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Biomedical subjects

H Bismuth

Publications and source records attributed to H Bismuth.

At least 379 records · Page 21Linked to original sources
PubMed1985

[Surgical treatment of hepatic metastases].

355 patients with hepatic metastases were followed between 1970 and 1984 at the Hôpital Paul Brousse. 132 cases were of colonic origin: 32 were treated by means of hepatic resection (including 5 metastasectomies), 7 by intra-hepatic anastomosis and 5 by devascularisation. The other 88 patients did not receive any surgical treatment. In 148 of the other 233 patients, the metastases were of non colonic gastro-intestinal or rectal origin and in the remaining 75 cases the metastases were derived from another site. 12 patients were treated by hepatic resection, 6 by devascularisation, 2 by intra-hepatic anastomosis and 2 by intubation of the bile ducts. One patient (0.5 per cent) died during the post-operative period following these operations. The long term survival was 73 per cent at 1 year and 29 per cent at 3 years. In conclusion, some patients are definitely cured by hepatic resection, although these patients cannot be predicted. For this reason, the surgeon's role consists of trying to decrease as much as possible the operative risk and to propose this type of treatment to all patients in which it may be beneficial.

Colonic Neoplasms↗
PubMed1984

Hepatic arterial embolization for malignant hypercalcemia in hepatocellular carcinoma.

A patient who presented with hypercalcemia was found to have an hepatocellular carcinoma. Medical treatment failed to normalize blood calcium levels. Liver resection was not feasible due to major extrahepatic involvement. Selective arterial embolization of the tumor was performed, resulting in correction of the hypercalcemia. This observation suggests that some life-threatening complications of unresectable hepatocellular carcinoma can be treated by arterial embolization of the tumor.

Carcinoma, Hepatocellular↗
PubMed1984

Transplantation of hepatocytes for treatment of surgically induced acute hepatic failure in the rat.

Efficacy of transplanted hepatocytes was evaluated in rats with a surgically induced acute hepatic failure. After 75% liver resection and portacaval shunt, the intrasplenic or intraperitoneal injection of 20 million isolated fresh hepatocytes was shown to significantly reduce the mortality rate. These results confirm that the transplantation of isolated hepatocytes may prevent death in rats with acute hepatic failure, and suggest that hepatocyte transplantation acts by a mechanism of hepatic support.

Acute Disease↗
PubMed1984

Reduced-sized orthotopic liver graft in hepatic transplantation in children.

Because of the rarity of child donors, in cases of adult donors room requirement for the liver graft is a major technical obstacle to liver transplantation in children. To overcome this difficulty in a child, the authors performed an orthotopic transplantation with an adult liver that had been reduced to the left lobe. The absence of technically-related complications suggests that this procedure might facilitate the performance of liver transplantation in children.

Body Weight↗
PubMed1983

[Cost of the surgical treatment of gallbladder lithiasis. Example of an attempted rationalization of medical care and expenditure].

A medical audit was conducted in a Paris hospital on patients who, in 1975, underwent cholecystectomy for uncomplicated gallstones. The audit comprised the duration of pre- and post-operative hospitalisation, the Social Security grading of medical acts, biochemical and radiological examinations and the quality of medical care, as assessed by morbidity and mortality rates. The results were brought to the knowledge of all members of the surgical team concerned. Similar studies conducted two and five years later showed that self-restriction on the part of the physicians resulted in improved costs through shorter stays in hospital (especially before surgery) and less extensive and numerous examinations, the incidence of complications remaining the same.

Adult↗
PubMed1983

Nutrition and immunity after peritoneovenous drainage of intractable ascites in cirrhotic patients.

Severe malnutrition and related impaired cell-mediated immunity are commonly found in cirrhotic patients with intractable ascites and may be responsible for the poor prognosis of these patients. The effects of LeVeen peritoneovenous shunting of ascites on protein reserves and cell-mediated immunity were studied in 31 cirrhotic patients with intractable ascites over a period of 1 year following operation. Arm-muscle circumference, serum albumin, and transferrin levels markedly increased and became close to the normal values. In the same period, delayed hypersensitivity improved. Although the lymphocyte count and the absolute T cell concentration in peripheral blood remained low after peritoneovenous shunting, the in vitro lymphoblastic transformation in response to phytohemagglutinin was augmented. An increased capacity to eat normal meals and the resumption of a good appetite due to the discontinuation of a salt-restricted diet seemed to be the most important factors in the dramatic improvement in the nutritional status of these patients. Restriction from heavy alcohol use may have also contributed, although the patients had already stopped drinking for several months before operation. Improvement in cell-mediated immunity might have been secondary to the increase in protein reserves.

Adult↗
PubMed1983

Surgical management of gallstones in cirrhotic patients.

Among the cirrhotic patients admitted to our department, 64 (17 percent) were found to have cholelithiasis. In 14 patients (22 percent), cholelithiasis caused cholecystitis, obstructive jaundice, or biliary pain. These 14 patients were operated on and underwent cholecystectomy. There was one postoperative complication (gastrointestinal bleeding from esophageal varices) and one death (due to acute respiratory failure). In 50 patients (78 percent) cholelithiasis was asymptomatic. Ten of the 50 patients died from liver failure and the stones were discovered at necropsy. Seven of the patients had radiographically demonstrated stones that were not operated on. They are alive at the present time, more than 2 years later. In the remaining 33 patients, the stones were discovered during portasystemic shunt procedures. In these patients, cholelithiasis was systematically treated by cholecystectomy (8 patients) or cholecystolithotomy (25 patients). Postoperative mortality and morbidity rates were not different in these 33 patients when compared with the rates in 170 patients who underwent portal surgery alone during the same period. Our results confirm the high incidence of cholelithiasis in cirrhotic patients. Complications of gallstones are not frequent but require an emergency operation that carries a high risk in these patients. On the other hand, elective surgical treatment of asymptomatic cholelithiasis at the time of portal diversion does not bear any peculiar risk. In such a situation, cholecystolithotomy is easier and probably safer than cholecystectomy.

