References of "Acta Chirurgica Belgica"
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See detailAxillary artery injury secondary to anterior shoulder dislocation: report of two cases.
MAWEJA, Sylvie ULg; SakalihasanN, Natzi ULg; VAN DAMME, Hendrik ULg et al

in Acta Chirurgica Belgica (2002), 102(3), 187-91

Vascular injuries secondary to isolated shoulder dislocation are rare. Unawareness for closed axillary artery trauma by many physicians treating shoulder dislocations, counts often for missed or delayed ... [more ▼]

Vascular injuries secondary to isolated shoulder dislocation are rare. Unawareness for closed axillary artery trauma by many physicians treating shoulder dislocations, counts often for missed or delayed diagnosis. The authors describe two cases that presented with an anterior shoulder dislocation, complicated by a disruption of the axillary artery with subsequent thrombosis. The various pathogenic mechanisms are discussed. The pathognomic triad consists of anterior shoulder dislocation, absent or diminished distal pulse and an axillary protruding hematoma. Prompt surgical arterial repair is mandatory. [less ▲]

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See detailAmputations in Diabetic Patients: A Plea for Footsparing Surgery
Van Damme, Hendrik ULg; Rorive, Marcelle ULg; Martens De Noorthout, B. M. et al

in Acta Chirurgica Belgica (2001), 101(3, May-Jun), 123-9

The authors observed a rather high rate of primary major amputation (above-knee or below-knee) performed for diabetic foot problems as well as an important revision rate for minor amputations (forefoot or ... [more ▼]

The authors observed a rather high rate of primary major amputation (above-knee or below-knee) performed for diabetic foot problems as well as an important revision rate for minor amputations (forefoot or toe) in diabetics. They reviewed their experience in order to compare it with more recent data from the literature, pleading for foot-sparing surgery. From 1993 to 1998, 186 amputations were performed on 146 diabetic patients. The cause of foot ulcers was neuropathy in 43 of them (51 episodes of diabetic foot problems) while in the remaining 103 patients (135 episodes of diabetic foot problems), diabetic macroangiopathy (absent ankle pulses) was on cause. For neuropathic foot problems, amputations were almost minor, resulting in a limb salvage rate of 90%. Only five of these patients (12%) had primary major limb amputation versus 43 of the dysvascular patients (42%). The reasons for major amputation by first intention were extensive tissue loss, intractable infection or non-reconstructible occlusive vessel disease, as judged by the surgeon. A foot-sparing surgery was attempted in 92 dysvascular cases. In only 44 of them, a preliminary vascular repair was performed. Twenty eight percent of the primary toe amputations and 24% of the forefoot amputations required secondary revision to a more proximal level. Minor amputations in case of diabetic neuropathy were characterized by a more favourable outcome: only 14% of the toe and 9% of the forefoot amputations failed. During follow-up, only 63% of the major amputations regained an autonomic walking capability with their prosthesis. Wound healing problems in diabetic foot are mainly due to infection and poor tissue perfusion. An aggressive control of the infection and distal revascularization of calf- or foot arteries, whenever possible, could improve the results of diabetic foot surgery. The poor functional recovery after major amputation (only 63% autonomic gait with limb prosthesis) argues for foot-sparing surgery whenever possible. [less ▲]

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See detailIatrogenic thyrotoxicosis. Causal circumstances, pathophysiology and principles of treatment. Review of the literature
Meurisse, Michel ULg; Preud'Homme, Laurence ULg; Lamberty, Geoffrey ULg et al

in Acta Chirurgica Belgica (2001), 101(6), 257-266

Thyrotoxicosis is the clinical syndrome that results when tissues are exposed to high levels of circulating thyroid hormones. In most instances, thyrotoxicosis is due to hyperthyroidism, a term reserved ... [more ▼]

