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Biomedical subjects

B Pol

Publications and source records attributed to B Pol.

At least 19 recordsLinked to original sources
PubMed1999

Morbidity of major hepatic resections: a 100-case prospective study.

OBJECTIVE: To assess the morbidity and its main risk factors after major hepatic resection. DESIGN: Retrospective study of prospectively collected data. SETTING: University hospital, France. SUBJECTS: 100 consecutive patients who underwent major hepatic resections, 1989-95. INTERVENTIONS: Major hepatic resection, defined as resection involving 3 or more segments according to Couinaud's classification, in all cases. MAIN OUTCOME MEASURES: All complications that affected outcome or prolonged hospital stay. Risk factors identified by univariate and multivariate analysis. RESULTS: 45 patients developed at least 1 complication and 7 died. The most common complications were: pleural effusion (n = 21), hepatic failure (n = 12), and ascites (n = 9). Univariate analysis showed that the following variables were significantly related to the morbidity: age >55 years, American Society of Anesthesiologists (ASA) grade II or more, bilirubin >80 micromol/L, alkaline phosphatase activity more than double the reference range, malignant tumours, abnormal liver parenchyma, simultaneous surgical procedures, operative time >4 hours, and perioperative blood transfusion > or =600 ml. The extent of resection did not correlate with postoperative complications. Multivariate analysis showed that volume of blood transfusion > or =600 ml and simultaneous surgical procedures were the most important independent risk factors for complicated outcome. CONCLUSIONS: The morbidity associated with major hepatic resections remains high, and the main determinants of outcome are intraoperative surgeon-related factors.

Adult↗
PubMed1998

Inflammatory process complicating giant hemangioma of the liver: report of three cases.

Three cases of giant hemangioma of the liver associated with clinical and laboratory signs of inflammatory process, including low-grade fever, weight loss, abdominal pain, accelerated erythrocyte sedimentation rate, anemia, thrombocytosis, and increased fibrinogen level with normal white blood cell count are described. One patient presented with slight cholestatic jaundice because of tumor-related bile duct compression, but the other two patients had normal liver function tests, except for a slight increase in gammaglutamyl transferase. Clinical and laboratory abnormalities disappeared after surgical excision. Inflammatory manifestations have rarely been reported during giant liver hemangioma. Intratumoral inflammation necrosis or bleeding could explain the symptoms but histological signs of inflammation were not detected in two of three surgical specimens. The release of immune mediators by liver endothelial cells lining the hemangioma is an alternative explanation. The incidence of inflammatory process complicating giant hemangioma is probably underestimated because our three cases were observed within a span of only 3 years.

Adult↗
PubMed1998

[Liver transplantation in the adult: who and when to transplant?].

INTRODUCTION: The shortage of cadaveric organ donors imposes a severe limit to the number of liver transplantations. A selection is thus necessary among patients: should the sickest be selected, or those who supposedly have the best chance to survive and recover? Optimizing the timing of transplantation during the course of the disease (not too early, but not too late) is another issue. CURRENT KNOWLEDGE AND KEY POINTS: Suitable candidates for transplantation are patients suffering from an irreversible, symptomatic liver disease. The goals of therapy are: firstly, to favorably modify the natural outcome of the disease; and secondly, in an acceptable risk taking manner. Major criteria for indication in the most common liver diseases can be summarized as follows: a) for chronic parenchymal liver diseases, a Child-Pugh score of 9 or 10, or less if complications have already occurred, is a mandatory and often sufficient criterion; b) for cholestatic liver diseases, a serum bilirubin level higher than 100-150 mumol/L is generally required; c) apart from "small" hepatocellular carcinomas on cirrhotic parenchyma (less than three tumors of less than 5 cm in diameter), most cancers are considered contraindications; d) acute liver failure requires early referral to a liver transplant center for potential emergency indication. FUTURE PROSPECTS AND PROJECTS: In an organ shortage situation which is likely to perdure, early consultative contact between the patient and the liver transplant team will allow improvement in the access to transplantation procedure.

Adult↗
PubMed1998

Surgical resection of locally recurrent colorectal adenocarcinoma.

