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Biomedical subjects

G Mentha

Publications and source records attributed to G Mentha.

At least 91 records · Page 5Linked to original sources
PubMed1997

[Small intestine graft in Switzerland: indications and potential recipients].

Small bowel transplantation is theoretically the best treatment for patients with short bowel syndrome and receiving total parenteral nutrition (TPN). The aim of our study was to determine the number of potential candidates for small bowel transplantation in Switzerland. We analyzed the clinical parameters of patients treated by TPN for short bowel syndrome obtained from university pediatric clinics, the SVK (Schweizerischer Verband für Gemeinschaftsaufgaben der Krankenkassen) and referring physicians. In 1995, 7 adults and 2 children were under TPN for short bowel syndrome. In the adult group (mean age 57), the causes of short bowel syndrome were 3 cases of mesenteric infarct, 2 cases of mechanical ileus, one Gardner syndrome and one inflammatory bowel disease. In the pediatric group, the causes of intestinal insufficiency were in one chronic enteropathy with malabsorption and in one congenital malformation. The average duration of TPN was 4.4 (1-10) years for the adults and 13 months for the children. The various complications related to TPN were repeated catheter sepsis in 5 patients, 2 cases of catheter thrombotic occlusion and 3 cases of cholestatic hepatopathy. The contraindications to small bowel transplantation were age, a history of malignant tumor, pulmonary hypertension and a psychiatric disorder. 4 patients were considered potential candidates for transplantation: 2 adults and 2 children, corresponding to an incidence of 0.5/million inhabitants. Considering that the prevalence and incidence of short bowel syndrome in Switzerland are comparable to those in other western countries, we think it should be possible to initiate a small bowel transplantation program in Switzerland.

Adult↗
PubMed1996

Monosegmental liver transplantation from an adult to an infant.

A shortage of small pediatric organ donors has led to the development of reduced size liver transplantation in children. However, the discrepancy between donor and recipient weight can limit the use of this procedure despite transplantation of the left lobe only. Monosegmental liver transplantation using segment III only was recently described. We report here the case of an 11 month old, 6.9 kg boy who received another monosegmental graft (segment II) from a 78 kg donor on an urgent basis. Because of the lack of parenchymal landmarks between segments II and III, sterile methylene blue solution was injected into the portal vein of segment III: parenchyma of this segment colored immediately and was resected accordingly. Three and a half years later, the growth, development, and nutrition of this child were normal. This procedure seems to be helpful when the left lobe of the graft is obviously too large.

Adult↗
PubMed1996

Operative injury to the hepatic artery. Consequences of a biliary-enteric anastomosis and principles for rational management.

Although the interruption of the hepatic arterial flow usually is well tolerated, this is not always the case, and it is important to predict in which circumstances complications are likely to occur. The main determinants that should guide the surgeon confronted with this problem are (1) whether the portal circulation is normal, (2) whether structures carrying collateral blood supply have been interrupted, and (3) whether some form of biliary reconstruction is needed. We present our experience with three patients in whom the hepatic artery was damaged at operation as examples of how this injury can be dealt with in practice and discuss the measures to prevent or treat the complications that developed.

Adult↗
PubMed1996

Auxiliary liver transplantation: regeneration of the native liver and outcome in 30 patients with fulminant hepatic failure--a multicenter European study.

