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Papers by Christophe Bazin

Research paper thumbnail of La radiofréquence dans le traitement palliatif à visée antalgique des tumeurs des parties molles

Journal de Radiologie, 2010

La radiofréquence dans le traitement palliatif à visée antalgique des tumeurs des parties molles

Research paper thumbnail of Spiral-CT: A new imaging method for vessels

Research paper thumbnail of RI-WS-15 Balisage tumoral par grains d’or avant radiotherapie stereotaxique par Cyberknife® : experience initiale a Nancy

Journal de Radiologie, 2007

Research paper thumbnail of Etude pilote du suivi thérapeutique du léflunomide en transplantation rénale

Journal de Pharmacie Clinique

La néphropathie à BK virus est une complication pouvant induire des troubles sévères chez les pat... more La néphropathie à BK virus est une complication pouvant induire des troubles sévères chez les patients transplantés rénaux. Une immunosuppression soutenue associant notamment tacrolimus et mycophénolate mofétil est un facteur de risque important. Il n’existe à l’heure actuelle aucun consensus pour traiter cette néphropathie. Les antiviraux classiques comme le cidofovir semblent avoir une efficacité insuffisante pour enrayer l’infection. La stratégie thérapeutique de première intention consiste habituellement en une réduction des doses des immunosuppresseurs. Le léflunomide se présente comme une alternative efficace dans certains cas. Nous présentons le suivi thérapeutique de 4 patients en échec après les mesures de première intention, à savoir une diminution des doses des immunosuppresseurs, voire un traitement par cidofovir. Les dosages du métabolite actif du léflunomide ont été réalisés en chromatographie liquide couplée à une détection UV à 295 nm. Les concentrations plasmatiques...

Research paper thumbnail of Cost of radiofrequency ablation in the treatment of hepatic malignancies

Gastroentérologie Clinique et Biologique

Our primary objective was to assess the cost of radio-frequency ablation (RFA) of hepatic maligna... more Our primary objective was to assess the cost of radio-frequency ablation (RFA) of hepatic malignancies and to compare it to hospital reimbursement paid in the French Prospective Payment System (PPS). A series of 305 patients were enrolled into a prospective study. All resources used during the RFA-related hospital stay were recorded. Costs were assessed from the perspective of the health care providers and computed for four groups of patients: percutaneous RFA in an outpatient setting (group Ia, N=44), percutaneous RFA in an inpatient setting (group Ib, N=94), laparoscopic RFA (group II, N=44) and intraoperative RFA combined with resection (group III, N=120). Mean hospital costs were estimated at euro 1581 (group Ia), euro 3824 (group Ib), euro 8194 (group II) and euro 12967 (group III). Costs per stay without intensive care in these groups were respectively euro 1581, euro 3635, euro 6622 and euro 10905 and reimbursement (intensive care excluded) was euro 560, euro 3367, euro 9084 ...

Research paper thumbnail of Une cause rare d'ascite : la fistule artérioveineuse splénique

La Revue de Médecine Interne, 1992

Research paper thumbnail of DIG-WP-48 Volumineux bourgeons tumoraux endoluminaux du tronc porte : le CHC n’a pas le monopole !

Journal de Radiologie, 2009

Research paper thumbnail of Cyclic antidepressants screening in emergency toxicology: Immunoassay study through cross-reactivity and molecular structures

Toxicologie Analytique et Clinique, 2015

Research paper thumbnail of Chimioembolisation des carcinomes hepatocellulaires : l’etiologie de la cirrhose est-elle un facteur predictif independant de survie

Journal de Radiologie, 2006

mois après le traitement. Après un délai de surveillance moyen de 39I16,5 mois dans le groupe A e... more mois après le traitement. Après un délai de surveillance moyen de 39I16,5 mois dans le groupe A et de 39I14 mois dans le groupe B, une récidive locale a été identifié respectivement dans 7/12 versus 11 12 tumeurs (P = 0,03). Dans le groupe A, 617 récidives locales étaient

Research paper thumbnail of Facteurs predictifs d’echec local du traitement par radiofrequence de lesions hepatiques

