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Biomedical subjects

B de Hemptinne

Publications and source records attributed to B de Hemptinne.

At least 37 records · Page 2Linked to original sources
PubMed2000

A single center's clinical experience with quadruple immunosuppression including ATG or IL2 antibodies and mycophenolate mofetil in simultaneous pancreas-kidney transplants.

UNLABELLED: Acute rejection remains a major problem in simultaneous pancreas-kidney (SPK) transplant and occurs in 60-100% of the cases. With the introduction of mycophenolate mofetil (MMF) replacing azathioprine (AZA) as a basis immunosuppressant, reduced rates of rejection have been reported. This study investigates the frequency and clinical relevance of allograft rejection in SPK patients receiving antithymocyte globulin (ATG) or Basiliximab induction therapy and cyclosporine Neoral (CyA), MMF, steroid basis immunosuppression. Between December 1996 and October 1999, 21 consecutive patients (15 males, 6 females) received a SPK transplant at our institution with a mean +/- standard deviation (SD) age of 42 +/- 6 yr. Of these, 14 patients were treated with anti-thymocyte globulin (ATG) Fresenius (rabbit) 3-5 mg/kg for 6 +/- 2 d, cyclosporine Neoral (CyA) (trough levels 350-400 ng/mL), MMF 3 g/d and low dose steroid therapy. Seven SPK patients were treated with Basiliximab (Simulect, Novartis 20 mg on d 0 and d 4 post-transplant) instead of ATG. The patients had an average human leucocyte antigen (HLA) mismatch of 3.9/6 and a negative cross match. All patients remained on triple drug therapy. Three patients were switched to tacrolimus instead of Neoral for CyA intolerance. The mean +/- SD cold ischemia time (CIT) of the organs was 10.1 +/- 2.4 h for the pancreas and 10.5 +/- 2.6 h for the kidney. RESULTS: Biopsy-proven rejection occurred in the kidney of 1 ATG patient (8%), which responded to steroid bolus therapy. One of the patients (14%) with Basiliximab induction developed renal allograft rejection, which was resolved after a 6-d course of anti-CD3 mAb (OKT3) treatment. All patients (100%) were free from rejection in the pancreas, as measured by urine amylase levels and glycemic control without the need for exogenous insulin with a mean glycosylated hemoglobin (HBA1C) of 5.1 +/- 0.7%, and serum creatinine with a mean of 1.24 +/- 0.24 mg/dL in a mean follow-up period of 17 +/- 15 months (median 12, range 2 37). CONCLUSION: Triple drug immunosuppression including cyclosporine, MMF and low dose steroids with ATG or interleukin 2 (IL2) receptor antibodies induction therapy appears to be a very suitable immunosuppressive regimen for combined pancreas-kidney transplant (PKT) with a marked reduction in the incidence of rejection.

Adult↗
PubMed2000

Hyperthermic intraperitoneal chemoperfusion in the treatment of locally advanced intra-abdominal cancer.

BACKGROUND: Surgical treatment of intra-abdominal cancer is often followed by local recurrence. In a subgroup of patients, local recurrence is the sole site of disease, reflecting biologically low-grade malignancy. These patients might, therefore, benefit from local treatment. Recently, debulking surgery followed by hyperthermic chemoperfusion has been proposed in the treatment of locally advanced or recurrent intra-abdominal cancer. This paper reviews the rationale and assesses the currently accepted indications for and results of this novel treatment. METHODS: A systematic web-based literature review was performed. Information was also retrieved from handbooks, congress abstracts and ongoing clinical trials. RESULTS: A growing body of experimental evidence supports the use of hyperthermia combined with chemotherapy as an adjunct to cytoreductive surgery. Randomized clinical trials are available to support its use in the treatment and prevention of peritoneal carcinomatosis following resection of pathological tumour stage pT3 or pT4 gastric cancer; several other phase III trials are ongoing. Numerous phase I and II trials have reported good results for various other indications, with acceptable morbidity and mortality rates. Case mix, limited patient numbers and absence of a standardized technique are, however, a drawback in many of these series. CONCLUSION: For a subgroup of patients with peritoneal cancer without distant disease, debulking surgery followed by hyperthermic chemoperfusion may offer a chance of cure or palliation in this otherwise untreatable condition. This novel therapy should, however, be considered experimental until further results from ongoing phase III trials become available.

