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Biomedical subjects

H Bismuth

Publications and source records attributed to H Bismuth.

At least 91 records · Page 5Linked to original sources
PubMed1998

What should we expect from a bioartificial liver in fulminant hepatic failure?

Fulminant hepatic failure is associated with high mortality. Liver transplantation is an effective therapy that improves survival, and because of donor organ shortage and urgency, a bioartificial liver could act as an effective bridge to liver transplantation in patients with fulminant hepatic failure. We discuss the place of the bioartificial liver in the treatment of other causes of liver failure.

Europe↗
PubMed1998

[Surgical therapy of metabolic liver diseases (glycogenosis, hypercholesterolemia)].

Up-to-date, most patients with serious chronic hepatic disease are best treated by liver transplantation. It has been confirmed the striking benefit of liver transplantation also for patients with glycogen storage disease or homozygous familial hypercholesterolemia who were refractory to medical treatment. Nevertheless, the advantage of achieving palliation without transplantation, thereby avoiding the need for chronic immunosuppression, is obvious. With reference to the mentioned above diseases, end-to-side portacaval shunt was used. A favourable effect was noted on body growth and a number of metabolic abnormalities. Hepatic failure did not occur, although in a few patients blood ammonia concentrations and serum alkaline phosphatase levels increased relative to preoperative values. To avoid an incomplete palliation provided by portacaval shunt, appropriate case selection is a problem. The Authors report their personal experience with portacaval shunt for the treatment of glycogenosis and familial hypercholesterolemia.

Adolescent↗
PubMed1998

Reduction of nonresectable liver metastasis from colorectal cancer after oxaliplatin chemotherapy.

Until recently, approximately 30% of patients with resectable hepatic metastases from colorectal cancer survived 5 years after surgery. Additionally, many patients present with unresectable metastases and can look forward only to palliative care. Whereas therapeutic approaches such as cryosurgery appear to improve resectability, a key to resecting hepatic metastases is the ability to shrink the metastatic sites to make them more amenable to surgery. The administration of traditional chemotherapeutic modalities by conventional means or via intra-arterial or portal vein infusion has not provided significant improvements. The recent introduction of the combination oxaliplatin-5-fluorouracil/folinic acid administered as a chronomodulated regimen, however, has provided better response rates with minimal toxicity. Recent results show that the resection of previously unresectable metastases became possible in up to 16% of patients after chemotherapy with a chronomodulated regimen of oxaliplatin plus 5-fluorouracil/folinic acid. Of the patients who had successful resections, 54% and 40% were alive at 3 years and 5 years after surgery, respectively. The results of these studies demonstrate that this new approach can significantly prolong survival for patients with a previously bleak outlook. As a result, new treatment algorithms are evolving, integrating chemotherapeutic and surgical strategies for the treatment of patients with metastatic colorectal cancer.

Antineoplastic Agents↗
PubMed1998

Successful treatment of severe azathioprine-induced hepatic veno-occlusive disease in a kidney-transplanted patient with transjugular intrahepatic portosystemic shunt.

Azathioprine-induced veno-occlusive disease of the liver mainly described after kidney transplantation is as rare as severe with a high mortality due to acute portal hypertension and liver failure. A kidney-transplanted patient with severe azathioprine-induced veno-occlusive disease of the liver and worsening despite drug discontinuation was treated by emergency transjugular intrahepatic portosystemic shunt. Whereas the veno-occlusive disease was controlled, the patient developed severe intractable portosystemic encephalopathy successfully treated by a stent reducer maintaining a certain degree of portal diversion. Twelve months after transjugular intrahepatic portosystemic shunt, liver function was normalized and the stent was thrombosed with a subnormal liver histology. Thirty-six months after transjugular intrahepatic portosystemic shunt the patient is alive with normal liver function tests and kidney graft function. Transjugular intrahepatic portosystemic shunt for treatment of severe veno-occlusive disease of the liver is an alternative to tide the patient over until recovery of liver function.

Adult↗
PubMed1998

[Value of percutaneous ethanol injection in the treatment of hepatocellular carcinoma in a cirrhotic liver].

Percutaneous ethanol injection treatment, introduced ten years ago as palliative therapy for patients with inoperable hepatocellular carcinoma, can now be used with a curative intent to treat small tumours with results comparable to surgical resection. This progress, made possible by sophisticated radiological techniques, makes percutaneous ethanol injection the treatment of choice for patients with poor liver function in whom resection is not possible and local control of the disease is desirable either for prolonged palliation or in view of liver transplantation. For patients with large tumours, or in case of recurrence after previous surgical treatment, a therapeutic approach combining transarterial lipiodol chemoembolisation and percutaneous ethanol injection has shown promising results and deserves further investigation.

