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Biomedical subjects

Y Chapuis

Publications and source records attributed to Y Chapuis.

At least 91 records · Page 5Linked to original sources
PubMed1991

Intraoperative ultrasonography for location of proximal limit of inferior vena caval thrombosis.

Appropriate surgical management of inferior vena caval thrombosis is dependent on the proximal limit of the thrombus. Cavograms, computed tomography, or magnetic resonance imaging all have their shortcomings in locating this limit. Intraoperative ultrasonography has allowed us to determine the exact proximal limit of vena caval thrombosis in two patients, one with suprarenal thrombosis, the other with infrarenal thrombosis. In the first patient, caval interruption and clearance of the inferior vena cava was greatly enhanced by the use of this method. Intraoperative sonography is useful in the surgical treatment of thrombosis of the inferior vena cava.

Adult↗
PubMed1991

Subcapsular hepatic necrosis in liver transplantation: CT appearance.

Eleven cases of subcapsular hepatic necrosis were found in 47 hepatic transplantation patients who underwent CT examination between the second and 14th postoperative day. CT examinations of all 11 cases showed nonenhancing hypodense subcapsular areas with irregular contours in the liver. Major vessels were free of obstruction. Anatomic correlation, possible in one case, confirmed the diagnosis. Size disproportion between the graft and the recipient abdominal cavity reduced hepatic blood flow and caused abnormal pressure points. One or both of these factors could result in ischemia in subcapsular areas and explain the subcapsular necrosis. Although it has good prognosis without treatment, subcapsular hepatic necrosis is important to recognize to avoid confusion with liver necrosis after vascular thrombosis.

Adolescent↗
PubMed1991

Liver transplantation in patients with a surgical portasystemic shunt.

Of 220 patients undergoing liver transplantation between March 1982 and April 1991, eighteen (8.1 percent) already had a surgical portasystemic shunt. Four patients had a distal splenorenal shunt, six a side-to-side portacaval shunt, three an end-to-side portacaval shunt, and five, a mesocaval shunt. The splanchnic venous system was assessed by Doppler ultrasound examination and angiography before liver transplantation. Perioperative mortality rate was higher but not significantly different from that observed in the population of patients without previous portasystemic shunt (33.3 percent versus 21.7 percent). Liver transplantation was particularly difficult in the six patients with a previous side-to-side portacaval shunt, in which the perioperative mortality rate was high (66.6 percent). Liver transplantation is feasible in patients with a previous portasystemic shunt but carries a higher risk. It is easier when no previous dissection of the hepatic pedicle has been done. Suppression of the shunt after revascularization of the graft must be performed in order to provide optimal venous flow to the hepatic graft.

Adolescent↗
PubMed1991

[Ectasing cholangitis and secondary biliary cirrhosis following intra-arterial hepatic chemotherapy. Treatment by liver transplantation].

A case of ectasing cholangitis, following intra-arterial chemotherapy with discontinuous infusion of fluorouracile, is described. The severe destruction of the intra-hepatic biliary ducts led to the constitution of large cavities in continuity with the biliary tree. These cavities were responsible for images which were mistakenly thought to be metastases. Consequently, secondary biliary cirrhosis developed, requiring orthotopic liver transplantation.

Adenocarcinoma↗
PubMed1990

Clinical features of adrenocortical carcinoma, prognostic factors, and the effect of mitotane therapy.

Adrenocortical carcinoma is a rare tumor, and only limited information is available about its natural history and the effects of therapy. We studied 105 patients (75 female and 30 male; mean age, 46 years) with adrenocortical carcinoma who were referred to us between 1963 and 1987. The average duration of symptoms before diagnosis was 8.7 months. At the time of diagnosis, 68 percent of the patients had endocrine symptoms, and 30 percent had distant metastases. Hormonal studies showed that 79 percent of the tumors were functional. Eighty patients underwent surgery, and 59 also received the adrenal cytotoxic agent mitotane. The median disease-free interval after surgery was 12.1 months (range, 1 to 175). Tumor dissemination occurred in 82 percent of the patients, most commonly to the lung, liver, and adjacent organs. The median survival time was 14.5 months (range, less than 1 to 175), and the five-year survival was 22 percent. Age over 40 years and the presence of metastases at the time of diagnosis were the only factors recognized as indicating a poor prognosis. Mitotane controlled hormonal secretion in 75 percent of the patients. Eight mitotane-treated patients had partial tumor regression, but the drug did not have a significant effect on survival. We conclude that adrenocortical carcinoma carries a poor prognosis. Mitotane therapy may offer transient benefits, particularly in controlling endocrine symptoms.

Adrenal Cortex Hormones↗
PubMed1990

Presence of villin, a tissue-specific cytoskeletal protein, in sera of patients and an initial clinical evaluation of its value for the diagnosis and follow-up of colorectal cancers.

Villin is an actin-binding protein found in a few normal adult epithelia, namely epithelial cells in the digestive and urogenital tracts. Moreover, villin production is maintained in malignant cells. We assumed that cell lysis and necrosis of solid tumors producing villin might result in villin release into blood. We analyzed the villin content of sera from 788 patients and controls using an enzyme-linked immunosorbent assay. Patients and controls were classified into healthy donors, patients with benign diseases of the gastrointestinal tract, patients with colorectal cancers, and patients with malignant nondigestive diseases. In the panel of sera analyzed, the sensitivity of the assay for colorectal cancers was 50.5%, and its overall specificity for malignant digestive tumors was 94.5%. Results were statistically analyzed comparing each group of sera with each other. We conclude that the presence of villin is indicative of a pathological state in the gastrointestinal tract (P less than 0.001). Finally, we followed villin levels after tumor resections (60 patients). We found that the villin level in sera remains low in remissions but is raised in recurrences. We suggest that the villin assay may have clinical utility as a diagnostic adjunct for adenocarcinoma of the gastrointestinal tract. It may also have some value in monitoring patients with advancing colorectal carcinomas after resection of these tumors.

