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O81 Laproscopic operations in treatment of liver echinococcosis
Abstracts
I European
Journal
of Internal
tered intravenously. On that day, the hospital was spending 170 Euro on AUD on this ward only. If only patients with indication for prophylaxis actually received it and ranitidine per OS was preferred these costs would have been reduced to 2 Euro. Conclusion: While unarguably beneficial in some patients, stress ulcer prophylaxis should not be prescribed indiscriminately to all patients admitted to the hospital. At present there are no data supporting the use of proton-pump inhibitors for prophylaxis except for patients taking nonsteroidal anti-inflammatory drugs. Our data reveal very heterogeneous prescription patterns among internists from the same department.
079 Syngenic transplantation of fetal V Coulic, P. Delrte, C. DePrez, (Brussels, Loverval, B)
liver S. Bakari,
L. Lasser,
Medicine
14 (2003)
Sl-S159
S23
3 patients: infections (n=3), thromboembolism (n=2). One patient had many warts. One patient died but we could’nt know if the death was related to PIL has he left France. Biological features were hypogammaglobulinemia (n=8), lymphopenia (n=6), increased of alpha 1 antitrypsine (16.3 ml/24 h-1000 ml/24 h). Duodenoscopy and enteroscopy (n=7) with biopsies showed intestinal lymphangiectasias in 5 patients, respectively: jejunals (n= l), duodenals (n=3), ileals (n=2). One patient refused the endoscopy. In one patient, no lymphangiectasy could be demonstrated and the diagnosis was based on the exclusion of other causes. 2 patients were followed respectively for 18 and 21 years. For the other patients the follow up range to 3 months to 4 years. 6 patients were submitted to a strict low fat diet with added medium chain triglycerides. 4 patients had regulary albumin perfusions and 2 patients had parenteral nutrition. 1 patient had a severe evolution with necessity of permanent hospitalisation for parenteral nutrition.
E. DeKoster
In vitro hepatic stem cells may differentiate into hepatocytes and bile duct cells (A.J. Strain, 2003). But the possibility of ectopic development of fetal liver in vivo seems to remain unexplored. Aim: To test the ectopic developmental pattern of fetal liver implanted into syngenic adult organisms, in order to answer the question whether fetal liver graft may be proposed for liver insufficiency supply. Material and methods: 17 Wistar and 17 Fischer adults rats were used as recipients. Donors were fetal aged either 15 or 20-21 days i.u. Recipients were adult males and females 4-6 months old. Under anaesthesia, a piece of the fetal liver (2X2X 1 mm) was introduced in a subcutaneous pouch of the recipient ear. Visual observation with measurement of the graft, biopsies for histological investigation (haematoxylin eosin staining) were performed from day 0 to day 120. Results: During the first week p.o. all the grafts lost their structure. The presence of apparently undifferentiated active cells with basophile cytoplasm was observed. Starting at S-10 days p.o., hepatoblasts and precursors of bile duct cells were detected. At 1 month p.o. columns of hepatocytes, sinusoids and bile ducts were identified in the implantation site. These islets of hepatic tissue looked able to function. At 3 months p.o the size of adult liver-like islets did not increase and even sometimes decreased, in both rat strains. Discussion and conclusion: Fetal liver ectopic implants seems to follow the same multiphasic rules of development as other grafted fotal organs (intestines, pancreas, stomach or heart). They are able to give growth to specific hepatic tissues. Their development seems to be limited. Such a phenomenon was previously observed in fotal pancreatic syngenic implantation in non-diabetic adult rats and was probably due to the absence of functional solicitation of the graft. Fetal liver transplantation is to be tested in experiments with host hepatic insufficiency before concluding that it may be of use in therapy of liver insufficiency
080 Primary intestinal lymphangiectasia: clinical features and follow About 8 cases F. Badet, F. Joly, B. FlouriC, M. GCrard-Boncompain, B. Bonnotte, Vital-Durand, H. Rousset (Pierre-B&ite, Paris, Lyon, Dijon, F)
up. D.
Background: Protein-losing enteropathy due to primary intestinal lymphangiectasia (PIL) is a rare and multiform disorder. Merhod: 5 French centers were asked to identify cases of PIL which they had followed. Diagnosis was defined by the presence of an exsudativ enteropathy after having excluded a secondary form of intestinal lymphangiectasia. Patients: We report 8 patients withPIL (5 men and 3 women), Main clinical features were oedema (n=8) with anasarque (n=2), pleural effusion (n=2) or pericarditis (n=l) or ascitis (n=l), diarrhea (n=3), lymphoedema (n =2) and abdominal pain (n = 2). Complication occured in
081 Laproscopic operations in treatment of liver echinococcosis O.A. Dmytryukova, VS? Khatsko, Y.G. Kolkin, A.G. Grintsov, Dudin, A.E. Kuzmenko, M.N. Akhtar (Donetsk, (IA)
A.M.
