364 research outputs found
De novo hepatocellular carcinoma of liver allograft: a neglected issue. Cancer Lett in corso di stampa
No full textDe novo hepatocellular carcinoma (HCC) is a rare neoplasm, ensuing after liver transplantation. Its definitive identification requires sophisticated molecular analyses. Hence, some cases, particularly those ensuing in patients who have been transplanted with HCC, are probably misclassified as recurrences of the primary tumor. Nevertheless, a tumor recurrence cannot be excluded in patients transplanted without apparent malignancy, because of an occult HCC. The main risk factor for de novo HCC is the recurrence of hepatitis/cirrhosis in the allograft. All the described de novo HCCs occurred at least 2 years after OLT, whereas most recurrent HCCs develop within 2 years from surgery. The treatment of this tumor can follow the recommendations of guidelines for primary HCC and, unlike recurrent HCC, re-transplant can be considered a therapeutic option for these patients. Prevention of this tumor relies on the prevention/cure of recurrent liver disease in the allograft and on judicious post-transplant immunosuppression.
The present review analyzes this topic by addressing seven key questions. An algorithm based on clinical factors – regarding primary and secondary tumors – to trigger the suspicion of de novo origin of a post-transplant HCC is proposed
Experimental and numerical study of expandable threaded connections and proposal of a new design
No full textThis paper investigates the behaviour of a flush oilfield premium connection during the cold expansion process. The objective has been to validate, through experimental tests of make up and expansion on prototypes designed traditionally, the numerical simulation generated to reproduce and interpret the mechanism that occurs during the whole process. A finite element model, able to understand the expansion mechanics, to explain the damages caused on the expanded prototypes and to define design changes in order to improve the mechanical strength and hydraulic seal, has been set up. Taking advantage of the calculation procedure, a new expandable connection has been developed, at first on the basis of numerical simulation, then assessed by means of experimental tests. The new connection has shown definitely better behaviour about the hydraulic seal, withstanding the maximum internal pressure of 5050 psi
Validation of noninvasive methods for the assessment of liver fibrosis in patients with recurrent hepatitis C after transplantation.
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Towards new tools for refined management of patients with advanced hepatocellular carcinoma under systemic therapy: Some enthusiasm with a word of caution
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Surveillance for early diagnosis of hepatocellular carcinoma: how best to do it?
No full textSurveillance for hepatocellular carcinoma (HCC) is considered a standard of care for patients with chronic liver disease who are at risk of developing this malignancy. Several studies have shown that surveillance can improve the prognosis of patients diagnosed with HCC through an increased likelihood of application of curative or effective treatments. Repetition of liver ultrasonography (US) every 6 mo is the recommended surveillance program to detect early HCCs, and a positive US has to entrain a well-defined recall policy based on contrast-enhanced, dynamic radiological imaging or biopsy for the diagnosis of HCC. Although HCC fulfills the accepted criteria regarding cost-effective cancer screening and surveillance, the implementation of surveillance in clinical practice is defective and this has a negative impact on the cost-effectiveness of the procedure. Education of both physicians and patients is of paramount importance in order to improve the surveillance application and its benefits in patients at risk of HCC. The promotion of specific educational programs for practitioners, clinicians and patients is instrumental in order to expand the correct use of surveillance in clinical practice and eventually improve HCC prognosi
Pulsatile perfusion of kidney allografts with celsior solution
No full textBackground Use of pulsatile perfusion (PP) to optimize outcomes in deceased donor renal transplantation remains controversial. This prospective analysis describes all cadaveric renal allografts transplanted at our center that were preserved with PP using Celsior solution. Methods We used the LifePort Kidney Transporter (Organ Recovery Systems) perfusion machine. Study outcomes included 1-year graft and patient survivals as well as rates of delayed graft function and need for posttransplant dialysis. Results Graft survival for PP was 90% and patient survival 100%. The incidences of delayed graft function was 10% and of posttransplant dialysis, 10%. Conclusion These data support the use of PP with Celsior solution. © 2010 Elsevier Inc. All rights reserved
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