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  • 1
    Electronic Resource
    Electronic Resource
    Liver transplantation for HCC. Treatment options on the waiting list (2003)
    Oxford, UK : Blackwell Publishing Ltd
    Alimentary pharmacology & therapeutics 17 (2003), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The most widely adopted criteria to admit and maintain patients with HCC and cirrhosis in the waiting list for liver transplantation are the Milano criteria, consisting in the presence of a single tumour ≤5 cm in diameter or up to three tumours, none exceeding 3 cm in diameter. Since the average time to transplantation has become longer than 10–12 months in most European and American Centers, the exclusion from the list during the waiting period due to increase of the neoplasm over the established criteria is not uncommon at present. It is mandatory, therefore, to seek an effective therapeutic strategy for patients with HCC waiting for transplantation. Surgical resection and eventual subsequent salvage transplantation seems a cost-effective strategy in resectable HCC. In unresectable neoplasms both transarterial chemoembolization and percutaneous ablation techniques are currently used and one or the other are chosen according to individual applicability, limitations and specific risks. However, although positive trends were reported, no definitive evidence has been produced so far about their efficacy in increasing patient's survival and decreasing tumour recurrence rates after transplantation. Adult-to-adult living donor liver transplantation is one possible way to shorten the waiting list, but this strategy involves important ethical implications. At present it appears justified to take it into consideration only if the waiting time for cadaveric OLT is expected to exceed 7 months. A more general and definitive attempt to overcome problems related to long waiting times for patients with HCC and relatively preserved hepatic function has been introduced in the USA very recently and consists in prioritizing patients with HCC. However, the overall efficacy of this approach will be established only in some years.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2036.17.s2.8.x
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  • 2
    Electronic Resource
    Electronic Resource
    Liver resection for hepatocellular carcinoma in cirrhotics and noncirrhotics. Evaluation of clinicopathologic features and comparison of risk factors for long-term survival and tumour recurrence in a single centre (2003)
    Oxford, UK : Blackwell Publishing Ltd
    Alimentary pharmacology & therapeutics 17 (2003), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : Differences in risk factors for survival and recurrence after liver resection for hepatocellular carcinoma (HCC) in patients with or without cirrhosis are not fully clarified.Aim : To review a single-centre experience of curative liver resections for HCC in order to evaluate clinicopathologic features and the long-term outcome of cirrhotic and noncirrhotic patients.Methods : From 1981 to 2002, 308 curative liver resections for HCC on cirrhosis (Group 1) and 135 for HCC without cirrhosis (Group 2) were performed. The main demographic, clinicopathologic and operative parameters, as well as early results were analysed and compared. Overall and disease-free survival were evaluated. Prognostic factors for survival and for tumour recurrence were studied by univariate and multivariate analysis.Results : Group 1 had worse preoperative liver function and higher frequency of hepatitis C virus infection. In Group 2, HCC showed larger mean tumour diameter (P 〈 0.001), poorer differentiation (P 〈 0.05) and more frequent macrovascular invasion (P 〈 0.05). Although more extended resections were performed in Group 2 (P 〈 0.001), there were no differences in blood transfusions, while post-operative complication rate was higher in Group 1 (P 〈 0.005). After 1992, in-hospital mortality was 2.9% in Group 1 and 1.1% in Group 2 (P = N.S.). The 3- and 5-year overall survival was 63.7% and 42.2% in Group 1, and 67.9% and 51% in Group 2 (P 〈 0.05). The 3- and 5-year disease-free survival was 49.3% and 27.8% in Group 1, and 58% and 45.6% in Group 2 (P 〈 0.005). Serum bilirubin level 〉 1.2 mg/dL, multiple nodules, micro and macrovascular invasion, diaphragm infiltration and blood transfusions independently affected survival in Group 1. Blood replacement was the only negative prognostic factor in Group 2. Independent risk factors for tumour recurrence were satellite nodules and resection performed before 1992 in Group 1, and age 〈 60 in Group 2.Conclusions : Despite a more aggressive behaviour, HCC without cirrhosis led to better overall and disease-free survival compared to HCC with cirrhosis after curative liver resection. Age and intra-operative blood transfusions are the only predictors of outcome in patients without cirrhosis. The impact of the latter on long-term survival in both our groups outlines the importance of surgical technique on the results of hepatectomies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2036.17.s2.9.x
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  • 3
    Electronic Resource
    Electronic Resource
    Duodenal involvement of Crohn's disease (1997)
    Springer
