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Biomedical subjects

G L Grazi

Publications and source records attributed to G L Grazi.

At least 55 records · Page 3Linked to original sources
PubMed1996

Surgical therapy for undifferentiated (embryonal) sarcomas of the liver in adults.

Undifferentiated (embryonal) sarcoma of the liver is a rare malignant mesenchymal tumor with a poor prognosis. Thirty cases worldwide have been reported over the last 40 years. The absence of specific symptoms, the rapid tumor growth, the normality of the common tumoral markers and the consequential delay in the diagnosis, often allow a significant enlargement of the hepatic mass. Three patients ages 15, 25, and 60 were admitted to our department with such a tumor. In spite of the large dimensions of the neoplasms, all underwent a right hepatectomy without any major surgical complications. Two of them died due to tumor recurrence after 10 and 67 months, respectively. The one case remaining is alive and disease free 62 months postoperatively. The latter one was the only case where a complete tumoral capsule was found in the resected specimen. Surgery is strongly recommended for every case with evidence of a liver-confined tumor even if it is large.

Adolescent↗
PubMed1995

Etiologic factors and clinical presentation of hepatocellular carcinoma. Differences between cirrhotic and noncirrhotic Italian patients.

BACKGROUND: It is not known whether the prevalence of hepatocarcinogenic factors differs between cirrhotic and noncirrhotic patients with hepatocellular carcinoma (HCC) or whether the clinical presentation of HCC in these two groups differs. METHODS: The prevalence of the putative etiologic factors of HCC and its clinical presentation in 373 patients with cirrhosis and 102 without cirrhosis seen from 1981 to 1992 were evaluated. RESULTS: Hepatitis C virus infection (76 vs. 48%, P = 0.003) and both current (22.5 vs. 10%, P = 0.007) and past (50.5 vs. 34.5%, P = 0.045) hepatitis B virus infections were more common in cirrhotic than in noncirrhotic patients with HCC. The absence of exposure to both viruses was much less frequent in the former (7 vs. 40%, P < 0.001). Heavy alcohol intake prevailed in patients with cirrhosis (30 vs. 16.5%, P = 0.01). Alpha-fetoprotein elevation was more common in cirrhotic patients (63% vs. 31%, P < 0.001); however, the prevalence of diagnostic (> 400 ng/ml) levels did not differ significantly (24 vs. 17%) between the two groups. Extrahepatic extension of HCC was more common in noncirrhotic patients (20.5 vs. 6.5%, P < 0.001) and its independent predictors were poor cancer differentiation and absence of cirrhosis. "Asymptomatic" cancers were more frequently encountered with cirrhosis. Abdominal pain was the most common presenting symptom in both groups. Signs of hepatic decompensation prevailed in cirrhotic patients, whereas a "toxic syndrome" dominated the clinical picture of the noncirrhotic patients. CONCLUSIONS: Hepatitis viruses are associated more with carcinogenesis of the cirrhotic than of the noncirrhotic liver. Alpha-fetoprotein is not a sensitive neoplastic marker, particularly in noncirrhotic patients. In the latter, HCC appears more advanced at diagnosis and symptoms of neoplastic toxicity are prominent.

Abdominal Pain↗
PubMed1995

Liver resection without blood transfusion.

A retrospective study was carried out of 522 elective liver resections to determine the impact of blood transfusion on the immediate postoperative outcome and on long-term survival. The number of liver resections without transfusion has increased in recent years, as a result of improvement in surgical technique with less blood loss during operation and more careful choice of the timing of transfusion. In resections carried out in the past 5 years, the indication for intraoperative transfusion was restricted and the decision was made jointly by the surgeon and anaesthetist, and in any case only if the haematocrit was below 25 per cent. Of resections carried out in the past 2 years, 59 per cent did not require intraoperative transfusion. Postoperative deaths and complications were related to blood transfusion, particularly in patients with cirrhosis, in whom stepwise logistic regression analysis showed that transfusion was the only factor that correlated significantly with complications. Transfusion also affected the long-term survival of patients operated on for hepatocellular carcinoma and colorectal carcinoma metastases in univariate analysis and was the only factor shown by multivariate analysis to correlate with survival for hepatocellular carcinoma in patients with cirrhosis.

Adolescent↗
PubMed1995

The role of tumor markers in the diagnosis of hepatocellular carcinoma, with special reference to the des-gamma-carboxy prothrombin.

