Multi-slice imaging of cystic tumors of the pancreas: Where are the limits of macroscopic characterization?

Les tumeurs kystiques du pancréas étaient considérées comme rares et leur diagnostic en imagerie était dominé par leur distinction des pseudokystes postnécrotiques et rétentionnels. La pratique plus fréquente d’examens en coupes en haute résolution (scanner et IRM surtout, échoendoscopie) a rendu le problème de leur identification beaucoup plus fréquent et même pluriquotidien, en même temps qu’elle a permis une meilleure connaissance de leurs potentialités évolutives, élément majeur de leur prise en charge thérapeutique puisque selon certains travaux récents, 30 % des adénocarcinomes ductaux du pancréas seraient issus de la dégénérescence de lésions initialement bénignes de type tumeurs intracanalaires papillaires et mucineuses (TIPMP) (devenues les plus fréquentes des tumeurs kystiques du pancréas). Les TIPMP intéressant le canal pancréatique principal ont un potentiel de malignité élevé puisque leur risque de dégénérescence est estimé à 50 % à cinq ans. Elles doivent donc théoriquement faire l’objet d’une exérèse la plus complète possible en s’efforçant d’éviter au maximum la pancréatectomie totale, grevée de lourdes séquelles nutritionnelles et fonctionnelles. Cette thérapeutique chirurgicale doit bien sûr être discutée en fonction de l’espérance de vie et du risque chirurgical chez chaque patient, en réunion de concertation pluridisciplinaire. Les TIPMP n’intéressant que des canaux secondaires du pancréas ont un risque de dégénérescence de l’ordre de 5 à 10 % à cinq ans. Elles doivent donc faire l’objet d’une surveillance par l’imagerie en coupes haute résolution pendant cinq ans et leur exérèse ne sera réalisée qu’en cas d’apparition d’éléments macroscopiques inquiétants. Contrairement aux adénomes mucineux et, à un moindre degré séreux, qui sont rencontrés avec une nette prédilection dans le sexe féminin, les TIPMP sont observées avec une fréquence globalement identique dans les deux sexes, tandis que l’exceptionnel kyste lymphoépithélial est l’apanage de l’homme d’âge moyen.Cystic tumors of the pancreas were considered to be rare. Their radiologic diagnosis has been dominated by their distinction from post necrotic and retention pseudocysts. Widespread use of cross-sectional imaging with high resolution CT and MRI has revealed their real prevalence. Their identification has become a common daily problem. These new imaging procedures have also enabled a better understanding of their potential for degeneration, a determining factor for treatment. According to recent clinical research studies, 30% of common ductal pancreatic adenocarcinomas would issue from the degeneration of previous benign intraductural papillary mucinous neoplasms (IPMN) lesions (which have now become the most frequently encountered cystic pancreatic tumor). IPMN involving the main pancreatic duct have a very high malignant potential; at five years, the estimated risk of degeneration is 50%. Theoretically treatment involves as complete as possible resection, with the main goal of avoiding total pancreatectomy and the subsequent serious nutritional and functional sequelae. This surgical treatment must be discussed with a multidisciplinary staff, considering each individual patient’s life expectancy and surgical risk. The five-year risk of degeneration for IPMN limited to the secondary pancreatic ducts ranges from 5 to 10%. A five-year follow-up is thus indicated for these patients; surgical resection can be proposed if mural nodules develop. Unlike mucinous and, to a lesser extent, serous adenoma, lymphoepithelial cysts of the pancreas are mainly encountered in the mid-aged male population

Benign metastasizing leiomyoma with lung cystic lesions and pneumothoraces: A case report

AbstractBenign metastasizing leiomyoma (BML) affects women of the middle age, and is a rare disease. Typically, in BML, uterine leiomyoma, and lung nodes are found. In the literature, only 3 cases of large cysts have been reported. In our case, we describe a patient with uterine leiomyoma with lung cysts, and several pneumothoraces

Comparaison des méthodes 2D et 3D dans l’évaluation des fonctions ventriculaires globales en scanner multi-détecteurs

