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Salari GR, Peny MO, Stadt JVD, Donckier V, Zalcman M, Gelin M. Late Liver Metastases of Small Bowel Leiomyoma. The Difficulty in Assessing Malignancy in Gastro-intestinal Smooth Muscle Tumours. Acta Chir Belg 2020. [DOI: 10.1080/00015458.1998.12098390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- G. R. Salari
- Departments of Digestive Surgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M. O. Peny
- Departments of Pathology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - J. Van de Stadt
- Departments of Digestive Surgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - V. Donckier
- Departments of Digestive Surgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M. Zalcman
- Departments of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M. Gelin
- Departments of Digestive Surgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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2
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Affiliation(s)
- J. Van de Stadt
- Department of Digestive Surgery, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium
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Mans L, Pezzullo M, D'Haene N, Van de Stadt J, Van Laethem JL. Pathological complete response after neoadjuvant immunotherapy for a patient with microsatellite instability locally advanced rectal cancer: should we adapt our standard management for these patients? Eur J Cancer 2020; 135:75-77. [PMID: 32554216 DOI: 10.1016/j.ejca.2020.04.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 01/04/2023]
Affiliation(s)
- L Mans
- Gastroenterology, Hepato-pancreatology, Digestive Oncology and Surgery Department, Erasme Hospital, Brussels, Université Libre de Brussels, Belgium.
| | - M Pezzullo
- Department of Radiology, Erasme Hospital, Brussels, Université Libre de Brussels, Belgium
| | - N D'Haene
- Department of Pathology, Erasme Hospital, Brussels, Université Libre de Brussels, Belgium
| | - J Van de Stadt
- Gastroenterology, Hepato-pancreatology, Digestive Oncology and Surgery Department, Erasme Hospital, Brussels, Université Libre de Brussels, Belgium
| | - J-L Van Laethem
- Gastroenterology, Hepato-pancreatology, Digestive Oncology and Surgery Department, Erasme Hospital, Brussels, Université Libre de Brussels, Belgium
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Stadt JVD, D’Hoore A, Duinslaeger M, Chasse E, Penninckx F. Long-Term Results after Excision Haemorrhoidectomy versus Stapled Haemorrhoidopexy for Prolapsing Haemorrhoids A Belgian prospective randomized trial. Acta Chir Belg 2016. [DOI: 10.1080/00015458.2005.11679665] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- J. Van de Stadt
- On behalf of the Belgian Section of Colorectal Surgery, a section of the Royal Belgian Society for Surgery
- Department of Digestive Surgery, Academic Hospital, Vrije Universiteit van Brussel, Brussels
| | - A. D’Hoore
- On behalf of the Belgian Section of Colorectal Surgery, a section of the Royal Belgian Society for Surgery
- Hospital Erasme, Université Libre de Bruxelles, Brussels; Department of Abdominal Surgery, Academic Hospital, Vrije Universiteit van Brussel, Brussels
| | - M. Duinslaeger
- On behalf of the Belgian Section of Colorectal Surgery, a section of the Royal Belgian Society for Surgery
- University Clinic Gasthuisberg, Leuven; Department of Digestive Surgery, Academic Hospital, Vrije Universiteit van Brussel, Brussels
| | - E. Chasse
- On behalf of the Belgian Section of Colorectal Surgery, a section of the Royal Belgian Society for Surgery
- Department of Digestive Surgery, Academic Hospital, Vrije Universiteit van Brussel, Brussels
| | - F. Penninckx
- On behalf of the Belgian Section of Colorectal Surgery, a section of the Royal Belgian Society for Surgery
- Hospital Erasme, Université Libre de Bruxelles, Brussels; Department of Abdominal Surgery, Academic Hospital, Vrije Universiteit van Brussel, Brussels
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Farinella E, Buggenhout A, Van de Stadt J. Modified H-pouch as an alternative to the J-pouch for anorectal reconstruction. Colorectal Dis 2014; 16:O332-4. [PMID: 24980779 DOI: 10.1111/codi.12701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 04/06/2014] [Indexed: 02/08/2023]
Abstract
AIM A modification is described of the J-pouch to facilitate ileoanal anastomosis in the presence of an anal or anovaginal fistula. METHOD The bowel is divided at the level of the apex of the J-pouch, the distal limb is advanced to project beyond the proximal limb by 3-5 cm. The pouch is constructed by a side-to-side anastomosis to form the H-pouch with a distal ileal segment, which is passed through the anal canal to form an ileoanal anastomosis. RESULTS The modification allows the treatment of anal and rectal disorders not resolvable by a usual J-pouch construction, as in cases where a rectal resection is needed for concomitant fistulation or destruction of the anal mucosa. The functional results are similar to those of the J-pouch, with no added postoperative morbidity. This technique helps to avoid permanent stoma in selected cases. CONCLUSION The modified pouch is relatively simple to perform and can help the surgeon to address complex anorectal disorders.
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Affiliation(s)
- E Farinella
- Clinic of Colorectal Surgery, Department of Digestive Surgery, ULB-Hopital Erasme, Brussels, Belgium
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Agrafiotis AC, Corbeau M, Buggenhout A, Katsanos G, Ickx B, Van de Stadt J. Enhanced recovery after elective colorectal resection outside a strict fast-track protocol. A single centre experience. Int J Colorectal Dis 2014; 29:99-104. [PMID: 23982426 DOI: 10.1007/s00384-013-1767-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2013] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Optimising the management of hospitalised patients is a major concern. In colorectal surgery, the concept of enhanced recovery has been popularised by means of "fast-track" protocols, aiming at patient's discharge on the second postoperative day. Nevertheless, a strict fast-track protocol has several limitations. It is very demanding for the patient and therefore applicable only to a limited number of patients. AIM In order to optimise, in every aspect, the postoperative recovery of each patient undergoing an elective colorectal resection inside our institution, we set up a "soft" enhanced recovery programme. MATERIAL-METHODS A retrospective analysis was conducted in 92 patients evaluating the respective impact of protocol application throughout the duration of the hospital stay. RESULTS When all the required measures of our protocol were correctly implemented, the median discharge day was postoperative day 3 (range 3-5 days). On the contrary, when deviations occurred, they resulted in longer hospital stay (p < 0.001). Patients operated by laparoscopy were discharged earlier than patients operated by laparotomy (p < 0.001). The use of nasogastric tube and postoperative drainage prolonged significantly the length of stay (p = 0.001 and p < 0.001 respectively). When the urinary catheter was not removed or oral feeding not resumed on postoperative day 1, the patients were discharged later (p < 0.001). CONCLUSIONS There are substantial possibilities of optimising the recovery process after an elective colorectal resection, outside a strict fast-track protocol.
