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Biomedical subjects

H Bismuth

Publications and source records attributed to H Bismuth.

At least 307 records · Page 17Linked to original sources
PubMed1988

Pyogenic liver abscess: an improvement in prognosis.

Forty-six patients with pyogenic liver abscess have been treated at Paul Brousse Hospital between 1966 and 1986. The overall mortality was 24 per cent, all 11 deaths occurring in 24 patients seen prior to 1978 when there was often a considerable delay in the diagnosis of liver abscess (mean 90 +/- 71 days). In seven patients the diagnosis was not made until post-mortem examination. The mainstay of treatment was surgical drainage. Since 1978 high resolution imaging techniques for the liver, and in particular ultrasound, have been available. The diagnostic delay has been significantly reduced (mean 28 +/- 20 days, P less than 0.01). Patients are receiving definitive treatment at an earlier stage in the evolution of the disease process, with fewer established complications prior to treatment (P less than 0.05). Percutaneous drainage under ultrasound control is the preferred initial drainage procedure in high-risk patients. There have been no deaths in 22 patients treated for pyogenic liver abscess since 1978 (P less than 0.001).

Aged↗
PubMed1988

Epithelioid hemangioendothelioma of the liver. Diagnostic features and role of liver transplantation.

Five cases of epithelioid hemangioendothelioma of the liver are reported. This unusual type of vascular tumor is often difficult to diagnose; its angiogenic nature is not overt at the radiologic level and may be overlooked by conventional histologic examination. At imaging procedures, epithelioid hemangioendothelioma of the liver presents as multiple focal hypovascular areas, disseminated in both lobes. The combination of these imaging abnormalities with a peculiar set of demographic and clinical features, including young age, good general condition, and progressive course, is suggestive. However, the final diagnosis can be established only by histologic examination of appropriate material collected by guided liver biopsies and may be helped by immunohistochemistry and ultrastructural examination. The accurate diagnosis of epithelioid hemangioendothelioma of the liver is of clinical and therapeutic relevance. In view of its favorable clinical course, orthotopic liver transplantation may be considered for the treatment of this tumor when intrahepatic dissemination contraindicates partial hepatectomy and extrahepatic extension, excluded by exploratory laparotomy, is absent.

Adult↗
PubMed1988

Bronchobiliary fistulas in adults.

Reported herein are 16 cases of nontraumatic bronchobiliary fistula in adults observed over 32 years. The fistulas were due to either biliary obstruction or infectious diseases involving the liver. All patients had biloptysis and other respiratory symptoms, and most had cholangitis, jaundice, and/or sepsis. The diagnosis was established by fistulography or cholangiography. All patients except one were treated surgically by relief of biliary obstruction and drainage of intra-abdominal abscesses. All 15 surgically treated patients had a successful outcome. Rapid diagnosis and early treatment of septic complications are necessary, but careful assessment and surgical relief of the biliary obstruction are essential in successfully treating this condition.

Adult↗
PubMed1988

Liver cell adenomas. A 12-year surgical experience from a specialist hepato-biliary unit.

Twenty-four patients with liver cell adenomas were referred to Paul Brousse Hospital between 1976 and 1987. This represents the largest reported surgical experience of this pathology from a single centre. Six patients had multiple adenomas, which were associated with glycogen storage disease in four. Two patients had polyadenomatosis, one of whom underwent successful liver transplantation after malignant transformation to hepatocellular carcinoma. Eighteen patients (median age of 33 years, range of 17-45 years) had either a solitary adenoma or two adenomas. Eighty-three per cent were women 87% of whom had received oral contraceptives or other hormone therapy before diagnosis (median duration of 11 years, range of 3-15 years). Fifty per cent of these patients presented with acute hemorrhage into an adenoma. Seventeen patients underwent surgical resection of their adenomas, with the remaining patient currently being treated by arterial embolizations to reduce the tumor size before surgery. There was no operative mortality or serious morbidity, and all patients remain well upon follow-up. Surgical excision of liver adenomas, where this can be done without causing mortality, is recommended. Resection relieves symptoms and removes both the risks of hemorrhaging into the tumour and of malignant transformation to hepatocellular carcinoma.