Aims: Improvement of results of treatment of patients with liver echinococcosis by reduction of traumatism of operations, frequency of postoperative complications, relapses and duration of the period of rehabilitation. Materials and methods: From 1997 years to present time is executed 42 laproscopic interventions in patients of liver echinococcosis. Among them was 23 men and 19 women in the age of from 8 to 58 years. Middle age of patients 32.1 k9.4 years. 6 patients were operated concerning accompanying lung echinococcosis. Single cysts were in 30 patients, multiple affections - in 12 operations were made with use of 3-5 trochar depending on number of cysts. Evacuation of liquid contents of cyst carried out after a puncture of thick needle electroaspirator. Cavity of cyst disinfected with 1% solution of Betadine with an exposition of 5 minutes. Walls of a fibrous capsule treated with 1% solution of Betadine. All patients accepted in the postoperative period mebendazole on 50 mg/kg of weight per day during 7-10 days. Results: All operations are executed without transition to laprotomy. Average duration of operation was 65.323.4 minutes (from 40 to 120 minutes). Duration of stay in a hospital has made 3.6+ 1.2 days (from 2 to 9 days). Drainage from a residual cavity took on 8-25 day after operation after ultrasonic control. Lethality was zero. In 8 (20.5%) patients were observed complications: in 5 - flow of bile on a drainage from a residual cavity (in 4 - bile flux has stopped independently and in was executed endoscopic papillosphincterotomy). In 2 - suppuration of a residual cavity (is performed a puncture and drainage of residual cavity in 1 - the suppuration in area of trochar puncture. At supervision during 4-36 after operation of relapse of echinococcosis is diagnosed for one patient (5.9%). Conclusions: Laproscopic echinococcectomy can be used with success in treatment of liver echinococcosis at presence in patients superficially located cysts. Use of complex therapy with Benzylimidazole carbamade allows to reduce frequency of relapses of echinococcosis.
Pneumology/Intensive
care medicine
082 Predicting length of stay in hospitalized COPD patients: usefulness of physical exploration J. Sbnchez-Leira, F. Garcia-Sutiez, J. Saborido-FrojBn, M. IglesiasGallego, 1. Villamil-Cajoto, J. Grandes-Ibiiiez, J.A. Diaz-Peromingo (Riveira, Pontevedra, E)
I European
Journal
of Internal
tered intravenously. On that day, the hospital was spending 170 Euro on AUD on this ward only. If only patients with indication for prophylaxis actually received it and ranitidine per OS was preferred these costs would have been reduced to 2 Euro. Conclusion: While unarguably beneficial in some patients, stress ulcer prophylaxis should not be prescribed indiscriminately to all patients admitted to the hospital. At present there are no data supporting the use of proton-pump inhibitors for prophylaxis except for patients taking nonsteroidal anti-inflammatory drugs. Our data reveal very heterogeneous prescription patterns among internists from the same department.
079 Syngenic transplantation of fetal V Coulic, P. Delrte, C. DePrez, (Brussels, Loverval, B)
liver S. Bakari,
L. Lasser,
Medicine
14 (2003)
Sl-S159
S23
3 patients: infections (n=3), thromboembolism (n=2). One patient had many warts. One patient died but we could’nt know if the death was related to PIL has he left France. Biological features were hypogammaglobulinemia (n=8), lymphopenia (n=6), increased of alpha 1 antitrypsine (16.3 ml/24 h-1000 ml/24 h). Duodenoscopy and enteroscopy (n=7) with biopsies showed intestinal lymphangiectasias in 5 patients, respectively: jejunals (n= l), duodenals (n=3), ileals (n=2). One patient refused the endoscopy. In one patient, no lymphangiectasy could be demonstrated and the diagnosis was based on the exclusion of other causes. 2 patients were followed respectively for 18 and 21 years. For the other patients the follow up range to 3 months to 4 years. 6 patients were submitted to a strict low fat diet with added medium chain triglycerides. 4 patients had regulary albumin perfusions and 2 patients had parenteral nutrition. 1 patient had a severe evolution with necessity of permanent hospitalisation for parenteral nutrition.
