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D Samuel

Publications and source records attributed to D Samuel.

358 records · Page 20Linked to original sources
PubMedDate not supplied

[Combined transplantation of liver and small intestine in an adult. First case in France. Surgical aspects].

BACKGROUND: We report hare the first adult case of combined liver-small bowel transplantation performed in France. CASE REPORT: A double liver + small bowel graft was transplanted in a 21-year-old patient hospitalized for 4 years for a short bowel syndrome requiring total parenteral nutrition. The patient also had severe hepatic fibrosis. The immediate post-operative period was uneventful. Two and one-half years after the double graft, the patient is on strictly oral nutrition, no longer has a stomy and lives a normal life in his home. DISCUSSION: The advent of tacrolimus has led to long-term success of bowel grafts, developed earlier in children and now possible in adults. Combined liver-small bowel transplantation is formally indicated in patients with cirrhogenic liver disease associated with ineversible small bowel failure.

Adult↗
PubMedDate not supplied

[Combined liver and small intestine transplantation in an adult. First case in France. Medical aspects: digestive and nutritional].

OBJECTIVE: We report the digestive, hepatic, intestinal and nutritional history of the first combined liver-small bowel transplantation performed in France in an adult recipient. Currently, the clinical course has been favorable at 30 months. METHODS: In May 1997, a 21-year-old man underwent a double liver-small bowel transplantation for irreversible chronic bowel failure with severe chronic liver disease subsequent to post-surgical short-bowel syndrome. After 28 laparotomies, there were 15 cm of small bowel left for the gastric anastomosis. The patient had a terminal jejunostomy and a left colostomy, excluding a short segment of the transverse colon and the rectum. Total parenteral nutrition including lipids and been initiated in December 1992 (3500 kcal/d) and had led to severe complications. Intestinal absorption before and after the graft were studied with the balance method (input-output) and used bomb calorimetry and measurements of the steatorhhea and creatorrhea. Functional enterocyte mass was assessed from serum citrullin. RESULTS: The postoperative period after the liver-bowel graft (220 cm small bowel with terminal ileostomy and jejunostomy) was uneventful. The immunosuppression protocol included tacrolimus, corticosteroids and azathioprin. One mild episode of acute rejection occurred at day 26 and was controlled with a corticosteroid bolus. No episode of liver rejection occurred. Moderate renal failure regressed partially after reestablishing the fluid-electrolyte balance and adapting tacrolimus dosage. Total parenteral nutrition which had sustained the patient for 4 and a half years was definitely discontinued three months after transplantation. Oral nutrition was initially associated with enteral nutrition (from day 20 to day 90) and became exclusive three months after the transplantation. Intestinal absorption coefficients measured before tranplantation, at 3 months (2200 kcal/d, ileostomy flow 1600 g/d), and at 18 months (2400 kcal/d, ileostomy flow 1300 g/d) post transplantation were, respectively, 22%, 90% and 88% for overall calorie absorption, 25%, 65% and 73% for fat absorption, and 47%, 83% and 67% for nitrogen absorption. At 18 months post-graft, there was a spectacular improvement in the patient's neurological status and his liver function was normal. Endoscopy, radiography, histology, and immunohistochemistry explorations were normal. Ileo-rectal anastomosis was re-established at 23 months post-transplantation. At 30 months the patient is living in his home and on 100% oral nutrition. CONCLUSION: Clinical, nutritional and functional outcome at 30 months in this first French case of liver-small bowel transplantation in an adult recipient has been excellent.

Adult↗
PubMedDate not supplied

[Adult to adult living-related liver transplantation. The Paul-Brousse Hospital preliminary experience].

AIM: Liver-graft shortages justify the development of adult living-related liver transplantation. The preliminary experience with this technique at Paul-Brousse Hospital is reported. PATIENTS ET METHODES: From January to July 2000, 7 adult to adult living-related liver transplantations were performed. Donors were 5 females and 2 males aged 20 to 53 years old (median: 41). A right liver graft was harvested in all cases. Recipients were 5 males and 2 females aged from 17 to 58 years old (median: 50) transplanted for viral cirrhosis (4 cases including 2 with hepatocellular carcinoma), subfulminant hepatitis (1 case), hepatocellular carcinoma on a healthy liver (1 case), and epithelioid hemangioendothelioma (1 case). Follow-up ranged from 41 to 157 days (median: 117 days). RESULTS: One donor had a biliary fistula that healed spontaneously. One donor had asterixis for 24 hours. The 7 donors are alive at home without any late complications. One recipient was retransplanted for hepatic artery thrombosis and 2 recipients had a biliary fistula that healed spontaneously. The 7 recipients are alive at home with normal liver function. CONCLUSION: Our experience and other reports suggest that adult to adult living-related liver transplantation is feasible with rare mortality and low morbidity in donors. Results in recipients are comparable to those obtained with cadaveric grafts. For a given patient the possibility of living related donation might extend the indications for transplantation without penalizing patients waiting for a cadaveric graft.

