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Biomedical subjects

D Franco

Publications and source records attributed to D Franco.

At least 145 records · Page 8Linked to original sources
PubMed1989

Hepatocellular carcinoma with normal adjacent liver. Hepatitis B virus DNA status.

We investigated hepatitis B virus (HBV) DNA status in the liver of 22 patients with hepatocellular carcinoma (HCC) developed on a non-cirrhotic, histologically normal liver tissue. HBV serological markers were present in 2 of the 22 subjects. HBV DNA sequences were identified in the liver of only 5 of the 22 patients with HCC. Evidence for clonal expansion of HBV-infected cells was found for one HBsAg-positive subject. This study indicates a much lower rate of HBV DNA positivity in the group of HCC developed on histologically normal livers as compared to that observed in HCC with liver cirrhosis.

Adolescent↗
PubMed1989

Hepatectomy without abdominal drainage. Results of a prospective study in 61 patients.

The increasingly simple postoperative course of major surgery has challenged the routine use of drainage after most abdominal surgical procedures. Therefore a prospective study was designed to determine if abdominal drainage could be safely avoided after liver resection and was evaluated in 61 consecutive patients. There was one postoperative death (1.7%) from variceal bleeding. Four other patients (6.7%) developed an abdominal complication: two right subphrenic hematomas requiring reoperation in one case and two incisional ascitic leaks requiring incisional repair in one patient. There was neither a subphrenic abscess nor bile peritonitis. Postoperative hospitalization was 11.5 +/- 3 days in the entire group and 8.5 +/- 1 days in patients without complications. These results suggest that liver resection can be performed safely without abdominal drainage and that the routine use of drains is unnecessary.

Abdomen↗
PubMed1989

Patterns of consumption of alcohol in Seville, Spain. Results of a general population survey.

The results of a general population survey of the patterns of consumption of alcohol in a representative sample of the province of Seville, Spain, are analysed in this article. The proportions of drinkers and abstainers and distribution by age, by sex and by urban-rural residency are discussed. Frequency of consumption declines as age increases in both sexes but the negative slope is more marked in females. Analysis of the results on quantity of alcohol consumed during the week prior to the interview shows that men drink more heavily than women in all age-groups and young people drink more heavily than other age-groups. The combination of data on frequency of consumption and maximum quantity of alcohol reportedly consumed on the highest drinking occasion shows that the majority of men belong to the High Frequency-Low Quantity typology, followed by High Frequency-Medium Quantity, but in women nearly 60% belong to the Low Frequency-Low Quantity typology, followed by High Frequency-Low Quantity. The highest proportions of both abstainers and heavy drinkers are found in the group of people with the lowest income.

Adolescent↗
PubMed1989

Patterns of improvement in resection of hepatocellular carcinoma in cirrhotic patients: results of a non drainage policy.

A prolonged ascitic leak through abdominal drains is a source of postoperative complications and of prolonged postoperative hospital stay after liver resection for hepatocellular carcinoma (HCC) in cirrhotic patients. Therefore we elected to abstain from routine abdominal drainage in the last 14 resections in cirrhotic livers. A significantly smaller number of patients had postoperative complications following liver resections without drainage (7%) than historical controls with abdominal drainage (59%, p less than 0.01). The number of complications related to ascites was significantly greater in patients with abdominal drainage (76%) than without (0%, p less than 0.001). Postoperative hospital stay was also significantly longer following resections with abdominal drainage (19 +/- 4 days) than in patients without (12 +/- 1 days, p less than 0.01). The long postoperative hospital stay in patients with abdominal drainage was related to ascitic discharge for a mean period of 13 +/- 10 days. No clinically significant accumulation of ascites was noted in patients without drainage. A more frequent utilization of hepatic vascular inflow occlusion did not account for the better results in the group of patients without drainage. These results suggest that routine abdominal drainage should not be used following liver resection for HCC in cirrhotic patients. This appears to be another of the technical details improving postoperative results in these patients.

Adult↗
PubMed1989

Long term results (greater than 5 years) in patients with peritoneovenous shunting for intractable ascites: liver function and cancer mortality.

This report is based on twenty-eight (26%) of 107 patients included in a protocol for prospective evaluation of elective peritoneo-venous shunting for intractable ascites in cirrhosis. These patients had no other procedures and survived more than 5 years after the operation. All patients were free of ascites except one in whom it was mild. One patient refused follow-up. Shunt patency was assessed in 23 patients In 14 patients (60.9%), the shunt was obstructed and the superior vena cava was occluded in 5 of them. In 9 patients (39.1%), the shunt was still functioning. No clinical or biological parameters differentiated these two groups of patients. Of the 24 patients who were alcoholics, 2 abstained completely and 20 significantly reduced their drinking habits. In 25 patients, the Pugh's score improved and was A at the time of the study. Seven patients (25.9%) developed a malignant tumor of the oro-pharynx or digestive tract, all other patients were alive and in good health. This study suggests that patients with intractable ascites treated by a peritoneo-venous shunt may survive for a long period. In patients abstaining from heavy drinking, it may function as a therapeutic bridge permitting spontaneous improvement of liver function. The risk of supervening neoplasms suggests that a continuous follow-up of these patients is warranted.

