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V Donckier

Publications and source records attributed to V Donckier.

At least 19 recordsLinked to original sources
PubMed2004

Biliary pleural fistula as a complication of radiofrequency ablation for liver metastasis.

Radiofrequency ablation (RFA) recently emerged as an efficient and safe local ablative method to treat unresecable liver tumours. Currently however, the full spectrum of potential complications of RFA remains undetermined. We report a case of severe biliary complication, associating main bile duct stricture and biliary pleural fistula, arising after extensive RFA for unresectable liver metastasis of central location. Treatment consisted of external drainage of the pleural effusion and internal endoscopic drainage via a biliary stenting. This description of a life-threatening complication emphazises the need to better knowledge of the contraindications of RFA, particularly for the treatment of large tumours at proximity of main bile ducts.

Aged↗
PubMed2003

Local ablative treatments for liver metastases: the current situation.

Surgical resection is the optimal treatment for liver metastases. However, due to their multifocality and/or insufficient remnant liver volume, the majority of liver metastases are unresectable. For this reason, several local ablative techniques have been developed, aiming to produce selective tumour destruction and thus increase the rate of patients amenable to curative-intent treatments. Among these techniques, cryoablation and radiofrequency ablation only have proven to have a curative potential, while transarterial chemoembolization and alcohol injection should be considered as palliative options only. The local recurrences after cryoablation and radiofrequency are equivalent, inferior to 10%, highly dependent of selection criteria. In contrast, morbidity is significantly increased after cryoablation, leading most of the teams to prefer the radiofrequency approach. Two major limitations for radiofrequency are, first, the risk to provoke heat biliary lesion in case of metastases located proximally to hilar plate, and second, the risk of insufficient ablation due to a cooling effect in case of metastases near to major vessels. Keeping in mind these limitations, selective use of radiofrequency may offer a significant benefit by allowing complete tumour clearance in patients with unresectable liver metastases.

Antineoplastic Agents↗
PubMed2003

[Multidisciplinary approach of hepatic metastasis of colorectal origin].

Surgery remains the only potentially curative treatment for liver metastases. After margin free resection, approximately 30% of the patients present long-term survival. Due to the metastases number and/or volume, only 10 to 15% of the patients are candidates for curative-intent surgery. Thus, the objectives of the diagnostic and therapeutic management are to select adequately the patients for surgery and to improve resection rate by the use of neoadjuvants methods. Positron emission tomography could improve the preoperative detection of hepatic and extrahepatic metastases leading to the exclusion of some patients from useless surgical exploration. For patients with initially resectable tumors, no benefit has been demonstrated for adjuvant chemotherapy. For non resectable metastases, two neoadjuvants methods should be evaluated, chemotherapy to reduce tumor volume and portal vein embolization of the tumor side to improve the hepatic functional reserve and allow larger resection. For non-accessible lesion, selective tumor destruction using radiofrequency offers promising perspectives. In conclusion, the multiplication of the diagnostic and therapeutic methods certainly improve the global management of patients with liver metastases but also makes more difficult the individual choice for the best treatment. For this reason, a multimodal approach is absolutely mandatory.

Colorectal Neoplasms↗
PubMed2002

Laparoscopic liver resection of benign liver tumors.

OBJECTIVE: The objective of this study was to assess the feasibility, safety, and outcome of laparoscopic liver resection for benign liver tumors in a multicenter setting. BACKGROUND: Despite restrictive, tailored indications for resection in benign liver tumors, an increasing number of articles have been published concerning laparoscopic liver resection of these tumors. METHODS: A retrospective study was performed in 18 surgical centres in Europe regarding their experience with laparoscopic resection of benign liver tumors. Detailed standardized questionnaires were used that focused on patient's characteristics, clinical data, type and characteristics of the tumor, technical details of the operation, and early and late clinical outcome. RESULTS: From March 1992 to September 2000, 87 patients suffering from benign liver tumor were included in this study: 48 patients with focal nodular hyperplasia (55%), 17 patients with liver cell adenoma (21%), 13 patients with hemangioma (15%), 3 patients with hamartoma (3%), 3 patients with hydatid liver cysts (3%), 2 patients with adult polycystic liver disease (APLD) (2%), and 1 patient with liver cystadenoma (1%). The mean size of the tumor was 6 cm, and 95% of the tumors were located in the left liver lobe or in the anterior segments of the right liver. Liver procedures included 38 wedge resections, 25 segmentectomies, 21 bisegmentectomies (including 20 left lateral segmentectomies), and 3 major hepatectomies. There were 9 conversions to an open approach (10%) due to bleeding in 45% of the patients. Five patients (6%) received autologous blood transfusion. There was no postoperative mortality, and the postoperative complication rate was low (5%). The mean postoperative hospital stay was 5 days (range, 2-13 days). At a mean follow-up of 13 months (median, 10 months; range, 2-58 months), all patients are alive without disease recurrence, except for the 2 patients with APLD. CONCLUSIONS: Laparoscopic resection of benign liver tumors is feasible and safe for selected patients with small tumors located in the left lateral segments or in the anterior segments of the right liver. Despite the use of a laparoscopic approach, selective indications for resection of benign liver tumors should remain unchanged. When performed by expert liver and laparoscopic surgeons in selected patients and tumors, laparoscopic resection of benign liver tumor is a promising technique.

