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Dupriez F, De Pauw L, Darius T, Mourad M, Penaloza A, Van Deynse D, Baltus C, Verschuren F. Fourteen years of experience in uncontrolled organ donation after cardio-circulatory death. Transplant Proc 2015; 46:3134-7. [PMID: 25420843 DOI: 10.1016/j.transproceed.2014.09.164] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Since 1999, a protocol for uncontrolled donation after cardio-circulatory death (DCD) has been carried out in our institution. We aimed at evaluating those 14 years of local experience. METHODS We reviewed the charts of uncontrolled donors from 1999 till 2013. Potential donors with a no-flow period less than 30 minutes were considered. Kidneys were perfused by the use of a double balloon triple lumen catheter after at least a 2-minute period of no touch. We analyzed grafts outcome and warm and cold ischemia times. RESULTS Thirty-nine procedures were initiated: 19 were aborted because of family refusal (n = 7), medical reasons (n = 7), or canulation failures (n = 5) and 20 harvesting procedures were completed. Transplantation was considered for 35 kidneys (cold storage [n = 5] and hypothermic preservation system [n = 30]). The causes of withdrawal from transplantation were mostly macroscopic lesions (poor perfusion, macroscopic parenchyma or vascular lesions, or infectious risk). We transplanted 22 kidneys locally and 3 were shipped to another Eurotransplant center. Mean donor age was 40 ± 13 years. Among the 20 donors, 13 came from the emergency unit and 7 from the intensive care unit. Mean no-flow time for out-hospital management was 8.7 ± 3.6 minutes. Mean time of cardiopulmonary resuscitation was 71 ± 46 minutes. Mean cold ischemia time was 19 ± 5 hours. Primary nonfunction and delayed graft function occurred in 1 and 12 cases (4.5% and 54%), respectively. Graft survival was 86% at 1 year. Causes of graft loss during the entire follow-up were graft rejection (n = 3), ischemically damaged kidney (n = 2), and recurrence of focal segmental glomerulosclerosis (n = 1). CONCLUSION In our experience, uncontrolled donors represent a valuable source of kidney grafts, with a prognosis of graft function and survival similar to the literature. To increase the number of available DCD organs, new techniques, such as the use of Normothermic ExtraCorporeal Membrane Oxygenation (NECMO), as well as improvement of recruitment of out of hospital potential donors have to be considered.
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Affiliation(s)
- F Dupriez
- Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium.
| | - L De Pauw
- Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - T Darius
- Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - M Mourad
- Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - A Penaloza
- Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - D Van Deynse
- Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - C Baltus
- Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - F Verschuren
- Surgery and Emergency Departments, Cliniques Universitaires Saint Luc, Brussels, Belgium
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Patrono D, Verhelst R, Buemi A, Darius T, Godefroid N, Mourad M. Presentation and management of mycotic pseudoaneurysm after kidney transplantation. Transpl Infect Dis 2015; 17:129-36. [PMID: 25620391 DOI: 10.1111/tid.12346] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/20/2014] [Accepted: 11/28/2014] [Indexed: 12/27/2022]
Abstract
Pseudoaneurysms (PAs) developing at the site of vascular anastomosis after organ transplantation are a rare but serious complication. We report a series of 3 cases of PA observed in a single center over a period of 18 years. The mode of presentation was acute bleeding in 2 cases. In the third patient, who underwent combined kidney and pancreas transplantation, the PA on the renal graft was discovered by chance. Graft removal associated with iliac artery ligation and extra-anatomic femoro-femoral bypass represents the standard treatment. However, interposition of a venous homograft may allow preservation of inferior limb perfusion and possibly graft salvage.
