationship between hCG and steroid hormone levels or steroidogenic enzyme activities. Ten adult men with hCG-producing tumors and 25 normal adult men were investigated. Seven men with testicular tumors were studied before and after hemicastration. The 2 patients with extratesticular tumors were investigated before and during chemotherapy. The remaining patient was studied every 2 months for 1 yr during the spontaneous course of the disease. Plasma progesterone (P), 17 alpha-hydroxyprogesterone (17-OHP), androstenedione (A), 17-hydroxy-delta 5-pregnenolone (17-OH delta 5-P), dehydroepiandrosterone (DHEA), T, E2, and hCG were measured, and ratios of steroid levels were also calculated. In patients with increased hCG values (i.e. > 5 IU/L), the mean plasma P, 17-OHP, A, 17-OH delta 5-P, DHEA, T, and E2 levels were higher (P < 0.01 at least) than those in patients whose hCG values were normalized or in controls. The patterns of these steroids were very different according to plasma hCG levels. Indeed, for hCG levels between more than 5 and 3.5 x 10(3) IU/L, positive correlations (P < 0.05 at least) were found between hCG levels and delta 4 T precursor, delta 5 T precursor, T, or E2 values. Conversely, for hCG values greater than 3.5 x 10(3) IU/L, hCG levels were negatively correlated (P < 0.05 at least) to all steroid values. Furthermore, in patients with increased hCG levels, the mean plasma P to 17-OHP ratio, 17-OHP to A ratio, A to T ratio, 17-OHP to T ratio, and 17-OH delta 5-P to DHEA ratio were similar to those in patients with normalized hCG values or in controls. In contrast, in patients with increased hCG levels, the mean plasma T to E2 ratio value was lower (P < 0.001) than that in patients with normalized hCG levels or in controls.(ABSTRACT TRUNCATED AT 400 WORDS)

Pseudotumoral organization of a twisted epiploic fringe or 'hard-boiled egg' in the peritoneal cavity.

A freely moving pseudotumoral formation resembling a peeled "hard-boiled egg" was discovered in the abdominal cavity of an 82-year-old male patient during exploratory laparotomy for assessment of hepatocarcinoma in the left lobe of the liver. The formation involved a twisted epiploic fringe, which was necrotic, sclerotic, and calcified. The absence of any attachment and the avascular aspect of this pseudotumor suggest a possibly self-sustaining mechanism for the laminar sclerosis organized around the necrotic adipose tissue.

[Intimal muscular fibrodysplasia responsible for an ischemic gastric ulcer in a patient with a von Recklinghausen's disease: a case report]. / Fibrodysplasie musculaire artérielle intimale responsable d'un ulcère gastrique ischémique chez une patiente ayant une maladie de von Recklinghausen: un cas.

A 78 year-old woman, suffering from a von Recklinghausen's disease sought medical assistance for hematemesis with anemia. This patient had previously experienced an amputation of the right arm for gangrene. Gastric fibroscopy unveiled a deep chronic ulcus developed in the antrum, highly suspect of malignancy. Multiple biopsies of the ulcer showed mainly interstitial gastritis. The persistence of the hematemesis imposed a subtotal gastrectomy. Pathological examination of the operative specimen evidenced an ischemic ulcer caused by arterial intimal muscular fibrodysplasia with associated neurofibromatosis in the neighboring sub-mucosal layer. This case report highlights the frequent association of phacomatosis especially von Recklinghausen's disease, with vascular lesions whose clinical expression mainly depends on the involved vascular area.

[Anemia in the elderly subject secondary to jejunal vascular malformation. Apropos of 2 cases]. / Anémie du sujet âgé secondaire à une malformation vasculaire jéjunale. A propos de deux cas.

Two cases of normocytic regenerative anemia in two patients aged 84 and 86 respectively were related to gastrointestinal bleeding. Abdominal angiography was negative in both cases. Only laparotomy provided a diagnosis of jejunal vascular malformation with the aid of peroperative endoscopy. Angiodysplasia was diagnosed in one case and capillary hemangioma in the other. In these very old people with very somber prognosis, anemia was corrected by surgery without recurrence after 8 and 10 months respectively. Gastrointestinal malformations are found in about 20 p. 100 of unexplained digestive hemorrhages. In most cases they are localized in the right large bowel, especially in old patients. Jejunal localizations are 7 to 8 times less frequent and have been described in younger patients. Up to now, selective abdominal angiography has been the main diagnostic procedure. We must insist on the value of peroperative endoscopy when angiography is negative.