Abdominal Neoplasms↗
PubMed2000

Effects of Re-arterialization on early graft function and regeneration in the rat model of heterotopic auxiliary liver transplantation.

In the rat model of heterotopic auxiliary liver transplantation, graft re-arterialization may influence the outcome of inter-liver competition. This was investigated in the current study using two transplanted groups with or without graft re-arterialization. Immediately after reperfusion, the re-arterialized grafts showed significantly higher bile flow rate and bilirubin excretion than the grafts without re-arterialization. DNA synthesis rate was also increased more drastically in the re-arterialized group following the transplantation. Without re-arterialization, the rats developed more pronounced cytolysis and cholestasis. Among the long-term survivors, all healthy re-arterialized grafts regenerated, whereas 5/6 non-re-arterialized grafts atrophied. These data demonstrate that the re-arterialization increases graft survival by improving early hepatic function, enhancing regenerative response and preventing post-transplant biliary complications in this rat model.

Animals↗
PubMed2000

Postoperative lavage and on demand surgical intervention in the treatment of acute necrotizing pancreatitis.

OBJECTIVE: To analyse our experience with a combined approach of postoperative local lavage and on demand surgical intervention in the treatment of acute necrotizing pancreatitis. PATIENTS AND METHODS: All patients operated on for acute pancreatitis in a tertiary hospital between June 1993 and July 1997 were studied retrospectively. Demographic data, Ranson score, APACHE II score at admission were recorded. Hospital charts and clinical courses were reviewed. RESULTS: Seventeen patients were treated surgically because of end stage multiple organ failure (MOF) (n = 13) or infected necrosis (n = 4). APACHE II and Ranson scores were 26.2 +/- 9.25 and 7.33 +/- 1.35 respectively. All patients had protracted clinical courses, and required aggressive intensive care therapy. Forty-eight surgical interventions were performed in 17 patients. Early mortality was 36 percent. Complications were numerous, and mostly consisted of intra-abdominal abscesses. Young age (under 55) was associated with significantly better outcome (22% vs. 87% mortality, p = 0.015). CONCLUSION: Continuous local lavage after surgical debridement, with on demand re-laparotomy, proves to be a valuable approach in patients with necrotizing pancreatitis with acceptable morbidity and mortality rates. It appears however, that the role of surgery for acute pancreatitis is limited to patients with infected necrosis or end stage MOF.

Adult↗
PubMed1999

[Liver transplantation preserving the vena cava and a temporary portocaval shunt].

The experience with laterolateral cavocavostomy for hepatovenous reconstruction in liver transplantation is reviewed with and without the use of a temporary portocaval shunt. A total of 65 liver transplantations were analyzed. In 49 transplantations a laterolateral cavocaval anastomosis was performed (group I). In group II (n = 16) the same technique was used after a temporary portal caval shunt was constructed. Mean arterial pressure (mmHg): group I 128 +/- 34; group II 109 +/- 32. Cardiac output (l/min) decrease during the anhepatic phase was 2.3 +/- 1.9 and 1.2 +/- 1.5, respectively (P < 0.05). The peroperative blood loss measured as the number of packed cells transfused was 16.4 +/- 15.8 versus 1.2 +/- 2.3 (P < 0.04) and fresh frozen plasma 19.0 +/- 14.7 versus 3.7 +/- 4.0 (P < 0.02). Course on ICU (days), liver function tests, renal function and the need for reoperation because of bleeding were not statistically significantly different between the groups. One-year patient survival was 82.7 and 85.7%, respectively. In conclusion, we found that despite preservation of the caval flow during hepatectomy, the additional use of a temporary portocaval shunt was advantageous with regard to peroperative hemorrhage and hemodynamic stability and can potentially facilitate implantation of the liver graft.

Adolescent↗
PubMed1999

Functional, life-threatening disorders and splenectomy following liver transplantation.

