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1.
Ann Surg Oncol ; 19(6): 2020-6, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22179632

RESUMO

BACKGROUND: Hepatocellular carcinoma (HCC) is an indication for liver resection or transplantation (LT). In most centers, patients whose HCC meets the Milan criteria are considered for LT. The first objective of this study was to analyze whether there is a correlation between the pathologic characteristics of the tumor, survival and recurrence rate. Second, we focused our attention on vascular invasion (VI). METHODS: From January 1997 to December 2007, a total of 196 patients who had a preoperative diagnosis of HCC were included. The selection criteria for LT satisfied both the Milan and the San Francisco criteria (UCSF). Demographic, clinical, and pathologic information were recorded. RESULTS: HCC was confirmed in 168 patients (85.7%). The median follow-up was 74 months. The pathologic findings showed that 106 patients (54.1%) satisfied the Milan criteria, 134 (68.4%) the UCSF criteria of whom 28 (14.3%) were beyond the Milan criteria but within the UCSF criteria, and 34 (17.3%) beyond the UCSF criteria. VI was detected in 41 patients (24%). The 1-, 3-, and 5-year overall survival rates were 90%, 85%, and 77%, respectively, according to the Milan criteria and 90%, 83%, and 76%, respectively, according to the UCSF criteria (P = NS). In univariate and multivariate analyses, tumor size and VI were significant prognostic factors affecting survival (P < 0.001). Two factors were significantly associated with VI: alfa-fetoprotein level of >400 ng/ml and tumor grade G3. CONCLUSIONS: Tumor size and VI were the only significant prognostic factors affecting survival of HCC patients. Primary liver resection could be a potential selection treatment before LT.


Assuntos
Biomarcadores Tumorais/análise , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Transplante de Fígado/mortalidade , Adulto , Idoso , Carcinoma Hepatocelular/cirurgia , Feminino , Seguimentos , Hepatectomia , Humanos , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Seleção de Pacientes , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , São Francisco , Taxa de Sobrevida
2.
Transplant Proc ; 43(4): 985-7, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21620032

RESUMO

INTRODUCTION: Today local anesthetic wound infiltration is widely recognized as a useful adjunct in a multimodality approach to postoperative pain management. The effectiveness of continuous wound infusion of ropivacaine for postoperative pain relief after laparoscopic living donor nephrectomy was analyzed in this retrospective, comparative analysis. METHODS: Twenty patients undergoing living donor nephrectomy were divided into two groups: standard analgesic therapy (n=10) and ropivacaine continuous infusion group (n = 10). RESULTS: We observed a significant difference in term of visual analogue scale scores, use of morphine, hospital stay, and bowel recovery in favor of the ropivacaine group. The cost analysis demonstrated an overall savings of 985 Euros/patient. DISCUSSION: Surgical wound infusion with ropivacaine was safe and seemed to improve pain relief and accelerate recovery and discharge, reducing the overall costs of care. Postoperative pain control in the donor is of primary importance for better patient compliance and greater perceived quality of health care service.


Assuntos
Amidas/administração & dosagem , Analgesia/métodos , Anestésicos Locais/administração & dosagem , Transplante de Rim , Laparoscopia , Doadores Vivos , Nefrectomia , Dor Pós-Operatória/prevenção & controle , Amidas/economia , Analgesia/economia , Anestésicos Locais/economia , Estudos de Casos e Controles , Análise Custo-Benefício , Defecação/efeitos dos fármacos , Custos de Medicamentos , França , Custos Hospitalares , Humanos , Infusões Intralesionais , Itália , Transplante de Rim/efeitos adversos , Transplante de Rim/economia , Laparoscopia/efeitos adversos , Laparoscopia/economia , Tempo de Internação , Morfina/administração & dosagem , Entorpecentes/administração & dosagem , Nefrectomia/efeitos adversos , Nefrectomia/economia , Medição da Dor , Dor Pós-Operatória/economia , Dor Pós-Operatória/etiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Ropivacaina , Fatores de Tempo , Resultado do Tratamento
3.
Transplant Proc ; 42(4): 1179-81, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20534255

