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Biomedical subjects

D Elias

Publications and source records attributed to D Elias.

263 records · Page 15Linked to original sources
PubMedDate not supplied

[Evaluation of 242 laparotomies for hepatic metastasis performed at the Institut Gustave Roussy over 5 years].

Two hundred and forty two laparotomies for single or multiple isolated liver metastases (LM) have been performed in 5 years. One hundred and seventy three were performed for LM from colo-rectal cancers and after abdominal exploration it has been carried out 46 hepatectomies, 92 implantations of catheter for intra-arterial hepatic chemotherapy (IAHC) and 35 abstentions. Sixty nine were performed for LM from miscellaneous origins and it has been carried out 32 hepatectomies, 18 implantations of catheter for IAHC and 19 abstentions. The main conclusions of this study are: 1) every preoperatively estimated unresectable LM has never been resectable at abdominal exploration. 2) When it was anticipated to perform an hepatectomy, it was possible to do it only in two-third of the cases, the main reason of non resectable LM was intra or extra hepatic diffusion. 3) When the LM has been preoperatively estimated as un-resectable, the metastatic disease was isolated in the liver in two third of the cases and it was almost always technically possible to place an arterial catheter (108 instances in 110 cases). 4) In 3% of the cases, pre-operative images of LM have not been confirmed at surgery and the diagnosis has been made on biopsies with frozen sections which, must always preceded local hepatic treatment.

Adult↗
PubMedDate not supplied

[Intermittent and ambulatory intra-arterial chemotherapy using a subcutaneous access chamber in the treatment of isolated hepatic metastases. Preliminary results].

Discontinuous daily ambulatory intra-arterial chemotherapy using a needle access chamber implanted subcutaneously was achieved for treatment of nonresectable isolated hepatic metastases. This original approach is a compromise between the uncomfortable exterior catheter and the exorbitant cost of a pump implant. Phase I study (6 cases) brought out the technical problems involved in this method. Phase II study (presently 11 cases) of only primary colonic or rectal tumor metastases treated with 5-fluorouracil and mitomycin C was undertaken. The preliminary results of this small series yields 64 percent objective improvement for which 55 percent are complete remissions.

Antineoplastic Agents↗
PubMedDate not supplied

[Rectal adenocarcinoma in adults under 35 years of age. Apropos of 37 cases].

Minimum follow up of 37 cases treated at the "Institut Gustave-Roussy (IGR)" over the last 10 years has been for more than 23 months. Twenty-three of these patients had been treated entirely by the IGR using surgery and radiotherapy (45 to 60 Gy). Excision was curative in 13 cases and palliative in 10. Several conclusions can be drawn: The relative frequency in inhabitants of mediterranean countries (particularly North Africa and Italy where this cancer is respectively 15 ans 17 times more frequent than in young Frenchmen) and in women; the absence of obvious predisposing factors; the frequency of mucosal colloid forms (57%), and the extent of the lesion at diagnosis (60%, of Dukes C2 and 20% of Dukes D) even when there was no delay between first symptoms and diagnosis; and the 2-year survival (45%) in the patients treated in the IGR alone, whereas it is 75% for the 285 patients over 35 years of age. Early diagnosis, including in young adults, is essential, as well as immediate radical surgery and radiotherapy.

Adenocarcinoma↗
PubMedDate not supplied

[Epidermoid epitheliomas of the rectum : a report on three cases (author's transl)].

Three cases of this rare condition are reported and the published literature reviewed. Their insidious clinical nature is underligned, as well as their weak sensitivity to radiotherapy. The etiopathogenicity of epidermoid epitheliomas of the rectum is discussed. These tumors are very rarely observed in the middle of rectal mucosa. Three cases treated at the "Institut Gustave-Roussy" are described, as well as serveral cases reported in the published literature.

Aged↗
PubMedDate not supplied

[Treatment of hepatocellular carcinoma in the presence of liver cirrhosis].