Cholecystectomy↗
PubMed1983

Suppression of the shunt and esophageal transection. A new technique for the treatment of disabling postshunt encephalopathy.

A new surgical procedure was developed for the treatment of disabling postshunt encephalopathy. This procedure consists of an esophageal transection with esophagogastric devascularization, followed by suppression of the shunt. Suppression of the shunt is performed postoperatively using external maneuvers. In the four patients treated, suppression of the shunt led to disappearance of the clinical manifestations of encephalopathy in three and to a significant improvement in one. Providing that the shunt is side-to-side, this new treatment would allow a dramatic improvement in the small number of patients in whom severe encephalopathy develops after portosystemic shunting.

Brain Diseases↗
PubMed1983

Effect of portacaval or mesentericocaval anastomosis on cholesterol metabolism in rats.

Portacaval anastomosis (PCA) lowered by 50% the cholesterol concentration in the plasma of rats. The free and esterified cholesterol contents in the lipoproteins were decreased with the very low density lipoproteins most affected (-85%). Cholesterol concentration as total content in the liver was reduced. The major change in the cholesterol metabolism, as studied with an isotopic equilibrium method, was the decrease in the intestinal absorption coefficient of dietary cholesterol (56.0 +/- 2.7% instead of 73.3 +/- 1.9% in controls). The rate of cholesterol transformation into bile acids was decreased (10.5 +/- 0.3 vs 14.5 +/- 0.5 mg/day/rat in controls). The rate of internal secretion of cholesterol was slightly reduced while the rate of fecal external secretion was increased, suggesting that the synthesis of cholesterol by extra-digestive tissues (including liver) was reduced after PCA. The effects of PCA on cholesterol metabolism were similar to those described for glucagon administration. Since this shunt results in hyperglucagonemia, it is suggested that this hormonal perturbation was the main factor involved in the modifications of cholesterol metabolism after PCA. Moreover, mesentericocaval anastomosis, which shunts only the intestinal blood and allows the pancreatic hormones a normal transport through the liver, did not significantly modify cholesterol metabolism. Only cholesterolemia (-28%) and the absorption coefficient of dietary cholesterol (66.0 +/- 2.3%) were slightly reduced.

Animals↗
PubMed1983

Spontaneous long-term acceptance of RT-1-incompatible liver allografts in inbred rats. Analysis of the immune status.

In several combinations of inbred rats, liver allografts are spontaneously tolerated, and after a few weeks liver tolerant rats are in a state of donor-specific transplantation tolerance. In vivo and in vitro experiments were conducted to analyze the immunological status of LEW or BN rats with spontaneously tolerated (LEW X BN) F1 liver allografts several months after transplantation. Acute rejection of secondary donor-specific heart allografts retransplanted from liver-tolerant rats to normal syngeneic hosts suggests that the state of tolerance in liver-tolerant rats is related to an active modification of the immune system of the rat and not to a reduced immunogenicity of the graft. No cytotoxic antibodies or cells were found in liver-tolerant rats. Reactivity in mixed lymphocyte culture was normal or slightly reduced. Arguments for the presence of splenic suppressor cells were found in LEW tolerant rats using a local graft-versus-host assay, but these could not be found in BN rats, or when attempting to transfer or to break the tolerance state. A nonspecific humoral blocking factor was found in vitro in liver-tolerant rats but transfer of serum from liver-tolerant rats to normal syngeneic hosts did not permit a significant prolongation of donor-specific heart allografts. These results suggest that more than one mechanism may be involved at the maintenance phase of liver allograft tolerance.

Animals↗
PubMed1983

Spontaneous long-term survival of liver allografts in inbred rats: comparison between semi-allogenic and fully allogeneic strain combinations.

Spontaneous tolerance of liver allografts can be observed in inbred rats. In order to study the influence of the density of major histocompatibility complex alloantigens on the fate of liver allografts in the rat, liver allografts were performed in a semi-allogeneic and a fully allogeneic combination. Comparisons of the fate of heart and kidney allografts were made in the same combinations. A similar proportion of spontaneously tolerated liver allografts was observed in the two combinations; after a few months these animals were in a state of donor-specific unresponsiveness. A spontaneous prolongation of kidney allografts was observed only in the semi-allogeneic combination. These animals were not in a state of donor-specific unresponsiveness. These results suggest that induction of liver allograft tolerance in the rat is not decisively influenced by the importance of the density of major histocompatibility complex antigens present on the graft and that its mechanism may be different from that which causes spontaneous prolongation of semi-allogeneic kidney allografts.

Animals↗
PubMed1983

Graft-versus-host reaction induced by spleen grafting in inbred strains of rats. Influence of portal venous drainage.

Acute graft-versus-host (GvH) reaction was induced by spleen grafting in inbred rats. A comparison of the influence of portal or caval drainage of the spleen graft on the survival time was made. This comparison revealed a prolongation of survival time in case of a portal drainage when the graft was an auxiliary half-spleen graft. This result suggests that the liver may have, in some conditions, protective capacities against an acute GvH reaction.

Animals↗