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INTRODUCTION: The treatment of pseudomyxoma peritonei (PMPs) and appendiceal mucocele (AM) has changed radically. To assess the contribution of preoperative imaging to the treatment strategy and choice of approach, a surgeon and a radiologist different from the initial radiologist examined the files of all patients treated for PMP or AM in four facilities in one district from January 1, 1996, through December 31, 2008. PATIENTS AND METHODS: The study included 27 patients (20 men and seven women, mean age: 63+/-13 years). Eleven patients had an intact AM, seven synchronous PMP (malignant appendiceal lesion in two of seven), six metachronous PMP (five with peritoneal mucinous carcinomatosis and one with diffuse peritoneal adenomucinosis) and three a ruptured AM but not PMP. The incidence of mucin-secreting tumors observed (27 cases in 12 years in a region of 500 000 inhabitants) corresponds to a prevalence of approximately five cases per year per million inhabitants. Acute clinical pictures (7/27) were significantly more frequent for the malignant forms (5/7) (p<0,02). RESULTS AND DISCUSSION: The overall sensitivity of computed tomography (CT) for all the criteria studied was 93%. The predictive value for AM rupture of visualization of thick calcifications was 100%. On the other hand, rupture never occurred when the CT showed an AM under pressure, with thin walls and septa. The predictive value for PMP of "scalloping" was 100%. The diagnostic accuracy of the initial reading was 25/27 for the imaging overall and 25/25 for the CT. Preoperative visualization of the exact size of the intact AM or of diagnostic information about ruptured AM and PMP helped to select an appropriate approach in 25 of 27 cases.

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Giant diverticula of the small intestine and colon are rare. Four cases treated at our institution in the last year are reported and compared to published cases; specific features and those which differentiate them from abdominal pseudocysts are described. They most commonly present a clinical tableau similar to commonplace diverticular disease. Awareness of this unusual condition and a good CT study are the keys to diagnosis. Giant diverticula may be acquired or congenital. The acquired type is simply a more spectacular version of commonplace diverticulosis while the congenital type, having a muscular wall and myenteric plexus, is more akin to intestinal duplications. Treatment is surgical and, in the case of sigmoid giant diverticula, usually requires a colon resection similar to that required for sigmoid diverticulitis.

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An exceptional cause of obstructive jaundice is reported in the present case. A 51-year-old woman progressively developed jaundice with pruritus, and abdominal ultrasonography revealed dilated intra- and extrahepatic bile ducts. Endoscopic retrograde cholangiography and endoscopic ultrasonography showed a tumor in the distal common bile duct, but failed to determine the nature of the lesion, and the patient underwent a pancreaticoduodenectomy. The final diagnosis was an inflammatory pseudotumor of the common bile duct. Inflammatory pseudotumors are uncommon, without evident pathogenesis, and are described in many organs. The localization in the common bile duct is exceptional. The prognosis is good, and a more conservative approach is possible if the diagnosis is certain before surgery.

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The long-term follow-up of 80 heart transplant patients (70 men, 10 women) from January 1982 to July 1985 who had received cyclosporine (CsA) showed a high incidence of mild to severe liver dysfunction. Fifty patients (62.5%) had long-lasting postoperative biological disturbances (alanine amino transferase greater than 2N and/or alkaline phosphatase greater than 1.5N for 3 months or more). Most patients were asymptomatic; eight were icteric, and one had arthralgia. The most common biological feature consisted of isolated elevation of ALAT (27 cases). Assessment of causes led to a definite etiology in 42 patients: 7 cardiac failure, 13 HBsAg-positive liver disease (26%) (chronic persistent hepatitis 8, chronic active hepatitis 2, subacute necrosis 2). Fourteen patients (28%) sustained non-A, non-B (NANB) hepatitis (chronic persistent hepatitis 5, chronic active hepatitis 1, cirrhosis 1), and 7 (14%) sustained a drug-related hepatitis. Liver biopsy and complete virus screening was contributive to the diagnosis in nearly all patients. Additionally, prolonged impairment of liver function tests occurred in 62% of heart transplant recipients, mostly during the first 6 postoperative months. Hepatitis B virus (HBV) and NANB hepatitis accounted for 26% and 28% of the cases of liver dysfunction, respectively; drug-induced hepatitis may have been involved in 14% of the cases. Complete hepatitis virus screening should be performed before heart transplant and in any case of abnormal liver function posttransplantation. HBV vaccination prior to heart transplant is recommended in HBsAg- and HBcAb-negative candidates for heart replacement. Long-term follow-up of these patients is mandatory to assess the severity of these liver dysfunctions.

