Biomedical subjects
Publications and source records attributed to G Delvaux.
Two cases of hepatic artery aneurysm are reported. The first presented as obstructive jaundice, the second as an upper gastrointestinal bleeding. The diagnosis was made by performing ultrasound, CT-scan and angiography. In both cases surgery was the treatment. However, in some cases, interventional angiography with embolisation of the affected vessel offers an alternative treatment.
Very large gallstones sometimes render laparoscopic cholecystectomy time consuming and difficult. In addition, several advantages of laparoscopy, namely decreased postoperative pain and minimal abdominal scarring, could be compromised by the need to enlarge the umbilical incision. Besides the solution of the mechanical or electrohydraulic fragmentation of such large gallstones, as described by several authors, we propose a posterior colpotomy as a simple technique for removing very large gallbladders in women.
An 80-year-old patient presented with multiple biliary papillomatosis of both intra- and extrahepatic bile ducts, with focal epithelial dysplasia. After repeated attempts at drainage the patient died of a massive hemorrhage. The histology of this very unusual tumor is discussed, and a complete review of the literature is presented.
The aim of this multicentric prospective randomized clinical trial was to study the efficacy of hepatic artery ligation (HAL) with and without portal infusion (PI) of 5-FU in patients with liver metastasis of colorectal origin. Seventy-four patients were randomized. Sixty-seven were fully evaluable. Thirty-five patients were eligible in the HAL + PI of 5-FU group and 32 in the HAL alone group. The 5-FU infusion had to be discontinued for technical reasons in 13 patients. Complications of HAL were relatively high, including four hepatic failures (WHO grading greater than 2). Side effects of chemotherapy were limited. Five patients out of 30 had a partial response (WHO criteria) and one patient had a complete response in the group treated by HAL and PI of 5-FU. Only one patient had a partial response in the HAL alone group. Median survival for both groups was 12 months. Median time to progression for both groups was 6 months. This study did not show any advantage of delivery using the portal route in addition to hepatic artery ligation in terms of progression nor in survival of patients.
Cell kinetic activity and adaptive response of rectal mucosa from patients with Hartmann's procedure were studied before and after restoration of colorectal continuity. Patients without colostomy and with normal rectal mucosa were used as controls. Autoradiography of in vitro labeled mucosal samples with [3H]thymidine was used. The proliferative activity in the rectal crypts was estimated by measuring labeling and mitotic indices, total DNA of isolated crypts, and total crypt cell numbers. One hundred forty days after creating a proximal end colostomy, labeling index (P less than 0.05), mitotic index (P less than 0.01), DNA content per crypt (P less than 0.05), and number of cells per crypt (P less than 0.05) decreased significantly compared to control values. Restoration of colorectal continuity resulted in a significant increase of the labeling index (P less than 0.05), the mitotic index (P less than 0.01), the DNA content per crypt (P less than 0.05), and the cell number per crypt (P less than 0.05). There were no significant differences between the postclosure values and the controls. These data indicated that excluding the human rectal mucosa from fecal stream determined a mucosal atrophy that could be reversed by restoration of colorectal continuity.
A case of recurrent bleeding from gastric varices due to isolated splenic vein thrombosis is reported. There was no evidence of pancreatic, retroperitoneal or infectious disease. The final diagnosis was made by intraoperative ultrasonography during an emergency laparotomy for massive bleeding from a ruptured gastric vein. Splenectomy is the treatment of choice in this case. The patient was cured after splenectomy.
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Wistar rats were stressed by immobilization in a cold environment during either 2 or 12 h. The animals were killed 1 h after intraperitoneal injection of 3H-thymidine and autoradiography was used. The proliferative parameters were estimated in the mucosa of the stomach after the 2-hour stress period. After the 12-hour stress period, labeling and mitotic indices were measured in the gastric mucosa as well as in the antrum, duodenum, ileum, colon and epidermis. The stress period of 2 h did not induce significant changes of the proliferative parameters in the mucosa of the stomach whereas cell proliferation was significantly inhibited in all examined tissues, including the skin, after the 12-hour stress period. Gastric hemorrhagic lesions were observed only in the oxyntic part of the stomach and occurred as early as 2 h after stress despite there was no change in the proliferative parameters at this time. The lesions became more obvious after the 12-hour stress period. Our observations indicate that inhibition of cell renewal by stress is not the mechanism by which stress erosions develop in the digestive mucosa.
An experimental end-to-end anastomosis of the common femoral artery was performed in 45 adult Wistar rats. The vessel wall condition was assessed at 10 min, 3 days, 1, 2, 4, and 8 weeks following surgery by scanning and transmission electron microscopy. The microsurgical procedure inflicts extensive trauma in all layers of the arterial wall, with a desendothelialization largely surpassing the surgical field. Reendothelialization was completed at 2 weeks. Apparently, and as compared to less damaging vessel wall manipulations, such deep medial and wide endothelial lesions do not retard vessel wall healing to normal functionality. Moreover, the formation of primary atherogenic structures by smooth muscle cell migration to the intima seems restricted.
