[Ultrasound-guided puncture-biopsy of the liver could replace blind puncture-biopsy in diffuse hepatopathies. Retrospective study of 1293 patients]. / La ponction-biopsie hépatique échoguidée pourrait remplacer la ponction-biopsie à l'aveugle dans les hépatopathies diffuses. Une étude rétrospective chez 1,293 patients.

OBJECTIVES: The aim of this retrospective study was to compare the efficiency and complications of percutaneous hepatic biopsy either guided by ultrasonography in the left lobe, or blindly by the intercostal route in the right lobe, in the diagnosis of diffuse liver diseases. PATIENTS AND METHODS: Liver biopsy was performed in 1,293 patients for 5 years. In group 1 (289 patients, including 140 out-patients), liver biopsy was guided by ultrasound. In group 2, blind intercostal liver biopsy was performed in 1,004 patients. Patients were observed for 6 hours after biopsy in both groups. RESULTS: The failure rate of liver biopsy was significantly lower in group 1 (1.7%) than in group 2 (9.25%, P < 0.01). The prevalence of the histological lesions was similar in both groups. No related-biopsy death occurred. Complications were more serious after blind biopsy (1 acute pancreatitis with a hematoma of the liver, 1 bile leakage around the gallbladder, 1 hemoperitonitis, 1 large intrahepatic hematoma), than after guided biopsy (1 small hematoma of the liver, 1 acute biliary pain on the 10th day). CONCLUSION: Hepatic biopsy guided by ultrasonography could replace blind biopsy in the diagnosis of diffuse liver diseases.

[Prognostic factors of hepatocellular carcinoma. Multifactorial analysis of 84 cases]. / Facteurs pronostiques du carcinome hépatocellulaire. Analyse multifactorielle de 84 cas.

To identify prognostic factors taking in account recent advances in diagnosis and treatment, 24 clinical, biological, and morphological factors were evaluated by means of uni- and multivariate analysis in 84 patients with hepatocellular carcinoma diagnosed between 1984 and 1991. Okuda's grading (P < 0.01), creatininemia (P < 0.01), and treatment (P < 0.05) were independent prognostic factors. Des-gamma-carboxyprothrombin reached a significant level (P < 0.05) in a subgroup of 32 recent patients but its prognostic value needs to be confirmed. Further prospective randomized trials comparing surgical and non-surgical treatment should take these factors into account.

Occult hepatocellular carcinoma in cirrhosis: value of ultrasound-guided biopsy of portal vein system thrombus.

We report two cases of occult hepatocellular carcinoma associated with alcoholic cirrhosis, in which the diagnosis of malignancy was respectively established by ultrasound-guided biopsy of umbilical vein and portal vein branch thrombus. When measurement of serum alpha-foetoprotein, and liver ultrasonography and/or computed tomography failed to clearly demonstrate hepatocellular carcinoma, the presence of a thrombosis of the portal vein system is highly suggestive of malignancy, which may be easily confirmed by venous biopsy.

[Hepatitis probably caused by exifone (Adlone)]. / Hépatites probablement dues à l'exifone (Adlone).

Exifone, a drug recently proposed for the treatment of cognitive deficiencies of old age, has been marketed in France beginning in April 1988. This report concerns 2 patients who developed jaundice after taking this drug for 2 and 5 months, respectively. Serum aminotransferase was markedly increased. There was no hepatic failure. In both cases, histologic examination of a liver sample showed centrilobular hepatocyte necrosis and cholestasis. Necrotic cells were infiltrated with numerous red blood cells and scarce inflammatory cells. These lesions were associated with alterations of the walls of centrilobular veins. Discontinuation of exifone was followed by the prompt disappearance of jaundice. Complete recovery occurred within 6 and 12 weeks, respectively.