Carcinoma, Hepatocellular↗
PubMed1998

[Indications and results of liver transplantation in the treatment of hepatocellular carcinoma in cirrhosis].

Liver transplantation is a treatment for hepatocellular carcinoma in cirrhosis which is both recognized, because potentially radical, and controversial because associated with a high risk of recurrence. This study reports the results of a consecutive series of 125 patients transplanted for hepatocellular carcinoma in cirrhosis over an 11-year period. Liver transplantation was indicated because of the tumour in 92 cases (74%) and the tumour was an incidental finding in 13 cases (10%) or was discovered on histological examination of the hepatectomy specimen in 20 cases (16%). The operative mortality at two months was 4% with a 20% morbidity, due to vascular (6%) or biliary (14%) complications. Tumour recurrence was observed in 26 patients (21%) Recurrence was exceptional in the incidental or histological forms of hepatocellular carcinoma (5%) and more frequent when the tumour constituted the indication for transplantation (27%). The risk of recurrence and the survival were significantly influenced by the maximal tumour diameter (greater than 30 mm), the number of tumour nodules (greater than 3) and the presence of portal invasion. Inclusion of these factors in patient selection during the second phase of the study allowed a reduction of the risk of recurrence from 33 to 11% and improvement of the 3-year post-transplantation survival from 53 to 76%. Tumours less than or equal to 30 mm in diameter, with no more than 3 nodules, and without portal invasion are ideal indications for transplantation. Tumours with more than 3 nodules and larger than 30 mm appear to constitute a contraindication to transplantation, unless tumour reduction can be achieved by chemoembolization. Intermediate forms of hepatocellular carcinoma between these two extreme forms are possible indications for transplantation, depending on the availability of liver transplants.

Adolescent↗
PubMed1997

Acute cyclosporine toxicity after liver transplantation is predicted by the lidocaine monoethylglycinexylidide test in the donor.

Cyclosporine toxicity is still a significant problem in the early period after liver transplantation. The monoethylglycinexylidide (MEGX) test performed in the donor has been suggested as a reliable test to predict liver graft function in the recipient. The MEGX test was performed in 50 consecutive donors, and the clinical course of recipients, metabolic parameters of the grafts, and cyclosporine levels were followed in detail for 10 days. Two patients died of sepsis and were excluded. Renal and/or neurological toxicity appeared in 15 of the remaining 48 patients (31%). In the 6 with neurological problems, MEGX values were low (41, 47, 50, 60, 94, and 101 micrograms/L). Nine patients had transient elevations of creatinine and urea; in 8 of these, cyclosporine levels remained in the normal range. Low MEGX values in the donors correlated with early evidence of cyclosporine toxicity (P < .0001), reduced graft function (bile output, P = .04; prothrombin time at day 5, P = .005), and prolonged stay in the intensive care (P = .022). The MEGX test is valuable and reflects the metabolic capacity of liver grafts. It can predict posttransplantation complications caused by cyclosporine toxicity, and further study would evaluate its incorporation into immunosuppressive protocols.

Adolescent↗
PubMed1997

Infected false hepatic artery aneurysm after orthotopic liver transplantation treated by resection and reno-hepatic vein graft.

Vascular complications after liver transplantation are relatively rare. Thrombosis of the host-transplant arterial anastomosis is the most frequently encountered vascular complication whereas only a few observations of infected anastomotic aneurysms, often leading to death by massive bleeding or loss of the transplant, have been reported. We report herein the case of a patient with an infected false anastomotic aneurysm of the hepatic artery associated with dissection of the celiac artery following orthotopic liver transplantation in a 35-year-old man who had received a liver transplantation for end-stage liver disease secondary to posthepatitis cirrhosis in March 1989. Starting at day 30, he had signs of infection associated with hemocultures positive for Staphylococcus aureus. A subhepatic collection was found on sonography and CT scan and also cultured positive for the same germ. Arteriograms demonstrated a celiac artery dissection associated with a false anastomotic aneurysm of the hepatic artery. Surgical treatment consisted of arterial reconstruction using a saphenous vein graft between the right renal artery and the hepatic artery of the transplant, followed by resection of the hepatic artery aneurysm and the celiac artery. Hepatic ischemia was 12 min. The immediate postoperative course was uneventful and postoperative angiograms showed that the reconstruction was patent at 5 years.

Adult↗
PubMed1997

A new technique of one-stage total hepatectomy in the rat.

