Biomedical subjects
Publications and source records attributed to M Salizzoni.
Three recently observed cases of Castleman's tumour are described. A brief summary of the clinical histories, themselves of little significance, the histological, diagnostic and therapeutic aspects of the disease are examined. The series is shown to be fully in line with those reported in the literature, and support is given to the view that the tumour is of inflammatory origin.
Two cases of pulmonary hernia, different in etiology and therapeutic indications, are described. We are discussing, then, anatomic, etiologic, pathogenic and clinic characteristics of this uncommon disease. At last, Authors, are making some considerations about indications on how to operate on pulmonary hernias and different repairing surgical technics.
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In spite of improvements in diagnosis and treatment, the fatal prognosis of lung cancer has persisted over the course of 25 years in a series of nearly 4000 patients. Only 30% (1149 cases) were operable, and on 23% of those resected (i.e. 7% of the total) survived for 5 years. An assessment is made of the relationship between survival and sex, age, tumour size and site, radiological picture, stage of invasiveness, type of surgery and degree of radicality, histological picture, and number of circulating lymphocytes. Age, sex and the type of resection (lobectomy or pneumonectomy) had no relation to prognosis. Palliative surgery was always associated with a fatal prognosis, as were cases with invasion of the chest wall, or, more particularly, with oat cell cancers. The outlook was more favourable in cases where radical treatment was given, in cases of squamous cancer, as opposed to other histological types, in those in stage 1 (Am. Joint Committee classification), and those with greater than 2000/mm3 lymphocytes--especially in adenocarcinomas.
Three cases of congenital a-v fistulas of the lung encountered in some 10,000 patients examined are reported. Emphasis is laid on the possibility that the disease may be misinterpreted for a long time and treated wrongly. It is considered that the most significant examination for diagnostic purposes is angiocardiopneumography because even in the rare cases in which it does not reveal the fistula, it shows up its existence by the early visualization of the left heart.
OKT3 is a monoclonal antibody used as T-specific immunosuppressor agent in the treatment of acute rejection of hepato- or renal-transplanted patients. The immunosuppressor effect is related to the elimination and modulation of T-cells after the binding between OKT3 and the specific antigen CD3+. This drug has been used in the treatment of acute rejection. The more frequent side effects is the immunogenic reaction Human Antibody Mouse Antibody (HAMA). The aim of this study is the evaluation of the dose and the administration route of the OKT3. The results of the antibody monitoring in the plasma of the treated patients and the analysis of the clinical data were evaluated to focus a valid therapeutic protocol as well as a more rational time sampling of the circulating drug to achieve a correct monitoring. The results show a gradual increase of the hematic concentration of the drug, positively correlating the clinical data of hepatic biopsy and lymphocytic screening. These results have permitted to modify the therapeutic protocol previously performed. It has been defined the administration route choosing i.v. infusion (5 mg/die/2 h), moreover it the therapy has been shortened to 6 days. The HAMA were also evaluated and the analysis of the data showed a negative results, suggesting the possibility of the OKT3 retreatment in the cases of rescue.
PURPOSE: To assess the results of radiological treatment of patients with hepatocellular carcinoma (HCC) performed before orthotopic liver transplantation (OLT). METHODS: Sixty-two transplanted patients with a total of 89 HCC nodules were studied; 50 lesions in 38 patients had been treated prior to OLT with transcatheter arterial chemoembolization (TACE; n = 29), percutaneous ethanol injection (PEI; n = 10), or combined therapy (TACE + PEI; n = 11). The induced necrosis was pathologically evaluated. The recurrence rate after OLT in the treated group of patients (n = 38) was compared with that in the non-treated group (n = 24). RESULTS: After TACE, necrosis was complete in 7 of 29 lesions (24.1%), partial in 11 of 29 (37.9%), and absent in 11 of 29 (37.9%). After PEI, necrosis was complete in 8 of 10 lesions (80%), and partial in 2 of 10 (20%). Using combined therapy, necrosis was complete in 11 of 11 lesions (100%). Four of 24 untreated and 4 of 38 treated patients did not survive OLT from causes not related to the HCC; 3 of 20 non-treated patients (15%) and 4 of 34 treated patients (11.8%) had post-OLT recurrence (these last four patients had undergone only TACE and did not have tumor necrosis at pathological examination). CONCLUSION: TACE of HCC prior to OLT had no influence on the recurrence rate. PEI and combined therapy (TACE + PEI) may be recommended in patients awaiting OLT.
