Determination of oenothein B as the active 5-alpha-reductase-inhibiting principle of the folk medicine Epilobium parviflorum.

Several extracts from Epilobium parviflorum, a plant used in Central Europe for the treatment of prostate disorders, were evaluated in a biochemical assay with 5-alpha-reductase. The aqueous extract displaying inhibition of the enzyme was analyzed, the fraction responsible for this activity was purified, and the active compound identified as a macrocyclic tannin, oenothein B (1).

Osteoid osteoma: MR imaging versus CT.

PURPOSE: To compare the performance of computed tomography (CT) and magnetic resonance (MR) imaging in diagnosis of osteoid osteoma. MATERIALS AND METHODS: Nineteen patients with histologically proved osteoid osteoma underwent CT and MR imaging before excision of the lesion. CT and MR images were compared regarding lesion conspicuity and detection of marrow, soft-tissue, and/or synovial changes adjacent to the primary lesion. RESULTS: CT was more accurate than MR imaging in detection of the osteoid osteoma nidus in 63% of cases. MR imaging was better than CT in showing intramedullary and soft-tissue changes in all cases. This may produce a misleading aggressive appearance on MR images. There was a statistically significant correlation between presence or absence of marrow or soft-tissue changes and treatment with antiinflammatory medications (P < .05). CONCLUSION: CT remains the best imaging modality for diagnosis of osteoid osteoma. MR images should not be interpreted without reference to plain radiographs and CT scans if serious errors in diagnosis are to be avoided.

[Transjugular intrahepatic portasystemic shunt and liver transplantation]. / Anastomose portosystémique intra-hépatique par voie transjugulaire et transplantation hépatique.

From the first one hundred consecutive patients treated by transjugular intrahepatic portosystemic shunt (TIPS), 12 subsequently underwent liver transplantation (a mean of 103 +/- 109 days after TIPS). Fourteen TIPS were created in 12 patients, with advanced cirrhosis (Child B = 5, C = 7) and portal hypertension. Seven patients presented either active variceal hemorrhage or refractory variceal bleeding, and 5 cases of refractory ascites. The shunt could be performed in all cases. Two patients experienced rebleeding (one after a shunt obstruction) and were successfully treated by insertion of a second TIPS. A histological study was performed in 10 cases. The shunt was patent in all cases (except in one case previously described), and the endoluminal surface was covered by a connective tissue layer and a new endothelium. We therefore conclude that this method is a safe and effective therapy for complications of portal hypertension, in patients referred for liver transplantation.

Transjugular intrahepatic portosystemic shunts using the Wallstent prosthesis: a follow-up study.

PURPOSE: The aim of the present study was to assess the efficacy of transjugular intrahepatic portosystemic shunts (TIPS) in 45 patients with cirrhosis during a mean follow-up of 7 months. METHODS: Forty-five consecutive patients treated by TIPS and who had been followed for at least 6 months after TIPS or until death, were included. Mean follow-up was 7.2 +/- 5.0 months. Shunt patency was assessed at 1 week and 1 month, then every 3 months after the procedure by Doppler US and angiography whenever needed. RESULTS: Thirty-six patients had been stented for refractory bleeding from ruptured esophagogastric varices. Of these, 8 patients (22%) rebled, 7 of whom were treated by a second shunt. Nine patients were treated for refractory ascites. Three patients had recurrent ascites due to shunt obstruction. All were treated by a second shunt which occluded in 2 patients. As a whole, 14 (31.1%) patients developed shunt obstruction within a mean of 120 +/- 136 days, 4 of whom remained asymptomatic. Other complications were septicemia by Staphylococcus aureus in 1 patient, transient encephalopathy in 9 patients, and disseminated intravascular coagulation in 1 patient. CONCLUSIONS: TIPS appears to be a relatively safe and effective technique in treating complications of portal hypertension in patients with cirrhosis. Shunt obstruction in 31% of our patients probably represents the most important limitation of this technique.

[Treatment of hemorrhages by rupture of cardio-tuberous varices with transjugular intrahepatic portasystemic shunt]. / Traitement des hémorragies par rupture de varices cardio-tubérositaires par anastomose porto-systémique intra-hépatique par voie trans-jugulaire.

Twelve consecutive patients admitted for bleeding from ruptured gastric varices were treated with transjugular intrahepatic portosystemic shunts and followed for a mean of 6 +/- 3 months (range: 8-293 days). The shunt was performed successfully in all 12 patients. The shunt occluded in 3 patients (respectively 19, 101 and 103 days after insertion) of whom one remained asymptomatic and two experienced rebleeding. Four patients presented with acute encephalopathy, spontaneously in two and after rebleeding in two. Three patients died, two after rebleeding and one of septic shock secondary to pneumonia. Overall, 9 patients survived a mean of 211 +/- 92 days with no rebleeding, 8 of whom have not yet experienced any complications. These results suggest that transjugular intrahepatic portosystemic shunts could be useful in treating hemorrhages from ruptured gastric varices and in preventing their recurrence.

[Left pancreatectomy with preservation of the spleen without its pedicle. Apropos of 13 cases]. / Pancréatectomies gauches avec conservation de la rate sans son pédicule. A propos de treize cas.

Overwhelming post splenectomy infections in childhood were first described by King and Shumaker in 1952. This septic risk, although a matter of controversy, also exists in adults. Thus, splenic conservation must become a surgical concern in left pancreas resections for benign or traumatic diseases. The authors report their experience with a simplified procedure in which the splenic pedicle is resected "en bloc" with the left pancreas. This technique has been employed in thirteen patients, in whom spleen could be preserved in twelve, without operative mortality and a low morbidity rate.

