1,721,062 research outputs found
Early identification of patients at increased risk of liver failure, postoperative complications and death after major hepatectomy
No full textIntroduction: Aim of this study was to identify early predictive markers of clinically significant liver failure (PHLF B/C), postoperative complications and mortality after major liver resections.
Materials and methods: 115 consecutive major hepatectomies (three or more segments) were carried out and retrospectively analyzed. Association beetween PHLF, major complications, in-hospital mortality, demographics, clinical-pathologic and perioperative factors was evaluated. Multivariate logistic regression analysis was used to develop a predictive model for PHLF B/C, Clavien-Dindo grades III-V complications and mortality. Sensitivity, specificity and the area under the receiver operating characteristic (AUROC) curve were assessed.
Results: PHLF B/C was observed in 25 of 115 (21.7%) patients. 41 (35.7%) developed major complications, in-hospital mortality was 3.5% (4 patients). Multivariate logistic regression analysis identified high serum bilirubin and increased prothrombin time (PT) ratio on postoperative day 3 (POD3) as indipendent predictive markers of PHLF B/C (P < 0.05). POD3 high serum bilirubin was the only early postoperative factor influencing the risk of major complications (P < 0.05) and in-hospital death (P < 0.001) on multivariate analysis. ROC curve analysis of PT ratio (AUC 0.775) and serum bilirubin (AUC 0.813) on POD3 showed respectively 73% and 83% sensivity and 27% and 28% specificity at a threshold of 1.35 and 1.75 mg/dL.
Conclusions: Rising of serum bilirubin and PT ratio early after hepatectomy appears strongly predictive of PHLF B/C. Compared to other studies, our threshold value of serum bilirubin was slightly lower with a higher sensitivity. POD3 high serum bilirubin was the only factor influencing in-hospital mortality and major complication rates
Salvage hepatectomy for HCC recurrence after failed RFA, TACE or PEI: an unlock gateway to think of
No full textIntroduction: Outcomes of salvage hepatectomy for local
recurrent hepatocellular carcinoma (HCC) after locoregional
or percutaneous treatments are still unclear.
Methods: We conducted a retrospective analysis of 92
consecutive patients with HCC who underwent either primary
liver resection (group 1, 65/92) or salvage hepatectomy
for recurrent HCC after failed percutaneous or locoregional
treatments (group 2, 27/92).
The two cohorts were compared in terms of perioperative
mortality and morbidity and long-term disease-free and
overall survival rates were analized.
Results: Group 2 patients were previously submitted to a
different range of treatments such as: RFA (17 cases), RFA
+ PEI (4 cases), TACE (4 cases), RFA + TACE (2 cases).
HCC average size was comparable between group 1 and 2
(27.6 mm vs. 27.5 mm, respectively). In 6/60 (group 1) and
11/27 (group 2) liver resections were performed laparoscopically.
Perioperative mortality rate was nihil in both
groups and morbidity rate was comparable. The median
progression-free survival was 16 months [CI 95% 12.3-
19.6] for group 1 and 43 months [CI 95% 22.5-63.4] for
group 2 (p=0.013). The median overall survival was 68
months [CI 95% 32.4-103.5] for group 1 and 81 months
[56-106.9] for group 2 (p=0.015).
Conclusions: Salvage hepatectomy for HCC recurrence in
patients not resected upfront, whose HCC relapsed after
failure of loco-regional or percutaneous procedures, appears
to be safe and effective. In our limited series, it
provided optimal outcomes in terms of disease-free and overall long term survival, being a reasonable option in
such patients
Laparoscopic cholecystectomy: analysis of the first 50 cases
No full textThe initial experience of laparoscopic cholecystectomy (50 cases), has been analyzed: the incidence of laparotomy, the complication rate and the postoperative course are in agreement with the data reported in the literature: however in the second half of the cases there was a striking reduction of laparotomies and complications while the postoperative course remained unchanged. Laparoscopic cholecystectomy is a relatively easy technique which requires nevertheless a didactic training and a constant application. On these premises the results can be good and explain the progressive diffusion of the techniques together with the development of the mini-invasive surgery
Femoral neuropathy due to a spontaneous hematoma of the iliopsoas muscle during therapy with heparin-calcium
No full textWith increased use of anticoagulant agents, femoral neuropathy subsequent to spontaneous hemorrhage within the ileo-psoas muscle has become a serious and more frequent clinical problem. The authors describe one case of femoral neuropathy from iliac muscle hematoma during heparin administration. The successful surgical treatment by decompression and drainage is reported. The anatomical and CT scanning features with the suspected pathogenesis are emphasized, as well as the role of early diagnosis in the assessment of prognosis and for successful operative decompression
Laparoscopic cholecystectomy: a need to drain?
