C4d: a marker for hepatic transplant rejection.

BACKGROUND: Acute rejection is still a common complication of hepatic transplantation. The diagnosis, based on the histological examination of the graft, may be difficult to confirm in the setting of combined hepatitis C virus infection. The presence of C4d in the portal capillaries could facilitate differentiation between acute rejection and relapsed hepatitis C. The deposit of C4d provides evidence of activation of humoral immunity. To attempt to confirm this hypothesis, we searched for the presence of C4d in posttransplant hepatic biopsies. METHODS: Thirty-six biopsies from 34 patients were analyzed retrospectively. The samples had been requested for one of the following reasons: suspected rejection, relapsed hepatitis C infection, or systematic check-up 1 year after the transplant. RESULTS: C4d expression was common in biopsies classified as acute rejection (33%) and chronic rejection (100%). C4d was never detected in the event of recurrent hepatitis C infection without rejection. CONCLUSION: These results, which are comparable to recently published data, give credence to the theory that C4d could be used as a marker for rejection following hepatic transplantation.

[Technical aspects of combined heart, liver and kidney procurement]. / Technique du prélèvement "multiorganes": coeur-foie-reins.

The goal of multiple organ procurement is to retrieve intact organs fully. This goal can only be reached if the organ dissection and preservation are optimal.

[Two tapes to control the main fissure of the liver]. / Deux lacs pour contrôler la scissure porte principale.

Herein we report a technique that allows a rapid and selective clamping of the left and right glissonian sheats and that secures the opening of the main fissure. The posterior face of segment IV capsula is opened immediately above the hilum on the left side of the gallbladder fossa. The tip of a right angled dissector is gently pushed in the liver substance from front to back while maintained against the hilar plate, until it arises in the caudate process just below the pedicle. A tape is used to encircle the Glisson sheath. Its inferior extremity can be picked up either on the right or the left side of the liver pedicle in order to clamp the right or the left portal pedicle, respectively. Both clamping precisely mark the anterior limit of the main fissure. Using a Kelly forceps, a second tape is introduced in the Couinaud space, between the inferior vena cava and segment one. The inferior extremity of this tape is then picked up above the Glisson sheat and allows to hang the posterior limit of the main fissure which can be securely approached. The two tapes technique cannot be applied when liver is fibrotic or when biliary ducts are dilated.

[Isolated popliteal arteries: results of surgical treatment and causes of failure]. / Artères poplitées suspendues: résultats du traitement chirurgical et causes des échecs.

UNLABELLED: Isolated popliteal artery is defined as an obstruction of a superficial femoral artery with a patent popliteal segment followed by an obstructed distal popliteal artery or a patent leg artery less than 5 cm long. PURPOSE: The aim of this retrospective study was to report the results of surgical treatment and the causes of failures. PATIENTS AND METHODS: From 1988 to 1996, 31 patients with isolated popliteal artery were operated on with femoropopliteal bypass. The age of the patients ranged from 45 to 92 years, (mean: 79 years); all had critical ischemia that threatened limb viability. All underwent preoperative arteriography and diagnosis was confirmed by intraoperative arteriography. RESULTS: In the postoperative course, there were 22 patent bypasses (68%) with minor amputation in five patients, and nine thromboses that required a major amputation in seven patients, a trans-metatarsal amputation in one, and a medical treatment in one. With a mean 37-month follow-up, seven thromboses required a major amputation in five patients, a new bypass in one and a medical treatment in one. The death rate was 34% at two years. The actuarial patency rates of the bypasses were 51% at one year, 38% at two years and 25% at five years. The limb salvage rate was identical. The patency rates were 65% at one, two and five years for venous bypasses and 38%, 13% and 0% respectively for PTFE bypasses. Statistical analysis showed two causes of failure: the absence of a run-off branch and the use of PTFE prostheses. No other statistically significant cause of failure was demonstrated among those analysed. Favourable anatomic conditions for a bypass to a leg artery were not predictive of failure of a femoro-popliteal bypass on the isolated arterial segment. CONCLUSION: Bypass to isolated popliteal artery is indicated in patients whose limb viability is jeopardized. Results may be considered as satisfactory especially if there is a run-off branch and if a venous graft is available for the bypass.

[Incisional hernia of the abdominal wall. Pathophysiology, etiology and prosthetic repair techniques]. / Eventrations de la paroi abdominale. Physiopathologie, étiologies et techniques de cure avec prothèse pariétale.

Postoperative incisional hernia is defined by 3 essential criteria, based on a perfect clinico-pathological knowledge of the abdominal wall: the site, dimensions, and defect. Two main elements predispose to incisional hernia: infection and mechanical factors. Local and systemic complications, accentuated in large incisional hernias, are respectively defined by two concepts: "incisional hernia lesion" and "incisional hernia disease". Precise assessment of these elements can guide the surgeon's operative strategy. Incisional hernias remain a relatively frequent complication of abdominal surgery. All of these patients generally require surgical repair of the abdominal wall. A French national survey showed that most surgeons now use prosthetic materials in 60% of primary repairs, and in 85% of recurrent cases. After reviewing the biomechanical characteristics and the in vivo behaviour of commercially available prostheses, the technical principles of prosthetic abdominal wall surgery will be considered together with the various implantation sites: retromuscular, intraperitoneal and premuscular. Based on their personal experience of 110 cases of large incisional hernias, treated between 1989 and 1998, the authors recommend the intraperitoneal position using expanded polytetrafluoroethylene, a reliable material which is well tolerated in contact with the viscera.