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Biomedical subjects

O Farges

Publications and source records attributed to O Farges.

At least 91 records · Page 5Linked to original sources
PubMed1989

Permeability of the rat biliary tree to ursodeoxycholic acid.

The permeability of the biliary epithelium to [14C]ursodeoxycholic acid (UDCA), a hypercholeretic bile acid, was compared to that of the 14C-labeled nonhypercholeretic bile acids cholic acid (CA), taurocholic acid (TCA), and tauroursodeoxycholic acid (TUDCA) by means of anterograde intrabiliary infusions and retrograde intrabiliary injections in the anesthetized rat. Anterograde intrabiliary infusions were performed by perfusing an isolated segment of common bile duct in vivo. After anterograde intrabiliary infusions, the fraction of unrecovered UDCA (that had presumably been absorbed from the biliary lumen) was 11.03 +/- 1.03 (SE)% (n = 6) of the administered dose. It was significantly higher than that of TUDCA (1.25 +/- 0.27%; n = 5; P less than 0.01), CA (2.62 +/- 0.43%; n = 4; P less than 0.01), and TCA (2.57 +/- 0.79%; n = 6; P less than 0.01). In separate experiments, bile was collected from the common bile duct and from the left hepatic duct. UDCA recovered from the left hepatic duct was found in the conjugated form, indicating that, after absorption in the common bile duct, it had been conjugated by the hepatocyte and secreted into bile. After retrograde intrabiliary injections of UDCA and CA, the cumulative percentages of recovered radioactivity were not significantly different (84.50 +/- 2.65 and 87.33 +/- 1.80%, respectively); however, peak recovery of UDCA was significantly delayed compared with that of CA. Moreover, UDCA was recovered mostly in the conjugated form, while CA was recovered mostly in the unconjugated form. These results suggest that, in the rat, UDCA is significantly more absorbed by the biliary tree than CA, TUDCA, and TCA. They support the hypothesis that UDCA undergoes a cholehepatic circulation.

Absorption↗
PubMed1989

[Treatment of hydrothorax in patients with cirrhosis using a peritoneo-jugular shunt].

Two cirrhotic patients with massive hydrothorax associated with ascites resistant to medical management were treated by insertion of peritoneovenous shunt. In each case the hydrothorax resolved within 2 to 4 months after shunt insertion. This treatment was still successful 10 to 26 months after surgery. The peritoneovenous shunt is an alternative to medical therapy for large effusions. Its effectiveness in resolving them supports the idea that diaphragmatic defects are involved in their formation.

Adult↗
PubMed1988

Pyogenic liver abscess: an improvement in prognosis.

Forty-six patients with pyogenic liver abscess have been treated at Paul Brousse Hospital between 1966 and 1986. The overall mortality was 24 per cent, all 11 deaths occurring in 24 patients seen prior to 1978 when there was often a considerable delay in the diagnosis of liver abscess (mean 90 +/- 71 days). In seven patients the diagnosis was not made until post-mortem examination. The mainstay of treatment was surgical drainage. Since 1978 high resolution imaging techniques for the liver, and in particular ultrasound, have been available. The diagnostic delay has been significantly reduced (mean 28 +/- 20 days, P less than 0.01). Patients are receiving definitive treatment at an earlier stage in the evolution of the disease process, with fewer established complications prior to treatment (P less than 0.05). Percutaneous drainage under ultrasound control is the preferred initial drainage procedure in high-risk patients. There have been no deaths in 22 patients treated for pyogenic liver abscess since 1978 (P less than 0.001).

Aged↗
PubMed1988

Liver cell adenomas. A 12-year surgical experience from a specialist hepato-biliary unit.

Twenty-four patients with liver cell adenomas were referred to Paul Brousse Hospital between 1976 and 1987. This represents the largest reported surgical experience of this pathology from a single centre. Six patients had multiple adenomas, which were associated with glycogen storage disease in four. Two patients had polyadenomatosis, one of whom underwent successful liver transplantation after malignant transformation to hepatocellular carcinoma. Eighteen patients (median age of 33 years, range of 17-45 years) had either a solitary adenoma or two adenomas. Eighty-three per cent were women 87% of whom had received oral contraceptives or other hormone therapy before diagnosis (median duration of 11 years, range of 3-15 years). Fifty per cent of these patients presented with acute hemorrhage into an adenoma. Seventeen patients underwent surgical resection of their adenomas, with the remaining patient currently being treated by arterial embolizations to reduce the tumor size before surgery. There was no operative mortality or serious morbidity, and all patients remain well upon follow-up. Surgical excision of liver adenomas, where this can be done without causing mortality, is recommended. Resection relieves symptoms and removes both the risks of hemorrhaging into the tumour and of malignant transformation to hepatocellular carcinoma.

