[Liver transplantation, vascular complications, role of imaging, percutaneous therapeutic possibilities]. / Transplantation hépatique complications vasculaires place de l'imagerie possibilités thérapeutiques per-cutanées.

Duplex Doppler ultrasound should be the first investigation when a vascular complication is suspected. Serial examinations may increase sensitivity. Color imaging enhances identification of small vessels and increases specificity. Angiography is not necessary unless an pseudoaneurysm is suspected. When duplex Doppler ultrasound is abnormal, angiography is performed to evaluate the possibility of treatment. Endovascular therapeutic procedures appear to have a limited field of application in comparison to percutaneous biliary procedures. Hemostatic embolization or dilatation of vascular strictures can be used either as definitive treatment or while waiting for a new graft to be performed under better conditions.

[Use of a constant-flow 2-phase injector for abdominal scanners in 60 patients]. / Utilisation d'un injecteur biphasique à débit constant pour les scanners abdominaux chez 60 patients.

The intravenous injection of a contrast medium is carried out in more than 80% of all the patients undergoing abdominal CT. The use of a constant-flow two-phase injector has several advantages in practice: possibility to vary the injections, safety, easy use, reproducibility, overall quality of the results and possibility to reduce the dose of contrast medium. The routine use of such equipment seems to be indispensable at present.

[Imaging in the diagnosis of vascular complications after hepatic transplantation]. / Imagerie dans le diagnostic des complications vasculaires après transplantation hépatique.

Twenty-nine vascular complications which occurred after 388 hepatic transplantations performed over a 5 year period (14 arterial thromboses, 4 aneurysms and ruptures of the hepatic artery, 8 portal thromboses and 3 peri-anastomosis portal stenoses) were investigated retrospectively in order to determine the role of imagery in diagnosing these vascular complications. The best screening examination for the diagnosis of hepatic artery thrombosis appeared to be pulsed Doppler coupled with echography. It provides a means of selecting candidates for arteriography, the only investigation allowing certain diagnosis of thrombosis. False aneurysms, suspected in cases of severe post-operative sepsis should be investigated with arteriography even if CAT scans and echo-pulsed Doppler imagery is normal. The diagnosis of portal thrombosis and stenosis relies on echo-pulsed Doppler imagery. In these cases, arteriography is carried out before treatment to evaluate the extent of vascular involvement. Thus echography coupled with pulsed Doppler is the best first intention screening examination to be performed whenever a vascular complication is suspected after hepatic transplantation. Nevertheless, arteriography remains the key examination for the diagnosis and evaluation of these complications.

[Intravenous digital angiography in the kidney transplant patient: results of a systematic prospective study in 164 patients]. / Angiographie numérisée par voie intraveineuse chez le transplanté rénal: résultats d'une étude prospective systématique chez 164 patients.

A prospective study on digital intravenous angiography (DIVA) in 164 renal transplant recipients performed from 1 to 2 months post-transplant was conducted to assess its usefulness in the screening of post-transplant renal artery stenosis (RAS). DIVA was uninterpretable in 32 patients (19%) on technical grounds (blood vessel or metallic clip superimposed). The global prevalence of RAS was 10.7% in 132 patients whose DIVA was informative. No correlation was found between the prevalence of RAS and renal function. The prevalence of RAS was significantly higher (p less than 0.01) in the hypertensive (26%) than in the normotensive group (6.6%), but RAS may occur in normotensive or even asymptomatic patients. Our data confirm the usefulness of routine post-transplant renal artery screening but arterial way will be preferred.

[digital angiography via intravenous route in the study of the transplanted kidney artery]. / Angiographie numérisée par voie intraveineuse dans l'étude de l'artère du rein transplanté.

Results of 351 intravenous digital subtraction angiographs (AN) of transplanted kidneys emphasized reliability of this examination for detection of renal artery stenosis. A prospective study of 219 patients (188 interpretable AN) showed significant stenosis of grafted artery in 22% of cases: 17% of the 126 patients with normal blood pressure and 34% of the 62 cases of hypertension. Digital subtraction allows, with a single injection, assessment of renal artery, nephrogram and excretory cavities, but it is not a substitute for conventional intravenous urography 1 to 2 months after grafting.

[Are there specific echographic signs of cortical necrosis of a grafted kidney?]. / Existe-t-il des signes échographiques spécifiques de la nécrose corticale du rein greffé?

The authors report three cases in which echotomographic findings were suggestive of cortical necrosis in a grafted kidney (cortical hypoechogenic border). This proved to actually be the diagnosis in one case only.

[Intrahepatic localization of a pancreatic pseudocyst]. / Localisation intra-hépatique d'un faux kyste du pancréas.

