Tubulocystic renal cell carcinoma: a new radiological entity.

UNLABELLED: Tubulocystic renal cell carcinoma (TC-RCC) is a recently identified renal malignancy. While approximately 100 cases of TC-RCC have been reported in the pathology literature, imaging features have not yet been clearly described. The purpose of this review is to describe the main radiologic features of this rare sub-type of RCC on ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), based jointly on the literature and findings from a multi-institutional retrospective HIPAA-compliant review of pathology and imaging databases. Using a combination of sonographic and CT/MRI features, diagnosis of TC-RCC appeared to be strongly suggested in many cases. KEY POINTS: • Tubulocystic renal cell carcinoma is a new entity with typical imaging features • Diagnosis of tubulocystic renal cell carcinoma can be suggested preoperatively by imaging • Cystic renal lesions with high echogenicity may correspond to tubulocystic carcinoma.

[Perioperative outcomes and mid-term results of radiofrequency ablation and partial nephrectomy in indications of renal tumor treatment and imperative nephron-sparing procedure]. / Traitement d'une tumeur rénale et préservation néphronique impérative : étude comparative des données périopératoires et des résultats à moyen terme de la néphrectomie partielle et de la radiofréquence.

OBJECTIVE: To compare morbidity, oncological and functional outcomes of percutaneous radiofrequency ablation (RFA) and partial nephrectomy in indications of renal tumor treatment with imperative nephron-sparing procedure. PATIENTS AND METHODS: Between January 2005 and December 2010, 50 consecutive patients were referred in our center for NP or RFA for a renal tumor with either a renal function impairment defined as estimated glomerular filtration (eGFR) less than 60 mL/min/1.73 m(2), and/or solitary kidney and/or bilateral tumors. Perioperative outcomes were compared. RESULTS: Thirty-six PN and 14 RFA were performed. RFA patients were older (79.2 vs. 62.5 years old), had a higher ASA score (3 vs. 2), a lower RENAL score (6 vs. 7.5) and a lower rate of tumor on solitary kidney or bilateral tumors (P=0.009). Overall complications (29.4% vs. 6.3%), transfusions (20.6% vs. 0) and longer hospital stay (9 vs. 3 days) were more likely to occur in the NP group. During a median follow-up of 22 months (4.3-53.7), eGFR decrease was similar between the two groups (P=0.34). On multivariate analysis, PN was associated with an increased occurrence of overall complications (OR=14.09, P=0.02) but with a similar eGFR decrease. No patient died. CONCLUSION: For patients with an indication of treatment of renal tumor and imperative nephron-sparing procedure, RFA seems to provide low morbidity and comparable functional outcomes as partial nephrectomy. Our limited follow-up does not permit to conclude on oncologic data.

[Early embolization in the non-operative management of blunt splenic injuries: a retrospective multicenter study]. / L'embolisation précoce dans le traitement non opératoire des traumatismes fermés de la rate. Etude rétrospective multicentrique.

AIM OF THE STUDY: Splenic artery embolization has been used as an adjunct to the non-surgical management of blunt splenic injury. No consensus on its indications has emerged from the literature. This multicentric study aimed to evaluate the results of this technique in France. PATIENTS AND METHODS: Between March 2000 and April 2006, 22 patients older than 15 years of age (mean age 29, range: 15-59) with splenicv rupture due to blunt trauma underwent splenic artery embolization in six Level I Trauma Centers in France. Splenic rupture was classified Moore II in 3 cases, Moore III in 12 cases, and Moore IV in 7 cases. Angiography was performed within 4 hours of admission in half of the cases. The main indications for splenic artery embolization were: extravasation of contrast medium on CT scan (10 cases, 45%); early pseudo-aneurysm (6 cases, 23%); hypotension despite fluid resuscitation and/or progressive need for transfusion (5 cases, 22%). RESULTS: There was no mortality. Nine patients experienced complications (41%) including 6 (27%) who developed left pleural effusion. Two patients eventually underwent splenectomy (one for persistent hemorrhage, one for splenic necrosis). The overall splenic salvage rate was 91%. CONCLUSION: Splenic artery embolization is a valuable techniche that hels to lower the rate of splenectomy for traumatic splenic rupture with relatively low morbidity.

[Serious complication of radiofrequency treatment of inoperable bronchial carcinoma]. / Complication majeure d'un traitement par radiofréquence d'une tumeur bronchique inopérable.

