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Biomedical subjects

B Launois

Publications and source records attributed to B Launois.

At least 55 records · Page 3Linked to original sources
PubMed1995

Intrahepatic anastomoses for malignant and benign biliary obstruction.

OBJECTIVE: To assess the role, techniques, and outcome of intrahepatic biliary anastomoses in patients undergoing resective or palliative surgery at the hepatic hilum. DESIGN: A retrospective review over a 23-year period of all patients undergoing intrahepatic bilioenteric anastomoses. SETTING: A major university teaching hospital in France. PATIENTS AND INTERVENTIONS: Over a 23-year period, 59 patients (19 with palliative, 35 with curative, and five with benign disease) underwent intrahepatic bilioenteric anastomoses. MEASUREMENTS AND RESULTS: There was a hospital mortality of six for the palliative group and four for the curative group. A significant fall in both the serum bilirubin and alkaline phosphate levels occurred after surgery (P < .5). Long-term follow-up was possible in 44 patients. Recurrent stenosis due to recurrent disease occurred in 100% of the palliative group and 69% of the curative group. There were two stenoses in four patients with benign disease. Recurrent cholangitis developed in 37 patients, five without apparent stenosis. The median survival for the palliative group was 6 months (range, 2 days to 13 months) and for the curative group, 21.7 months (range, 0.5 to 148 months); all the benign group remain alive. CONCLUSIONS: Despite the advent of modern endoscopic and percutaneous intubation techniques, intrahepatic anastomoses after tumor resection offer the only chance of cure for obstructing hilar malignant disease.

Adolescent↗
PubMed1995

Primary anastomosis with transverse colostomy as an alternative to Hartmann's procedure.

Hartmann's procedure remains the favoured option in patients with acute left colonic and sigmoid disease, despite the well documented morbidity and mortality associated with reversal. In 40 patients with left colonic pathology, primary anastomosis was performed; 32 had a covering transverse colostomy. There were six hospital deaths, five in the transverse colostomy group. Closure was not attempted in seven of the 27 patients surviving with a colostomy (three refused, four had disseminated malignancy). In the 20 undergoing closure, there was no morbidity or mortality. With advances in intensive care, antibiotic therapy and anaesthesia, it is reasonable to consider alternatives to Hartmann's procedure, particularly when subsequent reconstruction is envisaged.

Adult↗
PubMed1995

Malignant lymphoma of mucosa associated lymphoid tissue: a new etiology of amyloidosis.

Non Hodgkin Malignant lymphomas (NHML) of mucosa associated lymphoid tissue (MALT) are known to have multiple involvement of the digestive tract. We report one case, presenting with an infiltrative process of the jejuno-ileum, associating lymphoplasmacytoid proliferating cells and amyloidosis. The plasmacytoid cells expressed Alpha and scarce Mu heavy chains, and lambda light chain. Lympho-epithelial lesions were more obvious at the second site of involvement, in the gastric mucosa. The amyloid substance was negative with the Amyloid A component antibody and gave a background noise with Alpha, Mu and lambda chains. No similar report of amyloidosis associated with MALT NHML has been found in the literature.

Amyloid↗
PubMed1995

Venous allografts: a useful alternative to venous autografts in digestive surgery.

Over a 16 month period seven patients underwent surgery using venous allografts either to reconstruct the portal vein, or to construct a mesocaval 'H' graft or a shunt between the coronary vein and the subhepatic inferior vena cava. The allografts were harvested during multiorgan procurement from the bifurcation of the inferior vena cava, the common iliac vein and the external iliac vein and kept in a preservation solution at 4 degrees C for a mean time of 6 days (range 1-29) before use. Subsequent thrombosis was clinically evident in only two patients. The use of venous allografts appears to be a useful alternative to other venous replacements.

Adolescent↗
PubMed1995

Combined radiochemotherapy for postoperative recurrence of oesophageal cancer.

Postoperative recurrences are common after resection for oesophageal cancer. From January 1986 to September 1993 31 patients (30 males, one female, mean (SD) age: 57.5 (8.8) years) were treated for locoregional recurrence (n = 24), metastases (n = 6) or both (n = 1) occurring 15.0 (12.6) months after initial surgery. Radiotherapy and chemotherapy were combined in all cases. Symptomatic improvement was seen in 23 cases (74%) and lasted (excluding treatment period) for 6.3 (4) months. Objective tumoral response was seen in 20 patients (65%) including eight (26%) complete responses. Survival rates were at respectively six months, one, two, and three years: 70.7%, 47.1%, 17.1%, 4.3%. In conclusion, these results show that combined therapy could have a beneficial symptomatic effect and can be associated with prolonged survival in patients with postoperative recurrences of oesophageal cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Increased liver iron stores in patients with hepatocellular carcinoma developed on a noncirrhotic liver.