Intrahepatic false cysts of the pancreas are rarely observed, and only 5 cases have been reported in the published literature since 1965. Recent publications concerning false cysts located adjacent to or within abdominal parenchymas are reviewed. The most common sites are renal and splenic. Radiologic images usually simulate an intravisceral tumoral lesion, even when the false cyst is in contact only with the parenchyma, because of inflammatory changes. Diagnosis depends on complete radiographic exploration of the pancreas, including ultrasonography, a CT scan, and coeliomesenteric arteriography if possible, to detect possible signs of pancreatitis. Ultrasound guided cyst puncture is of marked diagnostic and possible therapeutic value.

[Echotomography in the study of Spigeli's lobe. Normal and pathologic aspects. Surgical therapeutic effects]. / Apports de l'échotomographie dans l'étude du lobe de Spiegel. Aspects normaux et pathologiques. Incidences thérapeutiques chirurgicales.

Ultrasonographic examination of the liver segment I, based on limiting vascular ans fissural elements, requires detailed knowledge of hepatic anatomical and organizational features. Findings are of two-fold interest for pre-operative assessment. Firstly, as a complement to essential arteriography it can establish the integrity of the segment when considering hepatectomy for liver tumors, and secondly it enables application of modifications in techniques for portocaval anastomoses. The data obtained can also assist diagnosis in cases of cirrhosis and Budd-Chiaris syndrome.

[Hepatic calcifications in isolated necrotizing, granulomatous hepatitis due to Brucella. A case report and review of the literature (author's transl)]. / Calcifications hépatiques au cours des hépatites brucellinnes granulomateuses et nécrosantes isolées. A propos d'un cas et revue de la littérature.

A case of isolated necrotizing, granulomatous hepatitis of Brucella origin is discussed, together with 6 similar cases reported in the published literature. The clinical picture is dominated by the history of the patient (occupation, geographical location), fever, right hypochondrial pain, and altered general condition. Radiological examination shows characteristic calcifications. Diagnosis is confirmed by serology, Brucella suis usually being involved. Pathological appearances are typical : large foci of hepatic necrosis surrounded by marked inflammatory zones with histiocytic cells arranged in palisades. The only possible treatment is surgical.

Ultrasonic diagnosis of primary carcinoma of the gallbladder: a review of 16 cases.

Sonographic findings in 16 patients (10 women, six men) with surgically documented gallbladder carcinoma are reported. Two principal forms are described: localized infiltrating, or fungating, tumors (eight patients) and diffuse tumors infiltrating the entire gallbladder wall (eight patients). In all cases, the tumors were adenocarcinomas. Eleven patients also had cholelithiasis. Contiguous extension and metastasis did not correlate with tumor size. The difficulties encountered an the differential diagnosis are discussed in relation to the different sonographic appearances.

[Ultrasonography and surgical complications after kidney transplants]. / Echotomographie et complications chirurgicales du rein transplanté.

The authors conducted a retrospective analysis of 28 case-reports of patients with kidney transplants who had been investigated by ultrasonography. The most representative cases in the 8 patients in whom this examination revealed the presence of surgical complications are described. They included three cases of urinoma, in one case with associated obstruction, two patients with lymphoceles, one of whom had obstruction, and one case each of perirenal hematoma, perirenal abscess, and an arteriovenous fistula following needle biopsy.

[Ultrasonography characteristics of primary cancers of the gallbladder. A report on 16 cases (author's transl)]. / Aspects échographiques des cancers primitifs de la vésicule biliaire. A propos de 16 cas.

Primary cancer of gallbladder was detected by ultrasonography in 16 patients (10 women, 6 men), and confirmed at operation. Two main types of lesion were found: 8 localized forms (infiltrating or vegetating), and 8 diffuse forms with infiltration of the gallbladder wall. The lesion was an adenocarcinoma in each case, and there was associated lithiasis in 11 patients. Extension by contiguity or metastases is independent of the size of the cancer. Problems related to etiological and differential diagnosis of these lesions are discussed in relation to the different ultrasonography appearances observed.

[Diagnostic value of ultrasonography in primary gallbladder cancer (author's transl)]. / Echographie et cancer primitif de la vésicule biliaire. Apports diagnostiques.

The authors analyze the clinical, radiological, and ultrasonography findings in a personal series of 3 cases, and 6 other cases reported in the published literature. As a result of their studies, they propose several groupings of symptoms and signs which enabled a precise diagnosis to be made in 5 cases.

[Giant diverticulum of the sigmoid: A report on one case and review of the literature (author's transl)]. / Diverticule géant du sigmoïde. A propos d'un cas et revue de la littérature.

The authors report a case of giant diverticulum of the sigmoid and review the approximately forty cases published in the literature. Clinical manifestations can be either an acute abdominal syndrome of symptoms of a chronic disease. Radiological appearances are usually characteristic: the giant diverticulum is located in the sigmoid, though in one case it arose from the transverse colon. An opaque image was noted in 15 of the patients following barium meal examination, and the lesion was associated with diverticulosis of the colon in every case. Apart from 4 cases, histological appearances were also typical: the colon wall is composed of fibrous tissue which has replaced the normal layers, and the neck of the giant diverticulum is always in the antimesenteric position.