Acceptance of sugar reduction in flavored yogurt.

To investigate what level of sugar reduction is accepted in flavored yogurt, we conducted a hedonic test focusing on the degree of liking of the products and on optimal sweetness and aroma levels. For both flavorings (strawberry and coffee), consumers preferred yogurt containing 10% added sugar. However, yogurt containing 7% added sugar was also acceptable. On the just-about-right scale, yogurt containing 10% sugar was more often described as too sweet compared with yogurt containing 7% sugar. On the other hand, the sweetness and aroma intensity for yogurt containing 5% sugar was judged as too low. A second test was conducted to determine the effect of flavoring concentration on the acceptance of yogurt containing 7% sugar. Yogurts containing the highest concentrations of flavoring (11% strawberry, 0.75% coffee) were less appreciated. Additionally, the largest percentage of consumers perceived these yogurts as "not sweet enough." These results indicate that consumers would accept flavored yogurts with 7% added sugar instead of 10%, but 5% sugar would be too low. Additionally, an increase in flavor concentration is undesirable for yogurt containing 7% added sugar.

Liver transplantation resolves the hyperdynamic circulation in hereditary hemorrhagic telangiectasia with hepatic involvement.

BACKGROUND & AIMS: Hepatic involvement in hereditary hemorrhagic telangiectasia is common but often asymptomatic. However, in some cases, the vascular lesions that involve the liver may lead to high-output cardiac failure and pulmonary hypertension that is predominant over hepatobiliary manifestations. Liver transplantation and treatment of these complications are described and discussed in this article. METHODS: Three patients with hereditary hemorrhagic telangiectasia and hepatic involvement received transplants. They had pulmonary hypertension and chronic right-sided heart failure caused by disseminated intrahepatic telangiectasias with shunts between the hepatic artery and hepatic veins or portal vein. Left-to-right intrahepatic shunt output was estimated to range between 51% and 57.5% of cardiac output. RESULTS: Hyperdynamic circulation disappeared after liver transplantation in all patients. Results of computed tomography and right-sided heart catheterization performed 6 months later were normal. Follow-up periods currently are 65, 53, and 29 months, and each patient continues to be asymptomatic. CONCLUSIONS: This report suggests that liver transplantation can be considered as an alternative and successful curative treatment that may prevent the irreversible evolution of cardiopulmonary disease.

Late resolution of hepatopulmonary syndrome after liver transplantation.

We report a 38-year-old patient with hepatopulmonary syndrome related to posthepatitis C liver cirrhosis. After liver transplantation, hypoxemia initially worsened markedly, then resolved completely 14 months after transplantation. Liver transplantation may be a reliable treatment of hepatopulmonary syndrome, but clinicians should be aware that the correction of hypoxemia may be delayed and that transient deterioration is possible.

Effectiveness of early alpha-interferon therapy for hepatitis C virus infection recurrence after liver transplantation.

The results in this short series show that early and prolonged alpha-interferon therapy for hepatitis C virus recurrence after liver transplantation could bring some benefit to the infected liver grafts. The risk of graft rejection was clearly minimised by maintaining immunosuppression at normal levels.

Lymphocytic bronchitis/bronchiolitis in a patient with primary biliary cirrhosis.

A 39 year old woman with severe primary biliary cirrhosis progressively developed exercise dyspnoea due to airflow obstruction. Sjögren's syndrome was not present. Bronchial and pulmonary biopsies demonstrated constrictive lymphocytic bronchitis/bronchiolitis, possibly a component of a generalized autoimmune process in this patient.

[Surveillance of children with liver transplantation]. / Surveillance de l'enfant transplanté du foie.

The benefit of liver transplantation in children with end-stage liver disease is now well established. About 80% of the children are alive 5 years after liver transplantation. These good results are obtained not only because of the improvements of the surgical techniques, but also secondary to the reffinements of the follow-up of the patients. In the intensive care unit, clinical, biological and radiological cares must be permanent, allowing graft function assessment, correction of the haemodynamic disturbances, initiation of specific therapies and the research of any complication which must be promptly treated. The main surgical complications are intraperitoneal haemorrhage, biliary and vascular failures. Bacterial and viral infections, rejection represent frequent medical complications. Following the discharge from the intensive care unit, the children are checked daily until patient and graft conditions reach normal status. As time goes, the risk of complications is decreasing, but does not disappear, underlying the need for regular and long follow-up. In almost children, liver transplantation offers normal growth and scooling.