The assessment of new and more sensitive serum markers for hepatocellular carcinoma (HCC) represents a useful contribution to the diagnosis of small liver tumors, still amenable by surgery. We evaluated the efficacy of the tumor markers proposed during recent years for the study of HCC: alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), serum ferritin (SF), tissue polypeptide antigen (TPA), and, finally, the more recently proposed des-gamma-carboxy prothrombin (DCP). Of the 227 patients included in this retrospective study, 111 had HCC, and 85 of these were also cirrhotic. The remaining 116 patients, considered as the control group, included 23 patients with liver metastases from colorectal cancer, 26 with benign hepatic lesions, 20 with tumors other than HCC without hepatic metastases, and 47 with other liver diseases. For each single tumor marker, the sensitivity, specificity, positive and negative predictive values, diagnostic accuracy, and Younden index were assessed. AFP and DCP proved to be the most effective, with sensitivity, specificity, and diagnostic accuracy of 54.9%, 97.4%, and 76.6% and of 53.3%, 88.1%, and 71.1%, respectively. The same parameters evaluated for combined use of the two markers were 74.2%, 87.2%, and 80.9%, respectively. Analysis of the other markers produced no further significant contribution. Of the 111 patients with HCC, 35 (33.3%) were positive for both AFP and DCP, 43 (41%) were positive for one of them, and 27 (25.7%) were completely negative. In the 44 patients who underwent liver resection or transplantation, DCP correlated significantly with the histological presence of microvascular thrombosis, the major factor determining long-term survival after curative surgery. As a tumor marker for HCC, DCP is at least as effective as AFP; the combined use of AFP and DCP significantly improves the chances of identifying HCC by serodiagnosis.

Adolescent↗
PubMed1995

[Incidence of dilatation of residual cystic duct in liver transplantation. Our experience with 152 cases].

In our series of patients, we studied the incidence of residual cystic duct mucocele, which is still considered a rare complication in orthotopic liver transplantation (OLT). 152 OLTs were performed in 138 patients in the II Surgery Dept. of Bologna University, May 1986 to June 1994; a termino-terminal choledocho-choledochal anastomosis was performed in 145 of them. A choledocho-jejunal anastomosis was performed in other 7 patients. In 3 patients we observed an anechoic ovoidal structure localized just before the portal vein, near the main bile duct (MBD). Then, we monitored the evolution of this finding by ultrasonography (US), Doppler US, CT and CT-cholangiography. Integrated imaging, clinical and surgical data, led to the diagnosis of non-obstructive mucocele of residual cystic duct in OLT. To date, this complication has not led, on our series, to the necessity of new surgical procedures for cholestasis by MBD compression, which is in disagreement with literature data. In our series, the incidence of residual cystic duct mucocele is 2%, which is a higher value than those reported in the literature, suggesting that this condition be investigated carefully as a non-rare complication in OLT.

Adult↗
PubMed1994

Functional outcome in handsewn versus stapled ileal pouch-anal anastomosis.

Eighty-eight of 119 patients who underwent ileal pouch-anal anastomosis for ulcerative colitis were evaluated. Forty patients had a handsewn anastomosis (Hs) with mucosectomy, and 48 had a stapled anastomosis (St). In each patient, we evaluated operative, morphologic, functional, and manometric features. The results in the Hs and St groups were similar when the anastomosis was within 1 cm of the dentate line. In particular, there was no correlation between the type of anastomosis and the number of bowel movements in a 24-hour period, the presence of the urge to defecate, and the use of antidiarrheal drugs. Leakage was significantly higher in the Hs group, even when the anastomosis was less than 1 cm from the dentate line. Pouchitis was more frequent in the Hs group, and, within this group, among those with a short distance between the anastomosis and the dentate line. No correlations were found between the presence of columnar epithelium or active colitis in the mucosa below the anastomosis, the functional outcomes, and the incidence of pouchitis.

Adenomatous Polyposis Coli↗
PubMed1994

Overexpression of p53 protein and Ki67 proliferative index in hepatocellular carcinoma: an immunohistochemical study on 109 Italian patients.

The overexpression of p53 protein and the Ki67 proliferative index was evaluated in 96 hepatocellular carcinomas (HCC), 67 in cirrhotic livers and 29 in non-cirrhotic ones, and in 13 non-carcinomatous lesions, all surgically resected from Italian patients. Overexpression of p53 was detected only in carcinomatous lesions, and was significantly related to the grade of HCC (P < 0.001). In fact, p53 was observed in 7/7 (100%) cases of grade IV, 13/43 (30.3%) of grade III, and 10/46 (21.7%) of grade II. The relationship between p53 and Ki67 scores was determined in serial sections from corresponding areas of both diffuse and patchy immunoreactivity. In the overall population, p53-positive tumors showed a significantly higher Ki67 score (15.9 +/- 5.5% vs 9.2 +/- 4.3% [P < 0.001]). This observation was evident in all grades of HCC.

Carcinoma, Hepatocellular↗
PubMed1994

Bisegmentectomy 5-8 for the removal of tumors of the 8th hepatic segment--a technical note.

