Replacement of liver venous endothelium.
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Animals↗
Biomedical subjects
F Bresadola
Publications and source records attributed to F Bresadola.
Intraoperative cholangiography in laparoscopic cholecystectomy during residency in general surgery.
BACKGROUND: The role of laparoscopic intraoperative cholangiography (IC) in the diagnosis of asymptomatic choledocholithiasis is still controversial. The aim of this study was to evaluate the diagnostic-therapeutic impact and the educational implications of this method for residents specializing in general surgery. METHODS: We reviewed the records of 835 patients who underwent laparoscopic cholecystectomy for cholecystolithiasis without choledocholithiasis. IC was routinely performed by both expert surgeons and residents in general surgery. RESULTS: The cholecystectomy was completed laparoscopically in 804 cases, but conversion to open surgery was required in 31 cases. IC was not completed in 140 cases (17.4%), and in 44 cases it revealed a suspected choledocholithiasis. The stones were treated via laparoscopy in 36 cases, laparotomy in six cases, and endoscopic retrograde cholangiopancreatography (ERCP) in two cases. Five patients were not diagnosed wit h choledocholithiasis. In one case, a lesion of the choledochus was discovered and treated laparoscopically. A total of 610 IC were done by expert surgeons and 225 by residents. The duration of the cholecystectomy with IC was significantly different between the two groups (76.9 +/- 12 vs 92.4 +/- 11), as was the feasibility index (88.6% vs 80.6%). CONCLUSIONS: Laparoscopic IC is a safe and accurate procedure for the diagnosis of unrecognized choledocholithiasis. Teaching of this procedure as part of the specialization in general surgery would be opportune because it would provide surgical residents with an additional tool for the diagnosis and treatment of this pathology of the common bile duct.
Adolescent↗
Carriage of HFE mutations and outcome of surgical resection for hepatocellular carcinoma in cirrhotic patients.
BACKGROUND: Aggressive hepatocellular carcinoma (HCC) complicates frequently hereditary hemochromatosis, a disease for which a strong candidate gene, named HFE, has recently been identified. Patients with HCC who are heterozygotes for mutations in the HFE gene might have distinct features and a distinct disease course. METHODS: The presence of the 2 mutations associated with hereditary hemochromatosis (C282Y and H63D) was sought by restriction fragment length polymorphism in 61 cirrhotic patients (46 males and 15 females) who underwent resection for HCC at a single institution. RESULTS: There were 4 heterozygotes for the C282Y mutation and 6 homozygotes + 20 heterozygotes for the H63D mutation, with no compound heterozygotes. Carriage of >/= 1 HFE mutated allele was significantly more frequent in HCC patients than in 149 control subjects (44% vs. 29%, P = 0.005). Among C282Y heterozygotes, 3 of 4 were female, compared with 12 of 57 wild-type carriers (P = 0.015); no gender distribution existed among patients carrying H63D alleles (6 of 26 vs. 9 of 35, P = 0.813). Survival was longer for patients with wild-type HFE than for those with mutated HFE (67% vs. 22% at 3 years; hazard ratio = 0.42, 95% confidence interval = 0.21-0.80) (P < 0.01). The negative effect on survival that resulted from possessing >/= 1 HFE mutated allele was maintained even after adjustment for gender, age, presence of tumor capsule, presence of comorbid factors, Okuda stage, Edmonson grading, and number of lesions (P = 0.01). CONCLUSIONS: Testing for HFE mutations may help identify HCC patients with dismal prognoses for whom surgical resection may not represent the best treatment option.
Adult↗
Laparoscopic treatment of symptomatic lymphoceles after kidney transplantation.
