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J Cinqualbre

Publications and source records attributed to J Cinqualbre.

At least 19 recordsLinked to original sources
PubMed1995

Effects of platelet-activating factor antagonist on preservation/reperfusion injury of the graft in porcine orthotopic liver transplantation.

To investigate the role of platelet-activating factor (PAF) in the preservation/reperfusion injury of the liver graft, the effect of treatment with a potent PAF antagonist (E5880) was evaluated in a pig orthotopic liver transplantation model. The graft liver was flushed out and preserved for 8 hr at 4 degrees C using a simplified University of Wisconsin solution. The PAF antagonist was administered into the University of Wisconsin solution (1 mg/L), into the rinsing solution (1 mg/L), and to a recipient pig (0.3 mg/kg d.i.v.) in group 1. The PAF antagonist was not given in the control group (group 2). Postoperative survival of more than 12 hr was 100% (9/9) in group 1 and 56% (5/9) in group 2 (P < 0.05). At 12 hr after reperfusion of the graft (RPF), the arterial ketone body ratio (acetoacetate to 3-hydroxybutyrate) increased to 1.54 +/- 0.15 (mean +/- SEM) in group 1, compared with 0.95 +/- 0.09 (P < 0.05) in group 2. In group 2, blood leukocyte count decreased to 8.3 +/- 0.9 (x 10(3)/microliters) at 2 hr after RPF, in contrast to a slight increase in group 1 (14.3 +/- 1.8 x 10(3)/microliter, P < 0.01). At 4 hr after RPF, glutamic oxaloacetic transaminase (461 +/- 59 vs. 712 +/- 97 U/L, P < 0.05), glutamic pyruvic transaminase (65 +/- 4 vs. 82 +/- 5 U/L, P < 0.05), and the lactate level (6.2 +/- 1.1 vs. 9.4 +/- 1.0 mmol/L, P < 0.05) in arterial blood were significantly lower in group 1 than in group 2. Light and electron microscopic study at 1 hr after RPF showed neutrophil sludging in the sinusoids and sinusoidal endothelial cell damage in group 2, while these findings were attenuated in group 1. It is suggested that PAF plays a key role in microcirculatory disturbance of the liver graft manifested on reperfusion, and that the treatment with E5880 has a protective effect against preservation/reperfusion injury of the graft in liver transplantation.

Adenosine↗
PubMed1995

Protective effects of N-acetylcysteine on hypothermic ischemia-reperfusion injury of rat liver.

We investigated whether intraportal injection of 150 mg/kg N-acetylcysteine (NAC) into rats reduced hepatic ischemia-reperfusion injury after 48 hours of cold storage and 2 hours of reperfusion. The organ was isolated and perfused to evaluate liver function. The control group received an intraportal injection of 5% dextrose. NAC increased L-cysteine concentrations 15 minutes after injection (1.29 +/- 0.11 mumol/g vs. 2.68 +/- 0.4 mumol/g, P < .05). However, neither treatment modified glutathione liver concentrations relative to preinjection values. After 48 hours of cold storage and 2 hours of reperfusion, livers from NAC-treated rats produced larger amounts of bile than those in the control group (5.04 +/- 1.92 vs. 0.72 +/- 0.37 microL/g liver; P < .05), and showed a significant reduction in liver injury, as indicated by reduced release of lactate dehydrogenase (679.4 +/- 174.4 vs. 1891.3 +/- 268.3 IU/L/g; P < .01), aspartate transaminase (AST) (13.94 +/- 3.5 vs. 38.75 IU/L/g; P < .01), alanine transaminase ALT) (14.92 +/- 4.09 vs. 45.91 +/- 10.58 IU/L/g; P < .05), and acid phosphatase, a marker of Kupffer cell injury (344.4 +/- 89.6 vs. 927.3 +/- 150.8 IU/L/g; P < .01) in the perfusate. Reduced glutathione concentrations in the perfusate were similar in the two groups (805 +/- 69 vs. 798 +/- 252 nmol/L/g), whereas oxidized glutathione (GSSG) concentrations were higher in the control group (967 +/- 137 vs. 525 +/- 126 nmol/L/g; P < .05). Reduced glutathione (GSH) concentrations in liver tissue collected at the end of perfusion were significantly higher in the NAC group (7.3 +/- 0.9 vs. 4.1 +/- 1.0 mumol/g; P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Acetylcysteine↗
PubMed1994

[Surveillance of patients receiving transplantation].

Organ transplantation is now considered as an effective method of treatment of definitive visceral failures, but it has generated new iatrogenic disorders of the immunocompromised hosts. Each transplanted patient is subjected to a life-long follow-up in order to assess the performances of the graft and to detect the complications of the immunosuppressive treatment. The rate of the outpatient consultations is decreasing, according to the development of a state of natural tolerance between the graft and its host, which limits the risks of acute rejection. The elements of the follow-up are quite similar whatever the grafted organ, which points out the identical medical problems of transplant patients. The medical staff of public hospitals is commissioned to organize the outpatient clinics of transplantation, but the crucial role of general practitioners must be emphasized.

