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Biomedical subjects

M Iappelli

Publications and source records attributed to M Iappelli.

At least 19 recordsLinked to original sources
PubMed2006

Intractable pruritus in patients with hepatitis C virus.

Intractable pruritus is one of the most common symptoms of chronic liver disease, especially experienced by patients with prolonged cholestasis. It can become the most distressing symptom in patients affected by chronic liver disease, causing a reduction in quality of life, interfering with daily activities, and leading to sleep deprivation or contributing to psychological disturbances up to suicide ideation. Therefore, pruritus that does not respond to medical therapy is an indication for liver transplantation. We treated nine patients with hepatitis C virus affected by intractable pruritus with the molecular adsorbent recirculating system. In each patient, liver function, renal function, and hemodynamic variables were evaluated before and after the treatment. Before undergoing the treatment each patient underwent abdominal ultrasound or computed tomography scan to exclude organic causes for pruritus. We observed a decrease in total bilirubin, creatinine, and bile acids together with a significant improvement in Visual Analog Scale for staging of pruritus in all the patients. Due to the small number of patients the results were not significant.

Adult↗
PubMed2004

Survival in kidney transplantation from living donors: a single-center experience.

BACKGROUND: Transplantation from living donors, in Italy, is still not accepted, in particular those from unrelated donors. The aim of this paper was to present the experience of one transplant center. MATERIALS AND METHODS: Since 1982, 608 transplants were performed from living donors using cyclosporine as the main component of immunosuppressive therapy. Among those, 402 transplants were from related living donors (338 one haplotype pairs and 25 zero haplotypes pairs) and 206 from unrelated living donors (171 spouses and 35 emotionally related subjects). RESULTS: Graft survival at 1, 5, and 10 years showed no statistically meaningful difference between the two groups. A group of 19 transplants performed in predialytic phase patients was compared with a contemporaneous group of 167 transplants performed in patients who were already receiving dialysis. These two groups did not show any statistically meaningful difference in graft survival at 1, 5, or 10 years. DISCUSSION AND CONCLUSIONS: We think that transplants from living donors, whether related or unrelated, must always be proposed as a therapeutic option for end-stage renal disease patients, since they show an higher graft survival than that from cadaveric donors, independent of the compatibility between donor and recipient and independent of the degree of relationship of the pair. Transplantation from living donors definitely is a complementary, not substitutive, program to that from cadaveric donors, which should always be encouraged with awareness campaigns among the population and targeted programs for healthy personnel.

Actuarial Analysis↗
PubMed2004

Low-dose intramuscular hepatitis B immune globulin and lamivudine for long-term prophylaxis of hepatitis B recurrence after liver transplantation.

The combination of lamivudine and hepatitis B immunoglobulins (HBIg) to prevent recurrence of HBV hepatitis has significantly improved the survival of patients transplanted for HBV-related end-stage liver disease. Generally, HBIg are administered intravenously. We evaluated the efficacy, tolerability, and cost savings of long-term intramuscular HBIg and lamivudine in 28 patients (23 men and 5 women), who received liver transplants for acute or chronic HBV-related liver disease. Twelve patients started lamivudine before and 16 at the time of liver transplantation. HBIg were administered intravenously during the first week (50 to 70,000 IU) and intramuscularly thereafter (1200 IU every 3 to 6 weeks) to maintain an HbsAb titer >100 IU/L. Mean follow-up was 20 +/- 13 months. Only one patient experienced HBV recurrence (9 months after transplantation). This patient had failed to follow the scheduled prophylaxis. Cumulative survival at 3 years was 83%. Intramuscular HBIg were well tolerated in all cases. Cost analysis comparing intramuscular vs intravenous HBIg administration showed that 39,490 Euros were saved per patient per year. These preliminary results show that low-dose intramuscular HBIg and lamivudine are efficacious and cost-effective for long-term prophylaxis of hepatitis B recurrence after liver transplantation.