Thyrotoxicosis is the clinical syndrome that results when tissues are exposed to high levels of circulating thyroid hormones. In most instances, thyrotoxicosis is due to hyperthyroidism, a term reserved for disorders characterized by overproduction of thyroid hormones by the thyroid gland. Nevertheless, thyrotoxicosis may also result from a variety of conditions other than thyroid hyperfunction. The present report focuses on the etiologies, pathophysiology and treatment of iatrogenic thyrotoxicosis. Iatrogenic thyrotoxicosis may be caused by 1) subacute thyroiditis (a result of lymphocytic infiltration, cellular injury, trauma or radiation) with release of preformed hormones into circulation, 2) excessive ingestion of thyroid hormones ("thyrotoxicosis factitia"), 3) iodine-induced hyperthyroidism (radiological contrast agents, topical antiseptics or other medications). Among these causes of iatrogenic thyrotoxicosis, that induced by the iodine overload and cytotoxicity associated with amiodarone represents a significant challenge. Successful management of amiodarone-induced thyrotoxicosis requires close cooperation between endocrinologists and endocrine Surgeons. Surgical treatment may have a leading yet often underestimated role in view of the potential life-threatening severity of this disease, whereas others kinds of iatrogenic thyrotoxicosis are usually treated conservatively. [less ▲]

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See detailNicardipine Protocol for Cabg Using the Radial Artery Clinical and Angiographic Data
RADERMECKER, Marc ULg; Grenade, Thierry ULg; Cao-Thian, S. K. et al

in Acta Chirurgica Belgica (2001), 101(4, Jul-Aug), 185-9

The routine use of arterial grafts in coronary surgery is facilitated by peroperative adjunction of antispasmodic drug to reduce the event of spasm. Diltiazem has been favoured in most clinical studies ... [more ▼]

The routine use of arterial grafts in coronary surgery is facilitated by peroperative adjunction of antispasmodic drug to reduce the event of spasm. Diltiazem has been favoured in most clinical studies devoted to the radial artery graft. The aim of this study was to assess the efficacy of a spasm preventing protocol associating hydrostatic dilation of the graft with a diluted solution of papaverine and nicardipine infusion, starting preoperatively and continued postoperatively in i.v. and per os forms. Between September 1996 and March 1997, a consecutive series of 50 patients underwent myocardial revascularization using the radial artery. The radial artery was prepared by hydrostatic dilation with papaverine (1%) and nicardipine was administrated at 0.25 microgram/kg/min and titrated according to the arterial systemic pressure. Operative mortality was 4% (sepsis). There was no evidence of perioperative MI nor hypoperfusion syndrome. Mean CKMB level at 18 hours was 36 micrograms/l. No ischaemic anomalies of the ECG were detected. Angiography performed in the last 20 patients showed a 98% (51/52) permeability rate for all graft; 19/20 radial grafts (95%) were patent. One radial graft presented a 50% stenosis at the proximal anastomosis, and another a moderate spasm (40%) in the middle part of the conduit. This study confirms that the radial artery conduit can be used with satisfactory results for routine coronary artery bypass. The use of nicardipine allows the control the vasoreactivity of the radial graft without totally obviating at least angiographic spasm. This drug is easy to titrate, and well tolerated in association to beta-blockers in the routine perioperative management of the coronary patients. [less ▲]

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See detailRupture of a Thoracic Aneurysm in the Left Bronchus
SCHILS, F.; Deprez, A. F.; CREEMERS, Etienne ULg et al

in Acta Chirurgica Belgica (2000), 100(2), 74-6

Aortobronchic fistula is a very unusual complication of thoracic aneurysm. We report the case of a 71-year old man with rupture of a thoracic aortic aneurysm in the left main bronchus. The patient had ... [more ▼]

Aortobronchic fistula is a very unusual complication of thoracic aneurysm. We report the case of a 71-year old man with rupture of a thoracic aortic aneurysm in the left main bronchus. The patient had suffered a car crash fifteen years ago, without any evidence of aortic rupture at the time. Thereafter, he developed an aortic isthmic dilation (36 mm in diameter). The patient suffered from long standing pulmonary insufficiency and emphysema and was admitted several times on an urgent basis for acute dyspnea. During an hospitalization for respiratory distress, he presented haemoptysis and left lung hyperinflation secondary to partial fistulization and extrinsic compression of the main left bronchus. Isthmic aortic resection and prosthetic grafting was performed and the left main bronchus was closed by an autologous pericardial patch. Ten days later, following an air-leak from the bronchial closure, a transposed latissimus dorsi flap was used by the plastic surgeon to repair the defect. Nevertheless, the patient died from multisystemic failure six weeks later. [less ▲]