    Diseases of the colon & rectum 40 (1997), S. 179-183 
    Details
    ISSN: 1530-0358
    Keywords: Crohn's disease ; Duodenum ; Fistula ; Stenosis ; Ulcers ; Strictureplasty
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: This study was designed to assess clinical and pathologic features of duodenal Crohn's disease (CD) and address its management according to different patterns of disease. METHODS: Twelve cases of duodenal involvement in CD are reported out of 336 patients treated between 1978 and 1993. They represent 3.6 percent of all cases. Three patients had a duodenal fistula, and nine had an intrinsic duodenal lesion. The duodenal fistula was in all cases a manifestation of recurrent CD involving an ileocolic anastomosis and the third portion of the duodenum. RESULTS: Treatment consisted of resection of the fistula's source and primary closure of duodenal breach. Of nine patients with intrinsic CD, five had stenosis and the remaining four had peptic ulcer-like lesions. Duodenal stenosis was treated with strictureplasty in three cases and duodenojejunostomy in two. No patient with ulcer-like lesions underwent surgery. CONCLUSIONS: Differences encountered in intrinsic duodenal lesions apparently reflect two different clinical patterns. Stenosis is not usually associated with multifocal disease and is often the first evidence of disease. Ulcer-like lesions are not specific; they do not evolve into stenosis as do ulcers in other sites of the disease, spontaneously disappear and relapse, and do not require surgery, except for complications. They are always associated with other locations of the disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02054984
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  • 4
    Electronic Resource
    Electronic Resource
    Conservative surgical management of terminal ileitis (1997)
    Springer
    Diseases of the colon & rectum 40 (1997), S. 234-239 
    Details
    ISSN: 1530-0358
    Keywords: Crohn's disease ; Strictureplasty ; Terminal ileitis ; Enterocolic anastomosis ; Surgical technique
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Terminal ileitis is the most frequent presentation of Crohn's disease. Resection of the terminal ileum and cecum with ileocolic anastomosis has always been considered the “gold standard” in the surgical treatment of this condition. This study illustrates an alternative technique referred to as “side-to-side enterocolic anastomosis.” METHODS: It consists of a longitudinal section of the terminal ileum starting 1 to 2 cm away from the beginning of the stricture and continued for a similar length on the ascending colon. A side-to-side anastomosis is then fashioned, in a kind of Finney-shaped strictureplasty. A series of five patients is reported. RESULTS: Average length of the anastomosis was 18.4 (range, 12–25) cm. Postoperative course was uneventful. Colonoscopy and large-bowel enema performed on some patients six months after surgery revealed a complete morphologic regression of the disease. All patients are presently in good condition, with no evidence of recurrence after an average follow-up of 8.9 (range, 6–15) months. CONCLUSIONS: “Side-to-side enterocolic anastomosis” can be a possible alternative option for the surgical management of Crohn's disease of the terminal ileum, providing at least regression of the morphologic aspects of the disease. Contraindications are presence of abscesses, fistulas, or rigid and fibrotic stricture. This technique can be considered a further example of nonresectional surgery such as strictureplasty. This makes it possible to conceive surgical treatment of Crohn's disease without resection in selected cases for the whole length of the small bowel and suggests the introduction of the new definition of “conservative surgical management of small-bowel Crohn's disease.”
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02054994
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  • 5
    Electronic Resource
    Electronic Resource
    Factors affecting recurrence in Crohn's disease Results of a prospective audit (1996)
    Springer
    International journal of colorectal disease 11 (1996), S. 294-298 
    Details
    ISSN: 1432-1262
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé. On a suggéré que certaines données cliniques et morphologiques étaient susceptibles de modifier l'évolution de la maladie de Crohn, en particulier quant à l'incidence des récidives après chirurgie. Une série de 233 patients ont été suivis prospectivement. Au cours d'une période de 15 ans, ces patients ont subi deux interventions de résection soit, la résection du foyer primaire et la résection d'une récidive de la maladie de Crohn. Le suivi minimum de ces patients est de 18 mois. Les facteurs de risque d'une récidive ont étéétudiés. Parmi ceux-ci on note la durée de l'évolution de la maladie avant la chirurgie primaire, le mode de présentation clinique au début (maladie transmurale ou non transmurale) le siège initial, la présence de lésions microscopiques sur les tranches de section, le type de geste chirurgical (anastomose versus stoma), la survenue de complications postopératoires et l'âge du patient. Seule la durée d'évolution avant le geste chirurgical initial a étéétablie comme représentant un facteur significatif en faveur d'une récidive.
