Biomedical subjects
Publications and source records attributed to B Vacher.
In September, 1983, a group of French and American experts met at the French National Health Laboratory to discuss their experience in monitoring for the safety of a hepatitis B vaccine in 42 chimpanzees. The observations made, conclusions reached, and recommendations for future studies are presented.
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Twenty-four resections under hepatic vascular exclusion (HVE) have been performed in patients with massive liver tumors. The procedure of HVE was used to minimize blood loss and the chance of gas embolism; it included clamping of the portal triad and occlusion of the inferior vena cava above and below the liver. In 12 of these patients the HVE was associated with clamping of the abdominal aorta above the celiac axis (AoC). During the "anhepatic" phase, which lasted 24 to 65 minutes (mean 39 minutes), neither venous shunt nor refrigeration was used. When HVE was associated with AoC, the circulation to the lower part of the body was completely excluded so that the systemic circulation was reduced to a small upper compartment in which the mean arterial pressure increased by 33% while the cardiac index decreased by 40%. The diastolic pulmonary arterial pressure remained unchanged. When HVE was not associated with AoC, the body was divided into an upper vascular compartment with normal venous resistance and a lower vascular compartment with increased resistance to the venous return and increased blood volume. The cardiac index, which was distributed to these two compartments, decreased by 40% to 50% but the mean arterial pressure decreased by only 14%. The good hemodynamic tolerance to HVE without AoC that was observed in these patients confirms the efficiency of collateral venous channels in the circumstances reported. AoC appears to be unnecessary in most patients if accurate fluid volume loading has been achieved before HVE. The study of acid-base balance demonstrates the ability of the human body to correct spontaneously the acidosis that follows the release of the clamps, provided a stable hemodynamic state is maintained. Only minor disorders of coagulation, without abnormal bleeding, were observed, and no prophylactic treatment was necessary. There were no deaths during operation, but a 25% postoperative mortality rate was observed mainly related to the underlying disease and the status of the remnant liver parenchyma. Despite its apparent sophistication, HVE is a simple and safe procedure for performing otherwise hazardous liver resections for tumors of large size or that are located close to the inferior vena cava and the suprahepatic veins. Its hemodynamic and metabolic consequences appear to be moderate.
A primary malignant tumor of the liver in a 48-year-old woman was resected by right hepatectomy extending to the medial segment of the left lobe, along with the retrohepatic inferior vena cava. The caval interruption was not followed by a venous reconstruction or an associated right nephrectomy. The favorable outcome suggests that resection of the suprarenal portion of the inferior vena cava can be considered in some exceptional cases, even if venous collateral circulation has not developed.
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Modalities for production of inactivated rabies vaccine derived from diploid hamster cell cultures are reported. The inactivated concentrated virus, purified by zonal centrifugation, is utilised for the preparation of vaccines destinated to carnivores, either in the form of monovalent vaccine or associated with distemper and canine contagious hepatitis vaccines. The inactivated concentrated virus is utilised for the preparation of bovine vaccine. The procedure is compatible with industrial production. The results concerning safety and potency tests of the experimental lots are presented.
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Explore the source record for details and available documents.