Luc Henry

Hepatic involvement in hereditary hemorrhagic telangiectasia: clinical, radiological, and hemodynamic studies of 11 cases.

BACKGROUNDnHepatic involvement in hereditary hemorrhagic telangiectasia (HHT) is infrequent and poorly studied. The aim of this study was to describe the clinical, radiological, and hemodynamic patterns of this involvement.nnnMETHODSnEleven consecutive patients with HHT and hepatic involvement observed within 12 years were retrospectively studied. They were 8 females and 3 males, mean age, 47.nnnRESULTSnThe patients presented with heart failure (4 cases), hepatomegaly and murmur of the right hypochondrium (7 cases), and digestive hemorrhage (6 cases). Eight patients had anicteric cholestasis. Celiac angiography showed a dilated hepatic artery in 8 cases, disseminated intrahepatic telangiectasias in 10, and early opacification of the hepatic veins in 7. Liver dynamic computed tomography (CT) scan performed in 7 patients allowed the diagnosis of liver involvement in each case. Hemodynamic studies were performed in 5 patients. A left-to-right intrahepatic shunt was proven in the 5 patients. Shunt output was estimated between 25% and 58% of cardiac output. Mild pulmonary hypertension was observed in the 5 cases.nnnCONCLUSIONSnDiagnosis of liver involvement in HHT can be made by dynamic CT scan or celiac angiography. The main feature of this involvement is high output heart failure due to left-to-right intrahepatic shunt. Thus, right-heart catheterization is necessary in these patients to confirm and evaluate the shunt.

Extracorporeal Ablation of Liver Tissue by High-Intensity Focused Ultrasound

High-intensity focused ultrasound (HIFU) may produce a well-delineated lesion of coagulation necrosis in deep organs, by means of an extracorporeal transducer. Applications of this method to the liver in animal models have been studied for many years. The effects of HIFU on the normal liver parenchyma and on hepatic tumors are reviewed. In the normal rabbit liver in vivo we showed the relation between intensity levels and exposure times and the need to adapt intensity to the depth of the target. No severe complications were observed when an intensity of 1,000 W/cm2 was used. HIFU is a noninvasive method for the local destruction of liver tumors. In experimental models, safety and efficacy were demonstrated. HIFU may be interesting for the treatment of some human liver tumors.

Métastases surrénaliennes des carcinomes hépatocellulaires. options thérapeutiques

Resume But de letude Cette etude a pour objet devaluer les possibilites therapeutiques et en particulier, le traitement chirurgical dans les metastases surrenaliennes des carcinomes hepatocellulaires. Malades et methodes La serie rapportee concernait 13 patients âges en moyenne de 64 ans (de 42 a 76 ans) atteints dun carcinome hepatocellulaire sur foie cirrhotique (n = 8) ou sur foie sain (n = 5). Les metastases surrenaliennes etaient synchrones dans quatre cas, metachrones dans neuf, unilaterales dans dix cas, bilaterales dans trois. Une surrenalectomie a ete realisee chez sept malades, dans le meme temps que lexerese hepatique trois fois ou secondairement quatre fois. Chez six patients, le traitement chirurgical na pas ete possible a cause du mauvais etat du malade ou de lalteration de sa fonction hepatique. Deux patients ont ete traites par alcoolisation percutanee, un par irradiation et les trois autres par un simple traitement symptomatique. Resultats Apres surrenalectomie et exerese hepatique simultanee, deux patients sont decedes dans les suites operatoires, lun dembolie pulmonaire, lautre de pancreatite aigue. La survie moyenne chez les cinq autres patients a ete de 38 mois apres la surrenalectomie et de 58,6 mois apres lhepatectomie. Apres alcoolisation, un patient a survecu 47 mois et lautre 7 mois. Le patient irradie a survecu 18 mois. Les trois patients ayant eu un traitement symptomatique ont eu une survie moyenne de 7,3 mois. Conclusion Les donnees de cette serie confrontees a celles de la litterature suggerent que les metastases surrenaliennes des carcinomes hepatocellulaires, isolees ou associees a une recidive intrahepatique controlee, peuvent etre traitees chirurgicalement quand leur resection est techniquement possible. Cette approche agressive semble la seule chance de prolonger la survie de malades selectionnes.