UNLABELLED: Splenectomy (SPL) in cirrhotic patients undergoing liver transplantation (LTx) may resolve specific problems related to the procedure itself, in case of functional and life-threatening clinical situations often occurring as a result of liver cirrhosis and portal hypertension. METHOD: A single-center experience of ten splenectomies in a series of 180 consecutive adult liver transplant patients over a period of 6 yr is reported. The mean patient age was 46.8 +/- 9.5 yr (range 25 57 yr). Indications for SPL were post-operative massive ascitic fluid loss (n = 3), severe thrombocytopenia (n = 3), acute intra-abdominal hemorrhage (n = 2), infarction of the spleen (n = 1), and multiple splenic artery aneurysms (n = 1). RESULTS: Extreme ascites production due to functional graft congestion disappeared post-SPL, with an improvement of the hepatic and renal functions. SPL was also effective in cases of thrombocytopenia persistence post-LTx, leading to an increase in the platelet count after about 1 wk. Bleeding episodes related to left-sided portal hypertension or trauma were also resolved. The rejection rate during hospitalization was 0%, and no other episodes were recorded in the course of the long-term follow-up. However, sepsis with a fatal outcome occurred in 4 patients, i.e. between 2 and 3 wk post-SPL in three cases and 1 yr after the procedure as a result of pneumococcal infection in the last case. Fatal traumatic cranial injury occurred 3 yr post-LTx in another case. Five patients (50%) are still alive and asymptomatic after a median follow-up period of 36 months. CONCLUSION: The lowering of the portal flow appears to resolve unexplained post-operative ascitic fluid loss as a result of functional graft congestion following LTx. However, because of the enhanced risk of SPL-related sepsis, a partial splenic embolization (PSE) or a spleno-renal shunt could be used as an alternative procedure because it allows us to preserve the immunological function of the spleen. SPL is indicated in case of post-transplant bleeding due to left-sided portal hypertension and trauma, spleen infarction, and to enable prevention of hemorrhage in liver transplant patients with multiple splenic artery aneurysms. Severe and persistent thrombocytopenia could be treated with PSE. Because the occurrence of fatal sepsis post-SPL is a major complication in LTx, functional disorders, such as ascites and thrombocytopenia, should be treated with a more conservative approach.

Acute Disease↗
PubMed1999

Alternative technique for creation of a proximal gastric pouch in laparoscopic adjustable silicone gastric banding.

BACKGROUND: Laparoscopic adjustable silicone gastric banding (LASGB) has become a widely used procedure for the treatment of morbid obesity. The original operation, as described by Kuzmak, has been subjected to modifications. Construction of a proximal gastric pouch is an important part of the operation. Until now, we used the technique of Niville. Since this was often complicated by gastric bleeding and/or serosal tears, we developed a new technique to construct a pouch. SURGICAL TECHNIQUE: A new technique, using a thread previously fixed to that portion of the fundus that will be used to construct the pouch, is described. CONCLUSION: A safe and easy adaptation of the LASGB technique is proposed to create the gastric pouch.

Gastroplasty↗
PubMed1999

Retrospective analysis of laparoscopic gastric banding technique: short-term and mid-term follow-up.

BACKGROUND: Although adjustable gastric banding shows good results concerning weight loss, several complications such as excessive vomiting, total dysphagia, and slipping of the stomach through the band with pouch dilatation may occur rather frequently. Different types of adjustable bands are available to prevent these short- and mid-term complications. METHODS: In this retrospective study, 120 consecutive laparoscopic adjustable gastric bandings were performed. In group I, 50 patients were treated with adjustable silicone gastric banding (ASGB) by an intragastric balloon calibration technique. Group II (n = 29) received the same band by a surgical technique with tunneling behind the esophagus toward the angle of His. Group III (n = 41) received Swedish adjustable gastric banding (SAGB) by the same technique as in Group II. RESULTS: Weight loss was approximately 15% of the excess weight after 3 months, 30% after 6 months, and 45% after 12 months in all groups. Total dysphagia was significantly more frequent in Groups I and II. The incidence of slipping of the band and pouch dilatation was more frequent in Group II. CONCLUSION: The diameter of the ASGB band is rather small and can cause total dysphagia independently of surgical technique. The SAGB is easy to perform and seems less vulnerable to complications like dysphagia and slipping of the band, probably because of the individual adjustment of the stoma diameter during surgery and good fixation of both band and ventral pouch with separate posterolateral sutures.

