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Biomedical subjects

C Smadja

Publications and source records attributed to C Smadja.

At least 73 records · Page 4Linked to original sources
PubMed1989

[Cost of the peritoneovenous shunt in patients with cirrhosis].

The cost of peritoneovenous shunting was evaluated in 15 cirrhotic patients with intractable ascites. With the assessment presently used in French Public Hospitals which is based on a contractual reimbursement by the Social Security per day of hospitalization, the cost of peritoneovenous shunting was F 37,227.40. Using the more refined method of cost analysis, the cost of the operative procedure was F 9,564 and that of postoperative hospitalization was F 8,067. Total expenses calculated by the cost analysis method (F 17,631) were much less that the reimbursement paid by Social Security. This study allowed to determine the actual cost of Surgical treatment of ascites, where expenses were greatest, and how to reduce them. Results of this report should be used when comparing cost and efficacy of medical and surgical treatments.

Adult↗
PubMed1989

[Results of the excision of benign tumors of the liver in 22 patients].

Between 1979 and 1987, 22 patients underwent resection for a benign liver tumor. A total of 24 tumors were resected: 8 adenomas, 8 focal nodular hyperplasias and 8 hemangiomas. In two patients, focal nodular hyperplasia was associated with hemangioma. Preoperative diagnosis of the nature of the tumor by radiologic investigations (ultrasonography, CT-scan, and selective angiography) was made in only 4 patients (18 p. 100), 3 with hemangioma and one with focal nodular hyperplasia. Ten patients underwent major hepatectomies and 12 had either a segmentectomy (8 patients) or atypical resection (4 patients). Progress in operative management significantly decreased transfusion of packed red cells (p less than 0.05) and that of fresh frozen plasma (p less than 0.02). Ten patients received no blood for fresh frozen plasma. Suppression of abdominal drainage when surgery was uneventful significantly decreased postoperative in-hospital stay (p less than 0.05) to a low 7.8 +/- 0.8 days and improved comfort of patients. These results confirm that preoperative diagnosis of a benign liver tumor is uneasy. They suggest that resection has become a benign procedure in selected surgical centers. The risk of ignoring malignant tumors or leaving a tumor with potential complications should prompt resection when the nature of a liver tumor has not been precisely determined by usual radiologic investigative procedures.

Adenoma↗
PubMed1988

Segmentectomies in the management of liver tumors.

Between 1982 and 1986, liver segmentectomies were performed in 19 patients with liver tumors, including ten hepatocellular carcinomas, six liver metastases, one cholangiocarcinoma, and two benign tumors. During surgery, patients received a mean (+/- 1 SD) of 1050 +/- 150 mL of packed red blood cells and 860 +/- 80 mL of fresh-frozen plasma. There were no operative deaths. The only complication was a prolonged leakage of ascites through the abdominal drain in one patient with cirrhosis. Seven patients with hepatocellular carcinoma were still alive at this writing, with a follow-up ranging from two months to four years. The four patients with metastases from colorectal carcinomas were alive after follow-up times ranging from six to 24 months. These results suggest that liver segmentectomy is a safe procedure and should be considered as the operation of choice for resection of limited liver tumors.

Adult↗
PubMed1988

Titanium catheter tip for peritoneovenous shunts.

Early obstruction of the venous tubing is a frequent complication after peritoneovenous (PV) shunting for ascites in cirrhosis and results in a high incidence of shunt failure. A titanium catheter tip, developed because of this material's thromboresistance, was employed in 13 consecutive cirrhotic patients receiving a LeVeen shunt for intractable ascites. While the mean interval before shunt occlusion was 4 +/- 3 months in our previous studies, none of the patients in the present series had venous catheter occlusion during follow-up, which averaged 8 +/- 2 months. The use of titanium in the venous tubing of PV shunts may significantly prolong the patency and function of these devices.

Catheterization↗
PubMed1988

Metabolic fate of a gastric glucose load in unrestrained rats bearing a portal vein catheter.

