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Evaluation of Doppler-ultrasonography in the diagnosis of transjugular intrahepatic portosystemic shunt dysfunction: A prospective study

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World Journal of Hepatology 2017年第27期9卷 1125-1132页

作者： Charlotte Nicolas Amelie Le Gouge Louis d’Alteroche Jean Ayoub Monica Georgescu Vincent Vidal denis Castaing Jean-Pierre Cercueil Patrick Chevallier Jerome Roumy Herve Trillaud Louis Boyer Vincent Le Pennec Christophe Perret Bruno Giraudeau Jean-Marc Perarnau STIC-TIPS group service d’Hepato-Gastroenterologie Hopital TrousseauCHRU Tours CIC CHRU de Tours INSERM United’echographie-doppler Hopital TrousseauCHRU Tours service de radiologie Hopital de la Timone Centre Hepato-Biliaire Hopital Paul Brousse service de radiologie CHRU Dijon service d’Imagerie Medicale Diagnostique et interventionnelle Hopital de l’ArchetⅡNice service de radiologie et Echographie CHRU Poitiers service d’Imagerie Medicale Hopital Saint Andre CHRU Bordeaux service d’Imagerie viscerale et vasculaire CHRU Clermont Ferrand service de radiologie CHRU Caen service de radiologie CHRU Nantes 不详

AIM To prospectively evaluate the performance of Dopplerultrasonography(US) for the detection of transjugular intrahepatic portosystemic shunt(TIPS) dysfunction within a multicenter cohort of cirrhotic *** This study was conducted in 10 french teaching hospitals. After TIPS insertion, angiography and liver Doppler-US were carried out every six months to detect dysfunction(defined by a portosystemic gradient ≥ 12 mm Hg and/or a stent stenosis ≥ 50%). The association between ultrasonographic signs and dysfunction was studied by logistic random-effects models, and the diagnostic performance of each Doppler criterion was estimated by the bootstrap method. This study was approved by the ethics committee of *** Two hundred and eighteen pairs of examinations performed on 87 cirrhotic patients were analyzed. Variables significantly associated with dysfunction were: The speed of flow in the portal vein(P = 0.008), the reversal of flow in the right(P = 0.038) and left(P = 0.049) portal branch, the loss of modulation of portal flow by the right atrium(P = 0.0005), ascites(P = 0.001) and the overall impression of the operator(P = 0.0001). The diagnostic performances of these variables were low; sensitivity was detection of TIPS dysfunction is poor compared to angiography. New tools are needed to improve diagnosis of TIPS dysfunction.

关键词： Transjugular intrahepatic portosystemic shunt Dysfunction Doppler-ultrasonography

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Faecal calprotectin and magnetic resonance imaging in detecting Crohn's disease endoscopic postoperative recurrence

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World Journal of Gastroenterology 2018年第5期24卷 641-650页

作者： Pierre Baillet Guillaume Cadiot Marion Goutte Felix Goutorbe Hedia Brixi Christine Hoeffel Christophe Allimant Maud Reymond Hélène Obritin-Guilhen Benoit Magnin Gilles Bommelaer Bruno Pereira Constance Hordonneau Anthony Buisson Université Clermont Auvergne CHU Clermont-Ferrand Service de radiologie CHU de Reims Service d’Hépato-Gastro Entérologie Université Clermont Auvergne Inserm 3iHP CHU Clermont-Ferrand Service d’Hépato-Gastro Entérologie Université Clermont Auvergne Inserm U1071 CH de Bayonne Service d’Hépato-Gastro Entérologie CHU de Reims Service de radiologie CHU Clermont-Ferrand DRCI Unité de Biostatistiques