Antiviral Agents↗
PubMed2003

Measurement of oxysterols and alpha-tocopherol in plasma and tissue samples as indices of oxidant stress status.

Oxidant stress seems to play a role in several setting of human pathology, such as atherosclerosis, cancer, and aging. The study of oxidant stress in human disease should be based on the evaluation of either sensitive and specific markers of enhanced oxidant stress, such as oxysterols, or antioxidant defense, by measuring alpha-tocopherol. We have developed a rapid method to measure the oxysterols 7beta-hydroxycholesterol and 7-ketocholesterol in plasma (50 healthy subjects) and tissue as an index of oxidant stress in vivo, and from the same sample alpha-tocopherol content. The mean plasma concentration of 7beta-hydroxycholesterol and 7-ketocholesterol was 4.6+/-1.1 and 13.4+/-7.6 ng/mL, respectively. Plasma alpha-tocopherol concentration was 5.8+/-1.0 micromol/mol cholesterol. Samples from atherosclerotic plaques contained 20 times more cholesterol, about 45 times higher oxysterols levels, and 600 times more alpha-tocopherol compared to normal arteries. No significant difference in cholesterol and oxysterol content was observed between cirrhotic and normal liver. However, cirrhotic liver contained significantly smaller concentration of alpha-tocopherol compared to normal liver. In conclusion, we have developed a rapid and reliable method for the assay of cholesterol oxidation products and alpha-tocopherol in plasma and tissue useful for estimation of oxidant stress/antioxidant balance.

Adult↗
PubMed1995

[Nonvascular interventional radiology in the treatment of post-liver transplant complications. The clinico-radiological correlations and technical considerations].

Eleven patients, included in a series of 105 orthotopic liver transplant recipients, underwent interventional radiologic procedures for post-operative complications. Seven patients had obstructive jaundice, three patients had sepsis, and one patient was bleeding from the T-tube. Cholangiography, performed in 9/11 patients, demonstrated stenosis of the anastomosis in six cases, stenosis of the intrahepatic biliary tree in one case, and stenosis of both tracts in the remaining two cases. Four patients were treated with bilioplasty (from 1 to 5 sessions), using balloon catheters (8-10 mm) followed by stones removal in one case, and by the placement of a metallic stent in another case. The follow-up ranged from one to three years: no biliary stasis occurred, during that period, in these patients. Another patient with recurrent cholangiocarcinoma of the biliary anastomosis, treated with Carey-Coons endoprosthesis and brachytherapy, died four months later without jaundice. In the three patients with sepsis and in the patient with bleeding from the T-tube, intra- or extra-hepatic (in one case) multiple abscesses were demonstrated. The conservative treatment with the placement of percutaneous drainage catheters, associated with internal biliary drainage in two cases, allowed complete symptoms resolution. The technical success obtained in all patients confirmed the effectiveness of interventional radiology in the treatment of biliary complications after liver transplant, thus avoiding the need of surgical reintervention.

Cholangiography↗
PubMed1990

[Surgical technique aspects in multiorgan transplantation: personal experience].

The Authors report their experience with multiorgan transplantation performed in 3 patients affected by multifocal cancer of the liver, either primitive (2 cases) or secondary (1 case). The rationale for this new approach was the unfeasible single liver transplantation taking into account the extracapsular diffusion of the neoplasia.

Adenocarcinoma↗
PubMed1989

[Transplantation of the pancreas: surgical aspects].

Based on their personal as well as international experiences, the authors describe different surgical techniques employed in pancreatic allograft related to different complications rate and patient and graft outcome. In fact, the surgical technique represents an only partially solved problem, because of the high percentage of complications dealing with the different approaches. Even though several procedures concerning either the site of implantation either the treatment of the exocrine function have been so far used, the results up to now obtained are the main limiting factor for a large clinical application of pancreatic transplantation.

Diabetic Nephropathies↗