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See detailThe Inferior Non Recurrent Laryngeal Nerve: A Major Surgical Risk During Thyroidectomy
Defechereux, Thierry ULg; Albert, V.; Alexandre, j et al

in Acta Chirurgica Belgica (2000), 100(2, Mar-Apr), 62-7

It is now widely established that systematic intraoperative location and diligent dissection of the recurrent inferior laryngeal nerve during thyroidectomy are the keystones to assure its anatomic and ... [more ▼]

It is now widely established that systematic intraoperative location and diligent dissection of the recurrent inferior laryngeal nerve during thyroidectomy are the keystones to assure its anatomic and functional preservation. The possibility of abnormal routes, like a non-recurrent cervical course of the inferior laryngeal nerve is an additional major argument for its systematic identification to avoid surgical damage. In 2517 cervicotomies performed between 1992 and 1997 for at least right thyroid lobe excision or parathyroid glands exploration, 20 cases of non recurrent laryngeal nerve were identified (0.79%). The embryological nature of such a nervous anatomical variation results originally from a vascular disorder, named arteria lusoria in which the fourth right aortic arch is abnormally absorbed, being therefore unable to drag the right recurrent laryngeal nerve down when the heart descends and the neck elongates during embryonic development. The surgeon must be aware of the possibility of a non recurrent laryngeal nerve, which arises directly from the cervical vagus and therefore represents a severe potential pitfall during thyroidectomy. Given the absence of reliable clinical symptoms and signs or investigations indicating preoperatively the possibility of a non recurrent nerve, guidelines are given to prevent intraoperatively this major surgical risk. [less ▲]

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See detailAssessment of Complex Perineal Fistulas
Bruyninx, Luc ULg; Meunier, Paul ULg

in Acta Chirurgica Belgica (2000), 100(3, May-Jun), 115-7

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See detailRenal Artery Occlusion Following Blunt Abdominal Trauma
Elen, Philippe ULg; Ozlu, E.; SakalihasanN, Natzi ULg et al

in Acta Chirurgica Belgica (2000), 100(3, May-Jun), 107-10

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See detailComparison between Open and Closed Repair for Abdominal Aortic Aneurysms: A Word of Caution
Limet, Raymond ULg; CREEMERS, Etienne ULg

in Acta Chirurgica Belgica (2000), 100(1), 12-5

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See detailIschaemic Colitis Following Aortoiliac Surgery
VAN DAMME, Hendrik ULg; CREEMERS, Etienne ULg; Limet, Raymond ULg

in Acta Chirurgica Belgica (2000), 100(1), 21-7

Ischaemic colitis following aortoiliac surgery is a feared complication. Its frequency varies from 7% after repair of ruptured abdominal aortic aneurysm (AAA) to 0.6% after bypass for aortoiliac occlusive ... [more ▼]

Ischaemic colitis following aortoiliac surgery is a feared complication. Its frequency varies from 7% after repair of ruptured abdominal aortic aneurysm (AAA) to 0.6% after bypass for aortoiliac occlusive disease (AOD). In order to analyse predisposing factors and outcome of ischaemic colitis, the authors reviewed their clinical experience from 1988 to 1998. It concerns 28 cases (16 ruptured AAA, 7 elective AAA, 5 OAD) of clinically evident colonic ischaemia. This means an incidence of 7% after repair of ruptured AAA, 0.6% after elective AAA repair, and 0.8% after bypass for AOD. Transmural necrosis (grade 3) was observed in 21 patients, grade 2 ischaemia in 5 patients, and grade 1 ischaemia in 2 patients. Fifteen patients with grade 3 ischaemia underwent colectomy (Hartmann's procedure) with a mortality rate of 66%. All non operated grade 3 patients died. Overall, 16 of the 28 patients died at hospital (57% mortality rate). None of the patients with mild (grade 2 or 1) colonic ischaemia died. Profound hypovolaemic shock and inflammatory AAA were the only significant predisposing factors leading to colonic ischaemia. Associated colon revascularization could not avoid the evolution to colon necrosis in four patients. Reimplantation of a patent inferior mesenteric artery or an internal iliac artery was performed in only 4.8% of all aortoiliac reconstructions, and did not influence the development of ischaemic colitis. The authors conclude that a more liberal use of postoperative sigmoidoscopy could allow detecting colonic ischaemia at an earlier stage and reduce ensuing mortality. A reinforced effort to restore or preserve colonic vascularization could lower the incidence of colonic ischaemia following aortoiliac surgery. [less ▲]