Adult↗
PubMed1990

Orthotopic liver transplantation for Byler disease.

Byler disease is a rare form of familial intrahepatic cholestasis that is fatal before puberty. This retrospective study reviewed the results of orthotopic liver transplantation in 14 children with Byler disease using 12 whole-liver grafts and 2 reduced-size grafts. One post-operative death occurred after retransplantation for arterial thrombosis. In the other patients, infectious problems and rejection episodes were the most frequent complications during the postoperative period. In the 13 patients alive, graft function, growth, and quality of life were good after an average follow-up of 17 months without any sign of disease recurrence.

Adolescent↗
PubMed1990

[Non-functioning tumors of the endocrine pancreas. Concept, diagnosis, treatment].

Five cases of nonfunctioning islet cell tumors of the pancreas are reported. There were 3 males and 2 females aged from 34 to 83 years (Average: 55.8 years). Two tumors were malignant since already metastatic, one tumor was probably malignant and two tumors were judged as benign. One patient died post-operatively. The four remaining patients are alive without recurrence after from 1.4 to 7.3 years. The concepts of nonfunctioning tumors of the pancreas and APUD system are discussed in view of these 5 cases and the relevant literature. The value of tumor markers as well as the radiographic appearances of these tumors are reported. Having a better prognosis than the adenocarcinoma of the exocrine pancreas, the nonfunctioning tumors of the endocrine pancreas are best managed by surgery. The indications and the results of surgery and chemotherapy are discussed.

Adenoma, Islet Cell↗
PubMed1990

Portal and hepatic arterial blood flow measurements of human transplanted liver by implanted Doppler probes: interest for early complications and nutrition.

Hepatic artery thrombosis and early acute rejection are severe complications of orthotopic liver transplantation (OLT). Their rapid detection is most desirable. The purpose of this study was to assess the usefulness of monitoring hepatic artery (HABF) and portal vein (PVBF) blood flows during the first week after OLT. At the end of operation, microprobes were sutured to the vessels, and their connecting tubes were externalized and connected to a pulsed Doppler flowmeter operating at 8 MHz. In 10 patients (ages ranged from 2 to 54 years) of 106, measurements of HABF and PVBF were done during alternative clamping of both vessels and before and after abdominal closure, every 12 hours during 7 days, and at day 7, before and after a 150 gm carbohydrate meal. At day 7 the probes were pulled out by gentle traction without complication, and all patients were allowed to go home. Reciprocal increase of flow during selective clamping was only observed for HABF (+45.8% +/- 47.6%; p less than 0.01). Abdominal closure decreased both HABF and PVBF by 13.8%, p less than 0.01, and 26%, p less than 0.05, respectively. In seven cases no significant variation of HABF and PVBF was observed during 7 days. In two patients with histologically confirmed early acute rejection, a marked decrease of diastolic HABF, without modification in PVBF, was the first manifestation and was rapidly corrected by boluses of steroids. In one patient disappearance of systolic and diastolic HABF led us to diagnose an arterial obliteration caused by a plicature, which was successfully surgically treated in the emergency department. In all patients, after oral ingestion of the carbohydrate meal, and only after this type of diet, a significant and deep decrease (-87%, p less than 0.001) of HABF was observed between 7 and 120 minutes without any change in PVBF. Such an effect was not observed in control patients. We conclude that this Doppler flowmetric technique with implantable microprobes is useful for rapid diagnosis of and strategy in treating early complications and is a new tool for pathophysiologic study of OLT consequences.

Dietary Carbohydrates↗
PubMed1990

[Preoperative imaging in primary hyperparathyroidism before first cervicotomy].

A primary neck exploration for primary hyperparathyroidism can be performed without any previous morphological investigations. However, ultrasonography, CT scan and thallium technetium isotope scan can facilitate the surgical procedure as they frequently reveal and localize a parathyroid adenoma, due to the frequently large size of most adenomas. Although not all of these morphological investigations are always successful, we strongly recommend the use, in particular, of ultrasonography which is a non-invasive and inexpensive method. The other investigations, which are more expensive and less widely available can be discussed for each individual patient. These morphological investigations are obviously indicated in persistent recurrent primary hyperparathyroidism.

Humans↗
PubMed1990

[Obstruction of the common bile duct by a cystic duct cyst in the recipient after liver transplantation].

Four cases of tension mucocele of the cystic duct of the graft after orthotopic liver transplantation have been described in the English literature. We report the case of a mucocele of the recipient's cystic duct occurring in a patient who underwent liver transplantation for sclerosing cholangitis secondary to histiocytosis X. At variance with the 4 previously reported cases, this complication could be related to progression of the initial disease in the recipient's cystic duct. To avoid such a biliary complication in patients undergoing a liver transplantation for sclerosing cholangitis, resection of the extra-hepatic duct must be as large as possible and choledochojejunostomy seems to be the best procedure for biliary reconstruction.

Adolescent↗