Journal de Radiologie, 2009

Objectifs: Evaluation prospective de la cholangite sclérosante (CS) dans d'Hépatite Auto-Immune (... more Objectifs: Evaluation prospective de la cholangite sclérosante (CS) dans d'Hépatite Auto-Immune (HAl) de l'adulte. Matériels et méthodes: Inclusion de 59 patients HAl consécutifs (âge moyen: 48 ans; femmes: 71 %) et de 27 témoins ayant une cirrhose d'étiologie ni biliaire ni auto-immune. Réalisation chez tous les patients d'une biopsie hépatique et d'une cholangio-IRM. Résultats: Quatorze des 59 patients HAl (24 %) présentaient des anomalies des voies biliaires intra-hépatique (VBIH) en IRM, mais chez aucun le diagnostic de CS a été porté en IRM ou en histologie. Parmi ces 14 patients, un syndrome de chevauchement HAl-CS a cependant était retenu chez un patient développant une cholestase sous corticothérapie. Le score de fibrose était le seul paramètre indépendant associé aux anomalies biliaires en IRM (OR: 2,4 ; 95 % CI : 1,4-4,7) et le pourcentage de patients avec anomalies biliaires en IRM Objectifs: L'ablathermie par radiofréquence semble être prometteuse pour traiter des tumeurs hépatiques non résécables. Cependant, le risque de récidive lésionnelle au niveau de la zone traitée est non négligeable. Le but de l'étude est de rechercher les facteurs de récidive locale dans le traitement de lésions hépatiques par radiofréquence. Matériels et méthodes: Etude rétrospective portant sur la période comprise entre janvier 2000 et le 31 mars 2007, monocentrique, incluant tous les patients ayant eu une radiofréquence hépatique. La procédure est réalisée par voie percutanée sous contrôle échographique ou scanographique, ou en peropératoire. Une surveillance clinique, biologique et scanographique post ablatherrnie, était réalisée à 3 mois, 6 mois, lan puis tous les ans. Résultats : Trois cent onze lésions ont été traitées chez 163 patients dont la répartition histologique sont pour 42 % (n =132) des CHC et pour 58 % (n = 179) des métastases hépatiques. La taille tumorale moyenne est de 24 mm (SD =13mm). 26 % des patients ont présenté au moins une morbidité. La mortalité a été nulle. Le taux de récidive locale est de 18,6 % et le taux de reliquat tumoral est de 14 %. Le facteur prédictif le plus important est la taille tumorale avec 44 % de récidive pour les lésions de plus de 30 mm, alors que ce taux est de 25 % pour des tailles inférieures (P = 0,002). La voie d'abord et le nombre de lésions sont prédictifs de récidive (p = 0,0005 et p = 0,01 respectivement). La localisation de la lésion par rapport aux vaisseaux et à la capsule hépatique n'influence pas ce taux de récidive. La médiane de survie est de 29 mois sans différence selon le type histologique de la lésion traitée. Conclusion: Le traitement par radiofréquence des lésions hépatiques est une technique efficace et sûre mais son indication doit être réservée aux patients ne pouvant bénéficier d'un traitement chirurgical ou en complément de ce dernier. Les meilleurs résultats sont obtenus pour des tumeurs uniques, de taille inférieure à 30 mm et traitées lors d'une procédure réalisée en peropératoire. Mots clés: Foie, radiologie interventionnelle -Radiofréquence, récidive Durée: 7 minutes Durée: 7 minutes 16 h 10

Research paper thumbnail of Retreatment with TACE: The ABCR SCORE, an aid to the decision-making process

Journal of Hepatology, 2014

Transarterial chemoembolization (TACE) is the standard of care for intermediate stage hepatocellu... more Transarterial chemoembolization (TACE) is the standard of care for intermediate stage hepatocellular carcinoma (HCC) and it is the most commonly used treatment for HCC worldwide. However, no prognostic indices, designed to select appropriate candidates for repeat conventional TACE, have been incorporated in the guidelines. From January 2007 to April 2012, 139 consecutive HCC patients, mainly with an alcohol- or viral-induced disease, were treated with TACE. Using a regression model on the prognostic variables of our population, we determined a score designed to help for repeat TACE and we validated it in two cohorts. We also compared it to the ART score. In the multivariate analysis, four prognostic factors were associated with overall survival: BCLC and AFP (>200ng/ml) at baseline, increase in Child-Pugh score by ⩾2 from baseline, and absence of radiological response. These factors were included in a score (ABCR, ranging from -3 to +6), which correlates with survival and identifies three groups. The ABCR score was validated in two different cohorts of 178 patients and proofed to perform better than the ART score in distinguishing between patients' prognosis. The ABCR score is a simple and clinically relevant index, summing four prognostic variables endorsed in HCC. An ABCR score ⩾4 prior to the second TACE identifies patients with dismal prognosis who may not benefit from further TACE sessions.

Research paper thumbnail of CV-WP-45 Les abords d’hemodialyse : de l’imagerie a la therapeutique

Journal De Radiologie, 2007

Recenser et expliciter les méthodes d’imagerie à disposition pour explorer un abord d’hémodialyse... more Recenser et expliciter les méthodes d’imagerie à disposition pour explorer un abord d’hémodialyse.Connaître la séméiologie et les images pièges.Savoir exiger les éléments cliniques pertinents.Proposer une stratégie thérapeutique adaptée.L’angioscanner est une alternative à l’écho-Doppler dans l’imagerie des fistules.Les données cliniques et hémodynamiques sont indispensables à l’interprétation éclairée des lésions.Le «cutting balloon » s’annonce comme une évolution notable dans le traitement des sténoses veineuses des montages de dialyse.

