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Biomedical subjects

J Lerut

Publications and source records attributed to J Lerut.

At least 91 records · Page 5Linked to original sources
PubMed1987

Biliary tract complications in human orthotopic liver transplantation.

The results of 393 consecutive orthotopic liver transplants in 313 patients were reviewed to determine the incidence of primary biliary tract complications. There were 52 biliary tract complications in 393 grafts (13.2%), and 5 directly related deaths. Choledochojejunostomy over an internal stent to a Roux-en-Y limb of proximal jejunum (RYCJ-S) was the most frequently used technique (175 cases) and the most successful with only 9 technical failures (5.2%). Choledochocholedochostomy over a T tube (CC-T) was used in 159 cases and was successful in all but 20 cases (12.6%). Other methods of reconstruction were associated with high failure rates or technical complexity that do not justify their use. Biliary leak and obstruction were the most common complications. Leakage after CC-T at the T tube exit site was usually directly repaired, but anastomotic leakage required conversion to RYCJ-S. Obstruction may be relieved by percutaneous balloon dilatation but definitive treatment also usually required conversion to RYCJ-S. The most common complication after RYCJ-S is functional obstruction by a retained stent, which has a low morbidity but may necessitate surgical removal. Anastomotic leaks, which occurred in 2 cases, were successfully managed by revision of the choledochojejunostomy.

Adult↗
PubMed1981

[Stenoses and occlusions of the innominate trunk (author's transl)].

Direct comparison with neuroradiologic and surgical data show that stenoses and occlusions of the innominate trunk may be recognized safely by Doppler ultrasound despite localisation close to the aorta. Formation of sonographically demonstrable and haemodynamically complicated vascular by-passes is the reason for the mainly asymptomatic or very uncharacteristic complaints of these cases (78%) among the relatively rare stenosing occlusions of the lumen (0,65%) of the innominate trunk (18 out of 2768 patients). Only in four cases were there focal neurological losses or symptoms of hypoperfusion of the arm. Invasive diagnostic measures should thus be used sparingly. The indication for vascular surgery should be limited to a few cases as long as the natural course of these extracranial vascular changes and the risk of cerebral injury have not been established with certainty.

Adult↗
PubMed1981

[Indications and therapy of obstructive aorto-iliac disease from a surgical viewpoint].

Operative management in patients with aortoiliac disease consists of thrombendarterectomy for unilateral and localised lesions and of aortofemoral/iliac graft implantations for bilateral and extensive lesions. Operative morbidity and mortality depend on the type of anesthesia and are influenced mainly by operating technique. The individual risk of operation depends on the localization of the disease and increases significantly if organ arteries are involved. Therefore, asymptomatic stenosis of the extracranial carotid arteries, renal, and mesenteric arteries have to be recognized, and for significant lesions prophylactical surgical management should be performed. An extensive noninvasive and invasive preoperative diagnostic program will detect asymptomatic stenosis in order to perform prophylactic reconstruction or to exclude those patients from major vascular operations, if the lesion is not accessible. In this particular small group of patients an extraperitoneal approach to the aortic bifurcation or an extra-anatomical bypass like femoro-crossover femoral or iliaco-femoral with revascularization of the profundal femoral artery is recommended. Continuous epidural anesthesia can reduce the risk of operation by reduction of cardial and respiratory complications and, together with the extraperitoneal or extra-anatomical approach the operative trauma is minimized.

Aorta↗
PubMed1980

Lymphatic complications in renal transplantation.

Lymphocele and lymphatic fistulae are relatively benign complications in renal transplantation. The incidence in our series of 248 renal transplants was 8%. The origin and pathogenesis of lymph collection and augmented lymph flow are discussed. The main importance of this complication lies in its differential diagnosis with urinary fistula and acute rejection episode or deep phlebothrombosis with all its therapeutic implications. Important lymph accumulations should be drained. We prefer as initial treatment a percutaneous closed aspiration which most successfully solves the problem. In case this method should fail, one can choose between external or internal drainage. As in literature, we actually prefer an internal marsupialisation, but completed by an omentoplasty if the leakage originates from the kidney.

Adolescent↗
PubMed1980

[Subclavian-carotid transposition in the treatment of obstructive subclavian disease with steal syndrome].