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See detailLaparoscopic Live Donor Nephrectomy: Initial Experience
Defechereux, Thierry ULg; Hamoir, Etienne ULg; Detry, Olivier ULg et al

in Acta Chirurgica Belgica (1999), 99(4), 179-81

Transplanting a kidney graft harvested from a live donor has been proposed and used to shorten the waiting time of kidney transplant candidates and to increase the graft pool. Live donor renal transplants ... [more ▼]

Transplanting a kidney graft harvested from a live donor has been proposed and used to shorten the waiting time of kidney transplant candidates and to increase the graft pool. Live donor renal transplants have demonstrated better results in term of graft survival rates, compared to renal transplants harvested from brain dead donor. Recently, laparoscopic live donor nephrectomy has been introduced to reduce the live procurement morbidity. This lower morbidity may result in increased acceptance of the donor operation. We initiated a program of laparoscopic live donor nephrectomy in January 1997 and up until June 1998, three cases were successfully performed in our department. The purpose of this paper was to report the first case of this program and its first year of follow-up. [less ▲]

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See detailTypical Presentation of Intramural Aortic Haemorrhage (Iah) with Evidence of Intimal Tear at Mri and Angiography
RADERMECKER, Marc ULg; LAVIGNE, Jean-Paul ULg; Limet, Raymond ULg

in Acta Chirurgica Belgica (1999), 99(1), 44-6

A typical appearance of IAH was evidenced by CT and TEE in a 56-year-old hypertensive female suspected of developping classical acute aortic dissection (AAD). Further examination with MRI and aortography ... [more ▼]

A typical appearance of IAH was evidenced by CT and TEE in a 56-year-old hypertensive female suspected of developping classical acute aortic dissection (AAD). Further examination with MRI and aortography showed unequivocally the presence of an intimal tear in the aortic arch. This coexistence of intimal tear has never been evidenced preoperatively in patients with IAH. This observation demonstrates at the outset that IAH is part of the spectrum of AAD. [less ▲]

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See detailAnalysis of Factors Influencing Long-Term Survival after Surgical Resection for Oesophageal Squamous Cell Carcinoma
Kolh, Philippe ULg; Honore, Pierre ULg; Gielen, J. L. et al

in Acta Chirurgica Belgica (1999), 99(3, May-Jun), 113-8

OBJECTIVE: We evaluated prognostic factors in 34 patients discharged from hospital after surgical resection for oesophageal squamous cell carcinoma. MATERIAL AND METHODS: There were 22 males and 12 ... [more ▼]

OBJECTIVE: We evaluated prognostic factors in 34 patients discharged from hospital after surgical resection for oesophageal squamous cell carcinoma. MATERIAL AND METHODS: There were 22 males and 12 females; mean age was 59.3 years (range 42-77 years). Preoperative neoadjuvant treatment consisted in chemotherapy alone in three patients and in combined radiochemotherapy in 14. Digestive continuity was restored with a gastric transplant in 26 patients and a colonic graft in 8. Surgery was curative in 28 patients and palliative in 6. There were three stage I, 14 stage II, 13 stage III, and 4 stage IV diseases. In 19 patients the lymph nodes were invaded. The tumour was well differentiated in 17 patients, moderately in 9, and poorly in 8. RESULTS: Follow-up ranged from 2 to 100 months. Overall median postoperative survival was 21 months. By univariate analysis, factors influencing survival were curative surgery (p = 0.04), stage (p = 0.006), and nodal involvement (p = 0.0003). Nodal involvement was an independent prognostic factor by multivariate analysis (p = 0.0002). Patient age and sex, perioperative transfusion, digestive transplant, tumour local extension, grade of differentiation, and distant metastasis did not influence survival. Also, we did not observe any significant benefit of preoperative or postoperative chemotherapy or radiochemotherapy. CONCLUSIONS: Nodal involvement was the most important prognostic factor influencing survival. Therefore, an earlier diagnosis of oesophageal cancer in a less advanced stage is important to improve survival rates. Our study could not confirm the benefit of neoadjuvant therapy in terms of late survival. [less ▲]

