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Biomedical subjects

D Franco

Publications and source records attributed to D Franco.

At least 127 records · Page 7Linked to original sources
PubMed1991

Splanchnic and systemic hemodynamics in cirrhotic patients with refractory ascites. Effect of peritoneovenous shunting.

The splanchnic and systemic hemodynamics of 14 patients with refractory ascites were studied and were compared to those of 15 patients with ascites responding to medical treatment. Among the 14 patients, 10 were grade B and 4 C, according to the Pugh classification. Of the 15 patients, 5 were Pugh B and 10 C. In patients with refractory ascites, free hepatic venous pressure was significantly higher and hepatic venous pressure gradient was significantly lower than in patients with responsive ascites. Hepatic and azygos blood flows were not significantly different between the two groups. Cardiac output was lower in patients with refractory ascites (p less than 0.05) than in those with responsive ascites. In patients with refractory ascites, six months after peritoneovenous shunting, there was a significant reduction of wedged and free hepatic venous pressures and azygos blood flow. Cardiac output increased by 20 % (p less than 0.02). This study shows that hemodynamic alterations in patients with refractory ascites is the consequence of increased intraabdominal pressure due to chronic ascites. Six months after peritoneovenous shunting splanchnic and systemic hemodynamics became similar to those observed in patients without ascites.

Adult↗
PubMed1991

Regulation of fatty-acid metabolism by pancreatic hormones in cultured human hepatocytes.

The effects of pancreatic hormones and cyclic AMP on long-chain fatty-acid metabolism were investigated in human hepatocytes isolated from 12 liver biopsy specimens and cultured for 4 days in an insulin-free medium. Glucagon (10(-6) mol/L) increased endogenous ketone body production by 150%. This resulted from alterations in the partition of long-chain fatty acids from esterification toward oxidation. Glucagon or cyclic AMP enhanced (14C) oleate oxidation (basal = 45.8% +/- 5.0%; glucagon = 66.8% +/- 5.3%; cyclic AMP = 67.6% +/- 5.0% of metabolized oleate) at the expense of oleate esterification. Insulin (10(-7) mol/L) antagonized the glucagon-induced oleate oxidation. After 24 hr in basal culture conditions, the rate of lipogenesis decreased to the same low rate as in glucagon-treated cells. The presence of insulin did not restore a high rate of lipogenesis. These results are the first direct evidence of a control of ketone body production by glucagon in the human liver.

Adult↗
PubMed1991

Expression of insulin-like growth factor II, alpha-fetoprotein and hepatitis B virus transcripts in human primary liver cancer.

Insulin-like growth factor II is a fetal growth factor structurally and functionally related to insulin and insulin-like growth factor I. Its mRNA expression is developmentally regulated in human liver, the reexpression of insulin-like growth factor II fetal transcripts being often observed in primary liver cancer. Insulin-like growth factor II and alpha-fetoprotein mRNAs were studied in 16 human primary liver cancers, most of which were highly differentiated. Hepatitis B virus transcripts were also analyzed in the tumors from hepatitis B virus chronic carriers. alpha-Fetoprotein mRNA was detected in only four tumors and in one nontumorous cirrhotic tissue; all these samples also displayed insulin-like growth factor II fetal transcripts. Furthermore, fetal insulin-like growth factor II mRNAs were observed in five tumors and six nontumorous cirrhotic areas not expressing alpha-fetoprotein mRNA. The presence of hepatitis B virus RNA was only observed in tissues not expressing alpha-fetoprotein or fetal insulin-like growth factor II mRNA. In conclusion, fetal insulin-like growth factor II transcripts are more frequently observed than alpha-fetoprotein mRNA in highly differentiated liver cancers and in surrounding cirrhotic areas. The reexpression of fetal insulin-like growth factor II transcripts might then be a marker of early steps of liver cell transformation.

Carrier State↗
PubMed1991

Analysis of morbidity and mortality rates in right hepatectomy with the preoperative APACHE II score.