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Affiliation(s)
- A C Agrafiotis
- Clinic of Colorectal Surgery, Department of Digestive Surgery, Erasme University Hospital-Université Libre de Bruxelles, Brussels, Belgium,
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Penninckx F, Kartheuser A, Van de Stadt J, Pattyn P, Mansvelt B, Bertrand C, Van Eycken E, Jegou D, Fieuws S. Outcome following laparoscopic and open total mesorectal excision for rectal cancer. Br J Surg 2013; 100:1368-75. [PMID: 23939849 DOI: 10.1002/bjs.9211] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND There are few reports on the oncological quality of resection and outcome after laparoscopic versus open total mesorectal excision (TME) for rectal cancer in everyday surgical practice. METHODS Between January 2006 and October 2011, data for patients with mid or low rectal adenocarcinoma who underwent elective TME were recorded in the PROCARE database. A multivariable model and the propensity score as a co-variable in Cox or logistic regression models were used for adjustment of differences in patient mix and non-random assignment of surgical approach. RESULTS Data for 2660 patients from 82 hospitals were recorded. Implementation of laparoscopic TME was highly variable. The oncological quality of resection was similar in the laparoscopic and the open group: incomplete mesorectal excision in 13·2 and 11·4 per cent respectively, circumferential resection margin positivity in 18·1 per cent, and a median of 11 lymph nodes examined per specimen in both groups. The hazard ratio for survival after laparoscopic versus open TME was 1·05 (95 per cent confidence interval 0·88 to 1·24) after correction for differences in patient mix, and 1·06 (0·89 to 1·25) after correction for the propensity score. The definitive colostomy rate was similar in the two groups: 31·0 per cent after open and 31·4 per cent after laparoscopic TME. Postoperative morbidity was lower and length of stay was shorter after laparoscopic TME compared with open TME. Survival was not negatively affected by converted laparoscopic resection, whereas postoperative morbidity, mortality and length of stay after converted laparoscopy were comparable with those after open TME. CONCLUSION Oncological outcome is comparable after laparoscopic and open TME in everyday surgical practice.
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Affiliation(s)
- F Penninckx
- Department of Abdominal Surgery, Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium.
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Penninckx F, Fieuws S, Kartheuser A, Van de Stadt J, Pattyn P, Mansvelt B, Bertrand C, Jegou D, Van Eycken L. 99. Laparoscopic versus open total mesorectal excision for rectal cancer – A reality check in the context of PROCARE, a Belgian improvement project. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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9
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Penninckx F, Beirens K, Fieuws S, Ceelen W, Demetter P, Haustermans K, Van de Stadt J, Vindevoghel K. Risk adjusted benchmarking of clinical anastomotic leakage rate after total mesorectal excision in the context of an improvement project. Colorectal Dis 2012; 14:e413-21. [PMID: 22321047 DOI: 10.1111/j.1463-1318.2012.02977.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Anastomotic leakage (AL) after total mesorectal excision (TME) is a major adverse event. This study evaluates variability in AL between centres participating on a voluntary basis in PROCARE, a Belgian improvement project, and how further improvement of the AL rate might be achieved. METHOD Between January 2006 and March 2011, detailed data on 1815 patients (mean age 65.5 years, 63% male) who underwent elective TME with colo-anal reconstruction for rectal cancer were registered by 48 centres. Variability in early clinical AL rate was analysed before and after adjustment for gender, age > 60 years, American Society of Anesthesiologists score of 3 or more and body mass index > 25 kg/m(2). RESULTS The overall AL rate was 6.7% (95% CI 5.6%-7.9%). Early AL required reoperation in 86.8% of patients. It increased length of hospital stay from 14.7 days to 32.4 days and in-hospital mortality from 1.1% to 4.8%. Statistically significant variability in AL rate between centres was not observed, either before or after risk adjustment. Nonetheless, further improvement may be achievable in some centres by targeting the adjusted performance of better performing centres. These centres used neoadjuvant treatment, rectal irrigation, mobilization of the splenic flexure, resection of the sigmoid colon, side-to-end colo-anastomosis with or without pouch and defunctioning stoma at primary surgery in a significantly higher proportion of patients than less well performing centres. CONCLUSION The overall AL rate was low but needs to be interpreted with caution because of incomplete registration. Further improvement might be achieved by adopting the approach of better performing centres.
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Affiliation(s)
- F Penninckx
- PROCARE p/a Foundation Belgian Cancer Registry, Brussels, Belgium.
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10
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Maréchal R, Vos B, Polus M, Delaunoit T, Peeters M, Demetter P, Hendlisz A, Demols A, Franchimont D, Verset G, Van Houtte P, Van de Stadt J, Van Laethem JL. Short course chemotherapy followed by concomitant chemoradiotherapy and surgery in locally advanced rectal cancer: a randomized multicentric phase II study. Ann Oncol 2011; 23:1525-30. [PMID: 22039087 DOI: 10.1093/annonc/mdr473] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Induction chemotherapy has been suggested to impact on preoperative chemoradiation efficacy in locally advanced rectal cancer (LARC). To evaluate in LARC patients, the feasibility and efficacy of a short intense course of induction oxaliplatin before preoperative chemoradiotherapy (CRT). PATIENTS AND METHODS Patients with T2-T4/N+ rectal adenocarcinoma were randomly assigned to arm A-preoperative CRT with 5-fluorouracil (5-FU) continuous infusion followed by surgery-or arm B-induction oxaliplatin, folinic acid and 5-FU followed by CRT and surgery. The primary end point was the rate of ypT0-1N0 stage achievement. RESULTS Fifty seven patients were randomly assigned (arm A/B: 29/28) and evaluated for planned interim analysis. On an intention-to-treat basis, the ypT0-1N0 rate for arms A and B were 34.5% (95% CI: 17.2% to 51.8%) and 32.1% (95% CI: 14.8% to 49.4%), respectively, and the study therefore was closed prematurely for futility. There were no statistically significant differences in other end points including pathological complete response, tumor regression and sphincter preservation. Completion of the preoperative CRT sequence was similar in both groups. Grade 3/4 toxicity was significantly higher in arm B. CONCLUSIONS Short intense induction oxaliplatin is feasible in LARC patients without compromising the preoperative CRT completion, although the current analysis does not indicate increased locoregional impact on standard therapy.
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Affiliation(s)
- R Maréchal
- Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium.