AIM To assess magnetic resonance imaging(MRI) and faecal calprotectin to detect endoscopic postoperative recurrence in patients with Crohn's disease(CD).METHODS From two tertiary centers, all patients with CD who underwent ileocolonic resection were consecutively and prospectively included. All the patients underwent MRI and endoscopy within the first year after surgery or after the restoration of intestinal continuity [median = 6 mo(5.0-9.3)]. The stools were collected the day before the colonoscopy to evaluate faecal calprotectin level. Endoscopic postoperative recurrence(POR) was defined as Rutgeerts' index ≥ i2b. The MRI was analyzed independently by two radiologists blinded from clinical *** Apparent diffusion coefficient(ADC) was lower in patients with endoscopic POR compared to those with no recurrence(2.03 ± 0.32 vs 2.27 ± 0.38 × 10^(-3) mm^2/s, P = 0.032). Clermont score(10.4 ± 5.8 vs 7.4 ± 4.5, P = 0.038) and relative contrast enhancement(RCE)(129.4% ± 62.8% vs 76.4% ± 32.6%, P = 0.007) were significantly associated with endoscopic POR contrary to the magnetic resonance index of activity(Ma RIA)(7.3 ± 4.5 vs 4.8 ± 3.7; P = 0.15) and MR scoring system(P = 0.056). ADC 100%(sensitivity = 0.75, specificity = 0.81, PPV = 0.75, NPV = 0.81) were the best cutoff values to identify endoscopic POR. Clermont score > 6.4(sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74), Ma RIA > 3.76(sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74) and a MR scoring system ≥ MR1(sensitivity = 0.54, specificity = 0.82, PPV = 0.70, and NPV = 0.70) demonstrated interesting performances to detect endoscopic POR. Faecal calprotectin values were significantly higher in patients with endoscopic POR(114 ± 54.5 μg/g vs 354.8 ± 432.5 μg/g; P = 0.0075). Faecal calprotectin > 100 μg/g demonstrated high perfor

关键词： Faecal calprotectin Magnetic resonance imaging Postoperative recurrence Crohn’s disease Clermont score Magnetic resonance index of activity

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Acute ulcerative jejunal diverticulitis:Case report of an uncommon entity

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World Journal of Gastroenterology 2008年第40期14卷 6265-6267页

作者： Wojciech Staszewicz Michel Christodoulou Stefania Proietti Nicolas demartines service de Chirurgie Viscerale Centre Hospitalier Universitaire Vaudois service de radiologie Centre Hospitalier Universitaire Vaudois

Jejunal diverticulosis is a rare entity with variable clinical and anatomical *** reported incidence varies from 0.05% to 6%.Although there is no consensus on the management of asymptomatic jejunal diverticular disease,some complications are potentially life threatening and require early surgical *** report a case of an 88-year-old man investigated for acute abdominal pain with a high biological inflammatory *** of multiple giant jejunal diverticulum was discovered at abdominal computed tomography (CT).As a result of the clinical and biological signs of early peritonitis,an emergency surgical exploration was *** first jejunal loop showed clear signs of jejunal *** segmental jejunum resection with end-to-end anastomosis was *** report confirmed an ulcerative jejunal diverticulitis with imminent perforation and acute local *** patient made an excellent rapid postoperative *** diverticulum is rare but may cause serious *** should be considered a possible etiology of acute abdomen,especially in elderly patients with unusual *** CT is the diagnostic tool of *** best treatment is emergency surgical management.

关键词： Jejunal diverticulum Diverticulitis Surgery Tomography

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Meso-Rex bypass for the management of extrahepatic portal vein obstruction in adults(with video)

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Hepatobiliary & Pancreatic Diseases International 2022年第1期21卷 25-32页

作者： Martin Brichard Samuele Iesari Jan Lerut Raymond Reding Pierre Goffette Laurent Coubeau service de Chirurgie et Transplantation Abdominale Cliniques Universitaires Saint-LucUniversitéCatholique de Louvain10 Avenue HippocrateBrussels 1200Belgium Pôle de Chirurgie Expérimentale et Transplantation Institut de Recherche Expérimentale et CliniqueUniversitéCatholique de LouvainBrusselsBelgium department of Clinical Sciences and Applied Biotechnology University of L’AquilaL’AquilaItaly department of General Surgery and Kidney Transplantation Fondazione IRCCS Ca’Granda Ospedale Maggiore PoliclinicoMilanItaly service de radiologie et Imagerie médicale Cliniques Universitaires Saint-LucUniversitéCatholique de LouvainBrusselsBelgium

