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Biomedical subjects

J Gugenheim

Publications and source records attributed to J Gugenheim.

At least 91 records · Page 5Linked to original sources
PubMed1994

[Surgical treatment of gangrene of the perineum].

Acute perineal gangrene due to anaerobic Gram negative bacilli or streptococci rapidly leads to tissue necrosis and death in 50% of the cases despite progress in intensive care. Emergency treatment requires adapted antibiotics, hyperbaric oxygen therapy and repeated surgery. Factors of poor prognosis include age over 60 years, lomboabdominal or crural extension, septic shock, positive blood cultures and lack of fecal derivation. Surgery is performed under general anaesthesia since loco-regional anaesthesia is contraindicated during the septic phase. Repeated operations are needed to make large incisions, evacuate pus, search for foreign bodies and resect damaged tissue in order to expose all the infected areas to air and hyperbaric oxygen. A colostomy must be performed in order to avoid fistulization and contamination of the infected areas. An indwelling urine catheter is usually sufficient although a suprapubic catheter may be needed at the risk of further extension of the gangrene. Surgical treatment is associated with intensive care and hyperbaric oxygen therapy. Three effective antibiotics are recommended. Using this aggressive surgical protocol, we have been able to reduce mortality to 20% in patients under 60 years of age.

Combined Modality Therapy↗
PubMed1994

Immunophenotyping and metastatic localization of breast cancer.

Monoclonal antibody SM 92 is involved in the immunophenotype of gastrointestinal and liver cells, SM 43 in ovarian cells, and SM 13 in lung cells. Based on a study of 61 breast adenocarcinoma patients, we found that tumors reacting with SM 92 appear associated with liver metastases, SM 43 with ovarian metastases, and SM 13 with lung metastases. These associations are highly significant. They lend some support to the concept that tumor cells that metastasize tend to go to sites where cells normally have the same surface antigens.

Antibodies, Monoclonal↗
PubMed1994

Potassium uptake and water content in hepatocytes isolated from rat livers preserved in Euro-Collins and UW solutions and after transplantation.

Isolated hepatocytes from the rat were used to assess the maintenance of liver cell function in relation to the composition of the preservation medium. After separation by collagenase, they were incubated in Krebs-Ringer-Bicarbonate medium (KRB), Euro-Collins (EC), or University of Wisconsin (UW) solutions. Potassium influx, cell volume, and transaminase release were measured in cells freshly separated from control livers or from livers preserved in vitro up to 12 h in these media or having undergone orthotopic liver transplantation (OLT). While ion exchange levels were retained in all media, cells shrank significantly in UW but were able to restore their volume after 3 h of liver preservation. With regard to in vivo conditions, UW appears to be the best medium to prevent edema and to maintain more stable potassium exchange and enzyme production. These results are of value for liver transplantation in humans.

Adenosine↗
PubMed1994

Role of non-parenchymal liver cells in ischaemia-reperfusion liver injury: protective effects of muramyl dipeptide.

It has been suggested that non-parenchymal liver cells play a central role after ischaemia and reperfusion of the liver. Male Lewis rats were subjected to 90 min of warm liver ischaemia. Four groups were constituted: group 1, no treatment; group 2, muramyl dipeptide treatment, activation of Kupffer cells; group 3, dextran sulphate injection, Kupffer cell blockade; and group 4, gadolinium chloride administration, Kupffer cell blockade. Dextran sulphate (4 mg/100 g) and gadolinium chloride (GdCl2, 0.7 mg/100 g) were given intravenously on day 2. MDP was injected intravenously (500 mg/250 g) 24 h before and 10 min after the intervention. Mortality rates were assessed and serum transaminases, histology of the liver and Kupffer cell phagocytic activity were evaluated 6 h after the end of ischaemia. MDP treatment significantly (P < 0.001) reduced mortality (30%) in comparison with the non-treated group (60%). The mortality rate was significantly higher in the dextran sulphate-treated (80%) and gadolinium chloride-treated (90%) groups in comparison with group 1. A significant reduction in transaminase levels was observed after MDP treatment, while blockade of Kupffer cells resulted in higher serum transaminase levels. The extent of necrosis and congestion was improved by MDP administration, while disruption of the vascular and sinusoidal integrity of the liver and extensive areas of necrosis were observed in dextran sulphate and gadolinium chloride-treated rats. Sheep red blood cell 51Cr liver uptake was deeply depressed 6 h after the end of ischaemia in group 1 (10 +/- 1.2%/g tissue). MDP injection restored the Kupffer cell activity (30.6 +/- 3.22%/g tissue) while dextran sulphate and gadolinium chloride administration markedly decreased SRBC 51Cr liver uptake. Our findings demonstrate that MDP in able to protect the liver from ischaemic insult while blockade of Kupffer cells was deleterious in rats subjected to liver ischaemia.