[Magnetic resonance imaging in the bone sites of malignant non-Hodgkin's lymphoma. Apropos of 16 cases]. / Imagerie par résonance magnétique dans les localisations osseuses des lymphomes malins non Hodgkiniens. A propos de seize observations.

The primordial role of MRI in the staging of primary or secondary bone tumors has been clearly established. The authors report a study of 16 patients with NHL with suspected bone involvement, investigated by conventional radiography, bone scan, CT, bone marrow biopsy and MRI. The authors believe that, in the future, MRI will have an important role in the staging and follow-up of treatment of bone lymphomas. Better than any other techniques, MRI provides a precise assessment of tumor extension. It also represents a valuable method for monitoring patients during treatment by visualising the course of the disease.

[Aneurysm of the pulmonary artery. X-ray computed tomographic and MRI aspects. A case report and review of the literature]. / Anévrysme de l'artère pulmonaire. Aspects TDM et IRM. A propos d'un cas et revue de la littérature.

A case of aneurysm of the pulmonary artery diagnosed by CT scan and MRI and confirmed by angiography is reported. The discussion considers the literature review.

[MRI in subacromial pathology. Report of 20 cases]. / IRM dans la pathologie sous-acromiale. A propos de 20 observations.

The authors report the results of MRI performed in 20 patients presenting clinical symptoms of subacromial pathology. The MRI results are correlated to the results of arthrography or arthro CT scan and also to surgical results. MRI is an excellent technique if a precise protocol with T2 weighted images is respected in order to visualize tears or minor perforations of the supraspinatus muscle.

[Obstructive intramural hematoma of the esophagus. A rare complication of endoscopic sclerotherapy of esophageal varices]. / Hématome intramural obstructif de l'oesophage. Une complication rare de la sclérose endoscopique des varices oesophagiennes.

Obstructive intramural hematoma of the esophagus is an unusual complication of endoscopic sclerotherapy. We report three patients with liver cirrhosis who experienced such a complication. In our series, the frequency was 1.6 percent. A few hours after sclerotherapy, all three patients complained of low retrosternal pain, dysphagia and hypersialorrhea. Endoscopy was performed in two patients and showed a typical bluish submucosal mass occupying the esophageal lumen. Outcome was favorable in all patients within one week of conservative treatment. We hypothesized that hematoma could be ascribed to variceal puncture. The extension of the hematoma with dissection of the esophageal wall which had been fragilized by previous sclerotherapy sessions could have been facilitated by impaired coagulation.

[Hepatic angiosarcoma. CT and MRI aspects. A case report and review of the literature]. / Angiosarcome hépatique. Aspect TDM et IRM. A propos d'un cas et revue de la littérature.

The authors report a case of hepatic angiosarcoma revealed by massive haemoperitoneum. They analyse the CT and MRI features of this rare tumour and recall the difficult diagnostic problems raised by cavernous angiomas. The new MRI diagnostic criteria must be recognized, but do not constitute formal proof of the diagnosis.

[Percutaneous transluminal endarterectomy of femoro-popliteal atheromatous lesions. Technique. Indications. Results after 6 months]. / Athérectomie transluminale percutanée des lésions athéromateuses fémoro-poplitéees. Technique. Indications. Résultats à 6 mois.

Percutaneous atherectomy was performed in 25 patients with 30 symptomatic femoro-popliteal stenosis. INITIAL RESULTS: 23 patients were successfully treated with disappearance of claudication and a mean 0.35 increase in the ankle-arm-index. Two early thrombosis occurred. Angiographic analysis: residual stenosis lower than 30% in 25 lesions; no dissection or embolization; effective treatment of eccentered and calcified lesions; no significant dissection after additional angioplasty. RESULTS AT 6 MONTHS FOLLOW-UP: (17 patients, 19 lesions): stable improvement in 14 patients; 2 restenosis; 1 new disease. Atherectomy restores a large lumen with minimal wall trauma, thus perhaps decreasing the restenosis rate.

[Percutaneous transluminal atherectomy of the femoropopliteal arteries. Technic, indications, results after 6 months]. / Athérectomie transluminale percutanée des artères fémoro-poplitées. Technique, indications, résultats à six mois.

Percutaneous atherectomy was performed in 25 patients with 30 symptomatic femoro-popliteal stenoses. Twenty-three patients were successfully treated with resolution of claudication and a mean 0.35 increase in the ankle-arm-index. Two early thromboses occurred. Residual stenosis was less-than 30% in 25 lesions, with no dissection, and no embolization. Atherectomy seems to be an effective treatment for eccentric and calcified lesions. At 6 months follow-up (17 patients, 19 lesions) clinical and Doppler improvement remained stable in 14 patients; 2 restenosis and 1 new disease occurred. Atherectomy restores a large lumen with minimal wall trauma, thereby possibly decreasing the restenosis rate.

[Multiple leiomyosarcoma of the small intestine. Apropos of a case]. / Léiomyosarcomes multiples du grêle. A propos d'un cas.

The authors report a case of multiple leiomyosarcomas of the small intestine, which is a very exceptional entity. After reviewing the pathological features and the distribution of leiomyosarcomas, they present the radiological and especially the computed tomographic findings of this type of tumour. They stress the difficulty of the differential diagnosis both in the solitary forms and in the exceptional multiple forms.

[Mesenterico-atrial shunt in the treatment of Budd-Chiari syndrome. Contribution of MRI in monitoring of 2 cases]. / Shunt mésentérico-atrial dans le traitement du syndrome de Budd-Chiari. Apport de l'IRM dans la surveillance à propos de deux cas.

The authors report the value of MRI in the long-term follow-up of two cases of mesenterico-atrial shunt for Budd-Chiari syndrome. They discuss the problems of differential diagnosis between slow flow and thrombosis, a significant risk with this type of shunt.