Aims and Background: Only few patients with cirrhosis and hepatocellular carcinoma (HCC) larger than 5 cm are amenable to resection or straight liver transplantation, and in such circumstances, multibipolar radiofrequency ablation (mbp-RFA) could be a reliable alternative. This study was aimed to assess the long-term outcome in patients treated with mbp-RFA for unresectable HCC > 5 cm. Methods: Eighty-three consecutive patients with cirrhosis (median age 70 years [37–93 years], 67 males, BCLC A/B/C: 54/21/8, 74 naive) with up to three HCCs, the largest > 5 cm in diameter (median: 6.2 cm, 5.1–9 cm, 22 infiltrative forms, 12 with segmental portal invasion of which 10 were infiltrative forms) were treated with mbp-RFA. Overall (OS) and recurrence-free (RFS) survival and their associated predictive factors were assessed. Results: Complete ablation was observed in 78/83 (94%) patients. Thirty-one side effects occurred, including 6 (7%) severe complications. After a median follow-up of 26.1 months (1–112 months), in naive patients the 3- and 5-year OS was 51% (38–62) and 24% (13–36), 63 and 30% for mass-forming and 25 and 6% for infiltrative form, respectively. Infiltrative form (HR: 2.5 [1.33–4.69], p = 0.004) was the only independent OS predictor. In naive patients with mass-forming and infiltrative form, the 3- and 5-year RFS were 47 and 17 and 18 and 18%, respectively. Alpha-fetoprotein (HR: 2.86 [1.32–6.21], p = 0.008), multinodular form (HR: 2.74 [1.4–5.38], p = 0.003) and infiltrative form (HR: 3.43 [1.67–7.01], p = 0.0007) were independent RFS predictors. Conclusions: mbp-RFA offers good OS in inoperable patients with cirrhosis and large HCC, with acceptable safety profile. For infiltrative forms, although mbp-RFA leads to complete responses in more than 80% cases, few only remain tumor progression-free in long-term.

PURPOSE:The goal of this study was to retrospectively evaluate the results of imaging-guided percutaneous ablation in patients with controlled intrahepatic hepatocellular carcinoma (HCC) with limited extrahepatic disease. MATERIALS AND METHODS:Eleven patients with limited extrahepatic disease and/or potential short-term clinical manifestations with controlled primary intrahepatic HCC were included into the study. There were nine men and two women, with a mean age of 67.4 years±10.2 (SD) (range: 54-85 years). All patients had extrahepatic disease treated by either radiofrequency ablation or electroporation. Extrahepatic disease consisted of lymph node metastases (5 patients), tumor seeding along a needle tract (3 patients), adrenal gland metastasis, bone metastasis and pulmonary metastasis (one patient each). RESULTS:Response to treatment was complete in 7/11 patients (64%). The mean survival time after treatment was 18.8±12.7 (SD) months (median, 16 months; range: 4-42 months). No severe complications associated with percutaneous treatment were observed. CONCLUSION:Our results suggest that imaging-guided percutaneous ablation techniques should be considered as a useful option for the treatment of extrahepatic disease in patients with HCC. Further studies are needed, however to fully determine the potential role of these techniques in this elective application.

UNLABELLED:For the treatment of small hepatocellular carcinoma (HCC), radiofrequency ablation (RFA) is in some centers considered a first-line therapeutic option. However, such a strategy is still under debate with regard to tumor and patient characteristics. In this single-center study we assessed the 5-year survival and prognosis factors in 235 consecutive patients with cirrhosis (Child-Pugh A/B: 205/30) who received RFA as first-line treatment for up to three HCC <or=5 cm (307 tumors; mean diameter: 29 +/- 10 mm; 53 multinodular forms). Among these patients, 67 satisfied the criteria for resection according to the Barcelona Clinic Liver Cancer. Complete ablation was obtained in 222 patients (94%). Overall, 337 RFA sessions were performed including iterative RFA for recurrence. Major complications occurred in three patients (0.9%), including one treatment-related death. After 27 +/- 20 months of mean follow-up, local or distant, or both, tumor recurrence occurred in 16, 88, and 11 patients, respectively. Twenty-nine patients underwent transplantation and were removed from the study at this point. Overall 5-year, recurrence-free, and tumor-free (including results of iterative RFA) survival rates were, respectively, 40%, 17%, and 32%. The overall 5-year survival rate was 76% for operable patients. Factors associated with overall survival were prothrombin activity (hazard ratio [HR] = 0.97, 0.96-0.98; P < 0.0001) and serum levels of alpha-fetoprotein (AFP) (HR = 1.02, 1.02-1.02; P < 0.0001), and factors associated with tumor recurrence were multinodular forms (HR = 2.34; 1.52-3.6; P = 0.0001) and serum AFP levels (HR = 1.015, 1.014-1.016; P = 0.015). Tumor size was associated with local recurrence but not with overall and tumor-free survival. CONCLUSION:RFA is a safe and effective first-line treatment of HCC up to 5 cm in diameter, especially for patients with a single tumor, a low serum AFP level, and well-preserved liver function.

