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J Pitre

Publications and source records attributed to J Pitre.

32 records · Page 2Linked to original sources
PubMed1996

[Attempt at preventing hyperacute xenogenic rejection by isotopic suppression of IgM in the recipient].

Hyperacute xenogeneic rejection is partly initiated by the binding of performed natural antibodies on the recipient's vascular endothelium. In this study, isotypic suppression of IgM in the recipient was conducted in the guinea pig-to-rat combination. Anti-IgM HIS 40 and 56 monoclonal antibodies were injected intraperitoneally in rats (n = 3) (Group 1). Control animals were rats (n = 13) treated by PBS (Group 2). Guinea pig hearts were implanted heterotopically in all rats. Depletion of circulating IgM in the recipient was assessed by ELISA. The circulating and splenic B-lymphocyte population was scanned by FACS analysis. Isotypic suppression was very effective for the depletion of circulating IgM in Group 1 rats (alpha < 0.01) as assessed by ELISA. Similarly, the rate of circulating and splenic B-lymphocytes was significantly decreased in treated animals (alpha < 0.01). However, the graft survival in Group 1 (14 +/- 6.9 min) was not different from that observed in Group 2 (15.4 +/- 5 min). Isotypic suppression of IgM in the recipient did not delay hyperacute xenogenic rejection in the guinea pig-to-rat combination. The prevention of hyperacute rejection must therefore be based on the various mechanisms of this phenomenon.

Acute Disease↗
PubMed1994

Extrafascial hyper-reduction of the hepatic graft.

The technique and limits of graft reduction in orthotopic liver transplantation (OLT) are not well-defined, especially for small recipients. To reduce the hepatic graft to the left lateral segment (segments II and III), the authors have used an extrafascial hepatectomy without any dissection of the hepatic hilum. Among 165 pediatric OLT, 22 procedures using such hyper-reduced hepatic grafts were performed upon 21 children of median age 2.6 years between 1988 and 1992. These 22 hyper-reduced hepatic grafts were transplanted orthotopically with conservation of the inferior vena cava of the recipient. The three-year patient survival rate was 66 percent (80 and 50 percent for those patients undergoing elective and emergent procedures, respectively). The main postoperative complications were: primary graft nonfunction (n = 1), arterial complications (n = 2), portal vein thrombosis (n = 1), intra-abdominal bleeding (n = 2) and biliary complications (n = 2). This technique is useful in instances of a large size discrepancy between the donor and recipient. However, it does not increase per se the absolute number of hepatic grafts available for transplantation.

Adolescent↗
PubMed1993

[Hepatocellular carcinoma on cirrhosis. Resection or transplantation].

In cirrhotic patients who develop hepatocellular carcinoma the only hope of prolonged survival is surgery. A review of the literature was carried out in order to determine precisely the indications for surgical treatment and the choice between liver resection and transplantation. With a low post-operative mortality rate, the survival rate 3 years after liver resection is almost 50 percent. The most favourable cases are tumours smaller than 5 cm, uninodular and well encapsulated, but intrahepatic recurrences are almost constant at 5 years. Liver transplantation does not improve the long-term survival. Its best indications are the same as those of liver resection. Because of graft scarcity and rapid tumoral progress in patients on the waiting list, liver transplantation must be reserved for unstable cirrhosis. In the other situations, liver resection must be considered in priority.

Carcinoma, Hepatocellular↗
PubMed1993

Controlled liver splitting for transplantation in two recipients: technique, results and perspectives.

A technique of controlled liver splitting for transplantation in two recipients is proposed, based on a full anatomical assessment of the graft including arteriography and cholangiography on the back-table. Using eight livers, 16 patients received a graft: right liver (eight patients), left lobe (four) or left liver (four). Twelve patients required urgent or very urgent transplantation. Anatomical assessment of the graft demonstrated a portal bifurcation in all cases, a common trunk of the left and middle hepatic veins in five, a right biliary duplication in three and duplication of the left branch of the middle hepatic artery in one. After revascularization of the graft, bleeding was greater in patients with a right graft, particularly if the middle hepatic vein had been ligated. The main postoperative complications were hepatic artery thrombosis (four cases), biliary complications (four), portal vein thrombosis (two), haematoma (two) and abscess (two). No primary non-function of the graft was observed. The postoperative survival rate was 75 per cent. The four patients in whom transplantation was not considered urgent are still alive. The immediate survival rate of the grafts was 69 per cent. These results compare favourably with those in the literature. In spite of the technical, logistical and ethical problems raised by this technique, the results suggest that controlled liver splitting for transplantation in two recipients may in the future significantly improve the feasibility of liver transplantation.

Adolescent↗
PubMed1993

[Single-stage resection of at least 6 liver segments in cases of liver tumors].