Iron was systematically studied in the nontumorous liver of 24 patients with hepatocellular carcinoma (HCC) developed on a noncirrhotic liver compared with 4 control groups (cirrhosis with and without HCC, liver metastasis, and normal liver) matched according to age, sex, and presence of chronic alcoholism. Assessment of liver iron was made by (1) histology according to iron distribution and quantification (total iron score: 0 to 60), and (2) biochemistry (liver iron concentration-N < 36 mumol/g) with calculation of the hepatic iron index (liver iron concentration/age). Patients with hepatocellular carcinoma developed on a noncirrhotic liver presented with (1) histological iron in 83%; (2) parenchymal iron excess significantly more frequent (90%) than in controls; (3) total iron score (15 +/- 12) and liver iron concentration (81 +/- 96) significantly greater than in controls; and (4) hepatic iron index significantly increased (1.4 +/- 1.5) when compared with control groups, except for the hepatocellular carcinoma complicating cirrhosis group (0.9 +/- 1.1). This study (1) shows a mild but unquestionable parenchymal iron excess in the nontumorous liver of most patients presenting with hepatocellular carcinoma developed on a noncirrhotic liver and, at a lesser extent, on cirrhosis, (2) should incite others to study the putative role of iron in the development of liver cancer both in patients with cirrhosis and those without it, whatever the cause of the underlying liver disease, and (3) add argument to take into account and to treat any liver iron excess, even when mild.

Adolescent↗
PubMed1995

[Adenocarcinoma of Brunner's glands: an entity exceptionally described. Report of a case].

The authors report two cases of adenocarcinoma arising from Brünner's glands. The diagnosis was made on histological, histochemical and lectin-histochemical grounds. Brünner's glands carcinoma cells were alike and located very close to normal Brünner's glands. Brünner's glands carcinoma cells contained neutral glycoproteins and were positive for Concanavalin A.

Adenocarcinoma↗
PubMed1995

[Salvage portacaval shunts after failure of intrahepatic shunt].

Creation of an intrahepatic shunt using a metallic prosthesis introduced via a transjugular approach constitutes an alternative to surgery in the treatment of portal hypertension. Although rare, the specific complications of this technique justify close collaboration between radiologists and surgeons. The authors report two serious complications after failure of intrahepatic shunt, requiring emergency laparotomy.

Esophageal and Gastric Varices↗
PubMed1995

Hemangiopericytoma of the pancreas: report of a case and review of the literature.

Hemangiopericytoma is an uncommon vascular tumor with variable malignant potential. The origin, structure and function of pericytes remains controversial. Intra-abdominal hemangiopericytomas are highly aggressive soft tissue tumors with a great propensity for malignant transformation. We report on a case of hemangiopericytoma of the pancreas in a 53-year-old female presenting with abdominal pain. Ultrasonography and CT scan revealed a cystic tumor of the head of the pancreas. The patient underwent successful pancreaticoduodenal resection and is alive with no signs of recurrence 25 months following surgery. Ultrastructural studies are necessary to differentiate hemangiopericytomas from other sarcomas. Malignancy may be ascertained only in the presence of metastases or local recurrence. Routine surveillance is advocated.

Female↗
PubMed1995

[Surgical treatment of hepatocarcinoma in cirrhosis].

In 1986, our institution published the first results of surgical resection of hepatocarcinoma in cirrhotic patients. The aim of this paper is to present long term results of this surgical management. From April 1978 to February 1992, 74 patients were operated on at the surgical clinic of University Medical Center of Rennes (35000) France. There were 60 hepatectomies and 14 transplantations. The mean age was 60.2 years +/- 9 years and the sex ratio: 70 males and 4 females. The etiology was alcoholic in 43 patients (58%), post hepatitis (B and C) in 22 patients (30%) and due to hemochromatosis in 9 patients (12%). According to the Child Pugh classification, 48 patients were Child A, 11 Child B and one Child C in the hepatectomy group and 9 patients Child A and 5 Child B in transplantation group. The operative mortality was 10% in hepatectomy group and 35.7% in liver transplantation group. Overall survival was 61.8% at 1 year, 47.1% at 2 years, 38.2% at 3 years and 20% at 5 years. 5 year survival is 21.4% after transplantation and 18.5% after resection. This difference is not significant. In conclusion, according to 5 years survival and to operative mortality the treatment of choice is hepatectomy in HCC in cirrhotic patients. However the best treatment is the prevention of cirrhosis.

Aged↗
PubMed1995

Surgical salvage after failed transjugular intrahepatic portosystemic shunting.

