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Biomedical subjects

X Rogiers

Publications and source records attributed to X Rogiers.

At least 127 records · Page 7Linked to original sources
PubMed1995

[Therapeutic approach to hemobilia].

AIM OF THE STUDY: Hemobilia, defined as hemorrhage arising from pathological changes in the biliary tract, represents a rare entity. In a retrospective study the presentation, diagnosis, and management of hemobilia were investigated. PATIENTS AND METHODS: Since January 1991 six patients suffering from severe hemobilia presented to our department. Jaundice, right upper quadrant abdominal pain, hematemesis and melaena were the most frequent symptoms leading to admission. Hemobilia originated from iatrogenic injury following percutaneous liver biopsy and endoscopic removal of common bile duct stones, and malignant hepatic or biliary tumors. Duodenoscopy revealed bleeding from the papilla in all patients. Diagnosis was confirmed by ERCP in all patients and angiography in 5 of 6 patients. RESULTS: Angiographic occlusion of an arterial lesion with coils was successfully achieved in one patient. One patient was treated conservatively. In 3 patients liver resections were performed to control bleeding and the underlying tumorous pathology. In another patient, operative ligation of the supplying artery had to be performed. Within a minimum follow-up of six months none of the six patients showed recurrence of hemobilia. CONCLUSION: Considering the impact of etiologic, diagnostic and therapeutic aspects in treatment of hemobilia we suggest an algorithm for a rational approach to hemobilia. Angiographic occlusion may control the bleeding and improve the patient's general condition. Definitive surgical treatment of hemobilia is safe and effective.

Aged↗
PubMed1995

Is radical surgery in locally advanced gallbladder carcinoma justified?

OBJECTIVES: Advanced gallbladder carcinoma is associated with a dismal long term prognosis. The aim of the present study was to evaluate the effectiveness of radical surgery in advanced stages of gallbladder carcinoma. METHODS: The course of 66 patients operated for advanced gallbladder carcinoma was evaluated in a retrospective study; 14% of patients had stage II, 29% had stage III, and 57% had stage IV tumors. Twelve patients underwent cholecystectomy (CHE) and lymphadenectomy of the hepatoduodenal ligament (LA); 17 patients underwent cholecystectomy combined with segment IV/V liver resection (CHE+LR) and LA; and 10 patients underwent right extended hemihepatectomy (EHH). Complete tumor resection (R0) was achieved in six patients with CHE and LA, in 14 patients with CHE combined with segment IV/V LR and LA, and in all patients with right EHH. Resections with microscopic residual tumor (R1) were performed in nine patients. Mean follow-up was 15.4 months (range 3-90 months). RESULTS: The perioperative mortality rate was 1.5%, and the morbidity rate was 20%. In R0 resections, mean survival was 23.3, 25.0, and 26.3 months for the patients who underwent CHE and LA, CHE combined with segment IV/V LR and LA, and right EHH, respectively. After 24 months, 46.4% of the patients with R0 resection were still alive compared with none of the patients with residual tumor. In the patients with R0 resection, no difference in survival was detected when node-negative status (pN0) was compared with positive locoregional lymph nodes (pN1a), whereas the degree of dedifferentiation (G2/G3) influenced survival. CONCLUSIONS: If complete resection is achieved, radical surgical procedures, including segment IV/V liver resection and extended right hepatectomy, significantly improve survival rates with an acceptable morbidity and mortality rate.

Adult↗
PubMed1994

Complications of adjacent organs in chronic pancreatitis managed by duodenum-preserving resection of the head of the pancreas.

Chronic pancreatitis frequently generates complications through involvement of adjacent organs. Distal common bile duct stenosis and segmental duodenal stenosis, the most frequent complications, are usually treated by resection or bypass procedures. This study presents experience with duodenum-preserving resection of the head of the pancreas in the treatment of patients with chronic pancreatitis with predominant involvement of the pancreatic head and coexisting complications involving adjacent organs. This procedure preserves the structure and function of the bile duct and duodenum. Sixty-six patients with severe chronic pancreatitis underwent duodenum-preserving resection of the head of the pancreas. Thirty-eight had associated complications of neighbouring organs: 37 had distal common bile duct stenosis, seven had duodenal stenosis, ten had evidence of segmental portal hypertension and one suffered from a pancreatopleural fistula. Details of all patients were documented prospectively; mean follow-up was 4.2 years. The complications of adjacent organs were permanently eradicated in 36 of 38 patients. Two patients required endoscopic stenting for persisting bile duct obstruction. There was substantial or complete relief of all symptoms in 35 patients. Duodenum-preserving resection of the head of the pancreas is effective in the treatment of severe chronic pancreatitis with predominant involvement of the pancreatic head and provides definitive management of associated complications of adjacent organs.

Adult↗
PubMed1994

Living donor for liver transplantation.