[Treatments of biliary fistulas following the removal of a Kehr tube after orthotopic liver transplantation]. / Traitements des fistules biliaires à l'ablation du drain de Kehr après transplantation hépatique orthotopique.

Biliary tract complications are a major source of morbidity after liver transplantation. From October 1990 to September 1992, 77 patients, including 13 children and 64 adults, received 80 liver transplants. Biliary reconstruction was performed using a choledochocholedochostomy with a T-tube in 40 recipients. We report the management of bile leaks following T tube removal in 6 patients. In all cases, bile leak was diagnose by ultrasound examination requested for abdominal pain. In the first 2 patients, a surgical treatment was applied: Roux-en-Y choledochojejunostomy was performed on the first patient and simple suture of the fistula in the second patient. Two patients were managed nonoperatively using endoscopic and radiological procedures allowing placement of bile duct prosthesis and abdominal drainage. In 2 patients with small localized sub-hepatic collection, no surgical or radio-endoscopic treatment was attempted; spontaneous resolution of the collections was achieved in 2 months on ultrasound examination. All patients are alive, although, the patient who was operated on with a roux-en-Y choledochojejunostomy developed thrombosis of the right hepatic artery and biliary anastomotic stenosis which required further operations. We advocate endoscopic placement of endobiliary prosthesis and percutaneous biliary drainage as first-line therapy for significant fistula after T-tube removal. The use of choledochocholedochostomy without a T-tube when possible for biliary reconstruction in liver transplantation could be an effective procedure, but requires further evaluation.

[Pediatric liver transplantation and related live donor. Technical and ethical considerations]. / Transplantation hépatique pédiatrique et donneur vivant apparenté. Considérations techniques et éthiques.

With improved results of liver transplantation, the number of candidates is increasing. However the scarcity of suitable grafts from cadaveric donors remains a limitation. In spite of the use of full size or reduced size grafts or partial grafts from split livers, some children still die while waiting for liver transplantation. We describe a successful orthotopic liver transplantation in a 10 months old female using the left lateral lobe (segments II and III) from her 27 years old father. The child suffered from biliary atresia, her condition was deteriorating with intractable ascites and increasing jaundice. The father asked us to give a part of his own liver to his daughter. The concept of this innovative therapy had already been submitted to a research-ethics consultation which gave us favorable conclusions. After careful donor evaluation, the left lateral lobe was harvested on July 22, 1992, including the left hepatic artery, left portal vein and left hepatic vein; hepatic artery for segment IV, which arose from the right structures, was preserved, The graft was immediately transplanted orthotopically after recipient total hepatectomy with inferior vena cava preservation. Cold ischemia time was 1 hour and 45 minutes, revascularization of the graft was homogeneous from the very beginning and its early function was excellent. Thirteen days after the operation, the donor was discharged in good condition. The child was reoperated at day 9 for a small biliary leak originating from the cut surface of the liver. After resolution of an episode of rejection and an intra-abdominal abscess, the child was discharged in good health with normal liver function 1 month post-transplant.(ABSTRACT TRUNCATED AT 250 WORDS)

[Veno-occlusive disease after liver transplantation. Association of acute cellular rejection and toxicity of azathioprine]. / Maladie veino-occlusive après transplantation hépatique. Association d'un rejet aigu cellulaire et de la toxicité de l'azathioprine.

Azathioprine vascular hepatotoxicity has been described mainly after renal transplantation. We report a new case in a patient who developed veno-occlusive disease of the liver 3 weeks after liver transplantation; regression of lesions were observed after discontinuation of azathioprine therapy. In this case, azathioprine hepatotoxicity may have been enhanced by a previous episode of severe, acute rejection prevailing in the hepatic veins. After liver transplantation, the diagnosis of azathioprine hepatotoxicity is difficult but should be suspected in the presence of non-inflammatory small hepatic veins lesions. Early withdrawal of the drug is mandatory for complete recovery.