Adolescent↗
PubMed2002

[The surgical gastroenterology department].

The Department of Digestive Surgery was born in 1977. It is a part of the medical surgical unit of gastroenterology and hepatopancreatology. The various developed sectors concern hepatic surgery and liver transplantation (treatment of hepatic tumors and cirrhosis), pancreatic surgery and surgery of the biliary tract (treatment of benign and malignant pancreatic tumors, tumor of the biliary tract, chronic pancreatitis and biliary stones), surgery of morbid obesity (gastroplasty or gastric by-pass), surgery of the upper digestive tract (benign and malignant tumors of the oesophagus or the stomach, treatment of gastroesophageal reflux), surgery of the abdominal wall, colorectal surgery and surgery of the inflammatory bowel diseases (colorectal cancer, familial polyposis, Crohn's disease, ulcerative colitis), proctologic surgery and surgery of anorectal functional disorders, neonatal and paediatric surgery.

Belgium↗
PubMed2001

Domino hepatic transplantation using the liver from a patient with primary hyperoxaluria.

BACKGROUND: We report a case of domino liver transplantation using the liver harvested from a patient who underwent a combined liver and kidney transplantation for primary hyperoxaluria (PH). METHOD: A cadaveric liver transplantation was performed in a 19-year-old man with PH. In a second step, the PH liver harvested from the first patient was transplanted in a 69-year-old man with hepatitis C-related cirrhosis, not a candidate for a classic liver graft owing to multifocal hepatocellular carcinoma. RESULTS: At 8 months after transplantation, the domino recipient has normal hepatic function and no signs of tumoral recurrence, but he progressively developed hyperoxalemia, hyperoxaluria, and renal insufficiency. CONCLUSION: Regarding the favorable postoperative clinical evolution, domino liver transplantations using livers from PH patients may represent a new opportunity for marginal candidates for liver transplantation. However, the progressive renal insufficiency expected in such domino recipients should limit this procedure to selected cases.

Adult↗
PubMed2001

Nondetection of sentinel lymph node with lymphoscintigraphy as a result of massive malignant invasion shown by positron emission tomography.

PURPOSE: The authors report the complementary roles of lymphoscintigraphy in sentinel node mapping and F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) in a massively invaded sentinel node. MATERIALS AND METHODS: A 49-year-old woman was referred to the authors' institution after the resection of a malignant melanoma (Clark IV, Breslow 5.25) of the right buttock. No evidence of regional or distant organ metastases was observed on bone scintigraphy or thoracoabdominal or cerebral computed tomographs. Preoperative lymphoscintigraphy showed drainage around a circular structure, without any node detected. F-18 FDG PET imaging detected an area of focal, markedly hypermetabolic activity at the same location. RESULTS: The focal, markedly hypermetabolic activity detected by F-18 FDG PET corresponded to a massively invaded sentinel node not shown by lymphoscintigraphy but found and removed at the time of surgery. Radical regional lymphadenectomy showed only one small additional lymph node micrometastasis detected after immunohistochemical staining for S-100 protein and HMB45 antigen. CONCLUSIONS: This case emphasizes the complementary roles of lymphoscintigraphy sentinel node mapping and F-18 FDG PET. Indeed, a massively invaded sentinel node may be detected by PET but missed by lymphoscintigraphy.

Female↗
PubMed2001

Transplantation tolerance and mixed chimerism: at the frontier of clinical application.

Although the persistence of donor-type hematopoietic cells in low numbers (microchimerism) is well established in some transplant recipients, its relevance for graft acceptance is still a matter of debate. On the other hand, clonal deletion of donor-specific alloreactive cells associated with mixed chimerism (macrochimerism) has reliably produced long-term graft tolerance in pre-clinical models. So far, the cytoablative conditioning regimens required to achieve mixed chimerism have hampered the clinical development of such protocols. Here, we discuss recent observations suggesting that the deliberate induction of hematopoietic cell chimerism might become a feasible strategy to achieve transplantation tolerance in clinics.