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Rats were submitted, at random, to either a diverting colostomy alone or to antrectomy with a colostomy. After a 48-h fasting period, animals from each group were refed, whereas control animals were kept fasting. Animals were killed at 0, 6, 12, 18, and 24 h after the time of refeeding. In vitro labeling of colon mucosa with [3H]thymidine and autoradiography were performed to determine the proliferative parameters in the colonic crypts, and scintillation counts on mucosal scrapings were used for the estimation of mucosal deoxyribonucleic acid synthetic activity. Refeeding increased the labeling index (p less than 0.01), mitotic index (p less than 0.01), and mucosal deoxyribonucleic acid synthesis activity (p less than 0.01) in the proximal colon as well as in the defunctioned distal segment. Despite suppression of the postprandial rise in serum gastrin (p less than 0.01), antrectomy did not abolish the proliferative reaction in any colonic segment. These data confirm the existence of a potent stimulant of colonic cell proliferation that is released systematically after feeding. They indicate that gastrin is not the responsible stimulant and that another, yet unknown, physiological factor is involved.
The major postprandial factors known to influence epithelial cell proliferation in the colon are intraluminal factors. In this study, a transverse colostomy was created in rats in order to avoid the intraluminal stimulation of the distal colon after feeding. After a 48-h fasting period, the animals were refed whereas controls were kept fasted. Refed animals with their controls were killed at respectively 0, 8, 12, 18, and 24 h after the time of refeeding. Autoradiography of in vitro labeled mucosal samples was used for determining the proliferative parameters in the colonic crypts. The uptake of [3H]thymidine in mucosal scrapings was measured for estimating DNA synthetic activity. Refeeding increased the labeling index of the crypts (p less than 0.01) and the mucosal DNA synthesis (p less than 0.01) not only in the proximal colon but also in the excluded distal colon. The increase in labeling index was followed by a significant mitotic peak in both segments. These data indicate that direct intraluminal stimulation is not the only mechanism involved after feeding. There are other potent physiological stimulants of epithelial cell proliferation in the colon which are released postprandially.
The effect of a transverse colostomy was compared to a sham operation and to transsection of the colon with reanastomosis in rats. The autoradiographic study after labeling with tritiated thymidine showed a significant decrease in proliferative activity at 5 days and at 3 weeks in the colonic segment distal to the colostomy. This observation was confirmed by the occurrence of mucosal atrophy and by a significant decrease in the mucosal DNA synthesis activity. It was concluded that the intraluminal presence of fecal bulk is an important factor in the maintenance of cell renewal in the colon of rats. Other factors seem, however, to be involved since a delayed but significant decrease in proliferative parameters was also observed proximal to the colostomy; no mucosal atrophy occurred in the latter segment.
BACKGROUND AND OBJECTIVES: The efficacy of a thoracic epidural block was assessed in 12 high-risk patients scheduled for elective percutaneous cholecystolithotomy. METHODS: A thoracic epidural catheter was inserted at level T8-9. The amount of 0.5% bupivacaine to block two thoracic epidural segments was calculated, adapted to age, height, and epidural level, and administered with 50 micrograms fentanyl. Hemodynamic and respiratory variables and patients' pain and movement were assessed throughout the procedure. RESULTS: Anesthesia was obtained with a minimal dose of local anesthetic. All patients were satisfied with this method. Neither hemodynamic nor respiratory impairment were observed after epidural injection. However, vagal reactions reported in other studies occurred in two patients upon puncture of the gallbladder. CONCLUSIONS: This minimally invasive anesthetic technique seems to be a good alternative for high-risk patients. However, careful monitoring of heart rate and blood pressure remains mandatory throughout the procedure.
Solitary exulceratio simplex (ulcer of Dieulafoy--Dieulafoy vascular malformation) is a rare and frequently overlooked cause of massive gastric hemorrhage. The source of the bleeding, a large, submucosal artery penetrating the centre of a small mucosal defect, is usually located in the upper portion of the stomach. The pathogenesis of this entity is not known. We report on two patients who were successfully treated by surgery. Clinical, morphological and pathogenetic aspects are discussed.
The clinical history, radiological investigations, pathologic findings and treatment of four patients affected by retroperitoneal leiomyosarcoma were compared with data of the literature. These tumors have a great tendency to develop local recurrences after excision, but metastases to lymph nodes and distant organs usually occur lately. CT examination of the retroperitoneal space is a sensitive tool in the diagnosis and follow-up. Complete excision of the tumor followed by radiotherapy improves significantly the prognosis. Chemotherapy is advisable only when disseminated metastases appear. No correlation was found between the histologic appearance and the clinical behaviour.
One hundred consecutive patients underwent a whole gut irrigation as preoperative care for surgery of the large intestine. The solution used was balanced for isotonicity with mineral salts and polyethylene glycol. The procedure was quite well tolerated by the patients, also by the elderly. Only slight changes in body weight or in serum ionic concentrations were noted. In 88% of the patients the preparation was considered to be good or excellent by the operating surgeon. There was a tendency for low rate postoperative infections.