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D Cherqui

Publications and source records attributed to D Cherqui.

At least 73 records · Page 4Linked to original sources
PubMed1995

[Surgical treatment of severe ulcerous hemorrhages: predictive factors of operative mortality].

OBJECTIVES: Multivariate analysis of operative mortality in patients with bleeding peptic ulcer. METHODS: Seventy-eight consecutive patients, who underwent emergency surgical treatment for bleeding peptic ulcer were reviewed retrospectively. There were 49 males and 29 females, with a mean age of 64.3 years, 2/3 of whom had associated medical disease. Surgical treatment was conservative in 63 cases: oversewing or ulcer excision, alone (n = 29) or associated with vagotomy (n = 34); and was radical in 15 cases: antrectomy+vagotomy (n = 10) or partial gastric resection (n = 5). RESULTS: There were 17 (21.8%) postoperative deaths and 19 (24.3%) bleeding recurrences. The causes of death included 9 bleeding recurrences, 7 organ failures and one duodenal leakage. On multivariate analysis, previous medical illness (cirrhosis or cardiac insufficiency (P < 0.001), shock at admission (P < 0.001), prolonged delay until surgery (P < 0.001), and bleeding recurrence (P < 0.001) were independently associated with increased mortality. In contrast, the type of surgical procedure did not influence postoperative mortality, whereas bleeding recurrence was more frequent in case of conservative surgery (P < 0.03) and anticoagulation therapy (P < 0.01). CONCLUSION: These results suggest that surgical treatment of bleeding peptic ulcer should be proposed early in high-risk patients. A radical procedure should be favoured since it reduces bleeding recurrence rate without increasing operative mortality.

Adult↗
PubMed1994

Orthotopic liver transplantation with preservation of the caval and portal flows. Technique and results in 62 cases.

Sixty-two OLTs in 61 patients were performed using a technical modification reported recently, including total hepatectomy with preservation of the inferior vena cava, partial clamping of the native vena cava, and side-to-side cavacaval anastomosis. We further modified the technique by adding the early construction of a temporary end-to-side portacaval shunt, and, more recently, by using an end-to-side caval reconstruction. With this technique, the caval and portal flows were maintained throughout the procedure. Hemodynamic parameters were analyzed prospectively during the operative period and remained stable at all stages of the procedure. Venous bypass was avoided in all cases without need for increased fluid infusion. Operative time and transfusion requirements were 6.8 +/- 1.6 hr and 9.8 +/- 4.3 U of packed RBC, respectively. There were no specific complications or deaths due to the technique used and hospital mortality was 10% (6/61). The technique used in this study is a safe adjunct to the technical armamentarium of clinical liver transplantation. Its main advantage seems to be hemodynamic stability throughout the procedure, obviating the need for venous bypass or fluid overload.

Anastomosis, Surgical↗
PubMed1994

Multimodal adjuvant treatment and liver transplantation for advanced hepatocellular carcinoma. A pilot study.

BACKGROUND: Orthotopic liver transplantation has been used in a large number of patients with primary liver cancer because it increases the possibilities of resection of large tumors. Despite isolated cases of prolonged survival, however, the results of liver transplantation for advanced tumors have been universally disappointing because of high rates of tumor recurrence. In an attempt to reduce the recurrence rate, a pilot study testing a multimodal adjuvant treatment in patients undergoing liver replacement for hepatocellular carcinoma was undertaken. METHODS: The treatment consisted of preoperative hepatic arterial chemoembolization (iodized oil, doxorubicin, and gelatin sponge) and radiotherapy (5 Gy in one fraction immediately before surgery), and postoperative systemic chemotherapy with mitoxantrone. Nine patients entered this study. The tumor was solitary in two cases (5 cm and 8 cm) and multifocal in seven cases (2-9 nodules, 3-9 cm). The postoperative TNM stages were II in one case, III in one case, and IVA in seven cases. RESULTS: Chemoembolization and radiotherapy were performed in seven cases each (five patients had both treatments). All patients underwent liver transplantation with conventional immunosuppression. One patient died of heart failure 4 days after surgery. The remaining eight patients received 4 to 10 courses of chemotherapy (mean 9). The main toxicity of chemotherapy was leucopenia. Two patients died of recurrence: one at 7 months and one at 11 months. Six patients are alive, five of them without evidence of disease, with a mean follow-up of 30 months (range 16-45) after liver transplantation. The 3-year actuarial survival is 64%. CONCLUSIONS: These results show that an aggressive adjuvant therapy can be used in association with liver transplantation in the treatment of advanced hepatocellular carcinoma without increased mortality and suggest that such a protocol could be effective in preventing tumor recurrence.