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Affiliation(s)
- D Patrono
- Department of Surgery, Surgery and Abdominal Transplantation Division, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Darius T, Monbaliu D, Jochmans I, Meurisse N, Desschans B, Coosemans W, Komuta M, Roskams T, Cassiman D, van der Merwe S, Van Steenbergen W, Verslype C, Laleman W, Aerts R, Nevens F, Pirenne J. Septuagenarian and octogenarian donors provide excellent liver grafts for transplantation. Transplant Proc 2013; 44:2861-7. [PMID: 23146543 DOI: 10.1016/j.transproceed.2012.09.076] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Wider utilization of liver grafts from donors ≥ 70 years old could substantially expand the organ pool, but their use remains limited by fear of poorer outcomes. We examined the results at our center of liver transplantation (OLT) using livers from donors ≥ 70 years old. METHODS From February 2003 to August 2010, we performed 450 OLT including 58 (13%) using donors ≥ 70 whose outcomes were compared with those using donors <70 years old. RESULTS Cerebrovascular causes of death predominated among donors ≥ 70 (85% vs 47% in donors <70; P < .001). In contrast, traumatic causes of death predominated among donors <70 (36% vs 14% in donors ≥ 70; P = .002). Unlike grafts from donors <70 years old, grafts from older individuals had no additional risk factors (steatosis, high sodium, or hemodynamic instability). Both groups were comparable for cold and warm ischemia times. No difference was noted in posttransplant peak transaminases, incidence of primary nonfunction, hepatic artery thrombosis, biliary strictures, or retransplantation rates between groups. The 1- and 5-year patient survivals were 88% and 82% in recipients of livers <70 versus 90% and 84% in those from ≥ 70 years old (P = .705). Recipients of older grafts, who were 6 years older than recipients of younger grafts (P < .001), tended to have a lower laboratory Model for End-Stage Liver Disease score (P = .074). CONCLUSIONS Short and mid-term survival following OLT using donors ≥ 70 yo can be excellent provided that there is adequate donor and recipient selection. Septuagenarians and octogenarians with cerebrovascular ischemic and bleeding accidents represent a large pool of potential donors whose wider use could substantially reduce mortality on the OLT waiting list.
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Affiliation(s)
- T Darius
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
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Rodríguez-Perálvarez M, Germani G, Darius T, Lerut J, Tsochatzis E, De la Mata M, Burroughs AK. Tacrolimus exposure after liver transplantation in randomized controlled trials: too much for too long. Am J Transplant 2013; 13:1371-2. [PMID: 23621166 DOI: 10.1111/ajt.12216] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Rodríguez-Perálvarez M, Germani G, Darius T, Lerut J, Tsochatzis E, De la Mata M, Burroughs AK. Tacrolimus Exposure After Liver Transplantation in Randomized Controlled Trials: Too Much for Too Long. Am J Transplant 2013. [DOI: 10.1002/ajt.12216] [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: 11/08/2022]
Affiliation(s)
| | - G. Germani
- The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Digestive and Liver Health; Royal Free Hospital; Pond Street, Hampstead, NW3 2QG; London; UK
| | - T. Darius
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint Luc; Université Catholique de Louvain (UCL); Brussels; Belgium
| | - J. Lerut
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint Luc; Université Catholique de Louvain (UCL); Brussels; Belgium
| | - E. Tsochatzis
- The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Digestive and Liver Health; Royal Free Hospital; Pond Street, Hampstead, NW3 2QG; London; UK
| | - M. De la Mata
- Gastroenterology and Hepatology Unit, CIBERehd, IMIBIC; Reina Sofía University Hospital; Córdoba; Spain
| | - A. K. Burroughs
- The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Digestive and Liver Health; Royal Free Hospital; Pond Street, Hampstead, NW3 2QG; London; UK
