Biomedical subjects
Publications and source records attributed to A De Roover.
We report the case of a patient with a symptomatic retroperitoneal tumor. The patient had undergone, 15 years earlier, an orchiectomy and three cycles of chemotherapy for a testicular mixed germ cell tumor. Histology after radical surgical excision revealed a metastasis of mature teratoma. The 183 month interval between initial treatment and relapse is one of the longest ever reported.
Most of the echinococcosis cases treated in Belgium are contracted in African and Mediterranean countries. In this paper the authors describe the case of a Mediterranean patient suffering from a hepatic hydatid cyst treated by oral albendazole and laparoscopic liver resection.
Alveolar echinococcosis is a serious parasitic disease, leading to large hepatic lesions. It must be distinguished from cystic echinococcosis, or hydatic cyst, caused by Echinococcus granulosus. Early diagnosis may allow surgical removal of the lesions by segmental hepatectomy, the only curative treatment. Parasitostatic medical treatment with albendazole may promote stabilization of the disease. Until recently, Belgium was considered a country at very low risk for alveolar echinococcosis, as no human case was reported, despite up to 51% of fox infection in southern Belgium autopsy series. Recently four patients presented with alveolar echinococcosis at the University Hospital Center of Liege, leading to the fear of a possible alveolar echinococcosis endemy in southern Belgium. Two of these patients underwent curative hepatectomy, but the other two had already pulmonary metastases at diagnosis and received palliative albendazole therapy. This article presents these cases, and reviews the clinical features of this parasitic disease.
Living related liver transplantation (LRLT) in adult recipients has been recently developed to overcome the organ donor shortage, but LRLT leaves the healthy donors at risk of serious post-operative complications, or even death. The aim of this paper is to report the prospective evaluation of the initial experience of adult LRLT at the University of Liège. From March 2002 till March 2003, in a consecutive series of 35 adult liver transplantations, five recipients (mean age: 51 years) underwent LRLT, including one retransplantation. Indications for transplantation were autoimmune hepatitis, hepatitis B virus related cirrhosis with hepatocarcinoma (two cases), hepatitis C virus related cirrhosis with hepatocarcinoma, and ischemic intrahepatic bile duct necrosis 10 years after primary liver transplantation. Mean age of the donors was 34 years (range: 21-53 years). All donation cases were intra familial at first degree. The right lobe was used as a graft in four cases and the left lobe in one case. All right lobe donors developed transient hyperbilirubinemia and hypocoagulation for 4 to 6 days. No severe complication (transfusion, bile duct fistula, reintervention, rehospitalization) nor significant long-term sequelae were observed in the donors. In the recipients, graft function was immediate, and there was no small-for-size syndrome. One recipient developed biliary fistula treated by reoperation. One recipient died from invasive aspergillosis 11 days after the procedure. The four other recipients were alive without recurrence of the disease at follow-up. This report confirmed that LRLT may be a valuable alternative to cadaveric liver transplantation in the era of organ donor shortage. However, even if there was no severe complication for the donors in our preliminary experience, LRLT puts healthy living donors at risk of significant morbidity and even death.
The authors describe the case of a 17-year-old girl who suffered from end-stage liver failure due to chronic autoimmune hepatitis. Liver failure was complicated by severe portal hypertension, hypersplenism and refractory ascites. Liver transplantation was indicated. She was listed for cadaveric whole liver transplantation, but her infrequent blood group (B) increased waiting time. Her condition deteriorated to Child C liver failure and living related liver transplant was considered. Her father was compatible and proposed himself for donation. Right lobe procurement was decided in order to provide sufficient liver mass. No transfusion of red cells, platelets, or fresh frozen plasma was used either in the donor or the recipient. Both recipient and donor left the ward at postoperative day 14, without complication. They were both asymptomatic and with normal liver tests at one year follow-up. Living related liver transplantation using the right lobe may offer an alternative to liver transplant candidates in this period of organ donor shortage.
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Spontaneous rupture of the oesophagus, so called Boerhaave's syndrome, still remains a surgical emergency. Early diagnosis governs the appropriate repair and the vial prognosis.