Adult↗
PubMed1994

[Cancer after transplantation].

Transplantation is associated with an increased risk of cancer. The major factor favouring carcinogenesis is the degree of immunosuppression rather than the nature of the drug used. A large number of these tumours are virus-induced, reflecting an immune system deficiency in combating viral infection. The transplanted patient should be closely followed, both early after transplantation and consistently thereafter, for early detection of such complications.

Humans↗
PubMed1994

Adenocarcinoma of the duodenum: factors influencing survival. French Association for Surgical Research.

The records of 66 patients with histologically proven adenocarcinoma of the duodenum were reviewed retrospectively to determine factors influencing survival. The parameters studied were age, sex, weight loss, jaundice, anaemia, duodenal stenosis, type of surgical procedure, tumour size and location, depth of parietal invasion, presence and location of lymph node metastases, and pancreatic invasion. These factors were assessed in a group of 46 patients who underwent curative resection of the tumour; 20 patients who received palliative procedures were excluded from statistical analysis. Survival curves were established by the Kaplan-Meier method and compared by the Mantel-Haentszel test. The actuarial 3- and 5-year survival rates of patients undergoing curative resection were 59 and 45 per cent respectively. None of the prognostic factors studied influenced survival. These results indicate that resection of adenocarcinoma of the duodenum should be performed whenever possible, even in the presence of lymph node metastasis and pancreatic spread.

Adenocarcinoma↗
PubMed1994

The recipient splenic artery for arterialization in orthotopic liver transplantation.

Adequate hepatic arterial reconstruction is essential for successful liver transplantation. In the case of insufficient recipient hepatic arterial flow, most surgeons recommend the use of the aorta for arterialization of the graft. We report here on a technique in which the recipient splenic artery is used in such a setting. The splenic artery is dissected from its origin on a 3-to-4 cm segment and divided. The proximal segment is flipped to the right and anastomosed to the graft's celiac axis in an end-to-end fashion. This technique was used in 7 of 79 orthotopic liver transplantations (9%) because the native hepatic artery was deemed to be inadequate for anastomosis. There were no complications related to the use of this technique and no arterial thromboses. Arterialization of hepatic grafts using the recipient proximal splenic artery is a simple, safe, and efficient technique that can be recommended in the presence of an inadequate recipient hepatic arterial flow.

Adult↗
PubMed1994

Common bile duct stricture as a late complication of upper abdominal radiotherapy.

We report the cases of two patients who developed symptomatic common bile duct stricture 10 years after upper abdominal radiotherapy for malignant lymphoma. Both patients were in complete remission and presented with marked obstructive jaundice. Endosonography was useful in both cases and showed segmental thickening of the bile duct wall narrowing in the lumen. Both patients underwent surgical exploration, confirming biliary obstruction due to intrinsic wall thickening, and had successful biliary drainage by Roux-en-Y hepatico-jejunostomy. Histological examination of the resected bile duct, in one case, and of a bile duct biopsy, in the other, was consistent with late irradiation injury. We conclude that stricture may be a delayed consequence of radiotherapy applied to normal bile ducts.

Abdominal Neoplasms↗
PubMed1994

[Survey of the quality of sleep during the perioperative period. Study of factors predisposing to insomnia].

