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C Gouillat

Publications and source records attributed to C Gouillat.

At least 37 records · Page 2Linked to original sources
PubMed1997

Liver resection or transplantation for hepatocellular carcinoma? Retrospective analysis of 215 patients with cirrhosis.

BACKGROUND/AIMS: Currently, surgical treatment of hepatocellular carcinoma in patients with cirrhosis is not clearly defined. The objective of this study was, in patients with cirrhosis with hepatocellular carcinoma, to compare liver resection to transplantation assessed by patient survival and to determine whether the tumor recurrence might be influenced by prognostic factors. METHODS: We have gathered all the available data from six French Medical Universities, for 215 patients with cirrhosis with hepatocellular carcinoma surgically treated either by liver resection (102) or by transplantation (113). RESULTS: The overall 5-year survival rate was similar in the transplantation group and in the resection group (32% vs. 31%, p=0.7). However, the 5-year survival rate without recurrence was higher in the transplantation group than in the resection group (60% vs. 14%, p<0.001). Three independent prognostic factors influenced significantly the survival without recurrence: the surgical treatment by transplantation (p<0.001), the number of tumors (p<0.01) and the tumor size (p<0.001). With these factors we defined a prognostic index (Ip) which allowed assessment of the probability of survival without recurrence: Ip= (Xie. x 1.41)+(Nbr T. x 0.19)+(Size TV. x 0.16); Xie=surgical treatment (Xie=0 if transplantation, Xie=1 if resection), Nbr.T. and Size TV.=number of tumors and size of the most voluminous tumor, respectively, according to the histologic study. CONCLUSIONS: These results and this prognostic index are encouraging for liver transplantation as treatment of hepatocellular carcinoma in selected patients with cirrhosis.

Adult↗
PubMed1997

Woodchuck hepatitis virus-induced carcinoma as a relevant natural model for therapy of human hepatoma.

BACKGROUND: Eastern American woodchuck (Marmota monax), naturally infected with woodchuck hepatitis virus, a virus similar to human hepatitis B virus, develops liver cancer with a high prevalence. AIMS: The aim of this work was to assess Marmota monax as a model of human hepatocellular carcinoma, especially to assess new potential adjuvant therapies after surgical resection. METHODS: Forty-four woodchuck hepatitis virus-infected animals were regularly screened by ultrasound examination from the age of 18 months and for a 30-month period. One or more liver tumors were diagnosed in 31 animals (70%). Five of them with multifocal tumor or poor general status were considered unsuitable for surgery. The other 26 were operated on. At laparotomy no tumor was found in three. RESULTS: The 18 liver tumors studied were hepatocellular carcinomas, grossly and microscopically similar to human hepatocellular carcinoma. Peritumoral parenchyma studied in 13 specimens was always non-cirrhotic but adequate staining demonstrated patterns of fibrosis in four cases. Clear evidence of chronic active hepatitis, periportal hepatitis and steatosis were demonstrated in five, seven and one of the 13 specimens, respectively. Tumors were treated by tumorectomy in eight animals, by alcoholization in seven and by laser photocoagulation in one. A simple tumor biopsy was performed in the other seven. Ten animals died postoperatively. All the survivors in the tumorectomy group died from tumor recurrence within 10-18 months after surgery. CONCLUSIONS: It is concluded that woodchuck hepatitis virus-induced liver carcinoma is a natural model of human hepatocellular carcinoma with similar pathology and natural history, including early ultrasonic detection and tumor recurrence after resection. Tumor excision is feasible in this animal model, which now provides the basis for assessment of new potential adjuvant therapies for human hepatocellular carcinoma in an attempt to reduce the high recurrence rate after surgical resection in humans.

Animals↗
PubMed1994

Human hepatocellular carcinoma transplanted in nude mice: a relevant experimental model to assess tumoral destruction by alcoholization.

Intratumor ethanol injection was studied in the treatment of small hepatocellular carcinoma (HCC). One of the major drawbacks of this technique remains the lack of objective information about its efficiency and the practical conditions of injection. To ensure accurate evaluation of alcoholization, we developed a model based on the tumor obtained after subcutaneous injection of human hepatoma cell lines into nude mice. Each of three cell lines (Hep G2, Hep 3B, PLC/PRF/5) was tested on 24 mice. A total of 0.1 ml of a solution containing 5 x 10(6) cells was injected under the abdominal skin of a male nude mouse weighing 30 g. The Hep G2 cell line appeared to be the most suitable for the model. It enabled us to obtain tumors of 20 mm in diameter within a mean delay (m +/- SD) of 45 +/- 16 days (range: 29-60) with only a 25% failure rate. No visceral spreading of the carcinoma was noticed and the tumors obtained, similar to human HCC, were convenient to be measured, monitored, and treated by alcoholization. To validate this model for alcoholization, 38 tumors ranging in diameter from 10 to 20 mm were treated using either a unique centrotumoral injection (n = 27) or five cross-shaped injections (n = 11). Intratumor absolute ethanol injection resulted in tumoral necrosis which was easily quantified as a percentage of the tumor volume, using a semiquantitative method. It is concluded that the Hep G2 cell line transplanted in nude mice resulted in a relevant model to assess tumoral destruction by alcoholization.