PURPOSETo prospectively evaluate the safety and effectiveness of percutaneous multipolar radiofrequency (RF) ablation for the treatment of large (>or=5.0 cm in diameter) hepatocellular carcinomas (HCCs).MATERIALS AND METHODSTwenty-six patients (four women, 22 men; median age, 72 years) with cirrhosis (Child-Pugh class A disease, 22 patients; Child-Pugh class B disease, four patients) and at least one 5.0-9.0-cm-diameter HCC without invasion of the portal trunk or main portal branches were treated with multipolar RF ablation performed by a single operator. The procedure was performed with three separate bipolar linear internally cooled electrodes with ultrasonographic guidance. Twenty-seven of the 33 tumors treated had a diameter of 5.0 cm or greater (median diameter, 5.7 cm; range, 5.0-8.5 cm); 12 of these 27 tumors were infiltrative, and four invaded segmental portal vein branches. Ten patients had a serum alpha-fetoprotein level higher than 400 microg/L. Results were assessed by using computed tomography. Primary effectiveness, complications, tumor progression, and survival rates were recorded. Probabilities of survival were calculated by using the Kaplan-Meier method.RESULTSOne to two RF ablation procedures per patient (mean, 1.15 +/- 0.43 [standard deviation]) led to the complete ablation of 22 (81%) of the 27 tumors (18 tumors after one and four tumors after two procedures), including three tumors that showed segmental portal vein invasion. All patients experienced postablation syndrome, and one experienced subcapsular hematoma and a segmental liver infarct, but no major complication occurred. After a mean follow-up of 14 months (range, 3-34 months), local and distant tumor progression and actual survival rates were 14% (three of 22), 24% (five of 21), and 65% (17 of 26), respectively. The probabilities of 1- and 2-year survival, respectively, were 68% (95% confidence interval: 49%, 86%) and 56% (95% confidence interval: 51%, 81%).CONCLUSIONHCCs larger than 5.0 cm (but smaller than 9.0 cm)--even those that are infiltrative and those that involve a segmental portal vein--can be completely and safely ablated with multipolar RF ablation.

PURPOSE: To compare the results of radiofrequency (RF) ablation with internally cooled electrodes (ICEs) versus perfused electrodes (PEs) in patients with cirrhosis with small (53 cm) hepatocellular carcinoma ineligible for resection.MATERIALS AND METHODS: Patients treated with RF ablation over two consecutive periods were analyzed retrospectively. From 2000 to 2002, 45 patients were treated with 17-gauge ICEs, and from 2002 to 2004, 44 patients were treated with 15-gauge PEs. The two groups were similar in age, sex, Child-Pugh stage, serum a-fetoprotein (AFP) level, and size and number of tumors (54 tumors in each group). Results were assessed by contrast medium-enhanced CT.RESULTS: In both groups, 52 of 54 tumors (96.3%) were completely ablated. Eight of 54 tumors (14.8%) treated with ICEs and 39 of 54 tumors (72.2%) treated with PEs required multiple RF applications (P <.00005). In the respective groups, one of 54 tumors (1.8%) and seven of 54 tumors (12.9%) required multiple RF sessions (P =.03). Complication rates were similar. The 2-year probabilities of local and distant (ie, separated from the ablation zone) tumor progression in the ICE and PE groups were 11% and 15%, respectively (P =.65), and 31% and 64% (P =.01), respectively. On multivariate analysis, serum AFP level greater than 100 ng/mL (P =.006) and the use of a PE (P =.003) were risk factors for distant tumor progression.CONCLUSIONS: RF ablation with the use of a PE requires more applications and sessions and is associated with a higher risk of distant tumor progression compared with the use of an ICE.