The creation of an intrahepatic portosystemic shunt using an expandable stent introduced by a transjugular route constitutes an alternative to surgical shunts for the management of portal hypertension. A 61-year-old woman with Child C cryptogenic cirrhosis and acute variceal bleeding presented a massive haemoperitoneum due to a tear at the portal vein confluence during a failed attempt at TIPS. Surgical salvage consisting in an end-to-side portocaval shunt was performed under adverse conditions because of massive haemorrhagic infiltration of the hepatic pedicle. The patient died shortly after surgery of irreversible shock. A 61-year-old male with Child C alcoholic liver disease underwent an urgent TIPS procedure for recurrent variceal bleeding. However, the stent was placed too distally, at the splenomesenteric junction, causing splenic and portal vein thrombosis. After surgical removal of the impacted stent and thrombectomy, an end-to-side portocaval shunt was performed. The patient died 1 month later of infected ascites. Although serious procedural complications are uncommon in expert hands, transjugular intrahepatic portosystemic shunting is an invasive technique that is associated with potentially fatal complications.

Esophageal and Gastric Varices↗
PubMed1994

Evaluation of efficacy of liver transplantation in alcoholic cirrhosis by a case-control study and simulated controls.

To assess the efficacy of liver transplantation in patients with alcoholic cirrhosis, we compared 2-year survival of 169 liver transplantation patients in 12 French centres with survival of two control groups treated conservatively. The matched group was 169 patients of similar age, cirrhosis severity, and bleeding history; the simulated group was 169 patients whose theoretical survival was determined in a cohort of 797 patients with alcoholic cirrhosis. The probability of survival to 2 years in transplanted patients was 73 (95% confidence interval 67-79%) versus 67% (59-75) in the matched and 67% (63-71) in simulated controls. When prognostic factors were taken into account, transplantation was associated with survival (r = 0.527; p = 0.069). Patients with severe liver disease (high-risk group) benefited most for 2-year survival: 64% (42-86) vs 41% (23-59) in the matched and 23% (19-27) in the simulated control groups (p < 0.01). There was no difference for patients at low and at medium risk. Liver transplantation increases the 2-year survival of patients with severe alcoholic cirrhosis. In patients with less severe disease, further studies should be done by non-randomised controlled studies with longer follow-up or by randomised trials.

Adult↗
PubMed1994

A randomized study of chemotherapy, radiation therapy, and surgery versus surgery for localized squamous cell carcinoma of the esophagus.

BACKGROUND: Despite well-established surgical approaches, the prognosis for patients with squamous cell carcinoma of the esophagus remains dismal. To assess the benefit of adjuvant chemotherapy and radiation therapy (CRT), a randomized trial with and without sequential preoperative CRT was undertaken; CRT combined 20 Gy and two courses of 5-FU and cisplatin. METHODS: Patients were included on the basis of the following criteria: squamous cell carcinoma of the esophagus, younger than 70 years of age, World Health Organization status below 2, estimated survival time greater than 3 months, and no previous treatment for the cancer. Patients were not included if they had experienced a loss in body weight greater than 15% or had tracheoesophageal fistula, metastases, or uncontrollable infection. RESULTS: Eighty-six patients thus fulfilled the criteria for inclusion (41 CRT, 45 non-CRT). The groups were well-matched for age, sex, tumor location, size, and grade. Operative mortality was 8.5% and 7%, respectively, for each group with a 27-day hospital stay for both groups. Long-term survival was not significantly different, with 47% of both groups alive at 1 year. CONCLUSIONS: The authors concluded that this neoadjuvant treatment did not change operative mortality or survival time for patients with squamous cell carcinoma of the esophagus.

Adult↗
PubMed1994

Surgical management of portal hypertension.

The surgical management of portal hypertension depends on the location of the obstruction. Suprahepatic obstruction is usually optimally treated by a surgical portacaval shunt. In extrahepatic obstruction the treatment should be sclerotherapy. For intrahepatic obstruction in emergency situations, sclerotherapy is the first choice, with portacaval systemic shunts or transjugular intrahepatic portal systemic stent shunt the second option. Liver transplantation in other situations should, if possible, be considered ahead of a portal diversion.

Budd-Chiari Syndrome↗
PubMed1994

Liver transplantation for severe Lepiota helveola poisoning.

Orthotopic liver transplantation in patients with fulminant hepatic failure secondary to Lepiota helveola poisoning has not, to our knowledge, been reported. Our recent experience with liver transplantation in a 27-year-old woman with acute hepatic failure secondary to this poisoning is described. The indications for orthotopic liver transplantation are discussed.

Adult↗
PubMed1994

[Liver transplantation with preservation of the inferior vena cava and "piggyback" reimplantation of the liver].

A modified technique of orthotopic hepatic transplantation with inferior vena caval preservation and piggy-back procedure is described. This procedure, used in 14 patients, avoided the need for temporary vena cava clamping in nine cases and reduced the need for venous bypass during orthotopic liver transplantation. The indications, results and advantages of this procedure are described.

Adult↗