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Delta coinfection or superinfection in a patient with chronic hepatitis B is characterized by a very transient delta antigenemia and an early seroconversion of IgM to IgG anti-delta. The persistent expression of delta antigen in the liver can be associated with acute, severe, or chronic hepatitis. In our two patients, delta antigenemia persisted respectively 10 weeks and 14 months with aggravation of liver histopathologic lesions without seroconversion. Such a serologic profile during delta infection does not seem to have been reported previously. These two cases concerned two patients with an important immunosuppression, one by a major immunosuppressive therapy and HIV superinfection, the other by an acquired immunodeficiency syndrome. The cytotoxic effect of delta virus in such circumstances is discussed.

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The monomorphic basal cell adenoma of parotid gland is a rare tumor of salivary glands. Its diagnosis is difficult with adenoid cystic carcinoma. In the case reported here, a peculiar type named membranous adenoma, the thickness of basement membranes, their penetration inside the epithelial lobules, form true cylinders as in adenoid cystic carcinoma. The histoenzymology and the electron microscopy provide important diagnostic arguments: activity of alkaline phosphatases lower than in cystic adenoid carcinoma; cells of adenoma more differentiated (epidermoid or secretory cells) than those of cystic adenoid carcinoma. The prognosis of the tumor is good, though recurrences may occur.

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A case of Basal cell adenoma occurring in a 42 year-old woman is reported. Histological examination showed trabeculae of basaloid cells with thick Basal Membrane at the periphery. By Electron Microscopy most of the cells displayed numerous desmosomes and intracytoplasmic tonofilaments indicating epidermoid differentiation. In addition some glandular cells were observed. No myoepithelial cell were present. Electron Microscopy may be useful to differentiate basal cell adenoma from Adenoid cystic carcinoma which is made up of a majority of poorly differentiated cells.

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1,000 endomyocardial biopsies performed in 110 patients treated by cardiac graft were reviewed. These biopsies permitted early detection of acute rejection after cyclosporin treatment and a good appreciation of its intensity. By this method, almost all rejection episodes were resolved after adequate treatment. Chronic rejection was diagnosed by arteriography used in vivo or in cardiac transplants removed by surgery or necropsy. Rejection provoked an obliterative fibrous endarteritis often complicated by atherosclerosis and its ischaemic consequences. 34 autopsies were performed in patients dead at a variable time after cardiac or cardio-pulmonary transplantation. In early death (14 cases), graft failure and systemic disorders were observed. Acute and chronic rejection was noted less frequently (9 cases). Systemic infections (10 cases) occurred either early (post-surgical complications) or late (bacterial, fungal and parasitic lesions). In one case, death was due to a contemporaneous bladder carcinoma. The complications of cyclosporin treatment are briefly discussed.

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A case of sialadenosis was studied by means of several morphological methods (light microscopy with micrometric measurement, transmission and scanning electron microscopy, immunopathology, histoenzymology). In that disease, these investigations seem to corroborate the hypothesis of a dyscrinism, true perturbation of the salivary excretion with storage of secretory granules in the cells and consecutive hypertrophy. This dyscrinism should result from a deterioration of branches of autonomic nervous system. In the case reported here, no etiology was proved but the hypothetic part of a recent antiulcerous treatment by Tagamet was suggested.

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