Metabolic and hormonal responses to the administration of a gastric load of glucose (2.4 mg/g body wt) were evaluated after a fast of 6-7 h in unrestrained rats bearing a portal vein catheter. For the purpose of this study, we have designed a new technique for a direct catheterization of the portal vein that allows serial blood sampling in unrestrained Wistar rats. On the 6th postoperative day, food intake, body weight gain, liver function, histology of the liver, pancreas, intestine, and splanchnic blood flows were similar to those of sham-operated control rats. In the basal state glucose turnover was 21.3 +/- 0.9 mg.kg-1.min-1. After glucose ingestion, a portoperipheral gradient of lactate was present, reflecting the production of lactate by the intestine. Insulin secretion was biphasic and peaked at 12 min (344 +/- 46 microU/ml), whereas portal glucagonemia (400-500 pg/ml) remained unchanged. Sixty minutes after gastric glucose administration, 50% of the load was delivered at the periphery, and glucose utilization was increased by 100%. Hepatic glucose production decreased after 20 min and was inhibited by 30% at 60 min. Liver glycogen concentration remained unchanged during the experiment despite a normal capacity for glycogen synthesis.

Animals↗
PubMed1988

[Resections of hepatocellular carcinomas in cirrhosis: results of a prospective study of 28 resections].

Twenty-eight liver resections were performed in 24 patients with cirrhosis and hepatocellular carcinoma: 6 major hepatectomies, 13 limited, and 9 atypical liver resections. Postoperative variceal rebleeding was precluded in 5 patients with previous bleeding by preoperative sclerotherapy. Intraoperative bleeding was minimized in 16 patients by clamping the hepatic pedicle. Ascites formation was prevented by reduction of intraoperative and postoperative fluid infusion. There were no operative deaths. Benign postoperative complications occurred in 5 patients (18 p. 100). In one patient, carcinoma was not found in the resected specimen. Nineteen of the 27 others tumors were less than 5 cm in diameter (70 p. 100). Twenty-two tumors were encapsulated (81 p. 100). One and two-year actuarial survival rates were 66 p. 100 and 48 p. 100 in the group of 23 patients after resection of one, or more than one tumor, respectively. In 17 patients with a tumor less than 5 cm in diameter, one and two-year survivals were 76 p 100 and 51 p. 100, respectively. In 16 patients with a free margin of healthy tissue of more than 10 mm, one and two-year survivals were 85 p. 100 and 61 p. 100 respectively. Our results suggest that: 1) the operative risk of liver resection in cirrhosis is low, provided preventive measures are taken to avoid intraoperative bleeding and postoperative variceal bleeding and ascites, and 2) late survival is good in selected groups of patients after resection of hepatocellular carcinoma and cirrhosis.

Adult↗
PubMed1988

[Peritoneovenous shunting in intractable ascites of cirrhosis. Results of a prospective study on improving prognostic factors].

A peritoneovenous (LeVeen) shunt was inserted in 39 patients with cirrhosis and intractable ascites. Based on the results of previous experience, the following procedures were performed to improve outcome: 1) intraoperative drainage of most of the ascites; 2) short-term antibiotic prophylaxis by cefotetan; 3) the use of a titanium venous catheter tip. There was no operative mortality. Operative morbidity was minimal. Mean postoperative in-hospital stay was 19 +/- 5 days. Two patients had recurrence of ascites. This resulted from obstruction of the valve in one patient and of occlusion of the venous catheter in the second patient. One-year probability of shunt failure was 5.8 p. 100. Among the long-term complications, variceal bleeding was the most frequent as it occurred in 8 patients and was responsible for death in 6. One-year probability of variceal bleeding was 18.6 p. 100. Overall one-year survival was 68 p. 100, 79 p. 100 in the group of 19 patients with Pugh scores of 8 and less, 58 p. 100 in the group of 20 patients with Pugh scores greater than 8. These results suggest that technically improved peritoneovenous shunting is a low operative risk surgical procedure with high efficiency in the treatment of intractable ascites in cirrhosis.

Adult↗
PubMed1987

Biliary metastases of breast carcinoma. The case for resection.

Obstructive jaundice developed in two patients 6 and 8 years after surgery for breast carcinoma. In both patients exploration disclosed a tumor of the hilus which was a biliary metastasis of breast cancer. Surgical resection was performed. Examination of the resected specimen showed infiltration of the duct walls by sheets of metastatic carcinomatous cells from the previous breast cancer. The postoperative course was uneventful in both patients with disappearance of all symptoms due to the biliary obstruction. The first patient died 4 years later from peritoneal deposits and the second was alive at 30 months with a metastasis to the hip. These observations differ from most of those previously reported, by the localization of the tumor at the hilus and the direct infiltration of the duct walls by the tumor. The results of this study suggest that aggressive surgical treatment may be the treatment of choice in patients with extrahepatic biliary metastases of breast carcinoma.

Adult↗
PubMed1987

Intractable ascites in systemic mastocytosis treated by portal diversion.