Acetylmuramyl-Alanyl-Isoglutamine↗
PubMed1994

Recurrence of hepatitis C virus after liver transplantation.

The hepatitis C virus is a common cause of chronic hepatitis after orthotopic liver transplantation (OLT). We evaluated 95 consecutive patients who underwent OLT at our institute between March 1988 and November 1992 and who had a follow-up period longer than 3 months. All patients had a second-generation test (ELISA + RIBA) for HCV antibodies (HCV Ab) before and monthly after OLT; all had a polymerase chain reaction (PCR) test for detection of viral RNA after the operation. Whenever biochemical abnormalities (hypertransaminasemia 2 times the normal range) were seen, a percutaneous liver biopsy was performed. Forty-two HCV Ab+ patients before OLT remained positive after OLT. In this group the PCR test was positive in 32 cases (78.5%). In 13/42 (30.9%) cases (all PCR+) with hypertransaminasemia histological examination showed signs of viral C hepatitis (score of Knodell minimum 3, maximum 12, median 5.5). Of 53 HCV Ab patients before OLT, only 1 became HCV Ab+ and PCR+ 15 months after OLT. In the remaining 52 patients 15 were PCR+. Twenty of 53 patients (37.7%) had a liver biopsy because of hypertransaminasemia: in no case did histology show any signs of hepatitis C. In conclusion, viral C recurs often after OLT for post-hepatitic C cirrhosis. The histological graft lesions are in most cases moderate. We did not observe any deaths related to viral C infection in grafted patients. According to our results post-hepatic C cirrhosis remains a good indication for OLT.

Adult↗
PubMed1993

[Biliary complications after a liver transplant].

Biliary tract complications are still an important source of morbidity and mortality after liver transplantation. Between March 1988 and September 1991 we performed 111 liver transplants in 109 patients (84 men and 25 women, mean age 44.5 +/- 1.1 year). Biliary tract reconstruction was via a choledocho-choledochostomy (n = 107) or via a Roux limb choledochojejunostomy (n = 4). Ten biliary complications (11.9%) occurred (6 biliary leakage, 3 biliary strictures, 1 biliary cast syndrome). Five patients (5.9%) necessitated operative repair (Roux limb choledochojejunostomy). No death was related to biliary tract complication.

Adult↗
PubMed1993

Simple column liquid chromatographic assay for serum neopterin.

A simple high-performance liquid chromatographic assay for serum neopterin with highly sensitive fluorimetric detection (limit 1 nM) is proposed. Comparison with results obtained by radioimmunoassay revealed a good correlation between the two techniques. The potential use of this method for the follow-up of liver transplant patients is discussed.

Adult↗
PubMed1993

[Dissection of the Calot's triangle by the celioscopic approach].

Laparoscopy seems to increase the frequency of post-cholecystectomy biliary complications. Irrespective of the instruments and techniques utilized, dissection of Calot's triangle must be performed in compliance with the classical rules of bile duct surgery. These rules are: always keep in contact with the gallbladder; completely dissect the Calot's triangle area which must not contain more than one biliary tract element; never dissect the cystic duct beyond the right border of the hepatic choledochus; never section an element that is not identified with certainty; systematically perform a peroperative transcystic cholangiography, in particular to detect the anatomical variants of the extra-hepatic biliary ducts.

Cholecystectomy, Laparoscopic↗
PubMed1993

Role of nonparenchymal liver cells in guinea pig to rat hepatic xenotransplantation.

This work was undertaken to investigate the role of nonparenchymal liver cells in a discordant model of hepatic xenografting. Three experimental groups were established: in group 1 guinea pig to Lew rat liver xenotransplantations were performed; in group 2 both donor and recipient were treated with dextran sulfate, a known inhibitor of the reticuloendothelial system phagocytic function; in group 3 both donor and recipient were injected with muramyl dipeptide, a synthetic immunomodulator stimulating the monocyte/macrophage axis. Survival time was assessed and xenoantibody titers 30 min before and after the intervention, Kupffer cell activity 30 min after transplantation, histology and immunoglobulin and complement deposits of the grafted liver were evaluated too. Survival time of the xenografted rats in group 1 was 6.4 +/- 0.31 h. Blockade of Kupffer cells by dextran sulfate administration significantly (p < 0.001) depressed the survival time (2.9 +/- 0.31 h) of the grafted rats, while a significant increase (p < 0.001) was observed in the muramyl dipeptide-treated group (9.3 +/- 0.52 h). A significant reduction of xenoantibody titers 30 min after intervention was observed in the muramyl dipeptide group while no reduction was observed in the dextran group. Thirty minutes after xenotransplantation sheep red blood cell 51Cr uptake was significantly depressed by dextran sulfate treatment while muramyl dipeptide administration restored the Kupffer cell activity. Histological changes worsened after dextran administration in comparison with the other groups. Immunoglobulins and complement deposits were diminished by dextran administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetylmuramyl-Alanyl-Isoglutamine↗
PubMed1993