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Demetter P, Ceelen W, Danse E, Haustermans K, Jouret-Mourin A, Kartheuser A, Laurent S, Mollet G, Nagy N, Scalliet P, Van Cutsem E, Van Den Eynde M, Van de Stadt J, Van Eycken E, Van Laethem JL, Vindevoghel K, Penninckx F. Quality of care indicators in rectal cancer. Acta Gastroenterol Belg 2011; 74:445-450. [PMID: 22103052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Quality of health care is a hot topic, especially with regard to cancer. Although rectal cancer is, in many aspects, a model oncologic entity, there seem to be substantial differences in quality of care between countries, hospitals and physicians. PROCARE, a Belgian multidisciplinary national project to improve outcome in all patients with rectum cancer, identified a set of quality of care indicators covering all aspects of the management of rectal cancer. This set should permit national and international benchmarking, i.e. comparing results from individual hospitals or teams with national and international performances with feedback to participating teams. Such comparison could indicate whether further improvement is possible and/or warranted.
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Affiliation(s)
- P Demetter
- (1) Pathology, Erasme University Hospital (ULB), Bruxelles.
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Maréchal R, Vos B, Polus M, Delaunoit T, Peeters M, Demetter P, Van Houtte P, Demols A, Van de Stadt J, Van Laethem J. Chemotherapy induction followed by preoperative chemoradiation versus preoperative chemoradiation alone in locally advanced rectal cancer (LARC): A randomized controlled phase II study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.3637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Affiliation(s)
- N Dauby
- Medico-Surgical Department of Gastroenterology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Adler M, Van Laethem JL, Franchimont D, Zalcman M, Van de Stadt J, Van Gossum A. [Organized colorectal screening in French Community of Belgium and polyp surveillance]. Rev Med Brux 2009; 30:253-260. [PMID: 19899371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Colorectal cancer is an important health care problem in Belgium and screening is now widely recommendend. The French Community has launched in March 2009, a campaign to build public and professional awareness of the importance of screening for colorectal cancer. With the goal of encouraging all persons age 50 to 74 to actively gain information and seek screening with the active participation of their house doctors, the campaign will work to clarify any myths or fears about screening options and ensure that the importance of screening and early detection will be understood. The program in the French Community propose guaiac-based fecal occult blood testing for average risk people and, in case of positivity a colonoscopy must be performed. A high quality colonoscopy should be offered first in case of significant personal and familial history of adenomas, colorectal cancer and some specific extracolonic neoplasia. Several strategies will be used to ensure follow up of this program and encourage wide participation of the population.
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Affiliation(s)
- M Adler
- Département Médico-chirurgical de Gastroentérologie, d'Hépatopancréatologie et d'Oncologie digestive, Hôpital Erasme, Bruxelles.
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Pitot D, Bouazza F, Chamlou R, Van de Stadt J. Elective colorectal surgery without bowel preparation: a historical control and case-matched study. Acta Chir Belg 2009; 109:52-5. [PMID: 19341196 DOI: 10.1080/00015458.2009.11680371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although full bowel preparation, including mechanical washout and non-absorbable antibiotherapy, has been considered for decades as a prerequisite to any elective colorectal surgery, recent literature has suggested that this habit was perhaps unjustified. The aim of this study was to assess the safety of ileocolic, colocolic and colorectal anastomosis in the absence of pre-operative mechanical bowel preparation. METHODS During a 1-year period, 59 consecutive patients underwent elective colorectal surgery with ileocolic, colocolic or colorectal anastomosis without any pre-operative preparation. This "non-prepared group" (NPG) was compared to a "control group" (CG) composed of the previous 127 consecutive cases of classically managed patients. To improve the statistical power we also compared the NPG to a "match-controlled group" (MCG) of 59 patients within the CG. Primary end-points were anastomotic leakage and abdominal infections. Secondary end-points were oral diet resume time and hospital stay. RESULTS There were no differences between the 3 groups for age, gender, BMI, immunodepression status, anastomosis site and suture technique. There were no differences between NPG and CG or MCG for anastomotic leakage (3.5%, 4.7% and 6.8% respectively, NPG/CG p = 0.68 and NPG/MCG p = 0.4) or for infectious abdominal complications. Mean diet resume time was 1.4 (1-5) days in the NPG versus 3.4 (1-19) days in the CG and 3.1 (1-6) days in the MCG (p < 0.00001). Median length of postoperative hospital stay was 5 (2-81) days in the NPG versus 8 (4-100) and 8 (4-100) in the CG and the MCG respectively. CONCLUSIONS In accordance with the recent literature, the present experience does not show any benefit of mechanical bowel preparation in elective colorectal resection. This suggests that bowel preparation could be omitted before this type of surgery.
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Mathieu A, Chamlou R, Le Moine F, Maris C, Van de Stadt J, Salmon I. Tailgut cyst associated with a carcinoid tumor: case report and review of the literature. Histol Histopathol 2006; 20:1065-9. [PMID: 16136488 DOI: 10.14670/hh-20.1065] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We report the case of a 49-year-old woman who presented a tailgut cyst lined by a variety of epithelium including squamous, columnar and transitional. Fortuitously a microscopic carcinoid tumor expressing immunohistochemically neuroendocrine markers was identified in the cystic wall. Tailgut cysts are congenital abnormalities located in the presacrococcygeal area occurring usually in adult patients. Clinical diagnosis is difficult because they are often asymptomatic. Patients may present symptoms resulting from local mass effects or complications. The differential diagnoses include rectal duplication cysts, cystic sacrococcygeal teratomas, epidermal cysts, epidermoid cysts, anal duct or gland cysts. Magnetic resonance imaging has recently become the modality of choice to image the cyst. Malignant transformation is rare; 23 cases including 10 carcinoid tumors have been reported in the literature. To our knowledge, this is the eleventh case of carcinoid tumor arising in a tailgut cyst.