Animals↗
PubMed2001

[Treatment of colorectal cancer: a resolute multidisciplinary approach].

Significant developments have been occurred in the field of colorectal cancer treatments over these last years, surgery clearly remaining the only curative therapy. Optimalized surgical approaches, such as total mesorectum excision, aggressive resections of liver metastases and development of innovative techniques of local destruction of hepatic lesions using radiofrequency attempt to prolong survival. New chemotherapeutic and biological agents, associated with a better knowledge of tumor biology open promising perspectives with regards to an increasing of survival, an improvement of quality of life and the possibility to resect curatively liver metastases initially unresectable, after neoadjuvant chemotherapy. The present paper aims to review the therapeutic approaches at the different stages of the disease and strongly insists on the multidisciplinary strategy required for an optimal management and a global view of colorectal cancer, shared by the surgeon, the gastroenterologist and/or the oncologist and the radiotherapist.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2000

Helical CT signs in the diagnosis of intestinal ischemia in small-bowel obstruction.

OBJECTIVE: The purpose of our study was to determine prospectively the value of helical CT and of various signs of ischemia in the context of acute bowel obstruction. SUBJECTS AND METHODS: All patients seen over a 3-year period with a CT diagnosis of small-bowel obstruction were included. There were 144 examinations in 142 patients. Images were interpreted prospectively with consensus by a fellow and an experienced gastrointestinal radiologist. Attention was focused on the presence of the following signs of strangulation and ischemia: reduced enhancement of the small-bowel wall, mural thickening, mesenteric fluid, congestion of small mesenteric veins, and ascites. A diagnosis of ischemia was made if enhancement of the bowel wall was reduced or if at least two of the other signs were found. Results were correlated with surgical findings in 73 cases and clinical follow-up in 71 cases. RESULTS: A diagnosis of ischemia was made at surgery in 24 patients. CT diagnosis was correct in 23 patients (96% sensitivity). There were nine false-positive diagnoses (93% specificity). The negative predictive value of CT was 99%. Reduced enhancement of the bowel wall had a sensitivity of 48% and specificity of 100%, mural thickening had a sensitivity of 38% and specificity of 78%, mesenteric fluid had a sensitivity of 88% and specificity of 90%, congestion of mesenteric veins had a sensitivity of 58% and specificity of 79%, and ascites had a sensitivity of 75% and specificity of 76%. CONCLUSION: Helical CT is a highly sensitive method to diagnose or rule out intestinal ischemia in the context of acute small-bowel obstruction.

Acute Disease↗
PubMed1999

Sporadic carcinoid of the stomach: a highly proliferative disease with a probable role for p53 protein dysregulation.

We describe here one case of sporadic carcinoid of the stomach, occurring in a 65-year-old man. It is a rare, recently recognized entity, with only few cases reported in the literature. We were able to detect strong MIB-1 and p53 expression in this tumour, with 86 and 80% of tumoral cells positive, respectively. These data suggest that gastric sporadic carcinoids are a highly proliferative entity probably induced by dysregulation of p53 function.

Aged↗
PubMed1999

Sentinel lymph node mapping in the management of high risk malignant melanoma.

In patients with malignant melanoma, the selective biopsy of the first draining lymph node, so-called the sentinel lymph node, allows to identify, with a low morbidity, the patients with nodal metastasis that require radical lymphadenectomy and adjuvant systemic chemotherapy. Herein, we report our initial experience in sentinel lymph node biopsy in 16 patients with malignant melanoma. The sentinel lymph node was localised using preoperative lymphoscintigraphy and injection of dye blue. Intraoperatively, the dissection was guided with a gamma probe and by the recognition of the blue nodes. In the 16 cases the sentinel lymph node was localised. In 50% of the cases, multiple sentinel nodes were demonstrated at lymphoscintigraphy and found during surgery. A limited postoperative morbidity was observed in three cases. Three patients presented nodal metastasis and underwent further radical lymphadenectomy. We conclude that sentinel lymph node mapping is a feasible and reproductive procedure. The preoperative lymphoscintigraphy is essential to identify multiple sentinel nodes and guide surgical dissection. The impact of this approach on the overall survival of patients with high-risk melanoma has still to be demonstrated in studies with a long follow-up.

Adult↗
PubMed1998

CD40 ligation prevents neonatal induction of transplantation tolerance.

