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Biomedical subjects

D Castaing

Publications and source records attributed to D Castaing.

169 records · Page 10Linked to original sources
PubMedDate not supplied

[Adult to adult living-related liver transplantation. The Paul-Brousse Hospital preliminary experience].

AIM: Liver-graft shortages justify the development of adult living-related liver transplantation. The preliminary experience with this technique at Paul-Brousse Hospital is reported. PATIENTS ET METHODES: From January to July 2000, 7 adult to adult living-related liver transplantations were performed. Donors were 5 females and 2 males aged 20 to 53 years old (median: 41). A right liver graft was harvested in all cases. Recipients were 5 males and 2 females aged from 17 to 58 years old (median: 50) transplanted for viral cirrhosis (4 cases including 2 with hepatocellular carcinoma), subfulminant hepatitis (1 case), hepatocellular carcinoma on a healthy liver (1 case), and epithelioid hemangioendothelioma (1 case). Follow-up ranged from 41 to 157 days (median: 117 days). RESULTS: One donor had a biliary fistula that healed spontaneously. One donor had asterixis for 24 hours. The 7 donors are alive at home without any late complications. One recipient was retransplanted for hepatic artery thrombosis and 2 recipients had a biliary fistula that healed spontaneously. The 7 recipients are alive at home with normal liver function. CONCLUSION: Our experience and other reports suggest that adult to adult living-related liver transplantation is feasible with rare mortality and low morbidity in donors. Results in recipients are comparable to those obtained with cadaveric grafts. For a given patient the possibility of living related donation might extend the indications for transplantation without penalizing patients waiting for a cadaveric graft.

Adolescent↗
PubMedDate not supplied

[Surgical treatment of hilus cancers].

Carcinomas of the hilus are malignancies which obstruct the upper part of the bile duct, including the Klatskin tumour but also neighbouring carcinomas invading the hilus and obstructing the biliary tract at this level. The aim of the treatment is to remove the tumour but in our experience, this radical treatment can be accomplished in only 10% of the carcinomas of the hilus. Therefore, the treatment is in the majority of the cases only palliative and the technique the authors used is the intrahepatic cholangio-anastomosis between the duct of Segment III and a Roux-en-Y jejunal loop by the approach of the intrahepatic duct in the Round Ligament fissura. In 61 cases of intrahepatic cholangioanastomoses, performed for the majority according this technique, the mortality was 6.5% and the mean survival 10.3 +/- 2.7 months with extremes of 2 to 72 months. The large variability of this survival is not in relation with the quality of the anastomosis but with the extent and the evolutivity of the carcinoma. Among the surgical and non-surgical palliative treatments of carcinomas of the hilus, the intrahepatic cholangio-anastomosis is the procedure which gives the best comfort and less iatrogenic complications.

Bile Duct Neoplasms↗
PubMedDate not supplied

[Peroperative echography in hepatobiliary surgery].

Intra-operative ultrasound allows to know precisely the intra-hepatic vascular anatomy and, by defining the precise relationship between tumor and vascular structures, has modified the therapeutic strategy in surgery of hepatic tumors. In biliary surgery, this procedure is useful in intrahepatic lithiasis. In surgery of digestive cancer, it permits to detect unknown hepatic metastases which may change the type of surgery indicated.

Biopsy, Needle↗
PubMedDate not supplied

[Peroperative echography in hepatobiliary surgery].

Intra-operative echography provides precise information on anatomy of the liver and accurately locates hepatic tumours, even small ones, thereby improving the operative strategy. It is most useful in biliary surgery for detection and treatment of intrahepatic lithiasis. By displaying undetected hepatic metastases, echography of the liver is of considerable value in surgery of common tumours of the digestive tract.

Biliary Tract Surgical Procedures↗
PubMedDate not supplied

[Evaluation of results of liver transplantation: experience based on a series of 1052 transplantations].

OBJECTIVES: The aim of this work was to evaluate outcome in a continuous homogeneous series of more than 1000 liver transplantations in order to determine risk groups. METHODS: Between November 1984 and February 1995, 1052 isolated orthotopic liver transplantations were performed in 922 patients (530 males, 392 females; mean age 41.7 years; age range 10 months - 78 years) at the Paul-Brousse Hospital liver transplantation unit. Immunosuppression was based on cyclosporin in all patients with FK506 in the most recent cases. RESULTS: Actuarial survival at 1,5 and 8 years for the 922 patients was 80.9, 71.7, and 69.1%. Certain factors affecting the intrinsic risk of transplantation were identified and could be used to calculate supplementary risk due to one or more other risk factors. In adults under 55 years in UNOS stage 1 or 2 (not hospitalized at call in) transplanted after 1990 for non-recurrent (absence of cancer, non-viral disease) chronic liver disease, the risk of death at 1 year was 6.5% and 4.4% between the first and second year. For patients transplanted for acute liver failure and for patients transplanted for chronic liver disease in UNOS stade 3 or 4 (hospitalized or in an intensive care unit at call in), there was a supplementary risk of death at 1 year of 20.3%, 13.3% and 31.6% respectively. There was no supplementary risk of death in these three groups after 1 year. In patients over 55 years, there was a 4.4% supplementary risk during the first year after transplantation and a 2% increase between the first and second year. In patients transplanted for cancer, the supplementary risk was 9.7% during the first year, 11.6% between the first and second year and 2.1% between the third and fifth year. CONCLUSIONS: On the basis of these results, it was possible to develop a method for assessing liver transplantation outcome in different units. The proposed criteria is the 1 year survival of patients with the basic risk alone, without any supplementary risk, as well as the retransplantation index (mean number of grafts used per patient). For the Paul-Brousse unit, this criteria is 93.5% (survival at 1 year) for a retransplantation index of 1.1.

Adolescent↗