AIM: Our goal was to evaluate the outcome of HCV(+) recipients after liver transplantation (LT) using HCV(+) donors and the interaction between donor and recipient viral strain. METHODS: We performed a retrospective analysis of 21 LT performed between 1998 and 2004 using livers from HCV(+) donors in HCV(+) recipients. Two hundred thirty-seven patients with HCV cirrhosis who underwent LT with livers from HCV(-) donors were the control group. Ishak score (IS) was evaluated for all HCV(+) grafts. The considered variables included donor age, hepatic enzymes, intensive care unit stay, HCV genotype, ischemia time, recipient age, UNOS status, Child score, HCV genotype (before and 6 months after LT) and IS (after LT). We analyzed patient, graft, and disease-free survival. RESULTS: HCV(+) donors were significantly older than HCV(-) donors. The cumulative 5-year patient and graft survivals and disease free intervals were not different between groups. IS grading was more than 2/18 in two cases; the only graft with a staging score over 2/6 was retransplanted for early nonfunction. In two cases, different HCV genotypes were matched and donor strain took over the recipient strain. In one patient, donor genotyping 2a-2c took over recipient genotyping 1b and 9 months after LT recurrent hepatitis was documented, but antiviral therapy cleared HCV. CONCLUSIONS: Livers from HCV(+) donors can safely be used in HCV(+) recipients. Hepatic biopsy must always be performed; livers with bridging fibrosis should not be used. The takeover of one strain by another may change the prognosis of the patient if the predominant strain is more sensitive to antiviral therapy.
AIM: Calcineurin inhibitors (CI) are associated with significant morbidity in transplant recipients. The aim of this study was to evaluate the effectiveness and safety of mycophenolate mofetil (MMF) monotherapy in liver transplantation (LT). METHODS: We analysed 32 patients (24 males, 8 female, of mean age 55.7 years) who underwent LT between 1994 and 2003. In 29 patients immunosuppressive therapy was cyclosporine; in three patients it was tacrolimus. Eleven patients were submitted for LT due to hepatitis B cirrhosis; eight for hepatitis C cirrhosis, six for alcoholic cirrhosis, and seven for other diseases. In these patients, MMF was added gradually, simultaneously reducing the dosage of CI up to complete withdrawal. We considered the efficacy (decrease in serum creatinine) and the incidence of complications (acute and chronic rejection, leukopenia, diarrhea). RESULTS: Patients were converted to MMF after a median of 50 months after LT. MMF monotherapy was started after a median of 9 months in association with CI. Indications for switch to MMF monotherapy were adverse effects of CI (renal disfunction in 30 patients) and de novo tumoral evidence after LT in two patients. Median dosage of MMF was 750 mg twice daily (500-1500 mg). There was a statistically significant decrease in serum creatinine levels (2.02-1.7 mg/dL; P = .0001). Side effects were: leukopenia in five of 32 patients (15.6%), diarrhea in four of 32 patients (12.5%), and one acute rejection. CONCLUSION: MMF monotherapy improved renal function and was not associated with a significant risk of allograft rejection. Side effects were mild with dose regimens up to 750 mg twice daily.
AIM: The impact of new-onset diabetes (NOD) posttransplantation has been underestimated in the past. The aim of this study was to evaluate the incidence of diabetes after liver transplantation. METHODS: We retrospectively analyzed the incidence of NOD in 899 patients transplanted in our center. According to International Consensus 2003 Guidelines, criteria for diagnosis of diabetes were: fasting plasma glucose > or =126 mg/dL, symptoms of diabetes plus casual plasma glucose concentrations > or =200 mg/dL, and 2-hour plasma glucose levels > or =200 mg/dL during an oral glucose tolerance test. We considered only patients with follow-up over 10 months. We evaluated the risk factors correlated with NOD (age, hepatitis C virus [HCV] positivity, tacrolimus vs cyclosporine, steatosic graft), and the outcomes of diabetic patient and their grafts. RESULTS: The incidence of NOD was 10.8% (90/830 patients). Sixty nine patients were diabetic before transplantation. Recipient age >45 years (14.7% vs 6.8%, P = .002, OR = 2.4) and HCV positivity (15.5% vs 7.8%, P = .001, OR = 2.2) significantly correlated with NOD. Multivariate analysis confirmed these variables to be independently associated with diabetic risk. Tacrolimus was associated with an increased risk of NOD (16.2% in HCV-negative patients, 25% in HCV-positive patients), but this difference was not statistically significant. Steatotic grafts (>10%) were associated with an increased risk of NOD (28.6% vs 10%, P = .001, OR = 3.6). The outcome of patients and grafts in the group of diabetic patients was not significantly different from all other patients. CONCLUSIONS: The incidence of NOD was more relevant in patients older than 45 years and/or HCV-positive. A steatotic graft was an important risk factor, and the match with high-risk patients should be avoided.
