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D Valla

Publications and source records attributed to D Valla.

170 records · Page 10Linked to original sources
PubMedDate not supplied

Obstruction of the hepatic veins or suprahepatic inferior vena cava.

Obstruction of the main hepatic veins or suprahepatic inferior vena cava is caused mainly by thrombosis or its fibrous sequela. One or several underlying thrombogenic disorders are usually present, the most common of which is an overt or occult primary myeloproliferative disorder. The major complications are ascites and gastrointestinal bleeding. A sizeable proportion of the cases are asymptomatic. Diagnosis is usually made at ultrasound or magnetic resonance imaging when collateral veno-venous circulation or endoluminal hepatic venous material are demonstrated. Natural history is poorly known. Overall, mortality is high in the early phase of the disease but once the acute episode is terminated, prognosis is good. Treatment includes anticoagulation to prevent recurrence or extension of thrombosis, nonspecific measures to control ascites and gastrointestinal bleeding, and procedures aiming to restore hepatic blood outflow. Portal-caval shunts are preferred when possible. In patients with obstructed inferior vena cava, the first choice is percutaneous angioplasty, and the second choice is portal-systemic shunts with the right atrium or superior vena caval circulation. Transplantation is proposed for patients with severe liver failure.

Budd-Chiari Syndrome↗
PubMedDate not supplied

[Endoscopic obturation of esophagogastric varices with bucrylate. I. Clinical study of 49 patients].

The authors report the results of endoscopic obliteration of recently bleeding esophagogastric varices with Bucrylate (isobutyl-2-cyanoacrylate) in 49 patients. Forty-five patients had cirrhosis; in all patients, propranolol was contraindicated or had failed, hepatocellular function was poor, or early rebleeding had occurred. In 15 cases, injections were made during active bleeding of esophageal or gastric varices; in 14 cases, the hemorrhage stopped immediately. The cumulative percentages of patients free of variceal rebleeding 1.6 and 12 months after inclusion were 88.63 and 58 p. 100 respectively. The cumulative percentages of patients surviving 1, 12 and 18 months after inclusion were 70, 53 and 46 p. 100 respectively. The cumulative percentages of survival at 6 months after inclusion were 100.63 and 13 p. 100 in grade A, B and C patients respectively. The major causes of death were liver failure and sepsis; autopsy revealed mediastinitis in 3 patients. Long-lasting esophageal strictures developed in two patients. This procedure differs from endoscopic sclerotherapy in that gastric varices can be adequately obliterated and the risk of early rebleeding seems to be decreased.

Adult↗
PubMedDate not supplied

[Endoscopic obturation of esophagogastric varices with bucrylate. II. Morphologic study based on 12 autopsy cases].

The authors report the results of postmortem histopathological studies in 12 patients who had been treated by endoscopic obliteration of esophagogastric varices with Bucrylate (isobutyl-2-cyanoacrylate). All patients had cirrhosis; 11 patients were Pugh classe C. Eleven patients had esophageal injections. Acute esophageal lesions were characterized by ulcerations in obliterated varices and diffusion of Bucrylate into the esophageal wall. Chronic lesions were characterized by disappearance of varices and Bucrylate, extending fibrosis of the esophageal wall and re-epithelialization of the mucosa. In one patient who had received gastric injections only, non ulcerated Bucrylate filled gastric varices were seen. Bucrylate seems to have a dual action on esophageal varices: immediate obliteration and acute necrosis of the vascular endothelium. Necrosis causes diffusion of Bucrylate through the esophageal wall, and later, secondary fibrosis whereas the product is progressively eliminated into the esophageal lumen.

Bucrylate↗
PubMedDate not supplied

[Assisted reproduction and hepatitis C virus infection].

Medically assisted procreation poses a difficult problem when one or both partners of couple are infected with HCV. Epidemiologic and fundamental works show a low risk of HCV sexual transmission and no pregnancy complications or fetal abnormalities have been reported. However, the outcome of HCV infected children is unknown. These contrasting findings suggest that medically assisted procreation using sperm of spouse needs to be cautious. Before medically assisted procreation, testing of couples for HCV antibodies must be done and interferon therapy is required for patients with histological chronic active hepatitis and for HCV positive mothers or infected couples. In the absence of specific legislation or consensual recommendations, detailed informations must be given to the couples in order to obtain an informed consent.

Female↗