Liver ischemia for hepatic resection: where is the limit?

BACKGROUND: A consecutive series of 50 patients who submitted to 53 hepatic resections with use of continuous normothermic liver ischemia is reported. METHODS: Portal triad clamping has been used in 28 cases, with associated inferior vena caval clamping above and below the liver (hepatic vascular exclusion) in 25 patients. The size of the tumor required major hepatic resection in 38 cases (71.7%). Malignant tumors (83%) were the most common indication for liver resection. Patients were placed in three groups according to the duration of liver ischemia: group A, less than 30 minutes (9 patients); group B, 30 to 60 minutes (29 patients); and group C, 60 or more (15 patients). RESULTS: No differences in mortality rates (5.7% in the entire series and 0% in group C) and morbidity rate could be shown. No significant difference was found in postoperative liver test results, and no persistent alteration remained thereafter. Liver biopsy at 6 and 12 months after operation did not reveal any chronic damage. Liver capability to regenerate was maintained as documented by postoperative computerized tomography scan or magnetic resonance imaging. CONCLUSIONS: Because interruption of hepatic blood flow in normothermia is safe for at least 60 minutes (up to 85 minutes in this study), vascular clamping is recommended for hazardous liver resections to minimize blood loss, which appears to be the main factor of death and morbidity.

[Cholestatic hepatitis induced by the amoxicillin-clavulanic acid combination. A case and review of the literature]. / Hépatite cholestatique due à l'association amoxicilline-acide clavulanique. Un cas et revue de la littérature.

We report the case of a patient who developed jaundice after receiving amoxicillin-clavulanic acid for 7 days. Laboratory features were consistent with acute cholestatic hepatitis. Histopathological examination of a liver specimen showed cholestasis. Complete recovery occurred within 2 months after withdrawal of the drug. Analysis of the 24 reported cases of amoxicillin-clavulanic acid induced hepatitis revealed a predominantly cholestatic syndrome occurring soon after drug administration. In all cases, hepatic dysfunction disappeared within 1 to 3 months after discontinuation of the drug. Because of the small number of cases in contrast with the widespread use of this drug, associated with blood hypereosinophilia or eosinophilic infiltration of portal triads in some cases, a hypersensitivity phenomenon is suggested.

[Short-term antibiotic prophylaxis in colorectal surgery: cefoxitin versus piperacillin. A double-blind randomized study, 60 cases]. / Antibioprophylaxie flash en chirurgie colo-rectale: céfoxitine versus pipéracilline. Etude randomisée en double aveugle, 60 cas.

A randomized, double-blind comparative trial of cefoxitine and piperacillin was conducted in two groups of 30 patients with a similar number of the usual risk factors. Doses of cefoxitine 2 g and piperacillin 4 g were administered only once, except in some cases when the operation lasted more than 5 hours. Analysis of the results showed that the two antibiotics had equivalent prophylactic effectiveness (congruent to 6%) in colorectal surgery.

[Association of pseudochylothorax and pleural tuberculosis. Apropos of a case]. / Association pseudochylothorax et tuberculose pleurale. A propos d'une observation.

The authors report a case of pseudochylothorax revealed by pleural tuberculosis. Classically, pseudochylothorax is a late complication of chronical and calcified pleurisy especially sequellae of tuberculosis treated by induced pneumothorax. Treatment consist on thoracentesis or aspiration with frequent remove. Surgical decortication can be useful. Specific chemotherapy is only necessary in the patients in whom tuberculosis is present or never treated with antibiotics.

[Alcoholic ketoacidosis. Apropos of a case with coma]. / Acidocétose alcoolique. A propos d'un cas avec coma.

Alcoholic ketoacidosis is rare and must be considered in the differential diagnosis of any alcoholic patient with acidosis. The pathogenesis is discussed on the basis of one case. It is easily reversible by simple saline plus glucose infusion.

[Metabolism of glucides and polyols and disorders of their utilization]. / Le métabolisme des glucides et des polyols et les troubles de leur utilisation.

The first part of this report is devoted to a description of the metabolic pathways of the principle carbohydrates and polyols. The second part is concerned with the utilisation of these energy-providing substrates, when used in parenteral alimentation. Notions emerge of "total clearance" and of coefficient of utilisation in relation to the rate of administration for each of them. Finally, the third part deals with disturbances of carbolydate and polyol metabolism during stress and diabetes and the possiblilities of the development of hyperlactatemia according to the substances used or the pathological circumstances encountered. A table attempts to summarise the potential complications in comparison with all the substrates used in parenteral alimentation.

[Antagonistic effects of naloxone against morphinomimetic agents. Apropos of 10 cases in gynecologic surgery]. / Etude des effets antagonistes de la naloxone à l'égard des analgésiques morphinomimétiques. A propos de 10 cas en chirurgie gynécologique.

The object of this study was the use of naloxone to correct hypoventilation related to the use of morphinomimetics without suppressing the analgesic effect of these agents. The study involved ten patients undergoing gynaecological surgery under neuroleptanalgesia and who at the end of surgery had hypoventilation due to the use of fentanyl (average dose : 4.87 microgram/kg/h) or phenoperidine (average dose : 48.7 microgram/kg/h). Naloxone was administered intravenously in an average dose of 1.37 microgram/kg (in one or two injections) followed by an intramuscular injection of an average of 0.73 microgram/kg. Under these conditions, respiratory depression was completely corrected in all cases, the effect being durable. Good analgesia was retained and there was a normal return to consciousness without undesirable effects.

[Five cases of disseminated intravascular coagulation after peritoneojugular shunt by Le Veen valve]. / Cino cas de coagulation intravasculaire disséminée après shunt péritonéo-jugulaire par valve de Le Veen.

The authors report the cases of five cirrhotic patients who underwent peritoneo-venous bypass via a Le Veen valve. Coagulation studies revealed on the one hand a worsening in certain pre-existent abnormalities (thrombocytopaenia, decrease in plasma coagulation factor levels), and secondly a frank increase in F.B.P and positivation of the transfer test. Clinically, two haemmorrhagic syndromes were seen, one of which was fatal. At no time was euglobulin lysis time less than 30 minutes. The administration of small doses of heparin corrected these laboratory abnormalities in all patients and stopped haemorrhage in one. These findings as a whole indicate that in these five cases the bypassing of ascites fluid led to a state of disseminated intravascular coagulation.

[Campylobacter fetus ssp fetus septicemia associated with a colonic abscess]. / Septicémie à Campylobacter fetus ssp fetus associée à un abcés colique.

Campylobacter is considered to be an opportunistic agent. The authors relate an unusual case with Campylobacter fetus ssp fetus (CF) septicemia and colic abscess. Human Campylobacteriosis is presumed to be a food-born disease related to contaminated animal products such as milk or meat. In some cases CF may be transmitted by drinking water or by fecal soiling via the hands. Conventional treatment uses macrolides with decrease the duration of diarrhea and reduce the fecal excretion of CF. Macrolides are ineffective in CF septicemias. In such cases aminoglycosides seem to be the drug of choice.