BACKGROUND: The incidence of lymphocele after kidney transplantation ranges from 0.6% to 18%. This study examines the use of laparoscopic ultrasound for the location of lymphoceles during laparoscopic drainage. METHODS: Between July 1993 and October 1998, we performed 147 kidney transplants. A symptomatic lymphocele was observed in 19 patients (12.9%). All of these patients underwent peritoneal laparoscopic fenestration of the lymphocele. The graft, kidney hilum, ureter, iliac vessels, and lymphoceles were identified by laparoscopic ultrasound. RESULTS: All but one patient were discharged within 24 h. One recurrence (5.2%), which was successfully treated by laparoscopy, was observed at a mean follow-up of 15.5 months. We had one complication (5.2 %)-a left hydrocele that occurred 2 days after drainage of a lymphocele located in the left iliac fossa. CONCLUSIONS: Laparoscopic peritoneal drainage of posttransplant lymphoceles shares the well known advantages of laparoscopy. Furthermore, laparoscopic ultrasound is a useful tool that allows the recognition of anatomical structures and decreases the risk of iatrogenic lesions.
Adult↗
Efficiency of doxorubicin handling by isolated hepatocytes is a valuable indicator for restored cell function.
Pig liver is a possible source of hepatocytes for extracorporeal bio-artificial liver devices. In order to evaluate recovered hepatocyte function following enzymatic isolation, we developed a cytochemical method that is based on the capacity of hepatocytes to sequester the anthracycline antitumour drug doxorubicin within intracellular acidic compartments. Doxorubicin is a naturally fluorescent molecule. Thus, the process of drug concentration within hepatocytes can be visualized in living conditions by fluorescence microscopy. Porcine hepatocytes harvested from heart-beating donors were grown either as isolated cell suspensions or as tissue monolayers. Immediately after isolation and at fixed culture times, cells were incubated with 0.1 mM doxorubicin in Hanks' balanced salt solution for 10 min at 37 degrees C in 5% CO2-humidified atmosphere and observed by fluorescence microscopy. Parallel electron microscopy was performed to compare fluorescence data with general cell morphology. To monitor lysosomal acidification capacity, the fluorescent pH-sensitive vital dye LysoSensor-Blue was used. Doxorubicin fluorescence showed different patterns of nuclear and cytoplasmic staining, according to the time allowed for cell recovery and the culture method. In particular, cytoplasmic fluorescence changed from a diffuse staining, that could be observed after cell isolation and in hepatocyte suspensions, to a punctate perinuclear and pericanalicular fluorescence detectable in fully recovered hepatocyte monolayers. This study indicates that the 'doxorubicin-fluorescence test' may be considered a simple and rapid procedure for assessing hepatocyte functional condition. It may provide valuable and 'real time' guidelines for judging the correct way these cells are to be collected, preserved and utilized for clinical purposes.
Animals↗
Application of a clinical score for the diagnosis of acute appendicitis in childhood: a retrospective analysis of 197 patients.
PURPOSE: The aim of this study was to validate a clinical scoring system for the diagnosis of acute appendicitis in childhood. METHODS: The authors retrospectively applied a clinical scoring system on 197 consecutive pediatric patients operated on for acute appendicitis. They therefore looked for a correlation between the management suggested by the scoring system and pathologic diagnosis on surgical specimens. RESULTS: Based on final pathologic specimen, surgery has been performed unnecessarily in 23% of cases. The proposed scoring system could have reduced unnecessary surgery to 2%. Only 8% of patients with acute appendicitis would have been discharged home. Sensitivity and specificity of the scoring system used in this study was 87% and 86%, respectively. CONCLUSION: The clinical scoring system proposed in this study could be of help in early clinical diagnosis of appendicitis to reduce the rate of unnecessary emergency surgery.
Adolescent↗
Temporary neurological improvement in a patient with acute or chronic liver failure treated with a bioartificial liver device.
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Animals↗
Long-term therapy for postrenal transplant erythrocytosis with ACE inhibitors: efficacy, safety and action mechanisms.