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See detailMedical aspects of obesity.
Scheen, André ULg; Luyckx, Françoise ULg

in Acta Chirurgica Belgica (1999), 99(3), 135-9

Obesity poses a serious health hazard and its treatment is often disappointing. Major advances have been made during recent years in the understanding of body weight regulation, with the discovery of ... [more ▼]

Obesity poses a serious health hazard and its treatment is often disappointing. Major advances have been made during recent years in the understanding of body weight regulation, with the discovery of leptin, a protein produced by adipocytes and acting on the central nervous system to reduce food intake, and that of beta-3 adrenergic receptors and uncoupling proteins which contribute to stimulate energy expenditure. Numerous metabolic complications are associated with abdominal obesity and most of them, such as diabetes mellitus, dyslipidaemias and arterial hypertension, appear to be linked to insulin resistance and may be part of the socalled metabolic syndrome or syndrome X. While very-low-calorie diets are usually effective in the short-term, they cannot, in the long-term and for most patients, solve the problem of severe obesity. Pharmacological antiobesity treatment may include drugs that reduce food intake, drugs that increase energy expenditure and drugs that affect nutrient partitioning or metabolism. All of these pharmacological approaches have potential efficacy, but unfortunately serious limitations. This is also the case of mechanical means, such as intragastric balloons. Consequently, bariatric surgery may be considered as a valuable alternative therapy in well-selected patients with morbid obesity refractory to classical treatments. In conclusion, obesity is a chronic disease and should be treated as such with reasonable expectations. [less ▲]

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See detailDiverticulosis and Diverticulitis in the Immunocompromised Patients
Detry, Olivier ULg; Honore, Pierre ULg; Meurisse, Michel ULg et al

in Acta Chirurgica Belgica (1999), 99(3, May-Jun), 100-2

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See detailHypnosis with conscious sedation instead of general anaesthesia? Applications in cervical endocrine surgery.
Meurisse, Michel ULg; Defechereux, Thierry ULg; Hamoir, Etienne ULg et al

in Acta Chirurgica Belgica (1999), 99(4), 151-8

Between April 1994 and June 1997, 197 thyroidectomies and 21 cervical explorations for hyperparathyroidism were performed under hypnosedation (HYP) and compared to the operative data and postoperative ... [more ▼]

Between April 1994 and June 1997, 197 thyroidectomies and 21 cervical explorations for hyperparathyroidism were performed under hypnosedation (HYP) and compared to the operative data and postoperative courses of a closely-matched population (n = 121) of patients operated on under general anaesthesia (GA). Conversion from hypnosis to GA was needed in two cases (1%). All surgeons reported better operating conditions for cervicotomy using HYP. All patients having HYP reported a very pleasant experience and had significantly less postoperative pain while analgesic use was significantly reduced in this group. Hospital stay was also significantly shorter, providing a substantial reduction of the medical care costs. The postoperative convalescence was significantly improved after HYP and full return to social or professional activity was significantly shortened. We conclude that HYP is a very efficient technique providing physiological, psychological and economic benefits to the patient. [less ▲]

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See detailFibromuscular dysplasia of the internal carotid artery. Personal experience with 13 cases and literature review.
VAN DAMME, Hendrik ULg; SakalihasanN, Natzi ULg; Limet, Raymond ULg

in Acta Chirurgica Belgica (1999), 99(4), 163-8

From January 1990 to December 1997, the authors observed 13 cases of fibromuscular dysplasia of the internal carotid artery. Four patients presented transient ischemic attacks, one amaurosis fugax, two ... [more ▼]

