[Economy of homologous blood during surgery].
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Biomedical subjects
Publications and source records attributed to P Testas.
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Two canine models of cirrhosis induced by administration of dimethyl-nitrosamine (DMNA) alone or in combination with hepatic vein ligation, were studied. The criteria used for development of cirrhosis were not only the appearance of portal hypertension, ascites, biochemical disorders or retention of BSP but also the formation of histological lesions such as sclerotic transformation of the liver lobules together with nodular regeneration. According to these criteria, the experimental protocol consisting in hepatic vein ligation and prolonged administration of DMNA was successful in inducing in animals liver cirrhosis similar to human conditions.
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Because liver exeresis and surgery for liver trauma still carry a great mortality by hemorrhage or air embolism due to suprahepatic or vena cava injuries, temporary vascular exclusion of the liver is considered. Based on hemodynamic, biologic, and anatomopathologic experimental and clinical data, a catheter was designed that allows isolation of the retro-and suprahepatic portions of the inferior vena cava and consequently vascular exclusion of the liver for 30 minutes. We report on seven patients in whom this technic was utilized (4 requiring hepatectomy and 3 traumatized), confirming the utility, ease, and efficacy of this method.
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Intestinal lesions after radiotherapy for pelvic malignant tumours are of two types: ulcerative colitis with stenosis and hemorrhage sometimes sevre and repeated, and ileal involvement with focal ischemic lesions and malabsorption responsible for nutritional disorders. It is difficult to distinguish them from a recurrence of the tumour in spite of endoscopy, arteriography and biopsy. The course in 3 stages is of great value in diagnosis. A reduction in the frequency of such complications may be hoped for by assessment and exclusion of predisposing factors, by strict observance of therapeutic rules. They are serious owing to the marked irreversible conjunctivo-vascular changes and the fragility of the irradiated tissues during operation.
Hepatic surgery has a high mortality due to hemorrhage or gas embolism due to tears of the hepatic veins or vena cava, hence the idea of temporary vascular exclusion. Based on clinical, hemodynamic, laboratory and pathological findings, we have designed a catheter which permits one to isolate the retro and suprahepatic segment of the vena cana and obtain hepatic vascular exclusion within 30 minutes. We report here six cases where this technic was used, 3 hepatectomies, 2 liver injuries, and one case of disobstruction of an iliac vein which confirm the use, ease and harmlessness of this method.
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