Intestinal function in children with very short bowel syndrome and related intestinal failure may improve after isolated liver transplantation. An infant with an ultrashort gut, ileo-cecal valve, and whole colon received total parenteral nutrition from the first days of life. Enteral feeding failed because of the progressive dilatation of the jejunal portion and motility disorders. He developed early severe cholestatic liver disease (aspartate transferase 186, alanine transferase 103 U/L, serum bilirubin 8.4 mg/dL) and subsequent liver failure. At 8 months of age, he benefited from isolated liver transplantation (left segment graft from living donor). His early posttransplant evolution was characterized by recovery of oral alimentation, improvement of digestive and absorption functions, but he did not achieve TPN-independence. At 20 months, 50% to 60% of his energy needs were covered by parenteral nutrition and he has satisfactory growth indices (3rd percentile for weight and height), reduced stool volume, and frequency. Isolated liver transplantation allowed, in this particular case, time for further intestinal adaptation thereby avoiding the need for intestinal transplantation early in life.
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Following the investigation on the correlation between scintigraphic pictures and histopathologic findings in 66 patients with suspected bronchial carcinoma, 84% of the scannings were positive and the data relative to the so-called "false negative" cases was analyzed. The presence of hilar or mediastinal lymph node metastases, histologically ascertained in about one-third of the patients, appeared significant; and a restricted accumulation of the radio-element was evident in 70.5% of the cases. In 10 of the cases with negative scintigraphic findings, pictures of reactive or hyperplastic lymphadenitis (almost all radiologically relievable) were obtained. Therefore, if it cannot be logically concluded that the negative scintigraphic findings at the mediastinal level indicate the absence of metastases in the lymph nodes, thus indicating surgery (or preventive mediastinoscopy), positive finding seem to be synonymous with extrapulmonary diffusion of the neoplastic process, with direct implication in determining the operability of the patient.
BACKGROUND/AIMS: The study aims to evaluate the pH and the presence of bile in the denervated whole stomach pulled up to the neck after subtotal esophagectomy. METHODOLOGY: The pH and the presence of bile in the gastric cavity were monitored by combined 24-hour pH and bilimetry in 16 patients having their whole stomach as an esophageal substitute (i.e., 8 with and 8 without a gastric drainage procedure) and in 25 healthy control subjects. The percentage of time during which pH was < 2 as well as the percentage of time during which bile absorbance was > 0.25 for the total, upright, and supine periods of recording were considered for each subject studied. Seven patients underwent a gastroscopy with biopsies. RESULTS: Intragastric acidity was normal in 50% of patients while it was reduced in the other 50%. Ten of the 16 patients (62.5%), i.e., 4 with (50%) and 6 without (75%) a drainage procedure, had excessive exposure of the gastric mucosa to bile. No significant correlation was found between the existence of a high intraluminal pH profile and excessive bile exposure (p = 0.9163). Bile exposure was significantly higher in whole stomach patients than in controls in both the upright and supine positions, irrespective of the existence or absence of a drainage procedure (p ranging from 0.0272-0.0001). Bile exposure in the supine position tended to be longer in patients without than in those with a drainage procedure (p = 0.0929). Helicobacter pylori-negative chemical gastritis was present in 3 of the 7 patients who underwent a gastroscopy, all 3 having excessive bile exposure and no food retention in the transplant lumen. CONCLUSIONS: Gastric denervation and transposition up to the neck increased exposure of the gastric mucosa to bile, irrespective of the patient's position and of the presence of a gastric drainage procedure. The absence of gastric drainage procedure tends to ensure exposure to bile prolongeLow gastric acidity, if present, is due to a reduction in acid secretion rather than to a buffering effect from duodenal juice having refluxed. Gastritis is more likely to be related to excessive exposure of the gastric mucosa to bile than to food retention.
Liver transplantation is the only therapeutic option for end-stage liver disease. When disease is due to hepatitis B, C or D viruses, transplantation is aggravated by important morbidity related to the recurrence of viral infections. The risk of reinfection has led to the identification of prognostic criteria and measures for preventing or diminishing the reinfection hazard. HBV recurrences can be diminished with the use after transplantation of immunoglobulins against the HBsAg (HBIg). With this prophylaxis the risk of reinfection is proportional to the viremic load before transplantation; it is high (> 90%) in patients with elevated viremia, low in non-viremic HBsAg carriers (such as those with fulminant hepatitis or HDV coinfection), intermediate in the remaining cases. The recent availability of potent antivirals against the HBV has provided a tool to further reduce the reinfection risk. Antiviral therapy or immunoprophylaxis, however, may lead to the emergence of resistant mutants; combination therapies appear in order to prevent this event. There is at present no valid prognostic indicator to identify HCV transplants at risk of recurrent disease or prophylactic measure to prevent reinfection. Reinfection is virtually universal and the course of infection is apparently benign over the short term in the majority of cases; the disease is rapidly progressive with cholestatic features mimicking chronic rejection in 10-20% of HCV reinfected transplants. Neither the HCV genotype nor coinfection with HGV appear to influence the clinical outcome. The long-term prognosis appears at present less favourable than previously perceived; several studies indicate a progressive reduction of the survival curve due to insidious HCV cirrhosis developing over 5 to 7 years. Interferon or Ribavirin monotherapy are not effective for prevention or therapy of recurrences while their combined use yields promising results.
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