From January 1990 to December 1997, the authors observed 13 cases of fibromuscular dysplasia of the internal carotid artery. Four patients presented transient ischemic attacks, one amaurosis fugax, two suffered from a minor stroke, four had non-focalized ischemic cerebral symptoms and two were asymptomatic. At angiography, all patients showed a typical image of "string of beads". Seven patients were operated on. Six had endoluminal graduated dilatation, with rigid dilators up to 4.5 mm, associated with thrombendarterectomy of the bifurcation in three and to correction of a kink in one case. In one case a venous interposition graft was done to exclude a saccular microaneurysm of the dysplasic internal carotid artery. In another case, backflow was insufficient after endoluminal dilatation, and a long venous patch allowed to restitute a normal vascular lumen. There was neither postoperative mortality nor stroke. Six patients, asymptomatic or with non focalized symptoms, were treated medically. During a mean follow-up of 47 months, only one of the 13 patients developed a transient ischemic attack; the patient had not been operated on and received only medical treatment. Prevalence, etiopathology, diagnosis and management of fibromuscular dysplasia of the internal carotid artery are discussed. Fibromuscular dysplasia is a rare cause of cerebral ischemia. For asymptomatic lesions, a conservative approach seems appropriate. Surgery is only to be considered for symptomatic lesions. Surgical graduated endoluminal dilatation, where necessary combined with standard endarterectomy of the carotid bifurcation, is a safe, efficient and durable operation. Some complex cases of fibromuscular dysplasia may necessitate patch insertion or excision and graft interposition. [less ▲]

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See detailHypnosedation: a valuable alternative to traditional anaesthetic techniques.
Faymonville, Marie-Elisabeth ULg; Meurisse, Michel ULg; Fissette, Jean ULg

in Acta Chirurgica Belgica (1999), 99(4), 141-6

Hypnosis has become routine practice in our plastic and endocrine surgery services. Revivication of pleasant life experiences has served as the hypnotic substratum in a series of over 1650 patients since ... [more ▼]

Hypnosis has become routine practice in our plastic and endocrine surgery services. Revivication of pleasant life experiences has served as the hypnotic substratum in a series of over 1650 patients since 1992. In retrospective studies, followed by randomised prospective studies, we have confirmed the usefulness of hypnosedation (hypnosis in combination with conscious IV sedation) and local anaesthesia as a valuable alternative to traditional anaesthetic techniques. The credibility of hypnotic techniques and their acceptance by the scientific community will depend on independently-confirmed and reproducible criteria of assessing the hypnotic state. Based on the clinical success of this technique, we were interested in confirming this phenomenon in healthy volunteers. The revivication of pleasant life experiences thus served as the cornerstone of a basic research program developed to objectify the neurophysiological attributes of the hypnotic state. We compared hypnosis to normal alertness with similar thought content. In our experience, the activation profile obtained during the hypnotic state was completely different from simple re-memoration of the same subject matter during normal alertness. This represents an objective and independent criteria by which to assess the hypnotic state. [less ▲]

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See detailManagement of Fulminant Hepatic Failure
Detry, Olivier ULg; Honore, Pierre ULg; Meurisse, Michel ULg et al

in Acta Chirurgica Belgica (1998), 98(6), 235-40

Fulminant hepatic failure is an infrequent but dreadful disease, occurring usually in young patients. Despite fulminant hepatic failure is reversible in most of the cases, some patients develop brain ... [more ▼]

Fulminant hepatic failure is an infrequent but dreadful disease, occurring usually in young patients. Despite fulminant hepatic failure is reversible in most of the cases, some patients develop brain edema and intracranial hypertension, which are the most common cause of death in these patients. Liver transplantation significantly improves the prognosis of selected patients in who precise criteria predict a low chance of survival. This review summarizes the modern standard of care of patients with fulminant hepatic failure, with particular underlining of the management of brain oedema and intracranial hypertension. [less ▲]

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See detailSuccessful Bridge to Transplantation with Pierce Donachy (Thoratec) Ventricular Assist Device
DEFRAIGNE, Jean ULg; DETRY, Olivier ULg; Demoulin, J.C. et al

in Acta Chirurgica Belgica (1998), 98(2), 90-4

Biventricular assistance with the Thoratec ventricular assist device was performed in a 48-year-old man waiting heart transplantation since 6 months. Indication for circulatory support was considered ... [more ▼]

Biventricular assistance with the Thoratec ventricular assist device was performed in a 48-year-old man waiting heart transplantation since 6 months. Indication for circulatory support was considered because of the development of progressive irreversible right heart failure with deterioration of the hepatic and renal functions. Orthotopic heart transplantation was performed after 13 days of circulatory support. No complications occurred during the assistance and in the posttransplant period. The patient was discharged on day 21 after transplantation. Five months after transplantation he is well and alive. [less ▲]

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