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Biomedical subjects

D Castaing

Publications and source records attributed to D Castaing.

At least 109 records · Page 6Linked to original sources
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↗
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↗