[Organized colorectal screening in French Community of Belgium and polyp surveillance]. / Le dépistage organisé du cancer colorectal en Communauté française de Belgique et surveillance des polypes.

Colorectal cancer is an important health care problem in Belgium and screening is now widely recommendend. The French Community has launched in March 2009, a campaign to build public and professional awareness of the importance of screening for colorectal cancer. With the goal of encouraging all persons age 50 to 74 to actively gain information and seek screening with the active participation of their house doctors, the campaign will work to clarify any myths or fears about screening options and ensure that the importance of screening and early detection will be understood. The program in the French Community propose guaiac-based fecal occult blood testing for average risk people and, in case of positivity a colonoscopy must be performed. A high quality colonoscopy should be offered first in case of significant personal and familial history of adenomas, colorectal cancer and some specific extracolonic neoplasia. Several strategies will be used to ensure follow up of this program and encourage wide participation of the population.

Transoral gastroplasty is safe, feasible, and induces significant weight loss in morbidly obese patients: results of the second human pilot study.

BACKGROUND AND STUDY AIMS: Bariatric surgical treatments have been proven to induce long-term weight loss in morbidly obese patients, but complications are relatively frequent. We recently reported a first human multicenter trial assessing the safety, feasibility, and weight loss results of the Transoral Gastroplasty (TOGA) system (Satiety Inc., Palo Alto, CA) at 6 months. Here we report the 6-month results of the second phase of the pilot trial with the TOGA system, with technical improvements to the device. PATIENTS AND METHODS: Patients met established criteria for bariatric surgery. The TOGA system, a set of transoral endoscopically guided staplers, was used to create a stapled restrictive pouch along the lesser curvature of the stomach. Follow-up was at 1 week and at 1, 3, and 6 months. At 3 months, re-treatment consisting in additional distal restrictions was allowed if necessary. RESULTS: Data were available for 11 patients in our center (7 female, mean age 44.2 years, mean body mass index 41.6). The procedure was completed safely in all patients. There were no serious adverse events. Mean excess weight loss was 19.2 %, 33.7 %, and 46.0 % at 1, 3, and 6 months, respectively. Average body mass index decreased from 41.6 before treatment to 33.1 at 6 months. Absolute mean weight loss was 9.9 kg, 17.5 kg, and 24.0 kg at 1, 3, and 6 months, respectively. A dramatic improvement in quality-of-life measures was observed in all patients. CONCLUSIONS: This second pilot trial confirmed the feasibility and safety of transoral gastroplasty. The early results and technical improvements reported in the present study are encouraging in terms of safety, early weight loss, and quality of life, and clearly allowed multicenter trials, which are planned to start soon.

A primary peritoneal pseudomyxoma peritonei arising from the Mullerian tissue: a case report.

A primary Pseudomyxoma Peritonei is uncommon. For a long time, ovaries, colon and appendix were proposed like a site origin of these enigmatic lesions. Recent publications show that the majority of cases are due to a rupture of appendicle adenoma. We report a case of a pseudomyxoma peritonei arising in an elderly patient with a previous medical history of appendectomy undergone in infancy. The pseudomyxoma was misdiagnosed as an abdominal abscess related to colitis. In our opinion, metaplasia of the Müllerian system is a possible source of a primary peritoneal pseudomyxoma.

Oesophageal perforation by an anterior cervical fixation device: management in debilitated patients.

Oesophageal perforation following anterior cervical fixation has been reported in the neurosurgical and orthopaedic literature as a rare complication of such procedure. The complications associated with oesophageal perforation may range from minor symptoms to mediastinitis and death. We report two oesophageal perforations following cervical fixation device migration in patients with poor prognosis, managed successfully with conservative surgical and endoscopic techniques.

Idiopathic eosinophilic oesophagitis: atypical presentation of a rare disease.

