Auxiliary heterotopic liver graft using splenopancreatic venous blood flow in pig.

An original model of auxiliary heterotopic liver graft perfused by splenopancreatic venous blood flow is studied in pig. Separate portal inflow is performed for each liver and permits efficient function in both graft and native liver. Ten pigs were evaluated 90 days after transplantation, five without portal graft reperfusion (group 1) and five with portal graft reperfusion by splenopancreatic venous blood flow (group 2). Mean biliary output was 4.8 +/- 3.3 ml/hr in group 1, 9.6 +/- 2.3 ml/hr in group 2; biliary conjugated bilirubin level was 0 in group 1, 145 +/- 117 mumol/liter in group 2; intrahepatic glycogen level was 0.9 +/- 1.1 g% in group 1, 4.25 +/- 1.56 g% in group 2. Livers and grafts were weighed to evaluate hepatic mass on the 90th day. A histological examination was performed for each graft and native liver. It was shown that an auxiliary liver graft perfused by splenopancreatic venous blood flow presents satisfying metabolic function for 3 months, without atrophying and without functional impairment of native liver. This original model could be indicated in acute hepatic failure if regeneration of native liver is expected or in metabolic disease when total hepatectomy of the native liver may be unnecessary.

Improvement of gingival and alveolar bone status in periodontitis-affected hamsters treated with 15-methyl prostaglandin E1.

Exogenous PGE1 at pharmacological doses suppresses acute and chronic inflammation manifestations. As periodontitis possesses features of both acute and chronic inflammation, attenuation of periodontal destruction in hamsters was attempted by using 15-M-PGE1, a stable PGE1 analog. The agent was tested at 2 different doses (100 and 150 micrograms/kg/d) and its effects were matched against disease-free and periodontitis-affected animals. No effect was found with the 100 micrograms regimen. In contrast, in the 150 micrograms group, in the gingiva around the first right mandibular molar the pocket epithelium and infiltrated connective tissue (ICT) areas, the mean vascular lumen, the number of PMNLs adherent to blood vessels and infiltrating the ICT were significantly reduced. The number of osteoclasts was markedly diminished as well, but their intrinsic activity was enhanced. Bone formation was totally inhibited in this treatment group. These results indicated that 15-M-PGE1 effectively improved gingival inflammation mostly by reducing edema and PMNL recruitment and controlled alveolar bone destruction by reducing the osteoclast recruitment. From a therapeutic point of view the complete inhibition of formation seems to contraindicate its use.

[Heterotopic experimental liver transplantation with portal revascularization of the graft on the distal splenic vein of the recipient]. / Transplantation expérimentale hétérotopique du foie avec portalisation du greffon sur la terminaison de la veine splénique du receveur.

A model of heterotopic liver transplantation had been studied. The graft was laid under the recipient liver and the portal blood flow was supplied by anastomosis with the distal part of the splenic vein. Both liver can then receive portal blood through two parallel portal circulation. Liver function of transplant was satisfactory at three months after transplantation. Their had been no alteration of the recipient liver during the same period.

[Hepatic epithelioid hemangioendothelioma. A case with liver transplantation. Review of the literature]. / Hémangioendothéliome épithélioïde hépatique. Un cas avec transplantation hépatique. Revue de la littérature.

Epithelioid hemangioendothelioma (HEE) is an unusual malignant neoplasm of vasculo-endothelial origin, arising in soft tissues, lung and liver. One case of hepatic HEE is reported in a 32 year-old man wit an isolated multinodular hepatomegaly. The diagnosis was made by the histologic examination of biopsy specimens. At the time of diagnosis, there was evidence of pulmonary metastasis. However, an orthotopic liver transplantation was performed. The tumor cells were immunoreactive with factor VIII-related antigen, BNH9 and vimentin. There was no expression of cytokeratin and epithelial membrane antigen. The patient is alive and well 24 months after. The thoracic X-ray are unchanged. This case is compared with the 84 others cases of the literature. Fourteen experienced a favorable outcome after transplantation. Extra-hepatic dissemination doesn't contra-indicate the graft. But hilar vascular involvement may be correlated with worse prognosis.

[Experimental heterotopic transplantation of the liver with anastomosis of the portal vein to the distal end of the splenic vein]. / Transplantation expérimentale hétérotopique du foie avec portalisation du greffon sur la terminaison de la veine splénique du receveur.

A model of heterotopic liver transplantation had been studied. The graft was laid under the recipient liver and the portal blood flow was supplied by anastomosis with the distal part of the splenic vein. Both liver can then receive portal blood through two parallel portal circulation. Liver function of transplant was satisfactory at three months after transplantation. Their had been no alteration of the recipient liver during the same period.

[Orthotopic liver transplantation for severe amanita phalloides poisoning]. / Transplantation orthotopique du foie pour intoxication grave par amanite phalloïde.

