Search PubMed⌕ Search

Biomedical subjects

D Castaing

Publications and source records attributed to D Castaing.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1987

Hepatic transplantation in Europe. First Report of the European Liver Transplant Registry.

At the 32 European centres where livers are transplanted the actuarial survival rate for 1218 patients was 44% at 1 year and 41% at 2 years. Perioperative mortality (30 days) was 30%. Recipients aged under 15 years had a higher survival rate than those aged over 15; the differences were 22% at 1 year and 32% at 2 years. For the 97 patients who received two or more liver grafts, actuarial survival was 27.7% at 1 and 2 years. Two-thirds of the transplantations were done since 1984. Since then the best results have been obtained for biliary atresia (88 cases; survival rates at 30 days, 1 year, and 2 years were 87%, 74%, and 68%). Primary biliary cirrhosis was the commonest benign indication for transplantation, with survival of 64% at 1 and 2 years. The proportion of transplantations that were done for patients with hepatocellular carcinoma was smaller after than before 1984; among transplantations done in adults after 1984, those done because of hepatocellular carcinoma gave the best perioperative survival rate (76%) but the worst 2 year survival (30.8%).

Actuarial Analysis↗
PubMed1987

Left intrahepatic cholangio-enteric anastomosis (round ligament approach): an effective palliative treatment for hilar cancers.

Palliation of obstructive jaundice in patients with hilar cancer can be achieved either by surgical bypass or by intubation and drainage. A simple and effective technique is presented which gives excellent palliation without the need for tubes or stents: left intrahepatic cholangio-enteric anastomosis, using the duct of segment III (i.e. the inferolateral segment of the left liver). The procedure is performed by using the round ligament approach to the duct of segment III in the base of the umbilical fissure. A defunctioned loop of jejunum is then anastomosed to this duct. Over a period of 25 years, 48 patients with hilar cancer had this procedure in this unit. The operative mortality (death within 2 months) was 6 per cent and the complication rate was 17 per cent. Seventy-three per cent of patients had complete relief of jaundice and a further 23 per cent had partial relief. The mean survival was 9.2 months and the quality of life was excellent. These data suggest that this is a very satisfactory palliative technique for patients with hilar cancer who are not suited for radical tumour excision.

Adenoma, Bile Duct↗
PubMed1987

Effect of portacaval anastomosis on plasma lipoproteins of lean and obese Zucker rats.

The distribution of cholesterol (C), triglycerides (TG), phospholipids (PL) and proteins in the different lipoproteins was studied in lean and obese Zucker rats under 2 conditions: non-operated and after portacaval anastomosis (PCA). All lipoproteins, but mainly the d less than 1.006 g/ml (chylomicrons + VLDL) fraction, were increased in obese rats. They were hypertriglyceridemic (+ 675%) and hypercholesterolemic (+ 207%). PCA decreased cholesterolemia by about 50% and triglyceridemia by 50-70% in both lean and obese rats. Except for VLDL, enriched in TG in obese rats, proportions of C, TG, PL and proteins in lipoproteins were about the same in obese and lean Zucker rats and were nearly unchanged by PCA, suggesting an increased number of particles in obese rats and a decreased number after PCA. Lipoproteins of obese rats were enriched in apo C and proportions of apo E and apo B were decreased in the d less than 1.006 g/ml fraction. PCA decreased the proportion of apo C in all lipoproteins.

Animals↗
PubMed1987

Effects of portacaval shunt on the cholesterol metabolism of genetically hypercholesterolemic rats ("Rico' strain).

The effects of portacaval anastomosis on the biodynamics of cholesterol in male adult rats of a genetically hypercholesterolemic strain (Rico) were studied using an isotopic equilibrium method. Animals received a sucrose-rich semipurified diet. In both hypercholesterolemic rats and controls, portacaval anastomosis decreased plasma cholesterol levels (27%), liver weight (35-43%) and total cholesterol content in liver and body pools. Rico rats were characterized by (1) a high input rate of newly synthesized cholesterol (internal secretion) (25.3 +/- 1.9 vs. 16.2 +/- 1.5 mg/day/rat in controls) related to increased hepatic cholesterogenesis, and (2) a high rate of cholesterol transformation into bile acids, while other parameters remained unchanged. Portacaval anastomosis decreased the internal secretion of cholesterol in Rico rats (20.1 +/- 2.0 mg/day/rat). Since the activity of the gut for cholesterol synthesis as shown by the fecal external secretion (cholesterol biosynthesized by the gut and directly eliminated in the gut and feces) was not modified, it is assumed that the reduction of internal secretion induced by portacaval anastomosis results from decreased hepatic cholesterogenesis.

Animals↗
PubMed1987

Emergency liver transplantation for fulminant hepatitis.

Orthotopic liver transplantation was done in 17 patients with fulminant hepatitis. The cause of the liver disease was infection with hepatitis B virus, or co-infection with hepatitis B virus and hepatitis D virus, or infection with hepatitis A virus in 6 patients; drug hepatotoxicity in 5; and indeterminate in 6. Grafts from incompatible blood groups, steatotic grafts, or reduced-size grafts were used in 5, 4, and 4 patients, respectively. Of the 17 patients, 5 died: 2 of early liver failure due to the poor quality of the graft, 1 presumably of accidentally transmitted acute infection with the human immunodeficiency virus, and 2 of decerebration occurring during or immediately after surgery. The 12 other patients were alive 2 to 15 months after transplantation.

Acute Disease↗
PubMed1986

Utility of operative ultrasound in the surgical management of liver tumors.

In this study the utility of operative ultrasound in the surgical management of 98 consecutive patients with liver and gastrointestinal tumors was assessed. All patients had preoperative work-up including ultrasound study of the liver as well as selective hepatic arteriography (50 patients) and computerized tomography of the liver (45 patients). At surgery, inspection and palpation of the liver as well as operative ultrasound examination were performed in all cases. Fifty-six patients were known to have liver tumors before operation, while 42 patients had their liver examined as part of the treatment of a primary gastrointestinal malignancy. A total of 126 liver tumors were found in 58 patients, all of whom were confirmed histologically. Eighteen nodules unsuspected before operation were found at surgery--nine by inspection and palpation of the liver, and nine others that were nonpalpable were found by operative ultrasound only. Eighteen lesions that were missed by all diagnostic modalities were found as secondary lesions on pathologic examination of the resected specimens. In addition to diagnostic applications, operative ultrasound was useful in localizing nodules and permitting guided biopsies deep in the hepatic parenchyma. In eight cases, segmental resections were performed with operative ultrasound to localize the plane of section and to catheterize the intrahepatic portal vein branch afferent to the tumor in order to perform balloon catheter occlusion of the vessel for control of bleeding. Operative ultrasound was found to be important in the surgical management of 19 of 98 patients (19%).

Aged↗