Tarek Smayra

Radio Frequency Ablation of Renal Cell Carcinoma: Preliminary Clinical Experience

PURPOSE We assess the feasibility, safety and efficacy of radio frequency ablation of small peripheral renal cell carcinomas. MATERIALS AND METHODS Five patients with a histologically proven renal cell carcinoma 30 to 40 mm. in diameter were treated with radio frequency ablation. A triple needle electrode was percutaneously advanced into each tumor under sonographic (4 cases) or computerized tomography (CT) (1) guidance. The radio frequency generator was activated for 15 minutes in each location where the electrode had been placed. Patients were then followed with CT and blood tests every 2 months for 6 months and every 3 months thereafter. RESULTS Four tumors required 1 radio frequency delivery and 1 required 2 applications during the same session. No complications were encountered except for a subcapsular hematoma in 1 patient, which resolved spontaneously. Two patients experienced transient hematuria. Of the patients 4 were discharged from the hospital after 2 days and 1 after 1 day. After 6 to 18 months (median 9) all patients were tumor-free on CT without suppress additional treatment. CONCLUSIONS In this small preliminary study radio frequency ablation of small peripheral renal cell carcinomas appears to be a feasible, safe and promising technique.

Unusual etiology of epigastric pain.

BACKGROUND Epigastric pain is a common presenting complaint encountered in urgent care settings. Although peptic, biliary, and pancreatic pathologies are the most frequent findings, other rare diagnoses also can be found. OBJECTIVES We report an unusual case of acute epigastric pain in which abdominal ultrasound was of great support in revealing the diagnosis. CASE REPORT A 64-year-old man presented to the Emergency Department after rapid onset of acute epigastric pain. Abdominal ultrasound showed a multi-cystic heterogeneous mass between the stomach and the liver. Abdominal computed tomography scan confirmed the gastric origin of the mass and showed torsion signs. Urgent laparotomy was performed with tumor excision. The diagnosis of pedunculated exophytic gastric stromal tumor was made and long-term follow-up was arranged. CONCLUSIONS Acute presentation revealed the presence of the tumor, which was excised surgically.

Hémothorax iatrogène massif jugulé par injection intercostale de lidocaïne-adrénaline

Resume Introduction Un hemothorax abondant est une complication peu frequente d’une ponction ou d’un drainage pleural. Il est principalement secondaire a une rupture vasculaire intercostale. Il necessite un drainage evacuateur, voire une thoracotomie d’hemostase lorsqu’il persiste. Observation Ce cas clinique rapporte la survenue, dans les suites d’un premier drainage pleural, d’un hemothorax grave avec etat de choc franc, persistant malgre un drainage evacuateur, chez une patiente âgee de 72 ans, a haut risque operatoire d’une thoracotomie d’hemostase. Le saignement a pu etre jugule par injection intercostale de lidocaine-adrenaline. Conclusion Cette observation suggere une indication d’injection intercostale premiere de vasoconstricteurs lors d’une hemorragie pleurale persistante par lesion vasculaire intercostale.

