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Biomedical subjects

M Julien

Publications and source records attributed to M Julien.

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

Orthotopic liver transplantation in the presence of partial or total portal vein thrombosis: problems in diagnosis and management.

From January 1989 to May 1992, 70 orthotopic liver transplantations (OLT) were performed in 69 patients, 53 of whom had cirrhosis (77%). Eleven patients (16%) had preoperative partial or total portal vein thrombosis (PVT). Ten of these patients had cirrhosis of various causes. PVT was total in three cases and partial in eight. Total PVT was detected preoperatively in all three cases. By contrast, partial PVT was diagnosed preoperatively in only three of the eight cases. In the five other cases of partial PVT, the obstruction was discovered intraoperatively during dissection of the portal vein. Surgical management of PVT consisted of phlebothrombectomy in ten cases followed by usual end-to-end portal anastomosis in nine cases and anastomosis of the graft's portal vein to the splenomesenteric confluence in one case. Atypical anastomosis of the graft's portal vein to a dilated choledocal vein was performed in one case of total PVT. There were no deaths or complications related to the presence of preoperative PVT or to its management. One patient died postoperatively of primary graft nonfunction at day 5. One patient had arterial thrombosis 3 months after OLT and was successfully retransplanted. Two patients died of recurrent carcinoma 3 and 7 months after OLT. Eight patients are alive 4 to 39 months after OLT. We conclude from this series that (1) the prevalence of preoperative PVT among patients transplanted for advanced cirrhosis may be high (19% of the cirrhotics in this series); (2) PVT is often partial and so difficult to diagnose preoperatively; (3) PVT, even when total, can be managed successfully during surgery and does not seem to affect survival.

Adult↗
PubMedDate not supplied

Proximal stenosis of the bile ducts: results with a new surgical endoprosthesis.

A new endoprosthesis designed for surgical intubation of neoplastic strictures of the proximal biliary tract has been developed. The technical aspects of intubation by this endoprosthesis are discussed, and the results in the first 25 patients are given. The results suggest that this device was well tolerated. Mortality and morbidity related to the endoprosthesis were low in comparison to the results given in the literature for intrahepatic cholangioenteric anastomosis. The authors conclude that this procedure could favorably replace intrahepatic cholangioenteric anastomosis as currently used for selected cases of malignant biliary stricture.

Adult↗
PubMedDate not supplied

Comparison of intramuscular and intravenous quinine for the treatment of severe and complicated malaria in children.

To compare the efficacy and side effects of intramuscular (i.m.) and intravenous (i.v.) quinine, children in Mozambique with severe and complicated malaria between 6 months and 7 years were randomized to treatment with i.m. or i.v. quinine, both in a dosage of quinine dihydrochloride 20 mg/kg followed by 10 mg/kg every 8 h. Of 57 children treated with i.m. quinine, 4 died, 3 had neurological sequelae and 2 had sterile intramuscular abscesses. Of 47 children treated with i.v. quinine, 6 died and 1 had neurological sequelae. The mean parasite clearance time was 58.6 h in the i.m. group and 59.3 h in the i.v. group. Mean temperature clearance times were 56.1 and 51.8 h, and mean coma clearance times 40.4 and 38.7 h, respectively. None of these differences was statistically significant. Mean trough and peak concentrations of quinine were almost identical in the 2 groups, ranging from 10.5 to 12.6 mg/L, which is in the therapeutic non-toxic range. It is concluded that i.m. quinine is as effective as quinine by i.v. infusion in children with severe and complicated malaria; that minor local side effects can probably be avoided by using diluted quinine for i.m. injection; and that the optimal dose regimen for children with severe and complicated malaria in Africa at present is probably quinine salt 20 mg/kg followed by 10 mg/kg every 12 h.

Child↗
PubMedDate not supplied

Palliative treatment of bile duct tumoral compression by an endoprosthesis: clinical results.

The palliative therapy of stenoses of the biliary tract is a difficult choice. Because percutaneous or endoscopic drainage methods are fraught with complications, an endoprosthesis for surgical intubation of the biliary tract has been developed. Thirty patients were treated by this method. After choledochotomy, the endoprosthesis is positioned surgically above the sphincter of Oddi, thereby avoiding ascending cholangitis. Twenty-nine patients (13 with gallbladder cancer, 11 with cholangiocarcinomas, 5 with metastases) presented with neoplastic compression, and one patient had an early postoperative stricture with loss of substance after right hepatectomy for hepatic metastases. The operative mortality was 3.3% (one pulmonary complication). Resolution of jaundice was obtained in all but two patients, and pruritus always resolved. The mean survival time for the patients with cholangiocarcinoma was 12.2 months and 6.33 months for those with gallbladder cancer. Indices of satisfaction (Bismuth's method) were 71% (gallbladder cancer), 93.5% (hilar cholangiocarcinoma), and 92% (metastatic compressions). This new type of surgical endoprosthesis is an alternative in the palliative treatment of neoplastic hilar compression because it is well tolerated, has a low rate of operative mortality or morbidity, and affords an acceptable quality of life for the patients.

Adenoma, Bile Duct↗