    Notes: Abstract. It has been suggested that certain clinical and morphological features can modify the outcome of Crohn's disease, particularly regarding recurrence after surgery. A series of 233 patiens was followed prospectively. They underwent a resectional surgical procedure for both primary and recurrent Crohn's disease during a fifteen-year period with a minimum follow-up of eighteen months. Possible risk factors for recurrence were studied. They included duration of disease before primary surgery, the type of clinical presentation at onset (whether ``Perforating'' or ``Non-perforating''), the initial anatomical location, the presence of microscopic disease at the resection edges, the type of surgical procedure (anastomosis vs stoma), post-operative surgical complications and the age of the patient. The duration of the disease before the initial operation was the only significant factor related to the recurrence rate.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003840050065
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  • 6
    Electronic Resource
    Electronic Resource
    Pulmonary complications of liver transplantation: radiological appearance and statistical evaluation of risk factors in 300 cases (2000)
    Springer
    European radiology 10 (2000), S. 1169-1183 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Liver – Transplantation – Pulmonary complications – Lung infection – Lung interstitial diseases – Lung radiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aim of this study was to evaluate the incidence, radiographic appearance, time of onset, outcome and risk factors of non-infectious and infectious pulmonary complications following liver transplantation. Chest X-ray features of 300 consecutive patients who had undergone 333 liver transplants over an 11-year period were analysed: the type of pulmonary complication, the infecting pathogens and the mean time of their occurrence are described. The main risk factors for lung infections were quantified through univariate and multivariate statistical analysis. Non-infectious pulmonary abnormalities (atelectasis and/or pleural effusion: 86.7 %) and pulmonary oedema (44.7 %) appeared during the first postoperative week. Infectious pneumonia was observed in 13.7 %, with a mortality of 36.6 %. Bacterial and viral pneumonia made up the bulk of infections (63.4 and 29.3 %, respectively) followed by fungal infiltrates (24.4 %). A fairly good correlation between radiological chest X-ray pattern, time of onset and the cultured microorganisms has been observed in all cases. In multivariate analysis, persistent non-infectious abnormalities and pulmonary oedema were identified as the major independent predictors of posttransplant pneumonia, followed by prolonged assisted mechanical ventilation and traditional caval anastomosis. A “pneumonia-risk score” was calculated: low-risk score ( 〈 2.25) predicts 2.7 % of probability of the onset of infections compared with 28.7 % of high-risk ( 〉 3.30) population. The “pneumonia-risk score” identifies a specific group of patients in whom closer radiographic monitoring is recommended. In addition, a highly significant correlation (p 〈 0.001) was observed between pneumonia-risk score and the expected survival, thus confirming pulmonary infections as a major cause of death in OLT recipients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003309900268
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  • 7
    Electronic Resource
    Electronic Resource
    Piggy-back versus conventional technique in liver transplantation: report of a randomized trial (1997)
    Springer
    Transplant international 10 (1997), S. 109-112 
    Details
    ISSN: 1432-2277
    Keywords: Key words Liver transplantation ; technique ; Piggy-back ; liver transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Liver transplantation with preservation of the recipient vena cava (the “piggy-back” technique) has been proposed as an alternative to the traditional method. We performed a randomized study on 39 cirrhotic patients, 20 who underwent the piggy-back technique (group 1) and 19 the traditional method using venovenous bypass (group 2) to evaluate the feasibility and true advantages of the piggy-back technique compared to the traditional method. Two patients were switched to the conventional technique due to the presence of a caudate lobe embracing the vena cava in one patient and a caval lesion in the other. Statistically significant differences between the two groups were only found for the warm ischemia time (48.5 ± 13 min for piggy-back vs 60 ± 12 min for the conventional method) and for renal failure (zero cases in group 1 vs four cases in group 2). We therefore believe that liver transplantation with the piggy-back technique can easily be performed in almost all cases, and that only a few, specific situations, such as a very enlarged caudate lobe, do not justify its routine use.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00003824
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