Hepatocellular carcinoma accounts for 90% of the primary malignant liver tumours. Most cases occur in cirrhotic livers. Management decisions should not be based on the stage of the tumour extension but rather on the functional situation of the liver. The first therapeutic option which should be considered is surgical resection if the case presents with a single tumour (or less than 4 tumours for some teams) without detectable metastasis nor intraportal thrombosis and if the liver remaining after surgery will be sufficient for normal hepatic functions. The disadvantage of resection is the high risk of recurrence in the long term. Liver transplantation cannot be proposed if the hepatocellular carcinoma has produced clinical signs but it can be a possibility in case of a resectable tumour in the framework of a prospective protocol comparing transplantation and resection. Intra-arterial injection of 131-iodine linked lipiodol is the only effective treatment in case of portal thrombosis. Chemoembolization of nonresectable hepatocellular carcinoma has led to spectacular tumour response but its effect on survival has not been demonstrated by randomized studies. For tumours less than 3 cm in diameter, even multifocal alcoholization has proved encouraging results. Although a randomized study of questionable quality suggested tamoxifen could be effective, there is no current indication for this drug. External radiotherapy may be a possibility in the future, especially with proton irradiation. Thus the current management of hepatocellular carcinoma is in a difficult, even paradoxical, situation since there is a wide therapeutic choice (resection, alcoholization, transplantation) for the rare cases with small tumours but almost no possibilities for the more severe cases most frequently encountered.

Adult↗
PubMedDate not supplied

[Surgical approaches to segment I for malignant tumors (20 cases)].

Seven complete and 13 partial resections of segment I (caudate lobe) were performed for malignant tumors. In all except one instance, removal of segment I was combined with other types of hepatic resection for technical or carcinologic reasons. Six were iterative hepatic resections for recurrent hepatic metastases. In two, the future remaining left lobe was hypertrophied by right portal venous embolization preoperatively. Hepatectomies were performed with intermittent portal triad clamping (mean total duration of 63 minutes, range of 20 to 120 minutes) and after preparation for total vascular exclusion. Associated partial resection of the inferior vena cava was necessary in three instances. Mean duration of operation was 285 minutes (range of 60 to 540 minutes) and mean blood loss was 1,749 milliliters (range of 200 to 5,200 milliliters). There was no postoperative mortality and the morbidity rate was low. Surprisingly, we discovered retrospectively that free margins were small (less than 5 millimeters) in 83 percent of the patients. Regardless of limited free margins and six iterative hepatectomies, eight patients were free of disease with a mean follow-up examination period of 19.2 months. Technical problems were different for each patient and a patient by patient adaptation was necessary. Left, right and central approaches were used accordingly. If resection of segment I associated with a right of left hepatectomy can currently considered as a standard hepatic resection, isolated complete resection of segment I remains a real technical challenge.

Adult↗
PubMedDate not supplied

Fibrin glue effectiveness and tolerance after elective liver resection: a randomized trial.

BACKGROUND/AIMS: The propensity of fibrin glue to achieve ultimate control of the liver raw surface and its tolerance after hepatic resection, were evaluated by a prospective study. MATERIALS AND METHODS: Seventy seven patients undergoing elective liver resection for benign lesions (n = 35) and malignant lesions (n = 42) including 7 with cirrhosis were studied. Randomization took place only at peritoneal closure and after completion of hemostasis and biliostasis. RESULTS: In the group with fibrin glue (n = 38), a single dose of 5 ml was applied to the liver cut surface. The appearance of the liver margin at abdominal closure was judged as dry in 34/35 (97%) patients with fibrin glue, versus 34/42 (81%) in those without (p = 0.016). Although postoperative morbidity and mortality were not different between the 2 groups, the mean total fluid drainage during the three postoperative days and bilirubin concentration were significantly lower in the group with fibrin glue; respectively 242 +/- 249 ml vs 505 +/- 666 ml and 24 +/- 21 mmoles/l vs 65 +/- 47 mmoles/l. CONCLUSIONS: Our results indicate that fibrin glue application to the hepatic stump after hepatic resection provides effective sealing with good systemic and local compatibility.

Adult↗
PubMedDate not supplied

Preoperative selective portal vein embolizations are an effective means of extending the indications of major hepatectomy in the normal and injured liver.

