[Choledochal obstruction in infants].
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Biliary Tract Diseases↗
Biomedical subjects
J Valayer
Publications and source records attributed to J Valayer.
Common bile duct calculi in infants.
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Cholestasis↗
[Portal hypertension and biliary atresia (author's transl)].
The study of portal pressure during surgical exploration for biliary atresia in the series of 260 children operated at the Hospital Saint-Vincent de Paul since 1968 showed that portal hypertension could be demonstrated in 61.8% of the cases before the age of 3 months. Among the 54 children surviving without jaundice, splenomegaly was found in 35 cases; esophageal varices were seen in 14 children, more frequently after 5 years of age. Bleeding from esophageal varices occurred only in cases with recurrence of jaundice or moderate biliary retention, i.e. for 6 children. A portocaval shunt was constructed in 7 cases; all had bled except one. One child died two and a half years later from pneumococcal sepsis after a splenorenal shunt with splenectomy; another child had numerous recurrence of bleeding episodes. Five children have a functional shunt and have not rebled. When biliary atresia is cured by hepatoportoenterostomy, with complete disappearance of biliary retention, the risk of bleeding from esophageal varices is unlikely, in spite of persistent cirrhotic alterations of the liver; in these children, there should very seldom be an indication for a portocaval shunt.
Bile Ducts↗
[Surgical treatment of portal hypertension in children. Retrospective study of 157 cases (author's transl)].
From 1959 until 1981, 157 children were treated for portal hypertension by esophageal varices ligation in 13 cases and by portosystemic shunt in 144 cases. The age of the patients at operation was correlated with the cause of portal hypertension : mean age was six and a half years for cases with extra-hepatic blockage, and ten years for cases with cirrhosis. In 73% of cases, the shunt was undertaken following a bleeding episode from esophageal varices; at the present time, the decision to undertake a prophylactic type of shunt would be much more questionable. Central splenorenal shunt and mesocaval shunt were the operations most frequently performed by the different surgical teams in charge of these children (respectively 69 and 47 cases). Among the postoperative complications, three cases of venous stasis in lower limbs occurred after a mesocaval shunt; one child died two and a half years after a central splenorenal shunt from pneumococcal sepsis. During the last two years, there is a tendency in our group to perform a Warren shunt for intrahepatic portal hypertension, and a mesocaval shunt with jugular vein interposition in the case of extrahepatic portal hypertension. Recurrence of bleeding from esophageal varices after simple ligation has been observed in 64% of the cases; after portosystemic shunts, the anastomosis was a success in 89.3% of the cases. Whereas a significant fall in portal pressure after completion of the anastomosis is of good prognostic value, the fact that in some cases intraoperative measurement of pressure before and after shunting may show no difference does not imply a secondary thrombosis of the anastomosis, since this complication was seen in only 13% of the cases in these conditions.
Adolescent↗
[Experience with mesocaval shunt with jugular vein interposition for treatment of portal hypertension in children (author's transl)].
From 1979 until 1981, 10 children aged 2 and a half to 15 years, were treated by mesocaval shunt with jugular vein interposition. In 6 cases, there were liver alterations in relation to Budd-Chiari's syndrome or cirrhosis, but the splenomesenterico-portal axis was uninvolved by thrombosis; in the other 4 cases, without any liver damage except fibrosis in one case, there was extensive thrombosis of the portal system. Thus the jugular graft may be simply set between the superior mesenteric vein and the vena cava, or may have to be anastomosed in an atypical position, between a pancreatic, jejunal, ileal vein and the renal vein or the vena cava. The right jugular vein is the longest and will be more suitable; it should be removed from a point situated above the opening of the facial tributary, so that the length of the graft would be approximately 7 cm. The anastomosis itself is rather a simple procedure if one takes care to mobilize the last segments of the duodenum and the pancreas. Mean fall in portal pressure of 10 mm Hg and a mean gradient of 3 mm Hg after completion of the anastomosis were demonstrated in most cases. Flow measures through the graft done in 8 cases gave a mean result of 800 ml per mn. Postoperative controls by means of ultrasonogram and angiography in all patients except the two most recent ones showed a patent anastomosis. But the longest follow-up is only 2 and a half years, and long term results are yet to be determined, especially in regards to the risk of late encephalopathy in cases with cirrhosis.
Adolescent↗
[The choice of an operation for correction of portal hypertension in children (author's transl)].
