Outcome of whole liver grafts harvested and transplanted by two different teams supports a new liver procurement organization.
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Cadaver↗
Biomedical subjects
F Paye
Publications and source records attributed to F Paye.
Percutaneous aspiration for bacteriological studies in patients with necrotizing pancreatitis.
BACKGROUND: Percutaneous computed tomography (CT)-guided aspiration of abdominal collections is performed in necrotizing pancreatitis to detect infection of necrosis, which is an adverse prognostic factor and requires surgical drainage. However, in the case of sterile aspirates, the outcome and the optimum management are subject to debate. This study examined the clinical and bacteriological outcome of patients with severe acute pancreatitis with initially sterile necrosis and assessed the efficiency of percutaneous drainage in this setting. METHODS: Seventeen patients hospitalized for necrotizing pancreatitis with a septic course underwent a preliminary sterile CT-guided aspiration. Eight patients underwent simultaneous percutaneous drainage of the punctured collection. Supportive therapy was continued unless severe clinical deterioration or proven secondary infection of necrosis indicated the need for necrosectomy and drainage. RESULTS: Secondary infection of necrosis was observed in two patients of nine who had only fine-needle aspiration cytology of the collection, and in seven of eight it was drained percutaneously (P = 0.01). Only one patient drained percutaneously recovered without surgery. Surgical drainage was required in 12 patients. The hospital mortality rate was 29 per cent and was not significantly affected by the bacteriological status of necrosis. CONCLUSION: Percutaneous drainage of sterile collections predisposed to secondary infection of the necrosis and did not cure the patients. A first sterile percutaneous aspiration did not predict a favourable course and surgery frequently remains necessary.
Adult↗
In vivo assessment of lipid peroxidation in experimental edematous and necrotizing rat pancreatitis.
Lipid peroxidation, which may be involved in the pathogenesis of acute pancreatitis, is usually assessed in vitro or indirectly using antioxidants or free radical scavengers. We assessed lipid peroxidation in an in vivo model by measuring ethane exhalation in two models of acute pancreatitis. Edematous acute pancreatitis was induced by a supramaximal intraperitoneal injection of cerulein. Necrotizing acute pancreatitis was induced by retrograde infusion of sodium taurocholate into the pancreaticobiliary duct. Rats were placed in closed chambers and ethane exhalation was measured in aliquots. Ethane exhalation was significantly increased (p < 0.002) in cerulein (n = 12)- but not in taurocholate (n = 6)-induced pancreatitis compared to controls (n = 12 and 6, respectively). Our results suggest that free radicals may play a role in the pathogenesis of edematous pancreatitis but do not play an important role in the progression to necrotizing pancreatitis.
Acute Disease↗
Pouch-related fistula following restorative proctocolectomy.
Prognostic factors and outcome of pouch-related fistula were analysed from a series of 21 patients, 20 of whom had an ileal J pouch manually anastomosed to the dentate line following mucosectomy. Fistula occurred more often after pouch formation for ulcerative colitis than for familial adenomatous polyposis. In 6 patients the fistula occurred more than 5 months after closure of the diverting loop ileostomy. The origin of the leak was the anastomosis in 14 patients, the vertical staple line in two and the end of the efferent limb in five. Nine forms of treatment were utilized and these were successful in 11 patients and unsuccessful in ten including three pouch excisions. Adverse prognostic factors were late fistula, the presence of an enterocutaneous or a pouch-vaginal fistula track, and diagnosed or suspected Crohn's disease. Resolution of the fistula followed none of six diverting loop ileostomies performed alone, three of 33 attempted drainage procedures, four of ten direct closures, and four of five repeat ileal pouch-anal anastomoses. It is concluded that an aggressive therapeutic approach using repeat ileal pouch-anal anastomosis increases the success rate.
Adenomatous Polyposis Coli↗
Release of nonesterified fatty acids during cerulein-induced pancreatitis in rats.
During acute pancreatitis, data obtained in vitro suggest that pancreatic lipase, acting on circulating or tissular triglycerides, might generate nonesterified fatty acids (NEFA) that could promote pancreatic and fat tissue necrosis. This work determined whether NEFA were actually produced in vivo in pancreatic tissue and in blood during cerulein-induced pancreatitis in rats. Intraperitoneal injections of cerulein induced pancreatitis. To promote the possible NEFA release by pancreatic lipase, a venous infusion of human very low density lipoprotein (VLDL) was used to cause hypertriglyceridemia. NEFA were measured in portal and aortic blood and in tissue extracts prepared from pancreas homogenates. NEFA did not increase either in peripheral or in portal blood. In pancreatic tissue, NEFA levels did not differ from controls. The major hypertriglyceridemia produced by human VLDL intravenous infusion neither altered the course of the disease nor promoted plasma NEFA release. The role commonly attributed to NEFA in acute pancreatitis seems questionable.
