Age associated changes in peripheral airway smooth muscle mass of healthy horses.

Peripheral airway smooth muscle (ASM) mass is increased in severe equine asthma, but no information is available on age related changes in ASM. In this study, peripheral ASM dimensions were determined in healthy horses of different ages. The thickness of the peripheral ASM layer was constant in horses of different ages, but ASM occupied a greater proportion of the inner wall area in young horses compared to older horses. This finding suggests that equine airways experience a decrease in the relative abundance of ASM with age.

Bone loss after orthotopic liver transplantation.

PURPOSE: We assessed changes in body composition and bone loss following liver transplantation to determine if bone loss is related to the underlying liver disease or to other factors such as sex, menopause, or graft rejection episodes. PATIENTS AND METHODS: Our cross-sectional study component compared bone mass and body composition in 31 patients at 1 year after liver transplantation versus 33 pregraft patients with chronic liver disease. Bone mass was measured by dual energy X-ray absorptiometry (DXA) using anteroposterior views of the total body to determine bone mineral content (BMC), and of the lumbar spine to assess bone mineral density (BMD). The body fat content was also determined by DXA. Radiographs of the thoracic and lumbar spine were also obtained. In our longitudinal study component, 16 patients from the pregraft group underwent bone mass assessment again 1 year after transplantation. RESULTS: Graft patients and pregraft patients both had reduced lumbar spine BMD compared to age- and sex-matched normal values (P < 0.001). A 4.75% increase in body fat content was observed after liver transplantation (P < 0.05). In the cross sectional study, bone mass of the spine and total body were not different in pre- and posttransplantation patients. However, the longitudinal study revealed significant decreases in spinal BMD and total body BMC, with a mean 3.5% decrease and a rate of loss of 0.55% per month. In addition, a dramatically high prevalence (29%) of vertebral fractures was observed in grafted patients, contrasting with a low prevalence (8.4%) of fractures in pregraft patients. Menopause, primary biliary cirrhosis, and chronic alcohol abuse were the principal contributing factors for osteoporosis. Patients with vertebral fractures had a marked 17.4% decrease of the lumbar spine BMD (P < 0.001) and a 22% decrease in total BMC when compared to patients without fractures (P < 0.01). CONCLUSION: Patients with orthotopic liver transplantation for chronic liver disease evaluated 1 year after transplantation have a high prevalence of vertebral fractures. Cross sectionally, bone mass was not different in patients before and after transplantation, but the longitudinal study showed that liver transplantation induced a marked and rapid bone loss. Bone loss due to transplantation could enhance the risk of new vertebral fractures, as shown by the high prevalence of vertebral fractures. These results emphasize the need to identify patients with low bone mass by bone densitometry before transplantation.

Hepatic outflow study after piggyback liver transplantation.

BACKGROUND: Hepatic vein outflow is discussed in liver transplantation after preservation of recipient retrohepatic vena cava. The aim of this study was to compare two methods of suparahepatic caval anastomosis. METHODS: From January 1993 to January 1995, 81 patients received 88 liver transplants because of liver cirrhosis (n = 70), acute liver failure (n = 7), elective retransplantation after hepatic artery thrombosis (n = 2), giant hemangioma (n = 1), and combined liver-small bowel transplantation (n = 1). Seven patients underwent urgent retransplantation, 12 had preoperative transjugular intrahepatic portocaval stent, and 11 had portal vein thrombosis. Five patients required extracorporeal venous shunt. A total of 82 liver transplantations had preservation of RHVC, and 70 patients received temporary end-to-side portacaval shunt. Suprahepatic caval anastomosis was carried out in 52 patients (group 1) between the graft suprahepatic vena cava and the ostia of recipient left and median hepatic veins. Thirty patients (group 2) had associated 3 cm vertical cavotomy with partial clamping of RHVC. In the fourth postoperative month 20 patients from each group had pressure and gradient measurement made among the hepatic veins, right atria, and the RHVC. RESULTS: Mean pressure gradient between hepatic veins and right atria was 0.75 +/- 0.49 mm Hg in group 1 and 2.06 +/- 0.85 mm Hg in group 2. Between the RHVC and the right atria it was 0.63 +/- 0.5 mm Hg in group 1 and 2.22 +/- 1.29 mm Hg in group 2. A pressure gradient higher than 3 mm Hg was considered hemodynamically significant. This pressure gradient was found between the hepatic veins and right atria in 10% of patients in group 1 and 40% of patients in group 2 (p = 0.03) and between the RHVC and right atria in 15% of patients in group 1 and 30% of patients in group 2 (p = 0.3). CONCLUSIONS: Preservation of the recipient RHVC with recipient caval anastomosis at the ostia of the median and left hepatic veins is a reliable technique without any hepatic venous outflow alteration. Associated cavotomy is not necessary.

