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Biomedical subjects

D Franco

Publications and source records attributed to D Franco.

At least 163 records · Page 9Linked to original sources
PubMed1987

Intractable ascites in systemic mastocytosis treated by portal diversion.

A 50-year-old male presented with intractable ascites due to systemic mastocytosis. The diagnosis of systemic mastocytosis was established by histology of the bone marrow which showed mast cell infiltration and fibrosis. Ascites was related to portal hypertension which was documented by esophageal varices at endoscopy and by an increase of wedged-free hepatic venous pressure gradient. Liver biopsy disclosed dense fibrosis of hepatic arterial and portal venule walls, resulting in complete obstruction of some portal radicles. Peliosis hepatis and fibrous deposits in the walls of hepatic venules were also present. Because of intractable ascites and significant malnutrition, a portacaval shunt was performed which cleared ascites and dramatically improved the general condition of the patient.

Ascites↗
PubMed1987

Bleeding from intestinal varices after a Warren shunt.

A 62-year-old man with alcoholic cirrhosis presented with massive gastrointestinal bleeding 4 years after a Warren operation. Angiographic examination suggested that the bleeding was due to ruptured jejunal varices. Treatment by propranolol and a side-to-side portacaval shunt failed to prevent further bleeding. An emergency laparotomy for life-threatening gastrointestinal (GI) rebleeding disclosed dense hypervascular adhesions between the second jejunal loop and the retroperitoneum, and a large submucosal varix of the jejunum that had ruptured. Development of intestinal varices after a Warren operation is facilitated by the persistence of a high pressure in the mesenteric territory and by adhesions between the initial part of the intestine and the area of dissection of the renal vein. This case illustrates one of the possible causes of rebleeding after a Warren operation.

Esophageal and Gastric Varices↗
PubMed1986

Results of portal systemic shunts in Budd-Chiari syndrome.

Nine patients with Budd-Chiari syndrome (BCS) were treated by a portal systemic shunt. One had thrombosis of the superior mesenteric vein (SMV) and another had complete obstruction of the retrohepatic inferior vena cava (IVC). All other patients had a marked stenosis of the retrohepatic IVC with caval pressure ranging from 12 to 24 mmHg (mean: 17 mmHg). Seven patients had an interposition mesocaval shunt using an autologous jugular vein. The patient with a thrombosed SMV had a portoatrial shunt. The patient with an obstructed IVC had a cavoatrial shunt after an erroneous portacaval shunt had failed to relieve ascites. There were no operative deaths and no major postoperative complications. One patient died 19 months after operation of acute leukemia complicating polycythemia rubra vera. All other patients were alive and well 8 months to 6 years after operation. None of them had encephalopathy. These results suggest several comments: Portal systemic shunts are a good treatment for BCS and have a low operative risk. The mesocaval shunt is an efficient procedure, even when there is stenosis of the IVC with high caval pressure; shunts to the right atrium should be performed only in the case of complete obstruction or inaccessibility of the IVC. The long-term prognosis is excellent, except in patients with potential malignancies. Therefore, portal systemic shunts should be indicated early in patients with symptomatic BCS.

Adolescent↗
PubMed1986

[Sugiura's operation: a Japanese exclusive?].

Fifteen patients with liver cirrhosis (11) or intrahepatic non cirrhotic portal hypertension (4) and previous variceal bleeding were electively treated by Sugiura's operation. There were no operative death. One patient (6.6 p. 100) had recurrent variceal bleeding 58 months postoperatively. One other patient had a self-limited episode of encephalopathy The 5-year actuarial survival rate was 81 p. 100. Four of the cirrhotic patients operated more than 5 years ago were alive at 5 years. The operation resulted in portal vein thrombosis in 2 patients, one of whom died. Results of this small series are quite similar to those of the largest Japanese series. They suggest that Sugiura's procedure has a low operative risk, is very efficient in preventing variceal rebleeding and does not result in encephalopathy.

Adult↗
PubMed1986

Recurrent ascites due to central venous thrombosis after peritoneojugular (LeVeen) shunt.

Twenty-five patients with cirrhosis with a peritoneojugular (LeVeen) shunt had recurrence of ascites because of obstruction of the venous catheter. They were investigated by direct shuntography and angiography of the superior vena cava (SVC). Shuntograms were suggestive of venous obstruction in all patients and showed either complete blockage at the tip of the venous catheter (87%) or partial obstruction (13%). Cavography disclosed a complete obstruction of the SVC or one of its branches in 65% of the patients, a nonobstructive mural thrombus in 17.5%, and sheathing around the catheter in another 17.5%. Blood clots formed at the tip of the catheter and not at its entrance into the vein. Replacement of the venous tubing or a contralateral shunt was successful in only one of eight patients with incomplete obstruction of the SVC. Failure was always due to recurrent venous obstruction. In patients with complete occlusion of the SVC, portal systemic shunts (12 patients) or peritoneosaphenous shunts (two patients) were always successful. These results suggest: that obstruction of the venous tubing of a LeVeen shunt is chiefly caused by the formation of a clot at the outlet of the tubing and that local procedures are prone to failure. Improvement of the long-term results of peritoneojugular shunting in intractable ascites of cirrhosis is clearly dependent on improvement of the venous tubing to decrease its thrombogenicity.