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Affiliation(s)
- A Mathieu
- Department of Pathology, Erase Hospital, Free University of Brussels, Belgium
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Van de Stadt J, D'Hoore A, Duinslaeger M, Chasse E, Penninckx F. Long-term results after excision haemorrhoidectomy versus stapled haemorrhoidopexy for prolapsing haemorrhoids; a Belgian prospective randomized trial. Acta Chir Belg 2005; 105:44-52. [PMID: 15790202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE To compare the postoperative evolution and the long-term efficacy after stapled haemorrhoidopexy (PPH) and Milligan-Morgan haemorrhoidectomy (MM). METHODS In a prospective randomized study, 40 patients requiring surgical treatment for prolapsing haemorrhoids grade II or III were assigned to either MM or PPH (20 each). Postoperative pain, wound healing were evaluated, as well as anal pressures and sphincter anatomy. Mean follow-up is 46 months. RESULTS Postoperative pain at rest and during defecation was less important after PPH if no resection of external piles or skin tags was associated (P < 0.0001). Healing time was shorter after PPH (P < 0.0001). Endoanal ultrasound remained unchanged postoperatively. Resting and squeeze pressures decreased after MM, but not after PPH (P < 0.01). After a mean follow-up of 46 months (12-56), persistent or recurrent symptoms, mostly mild and temporary, were observed after both MM and PPH, in 7 and 11 patients respectively (NS). After PPH, five patients (25%) complained of recurrent external swelling and/or prolapse (P = 0.047 vs. MM) requiring redo surgery in four of them, after 10, 13, 14 and 21 months. No redo-surgery was required after MM. Long term patient satisfaction after PPH was not better than after MM. CONCLUSIONS Postoperative pain is less important after PPH. This advantage disappears if any resection is associated with the stapling. At medium to long-term follow-up, PPH seems to carry a higher risk of symptomatic external haemorrhoidal disease, needing further surgery.
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Affiliation(s)
- J Van de Stadt
- Department of Digestive Surgery, Hospital Erasme, Université Libre de Bruxelles, Brussels;
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Anaf V, El Nakadi I, Simon P, Van de Stadt J, Fayt I, Simonart T, Noel JC. Preferential infiltration of large bowel endometriosis along the nerves of the colon. Hum Reprod 2004; 19:996-1002. [PMID: 15016784 DOI: 10.1093/humrep/deh150] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Little is known about the mode and the extent of infiltration of endometriotic lesions in the large bowel. METHODS In 31 patients undergoing large bowel resection for severe deep-infiltrating endometriosis of the sigmoid and rectum with severe digestive symptoms, we performed a prospective morphological, histological and immunohistological study (using the monoclonal antibodies S100 for the detection of the nerves and CD10 for the detection of the endometriotic stromal cells) on the large bowel resection specimen. The evaluation of invasion of the large bowel by endometriosis was performed by studying the presence, localization and mean number of lesions in the different layers of the colon, the relationship between endometriosis and the nerves of the colon, the nerve density in the respective layers of the large bowel and the presence of endometriosis on the resection margins. RESULTS The most richly innervated layers of the large bowel are the most intensely involved by endometriosis. We found that 53 +/- 15% of endometriotic lesions were in direct contact the nerves of the colon by means of perineurial or endoneurial invasion. The mean largest diameter of the lesion does not seem to be correlated with the depth of infiltration. The margins were positive in 9.7% of cases. In cases of positive margins, the endometriotic lesions were in close histological relationship with the nerves. CONCLUSIONS There is a close histological relationship between endometriotic lesions of the large bowel and the nerves of the large bowel wall. Endometriotic lesions seem to infiltrate the large bowel wall preferentially along the nerves, even at distance from the palpated lesion, while the mucosa is rarely and only focally involved.
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Affiliation(s)
- V Anaf
- Departments of Gyneacology, Academic Hospital Erasme, Free University of Brussels, Brussels, Belgium.
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Gelin M, Closset J, Donckier V, el Nakadi I, Van de Stadt J. [The surgical gastroenterology department]. Rev Med Brux 2003; 23 Suppl 2:51-5. [PMID: 12584913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
The Department of Digestive Surgery was born in 1977. It is a part of the medical surgical unit of gastroenterology and hepatopancreatology. The various developed sectors concern hepatic surgery and liver transplantation (treatment of hepatic tumors and cirrhosis), pancreatic surgery and surgery of the biliary tract (treatment of benign and malignant pancreatic tumors, tumor of the biliary tract, chronic pancreatitis and biliary stones), surgery of morbid obesity (gastroplasty or gastric by-pass), surgery of the upper digestive tract (benign and malignant tumors of the oesophagus or the stomach, treatment of gastroesophageal reflux), surgery of the abdominal wall, colorectal surgery and surgery of the inflammatory bowel diseases (colorectal cancer, familial polyposis, Crohn's disease, ulcerative colitis), proctologic surgery and surgery of anorectal functional disorders, neonatal and paediatric surgery.
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Van Laethem JL, Donckier V, Demols A, Franchimont D, Gay F, Van de Stadt J. [Treatment of colorectal cancer: a resolute multidisciplinary approach]. Rev Med Brux 2001; 22:503-12. [PMID: 11811046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Significant developments have been occurred in the field of colorectal cancer treatments over these last years, surgery clearly remaining the only curative therapy. Optimalized surgical approaches, such as total mesorectum excision, aggressive resections of liver metastases and development of innovative techniques of local destruction of hepatic lesions using radiofrequency attempt to prolong survival. New chemotherapeutic and biological agents, associated with a better knowledge of tumor biology open promising perspectives with regards to an increasing of survival, an improvement of quality of life and the possibility to resect curatively liver metastases initially unresectable, after neoadjuvant chemotherapy. The present paper aims to review the therapeutic approaches at the different stages of the disease and strongly insists on the multidisciplinary strategy required for an optimal management and a global view of colorectal cancer, shared by the surgeon, the gastroenterologist and/or the oncologist and the radiotherapist.
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Affiliation(s)
- J L Van Laethem
- Service Médico-Chirurgical de Gastro-Entérologie, Hôpital Erasme, U.L.B
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21
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Van Gossum A, Van Laethem JL, Demols A, Zalcman M, Van de Stadt J. [Preoperative evaluation of rectal cancer]. Rev Med Brux 2001; 22:A215-8. [PMID: 11680176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
For a patient with a rectal tumor, the preoperative staging should answer four questions: Is the rectal tumor unique? Is the patient operable? Are there distal metastases? What is the loco-regional extension? The loco-regional extension is well evaluated by the echo-endoscopy while the involvement of the surrounding organs is better assessed by CT-scan or resonance magnetic imaging.
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Affiliation(s)
- A Van Gossum
- Service Médico-Chirurgical de Gastro-entérologie, Hôpital Erasme, U.L.B
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22
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Melange M, D'Haens G, Devos M, Kartheuser A, Louis E, Pattyn P, Pelckmans P, Penninckx F, Potvin P, Schapira M, Van de Stadt J, Van Gossum AV. The medical management of severe acute and chronic ulcerative colitis--current recommendations from the Belgian Working Group. Acta Gastroenterol Belg 2000; 63:273-4. [PMID: 11189986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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23
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Van de Stadt J. Fistula in ano: the place of rectal advancement flap technique. Acta Chir Belg 2000; 100:123-7. [PMID: 11280176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Classical surgical techniques for anal trans- or suprasphincteric fistulas imply the division of the sphincters likely to induce postoperative continence impairment. The rectal advancement flap technique achieves healing of the fistula in a significant number of patients, while avoiding any sphincter division, and therefore the development of further incontinence.