A 72 year-old man presented severe dysphagia and weight loss of recent onset. Repeated oesophageal endoscopy and biopsies with macroforceps were normal. Oesophageal manometry disclosed features compatible with achalasia. Oesophageal EUS endoscopy localized an infiltrating process between muscular layers of the oesophageal wall and CT scan delimited a circular thickening in the inferior part of the oesophagus. Because of severe clinical presentation mimicking a possible oesophageal neoplasm like a lymphoma, partial oesophagectomy was performed and revealed eosinophilic oesophagitis. This unusual presentation emphasizes that idiopathic eosinophilic oesophagitis must be proposed in the differential diagnosis of dysphagia, even in old patient without apparent oesophageal lesion at endoscopy.

Laparoscopic Nissen fundoplication after failure of Enteryx injection into the lower esophageal sphincter.

BACKGROUND: We investigated the feasibility, safety, and efficacy of laparoscopic antireflux surgery (LARS) after failure of Enteryx injection in the lower esophageal sphincter for the treatment of gastroesophageal reflux disease (GERD). METHODS: Four patients underwent LARS after failure of Enteryx injection. Particular care was taken during the procedure to identify unusual material or fibrosis. RESULTS: All patients underwent LARS successfully. In three patients, tight adhesions with fibrous tissues and black foreign material were observed around the esophagus. No complications occurred during the procedures. The postoperative period was uneventful and functional results were excellent. CONCLUSION: LARS following Enteryx injection is feasible. Careful dissection is mandatory to avoid operative complications. Both techniques may be considered as options for treating GERD.

[The medical imaging and radiology department]. / Le Service d'Imagerie Médicale et de Radiologie Interventionnelle.

Technological developments arising from research have affected the whole wide spectrum of medical endeavor and have made a very significant impact on clinical practice and especially on imaging sciences. Ultrasonography brought spectacular advances, but CT and MRI became important landmark techniques. A further important development, which greatly increased the involvement of radiologists in direct patient management, was the growth of interventional and therapeutic techniques, called interventional radiology. Some statistics: approximately 155,000 patients per year including 19,000 CT Scans, 10,000 MRI exams, 21,000 ultrasound examinations and 1,000 therapeutic procedures. Some research activities: CT quantification of pulmonary emphysema, respiratory mechanics, MR and CT angiography, antenatal diagnosis of congenital and genetic diseases of the fetus, quantification of portal haemodynamics, MR imaging of bile and pancreatic ducts, morphologic and functional imaging of the brain, radiology of bone trauma, MR characterization in hepatic lesions.

[Preoperative evaluation of rectal cancer]. / Evaluation préopératoire du cancer du rectum.

For a patient with a rectal tumor, the preoperative staging should answer four questions: Is the rectal tumor unique? Is the patient operable? Are there distal metastases? What is the loco-regional extension? The loco-regional extension is well evaluated by the echo-endoscopy while the involvement of the surrounding organs is better assessed by CT-scan or resonance magnetic imaging.

Helical CT signs in the diagnosis of intestinal ischemia in small-bowel obstruction.

OBJECTIVE: The purpose of our study was to determine prospectively the value of helical CT and of various signs of ischemia in the context of acute bowel obstruction. SUBJECTS AND METHODS: All patients seen over a 3-year period with a CT diagnosis of small-bowel obstruction were included. There were 144 examinations in 142 patients. Images were interpreted prospectively with consensus by a fellow and an experienced gastrointestinal radiologist. Attention was focused on the presence of the following signs of strangulation and ischemia: reduced enhancement of the small-bowel wall, mural thickening, mesenteric fluid, congestion of small mesenteric veins, and ascites. A diagnosis of ischemia was made if enhancement of the bowel wall was reduced or if at least two of the other signs were found. Results were correlated with surgical findings in 73 cases and clinical follow-up in 71 cases. RESULTS: A diagnosis of ischemia was made at surgery in 24 patients. CT diagnosis was correct in 23 patients (96% sensitivity). There were nine false-positive diagnoses (93% specificity). The negative predictive value of CT was 99%. Reduced enhancement of the bowel wall had a sensitivity of 48% and specificity of 100%, mural thickening had a sensitivity of 38% and specificity of 78%, mesenteric fluid had a sensitivity of 88% and specificity of 90%, congestion of mesenteric veins had a sensitivity of 58% and specificity of 79%, and ascites had a sensitivity of 75% and specificity of 76%. CONCLUSION: Helical CT is a highly sensitive method to diagnose or rule out intestinal ischemia in the context of acute small-bowel obstruction.

