[Auxiliary homografts of a complete liver with arterilization of the portal system].
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Biomedical subjects
Publications and source records attributed to A Dagradi.
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The authors present their experience with 5 biliary cystadenomas (BCA) and 1 cystadenocarcinoma (BCAC). BCA are rare but intriguing lesions of the liver for the possibility of the former to evolve into malignant lesion. Preoperative diagnosis is often difficult also at ultrasound and CT scan. The possibility of BCA and BCAC should be always ruled out in every cystic lesion of the liver. In every doubt lesion surgical exploration is indicated and at least a biopsy should be performed. The procedure of choice for BCA is radical resection, while palliative procedures may be justified only in poor risk patients.
The development of major hepatic resective surgery during the last 50 years is due to a better knowledge of both hepatic regenerative capacity and intraparenchymal vascular and biliary anatomy. Two approaches of major hepatic resection have been described: 1) primary hilar approach; 2) primary transparenchymal approach. The authors review the indications of major hepatic resections in the treatment of hepatic tumors and discuss the advantages and the disadvantages of primary hilar and primary transparenchymal approaches, reviewing the data from the literature and the experience gained at the Clinica Chirurgica of the University of Verona from 1970 to 1989 of 289 major hepatic resections.
The diagnostic findings of hepatocellular adenoma and focal nodular hyperplasia became more frequent in the last years in our as in western experience. The improvement in diagnostic technique, a correct pathological identification and the diffusion of oral contraceptives explain this increase of incidence. In our series were present 11 hepatocellular adenomas and 19 focal nodular hyperplasias: all the HCA cases were radically resected, while only 15 FNH were resected, only two biopsied and two submitted to periodical follow-up. The tendency to spontaneous bleeding and the presence of diagnostic uncertainty versus well-differentiated hepatocellular carcinoma are mandatory indications for radical resections in all the HCA cases. FNH resection is reserved to symptomatic cases and wide wedge biopsy is at least required in presence of diagnostic doubts: the asymptomatic FNH ("hot spot" on Tc99m-HIDA scintigraphy) may be followed-up only.
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