PubMed Health⌕ Search

Biomedical subjects

L S Belli

Publications and source records attributed to L S Belli.

13 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↗
PubMed1991

Hepatocellular ballooning after liver transplantation: a light and electronmicroscopic study with clinicopathological correlation.

The histopathological features of orthotopic liver grafts were studied in 107 serial specimens from 25 patients, to assess the prevalence, possible pathogenesis and prognostic implications of hepatocellular ballooning. Ballooned hepatocytes were found in 46 (54%) of 85 biopsies taken five or more days after transplantation from 16 patients. They were not found in any of the protocol biopsies taken at the time of the operation. Ballooning usually appeared in the second week after transplantation, and in most patients persisted to the time of the latest biopsy studied. The affected cells were always found in acinar zone 3, and sometimes also in other zones. Forty-four of the 46 biopsies with ballooning were taken during a period of clinical and biochemical cholestasis. In 13 of the 16 patients the degree of ballooning paralleled the severity of the cholestasis. Electronmicroscopy of affected hepatocytes showed conspicuous dilatation of the cisternae of the rough endoplasmic reticulum rather than the classical features of cholestasis. It was therefore concluded that ballooning was associated with but not directly caused by bile retention. There was no obvious association between ballooning and cellular rejection, sepsis, immunosuppressive therapy or parenteral nutrition. The most severe early ballooning was associated with serum transaminase levels over 1000 IU/l within 48 h of transplantation, suggesting that ischaemia was one of the pathogenetic factors. Hepatocellular ballooning did not in itself appear to have sinister short-term prognostic implications.

Adolescent↗
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↗
PubMed1986

Immunophenotyping of mononuclear cell infiltrates associated with renal disease.

Twenty-eight frozen renal biopsy specimens with a marked mononuclear cell interstitial infiltrate (MCI) were analyzed with monoclonal antibodies and a biotin-avidin peroxidase technique to define the surface phenotype distribution of the infiltrating cells. Twelve cases were diagnosed as tubulointerstitial nephritis of acute and chronic presentation, of unknown cause in 5 cases or secondary to multiple myeloma or drug reactions. Sixteen cases occurred in primary and secondary glomerulonephritis, 3 cases being associated with lymphoproliferative disorders. The results showed a remarkable heterogeneity of the MCI composition, even in cases with similar clinical and pathological findings. Namely, the T cells accounted for the majority of the infiltrating cells in most cases but a variable predominance of the T cell subsets Leu3 and Leu2 was observed. B cells and monocytes were also prominent in some cases. Such differences in the MCI composition may indicate the activation of different mechanisms of tissue damage, or a different phase of the renal disease. In the three cases of glomerulonephritis associated with lymphoproliferative disorders, the malignant origin of the MCI was demonstrated in one case, while in the remaining cases it was excluded.

Antibodies, Monoclonal↗
PubMed1985

Influence of technical factors and different immunosuppressive regimens on kidney graft survival. Retrospective analysis on 300 kidney transplants.

300 patients underwent kidney transplantation. Uretero-neocystostomy was performed by means of the Politano-Leadbetter technique in the first 185 patients and direct ureterovesical anastomosis in the other 115 patients. Immunosuppression included conventional therapy (steroids, antilymphocyte globulins, azathioprine) and the association cyclosporine A and steroids. Retrospective analysis on these 300 patients indicates that the improved 1 year graft survival rate (85% vs 64%) we observed in the latest years has depended to the same extent, on improved surgical technique and on advent of cyclosporine A in our therapeutic protocols. Cyclosporine A at low starting doses immediately adjusted on whole blood trough levels (200-400 ng/ml) proved to be superior to other therapeutic schedules reported in this study (1-year graft survival rate: 94% vs 84%-73%). Direct ureterovesical anastomosis was characterized by a net reduction of urologic complications (2.5% vs 9.7%).

Antilymphocyte Serum↗
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↗