Auxiliary liver transplantation (LT) is a special procedure of LT which could be proposed to patients with fulminant hepatic failure (FHF) and has for aim that complete regeneration of the native liver (NL) left in place will allow the graft recipient to resume normal liver function after allograft withdrawal. We report 30 cases of auxiliary LT performed for FHF in 12 European centers. Twenty-five of 30 patients were younger than 50 years. The cause of FHF was hepatitis A virus (HAV) in 4 patients, hepatitis B virus (HBV) in 7, paracetamol overdose in 5, ecstasy in 2, hepatotoxic drugs in 4, autoimmune hepatitis in 2, liver lesions of preeclampsia in 1 and unknown in 5. A postoperative, both clinical and histological follow-up of more than 3 weeks was obtained in 22 patients, enabling us to look for indicators predictive of NL regeneration and outcome. Histological changes observed in the NL included complete regeneration in 68%, incomplete regeneration with obvious fibrous sequelae in 14% and severe liver fibrosis or cirrhosis in 18%, of the 22 patients studied. The percentage and distribution of necrosis observed in tissue samples of the NL at the time of transplantation was not related to the final outcome. Complete NL regeneration was observed in 15 patients, out of whom 14 were younger than 40 years. Patients with complete regeneration were mainly affected by FHF due to HAV, HBV, or paracetamol overdose. After a follow-up of 18/11 (mean/median) months (range, 3 to 67 months), 19 of the 30 patients (63%) survived and 13 of them (68%), i.e., 43% of the 30 patients, had resumed normal NL function, with interrupted immunosuppression, the ultimate goal of emergency auxiliary LT. We conclude that, in patients with FHF, auxiliary LT is a procedure feasible in a number of centers and is associated with a complete regeneration capability of the NL in a majority of survivors, especially in those younger than 40 years. Confirmation of these encouraging preliminary results by large-scale prospective studies is required.

Adolescent↗
PubMed1996

Increased levels of soluble complement receptor 1 in serum patients with liver diseases.

Complement receptor type 1 (CR1) is an integral membrane protein of many hematopoietic cells and is found in a soluble form in plasma. Preliminary data have indicated that soluble complement receptor 1 (sCR1) levels in serum were increased in patients with cirrhosis. In this study, sCR1 was measured in patients with various liver diseases with a newly established enzyme-linked immunosorbent assay (ELISA). sCR1 level was elevated in chronic active hepatitis C (24 patients, 62.6 +/- 31 ng/ML; 31 normal controls, 31.4 +/- 7.8 ng/mL, P < .001), and in cirrhosis (35 patients, 143.7 +/- 61 ng/mL, P < .001). The levels increased transiently in 3 patients who had amanita phalloides intoxication. In 25 patients with advanced cirrhosis (pretransplantation screening), there were significant inverse correlations between sCR1 and both the prothrombin index (rs = -.60, P < .002) and the aminopyrine breath test (rs = -.51, P < .01). Following liver transplantation, the levels dropped from 166 +/- 70 to 49 +/- 24 ng/mL (P < .0001), and serial measurements in the posttransplantation period showed a correlation with liver dysfunction, regardless of etiology. Since CR1 is not produced by hepatocytes, the most likely explanation for the increased level of sCR1 is reduced is reduced catabolism. Thus, sCR1 may be added to the short list of large glycoproteins that accumulate in liver disease.

Amanita↗
PubMed1996

Segmental anatomy of the liver: a review and a proposal for an international working nomenclature.

The segmental anatomy of the human liver has become a field of increasing interest to radiologists during the past few years. The number of different terminologies which have been used since the topic has been systemically investigated is, however, a source of serious confusion. The present paper describes the reasons why the authors plead for an international working nomenclature which distinguishes a right hemiliver consisting of a right posterior and a right anterior segment, formed by subsegments 6 and 7, and 5 and 8, respectively, and a left hemiliver consisting of a left medial and a left lateral segment, the former corresponding to segment 4, and the latter to subsegments 2 and 3. This basic concept, however, must be carefully tailored to the highly variable individual anatomy of each patient. Furthermore, some aspects of hepatic segmentation are not yet understood and require additional anatomical investigation.

Humans↗
PubMed1996

Circulating levels of IL-11 and leukaemia inhibitory factor (LIF) do not significantly participate in the production of acute-phase proteins by the liver.

To investigate the contribution of IL-11 and LIF to acute-phase protein (APP) production, we first analysed the effects of IL-11 and LIF on production of C-reactive protein (CRP), fibrinogen, and haptoglobin by human primary hepatocytes. We also measured the serum levels of IL-11, LIF, and CRP in serum from patients with inflammatory rheumatic diseases to assess the role of these cytokines in the APP response in vivo. We included patients with conditions associated with a high APP response such as rheumatoid arthritis (RA) or spondylarthropathy (SpA), and others usually associated with a weak APP response such as systemic lupus erythematosus (SLE), in order to investigate whether these cytokines could account for the differences in APP responses. Our results showed that IL-11 and LIF induced only minimal stimulation on production of APP by human primary hepatocytes compared with IL-6, known as the major inducer. Serum levels of CRP were elevated in RA and SpA, and significantly higher than in SLE patients. Despite the presence of a high APP response in some of our patients and despite the fact that we used sensitive assays to measure IL-11 and LIF, serum levels of both cytokines were not detected in any of the tested sera. In conclusion, our results show that circulating levels of IL-11 or LIF do not contribute significantly to the production of APP in vivo, and that they do not account for the difference in APP response between SLE and other inflammatory rheumatic diseases.

