Biomedical subjects
E Chaib
Publications and source records attributed to E Chaib.
Predicting the donor liver lobe weight from body weight for split-liver transplantation.
It is possible to obtain two good-quality hepatic transplants from a single cadaveric liver by separation of the right and left lobes of the liver. We attempted to define a relationship based only on donor body weight for predicting donor total liver weight as well as donor right (segments V-VIII) and left (segments II-IV) hepatic lobe weight. Segment I (caudate lobe) is resected and thus lost in this procedure. The study was performed on 60 human cadaveric livers. We correlated cadaveric body weight (mean +/- SD), 72.43 +/- 9.54 kg, with total liver weight, 1.54 +/- 0.36 kg, and right and left lobe weight, 0.88 +/- 0.23 kg and 0.65 +/- 0.17 kg, respectively, with total liver weight. A formula was obtained by linear regression which provided the following relationships: total liver weight (g) = [245.57 + 17.92 x (body weight, kg)]; right lobe weight (g) = [67.58 + 0.52 x (total liver weight, g)]; left lobe weight (g) = [-63.38 + 0.47 x (total liver weight, g)]. The selection of the recipient on the liver transplant waiting list can be made on the basis of these relationships.
Biliary tract reconstruction: comparison of different techniques after 187 paediatric liver transplantations.
Biliary complications after liver transplantation are common and cause significant morbidity and mortality. In order to evaluate the complications related to different sorts of biliary reconstruction, from January 1984 to July 1992 we retrospectively analysed 187 consecutive liver transplants in 136 paediatric patients at Addenbrooke's Hospital, Cambridge. There were 51 (27.2%) retransplantations. Biliary reconstruction consisted of: type 1-common bile duct-Roux loop (CBD-RL); n = 90 (48.1%); type 2-gallbladder conduit-Roux loop (GC-RL), n = 51 (27.2%); type 3-gallbladder conduit-common bile duct (GC-CBD), n = 20 (10.6%); type 4-common bile duct-common bile duct (CBD-CBD), n = 18 (9.6%); and type 5-common bile duct-common bile duct+gallbladder drainage (CBD-CBD+GB), n = 8 (4.2%). There were, in all 26 biliary complications (14%). Of these 26 complications, biliary stricture was the most common (17/26; 65.3%) and 6 out of these 17 (35.2%) were associated with chronic rejection. Hepatic artery thrombosis was directly related to biliary leakage in 6 out of 26 (23.1%) biliary tract complications. This series demonstrated that type 1 and type 4 reconstructions were related to fewer biliary complications (9/90, 10% and 2/18; 11%, respectively) than the other techniques: 8/51 (16%) for GC-RL 5/20 (25%) for GC-CBD and 2/8 (25%) for CBD-CBD+GB (P = 0.09).
Hepatic arterial variations and liver-related diseases of 100 consecutive donors.
We prospectively studied anatomical variations and diseases of the liver in 100 consecutive donor operations during a period of 1 year. The "normal" arterial anatomy with a single hepatic artery (HA) from the celiac trunk was seen in 76% of all cases. Seven of twelve different major variations of the HA may be considered as "rare", one of which cannot be found in the earlier literature. During harvesting, 6% of the livers were discarded, 3% on the basis of infection and 1% because of a polycystic disease. Two cases were rejected as the liver was found to be severely hypoperfused or hypoxic in an otherwise stable donor. Severe steatosis was macroscopically and histologically diagnosed in 3% of the cases, and in three donors a benign tumour was found in the liver or in the gall bladder. Two primarily nonfunctioning livers in the present series of 94 recipient operations were retrieved from this group of severely steatotic livers. As the donor liver was totally "normal" in only 2 out of 3 of the cases, the present study underlines the importance of searching for extremely variable anomalies of the HA and for liver-related diseases during organ harvesting.
[Histopathological changes in the ileum and jejunum of patients subjected to a bypass operation for treatment of obesity].
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[Jejuno-ileal bypass in the treatment of excessive obesity. Analysis of 36 cases].
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[Giant solitary gastrinoma of the pancreas].
The authors reported a case of giant solitary pancreatic gastrinoma. A 29-year-old woman complaining of upper abdominal pain and loss of weight of 6 months duration. Four months later she noticed moving abdominal tumor. At the surgery a tumor was identified on pancreatic body measuring 20 centimeters of dimension and it was completely removed. A partial pancreatectomy with pancreatic tail preservation was performed in addition to this the Wirsung duct was joined on pancreatic head. No abdominal metastasis was found. The gastrointestinal transit was re-established by end-to-side Roux-en-Y jejunum-pancreatic anastomosis. The final diagnosis was confirmed by immunohistochemical test (immunoperoxidase). The follow-up was made until 40th postoperative month and after surgery the plasma level of gastrin was 120 pg/ml but at present day is normal. The authors concluded that it was a benign giant solitary pancreatic gastrinoma.
[Portal thrombosis: early complication of azygo-portal disconnection in the treatment of bleeding esophageal varices].
The authors studied 30 patients with bleeding from esophageal varices due to portal hypertension. They underwent the disconnection of portal and azygos veins and splenectomy. The immediate postoperative complications were: portal thrombosis in four patients (13.3%); subphrenic abscess in two (6.6%); pulmonary embolism in one (3.3%) and esophageal perforation in one (3.3%). The manifestations of portal thrombosis were ascites, and fever (without leukocytosis). One patient with portal thrombosis who had intractable ascite was submitted to peritoneovenous shunting.