Follow-Up Studies↗
PubMed1992

[Enhancement of the quality of hepatic graft by restoration of hepatic glycogen reserves in the donor].

It has been suggested that depletion of donor hepatic glycogen reserves deleteriously affects the resistance of the hepatic graft to ischemic episodes. In this study, performed in the pig model, we showed that it is possible to enhance the quality of the graft at the time of reperfusion by using a method which rapidly restores the donor hepatic glycogen reserves. With the aid of an isolated liver perfusion model, we compared grafts (n = 24) harvested from pigs fed (group N), fasted for 24h (group J), or fasted with a restoration of glycogen reserves (group P). After the grafts were subjected to 8 hours of cold ischemia, the release of alanine aminotransferase, aspartate aminotransferase and lactic dehydrogenase in the perfusate increased in group J (P < 0.05 vs group N); the increase was corrected in group P (P < 0.05 vs group J). When the grafts were subjected to 15 minutes warm ischemia prior to the liver harvest, the production of bile was reduced in group J (P < 0.05 vs group N); bile production was reestablished in group P (P < 0.05 vs group J). The clinical application of such a method of donor nutritional conditioning, in the hours which precede organ harvesting, may enhance the quality of the hepatic graft at the time of transplantation.

Animals↗
PubMed1992

[Effect of nutritional status of the donor on the quality of hepatic graft. Value of restoration of glycogenic reserves of the donor].

Initial function of the graft is an essential factor for successful liver transplantation. The aim of this study was to evaluate the influence of the nutritional status of the donor on hepatic graft quality at reperfusion. Livers (n = 41) were taken from pigs normally fed or fasted for 24 h or fasted for 24 h and conditioned for 2 hours with a solution containing glucose, fructose and glutamine. The quality of liver grafts was evaluated using an original, blood-free isolated perfusion model, after 8 h cold storage, or after 15 min warm ischemia performed prior to harvesting. The hepatic concentration of glycogen and ATP, measured from in vivo biopsies, was decreased in fasted animals (P less than 0.05 vs fed) and restored by nutritional conditioning (P less than 0.05 vs fasted). At the time of reperfusion following 8 h cold ischemia, the liberation of aminotransferases and lactate dehydrogenase was elevated in livers coming from fasted animals (P less than 0.05 vs fed) and restored to fed levels after nutritional conditioning (P less than 0.01 vs fasted). After 15 min of warm ischemia, the bile secretion during the reperfusion period was decreased in the 24 h fasted livers (P less than 0.01 vs fed) and reestablished after nutritional conditioning (P less than 0.01 vs fasted). Perfusion of the donor liver, in the 2 h preceding harvest, with a solution of glucose plus neoglucogenic precursors enhances the quality of the liver graft at the time of reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

[Glycogen storage of the liver: a determining factor of initial function of the hepatic graft].

In this study we have investigated the effects of hepatocytes glycogen storage on the quality of livers for transplantation. Rats were fed or fasted for 24 h and hepatocytes isolated and cold stored in UW solution for 24 and 48 hours. Viability of the cells was analyzed by LDH release after 2 hours incubation in L15 with O2. Also, rabbits were fed, fasted (48 h) or glucose fed (48 h) and livers cold stored for 6, 24 and 48 h in UW solution. Functions of the livers were analyzed by isolated perfusion for 2 hours. Hepatocytes from fasted rats released significantly more LDH than hepatocytes from fed rats after 24 and 48 h cold storage. In rabbit livers, fasting depleted glycogen by 85% but had no effect on ATP or glutathione concentration. Livers from fasted rabbits produced similar amount of bile, released similar concentrations of lactate dehydrogenase and aspartate transaminase into the perfusate, maintained similar concentrations of glutathione after 24 hours preservation when compared to fed animals. After 48 h preservation livers from fasted animals were less viable than livers from fed animals and the decrease of liver functions in livers from fasted animals preserved for 48 hours was prevented by feeding glucose. This study shows that liver glycogen storage in hepatocyte is an important metabolite for successful liver preservation. Glycogen may be a source for ATP and antioxydant synthesis during the early period of reperfusion.

Adenosine Triphosphate↗
PubMed1991

[Changes in glutathione levels in the renal cortex of dogs during preservation by continuous hypothermic pulsatile perfusion].

A loss of glutathione (GT) from the kidney can cause increased sensitivity to oxygen free radical-induced injury. In this study we investigated the effects of kidney preservation on GT concentration in the cortex tissue, and how various GT precursors affect GT concentration in the dog kidney. During five day continuous machine perfusion of the kidney at 5 degrees C, there was a loss of GT from the cortex tissue (524 +/- 1% GT remained after 5 days). Perfusion with reduced glutathione (GSH, 3 mM) suppressed this loss (77 +/- 11% of GT remained after 5 days). Oxidized glutathione (GSSG) did not prevent the loss of GT. The addition of the three amino acids that make up GT (glycine, glutamic acid, and cysteine, 3 mM each) stimulated the synthesis of GT in the kidney during hypothermic perfusion (137 +/- 23% of control values at 5 days). The increase in tissue GT stimulated by GSH or other precursors was sensitive to the GT synthetase inhibitor, buthionine sulfoximine. This indicated active GT metabolism even at 5 degrees C in perfused kidneys. This study showed that in kidney preservation there was a loss of GT that could be suppressed by the addition of various precursors for GT synthesis. The loss of GT from preserved kidneys may be one cause of post-transplant renal injury which could be prevented by utilization of the appropriate GT precursors.

