Antithrombin III, blood loss, and transfusion requirements during liver transplantation.
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Antithrombin III↗
Biomedical subjects
L Belli
Publications and source records attributed to L Belli.
Biliary complications in orthotopic liver transplantation: experience with a modified technique of duct-to-duct reconstruction.
Biliary complications are described as frequent causes of morbidity during the postoperative course of orthotopic liver transplantation (OLTx), even in recent papers. The authors report here on their experience with duct-to-duct anastomosis as their method of choice for biliary reconstruction in a consecutive series of 100 OLTx in adult patients. The original technique, as described by Starzl, was modified by the authors by performing a wide, longitudinal plasty of both the donor and recipient bile ducts, joined together with two polidioxanone running sutures, producing the effect of a side-to-side anastomosis. This technique was used in all procedures, even when a significant discrepancy was evident between the ducts (n = 10). Follow-up was completed in 100% of the patients for a period of 2-40 months (mean 13.1 months). Four major complications (4%) occurred including hepatic abscesses due to ascending cholangitis, T-tube dislocation, partial occlusion by a branch of the T-tube at the anastomotic site, and disruption of the bile duct after T-tube removal. In four other patients, transient abdominal pain followed removal of the stent. Neither strictures nor fistulas were observed. Choledochocholedochostomy on a T-tube stent represents, in our experience, the technique of choice for biliary reconstruction in OLTx. The procedure, as described in the present study, proved to be safe in preventing strictures and leakages and appears to be feasible in nearly 100% of all adult patients undergoing OLTx.
Adult↗
Liver transplantation for chronic viral hepatitis.
Liver transplantation remains a problem for end stage liver disease due to chronic viral hepatitis, in contrast to the success with fulminant hepatitis B, D and C in which recurrence of viraemia is relatively rare. Following transplantation for chronic HCV disease recurrence of hepatitis C is infrequent and does not appear to be an important clinical problem. The complete picture will only be described when a suitable HCV-RNA test becomes routinely available. Patients with cirrhosis due to hepatitis B, with low levels of viraemia, or patients with hepatitis D are less likely to develop reinfection than those with high levels of HBV viraemia. The use of hepatitis B immunoglobulin in high doses for prolonged periods delays rather than prevents recurrence. It is a very expensive ancillary treatment. Patients with chronic hepatitis D related cirrhosis in whom levels of hepatitis B replication are suppressed, have a low recurrence rate even without immunoglobulin prophylaxis although HDAg remains in the liver. Hepatitis only reoccurs with recurrence of HBV infection. Unfortunately transplantation of HBV DNA and HBeAg positive patients has many shortcomings, and reinfection of the engrafted liver and subsequent development of hepatitis B is common. Survival rates are reduced in this latter group. At present there are no firm recommendations that can be given to prevent recurrence: HBIG in large doses and for prolonged periods would appear to be insufficient to prevent reinfection and these patients often die of recurrent disease. A major challenge for transplant groups will be the prevention of viral reinfection particularly in this latter group.(ABSTRACT TRUNCATED AT 250 WORDS)
Chronic Disease↗
[Imaging of the breast treated with quadrantectomy and radiotherapy. Interpretative difficulties in diagnosing asymptomatic recurrences].
This study was aimed at evaluating the incidence of breast carcinoma recurrences in a group of female patients treated with QU.A.RT. July 1989 to December 1990, 111 asymptomatic patients underwent physical examination, mammography (in both cranio-caudal and 45 degrees oblique projections), and US with 7.5 and 10 MHz probes. The study population was made of patients operated between 1984 and 1989 and subsequently treated with radiotherapy. Twenty-seven cases with suspect mammographic and US findings were selected and submitted to cytology with needle biopsy under US or stereotaxic guidance. Ten of them exhibited recurrences (9%) at cytology. Of the extant 17 cases, 5 had inflammatory lesions, 1 had liponecrosis, and 11 patients presented with no pathologic cells. The interpretative difficulties of mammographic and US findings were also examined. Problems were found to be related to both correct execution of the technique due to the treatment the breast is submitted to (volumetric reduction and structural distortion) and to correct image interpretation. Therefore we conclude that the two diagnostic methods be combined for they are complementary in the early detection of breast carcinoma recurrence.