RESUMO

INTRODUCTION: The aim of this study was to assess the impact of laparoscopic thermoablation (LTA) as a neoadjuvant therapy prior to orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). METHODS: Between January 2008 and January 2009, 12 consecutive patients, including 10 males and 2 females with unresectable HCC within liver cirrhosis, were treated with LTA under ultrasound (US) guidance. Most patients were in Child-Pugh class B (54.1%) with a mean age of 60.7 +/- 7.74 years (range, 45-69; median, 60). RESULTS: The LTA procedure was completed in all patients with thermoablation of 23 HCC nodules. LTA identified 4 new malignant lesions (20%) undetected by preoperative imaging (<0.5 cm). The mean length of surgery was 96 minutes (range, 45-118). Six procedures were performed in 4 patients. No postoperative hepatic insufficiency was reported. The mean hospital stay was 4.5 days; no postoperative morbidity was reported. Complete tumor necrosis was achieved in 19/23 thermoablated nodules (82.6%) as evidenced computed tomography (CT) scan by at 3 weeks after the treatment. All patients underwent OLT without complications. The histology of the native liver showed complete necrosis in 17/23 (74%) treated nodules. DISCUSSION: There is currently no convincing evidence that LTA allows one to expand the current selection criteria for OLT, nor that LTA decreases dropout rates on the waiting list. However, LTA does not increase the risk of postoperative complications. There is insufficient evidence that LTA offers any benefit when used prior to OLT either for early or for advanced HCC.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Cirrose Hepática/cirurgia , Neoplasias Hepáticas/diagnóstico por imagem , Transplante de Fígado , Técnicas de Ablação/métodos , Idoso , Biópsia , Carcinoma Hepatocelular/cirurgia , Feminino , Humanos , Laparoscopia/métodos , Cirrose Hepática/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Transplante de Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia , alfa-Fetoproteínas/análise
4.
Pathol Biol (Paris) ; 56(7-8): 487-91, 2008.
Artigo em Francês | MEDLINE | ID: mdl-18842359

RESUMO

Besides hepatocytes, representing the main replication site of hepatitis C virus, peripheral blood mononuclear cells also represent a crucial target for viral infection. Hepatitis C virus compartmentalization (i.e., non-random distribution) of viral variants between plasma and peripheral blood mononuclear cells, more frequently observed in liver transplant patients compared to non-transplanted patients, makes liver transplantation an interesting model for the analysis of hepatitis C leukotropism. This article aims to present, firstly, in clinical and biological features arguing favour of hepatitis C virus infection leukotropism and, secondly, to review current knowledge about compartmentalization between plasma and peripheral blood mononuclear cells, especially in the liver transplantation setting.


Assuntos
Hepacivirus/crescimento & desenvolvimento , Leucócitos Mononucleares/virologia , Transplante de Fígado , Células Sanguíneas/virologia , Estudos de Coortes , Crioglobulinemia/virologia , Hepacivirus/genética , Hepacivirus/isolamento & purificação , Hepacivirus/fisiologia , Hepatite C Crônica/complicações , Hepatite C Crônica/cirurgia , Hepatite C Crônica/virologia , Hepatócitos/virologia , Humanos , Fígado/virologia , Cirrose Hepática/etiologia , Cirrose Hepática/cirurgia , Cirrose Hepática/virologia , Linfoma não Hodgkin/virologia , Especificidade de Órgãos , Polimorfismo Conformacional de Fita Simples , Proteínas do Envelope Viral/genética , Replicação Viral
5.
Pathol Biol (Paris) ; 54(10): 556-60, 2006 Dec.
Artigo em Francês | MEDLINE | ID: mdl-17027191

RESUMO

Cirrhosis due to chronic infection by hepatitis C virus (HCV), associated or not to a primary hepatocarcinoma, has become the first indication of liver transplantation. Graft reinfection by HCV is considered to be systematic while its prognosis is variable from one patient to another. A better knowledge of factors implicated in the occurrence and severity of hepatitis C recurrence is crucial in order to make optimal patients' monitoring. This article aims to present available data in this field, clarifying the role of viral factors (viral load, genotype, evolution of viral quasispecies) and host-related factors (immune response) which could take part in the development of hepatitis C recurrence.


Assuntos
Hepatite C Crônica/fisiopatologia , Hepatite C Crônica/cirurgia , Transplante de Fígado , Carcinoma Hepatocelular/virologia , Hepatite C Crônica/epidemiologia , Humanos , Neoplasias Hepáticas/virologia , Recidiva
6.
Transplant Proc ; 37(6): 2828-9, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16182822