Acute-Phase Proteins↗
PubMed1996

Duplicated hepatic artery: radiologic and surgical implications.

Preoperative angiography of the coeliac trunk and superior mesenteric artery is routinely performed before liver resections and transplantations. For this purpose, it is usual to inject each branch of the coeliac trunk separately. Selective angiographic studies, however, may lead to overlooking surgically essential anatomic variations of the hepatic blood supply, as demonstrated by the present report. A case of a duplicated hepatic artery is presented, its radiologic and surgical implications discussed, and the relevant literature reviewed. This uncommon and particularly evocative feature illustrates the clinical importance of a sound knowledge of anatomical variants.

Adult↗
PubMed1996

[Follow-up and results of liver transplantation for primary biliary cirrhosis].

Primary biliary cirrhosis is regarded as one of the optimal indications for orthotopic liver transplantation in adults. With the decrease in the operative mortality, the analysis of the potential long-term complications including disease recurrence is becoming increasingly relevant. The purpose of this study was to evaluate the long-term results of liver transplantation for primary biliary cirrhosis in our center. From 1988, 14 patients were transplanted for this indication and all of them were alive with a mean follow-up of 43 months by the end of June 1995. At that time, all complications related to chronic liver disease were reversed by the transplant except for osteopenia. Lumbar column fractures and overweight were the major inconveniences encountered. Hypertension and diabetes related to antirejection therapy disappeared during the first year of follow-up in all but one patient. Recurrence of the disease was not encountered in this series where a triple association of immunosuppressive therapy was maintained in each patient. At long-term, the frequency of disease recurrence in the liver allograft seems quite low and even in this situation immunosuppressive agents may alter the evolution of the disease. All patients (n - 12) who had at least 1 year of follow-up had a normal level of bilirubin and their quality of life was good to excellent. These results, confirmed by the international experience, support the notion that patients suffering from primary biliary cirrhosis should be transplanted as early as complications from this chronic liver disease occur.

Adult↗
PubMed1996

[Ectopic varices, a rare cause of digestive hemorrhage].

From January 1986 to September 1995, 4 patients were hospitalized in our ward for gastrointestinal bleeding from ectopic varices. The patients were all female, aged 30 to 65 years. The etiology of portal hypertension in these patients was alcoholic cirrhosis, cirrhosis in Wilson's disease and previous alveolar echinococcosis treated by right hepatectomy, complicated by post-operative portal thrombosis. Clinical presentation in all 4 cases was lower gastrointestinal bleeding. Diagnosis was by emergency arteriography in 3 cases; no source was found in one case with recurrent hemorrhage. The 4 patients had a history of abdominal surgery. The location of the ectopic varices was small bowel and cecum. 3 patients were treated surgically: right colectomy, partial small bowel resection and porto-caval shunt with complete lysis of adhesions. One patient was treated conservatively with emergency placement of a TIPS (transjugular intrahepatic porto-systemic shunt), with simultaneous embolization of cecal varices. Upon laparotomy, all 3 surgical cases presented ectopic varices in post-operative adhesions. In conclusion, in a patient with portal hypertension presenting with lower gastrointestinal bleeding, hemorrhage from ectopic varices should be kept in mind and investigated by arteriography. A history of abdominal surgery seems to be a predisposing factor in development of ectopic varices by adhesion formation.

Adult↗
PubMed1996

Combined islet-lung transplantation in a cystic fibrosis patient.

