[Pelvic actinomycosis: Diagnostic and therapeutic aspects]. / Actinomycose pelvienne : aspects diagnostiques et thérapeutiques.

OBJECTIVES: Actinomycosis is a rare little known granulomatous suppurative disease, more common in women, aided by the use of contraceptive purposes intrauterine device (IUD). Pelvic location is the rarest with an extension to adjacent organs making preoperative diagnosis difficult and misleading clinical presentation. Early diagnosis of this affection determines the therapeutic strategy and avoids mutilating interventions especially in young women. METHODS: We reviewed the record of women who consulted the department of obstetrics and gynecology at Ben Arous hospital (Tunisia) between January 2003 and December 2013 for a pelvic pain syndrome and in whom diagnosis of actinomycosis was suspected by clinical and imaging and confirmed by pathology. RESULTS: Eight cases of gynecologic abdominopelvic actinomycosis were diagnosed during the study period. Seven patients were carriers of an intrauterine device, with an average duration of 5 years wearing. Functional signs were essentially pelvic pain and fever. Physical examination of patients mainly showed two clinical presentations: a pelvic tumor syndrome or abdominopelvic and an array of pelvic abscess or pelvic inflammatory disease. Radiological investigations were allowed to suspect the diagnosis of actinomycosis only in one patient, in whom percutaneous biopsy confirmed the histological diagnosis without resorting to a surgical procedure. Operative procedures performed were varied as appropriate. The diagnosis of actinomycosis was made by pathology without any cases of bacterial isolation. All patients received antibiotic treatment with penicillin. The subsequent evolution was favorable. CONCLUSION: The diagnosis of actinomycosis should be considered in any invasive abdominal mass of neoplastic appearance and in case of table of genital infection especially in patients bearing IUD for 5 years or more.

Use of yttrium-90 microsphere radioembolization of hepatocellular carcinoma as downstaging and bridge before liver transplantation: a case report.

BACKGROUND AND OBJECTIVE: Yttrium-90 microspheres radioembolization (Y90-RE) has been recently introduced as promising modality of treatment in patients with hepatocellular carcinoma (HCC) who are not otherwise candidates for local ablation, surgical resection, or liver transplantation (OLT). However, its use in downstaging HCC or as a bridge for OLT is still unclear. Herein, we have presented a case where Y90-RE was used to both downstage and to serve as a bridge for OLT. CASE REPORT: We report a 54-year-old lady who was known to have hepatitis B virus cirrhosis in addition to two focal hepatic lesions in segments 5 and 8, measuring 1.5 and 7.5 cm, respectfully. Extrahepatic spread was thoroughly ruled out. This tumor was clearly beyond both the Milans and University of California San Francisco criteria for OLT in HCC patients; therefore, we offered the patient Y90-RE in an attempt to downstage the tumor and as a bridge for OLT. Y90-RE was performed targeting the large lesion; the patient underwent cadaveric OLT 2 months thereafter. Gross examination of the explant showed necrotic tumor with obvious signs of irradiation-induced damage. Microscopic examination of the explant showed Y90 microspheres trapped in the large tumor with near-complete tumor necrosis. This patient completed 1-year post-OLT follow-up with no signs of tumor recurrence. CONCLUSIONS: The use Y90-RE in HCC may be useful for downstaging or as a bridge to liver transplantation.

CT findings of pulmonary artery dissection.

Pulmonary artery dissection is a serious fatal complication of chronic pulmonary arterial hypertension, always occurring at the site of maximal dilatation of the artery. Diagnosis is made mainly at autopsy as many of these patients experience sudden death when the main pulmonary artery dissects into the pericardium, causing acute cardiac tamponade. To our knowledge, five reported cases have described CT imaging findings of acute pulmonary artery dissection in the literature.

Accurate method for preoperative estimation of the right graft volume in adult-to-adult living donor liver transplantation.

BACKGROUND: Accurate estimation of graft volume is crucial to avoid small-for-size syndrome following adult-to-adult living donor liver transplantation AALDLT). Herein, we combined radiological and mathematical approaches for preoperative assessment of right graft volume. METHODS: The right graft volume was preoperatively estimated in 31 live donors using two methods: first, the radiological graft volume (RGV) by computed tomography (CT) volumetry and second, a calculated graft volume (CGV) obtained by multiplying the standard liver volume by the percentage of the right graft volume (given by CT). Both methods were compared to the actual graft volume (AGV) measured during surgery. The graft recipient weight ratio (GRWR) was also calculated using all three volumes (RGV, CGV, and AGV). Lin's concordance correlation coefficient (CCC) was used to assess the agreement between AGV and both RGV and CGV. This was repeated using the GRWR measurements. RESULTS: The mean percentage of right graft volume was 62.4% (range, 55%-68%; SD +/- 3.27%). The CCC between AGV and RGV versus CGV was 0.38 and 0.66, respectively. The CCC between GRWR using AGV and RGV versus CGV was 0.63 and 0.88, respectively (P < .05). According to the Landis and Kock benchmark, the CGV correlated better with AGV when compared to RGV. The better correlation became even more apparent when applied to GRWR. CONCLUSION: In our experience, CGV showed a better correlation with AGV compared with the RGV. Using CGV in conjunction with RGV may be of value for a more accurate estimation of right graft volume for AALDLT.