Research paper thumbnail of La radiofrequence dans le traitement palliatif a visee antalgique des tumeurs des parties molles

Journal De Radiologie, 2010

PurposeTo assess the efficacy of radiofrequency (RF) ablation for palliation of soft tissue tumor... more PurposeTo assess the efficacy of radiofrequency (RF) ablation for palliation of soft tissue tumor pain.

Research paper thumbnail of Evaluation of the Architect® tacrolimus assay in kidney, liver, and heart transplant recipients

Journal of Pharmaceutical and Biomedical Analysis, 2010

The narrow therapeutic range of tacrolimus requires therapeutic drug monitoring to prevent transp... more The narrow therapeutic range of tacrolimus requires therapeutic drug monitoring to prevent transplant rejection and to minimize nephrotoxicity. The aim of this study was to evaluate the analytical performance of the tacrolimus chemiluminescent microparticle immunoassay (CMIA) in everyday practice comparatively with other methods. CMIA imprecision and accuracy were tested using low, medium, and high concentrations in control samples. The limits of quantification (LOQ) of CMIA and antibodyconjugated magnetic immunoassay (ACMIA) were evaluated using negative whole-blood samples containing 0.4-5.7 ng/ml of tacrolimus from a stock solution. CMIA was compared with ACMIA, enzyme multiplied immunoassay (EMIT), and liquid chromatography-tandem mass spectrometry (LC-MS/MS), using 176 samples from recipients (135 men and 41 women) of heart (n = 19), kidney (n = 107), or liver (n = 50) transplants. CMIA total precision was 5.7%, 3.7% and 3.6% with the low-, medium-, and highconcentration controls, respectively; corresponding values for accuracy were 98%, 104%, and 104%. LOQ was 0.5 (95%CI, 0.22-1.38) with CMIA and 2.5 ng/ml with ACMIA. Linear regression results were as follows: CMIA = 1.2LC-MS/MS + 0.14 (r = 0.98); CMIA = 0.93EMIT + 0.36 (r = 0.975); CMIA = 1.15ACMIA − 0.25 (r = 0.988); and, for tacrolimus concentrations in the 1-15 ng/ml range, of special interest as many transplant recipients are given low-dose tacrolimus, CMIA = 1.05LC-MS/MS + 0.38 (r = 0.94). Two patients had falsely elevated tacrolimus concentrations due to interference in the ACMIA assay; one was a renal transplant recipient who stopped her treatment and had tacrolimus concentrations of 12.5 ng/ml by ACMIA and <0.5 ng/ml by CMIA; the other was an HIV-positive renal transplant recipient whose tacrolimus concentrations by ACMIA were 1.8-43.7-fold those by CMIA. Such interferences with ACMIA, which may be related to endogenous antibodies in the plasma, are likely to negatively impact patient care. In conclusion, the tacrolimus CMIA assay is suitable for routine laboratory use and does not suffer from the interferences seen with ACMIA in some patients.

Research paper thumbnail of Comparison of resection, liver transplantation and transcatheter oily chemoembolization in treatment of hepatocellular carcinoma

Journal of Hepatology, 1996

Resection and liver transplantation are currently considered as the most useful treatments for he... more Resection and liver transplantation are currently considered as the most useful treatments for hepatocellular carcinoma. However, transcatheter oily chemoembolization may be favourably compared with these two surgical treatments in patients with anatomically operable tumors. Between 1985 and 1991, 122 patients with an Okuda stage I tumor were hospitalized in two French hospitals. Among these patients, 33 remained untreated, 42 were treated by transcatheter oily chemoembolization, 30 by resection and 17 by liver transplantation. The four groups were closely comparable except for age, the patients in the two surgical groups being significantly younger. Moreover, the frequency of pTNM II tumor was significantly higher in the resection group. The 5-year probability of survival was close to 45% in each of the three treated groups and was significantly higher than in the untreated group (0% at 4 years, p &lt; 0.0001). The probability of cancer recurrence and/or metastatic dissemination was lower after transcatheter oily chemoembolization than after surgery. Thus, transcatheter oily chemoembolization seems comparable at 5 years with resection or transplantation for the treatment of resectable hepatocellular carcinoma.

Research paper thumbnail of Alveolar Echinococcosis of the Liver

Journal of Computer Assisted Tomography, 1990

ABSTRACT Nineteen cases of proven hepatic alveolar echinococcosis were examined by magnetic reson... more ABSTRACT Nineteen cases of proven hepatic alveolar echinococcosis were examined by magnetic resonance (MR) and the results were compared with CT. Fibrous and parasitic tissue showed low signal both on T1- and, generally, on T2-weighted images. In a few cases a high signal on T2-weighted images may be observed, due either to central necrotic zones or to small peripheral cysts. Central necrosis was more easily identified by MR than by CT. However, MR seemed to be less effective than CT in allowing us to reach a positive diagnosis, due to its inability to show microcalcifications. In addition, MR may not reveal small lesions. In most cases T1-weighted images revealed more clearly than CT did the margins of the lesions and the hepatic extension, especially to hepatic veins, vena cava, and perihepatic spaces.