Since living related liver transplantation was first performed in 1989, more than 150 cases have been performed worldwide, mostly in the United States and Japan. This paper reports the first series of living related liver transplantation in Europe. Twenty living related liver transplantation surgeries were performed over a 13-mo period, with an overall patient survival of 85%. For patients who underwent elective transplantation (n = 13), the survival rate was 100%. Technical complications included one arterial thrombosis necessitating retransplantation and five bile leaks requiring surgical revision. The technical improvements that permit avoidance of these complications are discussed. A detailed description of the living related liver procurement is given. All procurements yielded grafts of excellent quality. No intraoperative complications occurred, and no reoperations were necessary. No heterologous blood transfusion was needed. In two patients, incisional hernias developed after wound infection. Living related liver transplantation does not absolve the transplant community of efforts to promote cadaveric organ procurement. Nevertheless, living related liver transplantation does have the advantage of a readily available graft of excellent quality, permitting transplantation with optimal timing under elective conditions. Several centers are now preparing living related segmental liver transplants, following the model of our protocol, for three reasons: (a) to obtain superior results compared with cadaveric liver transplantation; (b) to overcome cadaveric organ shortage and further reduce pretransplantation mortality and (c) to provide viable organs in countries where cadaveric organ procurement is not established. When performed by a team experienced in pediatric liver transplantation and in adult liver resection, living related liver transplantation is an excellent modality for the treatment of end-stage liver disease in children.

Adult↗
PubMed1994

[Computed tomographic studies following segmental liver transplantation from living donors: the anatomy and pathological findings].

A lack of suitable pediatric donors and significantly better results than conventional transplantation have contributed to the steady increase in the number of segmental liver transplants from living donors throughout the world. This article describes the diagnostic impact of axial CT scans following transplantation in a retrospective evaluation of 18 CT examinations of 10 children with an average age of two years. Both spiral and conventional CT scans permit precise visualization of the postoperative anatomy of the upper abdomen that is more distinct than the images provided by ultrasonic scans. Thus, CT scans better facilitate detection of pathological findings. In 60% of the patients (67% of the examinations), the CT scan permitted a definite diagnosis; in the remaining cases, no morphological correlate to the clinical and laboratory findings was detected. In addition to traditional ultrasonic scanning, computed tomography represents a further noninvasive imaging technique for postoperative diagnostics following segmental liver transplants from living donors.

Child↗
PubMed1994

Liver transplantation for metastatic carcinoid tumors.

Seven patients with symptomatic metastatic neuroendocrine tumours (6 carcinoids, 1 malignant insulinoma) were referred for liver transplantation. In 5 patients extrahepatic tumor dissemination demonstrated by octreotide scintigraphy contraindicated organ grafting. Due to absence of clinical symptoms, 1 patient is excluded from transplantation at present. Only 1 patient with liver metastases from lung carcinoid underwent transplantation. He is tumor free 10 months postoperatively. Liver transplantation may be regarded as an adequate therapeutic procedure in selected patients with metastatic carcinoids causing malignant carcinoid syndrome.

Carcinoid Tumor↗
PubMed1994

[Primary sarcoma of the liver in adults].

Eleven adult patients with primary sarcoma of the liver underwent surgery at the University Hospital of Hamburg-Eppendorf between 1985 and January 1994. In 8 cases it was possible to resect the tumor with wide margins (R0), in 1 of these in the course of orthotopic liver transplantation. Three patients had primarily marginal resection (R1). By the end of the study period 7 of the patients who underwent initial R0 resection are tumor-free, with a mean survival time of 57 (5-104) months. The patient with orthotopic liver transplantation developed metastases 31 months after primary surgery. At 7 months after initial R1 resection, 1 patient is alive with no evidence of disease while 2 others died after 30 and 35 months, respectively. Patients with non-metastasized, primary sarcomas of the liver can expect long-term survival if the tumor is resected with wide margins in an anatomical hepatectomy. In the case of multifocal growth in the liver transplantation can be considered.

Adult↗
PubMed1994

[The status of liver transplantation in therapy of hepatocellular carcinoma].

The state of the art in liver transplantation for hepatocellular carcinoma is presented through a review of our own data and the pertinent literature. Preoperative evaluation should stage the tumor precisely to allow therapeutic consequences to be drawn. The major obstacle is correct preoperative lymph node staging which is currently possible in less than 50% of the patients. If candidates are selected for transplantation, early vascular exclusion should be performed during the operation to prevent tumor cell dissemination. The results of recent reports on liver transplantation for hepatocellular carcinoma following strict selection criteria are encouraging. Patients with cirrhosis and hepatocellular carcinoma (diameter < 10 cm) fared significantly better after liver transplantation than after resection. Patients with uninodular or binodular disease and tumors smaller than 3 cm even showed a recurrence-free 3 year survival of 83% [3]. We conclude that for some patients liver transplantation offers the only chance for cure. Only prospective, controlled trials will define the patients that profit most from liver transplantation. The rising need for donor organs will currently restrict this modality to a highly selected group of patients. Once effective adjuvant therapies become available more patients might, however, become eligible.