Morbidity and mortality rates in 70 patients who underwent major liver resection for liver tumors (primary and metastatic) were determined and correlated with the preoperative APACHE II score. Patients were divided into three groups according to their preoperative APACHE II score: low (0 to 3), mid (4 to 7), and high (8 and above). A higher score was closely correlated with increased postoperative morbidity and operative mortality rates. The group with low scores had a postoperative morbidity rate of 34% and a mortality rate of 0%, the group with mid scores had a postoperative morbidity rate of 54% and a mortality rate of 3%, and the group with high scores had a postoperative morbidity rate of 80% and a mortality rate of 20%. Age did not correlate with morbidity. It was therefore postulated that morbidity and mortality rates were related to the combination of points for abnormal physiologic variables and points for chronic health, or APACHE II score minus points for age. As the combination of these points increases the postoperative morbidity and operative mortality rates increase significantly (from 24% in the 0-point group to 69% in the greater than or equal to 3-point group). Also the two deaths occurred in the group with 3 or more points. The preoperative APACHE II score may be used by clinicians to evaluate before surgery the risk of postoperative morbidity and death in elective major liver surgery.

Adult↗
PubMed1991

The management of liver metastases.

The spontaneous life expectancy of patients with liver metastases from colorectal cancers is dismaying. Surgical resection is the only treatment which may help these patients. After resection the 5-year survival rate averages 25%. The best results are obtained in patients with one or few metastases localized to one liver lobe. There is no effective adjuvant therapy. Systemic or regional chemotherapy and immunomodulation have little effect in patients with inoperable metastases.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

[Dilatation of bile ducts in polycystic kidney disease in adults].

We report the cases of 4 adult patients with polycystic kidney disease and dilatation of bile ducts. Dilatation involved the extra-hepatic bile ducts in all 4 cases and also affected the intra-hepatic bile ducts in 3 cases. A prospective ultrasonographic study in search of biliary tract abnormalities was undertaken in 40 patients with dominant polycystic kidney disease. No bile duct dilatation was found in this series, which indicates that the lesion is rare. The 4 cases reported here increase the collection of hepatobiliary lesions associated with polycystic kidney disease of adults.

Bile Duct Diseases↗
PubMed1990

Polymerase chain reaction to detect hepatitis B virus DNA and RNA sequences in primary liver cancers from patients negative for hepatitis B surface antigen.

BACKGROUND AND METHODS: The role of hepatitis B virus (HBV) in the course of patients with primary liver cancer who are negative for hepatitis B surface antigen has been debated. We used the polymerase chain reaction to evaluate 28 such patients for the presence of DNA and RNA sequences of the virus; 22 of these patients had associated cirrhosis. The patients were from areas with different prevalences of HBV infection (South Africa, Italy, France, and Japan). RESULTS: Antibodies to the surface and core antigens of HBV were detected in 10 of the 23 patients tested. HBV DNA sequences were detected in 17 of the 28 patients, including 8 of the 10 with HBV antibodies and 6 of 13 without HBV serologic markers. HBV RNA molecules were found in four of five tumors tested. CONCLUSIONS: Our investigation indicates that transcriptionally active HBV genomes are present in various geographic areas among patients with liver cancer who are negative for hepatitis B surface antigen. This observation is consistent with an etiologic role for the virus in the development of these tumors.

Adult↗
PubMed1990

Expression of insulin-like growth factor II (IGF-II) in human primary liver cancer: mRNA and protein analysis.

Insulin-like growth factor II (IGF-II) is a polypeptide growth factor thought to be involved in fetal tissue development. We previously showed an increased expression of IGF-II mRNA in human primary liver cancer. The present investigation was undertaken to characterize the overexpressed IGF-II transcripts and to determine whether they are translated into protein. Two cDNAs with distinct 5' untranslated regions, corresponding to IGF-II transcripts expressed in fetal liver, were isolated from a primary liver cancer. Complete nucleotide sequence analysis showed an identical open reading frame of 540 bp, encoding a predicted polypeptide identical to the IGF-II isolated from serum. An increased synthesis of IGF-II protein was demonstrated by a protein-binding assay in tumorous liver samples, the highest levels being found in primary liver cancers with the highest IGF-II steady state level. By contrast, serum IGF-II content was low in most of primary liver cancer cases analyzed. Altogether, the results indicate reexpression of IGF-II both at the mRNA and protein levels in primary liver cancer. This finding is consistent with IGF-II being a marker of liver cell differentiation. In addition, this growth factor might be involved in liver cancer progression by an autocrine and/or paracrine mechanism.