BACKGROUND/AIMS: Liver tumors may be unresectable for volumetric reasons; the post-hepatectomy future remaining liver (FRL) will be too small to ensure survival. In some cases, preoperative selective portal vein embolization (PSPVE) of the tumorous part of the liver can permit the induction of hypertrophy of the FRL and convert patients from an unresectable to a resectable status. METHODOLOGY: Analysis of the efficiency of PSPVE in changing the volume of the FRL and in permitting curative hepatectomy was performed in a retrospective study of 28 initially unresectable (for volumetric reasons), consecutive cases treated from September 1987 to September 1995. Fifty percent of the cases had damaged liver parenchyma. PSPVE was performed in various locations, according to the site of the tumor and impairment of the liver parenchyma. RESULTS: Twenty-five PSPVE (89%) successfully induced sufficient hypertrophy of the FRL. Explanations could be found retrospectively for the 3 failures. For the 28 cases, the mean increase in the FRL was 70%, and the mean ratio between the FRL and the whole functional liver changed from 21.5% before PSPVE, to 33.9% after PSPVE. Twenty-three patients could be hepatectomized (82%). CONCLUSIONS: With this technique, liver tumors considered to be unresectable, due to life-threatening volumetric insufficiency, may be considered resectable lesions, and there is an increase in the safety of some extended hepatectomies. These good results were mainly due to application of the distal and proximal free flow embolization technique, with non-absorbable material, and perhaps to the long interval of one month between PSPVE and hepatectomy. Indications in normal liver parenchyma are for patients with a very small left lobe or those requiring a right hepatectomy with wedge resections of the left liver. Indications for damaged liver parenchyma also include some cases requiring left trisegmentectomy or central hepatectomy.

Adolescent↗
PubMedDate not supplied

Intermittent complete vascular exclusion of the liver during hepatectomy: technique and indications.

BACKGROUND/AIMS: Complete intermittent vascular exclusion of the liver (IVEL) combines clamping of the hepatic pedicle with clamping of the hepatic veins without interruption of the caval flow. The major advantages of this technique are that patient preclamping fluid overload is avoided, major haemodynamic changes due to caval clamping are escaped, and it allows a very long clamping time. Disadvantage of this technique is the necessity of looping the terminal part of the hepatic veins. METHODOLOGY: In this prospective study, 41 cases of IVEL (Representing 19% of the hepatectomies carried out for cancer during the same period) used for difficult hepatectomies were analyzed, and the operative technique is presented. RESULTS: IVEL was feasible in 90% of the 46 attempted cases, and completely controlled the bleeding in 90% of the cases. The mean duration of IVEL was 69.2 minutes (Range: 37 to 140), and was greater than 130 minutes in three patients. No liver failure occurred during the postoperative course. CONCLUSION: We conclude that IVEL without caval clamping is a new, and valuable, technique of vascular exclusion of the liver. Its application is indicated in the following conditions: 1. For patients who should have classical vascular exclusion but cannot tolerate vena cava clamping (18% of the cases), 2. for patients with pathological liver parenchyma when intrahepatic venous pressure is high, 3. for patients with impaired liver parenchyma, requiring conservative surgery that leads to anatomic or non-anatomic resection close to a vein (Example: A tumor located in the dihedral angle of the terminal part of two hepatic veins), 4. for patients with tumors closely located to a hepatic vein that must be preserved and sharply dissected (Example: A left trisegmentectomy that requires pelting of the right hepatic vein), and 5. for the scarce patient with tumors infiltrating the major hepatic veins, constraining a hepatic vein reconstruction to preserve liver function.

Blood Loss, Surgical↗
PubMedDate not supplied

[Treatment of malignant gastric or duodenal stenoses by the insertion of metallic prostheses under fluoroscopic control].

PURPOSE: To evaluate the efficacy of metallic stents for palliation of malignant gastro-duodenal stenosis. MATERIALS AND METHODS: Twenty-three patients aged from 36 to 88 years old presented with nausea, vomiting and weight loss due to duodenal (n = 16) or antro-pyloric (n = 7) malignant stenosis and underwent placement of 37 Wallstents (1 to 3 per patient) under fluoroscopic guidance. RESULTS: After initial stent placement 17 patients had normal food intake. One patient was able to eat fractionated meals. Five patients did not experience any improvement due to the presence of a jejunal stenosis downstream in 2, or insufficient stenosis coverage in 2 and stent migration in 1. Nine of the 18 patients with improvement died without symptoms within 101 +/- 56 days after stent placement and 6 were alive and symptom-free after a mean follow up of 176 +/- 83 days. Three asymptomatic patients were lost to follow up after 3 days, 1 and 2 months, respectively. CONCLUSIONS: Metallic stents appear to be a valuable option for the treatment of malignant gastro-duodenal stenoses.

Adult↗