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Affiliation(s)
- J Van de Stadt
- Department of Digestive Surgery, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium.
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24
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25
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Closset J, Van de Stadt J, Delhaye M, El Nakadi I, Lambilliotte JP, Gelin M. Hepatocellular carcinoma: surgical treatment and prognostic variables in 56 patients. Hepatogastroenterology 1999; 46:2914-8. [PMID: 10576372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND/AIMS Partial hepatectomy (PH) or total hepatectomy and orthotopic liver transplantation (OLT) may be curative in selected patients treated for hepatocellular carcinoma (HCC). The analysis of clinical series may help in the choice of the more appropriate treatment. METHODOLOGY During the past 11 years, 40 patients with HCC were treated by PH and 16 patients underwent total hepatectomy and OLT. Selection criteria for transplantation were the liver function and the tumor resectability. RESULTS The actuarial 1-, 3- and 5-year survival rates were 67%, 34% and 18%, respectively, after PH and 62%, 54% and 54% after OLT. The only prognostic factor after PH was the tumor extension to a single or both lobes. Patients with associated cirrhosis had significantly more post-operative complications, but a comparable long-term survival. The proliferative cell nuclear antigen labeling index (PCNA-LI), evaluated on tumoral tissue in 16 patients, showed that an index <30% indicates a better prognosis for HCC developing in non-cirrhotic liver. CONCLUSIONS For patients carefully pre-operatively evaluated, the presence of an associated cirrhosis does not seem to modify the long-term survival after PH, and OLT may offer more than 50% 5-year survival. A PCNA-LI <30% appears to be a good prognostic factor in patients without cirrhosis.
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Affiliation(s)
- J Closset
- Medicosurgical Department of Gastroenterology, Hôpital Erasme, Université Libre de Bruxelles, Belgium
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26
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Cuillerier E, Cellier C, Palazzo L, Deviere J, Rickaert F, Flejou JF, Van de Stadt J, Landi B, Parc R, Cremer M, Cugnenc PH, Barbier JP. [Intraductal papillary mucinous tumors of the pancreas: are there any preoperative clinical and laboratory factors predictive of degeneration. Results of a French-Belgium collective series]. Ann Chir 1998; 52:215-22. [PMID: 9752448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Intraductal papillary and mucinous tumors are rare. We retrospectively analysed clinical, surgical and histological features and outcome of 41 operated patients (29 males, 12 females, mean age = 63 years). The commonest presenting manifestation was acute pancreatitis (41%). Tumor was located in only one pancreatic segment in 45% cases. Forty one per cent of patients had invasive carcinoma, 20% had tumor with severe dysplasia and 39% with minimal or moderate dysplasia. Only elevated age was significantly associated with invasive carcinoma. Eleven out of 17 patients with invasive carcinoma (65%) had a recurrence after surgery and 6 (35%) died. Among 24 patients with noninvasive tumor, 2 (8%) recurred without tumor-related death in the follow-up (48 months). This study underlines the need for early surgical resection in patients with intraductal papillary and mucinous tumor because of the high frequency of invasive carcinoma and the poor outcome of patients with invasive carcinoma.
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Affiliation(s)
- E Cuillerier
- Service Médico-Chirurgical d'Hépato-Gastroentérologie, Hôpital Laënnec, Paris
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27
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Salari GR, Peny MO, Van de Stadt J, Donckier V, Zalcman M, Gelin M. Late liver metastases of small bowel leiomyoma. The difficulty in assessing malignancy in gastro-intestinal smooth muscle tumours. Acta Chir Belg 1998; 98:107-9. [PMID: 9689967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Two cases of small bowel tumour, resected and considered as benign leiomyomas, are reported. Both developed late hepatic metastases, 6 and 8 years after surgery respectively, diagnosed as leiomyosarcoma. Emphasizing the difficulties in assessing malignancy of these tumours and considering local and far dissemination, a long-term follow-up is recommended after surgical resection.
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Affiliation(s)
- G R Salari
- Department of Digestive Surgery, Université Libre de Bruxelles, Belgium
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28
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Donckier V, Van de Stadt J, Goldman M, Gelin M. Tolerance in liver transplantation: facts and perspectives. Acta Chir Belg 1997; 97:273-6. [PMID: 9457316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Today, liver transplantation is the treatment of choice for most of the patients with endstage liver failure. Nevertheless, immunosuppressive regimens are not yet optimal; rejection still represents the first cause of graft loss, and infections and malignancies related to the non specific immunosuppression are a major source of morbidity and mortality. Therefore, the development of protocols aiming to induce transplantation tolerance--the survival of the graft without immunosuppression--represents a crucial challenge for the future. In the present report, we discuss two different approaches in this perspective. First, as compared with other organ, liver graft may present a particular propension to induce chimerism. As this phenomenon could promote allograft survival, the enhancement of chimerism by administration of donor cells, simultaneously with the transplantation, may constitute a new therapeutic strategy to induce tolerance. Second, experimental observations indicate that the initiation of the immune reaction in the liver may preferentially induce a TH2-type response. As TH2 lymphocytes are poor effector of acute rejection, this phenomenon could contribute to the spontaneous survival of liver graft and their tolerogenic effect observed under some experimental conditions. However, the capacity of TH2 cells to induce lymphoproliferative disease and their possible role in chronic rejection will probably represent a major limitation for clinical use of this strategy.
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Affiliation(s)
- V Donckier
- Department of Digestive Surgery, Hôpital Erasme, Universtité Libre de Bruxelles, Belgium
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29
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Adler M, Verset D, Bouhdid H, Bourgeois N, Gulbis B, Le Moine O, Van de Stadt J, Gelin M, Thiry P. Prognostic evaluation of patients with parenchymal cirrhosis. Proposal of a new simple score. J Hepatol 1997; 26:642-9. [PMID: 9075673 DOI: 10.1016/s0168-8278(97)80431-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS The current shortage of organs makes it desirable to establish the prognosis of patients with cirrhosis in order to assess priority for liver transplantation. METHODS We compared the utility of two exogenous tests (aminopyrine breath test and lidocaine metabolization test), two clinical parameters (encephalopathy, ascites), 18 endogenous tests and five scores (Pugh, Merkel, Orrego, Adler, Pignon) for predicting 1-year mortality in patients with parenchymal cirrhosis. Retrospective (n=49 out of 63 patients) and prospective (n=38 out of 46 patients) series were included. Univariate, multivariate, receiver operator curves and survival curves were employed. RESULTS We found that endogenous tests were more discriminant than exogenous tests. The best parameters of the univariate analysis (encephalopathy, bilirubin, alkaline phosphatase, cholinesterase and bile acids) and their 25th and 75th percentiles were included in an additive new score which turned out to be superior to the five other scores. Prospectively, the sensitivity of our new score compared to the Pugh score was 82% versus 95% (NS) and the specificity was 89% versus 56% (p<0.01). CONCLUSIONS Our new simple score appears to be very powerful for predicting prognosis at 1 year for patients with cirrhosis and should be evaluated in other centers.
