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A 77-year-old man was referred for a PET/CT 18F-FDG after incidental discovery of a lobulated jejunal lesion during surgery for an abdominal aortic aneurysm. The lesion was not removed due to the risk of digestive perforation. PET/CT 18F-FDG did not show pathologic hypermetabolism. Subsequently, we decided to perform PET/CT 18F-DOPA to better characterize this incidentaloma. A moderate uptake was showed, less than the pancreas. After multidisciplinary discussion, taking into account macroscopic and imaging aspects, the hypothesis of an ectopic pancreas was retained, allowing the exclusion of surgical excision.

We report the case of a 64-year-old woman with musculoskeletal pain and elevated serum parathyroid hormone who had undergone parathyroidectomy for primary hyperparathyroidism 4 years earlier. An 18F-choline PET/CT scan was performed and incidentally showed an intense uptake in a right upper lobe pulmonary nodule and in the right hilar, mediastinal, and cervical lymph nodes. Histopathological analysis confirmed the diagnosis of a small cell lung cancer. Clinical symptoms and recurrent hyperparathyroidism were therefore consistent with a paraneoplastic syndrome. A complete metabolic response was achieved on 18F-FDG PET/CT scan after chemotherapy.

Giant cell arteritis is not an uncommon disease, and its extension is furthermore finely assessed with new-generation PET/CT system. 18F-FDG PET/CT is increasingly used in case of large-vessel vasculitis for optimal diagnosis, activity monitoring (even when treated with interleukin 6 receptor inhibitor), and evaluation damage progression. We reported the case of a 61-year-old woman with common giant cell arteritis pattern on 18F-FDG PET/CT (aorta and large arteries) and uptakes in all aorta branches, mainly impressive and uncommon in the abdomen. After 2 years of therapeutic optimization including IV tocilizumab and monitoring with 18F-FDG PET/CT, a complete metabolical response was assessed.

Promyelocytic sarcoma is an uncommon solid tumor made up of myeloblasts. It is characterized, like acute promyelocytic leukemia (APL), by a chromosomal translocation t(15;17) involving the retinoic acid receptor alpha (RARalpha) and the promyelocytic gene (PML). The diagnosis and monitoring of promyelocytic sarcoma is a challenge due to the rarity and severity of the disease. We describe a case with several initial sites and without APL. The patient was monitored with regular 18F-FDG PET/CT from diagnosis to complete response. The evolution of PET/CT imageries was compared to the quantification of PML-RARα fusion gene by RQ-PCR. In promyelocytic sarcoma medical care, 18F-FDG PET/CT appears to be an attractive tool for finding targets for biopsy, for the primary staging, for assessing therapeutic response and for detecting early relapse.

Homogenization has been used to release microfibrils from cellulose fibres to produce microfibrillated cellulose (MFC) Oven drying, atomization or freeze-drying were used to dry MFC Morphological differences were observed linked to the compaction of the system and the formation of microfibril agglomerates Thermal stability of the dried MFC, checked by TGA, decreased after homogenization and drying Char level at the end of the pyrolysis was higher than for cellulose fibres Derivative TGA (dTGA) showed a shoulder around 250 degrees C for the dried MFC Volatile degradation product detection by FTIR spectroscopy (FTIR) coupled to TGA and DSC showed that the shoulder corresponds to expected dehydration reactions of the cellulose Increasing the contacts between microfibril(s) (bundles) and agglomerates of the freeze-dried MFC by compression promoted dehydration reactions Homogenization and drying modified the thermal properties of the MFC No significant influence of freeze-drying kinetics on the thermal behaviour of the MFC was observed (C) 2009 Elsevier Ltd All rights reserved.