Adolescent↗
PubMedDate not supplied

A technique for typing Cryptosporidium isolates.

Antigens extracted from Cryptosporidium oocysts, which had been purified from faeces or chick egg culture, were electrophoresed in sodium dodecyl sulfate-polyacrylamide gels, and blotted onto nitrocellulose membranes. A Cryptosporidium genus-specific monoclonal antibody MAb-C1 bound to multiple bands using several detection techniques, and these corresponded to bands detected using immune rabbit antisera. Using a detection system with fluorescein isothiocyanate (FITC)-labelled MAb-C1 and alkaline phosphatase-labelled anti-FITC, bands were detected between 50 and 300 kDa. Blots were examined directly and by using a laser scanner. The system was shown to be specific for Cryptosporidium spp., giving no staining with a variety of other pathogens, and with negative samples. The oocyst antigen which bound MAb-C1 was stable, and banding patterns were not significantly affected by pretreatment of oocysts with proteinase K, trypsin, formalin, or sodium hypochlorite, methods commonly used during preparation and storage of C. parvum oocysts. However, banding was reduced with potassium dichromate. Of 76 samples containing Cryptosporidium oocysts, 53 showed one or more MAb-C1 staining bands. Cryptosporidium baileyi and C. parvum could be clearly differentiated by their banding patterns, indicating that the system will distinguish between species. Some isolates, including a single isolate of C. muris, produced weak bands which made interpretation difficult. The technique showed differences between isolates of C. parvum, with two different banding types found in human isolates, and other banding types seen in calf and lamb isolates. This method provides a useful way of characterising isolates which may be new species.

Animals↗
PubMedDate not supplied

Mycobacterial antigens in antibody responses of leprosy patients.

A reference system for M. smegmatis antigens in crossed immunoelectrophoresis was used to study antibody activities in serum samples of 91 leprosy patients. All polar and borderline lepromatous patients were positive. Mean numbers out of 14 M. smegmatis antigens involved were 4.3 and 3.5, respectively. Precipitins against antigen no. 1 were seen in all lepromatous cases. Antibodies against this antigen were detected in 50% of tuberculoid (polar, subpolar and borderline) cases. Antibody activity against M. avium and M. duvalii antigens was also detected using a staphylococcal radio-immuno-assay. Borderline and polar lepromatous cases showed elevated levels. Antigenic comparisons were made between four slow growing mycobacteria, fourteen fast growing mycobacteria and the leprosy bacillus using lepromatous serum pools as antibody reagents. Four of the antigens detected in M. leprae were also found in slow growing as well as fast growing species indicating a common occurrence among mycobacteria. Antigen no. 1 of M. duvalii, with an apparent molecular weight of 290,000, showed nonprotein characteristics. Further analysis of antigen no. 21, using lepromatous serum pools as antibody reagents, indicated the existence of at least two groups of antigenic determinants. In addition to determinants shared by all mycobacteria, there were antigenic structures apparently unique to M. leprae.

Antibody Formation↗
PubMedDate not supplied

[Evaluation of results of liver transplantation: experience based on a series of 1052 transplantations].