Research paper thumbnail of Cost of radiofrequency ablation in the treatment of hepatic malignancies

Gastroentérologie Clinique et Biologique, 2007

Objectives -Our primary objective was to assess the cost of radiofrequency ablation (RFA) of hepa... more Objectives -Our primary objective was to assess the cost of radiofrequency ablation (RFA) of hepatic malignancies and to compare it to hospital reimbursement paid in the French Prospective Payment System (PPS).

Research paper thumbnail of A case of gallbladder hemorrhage arising from a ruptured cystic artery pseudoaneurysm treated by arterial embolization with a successful follow-up two years later

European Journal of Radiology Extra, 2009

Spontaneous intracholecystic bleeding secondary to a false hepatic or cystic artery aneurysm is v... more Spontaneous intracholecystic bleeding secondary to a false hepatic or cystic artery aneurysm is very rare. It implies an inflammatory process that can yield a mass surrounding both the gallbladder and the duodenum and mimicking a gallbladder carcinoma. An 82-year-old man presented to the emergency department and complained of abdominal pain in the right upper quadrant, jaundice and a consequent weight

Research paper thumbnail of Effects of biliary obstruction on the penetration of ciprofloxacin and cefotaxime

European Journal of Gastroenterology & Hepatology, 2008

To evaluate the biliary penetration of ciprofloxacin and cefotaxime in patients with obstructed b... more To evaluate the biliary penetration of ciprofloxacin and cefotaxime in patients with obstructed bile ducts and to determine simple predictive markers of effective biliary concentrations of these drugs. Sixty-two patients treated with endoscopic biliary drainage were prospectively included in a nonrandomized way and received intravenous ciprofloxacin (200 mg twice daily) or cefotaxime (1 g three times a day) for more than 24 h before exploration. Blood and bile samples were collected at the time of drainage. Ciprofloxacin and cefotaxime concentrations were measured using high-performance liquid chromatography. Biliary penetration was assessed by the bile-to-plasma ratio of the concentrations of both antibiotics. Biliary penetration ranged from 0.06 to 42.7 for ciprofloxacin and from 0.01 to 1.14 for cefotaxime. The ratio was more than one in only 10 patients (35%) and three patients (9%) in ciprofloxacin and cefotaxime groups, respectively. Biliary concentration of the drug was more than 10 times the minimal inhibitory concentration in only 10 patients (35%) and in 12 patients (35%) in ciprofloxacin and cefotaxime groups, respectively. Serum bilirubin, alkaline phosphatase or gamma-glutamyl-transpeptidase were not good predictive markers of the biliary diffusion of the antibiotics. In patients with obstructed bile ducts, the biliary penetration of ciprofloxacin is poor and reaches effective biliary concentrations in a minority of patients. Cefotaxime biliary penetration is even poorer. No liver test can predict accurately the biliary penetration of the drugs.

Research paper thumbnail of Effects of discontinuing or continuing ongoing statin therapy in severe sepsis and septic shock: a retrospective cohort study

Critical Care, 2011

Introduction: Recent publications suggest potential benefits from statins as a preventive or adju... more Introduction: Recent publications suggest potential benefits from statins as a preventive or adjuvant therapy in sepsis. Whether ongoing statin therapy should be continued or discontinued in patients admitted in the intensive care unit (ICU) for sepsis is open to question. Methods: We retrospectively compared patients with severe sepsis and septic shock in whom statin therapy had been discontinued or continued. The primary endpoint was the number of organ failure-free days at day 14. Secondary end-points included hospital mortality and safety. The association of statin continuation with outcome was evaluated for crude analysis and after propensity score matching and adjustment. We also measured plasma atorvastatin concentrations in a separate set of ICU septic patients continuing the drug. Results: Patients in whom statin therapy had been continued in the ICU (n = 44) had significantly more organ failure-free days (11 [6-14] vs. 6 [0-12], mean difference of 2.34, 95%CI from 0.47 to 5.21, P = 0.03) as compared to others (n = 32). However, there were important imbalances between groups, with more hospital-acquired infections, more need for surgery before ICU admission, and a trend towards more septic shock at ICU admission in the discontinuation group. The significant association of statin continuation with organ failure free days found in the crude analysis did not persist after propensity-matching or multivariable adjustment: beta coefficients [95% CI] of 2.37 [-0.96 to 5.70] (P = 0.20) and 2.24 [-0.43 to 4.91] (P = 0.11) respectively. We found particularly high pre-dose and post-dose atorvastatin concentrations in ICU septic patients continuing the drug. Conclusions: Continuing statin therapy in ICU septic patients was not associated with reduction in the severity of organ failure after matching and adjustment. In addition, the very high plasma concentrations achieved during continuation of statin treatment advocates some caution.