Background:Extrahepatic portal vein obstruction(EHPVO)results in severe portal hypertension(PHT)leading to severely compromised quality of ***,pharmacological and endoscopic management is unable to solve this *** hepatic portal flow using meso-Rex bypass(MRB)may solve *** procedure,uncommon in adult patients,is considered the treatment of choice for EHPVO in ***:From 1997 to 2018,8 male and 6 female adults,with a median age of 51 years(range 22-66)underwent MRB procedure for EHPVO at the University Hospitals Saint-Luc in Brussels,***-toms of PHT were life altering in all but one patient and consisted of repetitive gastro-intestinal bleedings,sepsis due to portal biliopathy,and/or severe abdominal *** surgical technique consisted in interposition of a free venous graft or of a prosthetic graft between the superior mesenteric vein and the Rex recess of the left portal ***:Median operative time was 500 min(range 300-730).Median follow-up duration was 22 months(range 2-169).One patient died due to hemorrhagic shock following percutaneous transluminal interven-tion for early graft *** morbidity,defined as Clavien-Dindo score≥III,was 35.7%(5/14).Shunt patency at last follow-up was 64.3%(9/14):85.7%(6/7)of pure venous grafts and only 42.9%(3/7)of prosthetic *** relief was achieved in 85.7%(12/14)who became asymptomatic after ***:Adult EHPVO represents a difficult clinical condition that leads to severely compromised quality of life and possible life-threatening *** such patients,MRB represents the only and last resort to restore physiological portal vein *** successful in a majority of patients,this procedure is associated with major morbidity and mortality and should be done in tertiary centers expe-rienced with vascular liver surgery to get the best results.

关键词： Meso-Rex bypass Extrahepatic portal vein obstruction Extrahepatic portal hypertension Portal vein thrombosis Surgical procedure

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Unilateral Femoral Neck Fracture after Epileptic Seizure in Young Patient: A Case Report

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Open Journal of Orthopedics 2020年第8期10卷 166-171页

作者： J. C. Niyondiko P. Hakizimana P. Barasukana S. Manirakiza G. Ndayizeye C. P. Baramburiye S. Nimubona service de Chirurgie Orthopédique et Traumatologie Centre Hospitalo-Universitaire de Kamenge Bujumbura Burundi service de Neurologie Centre Hospitalo-Universitaire de Kamenge Bujumbura Burundi service de radiologie Centre Hospitalo-Universitaire de Kamenge Bujumbura Burundi

Femoral neck fracture occurring after an epileptic seizure is a rare and under-diagnosed injury. The majority of the reported cases in literature are old patients with osteoporosis. Younger patients present several risk factors of osteopenia and the treatment remains controversial. We present an outcome of a 23 years old patient with unilateral femoral neck fracture occurring during an epileptic seizure and we discuss the associated multiple risk factors of osteopenia and osteonecrosis of the hip. The patient was brought to the emergency department of Teaching Hospital of Kamenge (CHUK) complaining of pain in his left hip that had been progressing for one month after an epileptic seizure. There is a history of HIV infection since birth and epileptic seizures with ongoing treatments for both diseases. despite the high risk of avascular necrosis, the treatment choice has been influenced by the patient’s age and a conservative surgery by internal fixation with Dynamic Hip Screw has been made. Unfortunately, this treatment early resulted in osteonecrosis of the hip since HIV infection itself and the highly active anti-retroviral therapy increase its risk.

关键词： Femoral Neck Fracture Epileptic Seizure Osteopenia Internal Fixation

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Anatomical Study of MRI Optic Chiasm at the Bamako Anatomy Laboratory

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Forensic Medicine and Anatomy Research 2020年第2期8卷 11-17页

作者： Babou Ba Siaka Diakité Abdoulaye Kanté Tata Touré Moumouna Koné Nouhoum Ongoiba Abdel Karim Koumaré Siaka Sidibé Laboratoire d’Anatomie et de Morphologie Clinique FMOS BamakoMali service de radiologie CHU Point GBamakoMali service de Chirurgie“B” CHU Point GBamakoMali