OBJECTIVES: The aim of this work was to evaluate outcome in a continuous homogeneous series of more than 1000 liver transplantations in order to determine risk groups. METHODS: Between November 1984 and February 1995, 1052 isolated orthotopic liver transplantations were performed in 922 patients (530 males, 392 females; mean age 41.7 years; age range 10 months - 78 years) at the Paul-Brousse Hospital liver transplantation unit. Immunosuppression was based on cyclosporin in all patients with FK506 in the most recent cases. RESULTS: Actuarial survival at 1,5 and 8 years for the 922 patients was 80.9, 71.7, and 69.1%. Certain factors affecting the intrinsic risk of transplantation were identified and could be used to calculate supplementary risk due to one or more other risk factors. In adults under 55 years in UNOS stage 1 or 2 (not hospitalized at call in) transplanted after 1990 for non-recurrent (absence of cancer, non-viral disease) chronic liver disease, the risk of death at 1 year was 6.5% and 4.4% between the first and second year. For patients transplanted for acute liver failure and for patients transplanted for chronic liver disease in UNOS stade 3 or 4 (hospitalized or in an intensive care unit at call in), there was a supplementary risk of death at 1 year of 20.3%, 13.3% and 31.6% respectively. There was no supplementary risk of death in these three groups after 1 year. In patients over 55 years, there was a 4.4% supplementary risk during the first year after transplantation and a 2% increase between the first and second year. In patients transplanted for cancer, the supplementary risk was 9.7% during the first year, 11.6% between the first and second year and 2.1% between the third and fifth year. CONCLUSIONS: On the basis of these results, it was possible to develop a method for assessing liver transplantation outcome in different units. The proposed criteria is the 1 year survival of patients with the basic risk alone, without any supplementary risk, as well as the retransplantation index (mean number of grafts used per patient). For the Paul-Brousse unit, this criteria is 93.5% (survival at 1 year) for a retransplantation index of 1.1.

Adolescent↗
PubMedDate not supplied

Audit of patient acceptance of nasal surgery as a day case procedure.

A greater emphasis on day case surgery within the health service is seen as a method of improving efficiency and reducing expenditure. We interviewed 90 consecutive patients undergoing nasal surgery who had been preoperatively assessed as being fit for day case surgery. They were randomised into three groups regarding the duration of postoperative nasal packing. All patients stayed overnight following surgery and were interviewed prior to discharge. Some 52% of the overall sample would be happy to have nasal surgery performed as a day case. If the nasal pack was removed after two hours, this figure rose to 67%. This difference in patient acceptance did not attain statistical significance overall, but there was a significant difference in those undergoing submucosal resection. There was no difference in the age, sex distribution or type of surgery performed between each group. The audit commission quotes patient satisfaction with day case surgery at 80%. Nasal surgery was not examined in their report, but was included as one of a set of procedures suitable for consideration. Although day case nasal surgery may be safe, further research regarding patient acceptance is required.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

HCV infection and liver transplantation.

Acute and chronic liver diseases related to hepatitis viruses are the main indications for liver transplantation. The risk of viral reinfection after transplantation is the main limitating factor in these indications. HCV reinfection was demonstrated by demonstrating a sequence homology of the hypervariable region of HCV RNA in 2 patients before and after liver transplantation. HCV reinfection is almost constant, assessed by the persistence of HCV RNA in serum in 90% of cases. Acute lobular hepatitis appeared in 75% of patients at a median of 4 months post-transplantation with extremes between 23 days and 4 years. In our series, the 5 year actuarial rate of HCV acute hepatitis on the graft, chronic hepatitis and cirrhosis was 75%, 60% and 8%, respectively. HCV RNA level is dramatically increased after transplantation and seems to correlate with the occurrence of acute hepatitis on the graft. A positive relationship between genotype 1 b and prevalence and severity of HCV hepatitis on the graft have been suggested in European series. There is no demonstrated way to prevent HCV reinfection. The use of interferon for the treatment of HCV hepatitis on the graft was disappointing due to a poor antiviral effect and the occurrence of chronic rejection episodes in some patients. Promising results of the combination of interferon and ribavirin have been reported and need confirmation. The 5 year survival of patients transplanted for viral C cirrhosis in our Center is 78%. In conclusion, patients with endstage HCV cirrhosis are candidates for liver transplantation. Viral C reinfection is frequent, but medium term survival is good. However, longterm graft and patient survival remains unknown, and methods to prevent and treat HCV reinfection on the graft are needed.

Hepatitis↗
PubMedDate not supplied

Hepatic hypertrophic osteoarthropathy: the value of liver transplantation.

We describe 4 cases of hepatic hypertrophic osteoarthropathy treated successfully by liver transplantation. Hepatic hypertrophic osteoarthropathy is a rare and disabling condition associated with severe liver diseases. It responds poorly to conservative management, and liver transplantation is the only radical treatment option.

Adolescent↗