Breast Neoplasms↗
[Prevention of hepatic metastases in radically operated colonic cancers].
The prognosis of colon cancer, after curative resection, is mainly related to the outcome of metastases, and especially of liver metastases. It is generally accepted that adjuvant medical therapy is important in order to prevent the incidence of metastatic recurrences. The aim of the present review is to analyse the conclusions of the main recent randomized trials assessing the comparative value of different adjuvant protocols. The results obtained using either systemic infusion, the classical one, or intraportal infusion, which is mainly designed to prevent liver metastases, are reported. On the basis of the review, we can conclude that: adjuvant chemotherapy using combined drugs (MF, MOF) did not prove to be more active than 5-FU alone. The beneficial action of a combined 5-FU + levamisole regimen has been clearly demonstrated for patients with a Dukes C tumour. According to a unique and limited trial, intraportal adjuvant therapy has been shown to be effective for patients with Dukes B tumours, but this remains to be confirmed. On the basis of the present data, new adjuvant programs using combined chemotherapeutic and immunotherapeutic coupounds, and combined systemic and loco-regional infusion, could be developed.
Antineoplastic Combined Chemotherapy Protocols↗
[Guidelines for management of genital herpes infection in the experience of a health care center for sexually transmitted diseases in Buenos Aires (Argentina)].
During two years all clinical genital lesions compatible with herpes simplex virus (HSV) etiology were studied systematically through intent of virus isolation in BHK cells. Isolation of virus was confirmed in 85% of the 206 cases studied. All seems to indicate that around the 20% of the isolations belong to the type HSV1 and the rest to the type HSV2. Viral Antigen demonstration, by direct and/or indirect technics with antibodies poly or monoclonals shows to be less sensitive than the virus isolation. The systematic study of these sexually transmitted disease revealed two indicative results: 5.32 cases of Gonococia per each case of HSV were confirmed. It seems to be a possibly relation for the actual epidemiology moment of our country. The other is the need, specially in younger people, to explore systematically syphilis, not only in all the genital ulcers, also in presence of a typical clinical of HSV.
Adult↗
[The role of color Doppler echography in the diagnosis of breast tumors].
The authors discuss the results from a series of 45 patients with breast lumps. All patients were studied by means of mammography, sonography, color Doppler US, and biopsy. Abnormal Doppler signal was observed in 94% of the patients with breast cancer. However, this finding is not specific because it can be occasionally found in benign lesions too. The use of color Doppler US is suggested in those cases where neither US nor mammography is conclusive.
Adult↗
[Evaluation of bone age in patients with kwashiorkor].
The present work is the result of a multicentric study performed at Hoima and Kitgum Hospitals in Uganda on a group of 20 children with Kwashiorkor. Bone age was evaluated on the X-ray film of the children's left hand and wrist, according to Tanner and to De Roo, by 2 different evaluators. The final results were compared. Eighty-five % of the patients presented delayed bone maturation: such a result confirms the importance of malnutrition on skeletal development. The data reported by other authors are also discussed.
Age Determination by Skeleton↗
[Value of echographic examination in the study of osteomyelitis].
Beside conventional radiology and bone scintigraphy, an important role is played in the diagnosis of osteomyelitis by sonography (US). This technique is especially useful to detect fluid collections in the soft tissues adjacent to the bone. Ten patients with osteomyelitis were examined: in 8 cases the presence of fluid collections was demonstrated, which were sometimes spreading along the bone axis and sometimes localized in a single site. The collection was subperiosteal in all cases. Sonography proved thus useful in providing further information on the bone affected with osteomyelitis.