Dual phase helical CT of a primary malignant fibrous histiocytoma of the right renal vein.

A case is reported of primary malignant fibrous histiocytoma of the right renal vein involving the ipsilateral kidney which showed early enhancement on dual phase helical CT. The correct diagnosis of a primary tumour of the renal vein involving the kidney was not made but in retrospect could have been achieved pre-operatively by considering several CT features.

[Cap polyposis: a rare syndrome]. / Cap polyposis: un syndrome rare.

We report a case of inflammatory cap polyposis of the colon, a rare syndrome, affecting the rectosigmoid. It was observed in a context of mucous diarrhea. Endoscopic and radiological features consisted of elevated and umbilicated nodular lesions. Histology revealed polypoid lesions containing elongated crypts with superficial abrasions, covered by inflammatory and fibrinoid material. Etiopathogenesis of this new syndrome is unknown.

Role of the double-contrast barium enema in rectal stenosis due to suppositories containing paracetamol and acetylsalicylic acid.

Self-treatment of chronic headache with suppositories containing paracetamol and acetylsalicylic acid may lead to serious complications. We report the radiological features of five cases of rectal stenosis following the use of such suppositories. The role of the double-contrast barium enema in suggesting the diagnosis of this complication of a chronic and often unrecognized self-treatment is emphasized.

Late liver metastases of small bowel leiomyoma. The difficulty in assessing malignancy in gastro-intestinal smooth muscle tumours.

Two cases of small bowel tumour, resected and considered as benign leiomyomas, are reported. Both developed late hepatic metastases, 6 and 8 years after surgery respectively, diagnosed as leiomyosarcoma. Emphasizing the difficulties in assessing malignancy of these tumours and considering local and far dissemination, a long-term follow-up is recommended after surgical resection.

Contribution of computed tomography to decision making in the management of adhesive small bowel obstruction.

BACKGROUND: In adhesive small bowel obstruction, the early recognition of complications such as strangulation or volvulus is essential to choose between surgical or conservative initial treatment. The objective of this study was to determine prospectively the contribution of computed tomography (CT) to decision making in the management of these patients. METHODS: Patients with suspected adhesive small bowel obstruction had CT at admission. Patients with CT signs of volvulus or strangulation and/or clinical signs of peritoneal irritation underwent urgent surgery; other patients had conservative initial treatment. RESULTS: Fifty-four patients were evaluated. CT demonstrated signs of strangulation or volvulus in 19 patients, including three with signs of peritoneal irritation. Within this group, urgent laparotomy was performed in 17 patients and confirmed the CT diagnosis in 16. Thirty-seven patients without clinical or CT signs of complications had initial conservative treatment; among them, seven of 12 with a distal obstruction determined by CT required a delayed operation for persisting obstruction, compared with two of 25 patients with a proximal obstruction (P < 0.01). CONCLUSION: CT is useful for the evaluation of adhesive small bowel obstruction, to detect accurately patients with complications who require urgent operation and to determine the location of the adhesion, which represents a significant prognostic factor for success of conservative treatment.

[Mucosecretory and papillary intraductal tumors of the pancreas: clinicopathological considerations and radiological aspects including computed tomography symptomatology]. / Tumeurs intracanalaires mucosecretantes et papillaires du pancreas: considerations clinico-pathologiques et aspects radiologiques comprenant la semiologie tomodensitometrique.

Intraductal papillary-mucinous tumor of the pancreas (IPMT) is an uncommon entity, defined as an intraductal papillary proliferation of mucin-producing epithelial cells. Since the original description of the disease by Ohhashi in 1982, the definition and the classification of the disease has remained confused until the recently published classification of the World Health Organisation (WHO). The purpose of this article is therefore to report the clinico-pathological features of IPMT according to the WHO classification, to illustrate the radiological features especially the computed tomographic signs and to discute of the treatment.