[Liver transplantation with a graft taken from a heart transplant patient who was brain-dead]. / Transplantation hépatique avec un greffon prélevé chez un greffé cardiaque en état de mort cérébrale.

The shortage of organ donors has led to progressive softening of selection criteria for organ donation. We report on hepatic transplantation in a 55-year-old woman with primary biliary cirrhosis, whose donor was a 50-year-old heart transplant recipient who became brain stem dead, due to cerebral bleeding 8 months after transplantation. An orthotopic liver transplantation was performed. The postoperative course was uneventful and the recipient was alive and had normal liver function after a 42-month follow-up. Analysis of the literature included ethical consideration, potential hepatotoxic effects of immunosuppressive drugs and modification of the graft immunogenicity. It confirms that transplanted patients should not be a priori excluded from organ donation.

[Surgical treatment of acute cholecystitis. A retrospective study of a series of 192 patients operated on over a period of 3 years]. / Traitement chirurgical de la cholécystite aiguë. Etude rétrospective portant sur une série de 192 patients opérés en 3 ans.

Emergency conditions make laparoscopic treatment of acute cholecystitis challenging. The aim of this study is to retrospectively analyse our experience of cholecystectomy for acute cholecystitis performed between January 1995 and December 1997. In order to be included, patients had to present (i) symptoms of acute cholecystitis correlated with laboratory blood tests and ultrasonographic studies (ii) evidence of acute inflammation during the operation and (iii) histological confirmation of acute or subacute inflammation of the excised gallbladder. 192 patients were treated: 62 were totally managed laparoscopically (group CCN), 33 managed laparoscopically but required conversion to open cholecystectomy (group CCC) and 97 were managed conventionally by laparotomy (group CL). Mean age was significantly different between the three groups, (CCN: 55.6 +/- 15 years, CCC: 64.2 +/- 13 years, CL: 66.5 +/- 17 years), as was ASA score (CCN: ASA 3 and ASA 4: 16%, CCC: ASA 3 and ASA 4: 48%, CL: ASA 3 and ASA 4: 46%), and initial infectious signs (temp. > or = 38 degrees C: CCN: 35%, CCC: 39%, CL: 63%). Mean operative delay was significantly higher in the converted group [8.7 +/- 13 days (CCC) vs 4.5 +/- 8 days (CCN) and 5.4 +/- 8 days (CL)]. There were two (1%) bile duct injuries, one in the CCC group, the other in the CL group. Operative mortality was 2% (CCC: 0%, CCN: 0%, CL: 4%) and operative morbidity was 40% (CCN: 21%, CCC: 24%, CL: 57%). The mean postoperative hospital stay was shorter in the CCN group (6.5 +/- 3.5 days) and CCC group (9.6 +/- 4.4 days) vs the mean stay in the CL group (14.7 +/- 11.6 days). Appears to be beneficial for selected patients with low surgical risk to conclude laparoscopic cholecystectomy. It has yet to be shown whether this benefit can be extended to patients with a high surgical risk.

[Acute renal insufficiency following endourethral surgery with glycine irrigation]. / Insuffisance rénale aiguë au décours de la chirurgie endo-uréthrale sous irrigation de glycocolle.

The authors analyse a case of acute renal failure in an old patient after a TUR of the prostate. The involved mechanism seems to be a toxicity of the glycine solution. In case of severe "TUR syndrome" with important resorption of glycine, the glycine could be catabolysed in oxalate, creating an hyperoxalemia and hyperoxaluria. The high blood level of oxalates can be responsible of acute renal failure and anuria. The treatment is simple: hemodialysis is able to eliminate quickly (in one session) the oxalates from the renal tubules and to restore the renal function. Prospective studies will give us an idea of the propitious conditions for this pathology and for the prevention.

24-hour extracorporeal membrane oxygenation in the hypoxic dog: hemodynamics and pulmonary gas exchange.

Hemodynamic and pulmonary gas exchange values were investigated during 24-hour extracorporeal membrane oxygenation performed on 7 anesthetized dogs subjected to alveolar hypoxia. The chief effects of extracorporeal membrane oxygenation were demonstrated. The duration of the extracorporeal membrane oxygenation was associated with a progressive decline in the systemic arterial pressure and heart rate and a progressive increase in the pulmonary blood flow rate. Left-ventricular stroke work remained constant. The sum of the pulmonary and extracorporeal oxygen uptakes showed no change in spite of large variations in pulmonary flow rate.