SUBJECTS AND METHODS: Eleven patients with postrenal transplant erythrocytosis were treated with angiotensin-converting enzyme inhibitors for 18 months. RESULTS: Indices of red blood cell production and destruction, renal function and kalemia were followed-up during the treatment. Angiotensin-converting enzyme inhibitors (ACEi) led to a progressive and significant fall in hemoglobin and hematocrit compared to the basal values at every time interval considered with a maximum reduction at 12th month for hemoglobin ( 17.04 +/- 0.21 vs. 15.10 +/- 0.42 g/dl, p < 0.0001) and at the 6th month for hematocrit (53.74 +/- 0.56 vs. 45.7 +/- 1.19 %, p < 0.0001). Serum erythropoietin levels were reduced significantly after the first month of therapy (13.56 +/- 2.7 vs. 7.48 +/- 1.6 mUI/dl, p < 0.05) after which no further variations were recorded. In the course of ACEi therapy, there was an inverse correlation between percentage reduction in erythropoietin values and those of hemoglobin emerged (r = 0.24, p < 0.05) and hematocrit (r = 0.39, p < 0.01). Indices of red blood destruction including haptoglobin, bilirubin and lactic dehydrogenase, were unaffected by ACE inhibitors treatment, as was creatininemia and kalemia. Treatment was well tolerated by all patients who completed the study without major adverse side-effects. No patient required phlebotomy and no thromboembolic event occurred during angiotensin-converting enzyme therapy. CONCLUSIONS: Our results suggest that angiotensin-converting enzyme inhibitors are a safe and effective long-term therapy of postrenal transplant erythrocytosis. These agents decrease the erythropoietin synthesis but this effect is not the sole mechanism by which angiotensin-converting enzyme inhibitors act in postrenal renal transplant erythrocytosis.
Adult↗
[Sliding hiatal hernia in patients with gastroesophageal reflux: physiopathology and surgical treatment].
BACKGROUND: The aims of the study were to evaluate how the sliding hiatal hernia, in patients with gastroesophageal reflux disease (GERD), acts on the lower esophageal sphincter (LES) and esophageal clearance, and how surgical therapy corrects the physiopathological parameters. METHODS: Records of 25 patients with only GERD and of 15 with GERD associated to hiatal hernia (> 3.5 cm) were reviewed. Ten subjects without symptoms and/or endoscopic and functional signs of GERD were considered as control group. The selection of the patients was done by reviewing radiographic examination, endoscopy and functional tests (esophageal manometry, pH-monitoring). RESULTS: Manometry showed a greater LES incompetence (pressure and length) and a worse peristalsis (distal amplitude) in the group with reflux and hiatal hernia against patients with reflux only. Also, patients with hiatal hernia had more acid exposure (total time pH < 4 in the distal esophagus) and a longer time of esophageal clearance, at pH-monitoring. The functional tests in 8 patients, before and after laparoscopic Toupet fundoplication with posterior closing of the crura, showed a normalised LES, esophageal clearance and acid exposure. Esophageal peristalsis did not show any statistically significance. CONCLUSIONS: The presence of hiatal hernia, in patients with GERD, causes worse LES, peristalsis and clearance with a greater acid exposure of the esophagus. Fundoplication, by reconstructing the sphincter-diaphragm unit, normalises the preoperative physiopathology situation but without an effective peristalsis improvement.
Adult↗
Future of minimally invasive surgery.
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Forecasting↗
Laparoscopic vs open splenectomy in the management of hematologic diseases.
BACKGROUND: Laparoscopic splenectomy (LS) is becoming the gold standard in the treatment of several splenic diseases. Shorter postoperative stay and more rapid return to full activity are the primary advantages of LS. METHODS: Prospective data collection of 44 consecutive LS (group 1) and comparison with a historical control group of 56 consecutive open splenectomies (OS) (group 2) were performed for hematologic diseases. RESULTS: The LS patients started earlier on an oral diet (p < 0.0001) and left the hospital sooner (p < 0.0002) than OS patients. Less blood transfusion (p < 0.004) and pain medication (p < 0.0001) was required by LS patients. They also had fewer postoperative complications (p < 0.03). Compared by diagnosis, patients with laparoscopic idiopathic thrombocytopenic purpura or Hodgkin's disease started to eat earlier (p < 0.0001) and left the hospital sooner (p < 0.01). Multivariate analysis showed that time to oral diet and postoperative stay was related to operative technique and age. Morbidity and pain medications were related, respectively, to transfusion requirements and type of surgical approach. CONCLUSIONS: Used to manage hematologic diseases, LS is feasible, effective, and safe. It offers several advantages over the open approach. The type of surgical approach seems to be the crucial factor in determining the length of the postoperative course.
Adolescent↗
Elective transumbilical compared with standard laparoscopic cholecystectomy.