Adult↗
PubMed1989

[Cost of the peritoneovenous shunt in patients with cirrhosis].

The cost of peritoneovenous shunting was evaluated in 15 cirrhotic patients with intractable ascites. With the assessment presently used in French Public Hospitals which is based on a contractual reimbursement by the Social Security per day of hospitalization, the cost of peritoneovenous shunting was F 37,227.40. Using the more refined method of cost analysis, the cost of the operative procedure was F 9,564 and that of postoperative hospitalization was F 8,067. Total expenses calculated by the cost analysis method (F 17,631) were much less that the reimbursement paid by Social Security. This study allowed to determine the actual cost of Surgical treatment of ascites, where expenses were greatest, and how to reduce them. Results of this report should be used when comparing cost and efficacy of medical and surgical treatments.

Adult↗
PubMed1989

[Results of the excision of benign tumors of the liver in 22 patients].

Between 1979 and 1987, 22 patients underwent resection for a benign liver tumor. A total of 24 tumors were resected: 8 adenomas, 8 focal nodular hyperplasias and 8 hemangiomas. In two patients, focal nodular hyperplasia was associated with hemangioma. Preoperative diagnosis of the nature of the tumor by radiologic investigations (ultrasonography, CT-scan, and selective angiography) was made in only 4 patients (18 p. 100), 3 with hemangioma and one with focal nodular hyperplasia. Ten patients underwent major hepatectomies and 12 had either a segmentectomy (8 patients) or atypical resection (4 patients). Progress in operative management significantly decreased transfusion of packed red cells (p less than 0.05) and that of fresh frozen plasma (p less than 0.02). Ten patients received no blood for fresh frozen plasma. Suppression of abdominal drainage when surgery was uneventful significantly decreased postoperative in-hospital stay (p less than 0.05) to a low 7.8 +/- 0.8 days and improved comfort of patients. These results confirm that preoperative diagnosis of a benign liver tumor is uneasy. They suggest that resection has become a benign procedure in selected surgical centers. The risk of ignoring malignant tumors or leaving a tumor with potential complications should prompt resection when the nature of a liver tumor has not been precisely determined by usual radiologic investigative procedures.

Adenoma↗
PubMed1988

Differential expression of insulin-like growth factor II mRNA in human primary liver cancers, benign liver tumors, and liver cirrhosis.

We investigated insulin-like growth factor II (IGF-II) mRNA in three groups of human liver samples including primary liver cancers, benign liver tumors and cirrhosis; indeed these pathological conditions would allow us to distinguish between different steps in liver carcinogenesis. A 40- to 100-fold increase in IGF-II mRNA was shown in 9/40 of the liver cancer samples as compared to normal adult liver. RNA blot analysis using both IGF-II cDNA and oligonucleotide probes showed the reexpression of two fetal (6 and 5 kilobases) IGF-II transcripts in primary liver cancers and in some cirrhotic adjacent tissues; these included all the samples with enhanced IGF-II expression. By contrast the adult (5.3 kilobases) IGF-II transcript was identified in most of the benign liver tumors and liver cirrhosis; in addition, in some of these samples, the 5-kilobase fetal transcript was also detected. The increase of IGF-II mRNA in some liver cancers is consistent with an autocrine mechanism conferring a selective growth advantage to tumorous liver cells. Furthermore, these results indicate a differential expression of IGF-II transcripts in nonmalignant hepatocyte proliferation (benign liver tumors and cirrhosis) as compared to liver cancer. Finally this study suggests that, in liver cirrhosis and in some benign liver tumors, premalignant proliferative states might be identified by the presence of IGF-II fetal transcripts.

Fetus↗
PubMed1988

Segmentectomies in the management of liver tumors.

Between 1982 and 1986, liver segmentectomies were performed in 19 patients with liver tumors, including ten hepatocellular carcinomas, six liver metastases, one cholangiocarcinoma, and two benign tumors. During surgery, patients received a mean (+/- 1 SD) of 1050 +/- 150 mL of packed red blood cells and 860 +/- 80 mL of fresh-frozen plasma. There were no operative deaths. The only complication was a prolonged leakage of ascites through the abdominal drain in one patient with cirrhosis. Seven patients with hepatocellular carcinoma were still alive at this writing, with a follow-up ranging from two months to four years. The four patients with metastases from colorectal carcinomas were alive after follow-up times ranging from six to 24 months. These results suggest that liver segmentectomy is a safe procedure and should be considered as the operation of choice for resection of limited liver tumors.

Adult↗
PubMed1988

Should portosystemic shunt be reconsidered in the treatment of intractable ascites in cirrhosis?

