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Biomedical subjects

J Pirenne

Publications and source records attributed to J Pirenne.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

Contribution of large animal models to the development of clinical intestinal transplantation.

The intestine has long been seen as a "forbidden" organ to transplant and even nowadays it remains the most challenging abdominal organ to transplant. Large animal experiments have been pivotal, first in developing reproducible and clinically applicable surgical techniques for transplanting the intestine and second, in revealing the unique physiological, immunological, and microbiological challenge that intestinal transplantation (ITx) represents. More recently, large animal models have been used to test new immunosuppressive drugs (FK 506) that have been then successfully used clinically. ITx is no more an experimental endeavor and survival figures of about 70% can be reached at one year, justifying routine application of ITx to patients who do not tolerate total parenteral nutrition. However, ITx remains in 1999 an "unfinished product" and further research will need to be done to allow wider application of ITx to patients without total parenteral nutrition (TPN) related complications. Further research will focus on the following aspects: (1) refined understanding of the factors accounting for the high immunogenicity of the intestine; (2) development of immunomodulatory strategies to reduce graft immunogenicity and to induce specific hyporesponsiveness; (3) development of new immunosuppressants, and their usage in combination, to act more specifically on the immune response, and at the price of less toxicity; (4) development of surgical alternatives to alleviate the organ shortage: graft size reduction, live related ITx. Importantly these questions will need to be addressed in clinically relevant animal models before they are applied to man.

Animals↗
PubMedDate not supplied

Present status and future prospects in liver transplantation.

Results of liver transplantation (LTx) have largely improved over the last few years and a one year patient survival rate of around 90% for elective transplants can now be reached. This is mostly the consequence of better patient selection and preparation, improved surgical techniques, improved intra- and postoperative care, reduced incidence of primary non function (< or =5%) and hepatic artery thrombosis (< or =5%), the understanding that the liver induces a tolerogenic response and the development of more judicious immunosuppressive protocols. Because patient and graft survival have dramatically improved, other problems become more overt and need to be addressed: side effects of long-term exposure to immunosuppression, recurrent disease, development of biliary strictures. LTx for acute liver failure continues to bring special difficulties. Strategies need to be urgently developed to augment the number of donor grafts and to combat the profound organ shortage - currently the only limiting factor to wider application of LTx.

Animals↗
PubMedDate not supplied

[Surgical aspects of the treatment of adrenal gland diseases].

With the greatly enhanced accuracy of current endocrinologic diagnosis assisted by precise diagnostic imaging, together with greatly enhanced preparation of patients with endocrinopathy for safer anesthetic and surgical procedure (e.g. adrenal cortical cancers, cortisol and aldosterone producing adenomas and pheochromocytomas), operative procedures can be planned and conducted more precisely. For the surgeon, the strategy for treatment of functional and neoplastic disorders of the adrenal glands has essentially to consider the anatomy of the suprarenal glands, the deleterious effects of hormone excess before and during operation, the presumed nature of incidentally discovered adrenal mass and the size of the tumor.

Adrenal Gland Diseases↗
PubMedDate not supplied

Acute liver failure. Diagnosis, management and results after orthotopic liver transplantation.

From february 1989 till october 1992, we performed 13 orthotopic liver transplantations on 8 patients admitted with the diagnosis of fulminant hepatic failure. The mortality of this affection, despite many treatments is very high, from 60 to 90% at three months according to the literature. Liver transplantation seems to be actually the treatment of choice in many cases. The purpose of this study is to review current concepts about this affection, indications for liver transplantation and results in our small series with a survival rate of 85% at 3 months, 75% at 6 months and 1 year.

Acute Disease↗
PubMedDate not supplied

Short-bowel syndrome. Medical aspects and prospects of intestinal transplantation.

Major intestinal resection may result in diarrhea and malabsorption, a clinical entity known as the short-bowel syndrome. Nutritional prognosis after a wide intestinal resection depends on the extent of resection, the nature of the intestinal segment removed (ileum or jejunum), the function and the adaptative capacity of the remaining intestine, and the preservation of the colon and the ileocecal valve. Adequate management of this dreadful syndrome requires a multidisciplinary effort between various medical specialties: general and pediatric surgery, intensive care unit, nutrition, psychology, pediatric and adult gastroenterology. Intestinal transplantation is the only chance for a real cure in patients who depend on total parenteral nutrition. Although results of small bowel transplantation have dramatically improved over the last few years, it remains a challenging surgical and immunologic enterprise. Severe rejection and infection are the major obstacles.

Adult↗
PubMedDate not supplied

Combined liver-spleen-small intestine grafting in a rat model: role of transplanting additional lymphoid tissue on survival.

The aim of this study was to develop suitable models of combined intestinal grafting to examine the enhancing effect of intestinal grafting with additional lymphoid tissue using 30% of the liver mass and the whole spleen on recipient survival in the absence of immunosuppression. Grafts from DA (RT1a) rats were transplanted orthotopically to PVG (RT1(1)) recipients according to the following design: group 1 (n = 6), en bloc 30% liver/entire SB/spleen; group 2 (n = 7), en bloc 30% liver/SB; group 3 (n = 7), SB/spleen and group 4 (n = 7), SB control for the preceding groups. The orthotopic nature and proximal interposition of the SB graft allowed the assessment of protection afforded by components of the cluster on the SB graft using survival endpoints. Although group 4 hosts survived half as long compared to other groups, statistical significance was reached only in the case of group 1; group 1 MST equalled 15.3 days, significantly higher than group 4 (p = 0.01). Acute rejection was present in every grafted tissue and was equivalent whether liver was included or excluded in the cluster. GVHD was absent postoperatively using clinical or histological criteria; recipient spleens showed hyperplasia, donor spleens depicted lymphocytic depletion on histology. This study determined that statistically proven enhanced survival was obtained only after grafting 30% liver plus spleen with the entire SB. GVHD was rare in the fully allogeneic system despite transplanting a massive load of lymphoid tissue. The surgical models used in this study employing liver in the cluster, address the important question of how best to evaluate the role of heterotopic accessory liver grafting in providing tolerance to co-transplanted small intestine.

Animals↗