International audiencePURPOSE: To compare two methods of post processing cardiac CT data to measure global ventricular function. Materials and methods. Retrospective study where three readers measured the end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) of the right (n=22) and left (n=44) ventricles, using a 2D method (extrapolated volumetric method, EVM) and a 3D method (direct volumetric method, DVM) after cardiac CT with retrospective ECG gating. Inter- and intraobserver agreement were calculated based on the intraclass correlation coefficient (ICC) with 95% confidence interval (CI95%), and results obtained with each method were compared using the student t test for paired samples. RESULTS: Inter- and intraobserver reproducibility were very good for both methods, with ICC ranging between 0.694 and 0.992, without significant difference. For the left ventricle, EDV, ESV and EF were 16653 ml, 8351 ml and 5415% for DVM et de 20361 ml, 11558 ml and 4613% for EVM respectively. Right ventricular values were 15247 ml, 7534 ml, 5013% and 17253 ml, 9940 ml, 439% (p<0,0001). CONCLUSION: The very good inter- and intraobserver reproducibility for both methods validate their use in clinical practice. Volume measurements with DVM are always inferior to volumes with EDM, with inverse relationship for EF measurements.Objectifs.Évaluer comparativement deux méthodes de post-traitement en scanner cardiaque de mesures de la fonction ventriculaire globale.Matériels et méthodes.Dans cette étude rétrospective, trois opérateurs ont mesuré les volumes télédiastolique (VTD) et télésystolique (VTS), et la fraction d’éjection (FE) des ventricules droits (n = 22) et gauches (n = 44), avec une méthode 2D (méthode volumique extrapolée, MVE) et une 3D (méthode volumique directe, MVD), chez des patients ayant eu un scanner cardiaque avec synchronisation rétrospective à l’ECG. L’évaluation des reproductibilités inter et intra-observateurs a été fondée sur le coefficient de corrélation intraclasse (CCIC) et son intervalle de confiance à 95 % (IC95 %), et les résultats obtenus par les deux méthodes ont été comparés par le test t de Student sur séries appariées.Résultats.Les reproductibilités inter et intra-observateurs étaient très bonnes pour les deux méthodes, avec des CCIC variant de 0,694 à 0,992, sans différence significative. Pour le ventricule gauche, les VTD, VTS et FE étaient respectivement de 166 53 ml, 83 51 ml et 54 15 % par MVD et de 203 61 ml, 115 58 ml et 46 13 % par MVE. Ils étaient de 152 47 ml, 75 34 ml, 50 13 % et de 172 53 ml, 99 40 ml, 43 9 % pour le ventricule droit (p < 0,0001).Conclusion.Les très bonnes reproductibilités inter et intra-observateur des deux méthodes testées valident leur utilisation en clinique. Les volumes mesurés en MVD sont toujours inférieurs à ceux en MVE, avec une différence inverse en terme de FE

Additional benefit of procalcitonin to C-reactive protein for assessing disease activity and severity in Crohn's disease: Procalcitonin in inflammatory bowel diseases

International audienceBackground: Serum procalcitonin level (SPL) may reflect non-infectious inflammation. Aim: To assess the correlation of SPL with clinical, biological, endoscopic and radiological markers of disease activity in inflammatory bowel diseases (IBD) and to evaluate the additional diagnostic benefit of measuring SPL to that of C-reactive protein (CRP) for disease activity appraisal. Methods: We performed a prospective observational study. Spearman's rank correlation and receiver operating characteristic analysis were used to evaluate correlation and diagnostic accuracy, respectively. Results: In Crohn's disease (CD) (n=30), SPL was strongly correlated with clinical, biological, endoscopic and radiological disease activity markers. In CD, a SPL >0.14 µg/L demonstrated a high accuracy for detecting severe disease (Sensitivity=100%; Specificity=96%; AUROC=0.963; P=0.0001). The diagnostic accuracy of the 'SPL-CRP strategy' (CRP >5 mg/L and SPL >0.05 µg/L) was significantly superior to that of CRP alone for diagnosing severe CD (AUROC=0.783 versus 0.674; P=0.01). In ulcerative colitis (UC) (n=27), SPL was correlated with CRP and with endoscopic and radiological disease activity markers. Conclusions: In CD, the SPL was correlated with all disease activity markers and a cut-off of 0.14 µg/L could distinguish severe forms of the disease. The 'SPL-CRP strategy' was superior to CRP alone for diagnosing active or severe CD

Efficacy of Commercial Phage Based Treatment as a Control Strategy against Listeria Spp. and Effect of Host Characteristics on Lytic Capacity

Listeria monocytogenes can persist on food contact (FCS) and non-food contact surfaces (NFCS) and enter the food continuum by cross-contamination. Meat processing facilities are a known source of Listeria spp. contamination. Specificity and safety of use render bacteriophages suitable to control Listeria spp. in foods and food environments. Previous research has shown that host characteristics can affect lytic efficacy of bacteriophages. This study focuses on evaluating how phenotypic and genotypic characteristics of Listeria hosts influence lytic capacity of a commercial listeriophage cocktail in vitro. We also investigated the efficacy of listeriophage as a biocontrol strategy for Listeria spp. on non-food contact surfaces (NFCS) in a meat processing facility. In vitro lytic capacity was tested quantitatively using spot assay for 475 Listeria spp. isolates with varied phenotypic (attachment capacity, sanitizer tolerance) and genotypic (PFGE) characteristics. Lytic capacity was measured quantitatively for 55 isolates by monitoring growth of L. monocytogenes cultures with and without listeriophage over time and enumerating bacterial counts after 4h. Fifty-nine NFCS were tested in a meat processing facility for Listeria spp. weekly for three weeks. Each Listeria spp. positive site was treated with commercial phage then assessed for reduction in Listeria spp. Although enhanced attachment capacity and sanitizer tolerance of Listeria spp. isolates did not significantly (p\u3e0.05) influence phage susceptibility in vitro; history of persistence, incubation temperature, and concentration of listeriophage treatment were critical. Quantitatively, listeriophage treatment significantly (p\u3c0.001) affected growth and reduced bacterial counts of Listeria spp. compared to control samples. A total of 15, 21, and 14 sites were positive for Listeria spp. at weeks one, two, and three, respectively. Post-treatment Listeria spp. were detected in 12/23 sites, and numerically reduced in 4/12 sites by an average of 2.1 log CFU/sponge. Among the isolates subjected to spot assay, 60% strains showed low susceptibility to listeriophage, 36% showed moderate lysis, and 4% isolates showed confluent lysis by listeriophage. This study illustrates influence of bacterial host characteristics on lytic efficacy of listeriophage treatment. Further, we have preliminary evidence for listeriophage as a potential control strategy in food environments