[Pseudotumoral rectal endometriosis]. / Endométriose rectale pseudo-tumorale.

A case of rectal endometriosis, presenting in the form of acute obstruction, is described. The primary diagnosis was malignancy, but endometriosis was discovered at emergency operation. The diagnosis and management of rectal endometriosis are reviewed.

[Megacolon in adults. Apropos of 76 cases]. / Le mégacôlon de l'adulte. A propos de 76 cas.

27 patients with Hirschsprung's disease and 49 patients with idiopathic megacolon were followed for a period ranging between 6 months and 15 years. The diagnosis is essentially based on the barium enema and functional ano-rectal investigations. Duhamel's operation was performed in 26 patients with Hirschsprung's disease and in 34 patients with idiopathic megacolon. There was no mortality, but 10 cases of pelvic suppuration required colostomy, 9 of which were temporary. 8 cases of anastomotic stenosis developed as a late complication, but they were easily dilated by a simple surgical procedure. One patient developed sexual dysfunction (retrograde ejaculation). A good result was obtained in all patients with Hirschsprung's disease, except for one case of adynamic colon. Two patients with idiopathic megacolon were lost to follow-up. All but two of the remaining patients obtained a good or excellent result. Other operations were performed for idiopathic megacolon: 6 sphincterotomies, with 3 successes and 3 failures; 15 sigmoidectomies, including 3 with sub-peritoneal anastomosis (State's operation). There were 5 good results, 6 mediocre results and 4 failures which subsequently required a Duhamel's operation. Other techniques were performed more rarely: Swenson's operation with a short-term technical failure, 3 side-to-side ileo-sigmoid anastomoses with 3 failures which required a sub-total colectomy with ileo-sigmoid anastomosis. The longterm result was mediocre. The trans-rectal, colo-anal descent of the colon therefore appears to be the treatment of choice in megacolon in adults of whatever cause.

Effects of thyroid status on thyroid autoimmunity expression in surgically induced hypothyroid patients with Graves' disease.

We investigated, in 20 patients with Graves' disease and presenting with both a surgically induced hypothyroid state and increased serum antibodies (Ab) to the TSH receptor (R) levels, the relationships between thyroid status and the serum TSH-R or peroxidase (TPO) Ab levels under L-T4 treatment and after L-T4 cessation. The prevalence of positive TSH-R Ab (100%) and the log mean TSH-R Ab level (1.41 +/- 0.04%) observed during the surgically induced hypothyroid state decreased (p < 0.001, p < 0.01, respectively) under L-T4 therapy (prevalence of positive TSH-R Ab = 50%, log mean TSH-R Ab level 1.21 +/- 0.05%) and increased again (p < 0.001) after L-T4 cessation (prevalence of positive TSH-R Ab = 85%, log mean TSH-R Ab level = 1.45 +/- 0.06%) to reach levels lower (< 0.01) than that observed during the hypothyroid state for prevalence of positive TSH-R Ab but similar to that obtained during such a state for log mean TSH-R Ab value. The log mean TPO Ab level obtained during the surgically induced hypothyroid state (3.2 +/- 0.5 titer) decreased (p < 0.02) under L-T4 therapy (1.8 +/- 0.2 titer) and increased again (p < 0.02) after L-T4 cessation (3.0 +/- 0.5 titer) to reach a similar level to that obtained during the surgically induced hypothyroid state. There were positive correlations between log TSH levels and log TSH-R Ab values (r = 0.40, p < 0.001) or log TPO Ab levels (r = 0.33, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Evidence for the effect of antibodies to TSH receptors on the thyroid ultrasonographic volume in patients with Graves' disease.