BACKGROUND: Recurrence rates after curative resection of colorectal adenocarcinoma remain steady at 50 per cent. Thirty per cent of the deaths are linked to locoregional recurrence. The aim of this study was to evaluate the results of resection for locoregional recurrence. METHODS: This retrospective review analyzed a series of 120 patients who underwent resection of colonic (56) or rectal (64) locoregional recurrence. Sixty-nine resections were considered as curative. Sixty-one recurrences required extended resection. There were nine synchronous hepatic resections. RESULTS: The hospital mortality rate was 7 per cent and the morbidity rate was 40 per cent. The overall 5-year survival rate was 27 per cent. Survival was significantly higher: (1) after curative resection (44 versus 0 per cent after palliative resection, P < 0.0001); (2) in women (44 versus 11 per cent for men, P = 0.0036); and (3) after resection for intramural recurrence (45 versus 19 per cent for extramural recurrence, P = 0.0024). Multifactorial analysis showed that curability of the resection was the most important prognostic parameter. CONCLUSION: The results in this highly selected group seem to justify an attempt at reresection whenever possible. Long-term results may be improved by using adjuvant treatment.

Adenocarcinoma↗
PubMed1997

[Laparoscopic cholecystectomy after myocardial revascularization using the gastro-epiploic artery].

The authors report the case of a man operated by coronary artery bypass graft using the right gastro-epiploic artery. Laparoscopic cholecystectomy had to be performed postoperatively because of cholecystitis. Surgeons must be aware of the possibility of coeliotomy in the context of coronary artery surgery: this is a small incision, the sternotomy incision is only slightly lengthened towards the epigastrium. A history of such surgery requires certain precautions during subsequent abdominal incisions, particularly laparoscopic, and during dissection of the porta hepatis.

Arteries↗
PubMed1996

[Transanal excision of rectal tumors. New applications of the endo-GIA forceps].

Two new applications of the endo-GIA technique are presented for endoluminal intrarectal resection of benign or malignant tumors of the lower or middle part of the rectum. These procedures allow resection of sessile lesions with a large implantation base. Depending on the pathology and the type of implantation, resection can either be total or via the musculosa. Results have been good with this simple procedure which allows total tumor resection and an uneventful post-operative period.

Aged↗
PubMed1992

[Cancer of the pancreas. A plea for resection. 162 operated patients].

Between 1970 and 1990, 162 patients with carcinoma of the pancreas or the periampullary region were operated upon. A prospective study was conducted in 85 of them who underwent surgery after 1983. The tumour was resected in 63 patients (ductal adenocarcinoma in 43, periampullary carcinoma in 20). Biliary and/or gastrointestinal bypass was performed in 76 patients, and exploratory laparotomy in 23. The operative mortality rate was 3 percent (2/63) among patients with resection and 24 percent (24/99) among those with laparotomy with or without bypass. The longest survival (median: 33 months) was obtained in patients with periampullary tumours; it was 12 months after resection in patients with ductal adenocarcinoma and 4 months in the other cases. The preoperative estimate of unresectability was erroneous in 36.5 percent of the cases. Periampullary tumours were diagnosed only after pathological examination of the lesion removed in 47 percent. These results are in favour of radical surgery, especially since the operative mortality of resection is low and since resection, even palliative, gives a better survival rate than mere bypass.

Adenocarcinoma↗
PubMed1991

[Resection of the portal vein in pancreatectomy for cancer: technical considerations. Apropos of 4 cases].

Out of 150 carcinomas of the pancreas operated from 1970 through 1989, 50 pancreatectomies were performed, including 4 cases of segmental resection of portal vein with total pancreatectomy (2 cases) or duodenopancreatectomy (2 cases). The technical procedure is described and discussed. Segmental resection of portal vein is rare in our experience and has been always performed out of necessity because of the over estimation of the resectability. However, mortality and post-operative stay are not increased.

Adenocarcinoma↗
PubMed1990

[Severe hepatic trauma. Initial non-operative treatment. A case report].