En dépit d’un aspect de nécrose complète, pour 10 à 30 % des CHC on observe après radiofréquence une récidive locale. Une estimation fiable de l’épaisseur des marges de sécurité devrait permettre de mieux identifier les patients à haut risque de récidive. Un nouveau logiciel de volumétrie hépatique permet d’obtenir automatiquement une mesure du volume tumoral avant traitement et de la nécrose après. En admettant que les isocentres de la tumeur et de la zone d’ablation sont superposables, le simple rapport de ces volumes doit être proportionnel à l’épaisseur de la marge de sécurité. Nous avons évalué rétrospectivement la faisabilité et la fiabilité de cette mesure pour les patients pour qui nous avions les TDM pré et post-thérapeutiques en fichier DICOM. La mesure des volumes tumoraux et de nécrose était extrêmement rapide ne nécessitant qu’un nombre limité d’interventions manuelles. Les patients ayant présenté une récidive locale avaient les rapports volumiques qui se rapprochaient le plus de 1. Nos résultats suggèrent qu’en supplément de l’analyse du rehaussement par les produits de contraste, l’évaluation en imagerie des résultats de la radiofréquence des CHC pourrait être substantiellement améliorée par une approche volumétrique.

Quel est l’apport de l’IRM Gd-BOPTA dans l’évaluation posthérapeutique des carcinomes hépatocellulaires (CHC) après thermoablation radiofréquence (TARF) ? Quarante-six CHC traités par TARF (34 patients) ont été étudiés en IRM avec injection de Gd-BOPTA avant et 1 mois après le traitement. Le protocole d’imagerie comprenait une étude non spécifique de rehaussement (temps artériel et portal) et une étude de rehaussement hépatospécifique à 90 minutes. La taille maximale de nécrose mesurée à chaque temps de rehaussement a été comparée. La réponse globale au traitement a été jugée selon les critères habituels de l’imagerie et les données évolutives de chaque patient. Après un recul moyen de 22,3 mois, 4/46 nécroses incomplètes, 5/46 récidives locales, 12/46 récidives à distance et 1/46 mixte ont été observées. La nécrose apparaissait significativement moins étendue à la phase de rehaussement spécifique (p < 0,001) : Ø moyen = 26,6±11 mm versus 35±12 mm pour le temps portai et 33±12 mm pour le temps artériel. Cette tendance était plus accentuée pour les 9 CHC d’évolution locale défavorable. La phase de captation hépatospécifique du Gd-BOPTA permet une meilleure délimitation de la nécrose qui est surestimée aux temps de rehaussements non spécifiques.

Rôle du manipulateur dans la réalisation de macrobiopsies du sein en stéréotaxie conventionnelle. Les macrobiopsies sous vide ont été réalisées avec le système manuel VACORA® et recueil systématique de toutes les procédures et événements. Les indications ont été d’ordre diagnostique ou stratégique. Le but de l’examen et l’approche de la cible doivent être parfaitement connus des manipulateurs. Les avantages du système sont nombreux : qualité des prélèvements, maniabilité (appareil de petite taille, simple, mobile s’adaptant au potter stéréotaxique, non asservi à un équipement dédié), abord multiple (face, oblique, profil), coût. Les inconvénients sont liés à la position assise mais l’approche en décubitus latéral est possible. Pour réduire le temps d’examen et améliorer sa tolérance, un soin particulier doit être apporté dans le positionnement des patientes (confort et stabilité). Les limites sont liées aux éventuelles difficultés à dégager et comprimer la cible, selon la morphologie du thorax et du sein. Le système est utilisable sous echographie, IRM ou TDM. Le sytème VACORA® apporte une nouvelle approche des lésions mammaires infracliniques. En collaboration avec l’équipe médicale, le rôle du manipulateur dans la faisabilité et l’efficacité de cette technique est essentiel.

