Duodenal traumas

peer reviewe

Recent Advances in Liver Surgery and Transplantation

peer reviewedOver the last 20 years, significant improvements in hepatic surgery and transplantation have allowed better results. Better patients selection, new preoperative modalities aiming at modifying the volume of the liver or the tumour, new surgical techniques, and better postoperative management are the keys to improved outcome. These progresses are reviewed in this article. In hepatic surgery, the latest surgical improvements are the possibility of laparoscopic hepatic resection and of radiofrequency ablation. Modern neoadjuvant chemotherapy may in some cases allow a reduction of large liver colorectal metastases and render them resectable. Improved radiological techniques allow better planning of the surgical resections, reduction of the risks by calculation of the residual liver mass, and induction of liver hypertrophy by preoperative portal embolisation. In liver transplantation, the most significant changes were the use of living related liver donors and of non-heart beating donors to overcome the cadaveric organ donor shortage

Misdiagnosed Malignancy in Transplanted Organs

The case reports of three patients who received cancer-bearing organs at this institution are presented. A fourth recipient, who was to be transplanted with a cancerous kidney, was spared this disastrous complication. The relevant data regarding the donors is also alluded to, with special reference to the type and site of the primary malignancy. Following these case reports, the implications of these issues, their possible prevention, and further management are discussed

Cadaveric liver transplantation for non-acetaminophen fulminant hepatic failure: A 20-year experience

AIM: To investigate the long-term results of liver transplantation (LT) for non-acetaminophen fulminant hepatic failure (FHF). METHODS: Over a 20-year period, 29 FHF patients underwent cadaveric whole LT. Most frequent causes of FHF were hepatitis B virus and drug-related (not acetaminophen) liver failure. All surviving patients were regularly controlled at the out-patient clinic and none was lost to follow-up. Mean follow-up was 101 mo. RESULTS: One month, one-, five- and ten-year patient survival was 79%, 72%, 68% and 68%, respectively. One month, one-, five- and ten-year graft survival was 69%, 65%, 51% and 38%, respectively. Six patients needed early (< 2 mo) retransplantation, four for primary non-function, one for early acute refractory rejection because of ABO blood group incompatibility, and one for a malignant tumor found in the donor. Two patients with hepatitis B FHF developed cerebral lesions peri-transplantion: One developed irreversible and extensive brain damage leading to death, and one suffered from deep deficits leading to continuous medical care in a specialized institution. CONCLUSION: Long-term outcome of patients transplanted for non-acetaminophen FHF may be excellent. As the quality of life of these patients is also particularly good, LT for FHF is clearly justified, despite lower graft survival compared with LT for other liver diseases. (C) 2007 The WJG Press. All rights reserved

Diagnostic et traitement du syndrome hépatorénal

Le syndrome hépatorénal (SHR) est une insuffisance rénale propre au patient porteur d’une hépatopathie chronique à un stade avancé. Le mécanisme physiopathologique, encore imparfaitement connu, associe une vasoconstriction rénale à une vasodilatation splanchnique. Aucun examen n’est spécifique au SHR qui reste ainsi un diagnostic d’exclusion. Le pronostic du SHR est très sombre, l’évolution spontanée étant presque toujours fatale en moyenne dans le mois du diagnostic. La transplantation hépatique représente le traitement idéal mais est d’application limitée étant donné la courte survie des patients. Depuis peu, un traitement médical combinant un vasoconstricteur splanchnique, la terlipressine, et un expanseur plasmatique, l’albumine, donne des résultats favorables, permettant au patient de survivre jusqu’à la transplantation hépatique

Early diagnosis of pancreatic graft rejection trough amylasury evaluation

peer reviewe

Le prélèvement multiorganes: maillon essentiel d'une chaîne de solidarité

peer reviewe