[7 cases of liver transplantation with preservation of the vena cava inferior].

Orthotopic liver transplantation (OLT) with preservation of the inferior vena cava (IVC) was performed in 7 patients during a period of 7 weeks. For 5 years in this center are realized 180 OLT, the last 93 of them with preservation VCI (51.6%). This method had important advantages versus standard operation--blood loss and operating time are reduced, IVC does not clamped. This operation can be used in the majority of cases.

Adult↗
PubMed1993

[A difficult diagnosis: pelvic-abdominal actinomycosis abscess].

A laparotomy for hysterectomy was performed in a 46-year-old nulliparous woman who had worn an intra-uterine sterilization device for 8 years. The patient was in poor general health and had had abdominal pain and repeated episodes of fever over the preceding 3 months. An abscess of the abdominal muscle was found peroperatively. No perforations of the small or large intestine were observed. The pathology examination yielded the diagnosis of Actinomycosis. Actinomyces israeli is the most frequency observed Actinomycae in humans. It is a saprophyte organism of the intestinal flora, not usually found in the vagina and observed in 3.5% of cervical swabs of patients wearing an intra-uterine device (Gupta bodies). The frequency increases with the duration of insertion and the pathogenicity appears when the immune responses are deficient and/or when a cofactor is involved. Treatment relies on surgical exeresis and prolonged antibiotics (penicillin G or macrolides). Hyperbar treatment is sometimes used.

Abdominal Muscles↗
PubMed1993

[Disseminated infection due to Scedosporium apiospermum in liver transplantation. Differential diagnosis from invasive aspergillosis].

A case of fatal disseminated infection due to Scedosporium apiospermum occurring after liver transplantation is reported. Diagnosis was made at autopsy, as numerous fungal colonies were found in the lungs, heart, brain, kidney, spleen and liver. Scedosporium apiospermum was identified in pulmonary, cerebral and myocardial specimens by Sabouraud's glucose agar cultures. Infections due to Scedosporium (S. apiospermum ou Pseudallescheria boydii) occur in immunocompromised hosts, particularly after organ transplantation, and realize severe invasive fungal infection. Scedosporiosis is much more rare than aspergillosis and can be only identified by mycological study. This diagnosis is rarely performed during life time and allows an effective treatment by imidazoles.

Aspergillosis↗
PubMed1993

[Leiomyosarcoma of the liver: a case treated by transplantation].

A 68 year old woman with primary hepatic leiomyosarcoma, impairement of general status and right upper quadrant pain was diagnosed with liver tumor by sonography, CT scan and nuclear magnetic resonance imaging. Angiograms showed a hypervascular tumor. The patient was treated by hepatic transplantation but died 15 days after operation. The diagnosis of leiomyosarcoma was established by immunohistochemical and ultrastructural studies; the primary nature was confirmed by necropsy. Diagnostic and therapeutic features of primary hepatic leiomyosarcoma--the 19th case reported in the literature--are discussed.

Aged↗
PubMed1992

[Liver transplantation for hepatocellular carcinoma. Mid-term results].

The results of liver transplantation for hepatocellular carcinoma are disappointing. Thus, in 11 patients transplanted for hepatocellular carcinoma on cirrhosis, the actuarial survival rate at 3 years was 20 percent, with a postoperative mortality of 27 percent and 4 deaths caused by recurrence of the malignancy. These poor results contrast with those we obtained after liver transplantation for cirrhosis and finding of incidental hepatocellular carcinoma in the resected part of the liver. Out of 6 patients with incidental carcinoma only 1 died postoperatively (16.6 percent), and no case of recurrent malignancy was observed. These results confirm that the malignancy recurrence rate is high after transplantation for large carcinoma. On the other hand, the absence of recurrence after transplantation for incidental hepatocellular carcinoma encourages us to look for small carcinomas on cirrhosis.

Actuarial Analysis↗