Forty-eight hours after a women was poisoned by ingesting Amanita phalloides mushrooms, she developed fulminant hepatic failure with collapse, pH 7.24, lactic acidosis 7.6 mmol/l, hypoglycaemia 3.5 mmol/l, anuria and stage IV coma requiring tracheal intubation and mechanical ventilation. Transaminase level was up to 8,000 UI/l. Prothrombin and factor V levels were below 10 percent, with an APT time of 86 s versus a 29 s control time. Twenty-four hours after her admission, the patient underwent orthotopic liver transplantation. The postoperative period was uneventful, with return to consciousness and rapid normalization of hepatic biochemistry values, without signs of acute rejection. This 10th published case of orthotopic liver transplantation for Amanita phalloides poisoning with acute hepatic necrosis confirms that this type of treatment must be systematically envisaged in all such cases.

[Surgical treatment of peptic stenosis of the esophagus]. / Traitement chirurgical des sténoses peptiques de l'oesophage.

36 patients with peptic strictures were operated between 1981 and 1987. 40 operations performed because 4 recurrences after a first intervention obliged to a re-operation. The conservative procedure was used in 29 cases (72.5%). A resection had to be done in 11 cases (27.5%), with 3 re-operations after a first conservative treatment. 1 patient died in hospital. The follow up concerns all patient after a minimum of 2 years. 31 patients (88%) remained symptom free, but 4 patients required further surgery. No mortality and a low morbidity with conservative surgical method were observed. The rate of success was 76% with 24% of recurrence. For us, the best conservative method is total fundoplicatio if possible (sometimes on a gastric cone in case of reflux stricture with shortening of the esophagus). The duodenal diversion is recommended if approach of hiatus is too difficult (re-operation) and in case of alkaline reflux.

[Excision of cancer of the upper thoracic esophagus by initial right thoracotomy]. / Résection des cancers de l'oesophage thoracique supérieur par thoracotomie droite première.

The authors present their experience with right thoracic first approach in resection of upper thoracic esophageal carcinoma followed by gastro-esophageal anastomosis. This technique has got many advantages: any degree of tumoral extension can be managed by an adapted strategy for the situation; and the technique is particularly suitable for resection of upper thoracic esophageal lesions which usually present many hazard for their removal. Thirty three patients have been operated according to this technique. A satisfactory rate of complete resection was obtained. Mortality rate one month after the operation was of 6%, an although the extensive character of the lesions encountered in this survey of patients, long-life survival rate was satisfactory and seems that it could be ameliorated by the application of a preoperative radio-chemotherapy protocol.

[Fulminant and subfulminant hepatitis treated by orthotopic transplantation of the liver. Apropos of 10 cases]. / Hépatites fulminantes et sub-fulminantes traitées par transplantation orthotopique du foie. A propos de dix cas.

In the period between 15/12/1987 and 15/08/1989, ten patients with either fulminating or subfulminating hepatitis have been treated by orthotopic liver transplantation (O.L.T.). Six patients are doing well in the post-operative period with a mean follow-up of 12 months (7-23 months). No evidence of neurological sequelae has been observed and recurrence of HB virus infection was absent from the three cases who survived hepatitis B transplantation. Four out these ten patients died after initial successful O.L.T... One patient succumbed 7 days after O.L.T. from sepsis or early super-acute rejection, the second 21 days after O.L.T. from neuromeningeal listeria, the third 43 days post O.L.T. from acute rejection, while the fourth developed cytomegalovirus pneumonia and died 61 days after O.L.T. Orthotopic liver transplantation has become the treatment of fulminating hepatitis. It is an emergency which is usually accompanied by successive difficulties in decision making: indication criteria, then acceptance or refusal of ABO incompatible grafts (5/10) and of suboptimal donors. Orthotopic liver transplantation for fulminating hepatitis is technically easy to perform, but usually requires the use of extra-corporal veno-venous circulation. Accompanying intensive medical care is essential and usually includes one or multiple plasmaphereses to correct existing coagulopathy without any fluid or sodium overload to the circulation.

[Surgical treatment of chronic pancreatitis. Indications and results. An experience of 246 cases]. / Traitement chirurgical de la pancréatite chronique. Indications et résultats--Expérience de 246 cas.

Between 1972 and 1986, 246 patients, mainly alcoholic, with a mean age of 44 years, underwent a total of 270 laparotomies. Parenchymal resections were carried out in 99 patients and drainage and diversion procedures were carried out in 159. Pain was the principal symptom and led to surgery in 60% of cases; biliary or duodenal obstruction was present in 40 and 23.5% of cases respectively. Operative mortality was 9% for resections and 5.8% for other forms of surgery. In the long term, the best results were obtained in patients in whom a Whipple procedure was performed.

[Excisional surgery of hepatic metastases of colorectal adenocarcinoma]. / Chirurgie d'exérèse des métastases hépatiques des adénocarcinomes colorectaux.

Between 1981 and 1985, 39 patients had hepatic resection for colorectal cancer liver metastases 44 operations (5 iteratives resections) were performed with 33 major hepatectomy. There was no mortality. Long term results showed: a one year 53% survival, a two years 23% survival, a three years 11% survival. 28 patients had recurrences; 15 of these 28 had hepatic recurrences. According to recent literature the high level of hepatic recurrence suggest that surgical resection should be accompanied with regional chemotherapy.