Research paper thumbnail of La radiofréquence dans le traitement palliatif à visée antalgique des tumeurs des parties molles

Journal de Radiologie, 2010

La radiofréquence dans le traitement palliatif à visée antalgique des tumeurs des parties molles

Research paper thumbnail of Spiral-CT: A new imaging method for vessels

Research paper thumbnail of RI-WS-15 Balisage tumoral par grains d’or avant radiotherapie stereotaxique par Cyberknife® : experience initiale a Nancy

Journal de Radiologie, 2007

Research paper thumbnail of Etude pilote du suivi thérapeutique du léflunomide en transplantation rénale

Journal de Pharmacie Clinique

La néphropathie à BK virus est une complication pouvant induire des troubles sévères chez les pat... more La néphropathie à BK virus est une complication pouvant induire des troubles sévères chez les patients transplantés rénaux. Une immunosuppression soutenue associant notamment tacrolimus et mycophénolate mofétil est un facteur de risque important. Il n’existe à l’heure actuelle aucun consensus pour traiter cette néphropathie. Les antiviraux classiques comme le cidofovir semblent avoir une efficacité insuffisante pour enrayer l’infection. La stratégie thérapeutique de première intention consiste habituellement en une réduction des doses des immunosuppresseurs. Le léflunomide se présente comme une alternative efficace dans certains cas. Nous présentons le suivi thérapeutique de 4 patients en échec après les mesures de première intention, à savoir une diminution des doses des immunosuppresseurs, voire un traitement par cidofovir. Les dosages du métabolite actif du léflunomide ont été réalisés en chromatographie liquide couplée à une détection UV à 295 nm. Les concentrations plasmatiques...

Research paper thumbnail of Cost of radiofrequency ablation in the treatment of hepatic malignancies

Gastroentérologie Clinique et Biologique

Our primary objective was to assess the cost of radio-frequency ablation (RFA) of hepatic maligna... more Our primary objective was to assess the cost of radio-frequency ablation (RFA) of hepatic malignancies and to compare it to hospital reimbursement paid in the French Prospective Payment System (PPS). A series of 305 patients were enrolled into a prospective study. All resources used during the RFA-related hospital stay were recorded. Costs were assessed from the perspective of the health care providers and computed for four groups of patients: percutaneous RFA in an outpatient setting (group Ia, N=44), percutaneous RFA in an inpatient setting (group Ib, N=94), laparoscopic RFA (group II, N=44) and intraoperative RFA combined with resection (group III, N=120). Mean hospital costs were estimated at euro 1581 (group Ia), euro 3824 (group Ib), euro 8194 (group II) and euro 12967 (group III). Costs per stay without intensive care in these groups were respectively euro 1581, euro 3635, euro 6622 and euro 10905 and reimbursement (intensive care excluded) was euro 560, euro 3367, euro 9084 ...

Research paper thumbnail of Une cause rare d'ascite : la fistule artérioveineuse splénique

La Revue de Médecine Interne, 1992

Research paper thumbnail of DIG-WP-48 Volumineux bourgeons tumoraux endoluminaux du tronc porte : le CHC n’a pas le monopole !

Journal de Radiologie, 2009

Research paper thumbnail of Cyclic antidepressants screening in emergency toxicology: Immunoassay study through cross-reactivity and molecular structures

Toxicologie Analytique et Clinique, 2015

Research paper thumbnail of Chimioembolisation des carcinomes hepatocellulaires : l’etiologie de la cirrhose est-elle un facteur predictif independant de survie

Journal de Radiologie, 2006

mois après le traitement. Après un délai de surveillance moyen de 39I16,5 mois dans le groupe A e... more mois après le traitement. Après un délai de surveillance moyen de 39I16,5 mois dans le groupe A et de 39I14 mois dans le groupe B, une récidive locale a été identifié respectivement dans 7/12 versus 11 12 tumeurs (P = 0,03). Dans le groupe A, 617 récidives locales étaient

Research paper thumbnail of Facteurs predictifs d’echec local du traitement par radiofrequence de lesions hepatiques

