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E Chaib

Publications and source records attributed to E Chaib.

At least 19 recordsLinked to original sources
PubMed2005

The main hepatic anatomic variations for the purpose of split-liver transplantation.

BACKGROUND/AIMS: Variant hepatic anatomy must be recognized and appropriately managed during split-liver transplantation to ensure complete vascular and biliary supply to both grafts. The aim of this study was to demonstrate the importance of an assessment of the hepatic anatomical structures for the purpose of split-liver transplantation. MATERIAL AND METHODS: Human cadaveric livers (n = 60) were obtained during routine autopsies. The cadavers and the livers had to comply with the following requirements: (1) minimum age 18 years, (2) no liver pathology expected from medical history, and (3) no liver pathology noted at autopsy. Resections were carried out en bloc with liver, celiac trunk, left gastric artery, lesser omentum, superior mesenteric artery, and head of the pancreas. The main anatomical structures of the liver as hepatic artery, portal vein, biliary tree, and hepatic veins were dissected and correlated hepatic segments for the application of liver splitting. RESULTS: The right the median, and the left hepatic veins were unique, with in 59 (98.3%), 53 (88.3%) and 46 (76.3%) cases, respectively. The portal vein trunk divided into right and left branches in 59 (98.3%) cases. A median branch appeared in 9 (15.2%) cases and no bifurcation of the portal vein occurred in 1 (1.6%) case. The right and left hepatic ducts were multiple in 47 (78.3%) and 57 (95%) cases, respectively, however, the median, hepatic duct was unique in 16 (26.6%) cases. Examining the intrahepatic distribution of the right hepatic duct, we found 4 branches in 28 (59%) cases (segments V, VI, VII, and VIII) 2 branches in 11 (23%) cases, (segments V and VI) and 2 branches in 8 (17%) cases (segments VII and VIII). Fifty-seven cadavers had multiple left hepatic ducts. The intrahepatic dissection showed that the distribution of the major branches were toward hepatic segments II and III. Three separate branches of the left hepatic duct were found in 11 (19%) cases (segments II, III, and IV). Two intrahepatic ducts coming from hepatic segments V and VI drained separately into the left intrahepatic biliary tree in 1 (2%) case. The arterial supply of the liver was by right and left hepatic artery with only 9 (15%) cases there being median hepatic artery. The right hepatic artery, coming from the superior mesenteric artery, was present in 15 (25%) cases and a left hepatic artery originating from the left gastric artery in only 2 (3.3%) cases. The left hepatic artery had 2 exceptional origins, in 1 (1.6%) case coming directly from the abdominal aorta and in the other from the superior mesenteric artery. The right and left hepatic artery was accessory, in 11 (18.3%) and 2 (3.3%) cases, respectively. The right hepatic artery was dominant in 4 (6.6%) cases. The median hepatic artery was directed to segment IV in 6 (10%) cases and to segment II and III in 3 (4.9%) cases. CONCLUSION: The study showed that the technique of controlled liver splitting for transplantation in 2 recipients is an acceptable method to increase the number of liver allografts. The anatomical and technical details of the splitting procedure are critical for the success of this technique. Good graft function and avoidance of complications depend on each graft having an intact arterial and portal blood supply as well as biliary and venous drainage from all retained liver segments. The absence of a bifurcation of the portal vein is a rare anomaly and would certainly contraindicate a partition.

Adult↗
PubMed2005

Liver transplantation: waiting list dynamics in the state of São Paulo, Brazil.

São Paulo is the first Brazilian state to perform liver transplantation in 1968. Since then the recipient waiting list has increased; now approximately 150 new cases per month are referred to the single list at the central organ procurement organization. Official data have shown 37.3 monthly deaths on the waiting list in the state of São Paulo. The number of liver transplants has increased after the creation of São Paulo transplant notification centers but are insufficient to deal with the increasing waiting list. The aim of this study was to demonstrate the performance of our state liver transplantation program and analyze when the number of liver transplantations will meet our waiting list demand.

Brazil↗
PubMed2000

Performance enhancement of batch aerobic digesters via addition of digested sludge.

The impact of the feed sludge (FS) concentration and addition of digested sludge (DS) to an aerobic digester was evaluated with respect to its capability for removal of the total suspended solids (TSS) and volatile suspended solids (VSS). The aerobic digesters, which operated in a batch mode at constant temperature and mixing rate, were initially filled with FS to 25%, 50%, 75%, and 100% of the reactor's volume. The remaining volume of the reactor was occupied by the DS, having DS/FS ratio of 3, 1, 1/3, and 0. Analysis of the experimental data showed that in the absence of DS, TSS, and VSS destruction rates are very small; however, increasing DS/FS ratio from 1/3 to 3 results in 74-77% increase in VSS and TSS destruction, respectively. The increase of the DS/FS ratio associated with increased ratio of the measured viable biomass (Cc) to VSS concentration (Xv) suggested that DS serves as the source of viable cell mass needed for degradation of organic solids. Assuming pseudo-first-order kinetics, it was shown that while organic solid destruction rate constants (k) are inversely related to initial concentrations of sludge, their values increase with increasing DS/FS ratios.