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Affiliation(s)
- M Adler
- Medico-surgical Department of Gastroenterology and Hepato-Pancreatology, Hospital Erasme, Brussels, Belgium
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30
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Rypens F, Devière J, Zalcman M, Braudé P, Van de Stadt J, Struyven J, Van Gansbeke D. Splenic parenchymal complications of pancreatitis: CT findings and natural history. J Comput Assist Tomogr 1997; 21:89-93. [PMID: 9022775 DOI: 10.1097/00004728-199701000-00016] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Splenic parenchymal complications of pancreatitis are unusual and potentially life threatening. They usually require splenectomy in patients in poor condition. The present study describes natural history of splenic parenchymal complications and the role of CT scan in diagnosis and follow-up. METHOD A retrospective study of 16 consecutive patients with splenic complications diagnosed by CT during staging of pancreatitis was performed. The presence and importance of splenic infarct, abscess, subcapsular collection, and hemoperitoneum were correlated with the patients' symptoms, type of management, and follow-up. RESULTS No specific symptomatology was observed except in two cases of acute and massive hemoperitoneum. Fourteen infarcts, 11 subcapsular collections, 1 abscess, and 3 hemoperitoneums were observed. Four patients underwent splenectomy including two as an emergency for hemodynamic instability. Twelve patients were conservatively and successfully managed. CONCLUSION Most splenic parenchymal complications of pancreatitis regress spontaneously and may be managed conservatively. Surgical indication is based mainly on clinical findings. CT is useful for detection and follow-up of these complications.
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Affiliation(s)
- F Rypens
- Department of Radiology, Erasme Hospital, Brussels, Belgium
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31
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Huynh CH, Van de Stadt J, Devière J, Mehdi A, el Nakadi I, Cremer M, Lambilliotte JP, Gelin M. Preoperative endoscopic retrograde cholangiopancreatography: therapeutic impact in a general population of patients needing a cholecystectomy. Hepatogastroenterology 1996; 43:1484-91. [PMID: 8975953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND/AIMS The place of endoscopic retrograde cholangiopancreatography (ERCP) before open or laparoscopic cholecystectomy remains controversial. Most of the reports study highly selected series of patients and therefore do not give a survey of the actual situation in a general population. We describe here the therapeutic impact of preoperative ERCP in a continuous cohort of patients needing a cholecystectomy. MATERIAL AND METHODS Data concerning a 2-year continuous and unselected series of 452 patients undergoing cholecystectomy were evaluated. RESULTS Two hundred ninety-three patients (65%) presented with a chronic symptomatic biliary lithiasis and 159 patients (35%) with a complicated biliary lithiasis. A preoperative ERCP was performed in 206 patients, all presenting with a suspicion of associated lithiasis of the common bile duct (CBD). An endoscopic sphincterotomy was performed in 106 patients: 44 patients presented with CBD stones (9.7%), all successfully cleared by endoscopy. Laparoscopic cholecystectomy has been attempted in 367 patients (81%) and successfully performed in 333 patients (74%). Laparotomy as a first-choice procedure was performed in 85 patients (19%). Surgical choledochotomy was never performed. Postoperative ERCP was needed in 4 patients (0.88%) and in only 1 of them for a retained CBD stone (0.22%). CONCLUSIONS In a continuous series of patients needing a cholecystectomy, preoperative ERCP was performed on the basis of suspected CBD disorders. It allows CBD stone detection and extraction in almost 10% of the patients and avoids peroperative CBD exploration, with a very low rate of retained stones after surgery. The association of preoperative ERCP with subsequent laparoscopic cholecystectomy (when feasible) offers the patient a quick recovery and a short hospital stay.
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Affiliation(s)
- C H Huynh
- Department of Medicosurgical Gastroenterology Erasme Hospital, Université Libre de Bruxelles, Belgium
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32
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Mboti B, Van de Stadt J, Carlier Y, Peny M, Jacobs F, Bourgeois N, Adler M, Gelin M. Long-term disease-free survival after liver transplantation for alveolar echinococcosis. Acta Chir Belg 1996; 96:229-32. [PMID: 8950386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Alveolar echinococcosis of the liver is an uncommon and fatal disease resulting from hepatic infection by Echinococcus multilocularis. Liver transplantation has been proposed for unresectable cases with chronic complications, but up to now, no long-term follow-up has been reported. We report the case of a 29-year-old female who is disease-free more than six years after liver transplantation for a recurrent alveolar echinococcosis of the liver, confirming the place for liver transplantation in this disorder.
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Affiliation(s)
- B Mboti
- Department of Medicosurgical Gastroenterology and Liver Transplantation, Erasme Hospital, Université Libre de Bruxelles, Belgium
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33
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Azar C, Van de Stadt J, Rickaert F, Devière M, Baize M, Klöppel G, Gelin M, Cremer M. Intraductal papillary mucinous tumours of the pancreas. Clinical and therapeutic issues in 32 patients. Gut 1996; 39:457-64. [PMID: 8949654 PMCID: PMC1383356 DOI: 10.1136/gut.39.3.457] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND/AIM The clinical presentation, pancreatographic findings, and outcome of patients with intraductal papillary mucinous tumours have not been reported in a large patient series in the English literature. This study reviewed 32 patients diagnosed between 1980 and 1994, with special attention to these features. PATIENTS/METHOD Data on 24 operated and eight non-operated patients were abstracted from inpatient, outpatient, and procedure records. RESULTS Acute pancreatitis was the most common presentation seen in 56% of patients. Relapses occurred during an average of 43 months before diagnosis. A patulous papilla was observed in 55% of the cases. Endoscopic pancreatography showed communicating cysts, a diffusely dilated main pancreatic duct, and amorphous defects in 42, 71, and 97% respectively. An invasive carcinoma was found in nine of 24 (37.5%) of operated patients: six of the patients (66%) died or developed metastases within three years after surgery. No mortality was related to the tumour in absence of invasive carcinoma. Benign recurrence on the remaining pancreas was unusual and occurred late after surgery. CONCLUSIONS Intraductal papillary mucinous tumours must be considered in the differential diagnosis of relapsing pancreatitis. Despite slow growing, these tumours have an obvious malignant potential and a very poor prognosis when invasive carcinoma has developed. Early recognition and resection are the cornerstones of treatment.
