Rapid MR imaging with suspended respiration: clinical application in the liver

The authors demonstrate that it is possible to obtain highly T1-weighted images of the abdomen using a suspended respiration partial saturation (SRPS) method in a breath-holding interval. T2*-weighted images, which reflect tissue T2 as well as variations in the static magnetic field, can also be rapidly obtained. The authors studied five healthy subjects and 19 patients with a variety of liver abnormalities, including benign and malignant hepatic neoplasms, fatty liver infiltration, ascites, and hematoma. On T1-weighted multisection acquisitions, the entire liver can be screened for mass lesions in a single 20-second breath-holding interval. Phase-contrast SRPS images are sensitive to fatty infiltration of the liver. SRPS images are more sensitive to variations in magnetic susceptibility than spin-echo images are, which has been proved to be of value in the detection of hemorrhage. With continued pulse sequence development and clinical study, this method has the potential to become the method of choice for evaluation of the upper abdomen.     

Short-term effects of octreotide on blood pressure and plasma catecholamines and neuropeptide Y levels in patients with phaeochromocytoma: a placebo-controlled trial

OBJECTIVE The observation that phaeochromocytoma possess specific somatostatin binding sites led us to test the hypothesis that octreotide may have antisecretory potential in patients with phaeochromocytoma. We therefore compared the effects of octreotide and placebo on blood pressure and plasma catecholamines and neuropeptide Y. PATIENTS Ten consecutive patients referred to a tertiary care centre for the diagnosis and treatment of a phaeochromocytoma. DESIGN AND MEASUREMENTS We performed a crossover comparison of either three 100 μg subcutaneous injections of octreotide over one day or 3 injections of octreotide vehicle over another. Blood pressure was measured over 24 hours on each test day using an automatic ambulatory recorder. Blood samples were collected before (at 0800 and 0900 h) and after (at 1000, 1100, 1200, 1300 and 1500h) placebo or octreotide injection. Plasma catecholamines were assayed by high-performance liquid chromatography and neuropeptide Y was determined using a two-site amplified enzyme immunoassay. All patients then underwent surgery and tumoral somatostatin binding site density was determined by quantitative autoradiography. RESULTS Compared to placebo, octreotide did not alter mean 24-hour ambulatory blood pressure or plasma neuropeptide Y, or plasma or urinary catecholamine, levels. Although a moderate reduction in plasma noradrenaline was found in the two patients with the highest tumoral somatostatin binding site densities, overall octreotide induced variations in plasma noradrenaline did not correlate with somatostatin binding site density. Blood glucose increased from 5·4 ± 0·3 on placebo to 7·8 ± 0·5 mmol/l on octreotide (P< 0·01). CONCLUSION In the present controlled conditions, short-term administration of octreotide had no antisecretory effect in patients with phaeochromocytoma.     

Epithelioid sarcoma of soft tissues: a case of extrarenal renin-secreting tumour

The case of a young woman presenting with a renin-secreting soft tissue sarcoma is described. The primary extrarenal tumour as well as metastatic disease were associated with severe hypertension and both required surgical treatment. The location of these rare malignant tumours and their association with renin-dependent hypertension is discussed. In cases of this type, reappearance of hypertension suggests tumour recurrence.     

Treatment of status epilepticus in children with epilepsy]

The treatment of status epilepticus (SE) in children with epilepsy depends on the epilepsy syndrome, in order to avoid worsening drugs such as IV barbiturates in severe myoclonic epilepsy in infancy (SMEI) (Dravet's syndrome) or IV benzodiazepam in tonic SE of Lennox-Gastaut syndrome. Intensive care procedures should not be systematical in convulsive SE (CSE) and are not indicated in non-convulsive SE (NCSE). Generalized CSE mostly involve SMEI before 3 years of age, symptomatic generalized epilepsy and partial lesional epilepsy. Treatment is an emergency and relies on IV benzodiazepines and, if necessary, IV phenytoine using plasmatic concentrations for an optimal management. The partial CSE of partial lesional epilepsy can result in focal deficit and need the same treatment as generalized CSE. NCSE consist in absence and/or myoclonic SE and are often unrecognised during a long time until EEG is performed. They mostly involve myoclonic epilepsies and can be controlled by IV benzodiazepines. The frequency of partial NCSE is underestimated, particularly in infants. Diagnosis relies on video EEG and treatment is the same as that used in partial CSE.