Percutaneous treatment of extrahepatic recurrence of hepatocellular carcinoma.

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.

Latent autoimmune thyroiditis in untreated patients with HCV chronic hepatitis: a case-control study.

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.

Aortitis with antiphospholipid antibodies: CT and MR findings.

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.

[Mesenteric lymph node cavitation disclosing celiac disease in adults]. / Cavitation ganglionnaire mésentérique révélatrice de maladie coeliaque chez l'adulte.

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.

[Pneumococcal meningitis revealing dysplasia of the bony labyrinth in an infant]. / Méningite à pneumocoque révélatrice d'une dysplasie du labyrinthe osseux chez un nourrisson.

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 the otorrhea fluid, which also contained cerebrospinal fluid as confirmed cytochemically. The meningitis rapidly resolved with antibiotic treatment. Auditory brain stem responses were abolished from 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 oval and round windows. Three years after the operation, the child did not experience any further episode of otorrhea or 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.

[Secondary sclerosing cholangitis and chemo-embolization with lipiodol]. / Cholangite sclérosante secondaire et chimio-embolisation lipiodolée.

Two cases of sclerosing cholangitis after oily arterial chemoembolization are reported. In one patient angiocholitis with liver abscesses, in the other patient gradual cholestasis were the main clinical features. In both cases, endoscopic retrograde cholangiogram showed a stricture of the common hepatic bile duct and, in one case, irregularities of intrahepatic biliary tree. Histologic examination of the liver in the two patients pointed out the involvement of small bile ducts and arteriolar endarteritis obliterans. Ischaemia is likely to be the main mechanism of these two cases of sclerosing cholangitis as well as in those described after FUDR intra-arterial chemotherapy. The prevalence of sclerosing cholangitis after arterial oily chemoembolization is probably underestimated because of a non specific clinical presentation and need to be precise by further study.

Prospective study of screening for hepatocellular carcinoma in Caucasian patients with cirrhosis.

Screening is widely used to detect early hepatocellular carcinoma in Asian patients with cirrhosis. Its effectiveness in Caucasian patients has been suggested, but remains to be proven. Therefore we prospectively studied 118 French patients (68 males, 50 females, age 55 +/- 12) with Child-Pugh A or B cirrhosis (alcoholic in 82) and without detectable hepatocellular carcinoma. The screening program consisted of ultrasound examination of the liver and determination of blood alpha-fetoprotein and des-gamma-carboxyprothrombin levels every 6 months. The median follow up was 36 months (range 4-48). Only four patients were lost to follow up. Fourteen hepatocellular carcinomas were detected, in six cases by ultrasonography alone, in four by alpha-fetoprotein alone, in three by ultrasonography and alpha-fetoprotein and in one case by ultrasonography and des-gamma-carboxyprothrombin, but never by des-gamma-carboxyprothrombin alone. The tumor presented as a unique nodule in nine patients. The tumor was less than 3 cm in diameter without portal thrombosis or metastasis in three cases. Surgery was performed in only one case. In this study, the annual incidence of hepatocellular carcinoma was high (5.8%), but the screening methods used did not effectively identify potentially resectable tumors in Caucasian patients with cirrhosis.

[Anulography]. / L'annulographie.

Despite new imaging modalities such as MRI, the discography remains useful, particularly as the first step of chemonucleolysis. The anulography corresponds to a technical error due to the wrong position of the needle during the procedure. We have noticed 32 anulographies on 1226 discographies done in our department, between 1985 and 1989. The anulography exhibits a typical pattern that must be diagnosed; if not, that can lead to a diagnosis mistake or a wrong therapeutic attitude. The needle of discography must then be repositioned.