A 50-year-old male presented with intractable ascites due to systemic mastocytosis. The diagnosis of systemic mastocytosis was established by histology of the bone marrow which showed mast cell infiltration and fibrosis. Ascites was related to portal hypertension which was documented by esophageal varices at endoscopy and by an increase of wedged-free hepatic venous pressure gradient. Liver biopsy disclosed dense fibrosis of hepatic arterial and portal venule walls, resulting in complete obstruction of some portal radicles. Peliosis hepatis and fibrous deposits in the walls of hepatic venules were also present. Because of intractable ascites and significant malnutrition, a portacaval shunt was performed which cleared ascites and dramatically improved the general condition of the patient.

Ascites↗
PubMed1987

Bleeding from intestinal varices after a Warren shunt.

A 62-year-old man with alcoholic cirrhosis presented with massive gastrointestinal bleeding 4 years after a Warren operation. Angiographic examination suggested that the bleeding was due to ruptured jejunal varices. Treatment by propranolol and a side-to-side portacaval shunt failed to prevent further bleeding. An emergency laparotomy for life-threatening gastrointestinal (GI) rebleeding disclosed dense hypervascular adhesions between the second jejunal loop and the retroperitoneum, and a large submucosal varix of the jejunum that had ruptured. Development of intestinal varices after a Warren operation is facilitated by the persistence of a high pressure in the mesenteric territory and by adhesions between the initial part of the intestine and the area of dissection of the renal vein. This case illustrates one of the possible causes of rebleeding after a Warren operation.

Esophageal and Gastric Varices↗
PubMed1986

Pancreatic debridement in acute necrotizing pancreatitis: an obsolete procedure?

Thirty-eight patients treated by pancreatic debridement for acute necrotizing pancreatitis were studied. Group 1 consisted of 12 critically ill patients who underwent early surgery. Group 2 was formed from 15 patients operated upon secondarily for supervening complications and group 3 contained 11 patients operated upon electively for gallstone pancreatitis. The operative mortality was 100, 27 and 0 per cent for groups 1, 2 and 3 respectively. Pancreatic debridement was associated with a high morbidity whether performed for complications (66 per cent) or elective biliary surgery (36 per cent). These data suggest that there is probably only limited indication for pancreatic debridement in patients with acute necrotizing pancreatitis.

Acute Disease↗
PubMed1986

The use of CA-50 radioimmunoassay inhibition test in the differential diagnosis of benign and malignant liver diseases.

The value of a radioimmunoassay (RIA) in the detection of the human carcinoma-associated antigen CA-50 has been assessed in 50 normal subjects, 28 patients with various benign liver diseases and 91 patients with primary and secondary liver carcinomas. Sera from all normal subjects and 25 of 28 (89 per cent) patients with benign liver diseases had a CA-50 level below 17 units/ml. Three patients with sclerosing cholangitis and sixty (66 per cent) patients with primary or secondary liver tumours had CA-50 levels above 17 units/ml. CA-50 may therefore be a useful tumour marker for the diagnosis of liver carcinomas and for the post-treatment monitoring of patients with various liver malignancies.

Adult↗
PubMed1986

Results of portal systemic shunts in Budd-Chiari syndrome.

Nine patients with Budd-Chiari syndrome (BCS) were treated by a portal systemic shunt. One had thrombosis of the superior mesenteric vein (SMV) and another had complete obstruction of the retrohepatic inferior vena cava (IVC). All other patients had a marked stenosis of the retrohepatic IVC with caval pressure ranging from 12 to 24 mmHg (mean: 17 mmHg). Seven patients had an interposition mesocaval shunt using an autologous jugular vein. The patient with a thrombosed SMV had a portoatrial shunt. The patient with an obstructed IVC had a cavoatrial shunt after an erroneous portacaval shunt had failed to relieve ascites. There were no operative deaths and no major postoperative complications. One patient died 19 months after operation of acute leukemia complicating polycythemia rubra vera. All other patients were alive and well 8 months to 6 years after operation. None of them had encephalopathy. These results suggest several comments: Portal systemic shunts are a good treatment for BCS and have a low operative risk. The mesocaval shunt is an efficient procedure, even when there is stenosis of the IVC with high caval pressure; shunts to the right atrium should be performed only in the case of complete obstruction or inaccessibility of the IVC. The long-term prognosis is excellent, except in patients with potential malignancies. Therefore, portal systemic shunts should be indicated early in patients with symptomatic BCS.

Adolescent↗