Fifty-seven cirrhotic patients with intractable ascites had a portosystemic shunt. In 35 patients, a peritoneovenous shunt had previously failed. Forty-six patients were in Pugh's class B and 11 were in class C. There were three operative deaths (5.3%). Fifty-three (98.2%) of the 54 survivors were cleared of ascites. In one patient, ascites persisted because of postshunt heart failure that resulted in a marked increase of caval pressure. Twenty-seven patients (50%) had late encephalopathy, which was severe and disabling in 12 (22%). One- and three-year survival rates were 72% and 36%, respectively. These results suggest that although portosystemic shunts are remarkably effective in dealing with ascites, the high rate of postoperative encephalopathy is a strong argument against their routine use in the management of intractable ascites in cirrhosis.

Adult↗
PubMed1988

Titanium catheter tip for peritoneovenous shunts.

Early obstruction of the venous tubing is a frequent complication after peritoneovenous (PV) shunting for ascites in cirrhosis and results in a high incidence of shunt failure. A titanium catheter tip, developed because of this material's thromboresistance, was employed in 13 consecutive cirrhotic patients receiving a LeVeen shunt for intractable ascites. While the mean interval before shunt occlusion was 4 +/- 3 months in our previous studies, none of the patients in the present series had venous catheter occlusion during follow-up, which averaged 8 +/- 2 months. The use of titanium in the venous tubing of PV shunts may significantly prolong the patency and function of these devices.

Catheterization↗
PubMed1988

[Resections of hepatocellular carcinomas in cirrhosis: results of a prospective study of 28 resections].

Twenty-eight liver resections were performed in 24 patients with cirrhosis and hepatocellular carcinoma: 6 major hepatectomies, 13 limited, and 9 atypical liver resections. Postoperative variceal rebleeding was precluded in 5 patients with previous bleeding by preoperative sclerotherapy. Intraoperative bleeding was minimized in 16 patients by clamping the hepatic pedicle. Ascites formation was prevented by reduction of intraoperative and postoperative fluid infusion. There were no operative deaths. Benign postoperative complications occurred in 5 patients (18 p. 100). In one patient, carcinoma was not found in the resected specimen. Nineteen of the 27 others tumors were less than 5 cm in diameter (70 p. 100). Twenty-two tumors were encapsulated (81 p. 100). One and two-year actuarial survival rates were 66 p. 100 and 48 p. 100 in the group of 23 patients after resection of one, or more than one tumor, respectively. In 17 patients with a tumor less than 5 cm in diameter, one and two-year survivals were 76 p 100 and 51 p. 100, respectively. In 16 patients with a free margin of healthy tissue of more than 10 mm, one and two-year survivals were 85 p. 100 and 61 p. 100 respectively. Our results suggest that: 1) the operative risk of liver resection in cirrhosis is low, provided preventive measures are taken to avoid intraoperative bleeding and postoperative variceal bleeding and ascites, and 2) late survival is good in selected groups of patients after resection of hepatocellular carcinoma and cirrhosis.

Adult↗
PubMed1988

[Peritoneovenous shunting in intractable ascites of cirrhosis. Results of a prospective study on improving prognostic factors].

A peritoneovenous (LeVeen) shunt was inserted in 39 patients with cirrhosis and intractable ascites. Based on the results of previous experience, the following procedures were performed to improve outcome: 1) intraoperative drainage of most of the ascites; 2) short-term antibiotic prophylaxis by cefotetan; 3) the use of a titanium venous catheter tip. There was no operative mortality. Operative morbidity was minimal. Mean postoperative in-hospital stay was 19 +/- 5 days. Two patients had recurrence of ascites. This resulted from obstruction of the valve in one patient and of occlusion of the venous catheter in the second patient. One-year probability of shunt failure was 5.8 p. 100. Among the long-term complications, variceal bleeding was the most frequent as it occurred in 8 patients and was responsible for death in 6. One-year probability of variceal bleeding was 18.6 p. 100. Overall one-year survival was 68 p. 100, 79 p. 100 in the group of 19 patients with Pugh scores of 8 and less, 58 p. 100 in the group of 20 patients with Pugh scores greater than 8. These results suggest that technically improved peritoneovenous shunting is a low operative risk surgical procedure with high efficiency in the treatment of intractable ascites in cirrhosis.

Adult↗
PubMed1987

Biliary metastases of breast carcinoma. The case for resection.

Obstructive jaundice developed in two patients 6 and 8 years after surgery for breast carcinoma. In both patients exploration disclosed a tumor of the hilus which was a biliary metastasis of breast cancer. Surgical resection was performed. Examination of the resected specimen showed infiltration of the duct walls by sheets of metastatic carcinomatous cells from the previous breast cancer. The postoperative course was uneventful in both patients with disappearance of all symptoms due to the biliary obstruction. The first patient died 4 years later from peritoneal deposits and the second was alive at 30 months with a metastasis to the hip. These observations differ from most of those previously reported, by the localization of the tumor at the hilus and the direct infiltration of the duct walls by the tumor. The results of this study suggest that aggressive surgical treatment may be the treatment of choice in patients with extrahepatic biliary metastases of breast carcinoma.

Adult↗