Acute Disease↗
PubMed1986

[Endoscopic sclerosis of esophageal varices].

The increasing popularity of treatment of esophageal varices by endoscopic sclerosis is the result of two factors. First, the principle underlying the procedure, which tends towards selective occlusion of the submucous venous network at the esophagogastric junction, where the risk of rupture is maximal, while respecting other periesophageal bypass pathways of portal blood. Second, the improvement of the apparatus used, thus simplifying the operation and reducing risks, and the improved definition of the limitations of medicosurgical treatment of portal hypertension. Results may be altered by several variables: protocol of injections, particularly intra- or paravascular site of injection, nature of sclerosing agent, type of endoscopy performed, size of varices, etiology of portal hypertension and severity of hepatic lesion and especially the relation between time of operation and the hemorrhagic episode. Hemostasis of a ruptured esophageal varix was obtained in 75 to 100% of cases. Adequate follow up and repeat injections are essential for varicose recurrences (long-term relapse rate = 50%) to avoid hemorrhagic complications.

Emergencies↗
PubMedDate not supplied

Cavernous hemangiomas of the liver: are there any indications for resection?

A total of 163 patients with cavernous hemangiomas of the liver were managed at Paul Brousse Hospital between 1970 and 1992. The tumor was smaller than 4 cm in 54 patients and larger than 10 cm in 38 patients. The diagnostic sensitivities of the imaging procedures were as follows: ultrasonography 61%; angio-computed tomography scanning 77%; angiography 85%; magnetic resonance imaging 92%. The tumor was diagnosed during the evaluation of abdominal pain in 87 patients. Forty-seven patients had associated disorders that proved to be responsible for the symptoms. Fourteen patients with incapacitating symptoms underwent specific treatment of their tumor: resection (n = 8), embolization (n = 5), or hepatic artery ligation (n = 1). Seven of these patients are still symptomatic, indicating that the hemangioma was in fact not responsible for their symptoms. Twenty-five patients were given oral analgesic medications; in 21 the symptoms diminished or became infrequent. Unresected hemangiomas did not significantly increase in size, nor have they become complicated or symptomatic. These results indicate that resection of liver hemangiomas is rarely required, and such treatment should be carefully balanced against the risk inherent in liver surgery.

Adult↗
PubMedDate not supplied

Fenestration in the management of polycystic liver disease.

Thirteen patients with symptomatic polycystic liver disease who were selected for fenestration were reviewed. The main preoperative complaints that related to polycystic liver disease were severe abdominal pain, respiratory distress, clinical ascites, or leg edema. All symptoms disappeared after operation, and the number and size of the cysts were smaller. Five patients developed transient but massive ascites during the postoperative period, and long-term follow-up demonstrated a moderate recurrence of hepatomegaly in two patients. These postoperative complications and failures appeared to be at least partly related to a more extensive evolution of the disease in the patients in whom it developed.

Adult↗
PubMedDate not supplied

Herniorrhaphy and concomitant peritoneovenous shunting in cirrhotic patients with umbilical hernia.

From 1981 to 1987, a total of 40 cirrhotic patients with umbilical hernia were treated either by conventional herniorrhaphy (26) or by herniorrhaphy and concomitant insertion of a peritoneovenous (PV) shunt (14). The aim of concomitant PV shunt insertion was to reduce postoperative complications of herniorrhaphy in those patients with intractable ascites, or in whom difficulty to control postoperative ascites was contemplated. In the group of patients with PV shunt, 8 were class B and 6 were class C according to Child's classification; 7 patients had complicated hernia including 2 patients with skin ulceration, 4 with rupture, and 1 with incarceration. In the group with standard herniorrhaphy, 5 patients were class A and 21 were class B; 13 patients were operated on electively for uncomplicated hernia without ascites, 6 had incarceration, and 7 had skin ulceration. The technical procedure of concomitant PV shunting and hernia repair included: insertion of the valve, surgical repair of the hernia, and insertion of the venous tube. In that order, in-hospital mortality was nil. Postoperative complications included sepsis in 2 patients who had concomitant insertion of a PV shunt, and massive ascitic fluid production in 5 patients treated by conventional herniorrhaphy, resulting in ascitic leak from the surgical wound in 1 case. Recurrence of the hernia was observed in 6 patients treated by conventional herniorrhaphy, and in none who had a patent PV shunt.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMedDate not supplied

[Left hepatectomy].