To investigate the consequences of CD40 engagement on the neonatal induction of transplantation tolerance, BALB/c mice were injected at birth with (A/J x BALB/c) F1 spleen cells together with activating anti-CD40 mAb and grafted 4 wk later with A/J skin. Whereas A/J allografts were accepted in mice neonatally injected with F1 cells and control Ab, they were acutely rejected in mice injected with F1 cells and anti-CD40 mAb. Neonatal administration of anti-CD40 mAb resulted in enhanced anti-A/J CTL activity, increased IFN-gamma, and decreased IL-4 production by donor-specific T cells in vitro. Experiments using anti-cytokine mAb and IFN-gamma-deficient mice demonstrated that CD40 ligation prevents neonatal allotolerance through an IFN-gamma- and IL-12-dependent pathway. Finally, we found that newborn T cells express less CD40L than adult T cells upon TCR engagement. Taken together these data indicate that insufficiency of CD40/CD40L interactions contribute to neonatal transplantation tolerance.

Animals↗
PubMed1998

IL-12 prevents neonatal induction of transplantation tolerance in mice.

We investigated the effect of IL-12 on the induction of transplantation tolerance by neonatal injection of allogenic cells. We first observed that injection of newborn BALB/c mice with IL-12 and (A/J x BALB/c)F1 spleen cells prevented the Th2 alloimmune response induced by neonatal inoculation of F1 cells alone and allowed the differentiation of T cells secreting high amounts of IL-2 and IFN-gamma in mixed lymphocyte cultures with donor-type stimulators. Furthermore, IL-12 administration resulted in the emergence of anti-donor cytotoxic T lymphocyte responses although at lower levels than in control uninjected mice. In parallel, we found that mice injected at birth with IL-12 and F1 cells did not develop chimerism and were able to reject a donor-type skin graft as efficiently as control mice. We conclude that IL-12 inhibits the Th2 polarization of the newborn response to alloantigens and prevents thereby the establishment of transplantation tolerance.

Animals↗
PubMed1998

Contribution of computed tomography to decision making in the management of adhesive small bowel obstruction.

BACKGROUND: In adhesive small bowel obstruction, the early recognition of complications such as strangulation or volvulus is essential to choose between surgical or conservative initial treatment. The objective of this study was to determine prospectively the contribution of computed tomography (CT) to decision making in the management of these patients. METHODS: Patients with suspected adhesive small bowel obstruction had CT at admission. Patients with CT signs of volvulus or strangulation and/or clinical signs of peritoneal irritation underwent urgent surgery; other patients had conservative initial treatment. RESULTS: Fifty-four patients were evaluated. CT demonstrated signs of strangulation or volvulus in 19 patients, including three with signs of peritoneal irritation. Within this group, urgent laparotomy was performed in 17 patients and confirmed the CT diagnosis in 16. Thirty-seven patients without clinical or CT signs of complications had initial conservative treatment; among them, seven of 12 with a distal obstruction determined by CT required a delayed operation for persisting obstruction, compared with two of 25 patients with a proximal obstruction (P < 0.01). CONCLUSION: CT is useful for the evaluation of adhesive small bowel obstruction, to detect accurately patients with complications who require urgent operation and to determine the location of the adhesion, which represents a significant prognostic factor for success of conservative treatment.

Adult↗
PubMed1998

Isolation and infusion of donor CD34+ bone marrow cells in cadaver kidney transplantation.

BACKGROUND: Infusion of donor bone marrow cells induces tolerance in allograft models. CD34+ stem cells present in human bone marrow could be endowed with tolerogenic properties. METHODS: CD34+ stem cells were isolated from bone marrow extracted from vertebral bodies of cadaveric donors. Donor CD34+ cells (0.6-3.7 x 10(6)/kg) were infused during surgery in 10 kidney transplant recipients receiving OKT3 as induction therapy. Chimerism was investigated using nested PCR for donor-specific HLA alleles. RESULTS: The infusion of CD34+ stem cells was perfectly tolerated. Five patients remained free of acute rejection at follow-up, 47-325 days post-operatively. The five other patients underwent a single episode of corticosensitive acute rejection. Long-term chimerism was not induced in the seven patients investigated for the persistence of donor DNA. CONCLUSIONS: Infusion of donor CD34+ stem cells in kidney transplantation is safe. The clinical usefulness of the procedure remains to be established.

Adult↗
PubMed1998

Late liver metastases of small bowel leiomyoma. The difficulty in assessing malignancy in gastro-intestinal smooth muscle tumours.

Two cases of small bowel tumour, resected and considered as benign leiomyomas, are reported. Both developed late hepatic metastases, 6 and 8 years after surgery respectively, diagnosed as leiomyosarcoma. Emphasizing the difficulties in assessing malignancy of these tumours and considering local and far dissemination, a long-term follow-up is recommended after surgical resection.

Diagnosis, Differential↗