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Biomedical subjects

D Castaing

Publications and source records attributed to D Castaing.

At least 37 records · Page 2Linked to original sources
PubMed1989

[Evaluation of the spread of cancer of the exocrine pancreas and biliary tract].

The assessment of pancreatic and biliary tract carcinoma extension obviously depends on the possibilities of treatment. Resection being the only treatment of these malignancies, the assessment must be conducted in such a way as to search for its contra-indications, and it will deal successively with the patient's operability, the distal extension of the tumour (thoracic CT scan, Abdominal CT scan, ultrasonography of the liver and abdomen) and its local and regional extension (ultrasonography of the liver and pancreas, transparietal transhepatic cholangiography, angiography). If these examinations show no formal contra-indication to surgery, then exploratory laparotomy will be performed to determine whether the operation is technically feasible and whether it should consist of resection or palliative bypass.

Biliary Tract Neoplasms↗
PubMed1989

[Optimization of multiple abdominal organ procurement].

Multiple abdominal organ procurement should enable the kidneys, the liver and the whole pancreas to be removed. Simultaneous removal of the liver and pancreas depends on arterial variations. In subjects with one single hepatic artery simultaneous removal of the liver and the whole pancreas is always possible. In subjects with right hepatic artery, the whole pancreas can only be removed if the right hepatic artery and the median hepatic artery can be left to the liver transplanter and if the coeliac trunk, the common hepatic artery, the gastroduodenal artery and the splenic artery can be preserved to feed the pancreas.

Hepatic Artery↗
PubMed1989

Emergency orthotopic liver transplantation in two patients using one donor liver.

Because of its anatomy, the liver can be divided into two hemilivers suitable for use as two grafts for liver transplantation. The line of division is the main scissure, giving the right hemiliver (segments 5-8) and the left hemiliver (segments 2-4). Segment 1 (caudate lobe) has to be resected. The vessels are divided between the two grafts: the vena cava remains on the right; on the left, the left hepatic vein is sutured into the vena cava of the recipient, which is retained intact. The left graft retains only the left branch of the portal vein, the bile duct and the hepatic artery. The right graft retains the portal trunk, the common bile duct and the right branch of the hepatic artery. This procedure was used for emergency grafting of two patients with fulminant hepatitis when only one donor was available. Both recipients recovered from coma and regained normal liver function. However, both died from causes not specifically related to the operative technique, one from multiple organ failure on the 20th day and the other from diffuse cytomegalovirus infection on the 45th day.

Adult↗
PubMed1989

Hepatocellular carcinoma with normal adjacent liver. Hepatitis B virus DNA status.

We investigated hepatitis B virus (HBV) DNA status in the liver of 22 patients with hepatocellular carcinoma (HCC) developed on a non-cirrhotic, histologically normal liver tissue. HBV serological markers were present in 2 of the 22 subjects. HBV DNA sequences were identified in the liver of only 5 of the 22 patients with HCC. Evidence for clonal expansion of HBV-infected cells was found for one HBsAg-positive subject. This study indicates a much lower rate of HBV DNA positivity in the group of HCC developed on histologically normal livers as compared to that observed in HCC with liver cirrhosis.

Adolescent↗
PubMed1989

Acute cholangitis. Multivariate analysis of risk factors.

In order to identify risk factors in patients with acute cholangitis, 140 clinical, biochemical, etiologic, and pathologic variables of 449 attacks of acute cholangitis seen in one center over a 20-year period were analyzed. Simple regression revealed 24 factors with prognostic significance, but multivariate analysis detected only seven factors with independent significance in predicting mortality (acute renal failure, cholangitis associated with liver abscesses or liver cirrhosis, cholangitis secondary to high malignant biliary strictures or after percutaneous transhepatic cholangiography, female gender, and age). When the presence of each of these factors is weighted proportional to its coefficient of regression, patients with cholangitis could be scored on a scale of 0-27. A score of seven was clinically the most useful cut off--388 attacks of cholangitis associated with a score of less than 7 had a mortality rate of only 1.8%, whereas 61 attacks associated with a score greater than or equal to 7 had a mortality rate of 49%. The value of this scoring system needs to be confirmed in prospective studies, but it may prove useful, for example, in selecting a group of high-risk patients for urgent biliary decompression in an attempt to reduce the mortality associated with this pathology.

Acute Disease↗
PubMed1989

Major hepatic resection under total vascular exclusion.