Animals↗
PubMed1993

Histopathological assessment of tumoral destruction by alcoholization in an experimental model of human hepato-cellular carcinoma transplanted in nude mice.

This study aims to assess the efficacy of intra-tumoral alcoholization as a potential therapy against small hepatocellular carcinoma (HCC). The experimental model consisted of 20-mm diameter tumors resulting from subcutaneous abdominal injection of Hep G2 human hepatoma cell lines into nude mice (nu/nu). Alcoholization was performed using either a single centro-tumoral injection or multiple cross-shaped injections (tangential and oblique), during one sequence with a total dose of 0.1, 0.2 or 0.3 ml of 95% ethanol. Efficacy was assessed by the percentage of tumoral necrosis using a semi-quantitative method. Fifty-four tumors were alcoholized. Forty-eight hours following alcoholization, the tumor was regularly replaced by a necrotic ulcer. A single centro-tumoral injection always resulted in the persistence of a small peripheral edge of tumor cells even with the highest dose used (no dose-related effect). By contrast, the use of multiple injections restored a dose-related effect. Oblique cross-shaped injections of 0.3 ml of ethanol resulted in the highest mean tumoral necrosis rate (m +/- SD = 99 +/- 1%; range = 97-100). This study confirms that alcoholization is an efficient way to destroy hepatocarcinoma tissue and suggests that ethanol diffusion in HCC is less than 20 mm. In addition it demonstrates that increasing number and location of injections restores a dose-related effect, while efficacy is improved using oblique injections.

Animals↗
PubMed1993

Repeated hepatic resections for colorectal metastases.

Repeated hepatic resection (RHR) for recurrent colorectal metastases remains uncommon and controversial. We report our experience in order to assess the feasibility and the potential oncologic benefit of such an aggressive management. From 1981 to 1991, 13 patients underwent a RHR. The first hepatic resection had been an anatomic hepatectomy removing between two and six segments in 10 patients and a wedge resection in three. The RHR was performed after a mean delay of 16 +/- 10 months (5-35) from the first liver procedure. The RHR was an anatomic hepatectomy in eight patients (including a right hepatectomy in three) and a minor resection (tumorectomy or segmentectomy) in five. Three patients underwent a third liver resection for recurrence. There was no post-operative mortality. Eleven patients died from recurrence after a mean survival of 17 +/- 13 months from the second hepatic procedure (range: 6-47). One patient died from unrelated disease after 12 months and one was alive free of recurrence 22, 53 and 84 months after third, second and first hepatectomy respectively. The median survivals from the second and first hepatic resections were 17 and 31 months, respectively. It is concluded that in the well-trained team, RHR is feasible and safe even after major primary hepatectomy. However the oncologic benefit remains questionable.

Adult↗
PubMed1992

Pulmonary hemorrhage and glomerulonephritis in primary biliary cirrhosis.

We observed life-threatening intrapulmonary hemorrhages and focal proliferative glomerulonephritis in a 41-yr-old woman with primary biliary cirrhosis. The severity of the symptoms necessitated blood transfusions and mechanical ventilation; the patient improved with the help of corticosteroid therapy. No formal evidence of either Goodpasture's syndrome or any other well-defined systemic vasculitis could be found. Neutrophil cytoplasmic antibodies were initially positive and became undetectable after 3 mo of immunosuppressive treatment without relapse. This association has not been described previously and may be added to the list of extrahepatic immune-mediated conditions associated with primary biliary cirrhosis.

Adult↗
PubMed1991

[Value of intraoperative ultrasonography in the surgical treatment of malignant tumors of the liver].

