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D Grange

Publications and source records attributed to D Grange.

At least 19 recordsLinked to original sources
PubMed1992

Drug-induced prolonged cholestasis in adults: a histological semiquantitative study demonstrating progressive ductopenia.

Drug-induced acute hepatitis may be followed by prolonged cholestasis despite the withdrawal of the drug. Eight patients suffering from prolonged cholestasis caused by several drugs were investigated with sequential liver biopsies. At the early stage, lesions of acute cholangitis were observed in most patients; at the chronic phase, ductopenia, defined by the absence of interlobular bile ducts in at least 50% of small portal tracts, was demonstrated in all patients. Ductopenia might be the consequence of acute cholangitis; the degree of ductopenia and the chronicity of the disease might be directly related to the severity of the early acute damage of bile ducts. Consequently, in patients with severe cholestasis related to drugs, research of early morphological signs of acute cholangitis and then of ductopenia seems to be important.

Adult↗
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↗
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

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

[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

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

[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

Non-invasive diagnosis of pulmonary hypertension in chronic obstructive pulmonary disease. Comparison of ECG, radiological measurements, echocardiography and myocardial scintigraphy.

The respective value of four non-invasive methods for the diagnosis of pulmonary arterial hypertension (PAH) was investigated in 63 COPD patients, using right heart catheterization as the reference method: 22 patients had no resting PAH (pulmonary artery mean pressure (PAP) less than or equal to 20 mmHg); 26 patients had mild PAH (PAP = 21-30 mmHg); and 15 patients had moderate to severe PAH (PAP greater than 30 mmHg). The specificity of ECG was 86% and the sensitivity 51% (only 38% in mild PAH). The specificity of radiological measurements was 63% and the sensitivity 46% (38% in mild PAH). Echocardiography (echo) had the best results with a specificity of 75% and a sensitivity of 78% (73% in mild PAH), but reliable echo measurements were available in only 52 out of 63 patients. Myocardial scintigraphy had a specificity of 68% and a sensitivity of 66% (58% in mild PAH). A stepwise regression analysis (including one echo, one ECG, one radiological and one functional variable) explained only 43% of the variance of PAP (multiple r = 0.66). These results suggest that no individual method is sufficiently reliable for predicting the presence of PAH, and particularly mild PAH, but the combination of echo + myocardial scintigraphy allows the prediction of PAH with a good probability. The precise level of PAH cannot be estimated, even when using multiple regression equations.

Adult↗
PubMed1986

[Clinical aspects, epidemiology and economic impact of foot epidermomycosis in an industrial milieu].

Fungal infections of the feet are very common in some professions. This has been particularly studied in coal mine workers up to 50 p. 100 of whom were found to have dermatophytosis of the feet. The purpose of this study was to determine the clinical, epidemiological and evolutive characteristics of interdigital and plantar intertrigo of the feet among people working in a coking plant, a potash mine and a motorcar factory. We have also evaluated the cost of treatments in relation to their immediate effectiveness and their preventive effects on relapses. Initially, 208 workers entered the study: 84 (40.7 p. 100) had a mycotic infection (M) and 124 (59.3 p. 100) presented with a non-mycotic (NM) inflammation between the toes and on the soles, characterized by maceration of the skin, hyperhidrosis and bromhidrosis. Change in the lesions under treatment were subjected to statistical analysis. In both M and NM groups the workers were allocated by randomization to a double-blind treatment consisting of: group M: either 2 p. 100 miconazole powder or talcum powder with 2 p. 100 salicylic acid and boric acid; group NM: either 2 p. 100 miconazole powder or ordinary talcum powder. Each subject was seen on at least two occasions after 3 and 12 months of daily foot care and topical treatment. Mycological examinations in group M subjects showed that fungal infections of the feet were primarily due to Trichophyton mentagrophytes or to Trichophyton rubrum. A logistic regression analysis (BMDPLR program) of anamnestic and clinical data (table IV) led to a "mathematical model of the mycotic foot", characterized by 6 main parameters of statistically significant occurrence: a history of interdigital-plantar intertrigo, recurrent in 90 p. 100 of subjects in group M (significant association at 0.1 p. 100); a functional symptom, pruritus, present in 71 p. 100 of subjects with mycosis; the stronger, more disturbing the pruritus, the greater the probability of it being of fungal origin (significant association at 0.1 p. 100); 4 physical signs: lack of maceration (0.1 p. 100), lesions limited to the interdigital spaces and respecting the soles (0.1 p. 100), presence of interdigital fissures (0.5 p. 100) and vesiculation (2.5 p. 100). When the respective diagnostic values of these elementary symptoms were considered, it appeared that their various combinations might have predictive values which could be calculated.(ABSTRACT TRUNCATED AT 400 WORDS)

Computer Simulation↗
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

[Sclerosing cholangitis, chronic pancreatitis and Sjögren's syndrome].

A 63 year old man was followed up for chronic pancreatitis. After 2 years, he developed features of primary sclerosing cholangitis associated with Sjögren's syndrome. A review of the literature revealed 38 previous cases of chronic pancreatitis associated with sclerosing cholangitis; a sicca complex was also demonstrated in 3 of these cases. Chronic pancreatitis is mostly asymptomatic and the diagnosis is usually made at laparotomy or postmortem. Retrograde pancreatograms are abnormal in 15-75 p. 100 of patients with primary sclerosing cholangitis. The relationship between the two diseases is not a coincidence. On the other hand, the significance of the association with the Sjögren's syndrome remains controversial.

Cholangitis↗
PubMed1985

Surgical resection of segment VIII (anterosuperior subsegment of the right lobe) in patients with liver cirrhosis and hepatocellular carcinoma.

A limited liver resection was performed in two patients with cirrhosis and a hepatocellular carcinoma situated in segment VIII (anterosuperior subsegment of the right lobe). One of the patient had previously bled from esophageal varices. Resection of segment VIII was performed following the anatomical planes of section after complete mobilization of the right lobe of the liver. Both patients were alive and free of recurrence 14 and 30 months after surgery. Hepatocellular carcinomas are thus treatable by limited anatomic liver resection even when they are situated in the vicinity of the major hepatic veins and the vena cava.

Aged↗