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Rodríguez-Perálvarez M, Germani G, Darius T, Lerut J, Tsochatzis E, Burroughs AK. Reducing early exposure to calcineurin inhibitors: the key factor for a successful renal sparing strategy. Am J Transplant 2013; 13:239. [PMID: 23126593 DOI: 10.1111/j.1600-6143.2012.04306.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Rodríguez-Perálvarez M, Germani G, Darius T, Lerut J, Tsochatzis E, Burroughs AK. Tacrolimus trough levels, rejection and renal impairment in liver transplantation: a systematic review and meta-analysis. Am J Transplant 2012; 12:2797-814. [PMID: 22703529 DOI: 10.1111/j.1600-6143.2012.04140.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We hypothesized that current trough concentrations of tacrolimus after liver transplantation are set too high, considering that clinical consequences of rejection are not severe while side effects are increased.We systematically reviewed 64 studies (32 randomized controlled trials and 32 observational studies) to determine how lower tacrolimus trough concentrations than currently recommended affect acute rejection rates and renal impairment. Among randomized trials the mean of tacrolimus trough concentration during the first month was positively correlated with renal impairment within 1 year (r = 0.73; p = 0.003), but not with acute rejection, either defined using protocol biopsies (r = -0.37; p = 0.32) or not (r = 0.11; p = 0.49). A meta-analysis of randomized trials directly comparing tacrolimus trough concentrations (five trials for acute rejection [n = 957] and two trials for renal impairment [n = 712]) showed that "reduced tacrolimus" trough concentrations (<10 ng/mL) within the first month after liver transplantation were associated with less renal impairment at 1 year (RR = 0.51 [0.38-0.69]), with no significant influence on acute rejection (RR = 0.92 [0.65-1.31]) compared to "conventional tacrolimus" trough levels (>10 ng/mL). Lower trough concentrations of tacrolimus (6-10 ng/mL during the first month) would be more appropriate after liver transplantation. Regulatory authorities and the pharmaceutical industry should allow changes of regulatory drug information.
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Affiliation(s)
- M Rodríguez-Perálvarez
- The Royal Free Sheila Sherlock Liver Centre and University Department of Surgery, UCL, and Royal Free Hospital, Pond Street, London, UK
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Geerts A, Darius T, Chapelle T, Roeyen G, Francque S, Libbrecht L, Nevens F, Pirenne J, Troisi R. The multicenter Belgian survey on liver transplantation for hepatocellular failure after bariatric surgery. Transplant Proc 2011; 42:4395-8. [PMID: 21168706 DOI: 10.1016/j.transproceed.2010.07.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The prevalence of obesity has grown dramatically over the last decades, with nonalcoholic steatohepatitis increasingly observed. Therapeutic options for morbid obesity include bariatric surgery. Fatal liver failure (LF) has been recorded after jejunoileal bypass (JIB) but is controversial after biliopancreatic diversion (BPD, Scopinaro operation). We performed a survey on the frequency of liver transplantation (LT) after bariatric surgery in Belgium. An enquiry was sent to all Belgian liver transplant centers to investigate the occurrence of subacute and chronic LF after bariatric surgery. After weight-reduction surgery, 10 patients in 3 Belgian transplant centers were listed for LT due to severe hepatocellular failure. Nine of them had undergone a Scopinaro operation and 1 a jejunoileal bypass. The median time to develop LF was 5 years. The patient with JIB developed chronic LF after 25 years. Seven patients were transplanted; two died awaiting a graft and one is still on the waiting list. After LT, 1 patient developed rapid reappearance of LF at 10 months, requiring retransplantation. Two recipients died after LT because of multiorgan failure shortly after transplantation. In another case, a de novo cancer was fatal at 6 years' follow-up. The remaining recipients were doing well. According to this survey, the BPD operation carries a potential risk of LF. However, because there were only 10 cases, we remain unaware of the actual incidence of Scopinaro operation-induced LF. We advise strict follow-up of liver function and timely dismantling of BPD.
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Affiliation(s)
- A Geerts
- Liver Transplant Unit, Ghent University Hospital, Ghent, Belgium.
