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Biomedical subjects

O Boillot

Publications and source records attributed to O Boillot.

At least 73 records · Page 4Linked to original sources
PubMed1995

Metastatic endocrine tumors: is there a place for liver transplantation?

The authors describe their experience with liver transplantation (OLT) for metastatic endocrine tumors (MET) in order to determine reasonable indications for OLT in patients with this disease. Removal of the primary lesion and subsequent liver transplantation were performed in two separate procedures in all patients except one. Only those patients suffering from objective tumor progression and symptoms with no evidence of extrahepatic spread after complete work-up (including endoscopic ultrasonography (US) and 123I-labeled Tyr3-octreotide body scanning) underwent liver transplantation. Fifteen patients were referred for liver transplantation. Seven patients were excluded either because of stability of liver metastases (n = 3), extrahepatic spread, general contraindication (n = 2), or feasibility of aggressive surgical resection (n = 2). Liver transplantation was undertaken in eight patients with carcinoid tumor (n = 4), gastrinoma (n = 3) and glucagonoma (n = 1). Three patients did not survive the surgical procedure itself, whereas two additional patients died from chronic rejection or from recurrent disease. Three patients who received transplants for metastatic carcinoid tumor are alive without biochemical or imaging evidence of disease recurrence at 6, 15, and 52 months. The best indication for transplantation seems to be patients with metastases restricted to the liver and unresponsive to adjuvant therapy after aggressive surgical resection including excision of the primary lesion and reduction of hepatic metastases. In such highly-selected patients, liver transplantation remains a high-risk operation, but it can yield long-term survival.

Adult↗
PubMed1995

Lymphocytic bronchitis/bronchiolitis in a patient with primary biliary cirrhosis.

A 39 year old woman with severe primary biliary cirrhosis progressively developed exercise dyspnoea due to airflow obstruction. Sjögren's syndrome was not present. Bronchial and pulmonary biopsies demonstrated constrictive lymphocytic bronchitis/bronchiolitis, possibly a component of a generalized autoimmune process in this patient.

Adult↗
PubMed1994

[Surveillance of children with liver transplantation].

The benefit of liver transplantation in children with end-stage liver disease is now well established. About 80% of the children are alive 5 years after liver transplantation. These good results are obtained not only because of the improvements of the surgical techniques, but also secondary to the reffinements of the follow-up of the patients. In the intensive care unit, clinical, biological and radiological cares must be permanent, allowing graft function assessment, correction of the haemodynamic disturbances, initiation of specific therapies and the research of any complication which must be promptly treated. The main surgical complications are intraperitoneal haemorrhage, biliary and vascular failures. Bacterial and viral infections, rejection represent frequent medical complications. Following the discharge from the intensive care unit, the children are checked daily until patient and graft conditions reach normal status. As time goes, the risk of complications is decreasing, but does not disappear, underlying the need for regular and long follow-up. In almost children, liver transplantation offers normal growth and scooling.

Age Factors↗
PubMed1994

[Treatments of biliary fistulas following the removal of a Kehr tube after orthotopic liver transplantation].

Biliary tract complications are a major source of morbidity after liver transplantation. From October 1990 to September 1992, 77 patients, including 13 children and 64 adults, received 80 liver transplants. Biliary reconstruction was performed using a choledochocholedochostomy with a T-tube in 40 recipients. We report the management of bile leaks following T tube removal in 6 patients. In all cases, bile leak was diagnose by ultrasound examination requested for abdominal pain. In the first 2 patients, a surgical treatment was applied: Roux-en-Y choledochojejunostomy was performed on the first patient and simple suture of the fistula in the second patient. Two patients were managed nonoperatively using endoscopic and radiological procedures allowing placement of bile duct prosthesis and abdominal drainage. In 2 patients with small localized sub-hepatic collection, no surgical or radio-endoscopic treatment was attempted; spontaneous resolution of the collections was achieved in 2 months on ultrasound examination. All patients are alive, although, the patient who was operated on with a roux-en-Y choledochojejunostomy developed thrombosis of the right hepatic artery and biliary anastomotic stenosis which required further operations. We advocate endoscopic placement of endobiliary prosthesis and percutaneous biliary drainage as first-line therapy for significant fistula after T-tube removal. The use of choledochocholedochostomy without a T-tube when possible for biliary reconstruction in liver transplantation could be an effective procedure, but requires further evaluation.