BACKGROUND: A small animal model of one-stage total hepatectomy is needed for the study of the consequences of fulminant liver failure and to investigate the extrahepatic metabolism of drugs metabolized by the liver. The models of hepatectomy described previously in the rat have the disadvantage of multiple stages, technical difficulty, or achievement of only an incomplete removal of the liver tissue. METHODS: A Y-shaped graft was prepared from the inferior vena cava and the left renal vein of a donor rat. A total hepatectomy was performed in a recipient rat. The graft was placed and the portorenal and lower cavocaval anastomoses were performed by means of the polyethylene cuff technique. The upper cavocaval anastomosis was fashioned with a continuous suture. The procedure was performed on 49 rats, and the animals were studied for survival and biochemical profiles. RESULTS: The surgical procedure took a mean of 40 +/- 5 minutes and was not associated with any operative deaths. The portal clamping time did not exceed 15 minutes. Spontaneous mean survival of the anhepatic rats was 360 +/- 30 minutes, and glucose supplemented animals had a mean survival time of 20 +/- 5 hours. The anhepatic state was associated with significant metabolic and biochemical alterations. CONCLUSIONS: This procedure is quick to perform and does not require considerable microsurgical expertise. It provides a reproducible small animal model of total hepatectomy that is particularly useful for metabolic studies.

Animals↗
PubMed1997

De novo and apparent de novo hepatitis B virus infection after liver transplantation.

BACKGROUND/AIMS: The aim of this study was to clarify the aetiology of apparent de novo HBV infection after liver transplantation. METHODS: Twenty out of 570 HBsAg negative patients (3.5%) became HBsAg positive after transplantation and were studied. Donor and recipient sera were retrospectively tested for HBsAg, anti-HBs, anti-HBc, and HBV DNA by PCR. Donor and recipient livers were tested for HBV DNA by PCR on paraffin-embedded tissue. RESULTS: Group 1: HBV infection of donor origin (eight patients): one donor serum was HBsAg positive, three were serum HBV DNA positive, four were liver HBV DNA positive. Group 2: reactivation of latent HBV infection (eight patients) with detection of HBV DNA in pretransplant serum (seven patients) or in native liver (one patient): three were anti-HBs positive, two anti-HBc positive, and three with fulminant hepatitis had no serological HBV markers. Group 3: undetermined origin (four patients) defined by absence of HBV DNA in pretransplant donor and/or recipient sera and liver; however, acquired infection was suspected from two anti-HBs and anti-HBc positive donors. Two patients became HBsAg negative, and five HBV DNA negative. One died from HBV-cirrhosis and two were retransplanted. In the others, the last histology showed cirrhosis (three), chronic hepatitis (nine), acute hepatitis (one), and non-specific change (four patients). CONCLUSIONS: The prevalence of de novo HBV infection in liver transplant patients was 3.5%; the aetiology was determined in 16/20 patients: from the donor in eight, and from the recipient in eight. One should be cautious when donors or recipients are anti-HBc or both anti-HBs and anti-HBc positive.

Adult↗
PubMed1997

Long-term longitudinal study of intrahepatic hepatitis C virus replication after liver transplantation.

Recurrence of hepatitis C after liver transplantation is common and can lead to severe liver diseases. Although immunosuppression and high levels of viremia suggest a direct pathogenicity of hepatitis C virus (HCV), the relations between viral replication and long-term histological course are still unknown. Thirty-three patients with a mean histological follow-up of 3.5 years (3 months - 8.6 years) were analyzed. Nineteen patients were infected by genotype 1b. Liver HCV RNA was determined in parallel with the quantitation of an internal control (28S ribosomal RNA) by competitive polymerase chain reaction (PCR). Lobular hepatitis (LH) and chronic active hepatitis (CAH) occurred in 27 and 19 patients, respectively. Levels of liver HCV RNA determined in 84 biopsies were higher in cases of LH than in the other patterns (82 +/- 123 vs. 19 +/- 38; P < .01) and were unrelated to the genotype. Progression from LH to CAH was associated with a highly significant decrease of liver HCV RNA (P = .006), which was not observed in patients with stable histology. Among patients with CAH, those infected by genotype 1b had more severe liver damage and lower levels of liver HCV RNA than others (P = .04). Multivariate analysis showed that high levels of liver HCV RNA at the time of the first posttransplantation biopsy was an independent predictor of CAH (P = .01). After liver transplantation, the progression to CAH together with a decrease of liver HCV RNA suggests that a host's response is involved in the long-term viral pathogenicity. This response may be stronger and liver disease more severe in patients with high levels of replication at the time of LH and in those infected by genotype 1b.

Adult↗