Eleven patients with subclavian steal syndrome underwent end-to-side transposition of the subclavian into the common carotid artery. The post-operative evaluation was done in every case by neurological examination, brachial blood pressure measurement, transcutaneous Doppler examination and by angiography. The operative result of this reconstruction, which was performed mainly on high-risk patients, was excellent. The symptoms of subclavian steal disappeared. In all but one patient the brachial pressure raised to normal. After transposition a blood flow reduction of 20% was measured intraoperatively in the peripheral common carotid artery, while the vertebral blood flow reversed to its natural direction. The peripheral common carotid artery pressure measured simultaneously remained unchanged, and hemodynamic criteria of carotis steal were not detected. The blood flow quality at the anastomosis was measured by the turbulence index in patients with an ideal reconstruction. The amount of blood flow distortion caused by the anastomosis was negligible. Therefore a long patency is expected. In patients with occlusive disease of the proximal subclavian artery we like to recommend the transposition as the procedure of choice, because the method uses one single incision for the extrathoracic exposure and one anastomosis-only without any graft material.

Arterial Occlusive Diseases↗
PubMed1980

[Perforating stomach ulcer in newborns].

Acute peptic ulceration of the stomach and duodenum is rare in children. The surgical treatment in the event of complications should be kept as simple as possible and there is usually no ulcer diathesis present. The significance of the pneumoperitoneum without visceral rupture is stressed. The gastrographin meal should be considered if ulcer perforation is suspected.

Diagnosis, Differential↗
PubMed1979

Primary malignant duodenal tumors.

Fourteen patients with primary malignant duodenal tumors are studied. Twelve patients had adenocarcinomas and two patients had malignant lymphomas. Preoperative diagnostic procedures, such as radiographic study of duodenum with hypotonic duodenography, complete duodenoscopy with biopsy and artertiographic studies are discussed. Early diagnosis is the key for curative surgical treatment since these tumors seem to disseminate rather late. In patients with primary duodenal carcinoma the resectability rate was 66.7%-seven Whipple resections and one segmental resection. Only one patient in our series died after a Whipple resection. There was no mortality after other procedures. The five year survival rate was 14.2%. There is a definite correlation between regional lymph node involvement and survival time. The mean survival period after Whipple resection without lymph node invasion is 56.5 months in our series. The survival period after Whipple resection for adenocarcinoma with regional lymph node invasion (6 months) is identical to the survival after palliative internal derivations for duodenal adenocarcinoma (5.8 months). It is concluded that a positive peroperative frozen section of a regional lymph node should exclude resective procedures (except in patients who hemorrhage) because they have a higher mortality rate as derivative procedures. Fifty per cent of the patients treated for malignant duodenal lymphoma is tumor free two years after a radical surgical therapy combined with chemotherapeutical treatment from the early postoperative period.

Adenocarcinoma↗
PubMed1979

[Treatment of late occlusions and stenoses after an aortofemoral bypass operation].

Thirty-three patients with one or several late occlusions in 43 limbs of aortofemoral dacron grafts underwent 56 reconstructions because of impending limb loss. Thrombectomy alone with patch closure was less successful. Excision of the femoral anastomosis, resection of the distal part of the occluded prosthetic limb and replacement by a new velours graft tube together with profundaplasty and further downstream reconstruction revealed the best results. The early reocclusion rate was 10%, the late reocclusion rate was 10%. There was no operative mortality and no amputation. Two late deaths occurred, in one case due to grade III infection with sepsis. Another late graft infection was successfully managed by an extraanatomic bypass and excision of the infected limb. The reasons for late occlusions of aortofemoral grafts were found to be incomplete reconstruction of the outflow tract, technical failure at the time of primary reconstruction and progressive atherosclerosis. Hypertonus was common in all cases with progression of the disease. Technical details of the operative management for late occlusion are presented.

Adult↗
PubMedDate not supplied

Evaluation of a new immunoassay to measure sirolimus blood concentrations compared to a tandem mass-spectrometric chromatographic analysis.

A new immunoassay of sirolimus based on the microparticle enzyme immunoassay (MEIA) principle has been developed with collaboration of Abbott Diagnostics. Laboratories and Axis-Shield. Our laboratory evaluated this new assay on 153 whole blood samples (EDTA) drawn from a population of renal (n = 141) and hepatic (n = 12) transplant patients. Each blood sample was analyzed simultaneously by MEIA (Y) and by a reference method (X) used routinely in our laboratory, namely, liquid chromatography tandem mass spectrometry (LC-MS/MS). The statistical analysis of Passing-Bablok produced the following results: Spearman r value = 0.95, slope = 1.15 and intercept with the Y axis = +0.2 ng/mL. The observed global overestimation of 15% compared to the reference method could be explained by the cross-reactivity of sirolimus metabolites with the antibody. A complementary analysis taking into account the transplanted organ (kidney versus hepatic) did not show any significant difference between the populations, most likely owing to the low number of hepatic transplantation samples. The analytical performance of the MEIA method showed CV < or =10% and a limit of quantification of 1.5 ng/mL, which were acceptable for routine clinical monitoring. In conclusion, the MEIA method has shown robust, stable, reproducible, features with an excellent correlation with the reference LC-MS/MS method.

Chromatography, Liquid↗