RESUMO

Sirolimus (SRL) is suspected to induce proteinuria. We retrospectively studied proteinuria in a population of liver (n = 29) and kidney transplant (n = 30) recipients switched to SRL with progressive diminution or withdrawal of calcineurin inhibitors (CNI). We also observed estimated glomerular filtration rate (GFR), modification of treatment with antiproteinuric drugs, and changes in concentration of SRL. Collection of data started 3 months before SRL introduction at a mean follow-up of 21 months. Following SRL introduction, proteinuria was not detected in the 28 liver transplant patients, and was stable in the two others. In the kidney transplant group, proteinuria did not occur in 12 patients, remained stable in three, and was slightly increased in 14 (0.57 +/- 0.93 g/d vs 1.83 +/- 1.26 g/d). For all patients, eGFR remained stable; there was no difference in management of antiproteinuric drugs. As suspected, cyclosporin (CsA) and tacrolimus (FK) serum concentrations were decreased. We observed a significant correlation between the variation of proteinuria and the variation of serum concentration of CsA or FK (respectively, P = .001 and P = .007). On the other hand, we did not find any correlation between variation in proteinuria and concentration of SRL. This retrospective study suggests that in our cohort of liver transplant patients without previous renal damage, SRL did not provoke proteinuria. On the other hand, the slight aggravation of proteinuria in a subgroup of kidney transplant patients seems to be linked to the hemodynamic renal effects due to CNI withdrawal.


Assuntos
Transplante de Rim/imunologia , Transplante de Fígado/imunologia , Proteinúria/induzido quimicamente , Sirolimo/efeitos adversos , Colforsina/sangue , Colforsina/uso terapêutico , Ciclosporina/sangue , Ciclosporina/uso terapêutico , Taxa de Filtração Glomerular/efeitos dos fármacos , Humanos , Imunossupressores/efeitos adversos , Estudos Retrospectivos
7.
Ann Dermatol Venereol ; 132(4): 342-5, 2005 Apr.
Artigo em Francês | MEDLINE | ID: mdl-15886561

RESUMO

INTRODUCTION: Many cutaneous complications have been reported in patients treated with cyclosporine. Alterations of the pilosebaceous follicle are particularly frequent. Hypertrichosis, follicular keratosis, acne and folliculitis are very common. Nevertheless, the occurrence of sebaceous hyperplasia is exceptional. OBSERVATION: A 27 year-old man consulted in February 2003 for a papulous eruption of the face. He was treated by cyclosporine and prednisone since his renal transplantation in 1993. The lesions flowed together on the cheeks, forehead and temples. The histological analysis confirmed the diagnosis of sebaceous hyperplasia. There was a perceptible improvement of the cutaneous state after one month of isotretinoin treatment. DISCUSSION: Sebaceous hyperplasia appears in about 10 p. 100 of patients treated with cyclosporine. This side effect occurs only in men of a mean age of 40 years. An increase in sebaceous gland size is often described, but profuse forms are uncommon. Our case report is exceptional because of the young age of the patient, and the occurrence of diffuse sebaceous hyperplasia that appeared a long time after the introduction of cyclosporine.


Assuntos
Ciclosporina/efeitos adversos , Toxidermias/etiologia , Dermatoses Faciais/induzido quimicamente , Imunossupressores/efeitos adversos , Glândulas Sebáceas/patologia , Adulto , Toxidermias/patologia , Dermatoses Faciais/patologia , Humanos , Hiperplasia/induzido quimicamente , Masculino
9.
J Gynecol Obstet Biol Reprod (Paris) ; 28(6): 550-5, 1999 Oct.
Artigo em Francês | MEDLINE | ID: mdl-10598349

RESUMO

OBJECTIVES: To study the course of pregnancy after renal transplantation and to assess the impact of the pregnancy on the renal graft. MATERIAL AND METHODS: [corrected] Retrospective study of 20 pregnancies from 16 renal transplant recipients between January 1987 and December 1998. Mean patient age was 30.3 +/- 4 years. Mean time between transplantation and the onset of pregnancy was 56.4 +/- 34.8 months. RESULTS: The main maternal complications were hypertensive disorders (7 cases) of which 3 preeclampsia. The mean gestational age at delivery was 36 +/- 3.1 weeks. Ten patients delivered prematurely of which 9 were induced prematurity. Nine cesarean sections were carried out either for obstetrical reasons or for causes not directly related to the transplantation. The mean neonatal weight was 2386 +/- 644 g with five small for gestational age. We did not observe any acute rejection. The follow up revealed six cases of chronic rejection. None of them seemed directly related to the pregnancy. CONCLUSIONS: The course of pregnancy after renal transplantation is generally uncomplicated without increased risk of graft lose. However, a stable renal function and an interval of two years or more after the transplantation are requested before allowing a pregnancy. Hypertension, diabetes mellitus or impaired renal function (creatininemia > 150 mumol/l) are contraindications for pregnancy.


