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Biomedical subjects

H Bismuth

Publications and source records attributed to H Bismuth.

At least 325 records · Page 18Linked to original sources
PubMed1988

Liver transplantation for protoporphyria. Evidence for the predominant role of the erythropoietic tissue in protoporphyrin overproduction.

Protoporphyria is an inherited disorder of heme biosynthesis characterized by an overproduction of protoporphyrin in the erythropoietic and hepatic tissues, the relative contribution of which in the metabolic disorder has not been directly quantitated. Excess protoporphyrin is eliminated solely by the liver into the bile and feces. We describe the case of a patient with protoporphyria complicated by severe cirrhosis in whom liver transplantation was performed and resulted in almost complete disappearance of skin photosensitivity manifestations and reduction in the level of protoporphyrin in erythrocytes. However, the level of protoporphyrin in feces was not markedly different before and after liver transplantation, which suggests that overproduction of protoporphyrin was unchanged. These findings are consistent with the view that the diseased liver and ensuing low hepatic clearance of protoporphyrin contributed to accumulation of protoporphyrin in the body and that, at least in this patient, the role of the hepatic tissue in the overproduction of protoporphyrin was small in comparison with that of the erythropoietic tissue.

Adult↗
PubMed1987

Hepatic transplantation in Europe. First Report of the European Liver Transplant Registry.

At the 32 European centres where livers are transplanted the actuarial survival rate for 1218 patients was 44% at 1 year and 41% at 2 years. Perioperative mortality (30 days) was 30%. Recipients aged under 15 years had a higher survival rate than those aged over 15; the differences were 22% at 1 year and 32% at 2 years. For the 97 patients who received two or more liver grafts, actuarial survival was 27.7% at 1 and 2 years. Two-thirds of the transplantations were done since 1984. Since then the best results have been obtained for biliary atresia (88 cases; survival rates at 30 days, 1 year, and 2 years were 87%, 74%, and 68%). Primary biliary cirrhosis was the commonest benign indication for transplantation, with survival of 64% at 1 and 2 years. The proportion of transplantations that were done for patients with hepatocellular carcinoma was smaller after than before 1984; among transplantations done in adults after 1984, those done because of hepatocellular carcinoma gave the best perioperative survival rate (76%) but the worst 2 year survival (30.8%).

Actuarial Analysis↗
PubMed1987

Left intrahepatic cholangio-enteric anastomosis (round ligament approach): an effective palliative treatment for hilar cancers.

Palliation of obstructive jaundice in patients with hilar cancer can be achieved either by surgical bypass or by intubation and drainage. A simple and effective technique is presented which gives excellent palliation without the need for tubes or stents: left intrahepatic cholangio-enteric anastomosis, using the duct of segment III (i.e. the inferolateral segment of the left liver). The procedure is performed by using the round ligament approach to the duct of segment III in the base of the umbilical fissure. A defunctioned loop of jejunum is then anastomosed to this duct. Over a period of 25 years, 48 patients with hilar cancer had this procedure in this unit. The operative mortality (death within 2 months) was 6 per cent and the complication rate was 17 per cent. Seventy-three per cent of patients had complete relief of jaundice and a further 23 per cent had partial relief. The mean survival was 9.2 months and the quality of life was excellent. These data suggest that this is a very satisfactory palliative technique for patients with hilar cancer who are not suited for radical tumour excision.

Adenoma, Bile Duct↗
PubMed1987

Effects of portacaval shunt on the cholesterol metabolism of genetically hypercholesterolemic rats ("Rico' strain).