OBJECTIVE: To compare the transumbilical technique of laparoscopic cholecystectomy with standard laparoscopic cholecystectomy. DESIGN: Randomised open study. SETTING: Teaching hospital, Italy. SUBJECTS: 90 patients who required elective cholecystectomy under general anaesthesia. INTERVENTIONS: Standard laparoscopic cholecystectomy through 4 ports or transumbilical cholecystectomy through 2 ports. MAIN OUTCOME MEASURES: Amount of pain and analgesia, cost, side effects, and cosmesis. RESULTS: 25 patients were excluded from analysis (8 in the standard group because relevant data were not recorded; and 17 in the transumbilical group in 4 of whom relevant data were not recorded, and 13 for technical reasons). 32 patients who had standard, and 25 who had transumbilical cholecystectomy had operative cholangiograms. There were no complications, no side effects, and no conversions to open cholecystectomy. Those who had transumbilical cholecystectomy had significantly lower pain scores (p<0.05) and required significantly less analgesia during the first 24 hours (p<0.05) than those who had standard laparoscopic cholecystectomy. CONCLUSION: Once the learning curve has been completed, transumbilical cholecystectomy is possible without some of difficulties associated with standard laparoscopic cholecystectomy.
Adult↗
Laparoscopic splenectomy for haematological diseases: review of current concepts and opinions.
Laparoscopic splenectomy is now currently used by most surgeons in the treatment of many haematological diseases. The operative technique varies depending on the surgeon, but results are usually comparable among published series. We have reviewed 104 papers about laparoscopic splenectomy for haematological diseases and paid particular attention to surgical aspects and early postoperative results. We searched MEDLINE from January 1989 to April 1998, and of the 104 papers that we found 41 fulfilled our criteria of large series published in peer-reviewed journals that had been cited often. They usually compared laparoscopic and open splenectomy and focused on common problems (such as accessory spleens) and technical aspects (such as bleeding). Laparoscopic splenectomy is reported by most authors to be as safe and effective as open splenectomy for haematological diseases. It also has several advantages over the open approach, such as shorter and less complicated postoperative stay with better cosmetic results and more rapid return to full activities.
Hematologic Diseases↗
Splenectomy in hematology. Current practice and new perspectives.
BACKGROUND AND OBJECTIVE: Progress and changes in the management of blood diseases, in surgery and in video technology stimulate a critical reappraisal of splenectomy in hematology. DESIGN AND METHODS: We have collected information on the current practice of splenectomy in hematology in Italy and we have reviewed the results of a new technique of laparoscopic splenectomy (LS). RESULTS: Current splenectomy practice: the current practice in Italy is to offer splenectomy as front-line treatment for hereditary spherocytosis and as second-line for idiopathic thrombocytopenic purpura (ITP) and hemolytic anemia. Splenectomy is also offered in selected cases of leukemia and lymphoma but is going out of practice for hairy cell leukemia and Hodgkin's disease. The number of splenectomies that are performed every year is estimated to be higher than 10x10(6) persons (more than 500 cases per year). Laparoscopic splenectomy (LS): more than 700 cases of LS have been reported so far, for thrombocytopenia (470 cases) as well as for many other hematologic indications. The procedure carries a mortality of 0.8%, and a complication rate of 12%. Time spent in the operating theater ranges from 1.5 to 4 hours, blood transfusion requirement is minimal and the mean post-operative hospital stay is 3 days. INTERPRETATION AND CONCLUSIONS: Although a prospective comparison is not available, the results of LS compare favorably with the results of classic open splenectomy, so that LS is likely to become the technique of choice especially when the spleen is small, as in ITP. LS can also have some advantages in other cases of splenectomy, including splenomegaly for leukemia and lymphoma. These data and suggestions should stimulate and renew a discussion about splenectomy in hematology, with the purpose of establishing evidence-based guidelines.
Hematologic Diseases↗
Comparison of laparoscopic and open staging in Hodgkin disease.