Adult↗
PubMed1994

Partial hepatic resection for ischemic graft damage after liver transplantation: a graft-saving option?

BACKGROUND: Intrahepatic biliary strictures or parenchymal infarcts may occur after liver transplantation as a complication of ischemic damage to the graft. In some selected cases the lesions appear to be confined to a part of the liver. We report our experience with partial graft resection in this setting. METHODS: From January 1984 to December 1991, 286 liver transplantations were performed in 257 recipients. Seven patients, three children and four adults, underwent partial hepatectomy 3 to 218 weeks after liver transplantation of a full-size graft. The clinical presentation included septic parenchymal infarcts (n = 4) and nonanastomotic biliary strictures (n = 3) complicating (n = 5) artery thrombosis or not (n = 2). There were four left hepatectomies, two left lobectomies, and one right hepatectomy. In four instances partial hepatectomy was performed after failed attempt at biliary reconstruction (n = 2) or arterial revascularization (n = 2). Partial graft resection was performed extrafascially without Pringle's maneuver and mobilization of the remnant liver to preserve its vascularization. RESULTS: No surgical complications occurred, and none of the patients experienced acute hepatic failure during the postoperative period. All patients were discharged home 10 to 96 days (median, 23 days) after liver resection. Two patients had recurrent ischemic cholangitis. One patient underwent successful regrafting for recurrent Budd-Chiari syndrome; one patient died of tumor recurrence. Six patients were alive with a follow-up ranging from 12 to 45 months. CONCLUSIONS: These results suggest that partial graft resection is a safe and graft-saving option after liver transplantation in selected patients with localized ischemic damage of the graft.

Adult↗
PubMed1994

[Cystadenoma of the liver. Clinical, radiological and anatomopathological study of 5 cases, one associated with cystadenocarcinoma].

We describe the clinical, radiological and pathological features of 5 cases of cystadenoma, one associated with cystadenocarcinoma. In 3 of these patients, the presence of thick wall, endoluminal buds and septations at imaging investigations was suggestive of the diagnosis of cystadenoma or cystadenocarcinoma. In 2 of these patients, these imaging features were lacking. In 2 of these patients, partial surgical resection was performed and was followed by recurrence of the tumor. In all cases, the diagnosis was confirmed by pathology examination of the resection specimen. In conclusion, this study shows that diagnosis of cystadenoma or cystadenocarcinoma may be very difficult because of the absence of suggestive imaging features in some cases, and confirms that complete resection of the tumor, allowing pathology confirmation, is needed for the optimal treatment of cystadenoma or cystadenocarcinoma.

Adult↗
PubMed1993

Controlled liver splitting for transplantation in two recipients: technique, results and perspectives.

A technique of controlled liver splitting for transplantation in two recipients is proposed, based on a full anatomical assessment of the graft including arteriography and cholangiography on the back-table. Using eight livers, 16 patients received a graft: right liver (eight patients), left lobe (four) or left liver (four). Twelve patients required urgent or very urgent transplantation. Anatomical assessment of the graft demonstrated a portal bifurcation in all cases, a common trunk of the left and middle hepatic veins in five, a right biliary duplication in three and duplication of the left branch of the middle hepatic artery in one. After revascularization of the graft, bleeding was greater in patients with a right graft, particularly if the middle hepatic vein had been ligated. The main postoperative complications were hepatic artery thrombosis (four cases), biliary complications (four), portal vein thrombosis (two), haematoma (two) and abscess (two). No primary non-function of the graft was observed. The postoperative survival rate was 75 per cent. The four patients in whom transplantation was not considered urgent are still alive. The immediate survival rate of the grafts was 69 per cent. These results compare favourably with those in the literature. In spite of the technical, logistical and ethical problems raised by this technique, the results suggest that controlled liver splitting for transplantation in two recipients may in the future significantly improve the feasibility of liver transplantation.

Adolescent↗