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Mortier L, Stockmans G, Maleux G, Heye S, Aerts R, Monbaliu D, Darius T, Pirenne J, Meersseman P, George C, Van Steenbergen W, Cassiman D, Verslype C, Nevens F, Laleman W. Repetitive episodes of cryptogenic septicaemia in a patient with cirrhosis: a case of "heavy metal". Acta Gastroenterol Belg 2011; 74:82-87. [PMID: 21563658] [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: 05/30/2023]
Abstract
Endotipsitis or primary infection of a TIPS-stent, is an uncommon but possible life- threatening condition by its potential evolution to sepsis and death. Diagnosis should be suspected in patients with a TIPS-stent presenting with stent-dysfunction associated with fever or relapsing episodes of bacteremia/sepsis without any other alternative focus. A certain diagnosis is made by post-factum histopathological and/or microbiological examination of the TIPS-stent which is only possible after liver transplantation or at autopsy, whereas it can be highly suspected in case of repetitive positive blood-cultures without any other focus in a patient with a TIPS-stent. The microorganisms responsible for endotipsitis are most frequently of Gram-negative enteric origin. The regimen and duration of the treatment should be individualized and depends on multiple factors like the antibiotic sensitivity of the organism and the patients condition. In case of a fungal infection, longer treatment is recommended.
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Affiliation(s)
- L Mortier
- Department of Hepatology, University Hospital Gasthuisberg, KU Leuven, Belgium
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Darius T, Monbaliu D, Aerts R, Coosemans W, de Roey J, Blockmans D, Hiele M, Van Assche G, Ferdinande P, Dierickx D, Ectors N, Lerut E, De Hertogh G, Benedetti E, Pirenne J. Living Related Intestinal Transplantation for Churg-Strauss Syndrome: A Case Report. Transplant Proc 2010; 42:4423-4. [DOI: 10.1016/j.transproceed.2010.07.015] [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: 11/26/2022]
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Dierickx D, Monbaliu D, De Rycke A, Wisanto E, Lerut E, Devos T, Meers S, Darius T, Ferdinande P, Pirenne J. Thrombotic microangiopathy following intestinal transplantation: a single center experience. Transplant Proc 2010; 42:79-81. [PMID: 20172285 DOI: 10.1016/j.transproceed.2009.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transplant-related thrombotic microangiopathy (TMA) is a well-recognized complication of all types of transplantations. Despite its known relationship with immunosuppressive therapy, only a few cases have been reported following intestinal transplantation. METHODS We retrospectively reviewed the medical files of nine consecutive intestinal transplant patients between 2000 and 2008. RESULTS The diagnosis of TMA was established in 3 patients (33%). At diagnosis the immunosuppressive therapy consisted of tacrolimus (n = 3), combined with azathioprine (n = 1) or sirolimus (n = 2) and steroids (n = 2). The median time between transplantation and TMA was 104 days (range, 55-167 days). Levels of ADAMTS13, a von Willebrand protease, were within normal ranges in all 3 patients. Treatment consisted of stopping/tapering of tacrolimus, together with initiation of plasma therapy, leading to complete remission in all 3 patients. During further follow-up, all 3 patients showed severe graft rejection necessitating more profound immunosuppressive therapy, leading to graft loss in 1 patient and infection-related death in the 2 others. At a median follow-up of 52 months (range, 9-100 months) all remaining TMA-free patients (n = 6) were alive with functioning grafts under minimal immunosuppression. CONCLUSION Herein we have described 3 intestinal transplant patients who were diagnosed with transplantation-related TMA. Despite excellent disease control the final outcomes were dismal, which clearly contrasts with the outcome among TMA-free patients, who were all well with functioning grafts at last follow-up.
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Affiliation(s)
- D Dierickx
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium.