The emergency surgical treatment of severe hepatic traumas still carries a high mortality risk. We report a case of severe blunt trauma of the liver managed without surgery under CT guidance. This attitude--which does not exclude surgery as a later resort--requires haemodynamic stability of the patient, close monitoring in a surgical intensive care unit and repeated CT scans.

Adolescent↗
PubMed1990

Acute Budd-Chiari syndrome with hepatic failure and obstruction of the inferior vena cava as presenting manifestations of hereditary protein C deficiency.

The protein C system is essential in limiting the activation of coagulation in vivo. We report on a 29 year old woman with Budd-Chiari syndrome and occlusion of the inferior vena cava who presented with acute liver failure. She was successfully treated with an emergency mesoatrial shunt. Eight months after surgery, she has no ascites and normal liver function. She had a low concentration of plasma protein C on admission to hospital and during the follow up. Protein C deficiency subsequently was found in her father and two sisters, who were asymptomatic. Hereditary protein C deficiency should be considered in patients with Budd-Chiari syndrome.

Acute Disease↗
PubMed1990

Vascular reconstruction after extended resection of a retroperitoneal fibromatosis.

We report the case of a 25-year-old man who underwent successful en-bloc resection of a retroperitoneal fibromatosis, extended to the right kidney and testis, with excision of the right iliac arteries and veins. Arterial replacement was done by means of a right iliofemoral prosthetic graft. A right femorocaval prosthetic graft with a temporary arteriovenous fistula was used for venous replacement. The patient is still alive and after 3 years shows no sign of recurrence on successive computed tomographic scans. He has preserved patency of the right arterial and venous iliac grafts. To our knowledge, this is the first documented case of simultaneous arterial and venous iliac replacement successfully performed after excision of a retroperitoneal tumor.

Adult↗
PubMed1989

[Gastrocolonic excision of cancer. Retrospective analysis of the immediate postoperative course and long-term survival in 18 patients].

Eighteen patients underwent gastrocolic resection for cancer. Thirteen had primary gastric cancer and 5 had primary colon cancer (two of these 5 patients had local-regional recurrence after right hemicolectomy). Twelve resections were curative and 6 palliative. Twelve patients had more than 2 organs resected. Involvement of adjacent tissues or organs was present in 15 patients (11/13 gastric cancer and 4/5 colon cancer: 83%). All patients had immediate colonic anastomosis. The mean duration of postoperative stay was 22 +/- 8 days (SD). Mortality was 5.6% (1/18). Seven patients had post-operative complications (41%; 7/17); 3 of these 7 patients had anastomotic leakage (one colonic and two pancreatic fistulae; 3/17: 17.6%); the mean duration of postoperative stay for these three patients was 27 +/- 4 jours, (p less than 0.004). One colonic fistula complicated the 18 colonic anastomoses (5.5%). There was no reoperation in this series. The estimated 2-year survival for the entire group was 20%. The median survival was 9.5 mois; the median survival was 13.5 months after curative resections and 5 months after palliative procedure (p less than 0.01). The median survival was 8 months for gastric adenocarcinoma and 36 months for colon adenocarcinoma (p less than 0.05). Despite the poor results in gastric cancer extending to adjacent organs, complete excision is still recommended whenever feasible. Complete excision of advanced colon cancer may lead to prolonged disease-free survival depending on the lymph node status. With an acceptably low mortality, resection remains a better procedure than palliative diversion or exclusion for these advanced tumours.

Adult↗
PubMed1989

[Excision of colorectal cancers: what can be expected of lymph node excision?].

We report a series of 413 patients with colo-rectal adenocarcinoma. 328 had a curative resection and 277 of them had elective lymphadenectomy; 51 had no lymphadenectomy because of either age or poor general status. Operative morbidity and mortality were not increased by lymphadenectomy. Survival was related to the lymph node involvement: 70.6% 5 year survival in patients without lymph node metastases, 49.3% 5 year survival in patients with lymph node metastases (P less than 0.001). However lymphadenectomy did not affect the survival rate of the patients. We conclude that lymphadenectomy had no deleterious effect. However, its real benefit on long term survival must be evaluated in further prospective randomised studies.

Actuarial Analysis↗