Adolescent↗
[Tropical splenomegaly: echographic picture].
Tropical splenomegaly is a pathologic condition due to multiple causes, endemic malaria being the major one. Twenty-eight black patients, 10 males and 18 females, residing in a tropical area, were investigated with US. The morphological features and major diameters of the spleen were studied and the splenic volumetric index (IVS) was calculated. Typical features were the presence of small intraparenchymal calcifications (46%) and the enlargement of splenic vessels, with US wall reinforcement (75%). No nodular lesions were detected, but increased frequency of organ lobulation was observed. A definite and uniform increase in splenic diameters was seen in all cases; IVS in particular was greater than the accepted confidence limit (21.5 +/- 6.5). This characteristic features should help the echographist to recognize this condition for they supply useful clinical information.
Adolescent↗
A comparative clinical study on the effects of cardiopulmonary bypass with different flows and pressures on skeletal muscle cell metabolism in patients undergoing coronary bypass grafting.
This study compares the effects of cardiopulmonary bypass with different flows and pressures on intracellular energy metabolism, acid-base equilibrium, and muscle water compartments in two groups of patients undergoing coronary artery bypass grafting. Eighteen patients (16 men and two women aged 54 +/- 7 years, New York Heart Association class I-II) undergoing low flow (flow rate 1.5 L/min/m2 at 26 degrees C), low pressure (mean arterial pressure 40 to 60 mm Hg) cardiopulmonary bypass, as well as 10 age-matched and sex-matched patients undergoing normal flow (flow rate 2.2 L/min/m2 at 26 degrees C), normal pressure (mean arterial pressure 60 to 80 mm Hg) bypass were studied. Intracellular acid-base equilibrium (intracellular pH and intracellular bicarbonate), cell energetics (adenosine triphosphate, diphosphate, and monophosphate, phosphocreatine, and lactate), and muscle water compartments were evaluated in specimens of the quadriceps femoris muscle obtained by needle biopsy before and at the end of cardiopulmonary bypass. In both the low flow-low pressure and normal flow-normal pressure groups, adenosine triphosphate levels were unchanged at the end of bypass, whereas phosphocreatine concentration was decreased; muscle total water and extracellular water increased without variations of intracellular water; muscle and plasma lactate increased as intracellular bicarbonate decreased; intracellular pH values remained unchanged. The present study suggests the following: (1) Cardiopulmonary bypass is associated with the overall preservation of intracellular compartment metabolism in skeletal muscle (about 40% of body cell mass) of patients undergoing coronary bypass grafting, even though low phosphocreatine values and increased plasma and muscle lactate values found at the end of bypass could be an expression of cell functional reserve exhaustion; (2) the effects of cardiopulmonary bypass on cell metabolism are comparable, regardless of the flows and pressures used.
Blood Pressure↗
[Percutaneous transcatheter embolization in blood steal following myocardial revascularization. 2 case reports].
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Adult↗
Resection of pulmonary metastases in osteosarcoma. A retrospective analysis of 44 patients.
Between 1977 and 1985, 44 patients with osteosarcoma and pulmonary metastases were treated at Institut Curie and Marie-Lannelongue. Twenty patients were able to undergo operations according to our criteria. Of 17 patients who immediately after surgery were clinically and radiologically free of disease, six are alive with no evidence of disease and one suffered recurrent pulmonary disease; their 5-year survival is 37%. In 24 patients, various schemes for aggressive chemotherapy for measurable lung disease could be assessed. Only one patient had a complete response; there was one partial response, and three patients experienced stabilization of their disease for 6 to 8 months. Of five patients who had second line postoperative adjuvant chemotherapy, four relapsed within 2 months of stopping treatment. Surgical resection of lung metastases appears definitely to improve the outcome in osteosarcoma patients. Chemotherapy offers no advantage in treating bulk disease, but the prevention of new micrometastatic disease remains a possibility and should be assessed in randomised multicenter trials.