Carcinoma, Hepatocellular↗
PubMed1994

Hemobilia: presentation, diagnosis, and management.

OBJECTIVES: Hemobilia is defined as hemorrhage into the biliary tract. To define a rational approach toward this rare entity, we performed a retrospective study on the presentation, diagnosis, and management of hemobilia. METHODS: During the past 3 yr, eight patients suffering from severe hemobilia presented to our departments. Jaundice, right-sided upper abdominal pain, and hematemesis were the most frequent symptoms. Hemobilia originated from iatrogenic injury in three patients, malignant hepatic or biliary tumors in three, parasitic infestation (ascariasis) in one, and coagulopathy due to end-stage liver cirrhosis in one. Duodenoscopy revealed bleeding from the papilla in all patients. Diagnosis was confirmed by endoscopic retrograde cholangiopancreatography and angiography in seven patients. RESULTS: In three patients, major liver resections were performed that definitively controlled the bleeding and the underlying tumor. Angiographic occlusion of an arterial lesion was successfully achieved in two patients. In two patients, operative ligation of the supplying artery was required. The patient suffering from end-stage liver disease was treated by substitution of coagulation factors but died due to progressive metabolic liver failure. CONCLUSION: Angiographic occlusion is recommended as initial treatment to control hemobilia and to render the patient stable in preparation for elective and definitive surgery. Surgery becomes necessary when nonoperative attempts to stop the bleeding fail and is required for tumors and parasitic disease.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1994

Selective uptake of high-density lipoprotein-associated cholesteryl esters by human hepatocytes in primary culture.

High-density lipoprotein cholesteryl esters are taken up by many cells without simultaneous uptake of high-density lipoprotein apolipoproteins. This selective uptake was investigated in human hepatocytes in primary culture. Human high-density lipoprotein-3 (density, 1.125 to 1.21 gm/ml) was radiolabeled in both its apolipoprotein and in its cholesteryl ester moiety; uptake of these high-density lipoprotein3 tracers by hepatocytes was investigated. Apparent high-density lipoprotein3 particle uptake as measured with the cholesteryl ester tracer was in excess of that from the apolipoprotein tracer, indicating selective uptake of high-density lipoprotein3 cholesteryl esters by hepatocytes. This selective uptake is a regulated pathway in hepatocytes, as demonstrated by an inverse relationship between cell cholesterol and the rate of selective uptake. Studies on the mechanism of selective uptake have used inhibitors such as monensin, chloroquine, heparin, and a monoclonal antibody directed against low-density lipoprotein receptors. These experiments provide no evidence for a role of cell-secreted apolipoprotein E, endocytosis or retroendocytosis in selective uptake. The intracellular fate of high-density lipoprotein3-associated cholesteryl esters was investigated with [3H]cholesteryl oleate-labeled high-density lipoprotein3. Hepatocytes hydrolyzed [3H]cholesteryl oleate internalized from labeled high-density lipoprotein3; this catabolism was not inhibited by the presence of chloroquine. In parallel hepatocytes were incubated with [3H]cholesteryl oleate-labeled low-density lipoprotein. Cells hydrolyzed [3H]cholesteryl oleate taken up with low-density lipoprotein; however, this hydrolysis was inhibited by chloroquine, indicating lysosomal low-density lipoprotein cholesteryl ester catabolism. These experiments show that high-density lipoprotein3 cholesteryl esters selectively taken up by hepatocytes are hydrolyzed independently from the classical lysosomal catabolic pathway. The question was addressed if selective uptake mediates a net mass uptake of cholesterol rather than an isotope exchange phenomenon. Incubation of hepatocytes with high-density lipoprotein-3 suppressed endogenous sterol synthesis from sodium [14C]acetate. Hepatocytes were incubated in the presence of high-density lipoprotein3; medium cholesteryl esters decreased as a result of incubation with hepatocytes. These results show a net mass delivery of high-density lipoprotein cholesteryl esters to hepatocytes. In conclusion, the pathway for selective uptake of high-density lipoprotein cholesteryl esters could be demonstrated in human hepatocytes in primary culture. A role for selective uptake in high-density lipoprotein-mediated cholesterol delivery to the liver in human beings in vivo is proposed.

Animals↗
PubMed1993

Mesenteric involvement of thromboangiitis obliterans (Buerger's disease) in a woman.

Although patients with peripheral arterial occlusive disease due to thromboangiitis obliterans (TAO) have been well characterized and the relationship of this disease to tobacco is stressed, little attention has been focused on its ability to involve the mesenteric vasculature and its ability to affect women. We report a rare case of a known TAO female patient who presented with abdominal pain due to inflammatory changes of the mesenteric vessels. The resulting small bowel ischemic changes and formation of intramural gas were demonstrated on a small bowel follow-through and a plain abdominal film. An angiography finally showed a superior mesenteric artery occlusion.

Adult↗