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Biomedical subjects

J Lerut

Publications and source records attributed to J Lerut.

At least 19 recordsLinked to original sources
PubMed1995

[Liver transplantation in familial amyloidosis].

A 32-year-old Portuguese with hereditary amyloidosis had been suffering from polyneuropathy for 9 years. It began insidiously with polyneuropathic complaints in the legs which gradually got worse over the years and progressively impaired walking. He also had signs of autonomic neuropathy with severe orthostatic dysregulation, abnormal micturition and impotence. His general state had deteriorated during the last 3 years with a weight loss of 18 kg, due to treatment-resistant diarrhoea. As there is so far no known cure of the amyloidosis, which usually ends fatally from cachexia after an average of 10 years, liver transplantation was performed to reduce amyloid production and thus favourably influence the course of the disease. The patient's general condition has remained stable 32 months after the transplantation.

Adult↗
PubMed1995

Standardized quick en bloc technique for procurement of cadaveric liver grafts for pediatric liver transplantation.

This paper describes a quick procedure for cadaveric liver graft retrieval during multiple organ harvesting. The technique is based on minimal preliminary dissection, absence of in situ direct portal perfusion, and en bloc removal of the liver and pancreas, with an aortic patch encompassing the coeliac trunk and superior mesenteric artery. The results of 110 pediatric liver transplantations with 109 organs harvested using this technique are reported. There were no graft harvesting injuries. The liver graft primary nonfunction rate was 4.5% (5/110). The 3-month retransplantation rate was 10%. The actual patient survival rates were 93% at 3 months and 90% at 1 year; actual graft survival rates were 85.5% and 78%, respectively. The technique described was at least as safe as conventional procedures. A major advantage of the procedure is its flexibility, which allows for the easily combined procurement of other organs (whole pancreas and intestine).

Adolescent↗
PubMed1992

[Organ procurement].

Organ transplantation is increasing by becoming an important part of medicine and surgery. Its development is mainly restricted by a lack of organ donation. The authors describe the methods of donor treatment and organ procurement. Medical and paramedical professionals should be aware of the actual achievements in organ transplantation. Their motivation and their responsiveness should become the mainstays in the further development of transplantation.

Attitude of Health Personnel↗
PubMed1991

[The role of surgery in portal hypertension].

Following a historical review of the treatment of portal hypertension, the evaluation of the patient with bleeding esophageal varices is discussed. The aim of preoperative evaluation is to determine the best option for either emergency or elective treatment of bleeding esophageal varices. The most recent medical and surgical randomized studies with meta-analyses are discussed.

Esophageal and Gastric Varices↗
PubMed1991

Pylorus-preserving pancreatoduodenectomy. Experience in 20 patients.

Twenty patients underwent a pylorus-preserving pancreatoduodenectomy for benign or malignant periampullary and pancreatic disease. Eighteen patients had a partial and two patients a total pancreatectomy. There were 19 elective and 1 emergency operations. Post-operative mortality was 4% (1/20 patients) and the median follow up was 31 months (range, 15-75 months), during which period 8 patients with a malignant disease died. Pylorus-preserving pancreatoduodenectomy did not compromise survival in ampullary cancer. One patient developed a marginal ulcer during the study period and one of twelve patients, examined by technetium scintigraphy (done more than 3 months after the procedure), had delayed gastric emptying. Two patients presented with a gastric retention as the first sign of recurrent pancreatic cancer. The result of the operation was judged as excellent in 7 patients, good in 8 and as bad in only 2 of the 17 patients who survived more than 6 months. Body weight was studied in 15 patients surviving more than one year after operation; five patients had gained weight, two had lost weight and in 8 there was no difference. Pylorus-preserving pancreatoduodenectomy seems to be a valuable alternative in the treatment of patients with benign and selected malignant pancreaticobiliary disease.

Adult↗
PubMed1991

Chronic rejection and extrahepatic biliary tract obstruction 8 years after orthotopic liver transplantation using the gallbladder-conduit technique.

A case of delayed biliary obstruction and cholangitis, occurring in the setting of chronic allograft rejection, 8 years after liver transplantation using the gallbladder-conduit, is presented. Extrahepatic biliary obstruction may be seen in the late follow-up of liver grafting and rejection phenomena may play a significant role in the development of such obstruction.

Adult↗
PubMed1991

Fluctuation of anti-A and anti-B histo-blood-group antibodies in a patient after liver transplantation.

The concentrations of anti-A and anti-B IgM and IgG antibodies have been studied in the serum of a patient with blood group AB who received a type A donor liver. A newly developed ABO-ELISA was used for this purpose and the values were compared to hemagglutination titers. During the postoperative study period over 8 weeks, the anti-A and anti-B levels showed a higher fluctuation than was measured in preoperative samples. Thus, in this AB-type patient, anti-A IgM varied 10-fold, anti-A IgG 20-fold and anti-B IgG 16-fold. Peak values corresponded to rejection episodes. Immunoactivation in the patient was further documented by the presence of abnormally high levels of soluble interleukin-2 receptors (sIL-2R) in serum samples. The study shows that monitoring of anti-A/B antibodies may represent a further criterion to follow-up transplanted patients during the critical postoperative graft acceptance period.