Adolescent↗
Reappraisal of surgical treatment of small hepatocellular carcinomas in cirrhosis: clinicopathological study of resection or transplantation.
Thirty-two patients with hepatocellular carcinoma (HCC) occurring in individuals with cirrhosis had a potentially curative surgical procedure. Twenty-two had segmental hepatic resections (HR), and 10 underwent orthotopic liver transplantation (OLTx). The diagnosis of hepatic malignancy was established in each case preoperatively, and each case was studied intraoperatively by means of sonography. Postoperatively each surgical specimen was examined pathologically with attention to the possibility of intrahepatic tumor spread. Twenty-three of the 32 patients had single small HCC lesion (less than 5 cm diameter) identified preoperatively. Sixteen of these underwent HR and seven underwent OLTx. Multiple additional neoplastic lesions were found in 19% of the 16 HR cases and in 14% of those undergoing OLTx when the resection specimens were examined pathologically. Vascular invasion was present in 43% of the OLTx patients and in 25% of the HR patients. Subtotal hepatic resection for small HCC occurring in cirrhosis has produced few long-term survivals. Both pre- and intraoperative sonography have been shown to underestimate the extent and distribution of these tumors. Based upon this experience that (1) vascular spread occurs often in HCC and (2) a high risk of postoperative hepatic failure can be expected after HR in cirrhotic individuals, OLTx is the most rational surgical procedure for such cases as it has the potential to cure.
Carcinoma, Hepatocellular↗
Pylorus preserving pancreatoduodenectomy versus Whipple procedure for adenocarcinoma of the head of the pancreas.
Thirty eight patients underwent pancreatoduodenectomy for histologically confirmed adenocarcinoma of the head of the pancreas. Twenty one underwent a pylorus preserving pancreatoduodenectomy and seventeen the classical Whipple procedure. We undertook this retrospective analysis to compare longterm survival following the two different surgical procedures. Patients in the two groups were comparable for preoperative laboratory data, age and pathological staging. Minor and major morbidity was not different between the two group (33.3% and 35.2% respectively). In the pylorus preservation group a delayed resumption of full oral diet and a consequent prolonged hospital stay has been noted (21.3 days vs 15.4 days, p less than 0.05). Mean survival was 21 months in the pylorus preservation group and 17 in the Whipple group. No statistical difference was observed between the two survival curves. According to these data the pylorus preserving pancreatoduodenectomy represents a reasonable option for adenocarcinoma of the head of the pancreas.
Adenocarcinoma↗
[Acute gonorrhea. Treatment schedules. Evaluation].
It has become gradually more difficult to achieve therapeutic efficacy in the treatment of gonorrhea without the help of bacteriologic examinations that include the identification of resistant strains. We present information that evaluates the incidence of beta-lactamase producing strains and discuss the efficacy of the prescribed treatments.
Acute Disease↗
[Hepatocellular carcinoma (HCC): the long-term response to tamoxifen. A clinical case report and review of the literature].
A 52 years old female with hepatocellular carcinoma (HCC) was treated successfully with Tamoxifen. The tumor involved IV hepatic segment with hilar extension and biliary obstruction, was unresectable, and had been pretreated with hormone-chemotherapy. Tamoxifen treatment induced a PR of 6 months, with normalization of serum bilirubin, reduction of alfa-fetoprotein level and improvement of PS, and was free of toxicity. At disease progression intra-arterial chemotherapy with Cis platinum (CDDP) and 5-FU gave a further 4 months PR, until disease progression and exitus in hepatic coma. Tamoxifen therapy, even in the absence of E.R. assay is a useful tool in the management of HCC patients. Further randomized studies are necessary to ascertain the role of Tamoxifen in the treatment of HCC.
Antineoplastic Combined Chemotherapy Protocols↗
[Systemic-pulmonary fistula: description of 2 cases].
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Adult↗