Anal fissure is one of the most common and painful proctological pathologies affecting mainly young individuals. The physiopathology in the development of a chronic anal fissure seems to be a combination of internal anal sphincter hypertonia and poor vascularization at the posterior midline. Treatment of acute fissures is conservative with supportive therapy, leading to healing in the majority of the patients. Open or closed lateral internal sphincterotomy is the treatment of choice for chronic anal fissures. In low pressure chronic fissures, sphincterotomy should be avoided and a V-Y island advancement flap may be an alternative procedure. Sphincterotomy can induce anal incontinence, a feared complication of this technique. Recent interest has developed in chemical sphincterotomy with local botulin toxin injections or glyceryl trinitrate application. Long-term follow-up is needed to evaluate these new therapeutic options.

Fulminant hepatic failure is an infrequent but dreadful disease, occurring usually in young patients. Despite fulminant hepatic failure is reversible in most of the cases, some patients develop brain edema and intracranial hypertension, which are the most common cause of death in these patients. Liver transplantation significantly improves the prognosis of selected patients in who precise criteria predict a low chance of survival. This review summarizes the modern standard of care of patients with fulminant hepatic failure, with particular underlining of the management of brain oedema and intracranial hypertension.

The case reports of three patients who received cancer-bearing organs at this institution are presented. A fourth recipient, who was to be transplanted with a cancerous kidney, was spared this disastrous complication. The relevant data regarding the donors is also alluded to, with special reference to the type and site of the primary malignancy. Following these case reports, the implications of these issues, their possible prevention, and further management are discussed.

Strictureplasty for obstructive Crohn's disease is still controversial because lesions are left in place and the suture is performed on a diseased bowel. Many surgeons prefer to perform bowel resection, hoping for fewer complications and a lower recurrence rate. In this paper, the authors reports their strictureplasty experience. They performed a systematic retrospective review of the patients suffering from Crohn's disease who underwent strictureplasties during a 10-year period in the abdominal surgery department of the University Hospital of Liege Sart Tilman, and studied the short- and long-term clinical results of 68 strictureplasties performed in 18 patients. Median follow-up was 63 months (range 12 to 144). Mortality was 0% and septic morbidity was 11% (one wound abscess and one leakage). Among the 16 patients available for the latest follow-up, symptomatic stenotic recurrence had to be medically treated in hospital for 4 patients (25%) with a recurrence delay range of 19 to 49 months. Stenosis recurrence needed re-intervention in one patient 48 months after surgery: stenosis occurred at a distance from the corrected site. These results confirmed that strictureplasty is a safe and efficient procedure in selected patients undergoing surgery for obstructive Crohn's disease.

For about 15 years, inguinal hernias in adults have been treated preferentially in our institution by a short midline suprapubic approach (usually 8 cm) and the application of prosthetic material. The technique we use derives from that described originally by Stoppa et al. The preperitoneal dissection is carried out in the same manner. The difference is that the management of the hernia is achieved by a prosthesis considerably overlapping the hernial openings, one on each side in the case of a bilateral procedure. The prosthesis is fixed by a single suture in Cooper’s ligament and held in place principally by intraabdominal pressure. This technique has been spread through the Liege region largely by Lombard et al.

Objective We evaluated prognostic factors in 34 patients discharged from hospital after surgical resection for oesophageal squamous cell carcinoma. Material and methods There were 22 males and 12 females; mean age was 59.3 years (range 42-77 years). Preoperative neoadjuvant treatment consisted in chemotherapy alone in three patients and in combined radiochemotherapy in 14. Digestive continuity was restored with a gastric transplant in 26 patients and a colonic graft in 8. Surgery was curative in 28 patients and palliative in 6. There were three stage I, 14 stage II, 13 stage III, and 4 stage IV diseases. In 19 patients the lymph nodes were invaded. The tumour was well differentiated in 17 patients, moderately in 9, and poorly in 8. Results Follow-up ranged from 2 to 100 months. Overall median postoperative survival was 21 months. By univariate analysis, factors influencing survival were curative surgery (p = 0.04), stage (p = 0.006), and nodal involvement (p = 0.0003). Nodal involvement was an independent prognostic factor by multivariate analysis (p = 0.0002). Patient age and sex, perioperative transfusion, digestive transplant, tumour local extension, grade of differentiation, and distant metastasis did not influence survival. Also, we did not observe any significant benefit of preoperative or postoperative chemotherapy or radiochemotherapy. Conclusions Nodal involvement was the most important prognostic factor influencing survival. Therefore, an earlier diagnosis of oesophageal cancer in a less advanced stage is important to improve survival rates. Our study could not confirm the benefit of neoadjuvant therapy in terms of late survival.