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In noncolorectal, nonendocrine liver metastases, the role of surgery is less define than in colorectal or neuroendocrine cancer. This role is marginal as liver is not the primary site of metastases of these cancers. Less than 2 to 5% of the patients with these malignancies might be one day considered as potential candidates for liver resection, as most patients suffer from extra hepatic tumour spread at the time they develop liver involvement. However, in these few cases with liver metastases only, as no other therapeutic option may provide mid- or long-term tumour-free survival, liver resection is indicated in resectable liver metastases. Some prognostic factors have been established in the literature from the few published series: unique versus multiple hepatic metastases, unilobar vs bilobar, metachronous vs synchronous, R0 vs R1 or R2 liver resections. The type of primary tumour is also of great importance, as cutaneous melanoma, pancreatic and gastric adenocarcinoma have a very bad prognosis for liver resection of metastases, even after R0 resection. In these cases, percutaneous or laparoscopic radiofrequency ablation may find its place. In sarcoma, breast carcinoma, uveal melanoma, and genitourinary cancers, liver resection may provide satisfactory long-term results in selected cases, and is the standard of care for isolated, resectable metastasis. However, due to the scarcity of indication of liver resection for noncolorectal, nonneuroendocrine metastases, the decision should be multidisciplinary, and the patients should be informed of the advantages and pitfalls of the surgical procedure.
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Pancreatic injury after trauma can occur in the child as an isolated lesion after a minor injury. The consequences can be severe in the absence of prompt diagnosis and treatment. Determination of mechanism of injury, clinical examination, blood amylase levels and abdominal CT-scan are first line steps for the evaluation of the injury. ERCP and MRI can be useful tools to further document injury to the pancreatic duct. In the absence of duct injury, conservative treatment can be applied. For the other cases, the treatment is surgical although newer techniques may be applied in selected cases.
Important progress has been made in the treatment of liver metastases of advanced colorectal cancer. Surgery with curative intent, when possible, shows evidence of prolonged survival. Response rate and overall survival can be improved with modern polychemotherapy. Cytotoxic drug combinations and sequential treatments sometimes make surgery possible for initially non resectable lesions. Impact of loco-regional treatment such as hepatic arterial infusion chemotherapy must be defined in randomised trials. Radiofrequency ablation is also currently evaluated in clinical trials. In this review the benefit of each treatment is discussed.
Pancreas transplantation significantly improves the quality of life as well as the survival of the diabetic patient. It is also associated with stabilization and reversal of secondary diabetic complications. Improvements in organ preservation, surgical techniques and immunosuppression have achieved one-year graft survival of more than 90% for combined kidney-pancreas transplant and 80% for isolated pancreas transplantation. Recipient evaluation must weigh the benefits of the procedure with the risk associated with surgery and chronic immunosuppression. Combined kidney-pancreas transplantation appears today as the best treatment for the diabetic patient with end stage renal disease. Isolated pancreas transplantation is reserved to non-uremic patients with severe diabetic complications or with brittle glycaemic control and severe impairment of quality of life.
Alpha-1-antitrypsin deficiency is the most common inborn error of metabolism leading to liver transplantation, and the second cause of liver transplantation in children after biliary atresia. The authors report the case of a 6-year-old girl, who was suffering from end-stage liver disease secondary to alpha-1-antitrypsin deficiency. She was successfully treated by whole liver transplantation, the hepatic graft coming from a 3-year-old donor. Three months later she went back to school. The authors discuss the pathogenesis and the natural history of this frequent cause of liver transplantation in children.
Transplanting a kidney graft harvested from a live donor has been proposed and used to shorten the waiting time of kidney transplant candidates and to increase the graft pool. Live donor renal transplants have demonstrated better results in term of graft survival rates, compared to renal transplants harvested from brain dead donor. Recently, laparoscopic live donor nephrectomy has been introduced to reduce the live procurement morbidity. This lower morbidity may result in increased acceptance of the donor operation. We initiated a program of laparoscopic live donor nephrectomy in January 1997 and up until June 1998, three cases were successfully performed in our department. The purpose of this paper was to report the first case of this program and its first year of follow-up.