Journal de Radiologie, 2009

Objectifs: Evaluation prospective de la cholangite sclérosante (CS) dans d'Hépatite Auto-Immune (... more Objectifs: Evaluation prospective de la cholangite sclérosante (CS) dans d'Hépatite Auto-Immune (HAl) de l'adulte. Matériels et méthodes: Inclusion de 59 patients HAl consécutifs (âge moyen: 48 ans; femmes: 71 %) et de 27 témoins ayant une cirrhose d'étiologie ni biliaire ni auto-immune. Réalisation chez tous les patients d'une biopsie hépatique et d'une cholangio-IRM. Résultats: Quatorze des 59 patients HAl (24 %) présentaient des anomalies des voies biliaires intra-hépatique (VBIH) en IRM, mais chez aucun le diagnostic de CS a été porté en IRM ou en histologie. Parmi ces 14 patients, un syndrome de chevauchement HAl-CS a cependant était retenu chez un patient développant une cholestase sous corticothérapie. Le score de fibrose était le seul paramètre indépendant associé aux anomalies biliaires en IRM (OR: 2,4 ; 95 % CI : 1,4-4,7) et le pourcentage de patients avec anomalies biliaires en IRM Objectifs: L'ablathermie par radiofréquence semble être prometteuse pour traiter des tumeurs hépatiques non résécables. Cependant, le risque de récidive lésionnelle au niveau de la zone traitée est non négligeable. Le but de l'étude est de rechercher les facteurs de récidive locale dans le traitement de lésions hépatiques par radiofréquence. Matériels et méthodes: Etude rétrospective portant sur la période comprise entre janvier 2000 et le 31 mars 2007, monocentrique, incluant tous les patients ayant eu une radiofréquence hépatique. La procédure est réalisée par voie percutanée sous contrôle échographique ou scanographique, ou en peropératoire. Une surveillance clinique, biologique et scanographique post ablatherrnie, était réalisée à 3 mois, 6 mois, lan puis tous les ans. Résultats : Trois cent onze lésions ont été traitées chez 163 patients dont la répartition histologique sont pour 42 % (n =132) des CHC et pour 58 % (n = 179) des métastases hépatiques. La taille tumorale moyenne est de 24 mm (SD =13mm). 26 % des patients ont présenté au moins une morbidité. La mortalité a été nulle. Le taux de récidive locale est de 18,6 % et le taux de reliquat tumoral est de 14 %. Le facteur prédictif le plus important est la taille tumorale avec 44 % de récidive pour les lésions de plus de 30 mm, alors que ce taux est de 25 % pour des tailles inférieures (P = 0,002). La voie d'abord et le nombre de lésions sont prédictifs de récidive (p = 0,0005 et p = 0,01 respectivement). La localisation de la lésion par rapport aux vaisseaux et à la capsule hépatique n'influence pas ce taux de récidive. La médiane de survie est de 29 mois sans différence selon le type histologique de la lésion traitée. Conclusion: Le traitement par radiofréquence des lésions hépatiques est une technique efficace et sûre mais son indication doit être réservée aux patients ne pouvant bénéficier d'un traitement chirurgical ou en complément de ce dernier. Les meilleurs résultats sont obtenus pour des tumeurs uniques, de taille inférieure à 30 mm et traitées lors d'une procédure réalisée en peropératoire. Mots clés: Foie, radiologie interventionnelle -Radiofréquence, récidive Durée: 7 minutes Durée: 7 minutes 16 h 10

Research paper thumbnail of Retreatment with TACE: The ABCR SCORE, an aid to the decision-making process

Journal of Hepatology, 2014

Transarterial chemoembolization (TACE) is the standard of care for intermediate stage hepatocellu... more Transarterial chemoembolization (TACE) is the standard of care for intermediate stage hepatocellular carcinoma (HCC) and it is the most commonly used treatment for HCC worldwide. However, no prognostic indices, designed to select appropriate candidates for repeat conventional TACE, have been incorporated in the guidelines. From January 2007 to April 2012, 139 consecutive HCC patients, mainly with an alcohol- or viral-induced disease, were treated with TACE. Using a regression model on the prognostic variables of our population, we determined a score designed to help for repeat TACE and we validated it in two cohorts. We also compared it to the ART score. In the multivariate analysis, four prognostic factors were associated with overall survival: BCLC and AFP (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;200ng/ml) at baseline, increase in Child-Pugh score by ⩾2 from baseline, and absence of radiological response. These factors were included in a score (ABCR, ranging from -3 to +6), which correlates with survival and identifies three groups. The ABCR score was validated in two different cohorts of 178 patients and proofed to perform better than the ART score in distinguishing between patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; prognosis. The ABCR score is a simple and clinically relevant index, summing four prognostic variables endorsed in HCC. An ABCR score ⩾4 prior to the second TACE identifies patients with dismal prognosis who may not benefit from further TACE sessions.

Research paper thumbnail of CV-WP-45 Les abords d’hemodialyse : de l’imagerie a la therapeutique

Journal De Radiologie, 2007

Recenser et expliciter les méthodes d’imagerie à disposition pour explorer un abord d’hémodialyse... more Recenser et expliciter les méthodes d’imagerie à disposition pour explorer un abord d’hémodialyse.Connaître la séméiologie et les images pièges.Savoir exiger les éléments cliniques pertinents.Proposer une stratégie thérapeutique adaptée.L’angioscanner est une alternative à l’écho-Doppler dans l’imagerie des fistules.Les données cliniques et hémodynamiques sont indispensables à l’interprétation éclairée des lésions.Le «cutting balloon » s’annonce comme une évolution notable dans le traitement des sténoses veineuses des montages de dialyse.