Summary Background Assessment of metastatic involvement of the liver remains a diagnostic challenge. The objective of this study was to evaluate the potential role of FDG PET in the detection of liver metastases. Patients and methods Sixty-four patients with malignancy and possible liver involvement were included. Liver metastases were present in 31 cases, demonstrated by histopathological analysis in 15 cases and by follow-up in 16 cases. The negative cases were confirmed by pathology in four cases, peroperative ultrasonography in 12 cases, and follow-up in 17 cases. Whole-body FDG PET was compared to CT (n = 53) and US (n = 43). Results PET demonstrated a 97% sensitivity, an 88% specificity and a 92% accuracy, compared to 93%, 75% and 85%, respectively, for CT (P = NS). Concordant results were obtained in 44 of 64 patients (69%; 19 TP, 25 TN). PET provided new and accurate information in 15 of 64 patients (23.4%). PET demonstrated liver metastases in 11 patients in whom conventional methods yielded negative (two cases) or doubtful (nine cases) results. Four patients free of liver involvement were correctly staged with PET, while CT/US were equivocal. PET was erroneous in five of 64 cases (7.8%, four FP, one FN). Conclusions FDG PET allows an accurate screening of liver involvement in patients with malignancy. Combined with CT, it provides additional diagnostic information that could directly affect the management of these patients.

TODAY, donor organ shortage has lead to an increased waiting period before transplantation and has promoted an increasing number of deaths among the patients awaiting transplantation. One of the solutions to increase the donor pool is to accept “suboptimal” donors who whould not have otherwise been suitable for organ donation only a few years ago. This policy of accepting older or suboptimal donors should promote an increase in the risk of accepting donors with infraclinic malignancies, thus an increase in the risk of transferral of undetected malignancies from the donor to the recipient. In our department in 1991, two recipients developed metastases of a misdiagnosed choriocarcinoma that had caused the death of the donor by cerebral hemorrhage of nontraumatic origin. 1 These dire complications commanded us a a severe policy of malignancy detection during organ procurements, and we report the results of this policy in this article.

Immunosuppressed patients are susceptible to complicated diverticulitis, but reports of this complication are scarce in heart graft recipients. To estimate the prevalence of acute diverticulitis in heart graft recipients, we retrospectively reviewed the cases of diverticulitis in a series of 143 patients who underwent orthotopic heart transplantation in a period of 10 years. Six (4%) of these developed acute diverticulitis and required colectomy. All of them were male patients and were older than 50 years. Four patients underwent urgent laparotomy and colon resection with end colostomy (Hartmann procedure). The two other patients suffered from diverticulitis without generalized peritonitis and underwent laparoscopic sigmoidectomy with direct transanal end-to-end anastomosis. The postoperative outcomes of these six patients were satisfactory. As are other immunosuppressed patients, heart graft recipients are susceptible to diverticulitis. Early surgical management may be safe in well-compensated patients.