Adenoma, Bile Duct↗
PubMed1990

Systemic AA amyloidosis induced by liver cell adenoma.

Systemic AA amyloidosis is a rare complication of benign tumours. This report describes a patient with hepatocellular adenoma associated with reactive AA amyloidosis. He had a nephrotic syndrome with deteriorating renal function and an increase of serum concentrations of acute phase proteins, mainly C-reactive protein. Resection of the tumour was followed by improvement in renal function and a marked decrease of the serum concentrations of acute phase proteins.

Amyloidosis↗
PubMed1990

Comparison of rat liver preservation with Eurocollins and a modified University of Wisconsin solution: transplantation and isolation of hepatocytes for culture.

The efficiency of Eurocollins or modified University of Wisconsin (UW) solution (MUW) in preserving rat livers was compared. After cold storage with one of the solutions, the livers were transplanted or perfused by collagenase for isolation of hepatocytes. Five of the 6 rats receiving a graft preserved with MUW versus none of the 6 rat receiving a graft preserved with Eurocollins solution survived 24 h or more. A significantly greater number of hepatocytes were isolated from livers preserved with MUW than from livers preserved with Eurocollins solution. This suggests a better reperfusion of MUW-preserved livers by collagenase resulting from less endothelial injury. LDH release by cultured hepatocytes, ketone body production and stimulation by glucagon were not significantly different between the two groups. These results confirm the superiority of MUW solution over Eurocollins in preserving liver grafts. They suggest that the advantage of MUW solution results from better protection of vascular endothelium rather than of hepatocytes.

Adenosine↗
PubMed1990

Resection of hepatocellular carcinomas. Results in 72 European patients with cirrhosis.

This study was undertaken to determine the results of resection of hepatocellular carcinoma in cirrhotic patients in Europe, using the same criteria as in the Orient for detection, surgical management, and pathology of the tumors. Seventy-two patients had a liver resection. One- and 3-yr survival rates were 68% and 51%, respectively. Survival rate was significantly higher in Child's/Pugh's class A than in class B-C patients. Patients with a thickly encapsulated tumor lived longer than those with an infiltrating tumor and had in addition a significantly lower incidence of cancer recurrence. Class A patients with a thickly encapsulated hepatocellular carcinoma had a 77% 3-year survival rate. There was no relation between the size of the tumor or the presence of symptoms and survival. These data suggest that good results can be achieved by resection of hepatocellular carcinomas in European cirrhotic patients. A thickly encapsulated tumor and an adequate liver function are the main determinants of low cancer recurrence and high survival. The clinical results in this series are similar to those reported from the Orient.

Adult↗
PubMed1990

Failure of ascitic fluid replacement for prevention of coagulopathy post peritoneovenous shunt. Case report.

A case of successive coagulopathies post peritoneovenous shunt in the same patient is presented. These coagulopathies occurred after a LeVeen valve insertion with ascitic fluid evacuation, and after reopening the shunt with ascitic fluid evacuation, with the peritoneal cavity washed and replaced with normal saline solution. This case illustrates the fact that peritoneal lavage and the replacement of the ascites with normal saline decrease the severity of the coagulopathy but do not prevent it completely. Peritoneal lavage and ascitic fluid replacement when a LeVeen valve is inserted, should be performed in selected cases, especially those who had a recently treated bacterial peritonitis.

Ascitic Fluid↗
PubMed1989

Effect of haemodilution on transfusion requirements in liver resection.

