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Biomedical subjects

A Geubel

Publications and source records attributed to A Geubel.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

Adult hepatic retransplantation. UCL experience.

INTRODUCTION: Retransplantation is a rescue operation in orthotopic liver transplantation. Its appropriateness has been questioned on medical, economical and also on ethical grounds. MATERIAL AND METHODS: During the period february 1984-december 1997, 54 (14.5%) of 372 adult patients were retransplanted; three (0.8%) of them had two retransplantations. Indications were graft dysfunction [(primary non function (8x) and early dysfunction (14x in 13 patients)], immunological failure [acute (9x in 8 patients) and chronic (9x) rejection], technical failure [(hepatic artery thrombosis (5x in four patients), allograft decapsulation (1x), ischaemic biliary tract lesions (6x)] and recurrent viral allograft disease [HBV (4x) and HCV (1x)]. RESULTS: Five year actuarial patient survival after retransplantation was 70.8%, which was identical to this of non retransplanted patients (72%). Early (< 3 mo) mortality was significantly lower in elective procedures (9.1%--2/22 pat. vs 34.4%--11/32 pat. in urgent procedures--p < 0.05). Mortality was highest in the graft dysfunction (23.8%, 5/21 pat.) and immunological failure (41%, 7/17 pat.) groups. Five of six patients retransplanted for rejection, whilst being on renal support, and two of three patients retransplanted urgently twice died of infectious complications. All patients retransplanted because of recurrent allograft disease were long-term (> 3 mo) survivors. Both HBV-infected patients died of allograft reinfection 7 months later; the two HBV-Delta infected patients were, free of infection, 44 and 6 months after retransplantation under HBV-immunoprophylaxis. Length of hospitalisation after primary transplantation and retransplantation were identical (median of 16 days--range 11 to 40 vs 14 days (range 7 to 110). Economical study during the period 1990-1995 showed that costs of the first hospitalization of primary transplantation and of retransplantation could be equalized during the period 1994-1995 as a consequence of the more frequent use of elective retransplantation (median 1.3 million BF, range 720,988 to 8,887,145 vs 1.1 million BF, range 943,685 to 1,940,409). CONCLUSIONS: Hepatic retransplantation is a successful safety net for many liver transplant patients. Every effort should be made to do this intervention electively under minimal immunosuppression. In case of immunological graft failure and hepatic artery thrombosis retransplantation must be done early in order to avoid infectious complications; the same holds for ischaemic biliary tract lesions which cannot be cured by interventional radiology. Retransplantation for recurrent benign disease should be restricted to those diseases which can be effectively treated by (neo- and) adjuvant antiviral therapy.

Actuarial Analysis↗
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Diffuse liver angiosarcoma and cerebral cavernous angiomas in a young patient.

A case of a thirty-nine year old woman with cerebral cavernous angiomas who developed anaemia and thrombocytopenia secondary to diffuse liver angiosarcoma is reported. This unique association of liver angiosarcoma and cerebral cavernous angiomas may suggest that this tumour may potentially develop from benign vascular lesions. Hematologic abnormalities in angiosarcomas are moreover reviewed based on recent literature search.

Adult↗
PubMedDate not supplied

[Role of liver transplantation in the treatment of metastatic disease of the liver].

The authors report their experience of liver transplantation for metastatic tumor in 6 patients. Although good palliation can be offered with prolonged survival in some patients, secondaries of the liver remain the poorest indication for liver transplantation. A prospective multicentric study would be needed to evaluate the usefulness of post-transplantation chemotherapy.

Adenocarcinoma↗
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Chronic lymphocytic leukemia with portal hypertension and without liver involvement: a case report underlining the roles of increased spleno-portal blood flow and "protective" sinusoidal vasoconstriction.

We report the case of a 72-year-old woman with well-controlled chronic lymphocytic leukemia (CLL) and splenomegaly who developed portal hypertension with bleeding oesophageal varices in the absence of liver fibrosis or regenerative nodular hyperplasia at surgical wedge liver biopsy. The hepatic venous pressure gradient (HVPG) was elevated and splenectomy resulted in both its normalisation and the regression of oesophageal varices. This case shows the potential for an increased spleno-poral flow to generate severe portal hypertension likely through a "protective" sinusoidal vasoconstriction.

Aged↗
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Adult liver transplantation at UCL: update 2002.

The authors present the results of a single centre study of 587 liver transplants performed in 522 adults during the period 1984-2002. Results have improved significantly over time due to better pre-, peri- and post-transplant care. One, five, ten and fifteen year actuarial survivals for the whole patient group are 81.2; 69.8; 58.9 and 51.2%. The high incidence of de novo tumors (12.3%), of cardiovascular diseases (7.5%) and of end-stage renal function (3.6%) should be further incentives to tailor the immunosuppression to the individual patient and to direct the attention of the transplant physician to the long-term quality of life of the liver recipient.

Adult↗
PubMedDate not supplied

Genes and metals: a deadly combination.