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Affiliation(s)
- C Azar
- Department of Medico-Surgical Hepato-Gastroenterology, Université Libre de Bruxelles, Belgium
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34
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Detry O, Van Damme H, Van de Stadt J. Guidelines for authors of medical scientific manuscripts. Acta Chir Belg 1996; 96:140-3. [PMID: 8830867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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35
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Van de Stadt J, Van Damme H. The Royal Society for Surgery. Acta Chir Belg 1996; 96:49-50. [PMID: 8686400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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36
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Elnakadi I, Adler M, Closset J, Bourgeois N, Lemoine O, Van de Stadt J, Gelin M. [Current indications for liver transplantation in adults]. J Med Liban 1996; 44:80-5. [PMID: 9091632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- I Elnakadi
- Service médico-chirurgical d'hépato-gastro-entérologie, Hôpital Erasme, ULB, Bruxelles, Belgique
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37
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Herbaut AG, Van de Stadt J, Panzer JM, Lalmand B, Crick DH. Paradoxical contraction of pelvic floor muscles: clinical significance. Acta Gastroenterol Belg 1994; 57:13-8. [PMID: 8191853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Paradoxical contraction of pelvic floor muscles during defecation straining has been said to be a cause of constipation and difficulty in passing feces. Nevertheless, controversies about its clinical significance still remained. Twenty patients with constipation and electromyographic evidence of paradoxical contraction of both puborectalis and external anal sphincter were investigated. An anorectal manometry performed in 17 confirmed the paradoxical contraction in 13 (76%). Electromyography revealed neurogenic signs in 11. Defecography demonstrated the paradoxical contraction in 6 only, but, together with barium enema and colon transit time, showed associated anorectal disorders in 9 patients. Twenty control patients were also studied. None had difficulty defecating. Nevertheless, 8 of them (40%) had paradoxical contraction. These observations suggest that paradoxical contraction of pelvic floor muscles may by asymptomatic and that another cause of emptying difficulties has always to be looked for.
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Affiliation(s)
- A G Herbaut
- Department of Neurology, Hôpital Erasme, Bruxelles, Belgium
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38
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Bourgeois N, Jacobs F, Tavares ML, Rickaert F, Deprez C, Liesnard C, Moonens F, Van de Stadt J, Gelin M, Adler M. Listeria monocytogenes hepatitis in a liver transplant recipient: a case report and review of the literature. J Hepatol 1993; 18:284-9. [PMID: 8228121 DOI: 10.1016/s0168-8278(05)80271-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Listeria is an uncommon cause of hepatitis in adults. We report the case of a liver transplant recipient who presented with a clinical picture of acute hepatitis, 8 months after grafting. Blood cultures yielded Listeria monocytogenes. The patient made a full clinical recovery after adequate antimicrobial therapy (ampicillin and gentamicin intravenously for 4 weeks). Hepatitis was attributed to the Listeria infection. We believe this is the first reported case of Listeria hepatitis in an organ transplant recipient.
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Affiliation(s)
- N Bourgeois
- Department of Gastroenterology, Universite Libre de Bruxelles, Belgium
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39
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Closset J, Gelin M, el Nakadi I, Van de Stadt J, Lambilliotte JP. Results of surgical resection for hepatocellular carcinoma. Acta Chir Belg 1993; 93:98-101. [PMID: 8396830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
During the past 13-years, 35 patients with hepatocellular carcinoma (HCC) were treated by hepatic resection. There were 11 females and 24 males, the age ranged from 17 to 82 years with a mean of 59 years. HCC was associated with liver cirrhosis in 17 patients (48%). Fifteen patients underwent a major hepatectomy, 18 patients a partial hepatectomy (single or bisegmentectomy) and 2 patients had a wedge resection. One patient presenting with a spontaneous tumor rupture died immediately after surgery. Out of the 34 others, 3 died in the postoperative period (8.8%). Early complications occurred in 57% of the patients. The actuarial 5-years survival rate is 30%. The only prognostic factor is tumor extension to a single or both lobes. A significant difference in the survival rate has been observed between patients with or without underlying cirrhosis. Our experience suggest that long-term survival can be expected after surgical resection for HCC.
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Affiliation(s)
- J Closset
- Service de Chirurgie Digestive, Hôpital Erasme, Université Libre de Bruxelles, Belgique
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40
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Abstract
Twenty-four-hour systolic blood pressure, diastolic blood pressure, and heart rate profiles were recorded in 17 liver-transplanted patients by noninvasive ambulatory monitoring and were analyzed with the periodogram method. These recordings were compared with those of control subjects matched for age, sex, and daytime ambulatory blood pressure. Abnormal blood pressure patterns were found in seven of the 17 patients, whereas the other 10 patients had circadian blood pressure profiles that were not different from those of control subjects. These two groups of liver-transplanted patients did not differ in age, sex, oral dose of cyclosporine, specific serum cyclosporine level, and proportion of patients receiving azathioprine and antihypertensive medications. In contrast, the daily oral dose of prednisolone was significantly higher (p < 0.001) in the seven patients with abnormal circadian blood pressure patterns. Moreover, only the daily oral dose of prednisolone was inversely correlated with the magnitude of the nighttime systolic and diastolic blood pressure decrease (r = -0.64 and r = -0.66, p < 0.01). In contrast to blood pressure, patients and control subjects had similar circadian heart rate variations. We conclude that exogenous glucocorticoid administration may have a dose-dependent effect on the nighttime blood pressure fall and may play an important role in the pathogenesis of the abnormal circadian blood pressure profiles observed in liver-transplanted patients.