The prevalence of insulin-dependent diabetes mellitus (IDDM) in cystic fibrosis patients ranges from 2 to 8% and glucose intolerance up to 15%. In recent years, lung transplantation has helped to prolong life expectancy of cystic fibrosis patients and represents 10 to 30% of all indications for lung transplantation. The postoperative need for immunosuppressive therapy using diabetogenic agents has decompensatory effects on glucose regulation and will probably increase the number of insulin-dependent cystic fibrosis patients. We report the case of an insulin-dependent cystic fibrosis patient transplanted with a combined islet-lung allograft. The pre-transplantation C-peptide level was below 0.04 nmol/l and preoperative insulin requirement was some 100 U per day. A sequential bipulmonary lung transplantation was performed and, using the pancreas of the same donor, we isolated and purified the islets of Langerhans by a modified automated method. We obtained 232,200 islets equivalent, which were injected into the liver by portal embolization. The postoperative course was uncomplicated, the insulin requirement decreased to 50% of the preoperative need and the C-peptide value increased to normal values and remained with the normal range during a follow-up period of 15 months. In conclusion, we believe that, besides type I diabetic patients, insulin-dependent cystic fibrosis patients with a negative C-peptide value could also be good candidates for combined islet-lung allotransplantation.

Adult↗
PubMed1996

[Results of surgical treatment of hepatic metastasis of colorectal origin].

Surgery is the only treatment which can achieve long-term survival of patients with colorectal liver secondaries. This study reports the results in 71 patients with liver metastases who underwent hepatic resection from January 1980 to December 1994. The mean age was 60 years (range 37 and 80 years). Operations included 33 right hepatectomies, 5 extended right hepatectomies, 6 left hepatectomies, 11 left lobectomies,. Surgery was macroscopically and microscopically curative in 61 patients. Information was not available in 2 patients. Significant morbidity was observed in 37% of patients. Actuarial survival at 1, 3 and 5 years was 83%, 27% and 20% respectively. At the end of the follow-up, 50 patients had died and 6 were lost to follow-up. Techniques of hepatic resection for secondaries are well established and postoperative mortality is low. Pending advances in chemotherapy, we recommend surgery as being the only way of improving long-term survival in patients with colorectal hepatic metastases.

Adult↗
PubMed1996

[Efficacy of organ exchange rules in a 7 million population nation].

The suitability of organ exchange rules were analysed retrospectively in a country with a population of 7 million not connected to international organ sharing organisations following the opening of a national coordination centre 2 years previously. The results demonstrate that the sharing rules work frictionless and efficiently, and that compulsory registration of every organ donor (cadaveric and living) guarantees entire transparency of organ source and exchange, therefore preventing any illegal activity. An unacceptably high mortality rate for patients awaiting a highly urgent organ (specifically heart or liver) shows that connection to an international organ exchange organisation is desirable in this respect.

Health Care Rationing↗
PubMed1995

Systemic and splanchnic oxygen supply-demand relationship with fenoldopam, dopamine and noradrenaline in sheep.

The effects of intravenous administration of fenoldopam (0.3-10 micrograms.kg-1.min-1), dopamine (1-10 micrograms.kg-1.min-1) and noradrenaline (0.1-1 micrograms.kg-1.min-1) on systemic and splanchnic haemodynamics and oxygen supply-demand relationship were studied in 12 chronically instrumented, sedated sheep. Fenoldopam produced dose-dependent peripheral and splanchnic vasodilatation without change in arterial blood pressure. The coeliac trunk and portal vein blood flows were particularly sensitive to fenoldopam, whereas dopamine vasodilated these vascular beds only at high doses. Renal blood flow was not influenced by dopamine or fenoldopam, but decreased by noradrenaline. Fenoldopam maintained systemic oxygen extraction constant by increasing both oxygen supply and demand, while noradrenaline and dopamine increased oxygen supply more than demand, thus decreasing oxygen extraction. Both dopamine and fenoldopam increased oxygen delivery to the splanchnic organs while noradrenaline reduced it. Splanchnic oxygen consumption decreased with noradrenaline and increased with dopamine, resulting in a conserved oxygen extraction with both drugs, whereas oxygen consumption remained constant at all doses of fenoldopam infusion (i.e. dose-dependent decreased oxygen extraction). Both noradrenaline and fenoldopam, but not dopamine, were accompanied by increased portal lactataemia. We conclude that in sheep fenoldopam is a potent and selective splanchnic vasodilator but without vasodilatator effect on the renal circulation. The portal lactataemia associated with a decreased splanchnic oxygen extraction may present a significant limitation for some clinical applications of this drug.