Isolated resection of the 8th segment is a technical challenge. The deep location of the afferent portal pedicle mandates the performance of a wedge resection that leaves a deep and narrow wound in which hemostasis is difficult to achieve. Furthermore the relationships with the middle and right hepatic veins jeopardize the transparenchymal approach. For the removal of tumors located in the 8th segment, we propose a combined resection of the 8th and 5th segments, whose pedicles arise from the anterior right pedicle of the portal vein. The technique permits a safe liver resection and ensures a satisfactory surgical margin.

Aged↗
PubMed1994

[11 years of experience in the surgical therapy of the liver metastases from colorectal tumors].

Surgery represents the only therapeutic remedy for liver metastases from colo-rectal cancer where satisfactory long term survivals have been reported. We have retrospectively analyzed the 11 year experience in the resective treatment of 108 patients operated on at our Surgery Department. Fourteen wedge resections, 52 segmentectomies and 42 major hepatectomies have been carried out. The operative mortality rate has been 0.9%. The post-operative course was uneventful in 86 (79.6%) cases, while 19 (17.6%) had one complication, 2 (1.9%) had two and only one had three. Overall, 62 (57.4%) patients are alive and 46 (42.6%) have died. The actuarial survival rate has been 45.7% and 28% at 3 and at 5 years respectively. The pre-operative CEA value, the percentage of the tumoral parenchymal involvement and the year of the operation tabulated independently produced better results using Cox's multivariate analysis. On the basis of these variables, it has been possible to identify a group of 49 patients with a 3 and 5 year actuarial survival of 70.3%. The use of intra-operative echography is essential in this surgery, guiding anatomical resection without the need for blood transfusions. Liver resection must be considered for patients with single or multiple liver metastases that are surgically treatable.

Adult↗
PubMed1993

Surgical experience with 168 primary liver cell carcinomas treated with hepatic resection.

Liver resections were performed in 168 patients with hepatocellular carcinoma (HCC) over the past 10 years; 116 were cirrhotics. Operative mortality was 7.7% (8.6% in the cirrhotic group and 5.8% in non-cirrhotics). In the years 1987-1992 the operative mortality decreased from 15.6% to 4.9% (P < .05). A statistical analysis of survival was made with the data of 155 patients with a follow-up of more than 1 month after curative resection: 56 (36.1%) died, while 99 (63.8%) are currently alive, with a follow-up varying from 2 to 76 months. The actuarial survival rate is 56.7% after 3 years and 36.3% after 5 years (59% and 35.2% for cirrhotics; 52.2% and 37.7% for non-cirrhotics, respectively). Satisfactory results can be obtained after liver resections in HCC, even in the presence of cirrhosis. Further efforts are needed in the early diagnosis of HCC, to prevent the formation of satellite nodules and the intrahepatic tumoral spread, which represent the major cause of exclusion from surgical therapy.

Adolescent↗
PubMed1993

Prognostic indicators in patients with cirrhosis and hepatocellular carcinoma undergoing surgical resection.

A retrospective study was performed in order to identify factors significantly associated with operative mortality and post-operative complications in 114 patients with liver cirrhosis who underwent resection surgery for single hepatocarcinoma nodules (diameter < or = 7 cm) from 1980 to 1992. Vascular thrombosis, extrahepatic spread of the tumor, ascites, advanced cirrhosis, severe cardio-pulmonary disease, and renal failure were exclusion criteria. Forty-one pre-operative (demographic, clinical, laboratory, and histopathological features) and two peri-operative variables (amount of blood transfused and duration of operation) were cross tabulated using chi 2 test with operative mortality and post-operative complications, which were taken as end-point variables. Stepwise logistic regression analysis was then employed in order to define factors independently associated with end-point variables. Only partial thromboplastin time abnormality was significantly (P = 0.003) and independently associated with operative mortality. The length of the operation and the period during which surgery was carried out (1980-1986 and 1987-1992) were significantly (P < 0.001) and independently associated with the occurrence of at least one post-operative complication. The results suggest that the use of more restrictive selection criteria do not make it possible to lower operative mortality, although the coagulative status should be better assessed. Minimizing surgical stress and optimizing post-operative medical care are crucial for preventing post-operative complications.

Adult↗
PubMed1992

An unusual case of choledochal cyst causing hepatic failure requiring orthotopic liver transplantation.

The authors describe a case of orthotopic liver transplantation (OLT) in a patient with an infantile form of choledochal cyst that progressed to severe hepatic failure. Choledochal cyst must be included in the differential diagnosis of extrahepatic biliary obstruction in infants; it represents an additional reason to consider early exploratory laparotomy, both for diagnosis and to perform definitive excision. In the event that end-stage liver disease develops, OLT should be considered.

Choledochal Cyst↗