[Percutaneous ethanol injection of malignant liver tumors under ultrasonographic guidance]. / Alcoolisation percutanée guidée par échographie des tumeurs malignes du foie.

16 patients (14 males, 2 females, mean age: 59.2 years) underwent sonographic-guided ethanol injections as treatment for 23 hepatocellular carcinomas (HCC) complicating cirrhosis. All lesions were pathologically proven by sonographic-guided cytology. Tumor sizes ranged from 9 to 66 mm. Sterile 96% alcohol was injected with a 17.7 cm-long 22 gauge spinal needle at one week intervals. At each session, 8-50 ml was injected depending on the diameter of the tumor. We regarded as a "success" the negativation of the cytologies one, two and three months after the end of the treatment associated with normalization of alpha-fetoprotein levels and typical echographic and tomodensitometric changes. No serious complication was associated with the procedure. In the "Child A" group1, 6 of 7 tumors have been successfully treated, the largest measuring 66 mm. The seventh lesion is currently being treated. In the "Child B" group1 3 of 6 lesions have been successfully treated. No success has been obtained in the "Child C" group. Volumes of alcohol greater than previously reported may be useful for lesions larger than 40 mm. Percutaneous alcohol injections can be considered as an alternative to surgery even for lesions larger than 50 mm. Among 4 patients presenting with 11 liver metastases of colic and gastric adenocarcinoma and 1 patient with a small bowel carcinoid tumor, one remission with a follow-up of 5 months was observed.

[Percutaneous alcoholization of the celiac plexus under echographic guidance: an alternative to splanchnicectomy? Study of 21 cases]. / Alcoolisation percutanée du plexus coeliaque sous contrôle échographique: une alternative à la splanchnicectomie? Etude de 21 cas.

Celiac plexus block is usually performed under fluoroscopic or tomodensitometric guidance. We report on a new procedure using sonographic guidance. The patient lies in supine position. We use a real-time sonograph (Kontron Sigma 1 AC) with a 3.5 MHz probe. On a transverse plane, the celiac axis is localized emerging from aorta. After local anesthesia, the tip of the spinal needle (177 mm, 22 G) is placed close to aorta (about 5 mm) on both sides. 10 to 15 ml of 1 per cent lidocaine then 10 to 15 ml of absolute alcohol are injected on each side. 21 patients (10 males, 11 females, mean age: 61) underwent the procedure. They presented with cancer of the pancreas in 14 cases, metastatic nodes in 3 cases, cholangiocarcinoma in 2 cases and chronic calcifying pancreatitis (CCP) in 2 cases. No pain relief occurred in 3 patients (14 per cent). On of those presented with CCP but the endoscopic cystic diversion of a small cyst was successful to eradicate pain. Partial pain relief occurred in 5 cases (24 per cent). Total pain relief was obtained in 13 cases (62 per cent). No complication related to the treatment was observed. Sonography is a simple and safe method of guidance to perform alcohol block of the celiac plexus. The anterior approach may prevent neurologic complications related to other methods of guidance.

[Percutaneous echography-guided alcohol block of the celiac plexus as treatment of painful syndromes of the upper abdomen: study of 21 cases]. / Alcoolisation percutanée échoguidée du plexus coeliaque comme traitement des syndromes douloureux de l'abdomen supérieur: étude de 21 cas.

Celiac plexus block is usually performed under fluoroscopic or tomodensitometric guidance. We report on a new procedure using sonographic guidance. the patient lies in supine position. We use a real-time sonograph with a 3.5 MHz probe. On a transverse plane, the celiac axis is localized emerging from the aorta. Under local anesthesia, the tip of the spinal needle (177 mm, 22 g) is placed close to the aorta (about 5 mm) on both sides. 5 to 10 ml of 1% lidocaine, then 10 to 20 ml of absolute alcohol, are injected on each side. 21 patients (10 males, 11 females, mean age: 61.4) underwent the procedure. They presented with cancer of the pancreas in 14 cases, metastatic nodes from an extra-pancreatic tumor in 5 cases and chronic calcifying pancreatitis (CCP) in 2 cases. No pain relief was secured in 3 patients (14%). One of these presented with CCP, but endoscopic cystic diversion of a small cyst was successful in eradicating pain. Partial pain relief was secured in 5 cases (24%) and total pain relief in 13 cases (62%). No treatment-related complication was observed. We conclude that sonography is a simple and safe method of guidance in performing alcohol block of the celiac plexus. The anterior approach may prevent neurologic complications occurring with other methods of guidance using a posterior approach.

[Value of cyto-puncture and of ultrasonic-guided micro-biopsy in solid tumors of the pancreas]. / Apport de la cyto-ponction et de la micro-biopsie guidées par échographie dans la pathologie tumorale solide du pancréas.

43 patients (29 men, 14 women, average age 64.7 years) with a solid lesion of the pancreas underwent echography-guided cytopuncture (needle 22 G, 88 mm) associated in 11 cases with microbiopsy (needle 21 G, 150 mm). The lesions were localized in the pancreatic head (n = 27), body (n = 13) and tail (n = 3). The sensitivity and specificity of cytopuncture were 81% and 100% respectively. There were 27 true positives (26 pancreatic adenocarcinomas and one metastasis of a prostatic adenocarcinoma); 10 true negatives (5 cases of calcifying chronic pancreatitis, 3 benign endocrine tumors, 2 cases of acute pancreatitis); and 6 false negatives (4 adenocarcinomas and 2 intrapancreatic cholangiocarcinomas). There were no false positives. Microbiopsy diagnosed 5 adenocarcinomas out of 9 cases biopsied and 2 benign endocrine tumors not detected by cytopuncture. Its sensitivity was thus 56% for malignant lesions and 64% for all lesions biopsied. Its specificity was 100%. There was one (= 2.5%) complication (dissemination on the needle pathway). We conclude that echography-guided cytopuncture is a simple and effective method of diagnosing solid tumors of the pancreas. Biopsy, though of lower sensitivity, probably serves to increase the specificity of cytopuncture, in the case of benign lesions in particular.

Actions of VIP, hGRF, PHI and secretin: comparative studies in cerebral cortex and adenohypophysis.

We have examined the effects of hGRF on cyclic AMP and glycogen levels in mouse cerebral cortical slices. hGRF-44-NH2 and hGRF-28-OH did not stimulate cyclic AMP formation nor glycogenolysis and did not antagonize the stimulatory effects of VIP on cyclic AMP formation and glycogenolysis. These observations indicate that despite the structural homologies with VIP, hGRF does not interact with VIP receptors coupled to adenylate cyclase in mouse cerebral cortex. This is in contrast with observations in other tissues and species, such as rat and human intestinal epithelial membranes and rat pancreas. We have also compared the effects of hGRF, VIP, PHI and secretin on Growth Hormone (GH) release and cyclic AMP levels in anterior pituitary cells in vitro. VIP and PHI, but not secretin, promote at a high concentration (10(-6) M) a small but significant release of GH. This GH release is accompanied by increases in cyclic AMP levels. The concentration of VIP and PHI required to elicit these effects is high and suggests that VIP and PHI act as low affinity pharmacological analogs of hGRF on hGRF pituitary receptors.