Acute Disease↗
Nonesterified fatty acids in acute cerulein-induced pancreatitis in the rat. Are they really deleterious in vivo?
During acute pancreatitis, experimental data obtained in vitro suggested that pancreatic lipase generates nonesterified fatty acids (NEFA), noxious for acinar cells, by hydrolysis of pancreatic or circulating triglycerides. The purpose of this work was to determine whether experimentally induced high plasma NEFA levels do indeed aggravate in vivo cerulein-induced pancreatitis. Anesthetized Sprague-Dawley rats received cerulein and were simultaneously infused intravenously with either saline or a triglyceride + heparin mixture (TGH) in order to increase the amount of circulating NEFA. Plasma NEFA increased about fourfold (3.02 +/- 0.28 mumol/liter) in animals infused with TGH with respect to controls (0.75 +/- 0.05 mumol/liter). In rats receiving cerulein + TGH, pancreatic enzyme levels in plasma, ascites, and histological alterations of the pancreas did not differ from those observed in the rats receiving cerulein + saline. There was less macroscopic pancreatic edema (P < 0.01) in the cerulein + TGH group than in the cerulein + saline group. Separate infusion of either heparin alone or of triglycerides alone had no effect. We conclude that high levels of circulating NEFA do not aggravate cerulein pancreatitis in rats and may even induce a protective effect.
Acute Disease↗
[Intraperitoneal resorbable mesh in the prevention of postoperative wound dehiscence. A comparative study].
The purpose of this study was to compare efficiency of polyamide mesh externally applied to the skin and intraperitoneal resorbable mesh of polyglactine 910, for the prevention of wound dehiscence. Two consecutive and homogenous groups of 100 patients, operated by the same surgical team and presenting one or more risk factors of evisceration, were retrospectively compared. Use of intraperitoneal polyglactine mesh, significantly reduced rate of wound dehiscence (4% vs 13%), lowered frequency of reoperation in eviscerated patients (25% vs 61%), but did not improve prognosis of this complication (50% mortality). Potential effect of resorbable mesh on late fascial disruption remains controversial.
Aged↗
[Abscess of the spleen. Only medical treatment is sometimes possible].
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Abscess↗
[Role of remaining ductal cephalad obstruction on the results of lateral pancreaticojejunostomy in chronic pancreatitis].
AIMS: To report the results of a pancreaticojejunostomy in the treatment of chronic pancreatitis, and to assess the role of residual cephalic ductal obstruction in pain recurrence. METHODS: Thirty seven patients with painful chronic pancreatitis whose pancreatic duct diameter exceeded 6 mm were treated by lateral pancreaticojejunostomy and were retrospectively studied. Deobstruction of the cephalad portion of the main pancreatic duct was complete in 21 patients (group A), while residual obstruction was noted in 16 patients (group B). RESULTS: One patient died post-operatively (2.7%) and 6 patients underwent complications (16%) that were treated without reoperation. With a median follow-up of 52 months, 26 patients were pain free (70%). Pain recurrence occurred in 3 patients in group A (14%) who were treated medically, versus in 8 patients in group B (50%) of whom 4 needed iterative surgery. Ongoing alcoholic addiction did not influence pain recurrence, which onset significantly altered the weight increase observed after pancreaticojejunostomy. CONCLUSION: Lateral pancreaticojejunostomy has a low morbidity rate and offers long lasting pain relief in 86% of patients whose cephalad main pancreatic duct is completely deobstructed.
Adult↗
[Free fatty acids and acute pancreatitis. An in vivo experimental study].
Experimental in vitro studies support a theory which attributes a key role to pancreatic lipase in the physiopathology of acute pancreatitis. Pancreatic lipase would hydrolyse triglycerides either in circulation or in tissues, releasing Free Fatty Acids (F.F.A.). These F.F.A. would contribute to the genesis of necrotizing lesions by their detergent properties. This experimental work, tried to confirm this theory in vivo in rats, using the cerulein-induced pancreatitis model (four injections 20 micrograms/kg of cerulein subcutaneously). It has been demonstrated first that a five-times increase of circulating plasma F.F.A. (3.02 +/- 0.28 mmol/l versus 0.75 +/- 0.05 mmol/l in control) dit not worsen cerulein-induced pancreatitis and were rather protective than deleterious. Furthermore, F.F.A. levels did not increase either in portal and aortic plasma during these pancreatitis, despite a major lipase release. There was also no increase of pancreatic content of F.F.A., measured by organic extraction performed on pancreatic homogenates. The role commonly attributed to F.F.A. in acute pancreatitis, based on in vitro experiments seems questionable in vivo.
Acute Disease↗