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Biomedical subjects

C Huguet

Publications and source records attributed to C Huguet.

At least 19 recordsLinked to original sources
PubMed1979

[Selective distal spleno-renal shunt. A report of 14 patients (author's transl)].

Fourteen cirrhotic patients underwent distal splenorenal shunt to prevent recurrent hemorrhage from oesophageal varices. No post-operative mortality was observed. Transitory chylous ascites occured in 1 patient, portal thrombosis with concomitant early rebleeding in another one. Hypersplenism was improved post-operatively. Porto-caval encephalopathy was not observed. With a follow-up between 3 and 27 months, one single patient died from hepatic failure, variceal bleeding did not reccur in long term survivors.

Adult↗
PubMed1979

[Experimental hepatic ischemia].

Total clamping of the hepatic pedicle was performed for a period of two hours in the normothermic pig. During this time an external pulsed spleno-jugular shunt ensured effective-portal decompression. Under such conditions, the biological and histological consequences of this ischaemia were minimal and perfectly compatible with survival. This would suggest that the clinical syndrome of "shock liver" above all reflects splanchnic impairment.

Abdomen↗
PubMed1979

Interposition mesocaval shunt for chronic primary occlusion of the hepatic veins.

Five patients with primitive chronic Budd-Chiari syndrome were treated by Dacron interposed mesocaval shunts for medically uncontrollable ascites. In two instances, hepatomegaly and ascites disappeared for four and four and one-half years. In one patient with severe stenosis of the inferior vena cava, moderate ascites required tapping once a month one year later, despite proved prosthesis patency. In two patients, death occurred ten and 30 days after shunting due to thrombosis of the graft. Inferior vena cava stenosis appears to be the major factor for decision of opportunity and type of portacaval shunt. From our material, we can describe three types of stenosis: type I, due to caudate lobe hypertrophy, and type II, due to right lobe hypertrophy, are suitable for side-by-side portacaval or mesocaval shunts. Type III, regular and extended narrowing of inferior vena cava, observed in long term evolutive forms, is presumably due to fibrosis and is not a good indication for conventional infrahepatic shunting procedures. Since this study was completed, another patient had a side-to-side portacaval anastomosis for chronic Budd-Chiari syndrome without caval stenosis. The patient has been observed for seven months, and ascites did not reappear. This underlines the importance of a complete radiologic and hemodynamic preoperative study of inferior vena cava outflow impairment.

Adolescent↗
PubMed1978

Tolerance of the human liver to prolonged normothermic ischemia. A biological study of 20 patients submitted to extensive hepatectomy.

To evaluate the biological tolerance of the human liver to prolonged warm ischemia, two groups of extensive hepatic resection for tumor were compared. Group 1 (11 patients) performed with short hepatic inflow occlusion (7 [mean] +/- 2 [SEM] minutes), and group 2 (nine patients) operated with use of complete hepatic vascular exclusion and prolonged warm liver ischemia (38 [mean] +/- 5 [SEM] minutes). Comparison of biological values, such as transaminase, bilirubin, total protein, albumin, and fibrinogen levels, the platelet count, prothrombin complex, and proaccelerin level, did not show statistically significant differences between the two groups. Therefore, the hepatic warm ischemia period may be, if needed, safely extended beyond the classical 15 minutes. It lasted 65 minutes in one case without adverse effect. These clinical observations parallel recent experimental work and should destroy the myth of the high sensitivity of the liver to warm ischemia.

Adolescent↗
PubMed1978

Hemodynamic monitoring during complete vascular exclusion for extensive hepatectomy.

Hemodynamic monitoring during normothermic vascular exclusion of the liver, with or without clamping of the upper part of the abdominal aorta appears mandatory, based upon an experience with ten patients. Nine patients underwent extensive liver resection for major tumors unsuitable for conventional surgical procedures. No operative accidents were observed. Permanent monitoring during the procedure included pulmonary artery pressures, radial artery pressures, heart rate and cardiac output, measured by the thermodilution method. Hemodynamic changes after short isolated venous or aortic and combined clampings were also studied. With this procedure, the most critical period occurred immediately after the release of the clamps, with a major rise in the pulmonary artery pressures, which led to hemodynamic pulmonary edema level. The acute modifications of circulating blood volume actually carried a high risk of vascular overloading, and the most reliable method to avoid this was the permanent control of the pulmonary artery pressures. Blood volume replacement was, at its best, adjusted with the use of such a parameter, especially when hemorrhage was important. Combined aortic clamping reduced blood losses and minimized pooling in the splanchnic area and the lower extremities.

Adult↗
PubMed1978

Normothermic hepatic vascular exclusion for extensive hepatectomy.

In humans, there is still considerable controversy concerning the tolerance of the liver to warm ischemia. To avoid anoxic hepatocellular damage, chilled intraportal and intra-arterial infusion has been advised as an adjunct to hepatic vascular isolation. Fourteen patients with hepatic tumors underwent extensive hepatic resection, complete hepatic vascular exclusion being used but without the use of refrigeration. This procedure may considerably reduce blood loss during resection of large and hypervascular hepatic tumors and increase the safety of hazardous lobectomies. Careful hemodynamic monitoring including pulmonary artery pressure is necessary. Hepatic tolerance to prolonged warm ischemia up to 65 minutes is surprisingly good, in the absence of preoperative, extensive hepatic dysfunction. The use of this procedure is advised for resection of large hepatic tumors when the technical risks appear to be high. It is suggested that the classical delay of 15 to 20 minutes of normothermic hepatic ischemia may be safely extended to about one hour when necessary.

Adult↗