Animals↗
PubMed1991

[En bloc transplantation of liver, stomach, pancreas and small intestine in an infant. Apropos of a case].

The now common practice of joint kidney and pancreas or heart or lung transplantation is being completed by other combinations. This is shown by our case of en bloc liver-pancreas-stomach-duodenum-small bowel transplantation in an 18-month-old infant with small bowen atresia complicated by biliary cirrhosis secondary to total parenteral feeding, after the failure of an intraperitoneal visceral transplant at 1 year of age. The graft was taken from an 8-year-old donor and was not pretreated. Being made of the whole intraperitoneal visceral mass, it had to be adapted to the recipient's size by ex vivo exeresis of the right liver, of the spleen, of the terminal ileon and of the colon. Following intraperitoneal visceral exenteration in the recipient, the graft was inserted in an orthoptic position with a digestive reconstruction by esogastric anastomosis and terminal ileostomy. Immunosuppression combined steroids, azathioprine, ciclosporine, and the biological and immunological follow-up regarded the hepatic and pancreatic functions. The intestinal graft was controlled by repeated biopsies through the stomy. Rectal biopsies and lymphocyte typing in the peripheral blood allowed watching for the occurrence of a possible graft-versus-host disease. The outcome was marked by the persistence of massive lymphorrhea during three months and severe central neurological disorders caused by the difficulties to adapt the level of ciclosporine. The hepatic and pancreatic functions became normal within a few days, and the intestinal function allowed progressively suppressing parenteral feeding.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1991

[Surgery of gastrointestinal vessels, selective indications for revascularization in a syndrome suggestive of chronic small intestinal ischemia].

The authors present a critical review of the indications for revascularization of intestinal arteries in the presence of chronic ischaemia of the small intestine. They stress the extreme lability of the "chronic" clinical stage and emphasize the fundamental importance of establishing the diagnosis before the development of acute complications. Based on a personal experience of 92 intestinal revascularizations with a follow-up of one to 26 years, they stress the good quality of the results obtained after isolated revascularization of the superior mesenteric artery by direct or indirect reimplantation into the infrarenal aorta. However, they do not challenge the current tendency towards multiple revascularizations, but consider that the essential prerequisite for a correct result is the early surgical treatment of a disease which is still poorly understood and frequently disappointing.

Arteriosclerosis↗
PubMed1990

[Is Trendelenburg's procedure still useful in 1990? Apropos of 3 cases of massive pulmonary embolism surgically treated successfully in a general surgery department].

The authors report about 3 cases of massive pulmonary embolism operated successfully in a context of general surgery. As they discuss the data given by the literature, they establish the remaining indications of Trendelenburg's procedure, as well as the problems encountered today to perform it without the help of extracorporeal circulation.

Emergencies↗
PubMed1990

[Experience in hepatic transplantation. Report of 118 cases].

From February 1978 to November 1989, 118 orthotopic liver transplantations were performed in 106 patients, including 100 adults and 6 children; 11 of these grafts were performed before 1984. The study of this series emphasizes the casuistical peculiarities, with high incidence of alcoholic cirrhosis, 24/106 (22.6%) and of fulminating hepatitis, 17/106 (16%). The study of the results yields a real survival rate of 61% in the total series, 78% for the recent period including the past 3 years, and 86% if excluding the emergent cases. The comments also deal with the changes in the procedure and in postoperative complications, with some immunological issues and with the peculiar features connected with the insertion of this operation into a combined medical and surgical program of multi-organ transplantation.

Adult↗
PubMed1989

[Is the ultrasonic dissector an advance? Apropos of 70 hepatectomies].

The aim of this retrospective study was to determinate whether the ultrasonic dissector (U.S.D.) is a major advance over existing methods in hepatic surgery. Between 1983 and 1989, we performed 70 hepatectomies "réglées". Twenty seven patients were operated because of benign lesions and 43 patients because of malignant tumours. Transparenchymal approach using "Kellyclasy" or digitoclasy with control of the hilar vessels was carried out 39 times. U.S.D. was used 31 times. No mortality was observed during operating time or post-operative period. The postoperative morbidity was not attributable to the use of the U.S.D. On the whole, U.S.D. has modified neither the amounts of blood loss nor the duration of hilar clamping. However the use of U.S.D. presents 3 advantages: it allows sometimes to perform hepatectomy without pedicular clamping, it makes easy the transparenchymal approach of the large vascular and biliary structures, and it is useful in hydatic cyst surgery. Although the U.S.D. is not indispensable to carry out hepatectomy, it improves intraparenchymal control of vessels and biliary ducts, making therefore hepatic resection easier.

Constriction↗