Adult↗
PubMed1986

Portoatrial shunt in Budd-Chiari syndrome.

It is now well accepted that mesoatrial bypass is an efficient treatment of Budd-Chiari syndrome and that it is indicated when the inferior vena cava is obstructed. This report presents a patient in whom the superior mesenteric vein was thrombosed after a previous mesocaval shunt. A bypass was constructed between the left side of the portal vein and the right atrium with a 16 mm diameter reinforced polytetrafluoroethylene prosthesis. The prosthesis passed between the left lobe of the liver and the caudate lobe and had a direct trajection. The procedure was simple, the postoperative course was uneventful, and the patient was well 20 months later. This observation suggests that portoatrial shunt is a good alternative to mesoatrial shunts in patients with Budd-Chiari syndrome and unavailable inferior vena cava and superior mesenteric vein.

Adult↗
PubMed1985

Hepatitis B virus DNA in patients with chronic liver disease and negative tests for hepatitis B surface antigen.

We assessed the presence of hepatitis B virus (HBV) DNA in liver or serum samples from 134 patients with hepatitis B surface antigen (HBsAg)-negative chronic liver disease, including 20 with hepatocellular carcinoma. HBV DNA sequences were detected in 52 of the 88 liver samples (59 per cent), including 17 of the 20 samples from patients with hepatocellular carcinoma. Presumably "replicative forms" of HBV DNA were detected in only 5 of the 88 liver samples, 3 of which were from patients with no serologic marker for HBV. In most of the liver samples the DNA patterns were consistent with the presence of HBV or a closely related virus. Of the 105 serum samples tested, HBV DNA sequences were identified in 10 (9.5 per cent), 6 of which had no HBV serologic marker. Moreover, HBsAg-associated determinants were detected in 5 of 17 patients who were positive for HBV DNA and in none of 14 patients who were negative. This study demonstrates the high frequency of HBsAg-negative HBV DNA-positive viral infection of the liver and suggests that multiplication of HBV may occur in the absence of any conventional serologic marker for HBV.

Antibodies, Monoclonal↗
PubMed1985

The LeVeen shunt in the elective treatment of intractable ascites in cirrhosis. A prospective study on 140 patients.

One hundred and forty patients with an intractable ascites complicating a chronic liver disease received a peritoneovenous shunt (PVS) using the LeVeen valve. Operative mortality was ten per cent but was 25% in patients with severe liver failure. Intraoperative drainage of ascites sharply decreased postoperative complications and mortality. One-year actuarial survival rate was 81.4%, respectively 77.7%, 61.3%, and 24.7% in patients with good liver function and moderate or severe liver failure. Variceal hemorrhage occurred in 11 patients and late infection in another 11 patients. Thirty-eight patients (30.5%) had recurrence of ascites. This was mostly due to an obstruction on the venous side of the shunt. An elective portacaval shunt had to be done in 23 patients for recurrence of ascites or variceal bleeding. Among the 57 patients still alive at time of writing, 51 were free of ascites. These results suggest that PVS is an efficient operation. This procedure may be largely indicated in the selected and small group of cirrhotic patients with true intractable ascites and moderate or no liver insufficiency.

Adult↗
PubMed1985

Primary myeloproliferative disorder and hepatic vein thrombosis. A prospective study of erythroid colony formation in vitro in 20 patients with Budd-Chiari syndrome.

We assessed the prevalence of overt and latent primary myeloproliferative disorders in hepatic vein thrombosis. Cultures of bone marrow or peripheral blood mononuclear cells were done in 20 patients with Budd-Chiari syndrome. Erythroid colony formation in the absence of erythropoietin, which is a reliable indicator for a primary myeloproliferative disorder, was seen in 16 patients in whom Budd-Chiari syndrome was due to hepatic vein thrombosis, including 13 women aged 18 to 45 years. Among these 16 patients, the conventional criteria for the diagnosis of a primary myeloproliferative disorder were met in only 2. Primary myeloproliferative disorder, often without peripheral blood changes, is a major cause of hepatic vein thrombosis in young women.

Adolescent↗