Seven partial liver resections of at least six hepatic segments (five extended left hepatectomies, also called left trisegmentectomies, and two subtotal hepatectomies) were performed for tumor (of malignant nature in 6 cases). Six of seven patients were admitted for liver transplantation and one for liver resection. These procedures were performed under total vascular exclusion of the liver in six cases (with a veno-venous bypass in two cases) and with the Pringle maneuver in one case. Postoperative liver function was satisfactory in six cases whereas one patient died of hepatic failure on the tenth postoperative day. There was one bile duct stricture at eight months, after extended left hepatectomy. Four patients survived more than one year, three with hepatic tumor recurrence and one with distant metastases. Two patients were still alive, one after fourteen months with tumor recurrence in the liver, the other after seventeen months. In selected cases, partial hepatic resection of more than six segments can be performed for very large tumors. In cases of malignant tumors, a short period of survival with good quality of life can be offered to these patients.

Adult↗
PubMed1993

[Resection of hepatocellular carcinomas. Analysis of prognostic factors of a multicenter series of 153 patients].

In order to identify the prognostic factors of the resection of hepatocellular carcinoma, the results of 153 resections performed between January 1984 and December 1988 in 18 French centers were analysed. Cirrhosis was present in 76% of the patients. Among the postoperative complications (61%), the most frequent were ascites (35.3%) and liver failure (19%). Operative mortality was 20%. One-, 3- and 5-year survival rates were 52.7, 30.1, and 17.9%, respectively. The survival rate was significantly higher in patients with a curative resection, Pugh's class A or with a tumor less than 3 centimeters in diameter. After curative resection, actuarial survival rates without recurrence were 65, 24.4, and 16.7% after, 1, 3, and 4 years respectively. In this case, the survival rate was significantly related to the number of resected nodules and the size of the tumor but not to the presence of a capsule surrounding the tumor.

Actuarial Analysis↗
PubMed1992

[Benign non-parasitic splenic cysts. 9 cases].

Benign non-parasitic splenic cysts are uncommon. Their diagnosis can benefit from ultrasounds and computed tomography. However, it may be difficult, before surgery, to distinguish between true cysts, which are congenital with epidermal lining, and false cysts, which are consecutive to a trauma, inflammatory or degenerative, without epidermal lining. We report nine cases of non-parasitic splenic cysts and try to determine the preoperative diagnostic approach. To prevent the overwhelming post-splenectomy infection syndrome, conservative surgical treatment is mandatory. Various surgical methods are discussed.

Adult↗
PubMed1991

[Ectasing cholangitis and secondary biliary cirrhosis following intra-arterial hepatic chemotherapy. Treatment by liver transplantation].

A case of ectasing cholangitis, following intra-arterial chemotherapy with discontinuous infusion of fluorouracile, is described. The severe destruction of the intra-hepatic biliary ducts led to the constitution of large cavities in continuity with the biliary tree. These cavities were responsible for images which were mistakenly thought to be metastases. Consequently, secondary biliary cirrhosis developed, requiring orthotopic liver transplantation.

Adenocarcinoma↗
PubMedDate not supplied

[Peritoneal puncture dialysis in the monitoring and treatment of hemoperitoneum of traumatic origin?].

The great diversity of injuries after abdominal wound, need an adapted treatment. When laparotomy is indicated in uncontrollable hemorrhage, peritoneal lavage associated with C.T. scan seems to be interesting in the management of hemoperitoneum with a moderate injury severity score and stable arterial and venous pressures. Three patients were recently managed non operatively with good results. The authors draw up these three cases with inclusion criterias and limits of the method.

Abdominal Injuries↗
PubMedDate not supplied

Laparoscopic splenectomy versus open splenectomy: a comparative study.

BACKGROUND/AIMS: In 1993, we reported a new technique for laparoscopic splenectomy, namely the "hanging spleen" technique. The patient was placed in a right lateral supine position with the operator being located on the right of the patient. We herein report the results of 28 laparoscopic splenectomies performed with this technique until January 1996. MATERIAL AND METHODS: From 1993 to 1996, the results were compared with those of 28 patients operated on by open splenectomy from 1988 to 1995. The two groups were similar in terms of age, sex-ratio, and physical condition (ASA classification). Indications for splenectomy were the following in each group: idiopathic thrombocytopenic purpura (ITP) (n = 26 and 27, respectively) and hemolytic anemia (n = 2 and 1, respectively). RESULTS: Accessory spleens were found in 3 patients of the laparoscopic group and in 5 patients of the open group. Three conversions to open procedure were necessary in the laparoscopic group, but two conversions might have been avoided. We have observed significant advantages in the laparoscopic approach: shorter ileus and postoperative stay. On the other hand, the procedure was longer than with open splenectomies. Three patients had postoperative complications in the laparoscopic group, whereas nine patients had complications in the open group. Recurrence of ITP was observed in 2 patients of the laparoscopic group and in 4 patients of the open group. CONCLUSION: Our results suggest that laparoscopic splenectomy may be considered as a safe alternative to open splenectomy in patients with hematological diseases such as ITP and hemolytic anemia.

Adolescent↗