Animals↗
PubMed1995

[Risk in major hepatectomy. A consecutive series of 113 extensive hepatectomies].

Up to now, liver resections have been the initial treatment of almost all cancers and benign tumors limited to a liver lobe. This retrospective review assesses the results of a consecutive series of 113 major elective hepatic resections during a ten-year period. Major hepatectomy was defined by the resection of at least 3 Couinaud segments. Mean age was 52 years (20 to 79 years). There were 62 women and 51 men. 35 resections were performed for colorectal metastases, 22 for a benign tumor, 20 for non-colorectal metastases, 11 for hydatid disease, 10 for hepatocarcinoma, 7 for cholangiocarcinoma and 8 for other indications. The resections performed were 86 right hepatectomies with 18 extended right hepatectomies, 24 left hepatectomies with 4 extended left hepatectomies and 3 trisegmentectomies. Total vascular exclusion was used in 22 patients (19%). Mortality rate was zero. Significant morbidity was encountered in 24 patients (21%). These results suggest that the mortality rate may be independent of the extent of liver resection, provided that hepatic function is normal and preoperative selection adequate. With improving surgical management and techniques, and the use of intra-operative sonography, extensive liver surgery can now be performed with a very low mortality rate.

Adult↗
PubMed1995

Soluble interleukin-6 receptor strongly increases the production of acute-phase protein by hepatoma cells but exerts minimal changes on human primary hepatocytes.

Interleukin-6 (IL-6) interacts with a system of receptors, which include a 80-kDa IL-6-binding subunit (IL-6R) and a transducing element (gp130). The soluble form of IL-6R (sIL-6R) can bind its ligand and induce cellular responses by association with gp130, thus acting as an IL-6 agonist. We and others have previously shown that the responsiveness to IL-6 is different in hepatoma and human primary hepatocytes. We therefore compared the effects of sIL-6R on the two types of cells, and on the B9 hybridoma, another IL-6-sensitive cell line. Human primary hepatocytes, hepatoma cells PLC/PRF/5, and B9 cells were incubated with different concentrations of IL-6, sIL-6-R, or both. The hepatocyte culture supernatants were tested for their content of acute-phase proteins (APP). The proliferation of B9 cells was assessed by a colorimetric method. Results showed that sIL-6R alone markedly increased the production of APP by hepatoma cells in a dose-dependent manner, but affects only minimally primary hepatocytes and the proliferation of B9 cells. The combinations of IL-6R and its ligand enhanced the effects of Il-6 alone in both PLC/PRF/5 and B9 cells, but had no effect on primary hepatocytes. An immunohistochemical study indicated that the cell-surface expression of IL-6R was dramatically lower in hepatoma cells than in primary hepatocytes. In conclusion, our results show that the expression of IL-6R is low in the hepatoma cell PLC/PRF/5 when compared with primary hepatocytes and that this difference can, at least partly, explain their deficient responsiveness to IL-6. On the other hand, it appears that IL-6R expression by primary hepatocytes is sufficient and that circulating sIL-6R is unlikely to play a significant role in the modulation of IL6 effects.

Acute-Phase Proteins↗
PubMed1995

Orthotopic liver transplantation in hemophilia B: a case report.

Liver transplantation is a treatment modality that is being used with increasing frequency in cases of liver-based metabolic defects. This is a case report of a patient with hemophilia B who was treated since childhood with factor IX replacement for recurrent hemarthroses. Subsequent hepatitis B (HBV) and C (HCV) infection had resulted in the development of chronic active hepatitis, ultimately leading to cirrhosis. Orthotopic liver transplantation performed for endstage liver disease resulted in a rise in factor IX levels from 2% to 83% of normal values within 24 h postoperatively, and levels remained above 90% of normal values after postoperative day 3 without factor IX replacement. To our knowledge, only two cases of hemophilia B treated by orthotopic liver transplantation have been reported. This procedure has, however, only been implemented in cases of terminal liver insufficiency in hemophiliacs.

Blood Component Transfusion↗