OBJECTIVE: It has been demonstrated that antibodies (Ab) to thyroid-stimulating hormone receptors (R), which stimulate the thyroid gland, induce hyperthyroidism in patients with Graves' disease. Furthermore, it has been shown in thyroid cells in culture that thyroid-stimulating hormone receptor Ab acts through the adenosine 3', 5'-monophosphate pathway which stimulates both thyroid hormonogenesis and growth. We investigated the relations between thyroid autoimmunity expression and thyroid ultrasonographic parameters or thyroid hormonal status in patients with Graves' disease. PATIENTS: A prospective study of 53 consecutive patients referred with untreated Graves' disease. MEASUREMENTS: Measurements were made of serum TSH-R, peroxidase (TPO) and thyroglobulin (Tg) Ab and basal plasma free T4 (FT4), free T3 (FT3) and TSH. Thyroid morphological characteristics (number and total volume of nodule(s), total volume of lobes and total thyroid volume) were determined by ultrasonography. RESULTS: There were significant correlations (P < 0.001) between TSH-RAb levels and FT4 values (r = 0.48) or FT3 levels (r = 0.46). Likewise, significant correlations were found between TSH-RAb levels and total lobe volume values (r = 0.56, P < 0.001), total nodular volume values (r = 0.59, P < 0.01) or total thyroid volume values (r = 0.63, P < 0.001). By contrast, no correlation was found between TSH-RAb levels and the number of nodules or between any of the ultrasonographic parameters and TPOAb levels or TgAB values. CONCLUSIONS: This study demonstrates, in vivo, that TSH receptor antibodies modulate the thyroid ultrasonographic extranodular and nodular volumes in patients with Graves' disease.

Prevalence of subclinical hyperthyroidism and relationship between thyroid hormonal status and thyroid ultrasonographic parameters in patients with non-toxic nodular goitre.

OBJECTIVE: Basal plasma T4, T3 and TSH concentrations are usually normal in patients presenting with non-toxic nodular goitre. Using the evaluation of TSH response to TRH in a large series of such patients living in an area with normal iodine intake, we evaluated the prevalence of subclinical hyperthyroidism and the relationship between thyroid hormonal status and ultrasonographic parameters. PATIENTS: A prospective study of 242 consecutive patients (group I), referred with non-autoimmune nodular goitre, normal plasma free T4, total T3 and TSH levels, without (subgroup IA, 222 patients) or with (subgroup IB, 20 patients) clear-cut autonomous area(s) on scintigraphy. These patients were compared to 135 controls (group II). MEASUREMENTS: Plasma free T4 (FT4), total T3 (T3T) and TSH measurements. Evaluation of TSH response to TRH (delta level of increased TSH = peak TSH level during TRH test-basal TSH level), thyroid scintigraphy and morphological characteristics (number and total volume of nodule(s) and volume of extranodular tissue) determined by ultrasonography. RESULTS: In subgroup IA, (1) the mean (+/- SEM) basal TSH level (0.94 +/- 0.04 mU/I) and the mean value of increased TSH after TRH (4.92 +/- 0.34 mU/I) were lower (P < 0.001) than in group II (1.28 +/- 0.05 mU/I and 7.24 +/- 0.25 mU/I, respectively). The prevalence of SH (delta level of increased TSH below the mean -3 SD in controls) was 17.2%; (2) the mean FT4 level and the mean T3T value were not different (P > 0.05) from those of group II. In subgroup IB, (1) the mean basal TSH level (0.57 +/- 0.11 mU/I) and the mean increment of TSH after TRH (2.81 +/- 0.62 mU/I) were lower (P < 0.001) than in subgroup IA. The prevalence of subclinical hyperthyroidism was 75.0%; (2) the mean FT4 level (17.2 +/- 0.9 pmol/I) was not different from that in group II. However, the mean T3T value (1.99 +/- 0.01 nmol/I) was higher (P < 0.001) than in group II (1.65 +/- 0.05). In group I, subgroup IA and IB, there were significant (P < 0.05, at least) correlations between the numbers of nodules and both basal TSH levels and delta values of increased TSH or FT4 levels or T3T values. No correlations were found between other ultrasonographic data and plasma thyroid parameters. CONCLUSIONS: This study demonstrates a high prevalence of subclinical hyperthyroidism in patients presenting with non-toxic nodular goitres and suggests that the number of nodules, but not their total volume, is an important factor in the development of this condition.