Roughly quadrangular, the chiasma presents many morphological variations. The optical chiasm, odd and symmetrical structure of the optical pathways, is a required passage of the axons of neurons for the visual pathways. Any modification of its morphology evokes a pathological process, generally tumoral. The quality of MRI images rivals that of anatomical slices. So the MRI is essential for the study of the chiasma. The aim of this work was to study the morphometry of the optic chiasm in patients addressed for cerebral MRI to the imaging department of the university hospital of the POINT-G, during the period from July 29, to November 30, 2016. All patients who had a normal examination of the optic chiasma, numbering 15, were included in this study. In 86.66% of cases the chiasma had a quadrilateral form. Its average length was 8.73 mm and its average width was 13 mm. The average thickness was 4.13 mm.

关键词： Optical Chiasma MRI Laboratory Anatomy

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Prevalence and Predictive Factors of Severe Coronary Lesions in Algerian Patients Undergoing Coronary Angiography

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Open Journal of Pathology 2023年第4期13卷 184-194页

作者： Mourad Boukheloua Mohamed Berrehal Aziza Baali Souad Chelghoum Djamaleddine Nibouche service de Cardiologie Centre Hospitalier Universitaire Nafissa Hamoud Algiers Algeria service de Cardiologie Centre Hospitalier Universitaire Sétif Algeria service de radiologie Centre Hospitalier Universitaire Nafissa Hamoud Algiers Algeria service de Néphrologie Centre Hospitalier Universitaire Mustapha Bacha Algiers Algeria

Background: The severity of coronary lesions in patients with coronary artery disease (CAD) has important prognostic and therapeutic consequences. Clinical symptoms not always reflect the disease severity and this study aimed to evaluate coronary lesions in the Algerian population where these data are scarce. Methods: It was a prospective cross-sectional study conducted in consecutive patients with an age ≥20 years who underwent clinically-indicated coronary angiography in our center. The objective of the study was to determine the prevalence of severe coronary lesions assessed with the Gensini score. The predictive factors of severity were evaluated in a multivariate analysis. Results: A total of 507 patients were included (male, 79.7%;mean age, 58.8 years). Coronary angiography was prescribed most frequently for ST-segment elevation myocardial infarction (STMI) (46.9%) and non-STMI (38.1%). The prevalence of severe coronary lesions was 69.6% (95% CI 65.5 - 73.5). In multivariate analysis, the independent predictive factors of severe coronary lesions were male sex (odds ratio [OR] 2.00;p = 0.0141), diabetes (OR 1.92;p = 0.0070), left ventricular dysfunction (OR 1.81;p = 0.0059), age (OR 1.72;p = 0.0297) and no lipid-lowering treatment (OR, 0.47;p = 0.0388). Conclusions: Severe coronary lesions were present in two out three patients in this cohort of Algerian patients undergoing coronary angiography. Independent predictive factors of severe coronary lesions were male sex, diabetes, age, left ventricular dysfunction and no lipid-lowering treatment. It is important to identify these at-risk patients, as they should be explored at an asymptomatic stage before a cardiovascular event and receive prompt treatment with angioplasty or surgery.

关键词： Coronary Artery Disease Coronary Angiography Gensini Score Cardiovascular Risk Factors

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Duplication of the Inferior Vena Cava, Azygos Continuation and Retro Aortic Renal Vein: Fortuitous Discovery

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Forensic Medicine and Anatomy Research 2021年第3期9卷 31-40页

作者： Géraud Léra Akpo Ndeye Bigué Mar Soukeyna Abouabdillah Nfaly Badji Hamidou deme Youssoupha Kasse Ibrahima Niang Mamadou Lamine Gueye Marcel Mbarga Ibrahima Faye Abdoulaye Dione Diop Assane Ndiaye Sokhna Ba Diop El Hadji Niang service de radiologie Imagerie Médicale de l’h&#244pital Ariste Le Dantec Dakar Sénégal Laboratoire d’Anatomie UFR des Sciences de la Santé Université Iba der Thiam de Thiès Thiès Sénégal service de radiologie Imagerie Médicale de l’h&#244pital Fann Dakar Sénégal service de radiologie Imagerie Médicale de l’h&#244pital Dalal Jam Dakar Sénégal Laboratoire d’Anatomie UFR des Sciences de la Santé Université Assane SECK de Ziguinchor Ziguinchor Sénégal

