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C Ducerf

Publications and source records attributed to C Ducerf.

At least 73 records · Page 4Linked to original sources
PubMed1995

New approaches to the treatment of hepatitis C virus infection after liver transplantation using ribavirin.

BACKGROUND: Chronic liver failure resulting from hepatitis C virus infection often necessitates orthotopic liver transplantation. Recurrence of hepatitis C virus infection after transplantation is inevitable, and the infection is usually severe. Interferon and ribavirin have both been used to treat hepatitis C virus infection after liver transplantation, but neither interferon nor ribavirin monotherapy has demonstrated sustained biochemical or virologic responses or histologic benefit in transplant recipients with recurrent hepatitis C virus infection. The next logical approach to treatment was combination therapy. METHODS: Fourteen patients with recurrent hepatitis C virus infection were treated for 6 months with interferon alfa-2b (3 MU thrice weekly) and oral ribavirin (1000 mg/day). After 6 months, patients were maintained on ribavirin monotherapy until the end of the study. Safety and tolerability were satisfactory, and no patients experienced graft rejection during the study. RESULTS: Alanine aminotransferase levels were normalized in all patients after 6 months of therapy. Serum HCV RNA was negative in nine patients; the other five demonstrated a 50% quantitative reduction of HCV RNA. After a mean follow-up of 18 months, all but one patient maintained normal alanine aminotransferase levels. Twelve out of 14 patients achieved a histologic benefit. CONCLUSIONS: The biochemical and virologic responses and the histologic benefit seen after combination therapy are significantly better than those reported with either interferon or ribavirin monotherapy. Combination therapy appears to be effective in preventing the progression of HCV-related graft disease after liver transplantation.

Antiviral Agents↗
PubMed1994

[Heterotopic experimental liver transplantation with portal revascularization of the graft on the distal splenic vein of the recipient].

A model of heterotopic liver transplantation had been studied. The graft was laid under the recipient liver and the portal blood flow was supplied by anastomosis with the distal part of the splenic vein. Both liver can then receive portal blood through two parallel portal circulation. Liver function of transplant was satisfactory at three months after transplantation. Their had been no alteration of the recipient liver during the same period.

Anastomosis, Surgical↗
PubMed1993

Repeated hepatic resections for colorectal metastases.

Repeated hepatic resection (RHR) for recurrent colorectal metastases remains uncommon and controversial. We report our experience in order to assess the feasibility and the potential oncologic benefit of such an aggressive management. From 1981 to 1991, 13 patients underwent a RHR. The first hepatic resection had been an anatomic hepatectomy removing between two and six segments in 10 patients and a wedge resection in three. The RHR was performed after a mean delay of 16 +/- 10 months (5-35) from the first liver procedure. The RHR was an anatomic hepatectomy in eight patients (including a right hepatectomy in three) and a minor resection (tumorectomy or segmentectomy) in five. Three patients underwent a third liver resection for recurrence. There was no post-operative mortality. Eleven patients died from recurrence after a mean survival of 17 +/- 13 months from the second hepatic procedure (range: 6-47). One patient died from unrelated disease after 12 months and one was alive free of recurrence 22, 53 and 84 months after third, second and first hepatectomy respectively. The median survivals from the second and first hepatic resections were 17 and 31 months, respectively. It is concluded that in the well-trained team, RHR is feasible and safe even after major primary hepatectomy. However the oncologic benefit remains questionable.

Adult↗
PubMed1993

[Hepatic epithelioid hemangioendothelioma. A case with liver transplantation. Review of the literature].

Epithelioid hemangioendothelioma (HEE) is an unusual malignant neoplasm of vasculo-endothelial origin, arising in soft tissues, lung and liver. One case of hepatic HEE is reported in a 32 year-old man wit an isolated multinodular hepatomegaly. The diagnosis was made by the histologic examination of biopsy specimens. At the time of diagnosis, there was evidence of pulmonary metastasis. However, an orthotopic liver transplantation was performed. The tumor cells were immunoreactive with factor VIII-related antigen, BNH9 and vimentin. There was no expression of cytokeratin and epithelial membrane antigen. The patient is alive and well 24 months after. The thoracic X-ray are unchanged. This case is compared with the 84 others cases of the literature. Fourteen experienced a favorable outcome after transplantation. Extra-hepatic dissemination doesn't contra-indicate the graft. But hilar vascular involvement may be correlated with worse prognosis.

Adult↗
PubMed1992

Postoperative electromyographic profile in human jejunum.