Research paper thumbnail of La radiofrequence dans le traitement palliatif a visee antalgique des tumeurs des parties molles

Journal De Radiologie, 2010

PurposeTo assess the efficacy of radiofrequency (RF) ablation for palliation of soft tissue tumor... more PurposeTo assess the efficacy of radiofrequency (RF) ablation for palliation of soft tissue tumor pain.

Research paper thumbnail of Evaluation of the Architect® tacrolimus assay in kidney, liver, and heart transplant recipients

Journal of Pharmaceutical and Biomedical Analysis, 2010

The narrow therapeutic range of tacrolimus requires therapeutic drug monitoring to prevent transp... more The narrow therapeutic range of tacrolimus requires therapeutic drug monitoring to prevent transplant rejection and to minimize nephrotoxicity. The aim of this study was to evaluate the analytical performance of the tacrolimus chemiluminescent microparticle immunoassay (CMIA) in everyday practice comparatively with other methods. CMIA imprecision and accuracy were tested using low, medium, and high concentrations in control samples. The limits of quantification (LOQ) of CMIA and antibodyconjugated magnetic immunoassay (ACMIA) were evaluated using negative whole-blood samples containing 0.4-5.7 ng/ml of tacrolimus from a stock solution. CMIA was compared with ACMIA, enzyme multiplied immunoassay (EMIT), and liquid chromatography-tandem mass spectrometry (LC-MS/MS), using 176 samples from recipients (135 men and 41 women) of heart (n = 19), kidney (n = 107), or liver (n = 50) transplants. CMIA total precision was 5.7%, 3.7% and 3.6% with the low-, medium-, and highconcentration controls, respectively; corresponding values for accuracy were 98%, 104%, and 104%. LOQ was 0.5 (95%CI, 0.22-1.38) with CMIA and 2.5 ng/ml with ACMIA. Linear regression results were as follows: CMIA = 1.2LC-MS/MS + 0.14 (r = 0.98); CMIA = 0.93EMIT + 0.36 (r = 0.975); CMIA = 1.15ACMIA − 0.25 (r = 0.988); and, for tacrolimus concentrations in the 1-15 ng/ml range, of special interest as many transplant recipients are given low-dose tacrolimus, CMIA = 1.05LC-MS/MS + 0.38 (r = 0.94). Two patients had falsely elevated tacrolimus concentrations due to interference in the ACMIA assay; one was a renal transplant recipient who stopped her treatment and had tacrolimus concentrations of 12.5 ng/ml by ACMIA and <0.5 ng/ml by CMIA; the other was an HIV-positive renal transplant recipient whose tacrolimus concentrations by ACMIA were 1.8-43.7-fold those by CMIA. Such interferences with ACMIA, which may be related to endogenous antibodies in the plasma, are likely to negatively impact patient care. In conclusion, the tacrolimus CMIA assay is suitable for routine laboratory use and does not suffer from the interferences seen with ACMIA in some patients.

Research paper thumbnail of Comparison of resection, liver transplantation and transcatheter oily chemoembolization in treatment of hepatocellular carcinoma

Journal of Hepatology, 1996

Resection and liver transplantation are currently considered as the most useful treatments for he... more Resection and liver transplantation are currently considered as the most useful treatments for hepatocellular carcinoma. However, transcatheter oily chemoembolization may be favourably compared with these two surgical treatments in patients with anatomically operable tumors. Between 1985 and 1991, 122 patients with an Okuda stage I tumor were hospitalized in two French hospitals. Among these patients, 33 remained untreated, 42 were treated by transcatheter oily chemoembolization, 30 by resection and 17 by liver transplantation. The four groups were closely comparable except for age, the patients in the two surgical groups being significantly younger. Moreover, the frequency of pTNM II tumor was significantly higher in the resection group. The 5-year probability of survival was close to 45% in each of the three treated groups and was significantly higher than in the untreated group (0% at 4 years, p &lt; 0.0001). The probability of cancer recurrence and/or metastatic dissemination was lower after transcatheter oily chemoembolization than after surgery. Thus, transcatheter oily chemoembolization seems comparable at 5 years with resection or transplantation for the treatment of resectable hepatocellular carcinoma.

Research paper thumbnail of Alveolar Echinococcosis of the Liver

Journal of Computer Assisted Tomography, 1990

ABSTRACT Nineteen cases of proven hepatic alveolar echinococcosis were examined by magnetic reson... more ABSTRACT Nineteen cases of proven hepatic alveolar echinococcosis were examined by magnetic resonance (MR) and the results were compared with CT. Fibrous and parasitic tissue showed low signal both on T1- and, generally, on T2-weighted images. In a few cases a high signal on T2-weighted images may be observed, due either to central necrotic zones or to small peripheral cysts. Central necrosis was more easily identified by MR than by CT. However, MR seemed to be less effective than CT in allowing us to reach a positive diagnosis, due to its inability to show microcalcifications. In addition, MR may not reveal small lesions. In most cases T1-weighted images revealed more clearly than CT did the margins of the lesions and the hepatic extension, especially to hepatic veins, vena cava, and perihepatic spaces.