[Surgical treatment of intestinal obstruction].
The etiology of intestinal obstruction (I.O.) has changed markedly since the beginning of this century. In this series, the authors studied 121 cases of I.O. treated surgically; adhesions were the commonest cause of high intestinal obstruction, accounting for 43.03 percent in a total of 79 patients, with hernia being the obstruction lesion in 16.45 percent. Colo-rectal cancer were the commonest cause of low intestinal obstruction accounted for 73.81 percent, with volvulus of the sigmoid colon in 14.28 percent. Complications occurred in 15.7 percent of patients following operative intervention; wound infection was the most common postoperative complication. The overall operative mortality was 9.09 percent.
[Splenic abscess: report of 8 cases and review of the literature].
Eight patients with splenic abscess are reported. Etiological factors were sepsis, mainly due to endocarditis. Diagnosis was made by ultrasonography and computed tomography scans. Splenectomy was performed in four cases, transcutaneous drainage in three and abscess puncture in one case. Mortality was 12.5% (1/8). Since the introduction of US and CT scans early diagnosis and treatment was possible by which the mortality decreased.
[Crepitant abdominal cellulitis: a rare clinical presentation of sigmoid tumor].
Unusual infections associated with colorectal tumors may, in some instances, be the sole clue to presence of malignancy. The infections are either related to invasion of tissues or organs in close proximity to the tumor or secondary to distant seeding by transient bacteremia arising from necrotic tumors. The authors present one case of spontaneous crepitant cellulitis in the lower abdominal wall, associated with sigmoid tumor. The patient had abdominal pain in the left iliaca fossa, fever and skin necrosis of the lower abdominal wall in the last 4 hours. At surgery they performed debridement and excision of necrotic tissue (lower abdominal wall) and partial sigmoidectomy with sigmoid colostomy. The patient died 9 months after initial surgery. A study of tumor mass revealed an adenocarcinoma. The presence of crepitant cellulitis in a lower abdominal wall should result in a search for bowel perforation.
[Is it necessary to perform routine intraoperative cholangiography during cholecystectomy?].
The intraoperative cholangiography was carried out in 361 patients with gallstone disease. In 293 (81.16%) patients cholangiography was normal, in 68 (18.83%) was abnormal. Thirty-six (9.97%) patients had pre-operative asymptomatic common bile duct calculi and 20 (5.54%) patients had confirmed suspect of common bile duct calculi during cholangiography. Twelve (3.32%) patients were false-positive and one (0.27%) was false-negative. It is discussed the value of routine intraoperative cholangiography in patients with gallstone disease.
[Pancreatic complications of sulfasalazine].
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[A single layer suture in gastric cancer surgery].
A total or nearly total gastrectomy was performed in 30 patients with adenocarcinoma of the stomach. The continuity of the alimentary tract was restored by end-to-side esophagojejunostomy or gastrojejunostomy using a Roux-Y and all the cases had one layer extramucosa suture with 3-0 mononylon. The complications were: one case of left subphrenic abscess; one case of anastomotic leakage (esophagojejunum anastomosis); 2 cases of abdominal wound infection. Surgical mortality was 0%.
[Volvulus of the cecum. A case report].
The authors present one case of intestinal obstruction by volvulus of the cecum. The patient had abdominal pain for 4 days. This pain was colicky in nature and of greatest in density in the left iliac fossa. He was nauseated, had anorexia, and had been vomiting. Abdominal distension was present. Plain-roentgenogram of the abdomen showed an enormously distended gas-filled intestinal loop in the upper abdomen just to the left of midline. At surgery there was volvulus of the cecum located in the upper abdomen to the left of midline. The cecum was viable and was relocated in the right lower quadrant and secured to the antero-lateral abdominal wall (cecopexy). The patient made a good postoperative recovery.
[Involvement of pulmonary microcirculation in experimental acute pancreatitis].
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[Sphincteroplasty: its value in the treatment of distal lithiasis of the choledochus].
Twenty patients in whom sphincteroplasty was performed are presented. In 12 cases the indication was choledocholithiasis with stone impacted in the distal bile duct; 5 cases with choledocholithiasis and oddian stenosis, and 3 cases with residual choledocholithiasis associated with oddian stenosis. The average length of the incision of the ampullary area was 25 mm. The postoperative control made by tube cholangiography evidenced the presence of a wide open choledochoduodenal opening. Amylase activity was followed in all patients. One case of acute pancreatitis and one case of choledochal fistula were recorded as postoperative complications.
Obstructive jaundice caused by blastomycosis of the lymph nodes around the common bile duct.
A case of obstructive jaundice due to granulomatous blastomycosis is presented. The patient had complained of abdominal pain in the right hypochondrium and jaundice. During hospitalization, the laboratory tests showed evidence of obstructive jaundice and complementary tests a distended gallbladder, dilatation of the intra and extrahepatic bile ducts with enlarged lymph nodes of the hepatic hilus. During the operation a cholestatic liver, distended gallbladder and enlarged lymph nodes around the common bile duct were found. Histopathology of the lymph nodes revealed South American blastomycosis. The medical management consisted of amphotericin B. At present the patient is alive and well.