OBJECTIVE:Our purpose was to compare the accuracy of MR cholangiopancreatography and endoscopic sonography for the diagnosis of common bile duct stones in patients with a mild to moderate clinical suspicion of common bile duct stones.SUBJECTS AND METHODS:Forty-seven patients were prospectively enrolled. Inclusion criteria included acute pancreatitis, subclinical jaundice, and clinical features of common bile duct stone migration. Radial endoscopic sonography and MR cholangiopancreatography with the single-shot fast spin-echo technique were performed a maximum of 48 hr apart. The gold-standard diagnosis was obtained with ERCP (n = 20) or intraoperative cholangiography (n = 14) if the results of endoscopic sonography or MR cholangiopancreatography were abnormal or if a cholecystectomy was performed, or by clinical and biochemical follow-up (n = 11) if the results of endoscopic sonography and MR cholangiopancreatography were normal.RESULTS:The final diagnosis was common bile duct stones in 16 patients, malignant obstructions in four, and another biliary disease in two (lithiasis migration aspect with papillary edema); 23 patients had no biliary disease. The sensitivity and specificity of MR cholangiopancreatography were, respectively, 90.5% and 87.5% for etiologic diagnosis and 87.5% and 96.6% for the detection of common bile duct stones. The corresponding values for endoscopic sonography were 86.4% and 91.3% for etiologic diagnosis and 93.8% and 96.6% for visualization of choledocholithiasis. Accuracy did not significantly differ between the techniques.CONCLUSION:In cases of mild to moderate suspicion of choledocholithiasis, the accuracies of endoscopic sonography and MR cholangiopancreatography are similar. Because MR cholangiopancreatography is noninvasive, it may be preferred for this indication.

STUDY AIM:The aim of this retrospective study was to evaluate the short and long term results of abdominoperineal resection for local recurrence following low anterior resection of a rectal adenocarcinoma and to determine the prognostic factors.PATIENTS AND METHODS:From January 1978 to December 1996, 35 patients (17 women, 18 men) with a mean age of 59.4 years, underwent an abdominoperineal resection for local recurrence after low anterior resection of a rectal adenocarcinoma. The primary tumor was below the peritoneum in 29 cases, and the mean security margin was 3 cm under the tumor. Tumor staging at the time of primary surgery included 23 Dukes B, 11 Dukes C, and 1 Dukes D. The mean time elapsed between low anterior resection and local recurrence was 16.4 months. The histological diagnosis of recurrence was obtained preoperatively in 29 cases (82.8%).RESULTS:Resection was curative in 12 patients and palliative only in 23 patients. The recurrence was intramural in 3 cases, extramural in 10 cases, and mixed in 22 cases. Ten patients had an extended "en bloc" resection including one or several adjacent organs, and a synchronous metastasis was resected in 2 cases. The mortality rate was 2.8% (n = 1) and the morbidity rate was 23% (n = 8). The 1-year and 5-year survival rates were respectively 77 and 30.2% with the univariate analysis of prognosis factors of survival, there were four pretherapeutic factors (age, staging of the primary tumor, delay of the recurrence, CEA rate) and four therapeutic factors (curative resection, extramural recurrence, staging of the recurrence, postoperative radiotherapy). The curative or not curative type of resection was the only independent predictor of survival with multivariate analysis.CONCLUSION:The results of this study seem to justify an abdominoperineal resection for local recurrence after low anterior resection whenever possible. Long-term results may possibly be improved by using adjuvant treatment.

La frequence des stenoses des anastomoses pancreatico-gastriques est meconnue et peut-etre sous-estimee car elles sont souvent asymptomatiques. Nous rapportons une observation de pancreatite aigue recidivante secondaire a une stenose d'une anastomose pancreatico-gastrique 3 ans apres une duodeno-pancreatectomie cephalique, d'evolution favorable apres anastomose pancreatico-jejunale secondaire.