Pheochromocytoma: a tumour not to be trusted

A 59-year-old male with liver cirrhosis secondary to non-alcoholic steatohepatitis, and prior history of aesophageal variceal bleeding underwent abdominal magnetic resonance imaging (MRI) for increasing a-fetoprotein plasma levels. He was also known to have long-lasting diabetes mellitus. His medication included propranolol for prevention of rebleeding. The examination was performed on a Signa 1.5 Tesla (General Electric, Milwaukee, WI, USA) machine. It showed a dysmorphic but otherwise unremarkable liver, mild splenomegaly, moderate ascitis and a well-circumscribed, heterogeneous, highly enhancing extra-adrenal mass, measuring 5.8 cm, located to the right side of the aorta under the renal hilum (Figs 1–3). Extra-adrenal pheochromocytoma, or paraganglioma, was the first proposed diagnosis. However, because biological markers were normal (serum catecholamines, 24 h urinary catecholamines and urinary vanillylmandelic acid (VMA) levels), other diagnoses were suggested including retroperitoneal sarcoma and adenopathy secondary to hypervascular primary tumour such as neuroendocrine, melanoma, kidney, breast, thyroid or colon. Percutaneous computed tomography (CT)-guided biopsy was performed without premedication and without any side effect. During this procedure carried out without intravenous contrast injection, the highest density in the tumour was 23 Hounsfield units. Histology concluded to a pheochromocytoma. A surgery was planned, and, because the tumour was clinically and biologically silent and because biopsy was not complicated, it was decided not to prepare the patient with a-blockers. Unfortunately the patient developed a hypertensive crisis with a systolic blood pressure reaching 230 mmHg when the surgeon touched the tumour. The blood pressure was rapidly controlled, and the tumour was completely removed. The patient had unremarkable post-operative recovery. Most pheochromocytomas occur in the adrenal gland. However, extra-adrenal or ectopic pheochromocytomas do occur in 15–20% of cases and can be located in any organ containing chromaffin cells, mainly in the abdomen. The diagnosis of pheochromocytoma is easy when clinical signs and biological markers such as elevation of plasmatic concentration of catecholamines and 24-h urinary concentration of VMA are present, and the role of imaging is to localise the tumour prior to surgical removal. However, in about 10% of patients, there may be no or few symptoms and physical signs as in our

PULMONARY ARTERY ACCELERATED FLOW REVEALING HODGKIN'S LYMPHOMA.

We present a case in which transthoracic echocardiography was the first diagnostic tool to suspect mediastinal Hodgkins lymphoma by revealing a change in the hemodynamic of left pulmonary artery flow, and it was used as a follow-up method for monitoring treatment efficacy by demonstrating a normalization of pulmonary artery hemodynamics.

Radiologie parasitaire et tropicaleTROP5 Dans quelle mesure une echographie de l’arbre urinaire peut predire un reflux vesico-ureteral chez le nourrisson

Objectifs La cystographie retrograde (CR) est le « gold standard » diagnostic du reflux vesico-ureteral (RVU). Cette etude a pour but de determiner dans quelle mesure l’echographie, qui est un acte moins invasif, peut predire un reflux. Materiels et methodes Etude retrospective chez 60 nourrissons hospitalises pour un premier episode d’infection urinaire. Les signes echographiques etudies sont la taille des reins, leur differenciation, l’epaisseur corticale, la beance ou la dilatation des cavites pyelocalicielles, l’epaississement parietal pyelique, la dilatation ureterale retrovesicale et l’epaississement vesical. Une CR est realisee chez tous les patients. Resultats Chez 36 nourrissons (60 %), l’echographie et la CR sont normales. Dix (16,67 %) ont des anomalies echographiques et cystographiques. Huit nourrissons (13,33 %) ont une CR normale et une echographie montrant des anomalies non en rapport avec un RVU. Six (10 %) ont des echographies normales mais une cystographie pathologique : 4 RVU grade I ou II et 2 RVU grade III avec conservation d’un parenchyme renal normal. Conclusion Si une echographie normale ne peut pas eliminer un RVU, elle peut neanmoins predire un bon diagnostic car il s’agit alors d’un reflux grade I ou II, ou d’un reflux Grade III avec conservation d’un parenchyme renal normal.

TROP1 Comment obtenir un bon angioscanner de l’ensemble de l’aorte avec un scanner monobarrette

Objectifs Decrire une methode, non encore rapportee, capable de realiser un angioscanner de bonne qualite de l’aorte entiere avec un scanner helicoidal monobarrette. Materiels et methodes Acquisition helicoidale unique, de 60 secondes, recouvrant toute l’aorte en coupes de 5 mm, et en donnant les instructions au patient de realiser 2 apnees consecutives. Resultats Bonne opacification de l’aorte et bonne resolution spatiale sur toutes les coupes avec artefacts limites a 2 ou 3 coupes au niveau de la region thoraco-abdominale ou aucun vaisseau important ne nait. Conclusion Cette methode donne de meilleurs resultats qu’une methode utilisant deux helices ou une helice unique en respiration libre. Elle permet une bonne etude de l’ensemble de l’aorte dans les centres qui n’ont pas encore pu s’equiper d’un scanner multibarrette.