Research paper thumbnail of Cost of radiofrequency ablation in the treatment of hepatic malignancies

Gastroentérologie Clinique et Biologique, 2007

Objectives -Our primary objective was to assess the cost of radiofrequency ablation (RFA) of hepa... more Objectives -Our primary objective was to assess the cost of radiofrequency ablation (RFA) of hepatic malignancies and to compare it to hospital reimbursement paid in the French Prospective Payment System (PPS).

Research paper thumbnail of A case of gallbladder hemorrhage arising from a ruptured cystic artery pseudoaneurysm treated by arterial embolization with a successful follow-up two years later

European Journal of Radiology Extra, 2009

Spontaneous intracholecystic bleeding secondary to a false hepatic or cystic artery aneurysm is v... more Spontaneous intracholecystic bleeding secondary to a false hepatic or cystic artery aneurysm is very rare. It implies an inflammatory process that can yield a mass surrounding both the gallbladder and the duodenum and mimicking a gallbladder carcinoma. An 82-year-old man presented to the emergency department and complained of abdominal pain in the right upper quadrant, jaundice and a consequent weight

Research paper thumbnail of Effects of biliary obstruction on the penetration of ciprofloxacin and cefotaxime

European Journal of Gastroenterology & Hepatology, 2008

To evaluate the biliary penetration of ciprofloxacin and cefotaxime in patients with obstructed b... more To evaluate the biliary penetration of ciprofloxacin and cefotaxime in patients with obstructed bile ducts and to determine simple predictive markers of effective biliary concentrations of these drugs. Sixty-two patients treated with endoscopic biliary drainage were prospectively included in a nonrandomized way and received intravenous ciprofloxacin (200 mg twice daily) or cefotaxime (1 g three times a day) for more than 24 h before exploration. Blood and bile samples were collected at the time of drainage. Ciprofloxacin and cefotaxime concentrations were measured using high-performance liquid chromatography. Biliary penetration was assessed by the bile-to-plasma ratio of the concentrations of both antibiotics. Biliary penetration ranged from 0.06 to 42.7 for ciprofloxacin and from 0.01 to 1.14 for cefotaxime. The ratio was more than one in only 10 patients (35%) and three patients (9%) in ciprofloxacin and cefotaxime groups, respectively. Biliary concentration of the drug was more than 10 times the minimal inhibitory concentration in only 10 patients (35%) and in 12 patients (35%) in ciprofloxacin and cefotaxime groups, respectively. Serum bilirubin, alkaline phosphatase or gamma-glutamyl-transpeptidase were not good predictive markers of the biliary diffusion of the antibiotics. In patients with obstructed bile ducts, the biliary penetration of ciprofloxacin is poor and reaches effective biliary concentrations in a minority of patients. Cefotaxime biliary penetration is even poorer. No liver test can predict accurately the biliary penetration of the drugs.

Research paper thumbnail of Effects of discontinuing or continuing ongoing statin therapy in severe sepsis and septic shock: a retrospective cohort study

Critical Care, 2011

Introduction: Recent publications suggest potential benefits from statins as a preventive or adju... more Introduction: Recent publications suggest potential benefits from statins as a preventive or adjuvant therapy in sepsis. Whether ongoing statin therapy should be continued or discontinued in patients admitted in the intensive care unit (ICU) for sepsis is open to question. Methods: We retrospectively compared patients with severe sepsis and septic shock in whom statin therapy had been discontinued or continued. The primary endpoint was the number of organ failure-free days at day 14. Secondary end-points included hospital mortality and safety. The association of statin continuation with outcome was evaluated for crude analysis and after propensity score matching and adjustment. We also measured plasma atorvastatin concentrations in a separate set of ICU septic patients continuing the drug. Results: Patients in whom statin therapy had been continued in the ICU (n = 44) had significantly more organ failure-free days (11 [6-14] vs. 6 [0-12], mean difference of 2.34, 95%CI from 0.47 to 5.21, P = 0.03) as compared to others (n = 32). However, there were important imbalances between groups, with more hospital-acquired infections, more need for surgery before ICU admission, and a trend towards more septic shock at ICU admission in the discontinuation group. The significant association of statin continuation with organ failure free days found in the crude analysis did not persist after propensity-matching or multivariable adjustment: beta coefficients [95% CI] of 2.37 [-0.96 to 5.70] (P = 0.20) and 2.24 [-0.43 to 4.91] (P = 0.11) respectively. We found particularly high pre-dose and post-dose atorvastatin concentrations in ICU septic patients continuing the drug. Conclusions: Continuing statin therapy in ICU septic patients was not associated with reduction in the severity of organ failure after matching and adjustment. In addition, the very high plasma concentrations achieved during continuation of statin treatment advocates some caution.