Solitary skin metastasis as the presenting feature of differentiated thyroid microcarcinoma: report of two cases.

Cutaneous metastases from thyroid neoplasia are very rare. Most patients presenting with such a disease have also both internal metastases and a very enlarged thyroid gland. We reported here 2 patients presenting with differentiated thyroid microcarcinoma which was revealed by a solitary scalp lesion. The positive immunoperoxidase staining for thyroglobulin (TG) in the skin tumour cells asserted the diagnosis of metastatic thyroid carcinoma. The thyroid neoplastic micronodular formation was unrecognized by ultrasonography and it was only found at serial histological examination of the thyroid gland entirely removed during surgery. Histological procedure showed a solitary follicular microcarcinoma (diameter = 0.5 cm) in 1 patient, and two differentiated microcarcinoma, a follicular microcarcinoma (diameter = 0.4 cm) in a lobe and a follicular-papillary carcinoma (diameter = 0.5 cm) in the other lobe, in the second patient.

Effects of thyroid status on thyroid autoimmunity expression in euthyroid and hypothyroid patients with Hashimoto's thyroiditis.

OBJECTIVE: In patients with hypothyroid goitrous Hashimoto's thyroiditis, the recovery from hypothyroidism seems to be due to a spontaneous decrease of antibodies (Ab) to the TSH-receptor (R). In contrast, in patients with Graves' disease made euthyroid by antithyroid drug therapy, the suppression of TSH secretion by thyroid hormone during antithyroid drug treatment decreases the production of Ab to TSH-R. We investigated in patients with initially euthyroid or hypothyroid goitrous Hashimoto's thyroiditis the relationships between thyroid status and the serum TSH-R, peroxidase (TPO) and thyroglobulin (Tg) Ab concentrations in untreated or L-thyroxine (T4) treated patients. PATIENTS: A prospective study of 174 consecutive patients, referred with goitrous Hashimoto's disease in an initially euthyroid (group I, n = 78) or hypothyroid (group II, n = 96) state. The patients with positive (> or = 7%) TSH-RAb (group I, n = 18; group II, n = 22) were reinvestigated 12 months after the initiation of L-T4 therapy. After which, (1) L-T4 was continued and an evaluation performed 2 months later (i.e. 14 months after L-T4 initiation) in 9 patients of group I and in 11 patients of group II or (2) L-T4 was withdrawn and an evaluation performed 2 months later in 9 patients of group I and in 11 patients of group II. MEASUREMENTS: Measurements of basal plasma TSH, free T4 (FT4) and total T3 and serum TSH-R, TPO and TgAb. RESULTS: The prevalence of positive TSH-RAb levels did not differ between group I (23.1%) and group II (22.9%). However, the mean TSH-RAb level in group I (9.4 +/- 0.4%) was lower (P < 0.01) than in group II (11.6 +/- 0.5%). In the patients with positive TSH-R Ab, (1) the prevalences of positive TSH-RAb decreased (P < 0.001) under L-T4 therapy (group I = 22.2%, group II = 21.2%) and increased again (P < 0.01) 2 months after L-T4 cessation (group I = 77.7%, group II = 63.6%) to reach lower levels (group I, P < 0.05; group II, P < 0.01) than those obtained prior to L-T4 treatment. Statistical analysis of TSH levels through the course of the study confirmed these results. (2) In contrast to the variations of the mean TgAb values, the variations of the mean TPOAb levels in each group were in good agreement with those of TSH-RAb through the course of the study. (3) There were significant correlations between some parameters of thyroid status and both TSH-RAb (TSH, r = 0.43, P < 0.001; FT4, r = -0.35, P < 0.01) and TPOAb (TSH, r = 0.42, P < 0.001; FT4, r = -0.31; P < 0.01) levels. In contrast, no correlations were found between thyroid status and TgAb values. CONCLUSIONS: This study demonstrates that thyroid status can modulate thyroid autoimmunity expression, such as TSH-RAb and TPOAb, in patients with euthyroid or hypothyroid goitrous Hashimoto's thyroiditis. Similar results have been reported in patients with Graves' disease made euthyroid by the administration of thyroid hormone during antithyroid drug treatment.