Study aim: The aim of this retrospective study was to evaluate the short and long term results of abdominoperineal resection for local recurrence following low anterior resection of a rectal adenocarcinoma and to determine the prognostic factors.Patients and methods: From January 1978 to December 1996, 35 patients (17 women, 18 men) with a mean age of 59.4 years, underwent an abdominoperineal resection for local recurrence after low anterior resection of a rectal adenocarcinoma. The primary tumor was below the peritoneum in 29 cases, and the mean security marge was 3 cm under the tumor. Tumor staging at the time of primary surgery included 23 Dukes B, 11 Dukes C, and 1 Dukes D. The mean time elapsed between low anterior resection and local recurrence was 16.4 months. The histological diagnosis of recurrence was obtained preoperatively in 29 cases (82.8%).Results: Resection was curative in 12 patients and palliative only in 23 patients. The recurrence was intramural in 3 cases, extramural in 10 cases, and mixed in 22 cases. Ten patients had an extended "en bloc" resection including one or several adjacent organs, and a synchronous metastasis was resected in 2 cases. The mortality rate was 2.8% (n=1) and the morbidity rate was 23% (n=8). The 1-year and 5-year survival rates were respectively 77 and 30.2% with the univariate analysis of prognosis factors of survival, there were four pretherapeutic factors (age, staging of the primary tumor, delay of the recurrence, CEA rate) and four therapeutic factors (curative resection, extramural recurrence, staging of the recurrence, postoperative radiotherapy). The curative or not curative type of resection was the only independent predictor of survival with multivariate analysis.Conclusion: The results of this study seem to justify an abdominoperinal resection for local recurrence after low anterior resection whenever possible. Long-term results may possibly be improved by using adjuvant treatment. (C) 2001 Editions scientifiques et medicales Elsevier SAS.

Purpose: The aim of this study was to evaluate a new MR cholangiography sequence in which thick slices are obtained with half Fourier acquisition (SSFSE) in biliary obstructive diseases.Patients and methods: Fifty patients with suspected bile duct obstruction were prospectively investigated with MR cholangiography using SSFSE sequence with thick slices. The gold standard was ERCP (n = 40), percutaneous cholangiography (n = 1) or surgical findings (n = 9). According to this gold standard, 17 patients had bile duct lithiasis and 21 had neoplastic obstruction.Results: The sensitivity and specificity of MR cholangiography were 100% and 94% for the diagnosis of lithiasis obstruction and 95% and 97% for neoplastic obstruction. Agreement between the MR cholangiogram and the gold standard was good whatever the site of obstruction (range of kappa values: 0.79 - 1).Conclusion: MR cholangiography with SSFSE sequence is a useful, precise and easy to use technique. Acquisition time for thick slices is short (< 2 sec) limiting cardiorespiratory artefacts and eliminating the need for post-treatment.

PURPOSE:The aim of this study was to evaluate a new MR cholangiography sequence in which thick slices are obtained with half Fourier acquisition (SSFSE) in biliary obstructive diseases.PATIENTS AND METHODS:Fifty patients with suspected bile duct obstruction were prospectively investigated with MR cholangiography using SSFSE sequence with thick slices. The gold standard was ERCP (n = 40), percutaneous cholangiography (n = 1) or surgical findings (n = 9). According to this gold standard, 17 patients had bile duct lithiasis and 21 had neoplastic obstruction.RESULTS:The sensitivity and specificity of MR cholangiography were 100% and 94% for the diagnosis of lithiasis obstruction and 95% and 97% for neoplastic obstruction. Agreement between the MR cholangiogram and the gold standard was good whatever the site of obstruction (range of kappa values: 0.79-1).CONCLUSION:MR cholangiography with SSFSE sequence is a useful, precise and easy to use technique. Acquisition time for thick slices is short (< 2 sec) limiting cardiorespiratory artefacts and eliminating the need for post-treatment.

Mucinous ectasia of the pancreas ducts is a recently described cystic lesion which usually occurs in acute pancreatitis. Endoscopic retrograde pancreatography provides diagnosis. Mucinous ductal ectasia is considered to be a precancerous lesion. Surgical exeresis is recommended. Our two cases emphasize the difficulties encountered for differential diagnosis with other cystic lesions of the pancreas.

Mucinous ectasia of the pancreas ducts is a recently described cystic lesion which usually occurs in acute pancreatitis. Endoscopic retrograde pancreatography provides diagnosis. Mucinous ductal ectasia is considered to be a precancerous lesion. Surgical exeresis is recommended. Our two cases emphasize the difficulties encountered for differential diagnosis with other cystic lesions of the pancreas.