INTRODUCTION: Surgery remains the only curative treatment for primary non-small cell bronchial carcinoma. It is mainly appropriate for small, localised tumours. Some patients have contra-indications to surgery and radiofrequency offers a minimally invasive alternative with few complications. It is performed under general anaesthesia by a percutaneous approach. The main complications are mechanical, primarily pneumothorax, and infections are uncommon and generally mild. CASE REPORT: We report the case of a man treated by radiofrequency for a small bronchial carcinoma. The procedure was rapidly complicated by infection of the area treated, spreading throughout both lung fields and requiring intensive and prolonged antibiotic treatment. Resolution of the infection was slow despite appropriate treatment. The rapid onset and spread are explained by the immunosuppressed state of the patient. CONCLUSION: Radiofrequency is a recent treatment for bronchial carcinoma that is developing rapidly. Though it is associated with low morbidity and mortality the possibility of potentially fatal infective complications in certain patients should be recognised.

Polytraumatism and solid organ bleeding syndrome: The role of imaging.

In multiple injuries, features of bleeding from solid organs mostly involve the liver, spleen and kidneys and may be treated by embolization. The indications and techniques for embolization vary between organs and depend on the pathophysiology of the injuries, type of vascularization (anastomotic or terminal) and type of embolization (curative or preventative). Interventional radiologists should have a full understanding of these indications and techniques and management algorithms should be produced within each facility in order to define the respective place of the different treatment options.

[The role of magnetic resonance angiography in the follow-up of intracranial arteriovenous malformations treated by an intravascular approach]. / Rôle de l'Angio-IRM dans la surveillance des malformations artério-veineuses intra-crâniennes traitées par abord endo-vasculaire.

The purpose of our work was to measure the accuracy and reliability of MR-Angiography in the study and follow-up of intracranial arteriovenous malformations, and in particular to evaluate the results of endovascular treatment. Over an 18-month period 4 patients with such malformations were examined by MR-Angiography. There was an angioma of the corpus callosum, a left parieto-rolandic angioma, a posterior thalamic angioma and a cerebellar angioma. All examinations were performed with a Magneton-Impact 1 Tesla machine (Siemens, Erlangen, Germany), using a head coil, MR-Angiography with time-of-flight sequences and differential arterial and venous saturations. Each patient was examined by MR-Angiography first at the beginning of treatment, then when ambulatory after embolization. The morphological study applied to the afferent vessels, the nidus and the efferent veins. MR-Angiography proved to be very good in identifying the arteries feeding the malformation, and this made it easier to evaluate the reduction of their input after treatment, without having recourse to any arteriography. Beside, analysis of the nidus was facilitated by the judicious arrangement of arterial and venous saturations. In fact, the systematic use of MR-Angiography in the follow-up of intracranial arteriovenous malformations makes it possible to measure, with full reliability, the efficacy of the endovascular treatment under conditions of comfort unequalled in these out-patients, and selective angiography sequences need to be performed only during therapeutic phases.

[Radiofrequency ablation of malignant hepatic tumors. Preliminary experience apropos of 25 cases]. / Destruction de tumeurs hépatiques malignes par radiofréquence. Expérience préliminaire à propos de 25 cas.

STUDY AIM: Radiofrequency (RF) ablation of malignant hepatic tumors is an interesting and recent technique which offers new treatment possibilities. In this study, the preliminary findings have been reported on 25 patients with hepatic tumors who received RF treatment between January 1998 and February 2000. PATIENTS AND METHODS: Twenty-five patients (11 cases of hepatocellular carcinoma, HCC; and 14 cases of liver metastases, LM) underwent RF treatment. Thirty tumors (range: 10 to 54 mm in diameter) out of a total of 63 were destroyed by RF: 13 HCC (average diameter: 32 mm) and 17 LM (average diameter: 26 mm). Treatment consisted of six percutaneous and 19 surgical RF procedures. In the surgical group, there were 11 cases of hepatectomy: right hepatectomy in five patients with segment IV enlargement in one case, and sub-segmentectomy in six other patients. In all cases, hepatic tomodensitometry was performed at one month post-treatment and then every three months. RESULTS: Postoperative portal thrombosis occurred in two patients, one of whom died. Other postoperative complications were observed in five patients. During the mean follow-up period of 14 months (range: 2 to 28 months), two patients died (carcinosis, ascitic decompensation), two and four months respectively after RF treatment. In situ recurrence occurred in four HCC and two LM patients. Three HCC and four LM patients developed new hepatic or extra-hepatic lesions. CONCLUSION: RF is a particularly interesting technique for the treatment of bilobar or unresectable metastases. It appears to be equally as efficient as other local treatments for small-sized HCC. However, technical improvements remain necessary to increase the destructive field covered by RF. A more important follow-up is needed so that the long-term efficacy and specific role of this new therapy can be accurately assessed.

[Self-expandable metal stent in the treatment of obstructive cancer of the left colon. Preliminary results and review of the literature]. / La prothèse métallique auto-expansible dans le traitement du cancer obstructif du côlon gauche. Résultats préliminaires et revue de la littérature.

