Biomedical subjects
Publications and source records attributed to B Le Thai.
The authors report a case of transplantation of a horseshoe kidney in two recipients. Based on this case and a review of the literature, they emphasise the technical precautions required for collection and transplantation of these malformed kidneys.
Twenty-two patients with prostatic carcinoma have been studied by magnetic resonance imaging (MRI). Twenty-three examinations have been done for 2 stage A, 11 stage B, 2 stage C and 7 stage D. Prostatic signal and locoregional extension have been compared with rectal examination and the 3 prostatectomies. Cancer looked homogeneous in 4 cases, heterogeneous in 10 cases with a nodule in 5 cases either with hyper of hyposignal compared to the normal prostate. Local extension in stages C and D is seen, especially to the periprostatic fat and seminal vesicles. MRI appears to be sensitive but poorly specific in the diagnosis of prostatic cancer. On the other hand, it is an interesting examination in the staging of prostatic cancer. These results must be confirmed with more comparisons of images and prostatectomy specimens.
Liver allografts have a privileged status with regard to hyperacute rejection. In this experimental study, we have used extracorporeal liver hemoperfusion in sensitized rats in order to analyze reactions between lymphocytotoxic antibodies and the liver. In sensitized BN rats, a donor-specific (Lewis) extracorporeal liver hemoperfusion can delay hyperacute rejection of heart allografts and reduce the level of lymphocytotoxic antibodies. The decrease in the level of antibodies could be due to massive absorption of antibodies by the liver or to release of major histocompatibility complex antigens in a soluble form. Immunofluorescent examination of the hemoperfused liver revealed important deposits of C3 on Kupffer cells and of IgG on sinusoidal cells. On the contrary, in control rats in which a third-party (DA) liver hemoperfusion was performed, heart allograft survival was less prolonged, the decrease in the level of lymphocytotoxic antibodies was not significant, and the deposits of IgG and C3 were much less evident. The level of circulating immune complexes was unchanged after a donor-specific or a third-party liver hemoperfusion. These results support the hypothesis that resistance of the liver to hyperacute rejection might be due to a massive and nontoxic absorption of lymphocytotoxic antibodies on nonparenchymal liver cells.
Cyclosporine administration in patients with organ transplants may cause cholestasis. In the rat, intraperitoneal administration of cyclosporine, 10 mg/kg, for three weeks did not cause liver function test abnormalities or hepatic histological lesions. However a significant reduction of bile flow and bile acid secretion rates was observed. The fact that reduction of bile flow was related to a decrease of the bile acid-independent flow suggests that cyclosporine-induced cholestasis results from an inhibition of bile acid secretion. Whether this inhibition is caused by the parental molecule or by cyclosporine metabolites needs to be clarified.
A new technique of hepatectomy is described, using intra operative ultrasound and dental cleaner needle. The needle is inserted in the liver under ultrasonographic guidance, in order to mark the vessel which feed the tumor. Then the trans-section of the liver begins near the needle and the contact of its hip allows an elective ligation of the vessel. Thus the hepatectomy is performed safely along the ischaemic line of the subsegment bearing the tumor. The needle have been also used to mark the adjacent segmental portal vein and the hepatic vein which have to be secured during the operation. We have done 12 hepatectomies in cirrhotic patients with this technic without any complication.
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A critical review of the literature is presented concerning prognostic factors in hepatocarcinoma, notably after surgical resection. Several factors would not seem to play an important prognostic role: age, liver function, alpha fetoprotein level or histological staging of the tumor. Other debatable factors include: sex, since females have a better prognosis, the existence of cirrhosis and the surgical margin of security. On the other hand the situation is clear regarding several other factors such as: size of the tumor, the severity of cirrhosis, the number of nodules, the macroscopic existence of a capsule and the presence or otherwise of portal invasion.