The effects of portacaval anastomosis on the biodynamics of cholesterol in male adult rats of a genetically hypercholesterolemic strain (Rico) were studied using an isotopic equilibrium method. Animals received a sucrose-rich semipurified diet. In both hypercholesterolemic rats and controls, portacaval anastomosis decreased plasma cholesterol levels (27%), liver weight (35-43%) and total cholesterol content in liver and body pools. Rico rats were characterized by (1) a high input rate of newly synthesized cholesterol (internal secretion) (25.3 +/- 1.9 vs. 16.2 +/- 1.5 mg/day/rat in controls) related to increased hepatic cholesterogenesis, and (2) a high rate of cholesterol transformation into bile acids, while other parameters remained unchanged. Portacaval anastomosis decreased the internal secretion of cholesterol in Rico rats (20.1 +/- 2.0 mg/day/rat). Since the activity of the gut for cholesterol synthesis as shown by the fecal external secretion (cholesterol biosynthesized by the gut and directly eliminated in the gut and feces) was not modified, it is assumed that the reduction of internal secretion induced by portacaval anastomosis results from decreased hepatic cholesterogenesis.

Animals↗
PubMed1987

Decreased reticuloendothelial phagocytic capacity in cirrhotic and portacaval shunt rats.

In cirrhosis, the phagocytic function of the reticuloendothelial system (RES) is decreased. In order to investigate the mechanisms of the hepatic reduced phagocytic activity present in cirrhosis, the hepatic and splenic uptake of 51Cr sheep red blood cells (SRBC) and of colloidal carbon was measured in three groups of Sprague-Dawley rats. Group 1 consisted of 42 control rats, group 2 of 36 rats with end-to-side portacaval shunt and group 3 of 24 rats with carbon tetrachloride-induced cirrhosis. The hepatic uptake of 51Cr SRBC and of colloidal carbon was significantly (p less than 0.001) reduced in cirrhotic rats (group 3). Conversely, in rats with a portacaval shunt and a noncirrhotic liver (group 2), the hepatic uptake of 51Cr SRBC was moderately reduced, whereas the colloidal carbon hepatic uptake was not found to be decreased. These results suggest that the decreased RES phagocytic activity observed in cirrhotic rats is only partially due to portacaval shunt and that an intrinsic defective activity of hepatic phagocytic cells is probably present.

Animals↗
PubMed1987

Emergency liver transplantation for fulminant hepatitis.

Orthotopic liver transplantation was done in 17 patients with fulminant hepatitis. The cause of the liver disease was infection with hepatitis B virus, or co-infection with hepatitis B virus and hepatitis D virus, or infection with hepatitis A virus in 6 patients; drug hepatotoxicity in 5; and indeterminate in 6. Grafts from incompatible blood groups, steatotic grafts, or reduced-size grafts were used in 5, 4, and 4 patients, respectively. Of the 17 patients, 5 died: 2 of early liver failure due to the poor quality of the graft, 1 presumably of accidentally transmitted acute infection with the human immunodeficiency virus, and 2 of decerebration occurring during or immediately after surgery. The 12 other patients were alive 2 to 15 months after transplantation.

Acute Disease↗
PubMed1987

[Immunologic surveillance of liver transplant patients using monoclonal antibodies against lymphocyte subpopulations].

A precise immunological surveillance of liver graft recipients can allow the adaptation to each patient of an adequate immuno-suppressive treatment. In 11 liver-transplanted patients (7 primitive biliary cirrhoses, 2 post-hepatic cirrhoses, one bile duct atresia with one antitrypsin deficit) different lymphocyte subpopulations were tested before transplantation and at days 3, 5, 7, 15, 30, 60 and 120 after grafting using OKT3, OKT4, OKT8 (Orthoclone, France). In 6 patients presenting one or more rejections, the (T4+):(T8+) lymphocyte ratio was significantly increased during the days preceding rejection. In all cases, the (T4+):(T8+) ratio increase was linked to a (T4+) helper lymphocyte augmentation. In the 6 patients who did not present any rejection, the (T4+):(T8+) ratio did not increase at long term. A decrease of the (T4+):(T8+) ratio, along with an augmentation of (T8+) lymphocytes, was noticed at long term in patients free of chronic rejection. The evolution of T lymphocyte populations, followed using monoclonal antibodies and mainly the (T4+):(T8+) ratio, can provide a test for rejection predictability of for the prognosis of tolerance to liver allografts.

Antibodies, Monoclonal↗