In order to assess the quality of sleep in surgical patients the amount of self-rated postoperative insomnia and its predisposing factors, we conducted a three-fold questionnaire * survey in 176 consecutive patients undergoing elective orthopaedic, vascular or abdominal surgery. The first questionnaire was completed the day preceding surgery, the second at the day of discharge and the third two weeks later. This survey concerned the patient's general status, his usual sleep profile and factors which could interfere with sleep (hypnotics, pain, environmental factors) throughout the study period. It allowed quantification of these parameters and the assessment of their time-course. Perioperative insomnia appeared to be a long-lasting phenomenon which persisted after discharge. Factor analysis and multiple regression models showed that postoperative, self-rated insomnia was multifactorial and mainly explained by the amount of postoperative pain (p = 0.035).

Adult↗
PubMed1994

Hepatocellular adenoma: color Doppler US and pathologic correlations.

PURPOSE: To describe the color Doppler ultrasound (US) features of hepatocellular adenoma (HA) and correlate these findings with pathologic findings, with special emphasis on the blood vessels. MATERIALS AND METHODS: Color Doppler US was prospectively performed in eight patients with histologic proof of HA. Eleven lesions were studied. RESULTS: In seven lesions, color Doppler US demonstrated central color flow. In six of these lesions, pulse-wave Doppler US demonstrated a continuous and flat venous spectrum with frequency shifts of 0.20-0.60 kHz (mean, 0.37 kHz), which corresponded to pathologic findings of intratumoral veins 1-5 mm in diameter. The other lesion with central color flow demonstrated a triphasic venous waveform with 1.20-kHz frequency shift, which corresponded pathologically to a central vein 10 mm in diameter. In these seven lesions, color Doppler examination demonstrated both venous and arterial peritumoral flow. CONCLUSION: Color Doppler US enables detection of intratumoral veins associated with peritumoral veins and arteries in patients with HA; these findings correlate well with pathologic data. These results might help in the differential diagnosis of HA and focal nodular hyperplasia.

Adenoma, Liver Cell↗
PubMed1994

[Surgical treatment of severe acute pancreatitis. Results of a prospective multicenter study of the Associations of Research in Surgery].

OBJECTIVES: The aim of this prospective study was to appreciate, in severe acute pancreatitis, the therapeutic choice of the surgeons for the treatment of pancreatic necrosis and the timing of operation in biliary pancreatitis. METHODS: Forty-six centers participated in the study. For every included patient, cause and severity criteria of the pancreatitis, timing of surgery, surgical management and necrosis features were recorded. Mortality and morbidity, number of surgical operations and clinical course were analyzed depending on necrosis infection. RESULTS: From August 1986 to January 1990, 143 patients were included in the present study. The main causes of pancreatitis were gallstones in 66 patients and alcohol in 45. Other causes were found in 32 patients. Overall mortality was 23.8%. Mortality was higher in 38 patients with infected necrosis than in 41 patients with sterile necrosis (39% vs 27%). In patients with severe acute biliary pancreatitis operated on within the first seven days of pancreatitis, mortality and number of reoperations were higher than in patients operated on later (30% vs 14% and 40% vs 21% respectively). CONCLUSIONS: These results suggest that clinical trials on the treatment of pancreatic necrosis and on the timing of the treatment of biliary pancreatitis are needed. The analysis of mortality shows that it will be difficult to organize these trials.

Acute Disease↗
PubMed1994

[Liver transplantation with preservation of portacaval flow: comparison with the conventional technique].

A modified technique of liver transplantation was used in 46 adults. This technique consisted of: a) construction of a temporary end-to-side porto-caval shunt, b) total hepatectomy with preservation of the inferior vena cava, c) closure of the graft inferior vena cava at both ends, d) partial clamping of the recipient's inferior vena cava followed by side-to-side cavocaval anastomosis, e) suppression of the temporary porto-caval shunt with completion of the operation according to the conventional technique. The results obtained with this technique were compared to those of 40 transplantations performed with the conventional technique. The use of veno-venous extracorporeal circulation was able to be avoided in every case with the modified technique, but was necessary in 70% of cases with the conventional technique. A significant reduction of the operating time (7.2 vs 9.3 hours) and transfusional requirements (11.4 vs 20.3 units of packed cells) was observed. The principal characteristic of this technique was the haemodynamic stability of the patients throughout the operation. These results suggest that this technique is an reliable and effective alternative to the use of veno-venous extracorporeal circulation during liver transplantation in adults.

