One case of ureterohydronephrosis fistulized into an urinoma in a patient with an aortobifemoral prosthesis is reported. The analysis of the literature shows that this kind of expression is exceptional, both because of the location of the urinoma and of its tuberculous origin.

Aortic Valve↗

PubMedDate not supplied

[Propagation rate of arterial pressure waves as a function of age and physical training].

The arterial pulse wave velocity is determined to a large extent by the arterial elastic modulus. We tried to assess the importance of this parameter in cardio-vascular adaptation to exercise by measuring pulse wave velocity (c) in 45 sedentary subjects and 28 competitive cyclists whose ages ranged from 14 to 47 years. The measurements were performed at rest and during the recovery phase after ergometric exercise. At constant diastolic pressure, a positive linear relationship was demonstrated between c and age in both the sedentary and trained subjects. The slope of this relation was significantly different in the two groups. During the recovery phase, at constant diastolic pressure, a linear relationship was also established between c and the relative increase in systolic pressure in the sedentary group classified into six age subgroups. The slope of this relation increased with age. The part taken by diastolic flow velocity during exercise in the increase in c was demonstrated in 8 subjects by simultaneous Doppler ultrasonic recording of contra-lateral femoral arterial velocity. Nevertheless diastolic flow in exercise could not explain entirely the observed increase in c. An increase in arterial elasticity modulus during exercise should be postulated in order to explain the concomitant increase in arterial pulse wave velocity.

Adolescent↗

PubMedDate not supplied

[Conservative treatment of hepatic injuries. Management and course].

From January 1986 to June 1994, 252 cases of closed liver trauma were treated in an emergency setting. Non surgical conservative management, after a complete imaging work-up including CT scan in all cases, was applied in 142 cases (56.3%) with no hemodynamic complication. The spontaneous outcome in these cases was quite favourable in 131 (92.2%); all lesions had disappeared in 4 to 36 weeks. Complications were observed in only 6 cases: 2 intrahepatic abscesses managed with percutaneous drainage were not further complicated, 1 biliari fistula required surgical exploration, 1 intrahepatic bilioma was drained percutaneously, 1 disinsertion of the gallbladder was treated by laparoscopy and 1 operation for bleeding was required 48 hours after the trauma in 1 case. No deaths could be directly imputed to the liver trauma, 5 patients died from neurological causes. Non-surgical conservative treatment combined with strict prolonged surveillance is a reliable management option for patients with closed liver trauma.

Adolescent↗

PubMedDate not supplied

[Arterial and biliary complications of hepatic transplantation].

Despite progress in standardization of reconstruction procedures, arterial and biliary complications remain an important problem in liver transplantation. These complications directly affect graft survival and patient mortality. We review a series of 165 consecutive orthoptic liver transplantations performed in 146 patients including 3 children. Biliary reconstruction included bilio-biliary termino-terminal anastomosis in 88% of the cases and bilio-digestive choledoco-jejunal anastomosis in 12%. Biliary complications occurred in 15% (25/165) with more obstruction (64%, 16/25) than leakages (64%, 7/25); 28% (7/25) of these complications were related to biliary drainage (3 obstructions and 4 leakages). There were no arterial complications in the 7 patients with non-anastomotic biliary stenosis. The rate of arterial complications was 11%; with 8 stenoses, 5 thrombosis and 5 pseudoaneurysms. Among the 18 transplantations with an arterial complication, 7 (39%) also had a biliary complication. Among the 10 patients with a complete interruption of arterial blood flow (thrombosis or surgical ligature or a ruptured pseudo-aneurysm), 5 (50%) also had a biliary complication, 1 underwent early retransplantation and 2 died early. In conclusion, the biliary tree of the graft are particularly susceptible to interrupted arterial flow. Ischaemic biliary lesions predominate in the intra-hepatic biliary ducts. Biliary drainage is important.

Adolescent↗

PubMedDate not supplied

[Frequency and severity of viral hepatitis C after liver transplantation. Study in 28 patients].

OBJECTIVES AND METHODS: HCV cirrhosis is one of the major indications for liver transplantation. HCV recurrence rate is high but long term development to cirrhosis seems to be rare. This study included 28 patients with HCV infection (HCV RNA in blood, histologic lesions highly suggestive or compatible with HCV infection). RESULTS: Twenty-one out of the 28 patients were transplanted for hepatic chronic liver disease associated with HCV infection (reinfection), whereas only 7 out of 94 transplanted patients (7.4%) without pre-transplant HCV infection ("de novo" infection). Patients were followed clinically and histologically for a mean period of 26.8 months (range: 3-56). Of 26 patients with a good histological evaluation, 24 (92.3%) had chronic hepatitis: 7 with mild activity, 17 with moderate activity, 7 of whom had bridging fibrosis. Two patients had unusual features with associated lesions (necrotic hepatitis and chronic rejection in one case, acute hepatitis associated with CMV infection in the other). CONCLUSION: This study confirms the high prevalence of HCV recurrence, as well as the "de novo" infection risk, and suggests caution concerning long term prognosis.

Adult↗