Explore the source record for details and available documents.

Controlled Clinical Trials as Topic↗
PubMedDate not supplied

[Liver transplantation with a living related donor in the child].

OBJECTIVES: Liver transplantation with living related donor has been recently developed to compensate for the insufficient number of liver grafts for children. The major problem is ethical because it implies voluntary mutilation of a healthy person. This paper report results in 37 living related donors. PATIENTS: Recipients were followed in Enfants-Malades Hospital. Investigations and donor surgery were performed at the Digestive Surgery Unit of Beaujon Hospital. RESULTS: One donor was re-operated for bleeding, and another one a biliary fistula treated with percutaneous drainage for one week. The post-operative course was uneventful in the other donors, with a follow-up of between 2 and 50 months. Thirty-three children are alive (90%), one of them underwent a second transplant for arterial thrombosis. Vascular and infectious complications, and the number of rejection episodes were the same as in transplantations with a deceased donor. Biliary complications were frequent (15 patients out of 37) and significantly increased morbidity. A teenage boy who received a small graft (0.9% of his weight) presented initially with hepatic insufficiency without encephalopathy. CONCLUSION: This technique has been shown to have a good balance between benefits and risks. Our experience confirms this, especially in very young children. Each case should be discussed individually and parental consent should be obtained without external pressure. Experience with this technique should be continued and at the same time the use of cadaveric grafts should be optimized.

Adolescent↗
PubMedDate not supplied

Preoperative systemic 5-fluorouracil does not increase the risk of liver resection.

BACKGROUND/AIMS: The majority of patients who underwent surgery for colorectal liver metastases have been previously treated with 5-FU either as adjuvant chemotherapy or as a primary treatment. We have performed a retrospective study to assess whether this chemotherapy increases the risk of liver resection. METHODOLOGY: Mortality, morbidity and histology of the resected liver of two groups of patients having colorectal liver metastases who underwent major resection were studied. The first group included 17 patients who had received at least 2 courses of 5-FU chemotherapy within 3 months prior to liver resection. The second group included 18 patients who had received no chemotherapy and who were used as controls. RESULTS: Perioperative mortality was nil. Intraoperative blood loss during liver resection (1 +/- 2.5 vs. 1.2 +/- 2 units) was similar in the two groups. Changes of liver function tests on days 2 and 5 were similar in the two groups. Morbidity rate was similar in the two groups (29 vs. 22%) with a mean duration of postoperative hospital stay of 19 +/- 9 days in the 5-FU group and 16 +/- 6 days in the control group. Although 7 (41%) patients in the 5-FU group had an abnormal parenchyma consistency as compared to only 3 (17%) in the control group, the pathological findings within the resected specimen were not different. CONCLUSIONS: 5-FU based systemic chemotherapy does not increase the risk of liver resections.

Aged↗
PubMedDate not supplied

Resection of hepatocellular carcinoma: a European experience on 328 cases.

BACKGROUND/AIMS: Surgical liver resection has been demonstrated in Asian countries to be the best therapeutic option in patients with hepatocellular carcinoma. Because the value of this treatment is still debated in Western countries, the aim of this paper was to report a European experience of resection for hepatocellular carcinoma. METHODOLOGY: From 1990 to 1999, 239 men and 61 women aged from 15 to 77 years old underwent 328 resections including major resection in 138 (42%) cases. Normal liver was present in 53 patients (17%) and chronic liver disease was present in 247 including 152 (50%) with cirrhosis. RESULTS: In-hospital mortality was 6.4% and was significantly influenced by the presence of chronic liver disease (1.7% vs. 7.4%). Mortality after resection in alcoholic patients (14%), in patients with hepatitis C (9%) was significantly higher than in patients chronic hepatitis B (1%) (P < 0.05). The overall survival rates were 81%, 57%, 37%, and 13% at 1, 3, 5 and 10 years. Five-year survival rate was significantly higher (P < 0.05) in patients with normal liver as compared to chronic liver disease (50% vs. 34%). In patients with chronic liver disease parameters, which significantly influenced survival rate, were vascular invasion, tumor differentiation and the extent of resection. CONCLUSIONS: In this European study with varied profile of etiologies associated with hepatocellular carcinoma we showed that a five-year survival rate of 40% can be expected after resection and that chronic liver disease is a major factor influencing short and long-term prognosis.

Adolescent↗