Extracorporeal Circulation↗
PubMed1994

Prognostic value of early computed tomographic scans in severe acute pancreatitis. French Association for Surgical Research.

BACKGROUND: The prognostic value of computed tomographic (CT) scans in differentiating mild from severe forms of acute pancreatitis is well established. Nonetheless, in patients with a severe form of the disease, some will have a relatively uneventful course while others will have severe complications. This prospective, multicenter study was done to evaluate the prognostic value of early CT scan in a homogenous group of patients with a first attack of severe acute pancreatitis. STUDY DESIGN: Dynamic CT scans were performed within 48 hours after admission. A standardized form was completed for each CT scan, recording the following data: abnormal enhancement of the pancreas itself, characteristics of extrapancreatic collections, and visualization of the portal and splenic veins. Statistical analysis was based on the log rank test and Cox's model and used death and abscess occurrence as the two end points. RESULTS: Two hundred twenty-eight patients from 46 centers were included in the study. The median Ranson and Imrie scores were 3 and 4, respectively. Forty-seven patients died and 72 had an abscess. The CT scan findings indicating an increase in mortality rate were nonenhancement of the neck of the pancreas (p = 0.04) and extrapancreatic collections within the left (p = 0.001) and right (p = 0.02) pararenal posterior spaces. The risk of abscess increased when there was nonvisualization of the splenic vein (p = 0.0001), in the presence of extrapancreatic collections in the right pararenal posterior space (p = 0.03) and when the extrapancreatic collections were heterogenous (p = 0.003). CONCLUSIONS: This study demonstrated that the location of extrapancreatic collections and nonvisualization of the splenic and portal veins on CT scans were not previously recognized prognostic factors of complicated outcome in patients with severe acute pancreatitis.

Abdominal Abscess↗
PubMed1994

[Value of a powerful initial immunosuppression after liver transplantation. Prospective study of 60 cases].

With usual immunosuppression, the incidence of acute rejection after liver transplantation is higher than 60% in most series. The aim of this prospective study was to assess the value of a powerful initial immunosuppression on acute rejection, mortality and morbidity. REGIMEN. Group 1: patients with normal postoperative renal function (serum creatinaemia < 150 mumol/L) received cyclosporine from day 1 to day 15 by continuous i.v. infusion to reach a whole blood level of 400 to 500 ng/mL; after day 15, cyclosporine was reduced. Group 2: in cases of postoperative renal failure (serum creatinine > or = 150 mumol/L), anti-thymocyte globulins were used for 10 days; cyclosporine was introduced after recovery of renal failure at usual doses. In addition, all patients received steroids and azathioprine according to usual regimens. RESULTS. From January 1989 to June 1992, 60 cases were studied in 59 patients: 45 (75%) entered group 1 and 15 (25%) entered group 2. In group 1, there were 11 acute rejection episodes (24%) and one postoperative death at three months (2.3%). In group 2, two early deaths (within 5 days) were excluded from the study of rejection. Among the 13 remaining cases, there were three episodes of acute rejection (23%) and one hospital death at three months. Overall, there were 14 episodes of acute rejection (24%), 12 of which were steroid-responsive (86%), no chronic rejection, a usual rate of infections (57%), one retransplantation (1.7%) and a hospital mortality of 6.8% (4 of 59 cases). One year survival was 78%, with 5 of 7 late deaths due to recurrent cancer. CONCLUSIONS. Our results suggest that, after liver transplantation, a) high initial cyclosporine dose in patients with normal postoperative renal function is associated with reduced incidence and severity of acute rejection without increased mortality and morbidity, b) antithymocyte globulins are an efficient alternative to cyclosporine in patients with postoperative acute renal failure and saves OKT3 for the treatment of steroid-resistant rejection.

Adult↗