BACKGROUND: Staging laparotomy provides useful information for management of Hodgkin disease but has fallen into disfavor because procedure-related morbidity exceeds that of new chemotherapeutic regimens. OBJECTIVE: To determine the feasibility, effectiveness, and safety of laparoscopic staging for Hodgkin disease compared with those of open staging. PATIENTS: Fifty-five patients with Hodgkin disease of cell types including nodular sclerosis in 43 (78%), mixed cellularity in 9 (16%), and lymphocyte predominance in 3 (5%). STUDY DESIGN: Concurrent evaluation of laparoscopic staging (n = 15) and retrospective review of open staging (n = 40). INTERVENTIONS: Laparoscopic and open techniques of surgical staging for Hodgkin disease, including splenectomy, liver biopsies, and lymph node sampling. MAIN OUTCOME MEASURES: Operative time, duration of postoperative ileus and of postoperative hospitalization, morbidity, number of lymph nodes retrieved, alteration in pathologic stage, recurrence, and survival. RESULTS: For laparoscopic staging vs open staging groups, mean operative time was 202 vs 144 minutes (P=.001); mean postoperative ileus was 1.9 vs 3.2 days (P<.001); mean postoperative hospitalization was 4.4 vs 6.7 days (P<.001); complications occurred in 3 patients (20%) vs 11 patients (28%) (P=.57); and mean number of lymph nodes retrieved was 8.5 vs 4.6 (P=.05). In the laparoscopic staging group, 2 cases (13%) were upstaged and 2 cases (13%) were downstaged. In the open staging group, 6 cases (15%) were upstaged and 3 cases (7.5%) were downstaged. Follow-up data were available for all patients in the laparoscopic staging group, at a mean of 23.5 months postoperatively. All were alive, none had recurrent disease below the diaphragm, and 2 (13%) had residual mediastinal disease. Follow-up data were available for 31 patients (78%) in the open staging group at a mean of 52.5 months postoperatively. All were alive, 27 (87%) were disease free, 3 (10%) had had relapses above the diaphragm, and 1 (3%) had residual mediastinal disease. CONCLUSIONS: Compared with open staging, laparoscopic staging of Hodgkin disease is oncologically equivalent and functionally superior. These data should encourage reappraisal of the role of operative staging in the management of Hodgkin disease.
Adolescent↗
Donor spleen cell isolation for augmentation of donor-cell chimerism in organ transplantation.
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Adult↗
Bioartificial liver based on porcine hepatocyte: in vitro functional assessment.
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Animals↗
Persistent secondary hyperparathyroidism after renal transplantation.
BACKGROUND: The persistence of secondary hyperparathyroidism after renal transplantation is frequent and often complicated by overt hypercalcemia. Recent investigations have shown an effect of the different vitamin D receptor (VDR) genotypes on parathyroid hormone (PTH) secretion in both primary and secondary hyperparathyroidism. The aims of this study were (i) to assess whether persistent secondary hyperparathyroidism after renal transplantation is characterized by any change in calcium-controlled PTH secretion, and (ii) whether different VDR allelic distributions might play any role on this setting. METHODS: Eighty-one cadaveric renal transplantation recipients, followed-up for at least 12 months, were checked for PTH, other primary metabolic and clinical variables, and VDR B/b alleles (BsmI). In 22 of these the following parameters were evaluated: (a) kinetics parameters of the Ca-PTH relation curve; (b) vertebral mineral density; (c) calcitriol serum levels; (d) PTH-related peptide serum levels; and (e) urinary hydroxyproline. RESULTS: According to the stabilised PTH levels (reached by the third month), the patients were divided in two groups: group A (N = 40, PTH < 80 pg/ml) and group B (N = 41, PTH > 80 pg/ml). Group B differed from group A in that patients had higher PTH levels at the time of transplantation, were older in age, and spent more time on dialysis. Group B had increased maximal and minimal PTH levels, and higher set-point levels than Group A. The patients with the BB pattern of VDR genotype were characterized by the lowest PTH levels both at time of transplantation and after stabilization, and lower set point values than patients with Bb and bb patterns. CONCLUSIONS: Our study suggests that (i) the severity of pre-existing secondary hyperparathyroidism is the main factor determining its persistence after renal transplantation, (ii) persistent secondary hyperparathyroidism is characterized by an autonomous pattern of PTH secretion, (iii) the VDR BB genotype seems to be related to lower PTH levels.
Adolescent↗