ABO Blood-Group System↗
PubMed1991

Hepatic abscess following biliary tract surgery. Etiology, treatment and results.

Experience of seven consecutive cases of liver abscess following biliary tract surgery is presented. The age range was 41-83 years, and six of the patients were women. The interval from operation to appearance of abscess was 10 days to 14 months. Primary surgical drainage was used in two patients, who remained clinically well 6 months and 2 years later. Four of five patients with initially percutaneous drainage subsequently underwent operative drainage, but one refused further surgery and died 8 days later of sepsis. Multiple factors may predispose to both cholangitis and hepatic abscess following biliary tract surgery. Radiologic investigation of abscess must also focus on identifying underlying biliary pathology. Bactericholia and obstructed bile flow are two of the most important etiologic factors in hepatic abscess after biliary surgery. Experience with these cases suggests that a surgical approach may be preferable to percutaneous techniques in management also of the associated biliary pathology.

Adult↗
PubMed1990

[Surgery of benign and malignant primary liver tumors].

Better, noninvasive, diagnostics, better knowledge of anatomy and of surgical techniques have been responsible for a considerable development of liver surgery during recent years. Primary malignant liver tumours can only be cured by resection. The decision for resectional surgery should be based on different tumor characteristics, of whom the nature of the liver tissue (normal or cirrhotic) in which the tumor develops in of utmost importance. A malignant tumor should be resected with save, tumor-free margins, leaving behind as much normal functional parenchyma as possible. The role of complementary therapies as e.g. chemotherapy, chemo-embolisation and arterial ischemia must be further developed. Liver transplantation will probably play a more important role in the future development of liver cancer treatment. Surgery for benign liver tumors can be restricted most of the time to a limited resection; extended hepatectomies are rarely necessary. The more deliberate use of intraoperative ultrasound and hepatic vascular exclusion as well as the more frequent use of ultrasound dissectors will allow safer liver surgery; this applies especially for the excision of benign solid liver tumors. Because of their degenerative risks, liver adenomas should be excised. Focal nodular hyperplasia and haemangioma remain rare indications for surgery. The low morbidity and mortality of elective liver resections should favour a more widespread use of surgery for the treatment of malignant as well benign liver tumors.

Adenoma↗
PubMed1990

[Technic of papilloduodenectomy].

Local excision of preiampullary tumours first described in 1989 has been relegated in the background after introduction of pancreaticoduodenectomy in 1935. Recent reports suggest that ampullary excision may give good results. In order to define the place of this operation which may be a simple excision of the duodenal mucosa (ampullectomy) or a wide excision of the papilla encompassing the posterior duodenal wall and the distal bile and pancreatic ducts (papilloduodenectomy) it is important to make a clear distinction between these two techniques. We describe the technique of papilloduodenectomy and define the place of this operation, which may be useful in selected cases.

Ampulla of Vater↗
PubMed1990

Multiple tumors of the biliary tract.

Multiple synchronous tumors of the extrahepatic biliary tree are not frequently reported. Over a 2-year period, 54 operative procedures were performed for tumors of the extrahepatic biliary tract or periampullary region. In five of these cases, unsuspected tumors were observed. Of these, one patient had multiple benign papillomatosis of the extrahepatic biliary tree. All four of the other patients were found to have unsuspected small carcinomas of the gallbladder in association with mid- or low bile duct cancer. Multiple tumors of the extrahepatic biliary apparatus may occur more frequently than previously thought, and the incidence of unsuspected gallbladder cancer in association with bile duct cancer may be high. These tumors should be suspected and looked for in each instance by intraoperative endoscopy and careful histologic examination of the gallbladder.

Adenocarcinoma↗
PubMed1990

[Diagnosis and treatment of traumatic injuries of the duodenum and pancreas: 21 cases].

Twenty one consecutive patients who sustained injuries to the duodenum or/and pancreas were admitted to our hospital over a ten year period. Sixteen blunt injuries and 5 penetrating injuries were encountered. Penetrating injuries were always suspected and treated by time; following blunt injury diagnostic delay was encountered in 7 patients and insufficient surgical procedure because of intraoperative misinterpretation in 2 patients. Most of the patients had associated intra-abdominal organ injuries. Adjuncts to diagnosis such as abdominal roentgenograms, serum amylase levels and gastroduodenography were not helpful. CT-Scan and ultrasound allowed to confirm the suspected diagnosis in 3 cases only. Intraoperative diagnosis was also challenging. Complete mobilization of the structures surrounding the duodenum and the pancreas to provide entire exposure was necessary. In 6 patients treated first in a peripheral hospital, diagnosis of the injury have been missed at first laparotomy and reoperation was necessary in all of them. Suture closure of the duodenum and drainage of the pancreatic region were the most common reparative technique used. More complicated procedures with pancreatic and/or duodenal resection were performed in 6 patients. Overall mortality in patients surviving more than 24 hours was 14% (suture line dehiscence after delayed operation and one death due to brain injury).

Adolescent↗