This retrospective study was designed to assess the specific contribution of intraoperative ultrasonography (IOU) in a series of 50 surgical procedures for malignant tumors of the liver (including 27 hepato-cellular carcinomas (HCC) secondary to cirrhosis and 18 metastases). Compared to conventional pre- and intra-operative investigations, IOU was more sensitive (81%) but less specific (27%) for detection of tumor nodules, but was inaccurate in detection of daughter nodules in hepato-cellular carcinomas (HCC) secondary to cirrhosis. The main specific contribution of IOU was assistance in performing surgery. In 14 cases (52%) of HCC secondary to cirrhosis, IOU provided one or several additional pieces of information which resulted in changes of the planned surgical procedure in 11 cases (41%) mainly enabling limited resection of small deep impalpable tumors. In 10 cases (37%), IOU directly guided resection (echo-guided segmentectomy or tumorectomy). Contribution of IOU was poor in primary carcinoma in non-cirrhotic liver, but in 8 cases of metastasis (44%) IOU provided additional information which resulted in changes of the intended surgical procedure in 5 cases (28%) mainly leading to a more extensive resection. Finally IOU was considered to be indispensable in 15 cases of HCC cirrhosis (56%) and in 5 cases of metastasis (28%).

Carcinoma, Hepatocellular↗
PubMed1989

[Late results of Warren's distal splenorenal shunt].

To assess the long term results of the Warren distal splenorenal shunt, 53 patients suffering from chronic liver disease and managed with such a procedure from 1975 to 1981 for bleeding esophageal varices were evaluated. No rebleeding occurred after the immediate postoperative period. Five-year survival was 62 +/- 13 p. 100. No difference in survival was found between alcoholic cirrhotics and patients without any history of alcohol abuse. Of the 28 six-year survivors, 24 accepted endoscopy, which confirmed the absence of esophageal varices. Thirteen patients accepted mesenteric angiography; all had a patent shunt and significant hepatofugal collateral flow. Although reduced portal perfusion was maintained in 10 patients. Severe chronic encephalopathy occurred in 3 patients who had important hepatofugal collateral flow. At 5 years, operation resulted in a significant increase of the mean leucocyte and platelet counts in patients who had preoperative hypersplenism (p less than 0.001). In conclusion our data confirm the long term efficiency of the Warren distal splenorenal shunt in decompression of esophageal varices. Despite the development of hepatofugal collateral veins, portal perfusion is preserved in most cases, and disabling encephalopathy is rare.

Adult↗
PubMed1985

Adenocarcinoma in columnar-lined Barrett's esophagus. Analysis of 13 esophagectomies.

From 1977 to 1982, 13 patients with adenocarcinoma arising in the distal esophagus lined by columnar epithelium underwent esophagectomy with detailed analysis of the pathologic specimen. In three patients, microinvasive carcinoma was detected before dysplasia occurred. In five patients, the ectopic mucosa was discontinuous, prolonged cranially by islands of columnar epithelium scattered in the squamous mucosa. Variable degrees of dysplasia were found in the columnar epithelium in seven specimens in areas of intestinal metaplasia. In four patients with high-grade dysplasia, several foci of intramucosal carcinoma were identified. They were scattered over the whole length of the ectopic mucosa. These data strongly suggest that adenocarcinoma develops from dysplasia, the real premalignant lesion. Careful periodic screening must be carried out in patients identified as having Barrett's esophagus. Dysplasia may be detected and located by endoscopy with dye spraying with directed biopsies. Patients with high-grade dysplasia should undergo esophagectomy with resection of the whole ectopic mucosa because they are at high risk for development of carcinoma.

Adenocarcinoma↗
PubMed1984

[Reoperation for primary hyperparathyroidism].

Twenty-one patients in a series of 283 treated surgically for primary hyperparathyroidism between 1960 and 1982, underwent reoperation. Eleven had been previously treated elsewhere. The initial cervicotomy was negative in fourteen cases, but had led to the ablation of one or more adenomas in seven. The reason for reoperation was recurrence or persistence of hyperparathyroidism (HPT). It was commenced by cervicotomy in the eleven patients initially treated elsewhere, and by cervicotomy and/or sternotomy for the others. Reoperation involved ablation of adenomas in thirteen cases, but was negative in the remaining eight. Three of the eight underwent a second reoperation, with success in two cases. Overall, reoperations led to ablation of sixteen adenomas in fifteen patients. Ten adenomas were ectopic, including eight located mediastinally . Ten sternotomies were performed, leading to ablation of four mediastinal adenomas. Postoperative complications included five recurrent paralyses and two severe cases of hypocalcemia. One patient with parathyroidal carcinoma died of malignant hypercalcemia. Fifteen of the twenty one patients (71%) were cured of their HPT. Basing themselves on these cases, and a review of the literature, the authors describe the indications and practical management of reoperative surgery for primary HPT.

Adenoma↗