Adult↗
PubMed1998

Cold preservation of the porcine pancreas with histidine-tryptophan-ketoglutarate solution.

BACKGROUND: Histidine-tryptophan-ketoglutarate (HTK) has been used for experimental and clinical cardiac, renal, and liver transplantation. No experience exists in either experimental or clinical pancreas transplantation. METHODS: In the present study, the solution was employed to flush segmental pancreatic grafts and to autotransplant the grafts after 24, 48, and 72 hr of cold storage in a porcine model. The results were compared to those obtained from animals receiving pancreatic grafts flushed and preserved with UW (University of Wisconsin) solution. RESULTS: A total of 10 landrace pigs received a graft stored with HTK solution for 24 hr, and 6 animals received a graft stored with UW solution for 24 hr. Daily blood glucose levels were normoglycemic (i.e., blood glucose < 150 mg/dl), and glucosuria was absent in all transplant animals. Intravenous glucose tolerance tests were comparable to two unoperated controls. Seven totally pancreatectomized, nontransplant diabetic controls exhibited daily hyperglycemia, glucosuria (i.e., > 1,000 mg/dl) and highly impaired intravenous glucose tolerance tests (mean K-values of -0.52+/-0.19 vs. -1.25+/-0.46 for HTK, -1.30+/-0.81 for UW, and -1.53+/-0.81 for controls, P-value vs. diabetic <0.01). The changes in wet weight between flushing and reperfusion were +2.22+/-2.84 g for HTK and -1.40+/-2.70 g for UW stored grafts (P=0.034). After 48 hr of storage with HTK, 4/17 grafts were functioning and 1/11 recipients of grafts stored with UW were normoglycemic. All grafts stored for 72 hr in either HTK (n=3) or UW (n=3) uniformly failed to render the recipients normoglycemic. CONCLUSIONS: It is concluded that preservation of segmental pancreatic autografts for 24 hr with HTK solution provides reliable graft function, as does preservation with UW solution associated with an increase in wet weight after HTK preservation. Cold preservation with HTK and UW is feasible for 48 hr; however, the success rate is equally reduced with HTK and UW solution. Cold storage for 72 hr in either HTK or UW solution results in uniform graft failure in this model.

Adenosine↗
PubMed1998

Arterialization of the portal vein in pediatric liver transplantation. A report of two cases.

Portal vein arterialization (PVA) is an acquired concept in shunt surgery for portal hypertension. This technique, recently described as both a temporary and permanent procedure in adult liver transplantation, is reported by the authors in two cases of pediatric transplantation. The indication was low portal blood flow after reperfusion with poor graft function due to persistence of spontaneous retroperitoneal venous shunts. In both cases described, PVA allowed for satisfactory macroscopic liver reperfusion. The increase in portal blood flow from 150 to 500 ml/min in the second patient enabled the liver to be reperfused correctly and led to successful transplantation. The graft function in both cases improved in the 1st postoperative week, but the 1st patient 2 months after transplantation. Signs of hepatic hyperarterialization occurred in the second patient and this necessitated a dearterialization of the portal vein 2 weeks later. Although the benefit of this procedure appears to be beyond doubt in the immediate post-operative period, we have no data on long-term arterialization. We do think that PVA can be performed in pediatric liver transplantation, but it may need to be done only in special, individual situations when no valid alternative can be proposed, such as in the absence of a mesenteric vein and/or the presence of spontaneous retroperitoneal venous shunts.

Child↗
PubMed1997

[Sequential orthotopic liver transplantation--domino transplantation].

Familial amyloid polyneuropathy (FAP) is a rare indication for liver transplantation. The excised liver of the FAP patient can be transplanted into a selected patient. In the following report, sequential liver transplantation is described where a 34-year-old female FAP patient received a cadaver donor liver. The excised native liver was transplanted to a 60-year-old male patient suffering from hepatocellular carcinoma in cirrhosis due to hepatitis C.

Adult↗