E. DeKoster
In vitro hepatic stem cells may differentiate into hepatocytes and bile duct cells (A.J. Strain, 2003). But the possibility of ectopic development of fetal liver in vivo seems to remain unexplored. Aim: To test the ectopic developmental pattern of fetal liver implanted into syngenic adult organisms, in order to answer the question whether fetal liver graft may be proposed for liver insufficiency supply. Material and methods: 17 Wistar and 17 Fischer adults rats were used as recipients. Donors were fetal aged either 15 or 20-21 days i.u. Recipients were adult males and females 4-6 months old. Under anaesthesia, a piece of the fetal liver (2X2X 1 mm) was introduced in a subcutaneous pouch of the recipient ear. Visual observation with measurement of the graft, biopsies for histological investigation (haematoxylin eosin staining) were performed from day 0 to day 120. Results: During the first week p.o. all the grafts lost their structure. The presence of apparently undifferentiated active cells with basophile cytoplasm was observed. Starting at S-10 days p.o., hepatoblasts and precursors of bile duct cells were detected. At 1 month p.o. columns of hepatocytes, sinusoids and bile ducts were identified in the implantation site. These islets of hepatic tissue looked able to function. At 3 months p.o the size of adult liver-like islets did not increase and even sometimes decreased, in both rat strains. Discussion and conclusion: Fetal liver ectopic implants seems to follow the same multiphasic rules of development as other grafted fotal organs (intestines, pancreas, stomach or heart). They are able to give growth to specific hepatic tissues. Their development seems to be limited. Such a phenomenon was previously observed in fotal pancreatic syngenic implantation in non-diabetic adult rats and was probably due to the absence of functional solicitation of the graft. Fetal liver transplantation is to be tested in experiments with host hepatic insufficiency before concluding that it may be of use in therapy of liver insufficiency
080 Primary intestinal lymphangiectasia: clinical features and follow About 8 cases F. Badet, F. Joly, B. FlouriC, M. GCrard-Boncompain, B. Bonnotte, Vital-Durand, H. Rousset (Pierre-B&ite, Paris, Lyon, Dijon, F)
up. D.
Background: Protein-losing enteropathy due to primary intestinal lymphangiectasia (PIL) is a rare and multiform disorder. Merhod: 5 French centers were asked to identify cases of PIL which they had followed. Diagnosis was defined by the presence of an exsudativ enteropathy after having excluded a secondary form of intestinal lymphangiectasia. Patients: We report 8 patients withPIL (5 men and 3 women), Main clinical features were oedema (n=8) with anasarque (n=2), pleural effusion (n=2) or pericarditis (n=l) or ascitis (n=l), diarrhea (n=3), lymphoedema (n =2) and abdominal pain (n = 2). Complication occured in
081 Laproscopic operations in treatment of liver echinococcosis O.A. Dmytryukova, VS? Khatsko, Y.G. Kolkin, A.G. Grintsov, Dudin, A.E. Kuzmenko, M.N. Akhtar (Donetsk, (IA)
A.M.
Aims: Improvement of results of treatment of patients with liver echinococcosis by reduction of traumatism of operations, frequency of postoperative complications, relapses and duration of the period of rehabilitation. Materials and methods: From 1997 years to present time is executed 42 laproscopic interventions in patients of liver echinococcosis. Among them was 23 men and 19 women in the age of from 8 to 58 years. Middle age of patients 32.1 k9.4 years. 6 patients were operated concerning accompanying lung echinococcosis. Single cysts were in 30 patients, multiple affections - in 12 operations were made with use of 3-5 trochar depending on number of cysts. Evacuation of liquid contents of cyst carried out after a puncture of thick needle electroaspirator. Cavity of cyst disinfected with 1% solution of Betadine with an exposition of 5 minutes. Walls of a fibrous capsule treated with 1% solution of Betadine. All patients accepted in the postoperative period mebendazole on 50 mg/kg of weight per day during 7-10 days. Results: All operations are executed without transition to laprotomy. Average duration of operation was 65.323.4 minutes (from 40 to 120 minutes). Duration of stay in a hospital has made 3.6+ 1.2 days (from 2 to 9 days). Drainage from a residual cavity took on 8-25 day after operation after ultrasonic control. Lethality was zero. In 8 (20.5%) patients were observed complications: in 5 - flow of bile on a drainage from a residual cavity (in 4 - bile flux has stopped independently and in was executed endoscopic papillosphincterotomy). In 2 - suppuration of a residual cavity (is performed a puncture and drainage of residual cavity in 1 - the suppuration in area of trochar puncture. At supervision during 4-36 after operation of relapse of echinococcosis is diagnosed for one patient (5.9%). Conclusions: Laproscopic echinococcectomy can be used with success in treatment of liver echinococcosis at presence in patients superficially located cysts. Use of complex therapy with Benzylimidazole carbamade allows to reduce frequency of relapses of echinococcosis.
Pneumology/Intensive
care medicine
082 Predicting length of stay in hospitalized COPD patients: usefulness of physical exploration J. Sbnchez-Leira, F. Garcia-Sutiez, J. Saborido-FrojBn, M. IglesiasGallego, 1. Villamil-Cajoto, J. Grandes-Ibiiiez, J.A. Diaz-Peromingo (Riveira, Pontevedra, E)