Surgical management of gallstones in cirrhotic patients.

Among the cirrhotic patients admitted to our department, 64 (17 percent) were found to have cholelithiasis. In 14 patients (22 percent), cholelithiasis caused cholecystitis, obstructive jaundice, or biliary pain. These 14 patients were operated on and underwent cholecystectomy.

Microlithiasis of the gallbladder.

Patients with microlithiasis represent a small group compared with the general population of patients with gallstones. However, it is a group which deserves particular attention because of the risk of acute pancreatitis. For this reason, cholecystectomy should be advocated in patients considered to be at low anesthetic risk in which echography or roentgenography detects the presence of minute stones in the gallbladder, even in the absence of biliary disorders.

[Cost of the surgical treatment of gallbladder lithiasis. Example of an attempted rationalization of medical care and expenditure].

A medical audit was conducted in a Paris hospital on patients who, in 1975, underwent cholecystectomy for uncomplicated gallstones. The audit comprised the duration of pre- and post-operative hospitalisation, the Social Security grading of medical acts, biochemical and radiological examinations and the quality of medical care, as assessed by morbidity and mortality rates. The results were brought to the knowledge of all members of the surgical team concerned.

[Changes in hepatic blood flow after various types of portal shunt in the rat].

The relationship between liver trophicity and the early (24 h) or late (14 days) modifications of the hepatic blood flow were studied in the rat after several types of portosystemic shunts (portacaval shunt, mesocaval shunt, portacaval transposition and arterialization of the portal vein after portacaval shunt). Twenty-four hrs after portacaval shunt, the total hepatic blood flow was decreased to 60 p. 100 of the initial value and remained so during the following days.

Effect of portacaval or mesentericocaval anastomosis on cholesterol metabolism in rats.

Portacaval anastomosis (PCA) lowered by 50% the cholesterol concentration in the plasma of rats. The free and esterified cholesterol contents in the lipoproteins were decreased with the very low density lipoproteins most affected (-85%). Cholesterol concentration as total content in the liver was reduced.

Graft-versus-host reaction induced by spleen grafting in inbred strains of rats. Influence of portal venous drainage.

Acute graft-versus-host (GvH) reaction was induced by spleen grafting in inbred rats. A comparison of the influence of portal or caval drainage of the spleen graft on the survival time was made. This comparison revealed a prolongation of survival time in case of a portal drainage when the graft was an auxiliary half-spleen graft.

Spontaneous long-term survival of liver allografts in inbred rats: comparison between semi-allogenic and fully allogeneic strain combinations.

Spontaneous tolerance of liver allografts can be observed in inbred rats. In order to study the influence of the density of major histocompatibility complex alloantigens on the fate of liver allografts in the rat, liver allografts were performed in a semi-allogeneic and a fully allogeneic combination. Comparisons of the fate of heart and kidney allografts were made in the same combinations.

Treatment of postshunt encephalopathy with secondary arterialization: an experimental study in the rat.

Secondary arterialization of the hepatic stump of the portal vein has been performed in rats 7 days after portacaval anastomosis (PCA) at a date when the electrocorticographic changes of postshunt encephalopathy were evident. A complete regression of encephalopathy ensued. This correlated with an increase in the weight of the liver and estimated hepatic blood flow.

Liver atrophy and encephalopathy after portacaval shunt in the rat.

The effect of various types of portal diversion (portacaval, mesocaval and pancreatico-splenocaval anastomoses, portacaval transposition and arterialization) on liver atrophy and post-shunt encephalopathy was studied in the rat. Among all diversions, only portacaval anastomosis produced dramatic liver atrophy and encephalopathy. Moreover, portacaval anastomosis was also the only portal diversion which induced low body weight gain.

Surgically induced acute hepatic failure in the rat.

Several surgical procedures were tested in the rat in order to create a spontaneously lethal but potentially reversible acute hepatic failure. Two combined surgical procedures fulfill these conditions: '75% hepatectomy' plus portacaval shunt and '85% hepatectomy' plus 30-min clamping of the celiac and superior mesenteric arteries. These two procedures should constitute useful tools for the evaluation of new methods of hepatic support.

[Diagnostic value of selective angiography in the pancreatic affections (author's transl)].

A retrospective study of selective angiography of the coeliac axis and superior mesenteric artery was conducted in 60 patients having a pancreatic disease. The purpose of this study was to precise the frequency, the specificity and the diagnostic value of each radiological sign in malignant and non malignant pancreatic affection. In patients with cancer of pancreas, the best radiological sign are the presence of an arterial obstruction, an irregular arterial stenosis, a venous obstruction or a parenchymal hypervascularization.

Enhancement of Aflatoxin B1 induced liver carcinogenesis by portal diversion in the rat.

Conflicting results have been reported on the influence of portacaval anastomosis on liver carcinogenesis. The purpose of this investigation was to study the effect of portal diversion on liver carcinogenesis induced in the rat by a potent chemical liver carcinogen, Aflatoxin B1 (AFB1). Liver tumors appeared earlier and were significantly bigger in rats with shunts than in sham-operated controls.