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Biomedical subjects

R Bellusci

Publications and source records attributed to R Bellusci.

34 records · Page 2Linked to original sources
PubMed1988

Clinical experience with hepatic resections for hepatocellular carcinoma in patients with cirrhosis.

The results of 31 resections of the liver performed upon patients with cirrhosis and hepatocarcinoma are reported herein. The lesions were discovered mainly during routine echographic surveillance. Twenty-five of these patients with small tumors underwent a segmentary or subsegmentary resection. Intraoperative ultrasonography proved to be of paramount importance in these instances as it helped to recognize the lesion and outline the limits of the resection. In another 11 instances of primary tumors of the liver in patients with cirrhosis who underwent laparotomy, findings from intraoperative ultrasonography advised against exeretic operation because other intrahepatic lesions or neoplastic thrombi in portal branches were detected. The operative mortality rate in the 31 patients who underwent resection of the liver was 12.9 per cent. The actuarial three year survival rate is 58 per cent. The presence of an intact peritumoral capsule seems to be the best prognostic factor.

Adult↗
PubMed1986

Intraoperative ultrasonography in surgery for liver tumors.

Intraoperative ultrasonography was used in 37 patients during surgery for suspected liver tumors. The size, number, and site of the lesions were determined together with the relationship of the tumor to the intrahepatic vessel, as well as possible small daughter lesions within the liver. Final diagnosis in these patients was hepatocellular carcinoma in 19 cases, metastases from colorectal cancers in 15 cases, and benign lesions in three cases. Previously undetected small tumors were revealed in one patient with sigmoid cancer and in five patients with liver cell carcinoma who had cirrhosis. Vascular tumoral infiltrations were easily displayed and the surgical approach modified accordingly: a more extended resection was performed in two cases of huge central hepatic metastases. Intraoperative ultrasonography revealed seven cases of small (2 to 3 cm) hepatocellular carcinomas in cirrhotic livers that were not visible or palpable, thus allowing a subsegmentary resection. Finally, in three cases of atypical tumors, an intraoperative echo-guided biopsy specimen was required to establish the benign nature of lesions and resection was avoided. Intraoperative ultrasonography facilitates the diagnosis of small liver tumors and can also aid the surgeon in his choice of technique, especially in cases of cirrhosis of the liver. A resection can be avoided altogether when multiple lesions are involved, or echo-guided subsegmentary resections can be performed in cirrhotic livers when a less extended resection is required. This technique makes it possible to establish the relationship between the tumor and intrahepatic vessels, thus preventing vascular injury and making radical hepatic resection safer.

Biopsy↗
PubMed1984

Ultrasonographic study of portal venous system in portal hypertension and after portosystemic shunt operations.

One hundred sixty patients with portal hypertension were examined by means of ultrasonography in order to evaluate the sensitivity of this technique in the diagnosis of intrahepatic portal hypertension and in the detection of portal vein thrombosis. Thirty-eight of these patients were selected for a portosystemic shunt and were reexamined after operation to assess the value of ultrasonography as a screening test for the patency of surgical portosystemic shunts. In patients with intrahepatic portal hypertension the main ultrasonographic findings observed were dilatation of the portal trunk of more than 1.3 cm (56.6% of cases), patency and dilatation of the umbilical vein (5.8%), presence of intra-abdominal collateral vessels (11.6%), splenomegaly with dilatation of splenic vein radicles at the hilus (91.3%), and disappearance of normal caliber variations during respiration in splenic or mesenteric veins (78.5% and 88.4%, respectively). The disappearance of normal caliber variations proved a highly specific and sensitive finding. Partial or total occlusion of the portal trunk was observed at ultrasonography in 19 of 21 (90.5%) patients with portal vein thrombosis. Surgical portosystemic shunts were displayed in 28 of 37 patients (75.7%). Ultrasonography seems to be the most important noninvasive tool in the diagnosis of portal hypertension. In patients selected for surgical portosystemic shunts ultrasonography supplies morphologic data regarding liver parenchyma and abdominal vascular anatomy, and it should be performed as a routine screening test for assessment of surgical shunt patency.

Humans↗
PubMed1981

[Control of the patency of porto-systemic anastomoses].

After having discussed the direct and indirect methods to control the patency of porto-systemic anastomoses, the Authors report on their series of 42 cases (28 side-to-side porto-cava shunts, 6 end-to-side porto-cava shunts, 6 spleno-renal shunts, 2 mesenterico-cava shunts) where the postop. control was carried out with portography, hepatic superselective arteriography in 29 cases, transcaval catheterism of the anastomosis in 6 patients, and pre-op., and post-op. echotomography in 15 cases. Portography revealed 39 cases of patent anastomosis and thrombotic occlusion in 3 cases. The typical sign of shunt patency is the visualisation of the inferior V.C. and the less frequent disappearance of right gastric reflux. Furthermore the investigations consented the evaluation of altered post-shunt hepato-portal flow: side-to-side porto-cava shunt (25 patent anastomoses) revealed a complete deviation of portal glow towards the I.V.C. and in 15 cases there was inverted portal flow; portography after splenorenal shunt (5 cases of patent anastomosis) showed a preserved hepatopetal portal flow only in early controls (7 days) while in all long term controls it was hepatofugal. In 13 cases the morphology of the hepatic arterial system was compared before and after surgery; in 12 cases the hepatic artery was larger and its intrahepatic branches more tortuous after surgery Ultrasonography revealed only 8 patent shunts out of 15 examined since the amount of gas in the bowel rendered the exam technically insufficient.

