PubMed Health⌕ Search

Biomedical subjects

L De Carlis

Publications and source records attributed to L De Carlis.

15 recordsLinked to original sources
PubMed1992

The role of spontaneous portosystemic shunts in the course of orthotopic liver transplantation.

Spontaneous portosystemic shunts are commonly found in cirrhotic patients. Not yet established is their role after orthotopic liver transplantation (OLTx), especially when an increase in portal pressure develops, as during early acute rejection. In this study, 34 cirrhotic patients in a series of 70 OLTx are considered. Each patient had preoperative angiographic assessment, and, in 21 (62%), large spontaneous portosystemic shunts were evident. In 12 cases the shunts were not affected by the surgical procedure and were present during the postoperative period; in 9 the hepatectomy itself involved interruption of the shunts. The patient population was divided into two groups: patients with postoperative shunts (n = 12) and those without (n = 22). The two groups were similar in age, sex, Child's stage, transplantation variables, and number and grade of rejection episodes. However, mean transaminases (AST) values in the first 2 weeks were significantly higher levels in shunt versus nonshunt patients (421 +/- 335 vs 183 +/- 126; P less than 0.025), and this was even more evident when rejection occurred (626 +/- 375 vs 195 +/- 129; P less than 0.001). Furthermore, during an acute rejection reaction, three cases showed a true "steal phenomenon" through the large reopened shunts with ischemic damage to the grafts. The data indicate a possible detrimental effect of the spontaneous shunts on graft perfusion and suggest the prophylactic surgical interruption of the residual shunts during the transplantation.

Adult↗
PubMed1992

Factors in the development of a liver transplantation programme: experience of 100 consecutive transplantations in Milan's Niguarda Hospital.

From December 1985 to December 1990, 100 liver orthotopic transplantations (OLTX) were performed in 89 adults with cirrhosis and various other liver diseases; eight patients had two transplants and three of these had three transplants. Organ perfusion was done with Eurocollins in the first 30, then with UW solution. Immunosuppressants were a combination of cyclosporin A and steroids for the first 30 patients, and then a combination of antilymphocyte globulin, azathioprine, methylprednisolone and cyclosporin A. The OLTXs were examined as a whole and also divided into two groups, one for 1985-88 and one for 1989-90. The cumulative survival was 63% after 12 months, 40% after 36 and 42 months. It was poor for the patients who received transplants between 1985 and 1988, but for the second group, survival was improved to 78% after 12 and 18 months. For neoplastic patients, overall survival was 49% after 18 months and 23% after 36 and 42 months. In the second group it was markedly better (83% after 18 months). The recurrence rate for patients surviving more than three months was 17% for hepatocellular carcinoma and 50% for cholangiocarcinoma. Five patients (38%) out of 13 HBsAg-positives before the transplant and surviving more than three months had recurrent hepatitis-B virus. The remaining eight patients are HBsAg negative at present. The improved actuarial survival for the second group is accounted for by the better surgical and intensive care given now and the methodological differences.

Adult↗
PubMed1992

Surgical treatment of symptomatic giant hemangiomas of the liver.

Cavernous hemangiomas are the most common benign tumors of the liver. Twenty-four patients who had hepatic resections for giant symptomatic hepatic hemangiomas during a six year period at a single institute were retrospectively reviewed to analyze indications for surgical treatment and evaluate operative mortality and morbidity. There were 18 women and six men varying in age from 41 to 69 years with an average age of 52.5 years. Moderate to severe pain, discomfort, feeling of fullness, bloating and sensation of an abdominal mass were the most commonly reported symptoms. Ten patients had moderate anemia and two had severe anemia. Tumors were visualized by ultrasonography in all patients and by computed tomography in 18. Angiography was performed in all patients with diagnostic confirmation of a benign hemangioma in all but one patient in whom an angiosarcoma was suspected. The resection was feasible in each patient: 20 minor hepatic resections (three wedge, 11 segmentectomies, six bisegmentectomies) and four right hepatic lobectomies were carried out. There were no surgical deaths. Two patients had postoperative complications: one patient had a pneumonia on the right side and one had wound infection. The benign nature of the tumors was confirmed in all. The lesions varied in size from 5.6 to 26 centimeters in diameter. Symptoms and hematologic disorders were relieved in all patients in the follow-up. The results of our experience confirm that resection for giant symptomatic hepatic hemangioma represents a safe radical curative procedure. Medical treatment is justified in smaller lesions or in asymptomatic patients.