We present a rare case associating inferior vena cava’s (IVC) complex variations. Anatomical, embryological and clinical aspects are discussed. Duplication’s discovery was fortuitous during an abdominal ultrasound and was confirmed by the CT scan. The latter also highlighted azygos continuation, retro aortic renal vein and an iliac venous anomaly. These variants are important to know in order to be able to differentiate them from lymphadenopathy, para-vertebral masses, and aortic pathologies. It is necessary to report them before any retroperitoneal surgery or interventional vascular procedure.

关键词： Duplication IVC Continuation Azygos Tomodensitometry

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Gastrointestinal bleeding and obstructive jaundice: Think of hepatic artery aneurysm

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World Journal of Gastrointestinal Surgery 2016年第6期8卷 467-471页

作者： Fabrice Vultaggio Pierre-Henri Morère Christophe Constantin Michel Christodoulou Didier Roulin service de Chirurgie Generale Hopital du Valais 1950 Sion Switzerland Département d’Imagerie Medicale et radiologie Interventionnelle Hopital deSierre 1950 Sion Switzerland service de Chirurgie Hopital de Sierre 3960 Sierre Switzerland

Hemobilia is an uncommon and potential life-threatening condition mainly due to hepato-biliary tree traumatic or iatrogenic *** ruptured aneurysm of the hepatic artery is seldom *** report the case of an 89-year-old woman presenting with abdominal pain,jaundice and gastrointestinal bleeding,whose ultrasound and computed tomography revealed a non-traumatic,spontaneous aneurysm of the right hepatic *** oeso-gastro-duodenoscopy and colonoscopy did not reveal any bleeding at the ampulla of Vater,nor anywhere *** angiography confirmed the diagnosis of hepatic artery aneurysm and revealed a full hepatic artery originating from the superior mesenteric *** patient was successfully treated by selective embolization of *** discuss the etiologies of hemobilia and its treatment with selective embolization,which remains favored over surgical *** aneurysm of the hepatic artery is rare,especially without trauma,a high index of suspicion is needed in order to ensure appropriate treatment.

关键词： Hemobilia Hepatic artery aneurysm Obstructive jaundice Supra-selective micro-embolization Gastrointestinal hemorrhage

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Incomplete Situs Inversus Revealed by Acute Pain of the Right Hypochondrium

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Open Journal of Gastroenterology 2022年第10期12卷 263-270页

作者： Alice Nanelin Guingané Julien Sawadogo Adjirata Koama Bénilde Marie-Ange Tiemtoré-Kambou Roger Sombié Alain Bougouma service d’hépato-gastroentérologie CHU Bogodogo Ouagadougou Burkina Faso service de chirurgie générale et digestive du CHU-YO Ouagadougou Burkina Faso service de radiologie CHU Bogodogo Ouagadougou Burkina Faso service d’hépato-gastroentérologie CHU-YO Ouagadougou Burkina Faso

Situs inversus is an abnormal placement of the thoracic and/or abdominal organs that are inverted right/left from normal. It is a rare congenital malformation often discovered in childhood. In adults, it can lead to misdiagnosis. Clinical case: A 35-year-old female patient, seen in a hepatogastroenterology consultation for acute spontaneous pain in the right hypochondrium. She had no particular clinical history. A diagnosis of hepatopathy was suspected. Abdominal and pelvic CT scans showed the left liver, stomach and spleen in the right hypochondrium, but with the heart in place, suggesting incomplete situs inversus. The evolution in our patient was spontaneously resolved with analgesics and antispasmodics, which leads us to believe that the volvulus was probably partial and without other complications. Conclusion: In developing countries, antenatal diagnosis of situs inversus is rare and is usually made during a pathology that leads the patient to a medical consultation. CT is one of the key paraclinical examinations for its diagnosis as genetic tests are not widely available.

关键词： Situs Inversus Abdominal Pain Hypochondrium Abdominal CT Scan

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