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Affiliation(s)
- P van de Borne
- Hypertension Clinic, Hôpital Erasme, Université Libre de Bruxelles, Belgium
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41
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Van Laethem JL, Bourgeois N, Gelin M, Jacobs F, Peny MO, Van de Stadt J, Van Gossum A, Vereerstraeten P, Adler M. Digestive tract infections in kidney and liver transplantation in a single institution. Transplantation 1993; 55:433-5. [PMID: 8434398 DOI: 10.1097/00007890-199302000-00038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- J L Van Laethem
- Medico-Surgical Department of Hepato-gastroenterology, Erasme Hospital, Free University of Brussels, Belgium
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42
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Jacobs F, Byl B, Bourgeois N, Coremans-Pelseneer J, Florquin S, Depré G, Van de Stadt J, Adler M, Gelin M, Thys JP. Trichoderma viride infection in a liver transplant recipient. Mycoses 1992; 35:301-3. [PMID: 1302802 DOI: 10.1111/j.1439-0507.1992.tb00880.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A liver transplant recipient developed infection of a perihepatic haematoma due to Trichoderma viride. Before the infection was diagnosed, the patient received intense immuno-suppressive and prolonged antibacterial and anti-fungal therapies. Although the death of the patient was not directly related to the fungal infection, abundant quantities of this pathogen were recovered in the haematoma at post-mortem examination, despite previous surgical removal and treatment with amphotericin B and fluconazole.
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Affiliation(s)
- F Jacobs
- Infectious Diseases Clinic, Erasme University Hospital, Brussels, Belgium
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43
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Abstract
Splenic complications of acute pancreatitis are rare. We describe a spontaneous subcapsular splenic laceration during an episode of acute pancreatitis, without any evidence of one of the currently reported predisposing factors. Its spontaneous resolution suggests that conservative therapy can be proposed in such complications.
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Affiliation(s)
- V Donckier
- Department of Digestive Surgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Bourgeois F, Bourgeois N, Gelin M, Van de Stadt J, Doutrelepont JM, Adler M. [Acute hepatitis and poisoning by Amanita phalloides]. Acta Gastroenterol Belg 1992; 55:358-63. [PMID: 1462748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report the case of a 69-year-old woman who presented acute hepatitis due to Amanita Phalloides poisoning complicated of acute renal failure. Her clinical evolution was favorable under medical treatment whose actual modalities are discussed.
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Affiliation(s)
- F Bourgeois
- Service de Gastro-Entérologie Médico-Chirurgical, Hôpital Erasme, Bruxelles, Belgique
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Bourgeois N, Bourgeois F, Le Moine O, Van de Stadt J, Adler M. [Prevention and treatment of digestive hemorrhage due to ruptured esophageal varices in patients with cirrhosis]. Acta Gastroenterol Belg 1992; 55:369-79. [PMID: 1361090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
1) Emergency treatment. The best treatment remains endoscopic sclerotherapy, which controls the bleeding in 90% of the cases. Pharmacologic management stops the variceal hemorrhage in 80% of the cases and is indicated before endoscopic treatment can be performed. Intravenous somatostatin administration may be prolonged for 5 days, even more, and may thus prevent early rebleeding, which is not achieved neither by vasopressin nor by glypressin, which administration is restricted to 24 hours. Esophageal tamponade is useful to arrest a massive variceal bleeding, if vasoactive drugs are not available or not efficient, before endoscopic management. If the bleeding persists after 2 sclerotherapy sessions, an alternative treatment is mandatory: the patient should be sent to the surgeon for a portosystemic shunt if the operative risk is acceptable (child A and B) or should become a candidate for a transjugular intrahepatic stent shunt, especially if transplantation is considered afterwards. 2) Prevention of recurrent hemorrhage. A) Early (within 5 days after the initial bleeding). Somatostatin probably prevents early rebleeding, as do sclerotherapy. B) Late. B blockade (+ nitrates) or long-term sclerotherapy have the same efficacy. Their association may improve their results. 3) Prevention of the first bleeding episode. Propranolol decrease the risk of variceal rupture from 20% to 9% during the first year after the diagnosis of esophageal varices and is the only treatment which may be proposed to cirrhotics who did not yet bled form their varices.
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Affiliation(s)
- N Bourgeois
- Service Médico-Chirurgical de Gastroentérologie, ULB, Hôpital Erasme, Bruxelles, Belgique
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Jacobs F, Van de Stadt J, Gelin M, Nonhoff C, Gay F, Adler M, Thys JP. Mycoplasma hominis infection of perihepatic hematomas in a liver transplant recipient. Surgery 1992; 111:98-100. [PMID: 1728082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We report the case of a recipient of liver transplantation in whom postoperative perihepatic hematomas were infected by Mycoplasma hominis. Etiologic diagnosis was delayed because this organism is a rare cause of postoperative infection and usually does not grow on standard bacteriologic media. The role of M. hominis in postoperative infections and the diagnostic problems of this organism are discussed.
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Affiliation(s)
- F Jacobs
- Department of Digestive Surgery, Erasme University Hospital, Brussels, Belgium
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Geubel A, de Hemptinne B, Reynaert M, Otte JB, Van de Stadt J, Bourgeois N, Adler M, Gelin M. [Acute hepatic insufficiency: medico-surgical therapeutic approach]. Acta Gastroenterol Belg 1991; 54:239-41. [PMID: 1792839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- A Geubel
- Cliniques Universitaires Saint Luc, UCL
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Sahel J, Van de Stadt J. [Cysto-enterostomy in chronic pancreatitis]. Acta Gastroenterol Belg 1991; 54:287-9l. [PMID: 1792848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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49
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Van de Stadt J, Gelin M, Jacobs F, Bourgeois N, Lambert M, Adler M, Lambilliotte JP. Use of somatostatin for complications occurring after liver transplantation. Transplant Proc 1990; 22:2257-60. [PMID: 1699335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Somatostatin can be helpful after liver transplantation in some well-defined indications. In uncontrolled digestive haemorrhage, a short course of somatostatin therapy can be of great help in controlling the acute bleeding and to avoid emergency laparotomy. Somatostatin could also be helpful in bilio-pancreato-intestinal fistula, but in this case its advantage over elective surgical treatment remains to be confirmed.
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Affiliation(s)
- J Van de Stadt
- Department of Digestive Surgery, Hôpital Erasme, Université Libre de Bruxelles, Belgium
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Van de Stadt J, Gelin M, Bourgeois N, De Prez C, Adler M, Lambilliotte JP. Liver transplantation for fulminant and subacute viral hepatic failure in adults. Transplant Proc 1990; 22:1505-8. [PMID: 2389382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In our early experience, orthotopic liver transplantation was found to be successful in fulminant and subacute hepatic failure due to viral hepatitis in adults, with 66% 1-year survival rate. In the future, more accurate prognostic criteria would probably improve overall survival rate in acute hepatic failure, by allowing better and earlier selection of patients requiring liver transplantation.
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Affiliation(s)
- J Van de Stadt
- Department of Digestive Surgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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