The postoperative electromyographic profile of the proximal jejunum and its evolution during recovery from surgery were defined in fasted humans after cholecystectomy. An intraluminal probe supporting four groups of bipolar electrodes was transnasally inserted at the end of surgery to allow continuous recording of jejunal electrical activity over 4 consecutive days. Electromyographic activity was characterized by an early reappearance of phase 3 of migrating myoelectric complexes (MMC) lasting 5.2 +/- 0.6 minutes and occurring at 38.1 +/- 3.1-minute intervals at day 1 after surgery. During the 4 days after surgery, there was an increased duration of MMC, mainly consisting of phase 2 occurrence with an increased duration and lengthening of the MMC cycle. The amplitude of spikes during phase 3 increased. During the postoperative period, characterized by an inversion of the circadian rhythm, the velocity of propagation was higher (p less than 0.05) between 18:00 and 06:00 (4.0 +/- 0.5 cm/minute) than between 06:00 and 18:00 (3.1 +/- 0.3 cm/minute). In contrast, the duration of phase 2 was lower during nighttime (18:00 to 06:00) than during daytime. The authors conclude that during the early (1 to 2 days) period after cholecystectomy, the jejunal electromyographic activity is limited to phase 3 activity, but that a normal fasted pattern is recovered after 4 days. A progressive reorganization and coordination of the intestinal tract may account for this delay.

Aged↗
PubMed1992

[Experimental heterotopic transplantation of the liver with anastomosis of the portal vein to the distal end of the splenic vein].

A model of heterotopic liver transplantation had been studied. The graft was laid under the recipient liver and the portal blood flow was supplied by anastomosis with the distal part of the splenic vein. Both liver can then receive portal blood through two parallel portal circulation. Liver function of transplant was satisfactory at three months after transplantation. Their had been no alteration of the recipient liver during the same period.

Anastomosis, Surgical↗
PubMed1991

[Orthotopic liver transplantation for severe amanita phalloides poisoning].

Forty-eight hours after a women was poisoned by ingesting Amanita phalloides mushrooms, she developed fulminant hepatic failure with collapse, pH 7.24, lactic acidosis 7.6 mmol/l, hypoglycaemia 3.5 mmol/l, anuria and stage IV coma requiring tracheal intubation and mechanical ventilation. Transaminase level was up to 8,000 UI/l. Prothrombin and factor V levels were below 10 percent, with an APT time of 86 s versus a 29 s control time. Twenty-four hours after her admission, the patient underwent orthotopic liver transplantation. The postoperative period was uneventful, with return to consciousness and rapid normalization of hepatic biochemistry values, without signs of acute rejection. This 10th published case of orthotopic liver transplantation for Amanita phalloides poisoning with acute hepatic necrosis confirms that this type of treatment must be systematically envisaged in all such cases.

Amanita↗
PubMed1990

[Surgical treatment of diverticula of the thoracic esophagus].

Pathogeny of thoracic esophageal diverticuli, divided into parabronchial and epiphrenic, appears to have been modified by development of functional esophageal motility measurement. We present 23 patients with epiphrenic diverticuli and 3 with parabronchial diverticuli (15 male and 11 female with a mean age of 61 years). Twenty-four underwent surgery: 4 isolated diverticulectomy, 7 diverticulectomy and associated myotomy, 5 myotomy alone, 3 antireflux procedure alone. Three patients required esophagectomy for carcinoma in a diverticulum, for a huge diverticulum adherent to the inferior pulmonary vein. One patient presenting with perforation of a carcinomatous diverticulum in the pleura was treated with pleurotomy and has died. No fistula has been notified. Long term results had been analysed with a mean follow up of 4 years. Special attention has been reported on development of gastro-esophageal-reflux. The finding of a thoracic diverticulum requires evaluation by barium swallow, fibroscopy and functional test which should indicate the operation required. Long term analysis should include functional manometric evaluation and a pHanalysis as long term results are reduced by the appearance of gastro-esophageal-reflux.

Aged↗
PubMed1990

[Surgical treatment of peptic stenosis of the esophagus].

36 patients with peptic strictures were operated between 1981 and 1987. 40 operations performed because 4 recurrences after a first intervention obliged to a re-operation. The conservative procedure was used in 29 cases (72.5%). A resection had to be done in 11 cases (27.5%), with 3 re-operations after a first conservative treatment. 1 patient died in hospital. The follow up concerns all patient after a minimum of 2 years. 31 patients (88%) remained symptom free, but 4 patients required further surgery. No mortality and a low morbidity with conservative surgical method were observed. The rate of success was 76% with 24% of recurrence. For us, the best conservative method is total fundoplicatio if possible (sometimes on a gastric cone in case of reflux stricture with shortening of the esophagus). The duodenal diversion is recommended if approach of hiatus is too difficult (re-operation) and in case of alkaline reflux.

Adult↗
PubMed1989

[Excision of cancer of the upper thoracic esophagus by initial right thoracotomy].