Démontrer l’efficacité de la désobstruction tubaire en association avec les traitements adjuvants de procréation médicale. Analyse morphologique et cinétique des trompes et passages péritonéaux des salpingographies et cathétérismes tubaires sélectifs réalisées à partir de 100 obstructions confirmées lors d’hystérographies au ballonnet. Corrélation aux autres facteurs d’infertilité, gynécologiques, ethnographiques. Examen douloureux, la désobstruction tubaire nécessite une prise en charge adaptée et un matériel adéquat : prémédication préalable, assistance per-opératoire, accompagnement post-opératoire. Après occlusion de l’endocol et salpingographie sélective par cathéter béquille, la désobstruction tubaire est réalisée avec succès dans plus de 75 % des cas par microcathétérisme sélectif 3F sur guide hydrophile 25. Les poches péritonéales et phimosis peuvent être libérés par cathétérisme très distal du guide. Le suivi tardif montre des résultats non négligeables avec plus de 25 % de grossesses menées à terme, débutées dans un court délai suivant la désobstruction tubaire (2 à 12 mois). La qualité des segments tubaires désobstrués constitue un facteur prédictif. Ces résultats sont obtenus dans plus de 50 % des cas en association de traitement adjuvant (stimulation avec ou sans insémination). La désobstruction tubaire par cathétérisme sélectif distal constitue une technique participant efficacement au schéma thérapeutique de l’infertilité.

Evaluer l’efficacité des thermoablations par radiofréquence TARF bipolaire pour le traitement des volumineux carcinomes hépatocéllulaire (CHC). Douze CHC (chez 12 patients cirrhotiques) de 40 à 65 mm (∅ = 47,9 mm) ont été traités par TARF bipolaires consistant en l’insertion intratumorale simultanée sous contrôle échographique de deux électrodes humides perfusées en continu avec du sérum salé hypertonique (5 %). Les résultats ont été évalués selon les critères d’imagerie habituels et les données évolutives des patients. Le temps de procédure a été en moyenne de 60 minutes. Avec un recul moyen de 3 mois, 9/12 CHC ont été totalement nécrosés. Une séance et demie a été nécessaire. Aucune complication majeure n’est survenue. La technique de TARF bipolaire permet la destruction complète de volumineux CHC peu accessibles à la technique monopolaire conventionnelle.

In order to establish a relationship between Hepatitis C virus (HCV) chronic infection and autoimmune thyroiditis, 97 untreated patients with biopsy-proven HCV chronic hepatitis and 97 controls were studied. An ultrasound examination of the thyroid and an assay of serum thyroid-stimulating hormone (TSH), thyroid hormones and anti-thyroid antibodies were performed in all cases. The overall prevalence of thyroid abnormalities was higher in patients than in controls (17 vs. 4%,P <0.01) and the prevalence of anti-thyroid antibodies was significantly different between the two groups (P<0.02). HCV patients with (n=13) compared to HCV patients without anti-thyroid antibodies (n=84) were older, predominantly female, and more frequently had increased serum TSH levels or a hypoechogenic pattern of the thyroid gland, while Knodell's score and prevalence of cirrhosis were similar. Latent autoimmune thyroiditis is more frequent in untreated HCV patients than in controls. This finding raises questions about the mechanism of autoimmunity induced by HCV and provides an explanation for the high rate of overt autoimmune thyroiditis during interferon treatment in these patients.

We report a case of cavitation of the mesenteric lymph nodes, an uncommon complication of celiac diseases. Computerized tomography is the method of choice for diagnosis and follow up after gluten free diet.

Two cases of aortitis associated with the presence of antiphospholipid antibodies (APAs) are reported. Only CT and MR imaging were able to show these unusual form of aortitis preferentially affecting the outer aortic tunics. We conclude that aortitis could be a new manifestation of primary antiphospholipid syndrome (APS) and the initial pathological process before the development of aortic thrombosis, reported as a classical complication of APS.

Background.-Dysplasias of the bony labyrinth are frequently associated with cerebrospinal fluid fistula and are usually discovered because of recurrent meningitis.Case report.-A 1 year-old infant was admitted for a pneumococcal meningitis which appeared 2 days after the occurrence of a clear otorrhea from the right ear. The same organism was isolated from otorrhea fluid, which also contained cerebrospinal fluid as confirmed cytochemically. The meningitis rapidly resolved with antibiotic treatment. Auditory brain stem responses were abolished form the right ear. CT of the temporal bones showed a pseudo-Mondini type labyrinth dysplasia at the right ear and Mondini type dysplasia at the left one. A translabyrinthine cerebrospinal fluid fistula was discovered by surgical exploration of the right ear, occurring through a perforation in the stapedial foot plate. The leak was cured by packing the vestibule and obturating both and round windows. Three years after the operation, the child did not experience any further episode of otorrhea of meningitis.Conclusions.-Features suggesting a translabyrinthine fistula, especially otorrhea and deafness, should be systematically searched in any child with bacterial meningitis. Closure of these fistulas can prevent severe infectious recurrences.