Over a 9-year period, major resection was successfully performed on 51 occasions with total vascular exclusion using supra- and infrahepatic caval and portal vein clamping. The main indications for hepatic resection were centrally located tumor in liver metastases (62%) and hepatocellular carcinoma with no evidence of co-existing cirrhosis (25%). Major resections included extended and regular right hepatectomy, extended left hepatectomy, and segmentectomy. The mean duration of vascular exclusion was 46.5 +/- 5.0 minutes (range 20 to 70 minutes) and mean blood transfusion requirement was 1.4 +/- 0.4 units during vascular exclusion. There were significant correlations between postoperative fall in factor II levels and the number of segments removed (r = 0.37, p = 0.015) and between serum alanine aminotransferase levels at day 2 and the duration of vascular exclusion (r = 0.35, p = 0.02). One patient died 45 days after the procedure of multi-organ failure and sepsis. Nonfatal complications occurred in 7 patients (14%) and included respiratory infection (7 patients), biliary fistula (3 patients), and collection at the site of hepatic resection (3 patients). Total vascular exclusion is a safe and useful technique in resection of major hepatic lesions that involve hepatic veins.

Adolescent↗
PubMed1989

Segmental liver resection using ultrasound-guided selective portal venous occlusion.

Anatomical segmental resection of small hepatic lesions using operative ultrasonography is improved by selective intrahepatic portal venous occlusion. The technique was successfully performed in 15 of the 18 patients in whom it was attempted. The lesions resected included 7 hepatocellular carcinomas in cirrhotic patients, 5 hepatic metastases, 2 benign tumors and 1 gallbladder carcinoma. The mean duration of local vascular exclusion was 47 minutes (range, 22 to 80 minutes) and mean blood transfusion requirement was 1.3 units (range, 0 to 7 units). Five patients sustained postoperative complications and these included chest infection (2 patients), ascites (2 patients), pleural effusion (1 patient) and hemorrhage (1 patient) from the site of hepatic resection. There were no postoperative deaths. One patient required further resection of a recurrent colonic metastasis and two patients have died of disseminated disease. This technique has allowed limited anatomical resection of lesions that would have otherwise required extensive classical hepatic resections or would have not been amenable to resection.

Adult↗
PubMed1989

Repeat hepatectomy for recurrent malignant tumors of the liver.

The results of 34 repeat hepatectomies for recurrent malignant tumors of the liver in 28 patients are reported herein. There was no operative mortality, and the morbidity rate was 15 per cent. No instances of postoperative hepatic insufficiency were observed. Only five of the repeat hepatectomies were extensive (three or more hepatic segments). Thirteen resections were performed upon 11 patients for recurrent hepatocellular carcinoma. Four of these patients are still alive, one patient with a known recurrence (a mean survival time of 33 months with a range of four to 54 months). Ten resections were performed upon nine patients for recurrent metastases from the colon and rectum. Five of these patients are alive, four without apparent recurrence (a mean survival time of 13 months and a range of one to 35 months). Eleven resections were performed upon eight patients for recurrent miscellaneous malignant tumors, and four patients are alive, of whom three have a recurrence. The results of this study demonstrate that some patients benefit from repeat hepatectomy for recurrence of malignant hepatic tumors. Repeat hepatectomy is technically highly feasible. Economic hepatic resection with a sound oncologic basis (segmentectomy) is the operation of choice.

Adolescent↗
PubMed1988

Surgery for synchronous hepatic metastases of colorectal cancer.

Over the last 10 years 32 patients have had synchronous hepatic metastases from colorectal cancer treated surgically in this unit. As a general policy the metastases were resected 3-4 months after resection of the primary tumour. At the end of this interval a thorough assessment was made for recurrent local, regional or extrahepatic metastatic disease before making a decision to perform liver resection. Eighteen patients had a conventional liver resection (13 major liver resections, 5 limited liver resections) and 14 patients had an atypical liver resection (metastasectomy). Patients were followed at 4 monthly intervals after operation using ultrasonography and CEA determination. The operative mortality (within 60 days) was zero. Twenty-six patients (81%) had a totally uncomplicated postoperative course. The period of hospitalization was 14 +/- 2 days. Two patients had a second liver resection at a later date on account of tumour recurrence. The survival rates at 1, 2 and 3 years were 84%, 58% and 33% respectively. These results confirm that synchronous hepatic metastases from colorectal cancer can be resected with minimal morbidity and mortality and that worthwhile improvements in life expectancy result.

Adult↗