The authors present their experience with right thoracic first approach in resection of upper thoracic esophageal carcinoma followed by gastro-esophageal anastomosis. This technique has got many advantages: any degree of tumoral extension can be managed by an adapted strategy for the situation; and the technique is particularly suitable for resection of upper thoracic esophageal lesions which usually present many hazard for their removal. Thirty three patients have been operated according to this technique. A satisfactory rate of complete resection was obtained. Mortality rate one month after the operation was of 6%, an although the extensive character of the lesions encountered in this survey of patients, long-life survival rate was satisfactory and seems that it could be ameliorated by the application of a preoperative radio-chemotherapy protocol.

Actuarial Analysis↗
PubMed1989

[Fulminant and subfulminant hepatitis treated by orthotopic transplantation of the liver. Apropos of 10 cases].

In the period between 15/12/1987 and 15/08/1989, ten patients with either fulminating or subfulminating hepatitis have been treated by orthotopic liver transplantation (O.L.T.). Six patients are doing well in the post-operative period with a mean follow-up of 12 months (7-23 months). No evidence of neurological sequelae has been observed and recurrence of HB virus infection was absent from the three cases who survived hepatitis B transplantation. Four out these ten patients died after initial successful O.L.T... One patient succumbed 7 days after O.L.T. from sepsis or early super-acute rejection, the second 21 days after O.L.T. from neuromeningeal listeria, the third 43 days post O.L.T. from acute rejection, while the fourth developed cytomegalovirus pneumonia and died 61 days after O.L.T. Orthotopic liver transplantation has become the treatment of fulminating hepatitis. It is an emergency which is usually accompanied by successive difficulties in decision making: indication criteria, then acceptance or refusal of ABO incompatible grafts (5/10) and of suboptimal donors. Orthotopic liver transplantation for fulminating hepatitis is technically easy to perform, but usually requires the use of extra-corporal veno-venous circulation. Accompanying intensive medical care is essential and usually includes one or multiple plasmaphereses to correct existing coagulopathy without any fluid or sodium overload to the circulation.

Acute Disease↗
PubMed1988

[Excisional surgery of hepatic metastases of colorectal adenocarcinoma].

Between 1981 and 1985, 39 patients had hepatic resection for colorectal cancer liver metastases 44 operations (5 iteratives resections) were performed with 33 major hepatectomy. There was no mortality. Long term results showed: a one year 53% survival, a two years 23% survival, a three years 11% survival. 28 patients had recurrences; 15 of these 28 had hepatic recurrences. According to recent literature the high level of hepatic recurrence suggest that surgical resection should be accompanied with regional chemotherapy.

Actuarial Analysis↗
PubMedDate not supplied

Treatment of recurrent hepatitis C following liver transplantation.

Cirrhosis due to hepatitis C virus infection is now the most common indication for liver transplantation in Western Europe and the United States. In the absence of effective prophylaxis, recurrent hepatitis C virus infection is almost inevitable. Although the natural history and intermediate-term outcome of recurrent infection with hepatitis C virus are now better documented, factors that may influence the recurrence of hepatitis and consequent progression of graft disease remain unclear. Interferon used as a single agent for the treatment of recurrent infection has proven unsatisfactory. Early intervention for recurrent infection with the combination of interferon and ribavirin appears promising, and this approach may prevent or delay progression of hepatitis C virus-related graft disease after liver transplantation.

Antiviral Agents↗
PubMedDate not supplied

Small nodule detection in cirrhotic livers: evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver.

PURPOSE: The purpose of this work was to evaluate the detection and characterization of nodules > or = 8 mm and small hepatocellular carcinomas (HCCs) in liver cirrhosis. METHOD: Pathologic examination and results of US, helical CT, and dynamic MRI with gadolinium were compared after orthotopic liver transplantation (OLT) of 43 cirrhotic patients. Nodules were classified as macroregenerative nodules (MRNs), borderline nodules (BNs), and HCC. RESULTS: Pathologic examination classified 69 nodules: 50 MRNs, 6 BNs, and 13 HCCs. Sensitivities of MRN, BN, and HCC detection were, respectively, for US imaging 2% (1/50), 33.3% (2/6), and 46.2% (6/13); for helical CT 2% (1/50), 50% (3/6), and 53.8% (7/13); and for MRI 42% (21/50), 50% (3/6), and 76.9% (10/13). MRI detected 21 MRNs. They presented on T1/T2-weighted images as hyperintense/hypointense (n = 8), hyperintense/isointense (n = 7), hypointense/hypointense (n = 4), hypointense/isointense (n = 1), and hypointense depicted only on echo planar imaging (n = 1). The three detected BNs were hyperintense/hypointense nodules. The 10 detected HCCs appeared hyperintense/isointense (n = 7), hyperintense/hypointense (n = 2), and hypointense/isointense (n = 1). None of the MRNs but eight HCCs and one BN were enhanced after gadolinium injection. CONCLUSION: Contrast-enhanced MRI is the most sensitive technique for detecting liver nodules. No MR signal intensity pattern characteristic of small HCCs enables differentiation from benign nodules, however. Gadolinium enhancement is the most sensitive and specific characteristic of HCC.

Adult↗