Between April, 1988, and February, 1989, 22 consecutive patients underwent liver resection (17 hepatectomy, 5 segmentectomy) with intraoperative haemodilution to avoid blood transfusion. The results were compared with those of 22 patients who underwent liver resection without haemodilution between February, 1987, and April, 1988, and who were matched for the nature of the tumour and the type of liver resection. Age, preoperative haematocrit and haemoglobin concentration, and intraoperative blood loss did not differ between the groups who did and did not undergo haemodilution. There was no abnormal bleeding during liver transection in haemodiluted patients. No allogeneic blood products at all were needed in a significantly greater proportion of the group with haemodilution than of the group without (19 [86%] vs 6 [27%]). The two groups also showed significant differences in the total requirements of allogeneic packed red cells (haemodilution 9 units, no haemodilution 84 units) and fresh frozen plasma (9 vs 119 units). Although the haematocrit was slightly but significantly lower in the group who underwent haemodilution than in those who did not on postoperative days 1 and 8, the differences had disappeared by the second postoperative month. Postoperative complication rates, abnormal results in liver biochemical tests, and lengths of hospital stay were the same in patients with and without haemodilution. Intraoperative haemodilution in patients undergoing liver resection reduced requirements for all blood products, further lowering the risks associated with liver resection.

Blood Transfusion↗
PubMed1989

Improved early results of elective hepatic resection for liver tumors. One hundred consecutive hepatectomies in cirrhotic and noncirrhotic patients.

Liver resection for a neoplasm was performed in 100 patients between 1979 and 1987. There were 43 hepatocellular carcinomas (70% of them arising in patients with cirrhosis), 28 metastases from colorectal cancers, 20 benign tumors, and 9 miscellaneous tumors. Forty-nine patients had a major liver resection, 36 a segmentectomy, and 15 a nonanatomic liver resection. Great care was taken to avoid intraoperative and postoperative bleeding, including late ligation of the hepatic vein, the use of Kelly fracture and resorbable clips for hemostasis of transection planes in 74 patients, and temporary clamping of the portal pedicle in 22. Drainage of the abdomen was avoided in 21 patients to prevent ascitic leakage to decrease the postoperative hospital stay. Operative mortality was 1%. There were eight major complications, including one bile leak, one subphrenic abscess, and three subphrenic hematomas. The use of resorbable clips significantly reduced operative time and transfusion requirements. In patients with cirrhosis, temporary clamping of the hepatic pedicle significantly decreased blood loss. Avoiding drainage significantly decreased the postoperative hospital stay.

Adult↗
PubMed1989

Morphological and histological features of resected hepatocellular carcinoma in cirrhotic patients in the West.

The pathological findings of 26 consecutive resections for hepatocellular carcinomas developing in cirrhotic patients were analyzed morphologically with a special interest in the presence of a capsule, vascular extension and satellite nodules. Tumor sizes varied from 2 to 11 cm. There were 20 expanding (76.9%) and six infiltrating tumors. Infiltrating tumors were significantly larger than expanding tumors (p less than 0.01). Histologically, the most common subgroups were the trabeculated pattern (65.4%) and the Edmonson-Steiner Type II (53.9%). Of the 20 expanding tumors, only six had direct spread in the liver parenchyma adjacent to the tumor (p less than 0.02). There was a significant relationship between the presence of a tumor extension in the distal portal branches and the presence of satellite nodules around the tumor (p less than 0.01). Survival at 6 months was significantly lower in patients with infiltrating (16.7%) than in those with expanding tumors (75%), (p less than 0.05). The present results indicate that pathological features of hepatocellular carcinomas in cirrhotic patients in Western countries are similar to those encountered in the East: (a) tumors are frequently encapsulated; (b) the propensity for the tumor to spread is closely related to the presence of a tumor capsule. This study suggests that a thorough preoperative search for the capsule should be made whenever resection of a hepatocellular carcinoma in a cirrhotic patient is contemplated.

Carcinoma, Hepatocellular↗