Bacteria, Aerobic↗
PubMed1995

Splenic abscess.

Explore the source record for details and available documents.

Abdominal Abscess↗
PubMed1995

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.

Adult↗
PubMed1994

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).

Adolescent↗
PubMed1994

Does intrathymic injection of alloantigen-presenting cells before islet allo-transplantation prolong graft survival?

Current immunosuppressive agents have potentially dangerous side-effects, are non-specific and most are also diabetogenic. We investigated tolerance induction with intrathymic injection of purified antigen-presenting cells (APC) plus a single dose of antilymphocyte serum (ALS) intraperitoneally before allogeneic islet transplantation in the rat model WAG to Lewis (RT1u to RT1l). Purified donor APC [non-parenchymal cells (NPC) or dendritic cells (DC)] were prepared from liver and spleen, respectively. Isograft function for more than 120 days proved that islet isolation, purification and transplantation procedures were adequate. A total of WAG DC (4 x 10(5)) or NPC (2 x 10(6)) in 20 microl were injected into both lobes of the thymus of 140-210 g Lewis recipients followed by a single injection of ALS. Three days later, diabetes was induced with streptozotocin (60 mg/kg). Four days later allogeneic islets were grafted into the liver by intraportal injection of 3000 WAG islets. Control animals (n = 8) received 20 microl saline intrathymically instead of APC. Graft function was assessed by blood glucose measurements with glucose levels above 15 mmol/l on 3 consecutive days defined as graft rejection. Animals given DC (n = 9) or NPC (n = 8) intrathymically plus 1 ml of ALS, rejected their grafts in an accelerated fashion with a median survival time (MST) of 3 days. However, control animals rejected their grafts with a MST of 7 days, but with two animals surviving for more than 2 months. In conclusion, intrathymic inoculation with purified APC plus a single dose of ALS did not prolong allogeneic islet graft function but induced accelerated rejection of the islet allografts.

Animals↗
PubMed1993

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.

Hepatic Artery↗
PubMedDate not supplied

[Isogenic islet transplantation on the rat liver (method for isolation and purification of the Langerhans islets)].

The major indication for pancreas or islet transplantation is diabetes mellitus type I. This process has to supply the insulin necessity keeping glucose under control. We have studied isogenic islet transplantation on the rat (WAG-RT1u) liver. The method of isolation and purification of the islets obtained 2.834 +/- 551.64 islets with purity of 83 +/- 2.45%. Diabetes was induced by streptozotocin and seric glucose prior transplantation was 35 mmol/L. The islet transplantation of 2.834 +/- 551.64 islets in the rat liver has normalized glucose test from 9.62 +/- 2.65 mmol/L 10 days after transplantation to 7.43 +/- 0.27 mmol/L later in the follow-up (P < 0.05). The median survival time of the islets was 73 days. In conclusion both the method of isolation and purification of the islets and islet transplantation was effective in the control of the diabetes induced by streptozotocin with median survival time of both islet and rat more than 73 days when rats were sacrified.

Animals↗
PubMedDate not supplied

[Angiographic aspects of the hepatic veins in portal hypertension in schistosomiasis. The importance in assessing the hepatic vein pressure].

The authors comment upon the importance of the hepatic wedged venous pressure for the appraisal of the circulatory conditions of the portal system, mainly in cirrhotic patients. Wondering about the irregular results obtained in the study of schistosomotic portal hypertensive patients by occlusive catheterization and with the use of an occlusive balloon catheter, noted the scarcity of angiographic studies on the subject in this pathology. Present the angiographic aspects that were obtained from patients with schistosomotic portal hypertension complicated by digestive bleeding, by means of injecting the contrast material into a hepatic vein of the right hepatic lobe via a loosely introduced catheter. Those radiological aspects were distributed in two categories: 1) type I-presenting variable sinusoidal filling. Presence of anastomotic intraparenquimatous communications with or without calibrous anastomotic veins between the hepatic veins, 2) type II-presenting no sinusoidal filling. Presence of multiple anastomotic communications of varied calibers between the hepatic veins. Commenting the difficulty of assessing the wedged pressure in patients with schistosomotic portal hypertension because of the easy communication between the hepatic veins, the authors point out that the measured pressure, in all the cases, will be that of the opposite hepatic vein. That pressure, in this pathology, might represent the sinusoidal resistance (when present) between hepatic veins, instead of relating to the portal vein. Suggestion is made that the measure of the wedged hepatic pressure, in patients with schistosomotic portal hypertension, be appraised considering the angiographic aspects of the hepatic veins.

Angiography↗
PubMedDate not supplied

[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.

Adult↗
PubMedDate not supplied

[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.

Adolescent↗
PubMedDate not supplied

[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.

Adolescent↗
PubMedDate not supplied

[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.

Abscess↗
PubMedDate not supplied

[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.

Abdominal Muscles↗
PubMedDate not supplied

[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.

Adolescent↗