The choice of a surgical procedure for correction of portal hypertension in children should be guided by the site of the blockage on portal circulation, its anatomic and hemodynamic conditions, and also by the experience of the surgical team. At the present time, in our series, distal splenorenal shunt, or meso caval shunt with jugular vein interposition are preferred to the more usual ones, such as the central splenorenal shunt with splenectomy or mesocaval shunt with iliac vein. Thus an extrahepatic block would be treated by an interposition shunt, or a distal splenorenal shunt if the splenic vein is of a proper diameter; an intrahepatic block would be treated by a Warren shunt, even though some of the latest publications on the subject underline the fact that the disconnection part of the operation does not last with time; in the case of a suprahepatic block, a mesocaval shunt with interposition could be constructed provided the pressure in the lower vena cava is not too elevated; the same operation could be planed for difficult situations such as failures of a previous shunt or extensive thrombosis of the portal vein and tributaries. As for direct action on esophageal varices, every one agrees about the poor quality of results in the case of simple ligation; however the experience with more extensive operations such as Sugiura's procedure, and also that of endoscopic sclerosis or embolization in children are yet short and limited.
Child↗
[Production of oxygenated free radicals and the role of exogenous antioxidants in liver transplantation in rats].
It has been suggested that, in transplantation organs, the lesions observed after conservation then reperfusion could be related to the formation of oxygenated free radicals. The aim of our work was first to verify the hypothesis that oxygenated free radical are formed after ischaemia-reperfusion of the liver, then to evaluate the effects of the allopurinol and glutathion, known antagonists of oxygenated free radicals, contained in the University of Wisconsin conservation fluid. The University of Wisconsin solution was compared with a Collins solution which does not contain oxygenated free radical antagonists. An orthotopic liver transplantation model was used in Wistar rats. Three groups were studied. In the control group, 5 rats underwent laparotomy then were closed with no surgery being performed. In the Wisconsin group (n = 6) and the Collins group (n = 6) the livers were washed and conserved in the corresponding solution at 4 degrees C before transplanting. Plasma levels of malonyldialdehyde, measured by high performance liquid chromatography, were used as a marker for the formation of oxygenated free radicals. Impaired liver function was assessed on the basis of mortality and serum transaminases, alkaline phosphatase and total bilirubin levels. Liver biopsy was performed at sacrifice. The level of malonyldialdehyde was significantly higher in the transplanted groups compared with the control group (p < 0.01). There was no difference between the Wisconsin and the Collins groups. Hepatic function was significantly reduced in the transplanted groups compared with the control group (p < 0.05). There was no significant difference between the Wisconsin and the Collins groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
[Kasabach-Merritt syndrome with pancreatic hemangioma in an infant].
BACKGROUND: Kasabach-Merritt syndrome is characterized by one or more large hemangiomas associated with thrombocytopenia due to platelet trapping. The hemangiomas may be located in the abdominal viscera, in which case, treatment may be difficult. CASE REPORT: A 2 1/2 month-old boy was admitted because of the discovery of an abdominal mass. He was anemic (hemoglobin: 6.8 g%; reticulocytosis: 288,000/mm3), thrombocytopenic (50,000/mm3), hypofibrinogenemic (0.95 g/l), with fibrin split products in the blood. Ultrasonography showed that this mass was retroperitoneal and heterogeneous. X-rays delineated the mass, which distorted the duodenal loop and pressed forward against the stomach. Surgery showed that the mass included the pancreas, the root of mesenterium and the extrahepatic bile duct. This mass was biopsied. Histological examination showed infantile type hemangioendothelioma. Abdominal angiography showed that the mass was not very hypervascularized, and there were no dilated supplying blood vessels. An aortogram showed two other small vascularized areas. The patient was given methylprednisolone, but the volume of the mass remained unchanged, while hepatosplenomegaly and jaundice developed and ultrasound showed dilated extra- and intrahepatic biliary ducts. The patient was then given interferon alpha 2b for 1 month. Embolization of the small supplying arteries was performed because of a lack of improvement after 1 week of treatment. This procedure was followed by rapid disappearance of the signs of consumption coagulopathy, a progressive improvement in cholestasis, and decrease in the mass. CONCLUSION: Improvement in manifestations of this Kasabach-Merritt syndrome is difficult to assign to one of the several therapies. The rapid disappearance of consumption coagulopathy after arterial embolization suggests that this treatment was successful in our patient.
Hemangioendothelioma↗
[Ano-rectal abnormalities and esophageal atresia; familial and epidemiological studies].
The authors estimate the frequency of anorectal malformations (0.30 p. 1,000) and oesophageal atresia (0.20 p. 1,000) and record an increase in the sex-ratio along with a high percentage of associated malformations. From the available data and a family study on 366 anorectal malformations and 327 oesophageal atresia, they suggest the possibility of a dominant autosomal inheritance with weak penetrance, in certain cases of anorectal malformations and of a polygenic heredity in oesophageal atresia. The findings do not allow to reassure the parents completely of the sporadic cases, since the recurrence risk is 1-2 p. 100.
Abnormalities, Multiple↗