Female↗
PubMed1991

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↗
PubMed1989

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↗
PubMed1988

The role of donor and recipient factors in initial renal graft non-function.

ATN is a deleterious problem in the outcome of kidney transplantation. This complication is usually related to multiple factors including donor parameters, surgical technique, ischemic time, and recipient variables. In order to develop prophylactic measures, out of 430 kidney transplants performed in our Department, a series of 90 consecutive cadaveric renal allografts has been considered in this study. The overall incidence of IGNF was 23/90 (25.5%). Kidneys from MOD revealed a lower rate of IGNF (7/35 = 20%) when compared with organs from SOD (16/55 = 29%, P = NS). No difference was noted when kidneys were removed together with heart and/or liver and/or pancreas. Out of the donor factors, only CID was significant (17 +/- 9 hours in IGNF v 11 +/- 10 hours in patients with IGF, P = less than .05). Analysis of data concerning the fate of paired kidneys revealed two cases of IGNF in both kidneys from the same donor v 14 cases of IGNF in only one of the two paired grafts (P = NS). We conclude that: 1. Donor factors are clearly associated with a minority of IGNF. 2. The introduction of multiorgan procurement programs does not complicate early function. 3. Recipient factors (immunological events and intraoperative fluid management) provides important additive effects on initial graft nonfunction.

Adolescent↗
PubMedDate not supplied

Thromboendarterectomy (TEA) in the recipient as a major risk of arterial complication after kidney transplantation.

The authors analyze a series of 383 kidney transplantation pointing out the role of recipient's vessels atherosclerosis in the determination of vascular complication of the kidney graft. Three groups were considered. The first included 55 patients which required TEA for severe atherosclerotic lesion of the anastomosed vessels. The second group included 305 patients who didn't required TEA; the third group was of 20 patients who received a graft with multiple arteries which required more than one anastomosis. A significative higher rate of arterial complications was evident in the first group (p less than 0.001). Within this group the end to end arterial anastomosis was more frequently associated to thrombosis or stenosis than the end to side one (p less than 0.05). Kidney with multiple vessels also presented with an higher rate of complications (p less than 0.05).

Adult↗
PubMedDate not supplied

Veno-venous bypass without heparin in orthotopic liver allotransplantation in the pig.

It is now widely accepted that a veno-venous bypass is required to minimize the problems of the anhepatic phase in orthotopic liver transplantation. A technique that does not require systemic anticoagulation is needed to prevent damage by heparinization in hepatic patients. The use of heparin-bonded cannulas offers low risks of thromboembolic complication. Fourteen orthotopic liver transplantation were performed in pigs, including 7 with a roller pump and 7 with a centrifugal pump, without systemic anticoagulation and with heparin-bonded circuits except for the portal cannula, connectors, centrifugal pump head and the tract of the circuit on which the roller moves. All the circuits were previously utilized in clinical liver transplantation and repeatedly washed in saline solution and sterilized for each experiment. The haemodynamic control of the anhepatic state was excellent without hypotension and venous engorgement. In only one case a thromboembolic complication was noted. Arterial pressure, heart rate, urine flow, creatinine, arterial pH and thromboelastographic data did not change significantly while on bypass. No difference was found in the use of either a roller or a centrifugal pump even when the blood flow fell to less than 1000 ml/min to 500 ml/min.

Animals↗
PubMedDate not supplied

Heterotopic liver allograft in acute hepatic failure in pigs.

Seven heterotopic liver allotransplantations were performed in pigs with total, acute hepatic necrosis, induced by arterial and portal vein devascularization. Six pigs survived for 4, 6, 7, 7, 23 and 90 days respectively. Good results can be obtained only with intensive perenteral postoperative support lasting the first three days. The viability of the graft is shown by the biochemical indices and the survival of the animals. These results confirm that a heterotopic liver transplantation provides a viable substitute when the host liver is affected by acute irreversible hepatic necrosis.

Animals↗