Acute Disease↗
PubMed1988

Relationship between the liver and lymphocytotoxic alloantibodies in inbred rats. Specific absorption by nonparenchymal liver cells.

Liver allografts have a privileged status with regard to hyperacute rejection. In this experimental study, we have used extracorporeal liver hemoperfusion in sensitized rats in order to analyze reactions between lymphocytotoxic antibodies and the liver. In sensitized BN rats, a donor-specific (Lewis) extracorporeal liver hemoperfusion can delay hyperacute rejection of heart allografts and reduce the level of lymphocytotoxic antibodies. The decrease in the level of antibodies could be due to massive absorption of antibodies by the liver or to release of major histocompatibility complex antigens in a soluble form. Immunofluorescent examination of the hemoperfused liver revealed important deposits of C3 on Kupffer cells and of IgG on sinusoidal cells. On the contrary, in control rats in which a third-party (DA) liver hemoperfusion was performed, heart allograft survival was less prolonged, the decrease in the level of lymphocytotoxic antibodies was not significant, and the deposits of IgG and C3 were much less evident. The level of circulating immune complexes was unchanged after a donor-specific or a third-party liver hemoperfusion. These results support the hypothesis that resistance of the liver to hyperacute rejection might be due to a massive and nontoxic absorption of lymphocytotoxic antibodies on nonparenchymal liver cells.

Absorption↗
PubMed1988

Delayed rejection of heart allografts after extracorporeal donor-specific liver hemoperfusion. Role of Kupffer cells.

Liver allografts have a privileged status in regard to acute rejection. In this experimental study, we have analyzed the immunosuppressive effects of an extracorporeal liver hemoperfusion. In the LEW-to-BN combination of inbred rats, donor-specific liver hemoperfusion can significantly delay acute rejection of heart allografts. Analysis of the immunological status of these animals revealed a significant decrease in donor-specific lymphocytotoxic antibodies and in cytotoxic T lympholysis. Reactivity in mixed lymphocyte culture was normal. After third-party (DA) liver hemoperfusion or after donor-specific (LEW) splenic hemoperfusion, prolongation of heart allograft survival was moderate. Previous blockade of Kupffer cells suppressed the effects of donor-specific liver hemoperfusion. These results suggest that the sequestration by Kupffer cells of a clone of cytotoxic T cells and/or lymphocytotoxic antibodies may explain the immunosuppressive effects of donor-specific liver hemoperfusion.

Animals↗
PubMed1988

Surgery for synchronous hepatic metastases of colorectal cancer.

Over the last 10 years 32 patients have had synchronous hepatic metastases from colorectal cancer treated surgically in this unit. As a general policy the metastases were resected 3-4 months after resection of the primary tumour. At the end of this interval a thorough assessment was made for recurrent local, regional or extrahepatic metastatic disease before making a decision to perform liver resection. Eighteen patients had a conventional liver resection (13 major liver resections, 5 limited liver resections) and 14 patients had an atypical liver resection (metastasectomy). Patients were followed at 4 monthly intervals after operation using ultrasonography and CEA determination. The operative mortality (within 60 days) was zero. Twenty-six patients (81%) had a totally uncomplicated postoperative course. The period of hospitalization was 14 +/- 2 days. Two patients had a second liver resection at a later date on account of tumour recurrence. The survival rates at 1, 2 and 3 years were 84%, 58% and 33% respectively. These results confirm that synchronous hepatic metastases from colorectal cancer can be resected with minimal morbidity and mortality and that worthwhile improvements in life expectancy result.

Adult↗
PubMed1988

[Cancer of the bile ducts and pregnancy. Apropos of a case].

The authors report a case of successful pregnancy 8 years after surgery and chemotherapy for biliary cancer with secondaries in the liver. The authors, in considering this case, have analysed the sequelae of chemotherapy for cancer on fertility. They discuss the need to preserve the ability to produce oocytes in young women who need treatment for cancer.

Adult↗