No full textThe authors summarize their experience about the use of a drain after laparoscopic cholecystectomy. After an initial period without drainage, the drain is now routinely used by the Authors and their clinical experience suggests that it is probably very useful during the initial training and probably prevented some reoperations when biliary leakage and/or small hemorrhage from the gallbladder bed were present. Therefore the opinion of the Authors is to always drain after laparoscopic cholecystectomy, specially during the initial experience or after a particularly difficult operation
Genepool variation and phylogenetic relationships of an indigenous north-east Italian grapevine collection revealed by nuclear and chloroplast SSRs.
No full textA germplasm safeguard programme was set up with 19 grapevine varieties considered as indigenous to northeastern
Italy. To better estimate how genetic structure can be used to obtain a conservation perspective of local varieties,
genetic variability was examined at 30 nuclear and 3 chloroplast polymorphic microsatellite loci in the native varieties plus 7 European cultivars taken as reference. The genetic profiles of all the cultivars were searched for possible parentage relationships and several suspected cases of the same variety having different names were investigated. The alleles shared at the loci suggest a parent–offspring relationship between Merlot and Cabernet Franc, ‘Gruaja’ and ‘Negrara Veronese’, and Marzemina Nera and Marzemina Bianca. Alleles at the 30 nuclear loci are consistent with Raboso Veronese being the progeny of Marzemina Bianca and Raboso Piave. Chloroplast-specific haplotypes were singled out for the first time in this indigenous germplasm and should be considered typical of the region. It is hypothesized that there are many specific haplotypes for the local varieties due to a past contribution of wild grapevine to the cultivated gene pool. The majority of investigated cultivars were demonstrated to constitute an independent source of genetic variation, and therefore a possible valuable resource of genetic traits for breeders
Gallstone pancreatitis and laparoscopic cholecystectomy
No full textLaparoscopic cholecystectomy is now considered the gold-standard for the treatment of gallbladder stones (NH Consensus Conference 1992). Moreover, its feasibility in complex problems like acute cholecystitis, common bile duct stones and biliary pancreatitis is more widely recognized. The aim of this paper is to evaluate the efficacy of the laparoscopic treatment in acute biliary pancreatitis comparing it with the traditional open surgery. Since February 1991 to January 1995 we treated 18 patients submitted with a diagnosis of acute biliary pancreatitis. In 15 patients the pancreatitis was interstitial while 3 had necrotic pancreatitis. All patients, except 2, were submitted to a laparoscopic cholecystectomy during the same admission, with a mean interval of 11 days from the day of admission to surgery. The other 2 cases, who suffered a severe necrotic pancreatitis, were operated after 3 months. Endoscopic retrograde-cholangiopancreatography (ERCP) was performed in 8 cases (38.8%), with 7 papillosphincterotomy (PST) and stone extraction. In only one case it was necessary to convert to open surgery. The mean operation time was 55 minutes. One patient died due to cardiorespiratory failure 16 days after surgery (death rate: 5.5%). Complications were not observed in the other patients. Our results are similar to those observed in the literature showing that the majority of the patients with biliary pancreatitis can be submitted to laparoscopic surgery with advantage. In case of common bile duct stones, we prefer to perform an ERCP with PST if necessary. We did not observe complications with this strategy but it is probably that in the future the laparoscopic approach will be applied for both gallbladder and CBD stones. At the moment this is reserved to the more experienced surgeons and specialized centers
Complications after surgery for gastric cancer
No full textThe improvement in surgical and anasthesiological techniques have allowed a reduction in oncological surgical morbidity and mortality. The objective of this retrospective study is to evaluate the morbidity and the mortality in oncological gastric surgery up to date. Between 1979 and 1994 we evaluated 281 patients for gastric cancer, of whom 249 underwent surgery. The patients ranged in age from 34 to 88 years, with a mean age of 67,8 years, and included 158 males and 91 females. An oncological radical excision was performed in 184 patients (122 gastroresections and 62 gastrectomies). The other 65 patients underwent exploratory or palliative surgery: 26 explorative laparotomies, 26 gastroenteroanastomoses, 9 gastroresections, 3 digiunostomies and one gastrostomy. The overall post-operative morbidity has been 40,1%, 27,3% was generical and 12,8% was surgical morbidity. The overall mortality has been 9,6%, of whom about one third following surgical complications. In our experience the factors related with morbidity and mortality have been: age, preoperative nutritional state and stage of the disease
Percutaneous transluminal angioplasty in the treatment of stenosis of the renal artery in solitary functioning kidney
No full textThe authors report 2 cases of patients with single functioning kidney and severe hypertension caused by renal artery stenosis who were treated by percutaneous transluminal angioplasty (PTA). In one case an early and persistent improvement of renal function and a reduction of pressure values were observed. In the other patient, with preexistent severe functional damage, a progressive impairment of renal function required haemodialysis. On the basis of these results and of other reports in the literature, PTA is proposed as elective treatment of renal artery stenosis in patients with single functioning kidney
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