Adult↗
PubMed1981

Plasma amino acid patterns in experimental acute hepatic failure: comparison between hepatectomy and liver devascularization in pigs.

To clarify the physiopathologic mechanism leading to a marked increase in aromatic amino acids (AAA) in acute hepatic failure (AHF), we compared two experimental models of AHF. Ten pigs were submitted to one-stage hepatic devascularization (group A); in eight other pigs total hepatectomy was performed (group B). The animals were maintained under constant glucose infusion. The mean survival time in group A was 23 +/- 2 hours; after hepatectomy it was 30 +/- 4 hours. Hepatic coma progressively deepened from 8 +/- 3 hours in Group A animals and was delayed until 17 +/- 5 hours in the anhepatic pigs. AAA, methionine, and tryptophan immediately increased markedly in pigs with liver ischemia. In group B animals, AAA showed a slight increase only 18 hours after hepatectomy, whereas there were no significant differences in methionine and tryptophan. The different amino acid patterns in the two groups of animals demonstrate that hepatocyte necrosis is a major source of plasma amino acids after liver devascularization. The slight increase in AAA after total hepatectomy suggests that a release mechanism from muscular mass is involved in the later stages of the experiment. The onset of coma is related to the increase in AAA rather than to alterations in blood ammonia that did not differ in either group of animals.

Amino Acids↗
PubMed1980

[Hepato-portal circulatory changes after splenorenal anastomosis].

Hepatoportal circulation changes after the shunt were examined angiographically in 5 patients subjected to splenoportal anastomosis and splenectomy. Arterioportography was employed in all cases. Catheterisation of the anastomosis was carried out in 1 patient and suprahepatic phlebography in another. The anastomosis was found to be patent in all cases. A hepatopetal portal flow was noted solely in the two patients examined six days after surgery. Disappearance of hepatic portal perfusion was observed in one of these patients on the 15th postoperative day. Controls carried out one month, one year, and five years after the operation showed that the mesenteric-portal flow was fully deviated through the shunt towards the vena cava in all patients. Selective hepatic arteriography showed an inverted portal flow in 3 patients. An increase in the calibre of the trunk of the hepatic artery and the entire intrahepatic artery network was always present.

Adult↗
PubMedDate not supplied

Treatment of vascular complications following liver transplantation: multidisciplinary approach.

BACKGROUND/AIMS: Complications affecting the vascularization of the graft following orthotopic liver transplantation still represent a significant cause of graft loss and patient mortality. Strategies have recently been developed for the early detection and treatment of these complications before irreversible graft failure takes place. METHODOLOGY: A series of 429 consecutive liver transplants performed on 384 patients between April 1986 and December 1998 was retrospectively reviewed to assess the incidence of all the vascular complications and the results of their treatment with either surgery or interventional radiology. RESULTS: The incidence of vascular complications was 6.06% for the hepatic artery, 2.56% for the inferior vena cava and 1.16% for the portal vein. As regards anastomotic stenosis and thrombosis, the requirement of retransplantation decreased progressively with the advent of systematic postoperative screening with duplex Doppler ultrasonography and the introduction of graft-salvage procedures, falling from 50% for those cases diagnosed before 1996 to 19% for those diagnosed from 1996 on. Mortality following 18 graft-salvage procedures was 11.1% versus 41.6% following retransplantation. Graft-salvage procedures were successful in 14 out of 18 cases. CONCLUSIONS: Close surveillance of the vascular anastomoses and multidisciplinary approach to the treatment of vascular complication after liver transplantation considerably reduces graft loss and patient mortality.

Anastomosis, Surgical↗
PubMedDate not supplied

Hepatic resection for tumours in cirrhotic livers.

A liver resection was performed in 25 out of 36 cirrhotic patients operated on for liver cell carcinomas. In the remaining 11 cases hepatectomy was not performed mainly because of the presence of other intrahepatic neoplastic nodules or thrombi in the portal branches revealed by intraoperative echography. The operative mortality in the 25 patients operated on was 16%; the actuarial survival at three years is 58%. Liver resection was carried out using a transparenchymal procedure; in 18 cases clamping of the hepatic pedicle was performed for an average period of 15 min. Twenty patients with small tumours had a segmentary or sub-segmentary resection; intraoperative echography proved indispensable in this situation, making it possible to recognize the lesion and outline the limits of the resection. The presence of a peritumoral capsule seems to have been an important prognostic factor.

Aged↗