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Darius T, Monbaliu D, Aerts R, Laleman W, Roskams T, Van Steenbergen W, Cassiman D, Verslype C, Maleux G, Nevens F, Pirenne J. Rescue of a Marginal Liver Graft by Sequential Treatment With Molecular Adsorbent Recirculating System and Transjugular Intrahepatic Portosystemic Shunt: A Case Report. Transplant Proc 2009; 41:3427-9. [DOI: 10.1016/j.transproceed.2009.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Abstract
In contrast to a wandering or ectopic spleen which is vascularized by the original splenic vessels this case describes a true ectopic, locally vascularized spleen in the pelvis. To our knowledge this anomaly has never been described in the literature before.
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Chateau-Degat ML, Darius T, Legrand AM, Dewailly E, Nguyen NL, Chinain M, Beuter A, Vauterin G, Chansin R. Neurologic Signs of Ciguatera Disease: Evidence of their Persistence. Am J Trop Med Hyg 2007. [DOI: 10.4269/ajtmh.2007.77.1170] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Chateau-Degat ML, Beuter A, Vauterin G, Nguyen NL, Chinain M, Darius T, Legrand AM, Chansin R, Dewailly E. Neurologic signs of ciguatera disease: evidence of their persistence. Am J Trop Med Hyg 2007; 77:1170-1175. [PMID: 18165542] [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: 05/25/2023] Open
Abstract
Ciguatoxins exert their effect on the voltage-sensitive sodium channels of the cellular membranes of all excitable tissues. This effect confers to ciguatera disease (CD) its neurologic hallmarks. A prospective study among French Polynesian adults over a two-month period was conducted to characterize and determine the persistence of neurologic symptoms of CD. We compared 47 patients with CD with 125 controls. In the acute phase of the disease, patients had mainly sensory disturbances as detected by an hypoesthesia on the palm of the hand and poorer sway performance compared with controls. Follow-up two months showed improvement of sway performance that eventually reaching control levels. However, for light-touch threshold, even if we observed a decrease threshold towards normal values, more than 50% of patients did not reach normal values 60 days after disease onset. Our results support the existence of neurologic impairments of CD and suggest their persistence for at least two months after onset.
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Affiliation(s)
- M-L Chateau-Degat
- Public Health Research Unit, Laval University Medical Research Center, Sainte Foy, Quebec, Canada
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Darius T, Aelvoet C, Tollens T, Vanrykel JP. Spontaneous reduction of the prolapsed stomach in a case of anterior band slippage after laparoscopic adjustable gastric banding. Acta Chir Belg 2007; 107:710-2. [PMID: 18274193 DOI: 10.1080/00015458.2007.11680155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Band slippage is a common late complication after laparoscopic adjustable gastric banding. We present the first report in literature of a spontaneous reduction of the prolapsed stomach after band deflation in a case of anterior band slippage.
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Affiliation(s)
- T. Darius
- Department of General Surgery, AZ Imelda, Bonheiden, Belgium
| | - Ch. Aelvoet
- Department of General Surgery, AZ Imelda, Bonheiden, Belgium
| | - T. Tollens
- Department of General Surgery, AZ Imelda, Bonheiden, Belgium
| | - J.-P. Vanrykel
- Department of General Surgery, AZ Imelda, Bonheiden, Belgium
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Abstract
In this paper, we present an asymptomatic young patient with solid and cystic papillary neoplasm of the pancreas. It is an extremely rare tumour mostly seen in young females. It is often diagnosed incidentially or during investigations of gastrointestinal complaints. In differential diagnosis, any cystic and/or solid pancreatic disease process should be considered. Prognosis is excellent after radical resection and recurrence is rarely seen.
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Affiliation(s)
- T Darius
- Department of General Surgery, AZ St. Maarten, Mechelen, Belgium.
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Château-Degat M, Chinain M, Darius T, Legrand A, Nguyen N, Chansin R, Dewailly É. A47 - Prévalence de la symptomatologie chronique de la ciguatera en Polynésie Française. Rev Epidemiol Sante Publique 2005. [DOI: 10.1016/s0398-7620(05)84723-6] [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: 11/26/2022] Open
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