CURRENTLY, STANDARD immunosuppressive protocols for solid organ transplantation include a calcineurin inhibitor (CNI), either cyclosporine or tacrolimus. These drugs are powerful immunosuppressors but present significant immunological side effects. Among them, chronic nephrotoxicity represents a serious clinical challenge even years after transplantation. In particular, many liver transplant recipients who enjoy long-term survival develop progressive end-stage renal disease requiring dialysis and/or renal transplantation. With experience, transplant physicians have learned to use much lower doses of immunosuppressive drugs, thereby reducing the rate and severity of their side effects, but in the long run, low-dose CNI may still induce progressive impairment of renal function. Mycophenolate mofetil (MMF) is a potent inhibitor of inosine monophosphate dehydrogenase with a relatively selective effect on Tand B-lymphocyte activation and proliferation. MMF has no nephrotoxic side effect and seems to have superior immunosuppressive potency compared with azathioprine. In this nonrandomized, consecutive, prospective, pilot study, the authors offered CNI withdrawal to stable liver recipients who experienced progressive chronic renal failure years after successful liver transplantation. CNI was successfully replaced by MMF monotherapy, without signs of chronic graft rejection at follow-up, and with significant improvement of serum creatinine levels.

The influence of the length and origin of a small bowel graft on graft versus host disease (GVHD) was studied in 33 (Lewis x brown Norway) F1 hybrids transplanted with different types of Lewis small bowel grafts. Recipients of an entire small bowel graft (N = 9), a jejunal graft (N = 6), or an ileal graft (N = 6) displayed a similar acute lethal GVHD, with 100% mortality rate and equivalent survival time (15 +/- 0.7, 16.8 +/- 0.9, and 16 +/- 0.6 days, respectively) (P greater than 0.01). On the other hand, 80% of the recipients of a segmental jejunal graft (N = 10) recovered from a transitory form of GVHD and regained weight similarly to the isografted rats (N = 4). It was concluded that the entire small bowel, jejunum, and ileum can provoke an equivalent GVHD after transplantation, whereas a segment of jejunum decreases the intensity of GVHD, probably by reducing the amount of transplanted lymphoid tissue.

In this paper, we addressed the implications of misdi- agnosed malignancy in transplanted organs. As the best prevention for this dreadful complication of trans- plantation is detection of the malig- nancy in the donor, we recom- mended careful observation of the donor during procurement, an im- mediate frozen section of any

Immunocompromised patients are particularly at risk for complicated diverticulitis. They are more sensitive to infections and develop fewer abdominal symptoms. When they develop diverticulitis, the course of the disease is very often complicated by free colonic perforation and peritonitis leading to high mortality rates. The purpose of this paper was to review natural course and the management of diverticulitis in the immunocompromised patients.

The small bowel (SB), an organ replete with lymphocytes, may provoke graft-versus-host disease (GVHD) after transplantation (Tx). Since tumor necrosis factor (TNF) has been suspected of mediating the tissue lesions of GVHD, we sought to determine whether TNF could be detected in the serum of rats undergoing GVHD after SBTx or lymphocyte transfer. For this purpose, post-operative serum TNF activity was determined in Lewis x Brown after undergoing transplantation of an entire (group 1; n=8) or a segmental (group 2; n=4) Lew SB, or after i. p. injection with lethal doses (500×106) of Lew lymphocytes (group 3; n=3). Control LBNF1 received i.p. small doses (50×106) of Lew lymphocytes (group 4; n=4). Serum TNF activity was assessed using the WEHI bioassay. In rats with acute and lethal GVHD after entire SBTx (group 1) or injection with large doses of lymphocytes (group 3), TNF activity gradually increased and reached high levels by the time the rats were agonal. In segmental SBTx rats (group 2), GVHD was less severe than in entire SBTx rats. Similarly, the increase in TNF activity was less intense and only transient since it had returned to control levels by the time the rats had completely recovered from GVHD. In control rats primed with small doses of lymphocytes (group 4), GVHD did not occur and no increase in TNF activity was detected. We conclude that: (1) GVHD after SBTx or lymphocyte transfer is associated with the appearance of TNF in the serum and (2) the intensity and the reversibility of this phenomenon correlate with clinical severity and lethality of GVHD. These data strongly suggest that TNF is involved in the pathogenesis of GVHD.