Continuous arteriovenous haemodialysis during emergency hepatic retransplantation: two case reports.

Two patients with severe hepatic and renal failure underwent emergency hepatic retransplantation (2nd and 6th day after transplantation). Continuous arteriovenous haemodialysis was begun before surgery and successfully performed, without any incident, during the retransplantation with a biospal (SCU/CAVH AN 69 S) device, without pump. Vascular access was obtained with femoral catheters. Such a continuous dialysis and ultrafiltration allowed us to infuse massive amounts of blood products before and during surgery and to maintain pH, potassium and lactate at levels compatible with survival in anuric patients. Standard haemodialysis replaced CAVHD when haemodynamic stability was restored.

Repeated hepatic resections for colorectal metastases.

Repeated hepatic resection (RHR) for recurrent colorectal metastases remains uncommon and controversial. We report our experience in order to assess the feasibility and the potential oncologic benefit of such an aggressive management. From 1981 to 1991, 13 patients underwent a RHR. The first hepatic resection had been an anatomic hepatectomy removing between two and six segments in 10 patients and a wedge resection in three. The RHR was performed after a mean delay of 16 +/- 10 months (5-35) from the first liver procedure. The RHR was an anatomic hepatectomy in eight patients (including a right hepatectomy in three) and a minor resection (tumorectomy or segmentectomy) in five. Three patients underwent a third liver resection for recurrence. There was no post-operative mortality. Eleven patients died from recurrence after a mean survival of 17 +/- 13 months from the second hepatic procedure (range: 6-47). One patient died from unrelated disease after 12 months and one was alive free of recurrence 22, 53 and 84 months after third, second and first hepatectomy respectively. The median survivals from the second and first hepatic resections were 17 and 31 months, respectively. It is concluded that in the well-trained team, RHR is feasible and safe even after major primary hepatectomy. However the oncologic benefit remains questionable.

[Electromyographic profile of the human jejunum after abdominal surgery]. / Profil électromyographique du jéjunum humain après chirurgie abdominale.

The purpose of this work was to describe the electromyographical profile of the jejunum observed after various types of abdominal operations. The electromyogram of the first 140 centimeters of the small intestine was recorded on a continuous basis by an intraluminal tube between the 6th and 20th day after abdominal surgery in twenty patients. Results allow us to describe a profile of the patient's intestinal electromyogram after abdominal surgery. It was characterized by three consecutive periods: a) early reappearance of migrating myoelectric complexes occurring during the first period; b) a very short second period beginning immediately before the expulsion of gases; during this period the electrical activity fluctuated and appeared disorganised; c) finally, during the third period, after gas expulsion, peristaltic rushes were associated with normalized migrating myoelectrical complexes. Both early and permanent migrating myoelectrical complexes characterize the normal postoperative period. Continuous linear integration of the jejunal electromyogram might be a useful tool for the monitoring of postoperative intestinal motility as a routine procedure.

[What is the potential number of indications for liver grafts in France per year?]. / Quel est le nombre potentiel d'indications de greffes de foie en France chaque année?

The progress recently made in liver transplantation requires an estimation of the potential number of cases per year in France. The study of French Death Rate per age group, compared with either formal, discutable or aleatory indications of transplantation, is a valuable basis for that calculation. It confirms the relative scarcity of the potential number of liver transplantations, which can be estimated at between 2 or 3 per year and per million inhabitants.

[Hemodynamic tolerance and rapid hypertrophy of a hepatic graft corresponding to less than 30% of the ideal mass in pigs]. / Tolérance hémodynamique et hypertrophie rapide d'un transplant hépatique de moins de 30% de la masse normale chez le porc grâce à une anastomose mésentérico-cave terminalisée.

BACKGROUND AND OBJECTIVE: Evaluation of a new pig liver transplantation technique for survival and hypertrophy of a small-sized graft by providing adapted and controlled venous portal flow. MATERIAL AND METHODS: [corrected] Twenty Large-White pigs underwent heterotopic liver transplantation after a mesocaval shunt and ligation of the superior mesenteric vein downstream from the shunt. The donor-to-recipient weight ratio was below 30%. Furthermore, recipient's biliary duct and portal vein into the hilum were tied. In a control group, no mesocaval shunt was performed and the graft received the entire splanchnic venous flow. RESULTS: The mesocaval shunt provided diversion of 60% of the splanchnic blood flow. The median survival of study pigs was 39 days (range: 8-98). Median serum bilirubin levels at 1 week were 12 micromol/L (range: 4-59). At autopsy, graft weight was increased to 2.7 times the initial weight and histological findings were normal. In the control group, all pigs died quickly from acute splanchnic congestion. CONCLUSION: In a model of heterotopic liver transplantation using small-sized grafts, complete diversion of mesenteric blood flow through a mesocaval shunt resulted in hemodynamic tolerance and hypertrophy of a graft corresponding to less than 30% of the ideal mass.

