1,721,387 research outputs found
Wound healing events and arterial complications with everolimus versus tacrolimus based regimens in de novo liver transplant recipients. O-22
No full textUse of Everolimus in Liver Transplantation: Recommendations From a Working Group
Full text linkImmunosuppression after liver transplantation (LT) is presently based on use of calcineurin inhibitors (CNI), although they are associated with an increased incidence of renal dysfunction, cardiovascular complications, and de novo and recurrent malignancies. Over the past decade, mTOR inhibitors have received considerable attention as immunosuppressants as they are associated with a more favorable renal profile vs. CNI, as well as anti-proliferative activity in clinical studies. Comprehensive guidelines on use of everolimus (EVR) in LT are still lacking. In Italy, a project "Everolimus: the road to long-term functioning" was initiated to collect the experience on EVR after LT with the aim of providing guidance for transplant clinicians. Herein, recommendations by this national consensus group, based on Delphi methodology, are presented. Consensus was reached on 20 of the 23 statements proposed, and their level of evidence, grade of recommendation, and percent of agreement are reported. Statements are grouped into 4 areas: A) renal function; B) time of EVR introduction, CNI reduction and elimination, and risk for graft rejection; C) anti-proliferative effects of EVR; and D) EVR adverse events. The high level of consensus shows that there is good agreement on the routine use of EVR in predefined clinical scenarios, especially in light of posttransplant nephrotoxicity and other adverse events associated with long-term administration of CNIs
Right hepatic artery pseudoaneurysm and cystic duct leak after laparoscopic cholecystectomy.
No full textLaparoscopic cholecystectomy (LC) seems to be associated with an increased risk of biliary or vascular injuries. Hepatic artery pseudoaneurysms (HAP) are rare complications of LC. HAP can occur in the early or late postoperative period. Patients with HAP present with abdominal pain, hemobilia, and liver function test (LFT) alterations. We report the case of a patient who was affected with a cystic duct stump leak associated with a right HAP and was treated by endoscopic biliary drainage and angiographic coil embolizatio
Metastasi gastrointestinali di adenocarcinoma renale. A proposito di un caso e revisione della letteratura
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Alternative laparoscopic managements of perforated peptic ulcers.
No full textSurgery--namely, suture closure-is still the treatment of choice for perforated peptic ulcers, despite the proven efficacy of Taylor's conservative approach. Such conservative management, however, has been proven less effective in high-risk patients and those with perforations more than 12 h old. Here we suggest alternative laparoscopic treatments for perforated peptic ulcers. We have treated laparoscopically six patients (one F, five M; mean age 57.6 years; range 31-81 years); the mean duration of the operation was 52 min; the median hospital stay was 7 days (6-15 days); H2-blockers, antibiotics, and fluids were administered in the p.o. course; the follow-ups range from 6 to 18 months. On the basis of our experience, the treatment of choice for perforated peptic ulcers is Taylor's conservative procedure and laparoscopic drainage of the abdominal cavity when there is mild peritoneal reaction (usually less than 6 h from the onset of perforation). In case of remarkable peritonitis (usually more than 12 h), it is mandatory to add an accurate lavage. When the site of perforation is concealed by the peritoneal inflammation it should not be searched; when visible, it might be obliterated with the round ligament or an omental tissue strand, particularly if larger than 1 cm in diameter
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