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Biomedical subjects

R Nakache

Publications and source records attributed to R Nakache.

At least 19 recordsLinked to original sources
PubMed2004

Analysis of late operations in transplant patients.

OBJECTIVE: The charts of 174 consecutive patients were analyzed for incidence, etiology, and outcome of late operations (1 month or more posttransplant) following liver (OLT), kidney (KT), or pancreas-kidney (SPK) transplantation. MATERIALS AND METHODS: Clinical and demographic data were analyzed by chi-square analysis and Fisher exact tests to compare subpopulations. All P values <.05 were considered statistically significant. RESULTS: Censured data revealed 155 patients who did not suffer death or organ loss within 30 days of transplant. Late operations were performed on 89 occasions in 57 patients (65% occurred within 1 year posttransplant) with 20 patients having two or more late operations. Of these 89 procedures, 40% were emergent, 37% were related to the transplant operation, 38% were related to the initial disease, and 73% were major interventions. Fifty-six procedures were performed by the transplant surgery team and all occurred in the same facility as the transplant. CONCLUSIONS: Transplant recipients have a high incidence (36%) of late operations, most within the first year and most related to either the transplant or the original disease. This heavy operative load is important in planning resource allocation. Oversight by and involvement of the transplantation service in these procedures may contribute to the favorable outcome of these operations.

Humans↗
PubMed2000

[FK506 (tacrolimus) does not increase hepatic damage due to hypoperfusion].

Deterioration of hepatic function following liver transplantation is a known complication, sometimes attributed to the use of cyclosporin A. Reaction to tacrolimus (Prograf), a relatively new and effective immunosuppressant drug, is thought to result in a much lower grade of organ dysfunction, especially in the transplanted liver. Using the ex-vivo rat model of isolated perfused liver, we evaluated hepatocellular damage and oxygen extraction when tacrolimus was administered following liver hypoperfusion. Tacrolimus did not worsen hepatic dysfunction caused by the hypoperfusion. Therefore using tacrolimus in the perioperative period might be safer than cyclosporin A, which tends to worsen hepatic damage in the presence of hypoperfusion.

Animals↗
PubMed2000

Metastases to the retroperitoneum in patients with extremity soft tissue sarcoma: an unusual metastatic pattern.

BACKGROUND: Extremity soft tissue sarcoma (STS) metastasizes preferentially to the lungs via the hematogenous route. Metastases in extrapulmonary sites such as bone, brain, and subcutaneous tissues are observed less frequently. To the authors' knowledge, limb STS primarily metastasizing to the retroperitoneum has not been described to date. The current study reviews the clinical course, management, and patient prognosis in such a pattern of metastasis. METHODS: Records of patients with retroperitoneal metastases originating from an extremity STS between 1994-1998 were reviewed. Patient demographics, primary tumor site, other tumor sites, local recurrence, distant metastasis, treatment, and survival were analyzed. RESULTS: Ten patients were included in the study. All had primary STS of different histologic types and high histologic grade confined to a lower limb. The retroperitoneal metastases were diagnosed between 6-120 months (mean, 45 months) after diagnosis of the primary sarcoma. At that time, one patient had evidence of local recurrence of the primary tumor site, two patients had lung metastases, and one patient had diffuse bone metastases. Eight patients were eligible for surgery. In six of these patients the metastases were excised completely. The median follow up was 12 months. Of the six patients who underwent complete resection, 3 were alive at last follow-up with no evidence of disease after 12 months, 14 months, and 24 months, respectively. Two patients with recurrent retroperitoneal disease and one patient with retroperitoneal and lung metastases died despite systemic chemotherapy. CONCLUSIONS: Extremity STS can metastasize hematogenously to the retroperitoneum, a fact that mandates a high index of suspicion and abdominal imaging studies during the follow-up of such patients. Retroperitoneal metastases necessitate aggressive surgical resection to enable prolongation of survival.

Adult↗