Assuntos
Transplante de Rim , Complicações na Gravidez , Adulto , Cesárea , Feminino , Idade Gestacional , Rejeição de Enxerto , Humanos , Hipertensão/complicações , Imunossupressores/uso terapêutico , Trabalho de Parto Prematuro , Pré-Eclâmpsia , Gravidez , Estudos Retrospectivos
11.
Tissue Antigens ; 50(4): 347-50, 1997 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-9349617

RESUMO

HLA class I typing performed in parallel by molecular biology and serology has revealed cases where an HLA class I allele was identified whereas the corresponding antigen was not detected on the cell surface. In the present report, we describe four members of a family in whom an HLA-A1 allele identified at the molecular level was typed as A "blank" by lymphocytotoxicity. This serologically blank antigen was undetectable by isoelectric focusing (IEF). Sequencing of the HLA-A*01 allele from the promoter region to the eighth exonic region revealed insertion of a "C" nucleotide at the beginning of the fourth exon as compared to the common HLA-A*0101 allele. This mutation causes a frame shift, giving rise to an early stop codon in the fourth exon.


Assuntos
Alelos , Éxons/genética , Mutação da Fase de Leitura , Genes MHC Classe I , Antígeno HLA-A1/genética , Mutagênese Insercional , Códon/genética , Análise Mutacional de DNA , Feminino , Expressão Gênica , Antígeno HLA-A1/biossíntese , Teste de Histocompatibilidade , Humanos , Transplante de Rim/imunologia , Masculino , Dados de Sequência Molecular , Reação em Cadeia da Polimerase , Alinhamento de Sequência , Homologia de Sequência do Ácido Nucleico , Testes Sorológicos , Regiões Terminadoras Genéticas/genética
12.
Clin Infect Dis ; 22(1): 171-3, 1996 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-8824991

RESUMO

Human herpesvirus 6 (HHV-6) has been frequently isolated from immunocompromised patients. To determine if a routine survey of HHV-6 infection is needed after organ transplantation, as is the case for human cytomegalovirus infection, we observed patients who had received kidney, liver, and kidney-liver transplants; these patients were followed up for the first 3 months after transplantation. HHV-6 infection was diagnosed by isolation of the virus and by the results of serological tests. Antibodies to HHV-6 were detected in 28 (87.5%) of the 32 recipients, before the transplant, whereas only 4 (12.5%) of the 32 recipients were seronegative for HHV-6. After engraftment, HHV-6 infection occurred in 10 (31%) of the 32 recipients; infection was diagnosed by isolation of the virus (6 of 32 recipients) or by the results of serological tests (4 of 32 recipients). Regardless of whether they had HHV-6 primary infection or reactivation, severe clinical manifestations were observed only in patients who had concomitant cytomegalovirus infection, and no correlation could be found between graft rejection and HHV-6 infection. These results suggest that HHV-6 infection occurs frequently in organ transplant recipients and that it is usually not associated with severe clinical manifestations unless accompanied by a concomitant CMV infection.


Assuntos
Infecções por Herpesviridae/etiologia , Herpesvirus Humano 6 , Transplante de Rim/efeitos adversos , Transplante de Fígado/efeitos adversos , Adulto , Idoso , Anticorpos Antivirais/sangue , Seguimentos , Infecções por Herpesviridae/diagnóstico , Infecções por Herpesviridae/epidemiologia , Herpesvirus Humano 6/imunologia , Herpesvirus Humano 6/isolamento & purificação , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade
13.
Chirurgie ; 119(9): 569-73, 1993.
Artigo em Francês | MEDLINE | ID: mdl-7729207

RESUMO

Among the patients treated for alcoholic cirrhosis, only a small group could be candidates for liver transplantation (LT). The aim of this multicentric study was to analyse the results of LT in a group of 75 patients with alcoholic cirrhosis (AC) compared with a group of 61 patients with non-alcoholic cirrhosis (NAC). Results were similar in both groups concerning survival rate and quality of life. However the ability to go back to a normal professional life was less in the AC group. The reported recurrence of alcoholic intoxication, which was around 26%, was much lower for patients who interrupted alcohol consumption during at least 3 months before L.T.


Assuntos
Cirrose Hepática Alcoólica/cirurgia , Cirrose Hepática/cirurgia , Transplante de Fígado , Adolescente , Adulto , Idoso , Feminino , Humanos , Cirrose Hepática/reabilitação , Cirrose Hepática Alcoólica/reabilitação , Transplante de Fígado/mortalidade , Transplante de Fígado/reabilitação , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Recidiva
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