AIM: To report our preliminary experience with self-expandable metal stent in the treatment of acute malignant obstruction of the left colon and to review the literature on this specific subject. PATIENTS AND METHODS: From March to September 1999, 8 consecutive patients with a mean age 71 were admitted as an emergency for acute malignant obstruction of the left colon. A self-expandable metal stent was inserted under radioscopic and, in 4 cases, endoscopic guidance. The patients then underwent bowel preparation before operation, if required. RESULTS: There was no mortality. Bowel preparation was satisfactory in 6 cases. Complications occurred in 1 patient, who was operated on day one for peritonitis due to perforation of the tumour by the prosthesis inserted after dilatation. Another six patients were operated: 2 had resection followed by anastomosis; 3 had resection and anastomosis protected by ileostomy; 2 had Hartmann's procedure. The last patient retained the prosthesis as palliation. In the literature, self-expandable metal stent application in obstructed carcinoma of the left colon gives satisfactory results. CONCLUSION: Based on our experience and a review of the literature, we provide practical recommendations when inserting self-expandable metal stents for acute malignant left colonic obstruction.

[Damage control laparotomy for haemorragic abdominal trauma. A retrospective multicentric study about 109 cases]. / La laparotomie écourtée dans les traumatismes abdominaux hémorragiques. Etude multicentrique rétrospective sur 109 cas.

AIM OF THE STUDY: Damage control laparotomy is a new approach to the more severe abdominal traumas. It stems from a better understanding of the physiopathology of the haemorragic shock. PATIENTS AND METHODS: A national retrospective study from 27 centers about 109 trauma patients who underwent a damage control procedure between January 1990 and December 2001, is analysed. Surgical procedures included 97 hepatic packing, 10 abdominal packing, 4 exclusive skin closure, 1 open laparotomy technique and 3 digestive stapplings. RESULTS: The mortality rate is 42%. Eleven abdominal compartment syndromes have occurred with 7 decompressive laparomy (4 deaths). CONCLUSION: This study is based on the largest series of damage control laparotomy published in France. Results in terms of mortality and morbidity are similar to those of published studies from the USA.

Blunt splenic injury: outcomes of proximal versus distal and combined splenic artery embolization.

PURPOSE: To assess clinical outcomes of blunt splenic injuries (BSI) managed with proximal versus distal versus combined splenic artery embolization (SAE). MATERIALS AND METHODS: All consecutive patients with BSI admitted to our trauma centre from 2005 to 2010 and managed with SAE were reviewed. Outcomes were compared between proximal (P), distal (D) or combined (C) embolization. We focused on embolization failure (splenectomy), every adverse events occurring during follow up and material used for embolization. RESULTS: Fifty patients were reviewed (P n = 18, 36%; D n = 22, 44%; C n = 8, 16%). Mean injury severity score was 20. The technical success rate was 98%. Four patients required splenectomy (P n = 1, D n = 3, C n = 0). Clinical success rate for haemostasis was 92% (4 re-bleeds: P n = 2, D n = 2, C n = 0). Outcomes were not statistically different between the materials used. Adverse events occurred in 65% of the patients during follow up. Four percent of the patients developed major complications and 56% developed minor complications attributable to embolization. There was no significant difference between the 3 groups. CONCLUSION: SAE had an excellent success rate with adverse events occurring in 65% of the patients and no significant differences found between the embolization techniques used. Proximal preventive embolization appears to protect in high-grade traumatic injuries.

Saccular intracranial aneurysms: endovascular treatment with mechanical detachable spiral coils.

PURPOSE: To evaluate endovascular treatment of saccular intracranial aneurysms with mechanical detachable spiral coils. MATERIALS AND METHODS: Fifty-three patients with 56 saccular aneurysms underwent endovascular treatment with spiral coils. All but five had symptomatic subarachnoid hemorrhage staged according to the Hunt and Hess classification as follows: stage IV or V (n = 20), stage III (n = 10), stage I or II (n = 20), and stage 0 (asymptomatic [n = 6]). RESULTS: Forty-seven aneurysms were occluded (100% occlusion) on follow-up angiograms with the following time distribution: 24 months for six aneurysms (six patients), 12 months for 14 aneurysms (11 patients), 6 months for 13 aneurysms (13 patients), 4 months for four aneurysms (four patients), and only immediate postprocedure study for 16 aneurysms (16 patients) (excludes two deaths and one failure). CONCLUSION: In this relatively small group, endovascular treatment with mechanical detachable spiral coils had a success rate of 90%, and it appears to be a rapid, reliable, and relatively safe technique in the treatment of life-threatening subarachnoid hemorrhage.