[Hepatic epithelioid hemangioendothelioma. A case with liver transplantation. Review of the literature]. / Hémangioendothéliome épithélioïde hépatique. Un cas avec transplantation hépatique. Revue de la littérature.

Epithelioid hemangioendothelioma (HEE) is an unusual malignant neoplasm of vasculo-endothelial origin, arising in soft tissues, lung and liver. One case of hepatic HEE is reported in a 32 year-old man wit an isolated multinodular hepatomegaly. The diagnosis was made by the histologic examination of biopsy specimens. At the time of diagnosis, there was evidence of pulmonary metastasis. However, an orthotopic liver transplantation was performed. The tumor cells were immunoreactive with factor VIII-related antigen, BNH9 and vimentin. There was no expression of cytokeratin and epithelial membrane antigen. The patient is alive and well 24 months after. The thoracic X-ray are unchanged. This case is compared with the 84 others cases of the literature. Fourteen experienced a favorable outcome after transplantation. Extra-hepatic dissemination doesn't contra-indicate the graft. But hilar vascular involvement may be correlated with worse prognosis.

[Orthotopic liver transplantation for severe amanita phalloides poisoning]. / Transplantation orthotopique du foie pour intoxication grave par amanite phalloïde.

Forty-eight hours after a women was poisoned by ingesting Amanita phalloides mushrooms, she developed fulminant hepatic failure with collapse, pH 7.24, lactic acidosis 7.6 mmol/l, hypoglycaemia 3.5 mmol/l, anuria and stage IV coma requiring tracheal intubation and mechanical ventilation. Transaminase level was up to 8,000 UI/l. Prothrombin and factor V levels were below 10 percent, with an APT time of 86 s versus a 29 s control time. Twenty-four hours after her admission, the patient underwent orthotopic liver transplantation. The postoperative period was uneventful, with return to consciousness and rapid normalization of hepatic biochemistry values, without signs of acute rejection. This 10th published case of orthotopic liver transplantation for Amanita phalloides poisoning with acute hepatic necrosis confirms that this type of treatment must be systematically envisaged in all such cases.

[Excisional surgery of hepatic metastases of colorectal adenocarcinoma]. / Chirurgie d'exérèse des métastases hépatiques des adénocarcinomes colorectaux.

Between 1981 and 1985, 39 patients had hepatic resection for colorectal cancer liver metastases 44 operations (5 iteratives resections) were performed with 33 major hepatectomy. There was no mortality. Long term results showed: a one year 53% survival, a two years 23% survival, a three years 11% survival. 28 patients had recurrences; 15 of these 28 had hepatic recurrences. According to recent literature the high level of hepatic recurrence suggest that surgical resection should be accompanied with regional chemotherapy.

[Crohn's disease. Apropos of 72 surgical cases]. / La maladie de Crohn. A propos de 72 cas opérés

The authors report a series of 72 cases of Crohn's disease, and discuss the clinical and pathological aspects, the surgical treatment and results. A critical study of the operations in view of the requirements of the disease showed that incomplete resection was mainly responsible for the recurrences. In most cases, the word relapse was more suitable to describe the poor results noted. Immediate radical removal gives such good results that these outweigh the functional disadvantages.

[Heterotopic experimental liver transplantation with portal revascularization of the graft on the distal splenic vein of the recipient]. / Transplantation expérimentale hétérotopique du foie avec portalisation du greffon sur la terminaison de la veine splénique du receveur.

A model of heterotopic liver transplantation had been studied. The graft was laid under the recipient liver and the portal blood flow was supplied by anastomosis with the distal part of the splenic vein. Both liver can then receive portal blood through two parallel portal circulation. Liver function of transplant was satisfactory at three months after transplantation. Their had been no alteration of the recipient liver during the same period.

[Peroperative radiotherapy. Initial experience at the Red Cross Hospital]. / Radiothérapie per-opératoire. Première expérience à l'Hôpital de la Croix-Rousse.

Intra operative radiation therapy is a new look at an old idea (Rich). In relation with the first experience at the Croix-Rousse Hospital with orthovoltage, a review of technical choices, surgical problems, and biological questions is presented. The analysis of literature about accumulated clinical results suggest that local control in recurrence, residual, or inoperable tumor can be obtained by combined surgery IOR, and external beam irradiation. This short experience demonstrate the feasibility of the treatment as a routine and emphasizes the need for continued study.