Wilson's disease is an autosomal recessive disease of copper metabolism, with an estimated prevalence of 1:30000. The most common presentations of WD are liver disease and neurological disturbance. For many years the diagnosis was based on the results of several clinical and biochemical tests, for which several limitations had been reported. In recent years the developments of new techniques in genetic and molecular biology have provided useful tools in the diagnosis of Wilson's disease. However, the presence of several mutations and the fact that most patients are compound heterozygote means that the problem is not completely resolved. Chelators and zinc salts have been largely used in the treatment of WD patients with a favorable outcome, but the debate continues as to the agents of first choice. Liver transplantation is a cure for patients with decompensated liver disease but its effect on the neurological outcome is still not clear.

Adolescent↗
PubMedDate not supplied

[Arterialization of the portal vein associated with a portocaval shunt: long-term results of a controlled prospective study].

In order to evaluate the benefit of arterialization of the portal vein in conjunction with a therapeutic end-to-side porto-caval shunt, we started in December 1979 a prospective randomized study, comparing these two techniques in Child class A and B cirrhotic patients with a hepatopetal portal flow of at least 100 ml per min. Sixty-four patients have been included in the study: 33 underwent a porto-caval shunt (NART) and 31 were arterialized (ART). The two groups of patients were similar as regards clinical and hemodynamic parameters. The operative mortality was lower after arterialization, considering the whole group (ART: 6.5%, NART: 12%) and high risk patients (Child class B: ART: 0%, NART: 22%--emergency operation: ART: 0%, NART: 17%) but the differences were not statistically significant. Postoperative ascites was more frequent in arterialized patients (ART: 45%, NART: 18%; p = 0.02), with an increased need for reoperation (ART: 26%, NART: 6%; p less than 0.05). The mean follow-up period is 56.9 +/- 28.1 months (SD) for the 58 surviving patients. The five-year actuarial survival rate is 68% for ART patients and 60.6% for NART patients (NS). In child B patients the five-year actuarial survival rate is 75% in ART patients and 22% in NART patients (p less than 0.05). Actuarial estimation of arterialization patency--proved by angioscan--is 38% at five years. There were no significant differences in the incidences of postoperative and long-term encephalopathy and liver function between the two groups. In conclusion, arterialization of the portal vein in conjunction with a therapeutic end-to-side porto-caval shunt improved survival in high risk patients (Child class B), did not increase operative mortality in Child A and B patients, was followed by a higher incidence of postoperative ascites and did not decrease the incidence of long-term encephalopathy.

Adult↗
PubMedDate not supplied

[Hepatic transplantation in cirrhosis].

The authors review the indications and outcome of liver transplantation for hepatic cirrhosis of various aetiologies in adults, on the basis of their experience and that of the literature. Up to 1989, they performed 107 liver transplantations in 93 adults, including 70 patients with cirrhosis: primary biliary cirrhosis (PBC) in 20, primary sclerosing cholangitis (PSC) in 2, secondary biliary cirrhosis in 1, post-necrotic cirrhosis in 35, alcoholic cirrhosis in 5, metabolic cirrhosis in 7. The best indications are PBC with rising bilirubinemia (greater than 5 mg/dl) or portal hypertension and PSC with severe and diffuse lesions. The outcome of transplantation was satisfactory in patients with PBC: 16 survived with a mean follow-up of 23 months. In patients transplanted for postnecrotic cirrhosis the outcome might be better if HBS is associated preoperatively with delta antigen: 6 patients of this group survived with a mean follow-up of 12.6 months while in the group of 8 patients with HBS not associated preoperatively with delta antigen, 6 patients survived with a mean follow-up of 12.8 months. There was a trend toward a higher hospital mortality after transplantation in cirrhotic patients with pulmonary arterio-venous shunts in comparison with cirrhotic patients without significant pulmonary arterio-venous shunts preoperatively.

Cholangitis, Sclerosing↗
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[Is immunosuppressor treatment effective in lymphocytic gastritis? Apropos of a case associated with an intestinal lymphoma].

We report the case of a patient with "lymphocytic gastritis" surprisingly associated with an intestinal lymphoma which was treated after intestinal resection by corticosteroids and a combination of antimitotic agents. Comparing gastric mucosa before and 3 months after therapy, we observed a striking reduction of inflammation. Such a case suggests the possibility of a beneficial effect of immunosuppressive therapy on "lymphocytic gastritis" and favors the hypothesis of an immunological disorder.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Human fascioliasis: cure by mebendazole? A case report.

We report a case of invasive human Fasciola hepatica infection in which, for the first time, a successful treatment with high doses of mebendazole (4 g/day for 3 weeks) was achieved. This therapy resulted in a prompt and prolonged normalization of eosinophil counts, liver enzymes abnormalities and specific serological tests together with the disappearance of liver necrosis indicating the eradication of liver flukes. The efficacy of mebendazole in the treatment of fascioliasis must be confirmed by further studies.

Adult↗