Les dysplasies du labyrinthe osseux s'accompagnent fréquemment de fistules souvent méconnues chez l'enfant et en général découvertes après un ou plusieurs épisodes successifs de méningite bactérienne. Un nourrisson a été hospitalisé à l'âge de l an pour une méningite à oneumocoque survenue 2 jours après l'apparition d'une otorrhée droite claire. Le méme germe a été isolé dans l'otorrhée, dont l'examen cytochimique a confirmé la nature cérébrospinale. L'évolution sous antibiothérapie a été rapidement favorable. Les potentiels évoqués auditifs du tronc cérébral étaient abolis à droite et normaux à gauche. L'examen lomodensitométrique des rochers a révélé des malformations labyrinthiques de type pseudo-Mondini à droite et de type Mondini à gauche. Le diagnostic de fistule cérébrospinale translabyrinthique droite a été confirmé par l'exploration chirurgicale. La fuite du liquide céphalorachidien a été localisée au niveau d'une perforation de la platine de l'étrier. L'étanchéité a été obtenue par comblement du vestibala et obturation des fenêres ovale et ronde. Trois ans après l'intervention chirurgicale, l'enfant va bien et n'inpésenté aucune récidive d'otorrhéa ou de méningite. La recherche de signes en faveur d'une fistule translabyrinthique, notamment d'une otorrhée de liquide céphalorahidien et d'une surdité, devrait être systématique chez tout enfant présentant une méningite bactérienne. L'oblitération de telle fistule permer d'éviter la survenue de récurrences infectieuses graves.

Journal Article Aortitis: A New Manifestation of Primary Antiphospholipid Syndrome Get access O. FAIN, O. FAIN *Departments of Internal Medicine93140 Bondy, France Search for other works by this author on: Oxford Academic PubMed Google Scholar E. MATHIEU, E. MATHIEU *Departments of Internal Medicine93140 Bondy, France Search for other works by this author on: Oxford Academic PubMed Google Scholar O. SEROR, O. SEROR †Departments of Radiology93140 Bondy, France Search for other works by this author on: Oxford Academic PubMed Google Scholar N. GANNE, N. GANNE ‡Departments of Gastroenterology93140 Bondy, France Search for other works by this author on: Oxford Academic PubMed Google Scholar M. H. AUROUSSEAU, M. H. AUROUSSEAU §Departments of Haemostasis Laboratory, Jean Verdier Hospital93140 Bondy, France Search for other works by this author on: Oxford Academic PubMed Google Scholar E. CODERC, E. CODERC †Departments of Radiology93140 Bondy, France Search for other works by this author on: Oxford Academic PubMed Google Scholar M. SITBON, M. SITBON *Departments of Internal Medicine93140 Bondy, France Search for other works by this author on: Oxford Academic PubMed Google Scholar M. THOMAS M. THOMAS *Departments of Internal Medicine93140 Bondy, France Search for other works by this author on: Oxford Academic PubMed Google Scholar Rheumatology, Volume 34, Issue 7, July 1995, Pages 686–687, https://doi.org/10.1093/rheumatology/34.7.686 Published: 01 July 1995 Article history Accepted: 30 March 1995 Published: 01 July 1995

3-Methylpiperidine derivatives of 1-[1-(2-thienyl)cyclohexyl]piperidine (TCP) and l-[1-(2-benzo[b]thiophenyl)cyclohexyl] piperidine (BTCP) were obtained in their racemic and homochiral forms. They have been tested for their affinity for the PCP receptor labeled with [3H]TCP and for the dopamine transporter labeled with [3H]BTCP. The homochiral TCP derivative (+)-R displayed a very high affinity (5.2 nM) and selectivity for the PCP receptor. In contrast, the homochiral BTCP derivative (−)-S therefore of opposite configuration, displayed a very high affinity (3.5 nM) and selectivity for the dopamine transporter.