264 research outputs found
Renewed considerations on the utility (or the futility) of hepatic resections for breast cancer liver metastases
No full textIndication for liver resection (LR) for localized hepatic metastases from breast cancer (BC) is
still a matter of debate. A literature review of recent scientific papers pertaining to hepatectomies for BC
liver metastases (LM). We based our systematic review on case series on literature reviews, comparative
studies and cost-utility analysis which have been selected based on criteria regarding surgery, possible
prognostic factors and evaluation of long-term survival. There is a strong inhomogeneity in the reported
data, with 5-year survivals ranging from 21% to 58%. There is no agreement in the evaluation of prognostic
variables predicting good survival, with the only exception of the time of treatment of the primary BC until
the diagnosis of metastases. Three out of the four comparative studies report better survivals for patients
who underwent a hepatectomy in comparison to those treated with chemotherapy alone, but their strength
in terms of scientific evidence is weak. The only cost utility analysis revealed that 2 out of the 3 scenarios
considered were in favor of the treatment with surgery followed by conventional chemotherapy. There is
no definitive proof on the effectiveness of LRs for BC LM. Surgery can be proposed when it is possible to
perform radical surgery, with R0 margins and saving at least 30% of the liver with its vascular and biliary
connections. Stable skeletal metastases are not a contraindication. The interval between treatment of the
primary location and diagnosis of hepatic metastases is the only prognosis criteria available
Web relationships between physicians and individuals seeking information on hepatopancreatobiliary diseases.
No full textHYPOTHESIS: The Internet has led to widespread Web consulting, the proportions of which are not yet known; there is not yet agreement on its management. DESIGN: We verified the typology and needs of people and patients of a single-language population inquiring about a homogeneous group of diseases treated in tertiary reference centers and their reason for writing. Data were extracted and coded from e-mail messages received over 27 months by a noninstitutional Web site devoted to surgically treatable hepatopancreatobiliary diseases. Consultation activity was verified by the number of answers and subsequent messages. MAIN OUTCOME MEASURES: One thousand forty-seven users sent 1788 messages to one of the Web site addresses; 1179 (94.6%) of them inquired about clinical problems. Data were collected on the demographics of senders and patients, the nature of the clinical problem, and the reasons for the messages. RESULTS: A mean of 2.1 messages per day were received. Queries were sent by patients in 260 instances (22.1%) and by others in 750 (63.6%). Two hundred thirty-seven (20.1%) e-mails had medical enclosures. The presence of a malignant disease was reported in 705 messages (59.8%). Description of previously undertaken therapy was present in 613 cases (52.0%). An answer was given to 1177 first messages (94.4%) and a follow-up message was received from 401 users (34.1%). Second messages were characterized by a shorter time to receive an answer (mean, 2.5 +/- 3.6 days vs 3.5 +/- 5.3 days). Each user sent a mean number of 1.4 +/- 0.7 messages (range, 1-8). CONCLUSIONS: Web consulting is a powerful tool for patients and health professionals that emerged owing to physician communication problems. Nevertheless, the Internet is still pushing physicians toward a reconsideration of the principles of medical ethics and a reevaluation of rules and regulations to deal with these new communication methods
Liver resections: complications and survival outcome
No full textToday, liver resection represents one of the most effective therapies in the treatment of defined liver diseases, particularly for hepatocellular carcinomas, liver metastases and tumors originating from the bile ducts. There have been a number of improvements in the technique but the use of kellyclasia associated with meticulous control of hemostasis and biliostasis appears to be more effective and efficient. The procedure is still burdened with some postoperative complications, the more characteristic of which are liver insufficiency, biliary leakage and ascites. Several neoplastic diseases, both primitive and secondary, can benefit from this therapy with substantial improvement of long-term survival, and a
notable change in the natural history of the disease. For these situations, a consultation should always be performed by a surgeon experienced in hepatic surgery
A case report of giant hepatic hemangioma spontaneous regression in adult, non-cirrhotic patient and literature review
No full textHepatic hemangiomas (HHs) are defines as “giant” when are larger than 4 cm. The following case is reviewed due its unusual evolution. A case of 64-year-old woman was found at CT scan to have a “giant” HH (>20 cm in diameter). In 2015 (8 years after initial diagnosis), in the absence of treatments, abdominal CT scan highlighted the initial spontaneous regression of the HH, that progressed over time. Management of giant hemangiomas remains debated. Surgery should be restricted to specific situations, depending on growth pattern, symptom persistence, risk of complications and patient anxiety. Usually HHs remain stable in size over time and only a prolonged clinical and radiological follow-up is advised. The commonly known natural history of HHs in non-cirrhotics do not include decrease in size or regression. Clearly documented cases of spontaneous regression of giant HHs in non-cirrhotic adult patients have not yet been reported
I risultati del trapianto di fegato nei pazienti HCV positivi
No full textL’insufficienza epatica secondaria alla cirrosi causata dal virus dell’epatite C rappresenta oggi la principale indicazione per il trapianto di fegato. Il problema maggiore per i pazienti che eseguono questo intervento è rappresentato dalla recidiva della malattia. A 5 anni dall’intervento circa il 30% dei trapiantati presenta una cirrosi documentata dall’esame istologico e un 10% muore o perde il graft per motivi direttamente correlati al virus. La velocità e la severità con cui la malattia si sviluppa è multifattoriale ed è secondaria a fattori legati al virus, al donatore, all’intervento chirurgico, a relazioni immunologiche ed anche alla terapia antirigetto. La recidiva dell’epatite rappresenta tuttavia un fattore meno importante se confrontato con i decessi dei pazienti inseriti nella lista di attesa e la mortalità direttamente legata alla procedura chirurgica
Corrigendum to “Evolution of pancreatectomy with en bloc venous resection for pancreatic cancer in Italy. Retrospective cohort study on 425 cases in 10 pancreatic referral units” (International Journal of Surgery (2018) 55 (103–109), (S174391911830774X), (10.1016/j.ijsu.2018.05.025))
No full textThe authors regret that the affiliation for Gian Luca Grazi was incorrect and should appear as above. The authors would like to apologise for any inconvenience caused
Principles of Surgical Oncology
No full textThe chapter describes the basis of the surgical therapy of cancer diseases, with considerations on the correct evaluation of the extent of the disease, of its biological aggressiveness and of the general condition of the patient
Speech disorder related to tacrolimus-induced pontine myelinolysis after orthotopic liver transplantation
No full textWe report a case of speech disorders after tacrolimus treatment and resolution after discontinuatio
Hepatic artery stenosis in liver transplanted patients treated with pegylated Interferon alpha-2b and Ribavirin
No full textNo abstract availabl
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