1,721,464 research outputs found
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
Full text linkToday, 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
Liver transplantation for benign hepatic tumors: A systematic review
No full textOrthotopic liver transplantation (OLT) has been performed for several benign hepatic tumors. Most of these diseases are usually managed conservatively, or treated by liver resection. OLT might be required when the lesions are symptomatic, diffuse in hepatic parenchyma, causing life-threatening complications or malignant transformation cannot be ruled out. Polycystic liver disease is the most common indication for OLT. We present a review of transplantable benign hepatic lesions to evaluate the need of OLT for these diseases, to summarize in which OLT is a good therapeutic option, and to show the early and long-term survival which might be expected. Copyright © 2010 S. Karger AG, Basel
Iliac Approach for Vascularization of an Intestinal Graft at Retransplantation.
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Prognostic criteria for postoperative mortality in 170 patients undergoing major right hepatectomy
No full textBackground: Postoperative hepatic failure is a dreadful complication after major hepatectomy and carries high morbidity and mortality rates. In this study, we assessed the accuracy of the 50/50 criteria (bilirubin >2.9 mg/dL and international normalized ratio >1.7 on postoperative day 5) and the Mullen criteria (bilirubin peak >7 mg/dL on postoperative days 1-7) in predicting death from hepatic failure in patients undergoing right hepatectomy only. In addition, we identified prognostic factors linked to intra-hospital morbidity and mortality in these patients. Methods: One hundred seventy consecutive patients underwent major right hepatectomy at a tertiary medical center from 2000 to 2008. Nineteen (11.2%) patients suffered from liver cirrhosis. Univariate and multivariate analyses were performed to identify predictors of intra-hospital mortality, morbidity and death from hepatic failure. Results: The intra-hospital mortality was 6.5% (11/170). Of the six patients who died from hepatic failure, one was positive for the 50/50 criteria, but all six patients were positive for the Mullen criteria. Multivariate analysis showed that male gender, hepatitis C (HCV), hepatocellular carcinoma, postoperative bilirubin >7 mg/dL and ALT<188 U/L on postoperative day 1 were predictive of death from hepatic failure in the postoperative period. Age >65 years, HCV, reoperation, and renal failure were significant predictors of overall intrahospital mortality on multivariate analysis. Conclusions: The Mullen criteria were more accurate than the 50/50 criteria in predicting death from hepatic failure in patients undergoing right hepatectomy. A bilirubin peak >7 mg/dL in the postoperative period, HCV positivity, hepatocellular carcinoma, and an ALT level <188 U/L on postoperative day 1 were associated with death from hepatic failure in our patient population
Peliosis hepatis. Personal experience and literature review
Full text linkPeliosis hepatis (PH) is a disease characterized by
multiple and small, blood-filled cysts within the
parenchymatous organs. PH is a very rare disease,
more common in adults, and when it affects the liver, it
comes to the surgeon’s attention only in an extremely
urgent situation after the lesion’s rupture with the
resulting hemoperitoneum. This report describes the
case of a 29-year-old woman affected by recurring
abdominal pain. CT scans showed a hepatic lesion
formed by multiple hypodense areas, which showed
an early acquisition of the contrast during the arterial
phase. Furthermore, it remained isodense with the
remaining parenchyma during the late venous phase.
We decided on performing a liver resection of segment
VII while avoiding a biopsy for safety reasons. The
histopathologic examination confirmed the diagnosis
of focal PH. PH should always be considered in the
differential diagnosis of hepatic lesions. Clinicians
should discuss the possible causes and issues related to
the differential diagnosis in addition to the appropriate
therapeutic approach. The fortuitous finding of a
lesion, potentially compatible with PH, requires elective
surgery with diagnostic and therapeutic intents. The
main aim is to prevent the risk of a sudden bleeding
that, in absence of properly equipped structures, may
have a fatal outcome
The role of lymphadenectomy for liver tumors. Further considerations on the appropriateness of treatment strategy
No full textOBJECTIVE: To evaluate the role of regional lymphadenectomy in patients with liver tumors. BACKGROUND: Lymph node status is 1 of the most important prognostic factors in oncologic surgery; however, the role of lymph node dissection remains unclear for hepatic tumors. METHODS: A total of 120 consecutive patients undergoing liver resections for primary and secondary hepatic tumors were prospectively enrolled in the study. "Regional" lymphadenectomy was carried out routinely after specimen removal. Incidence, site, and influence on survival of node metastases were analyzed. RESULTS: Only 1 postoperative complication (intra-abdominal bleeding) was related to lymph node excision. Median number of dissected nodes was 6.8 +/- 3.6. Periportal, pericholedochal, and common hepatic artery stations were always removed. Lymph node metastases were found in 17 (16.5%) patients. The percentage rises to 20.3% when considering only noncirrhotic patients. The incidence of lymph node metastases was 7.5% for hepatocellular carcinoma, 14% for colorectal metastases, 40% for noncolorectal metastases, and 40% for intrahepatic cholangiocarcinoma (P < 0.002). Median survival time was 486 +/- 93.2 days among all patients with node metastases and 725 +/- 29.7 among patients without node metastases. The 2-year survival was 37.1% and 86.7%, in the 2 groups (P < 0.05). The 2-year recurrence rate was 77.6% and 45.3%, respectively (P < 0.05). CONCLUSIONS: Regional lymphadenectomy is a safe procedure after liver resection, and it should be routinely applied in patients with primary and secondary hepatic tumors, particularly in those without chronic disease. A careful evaluation of node status is nevertheless advisable also in patients with hepatocellular carcinoma on cirrhosis
Prognostic criteria for postoperative mortality in 170 patients undergoing major right hepatectomy
No full textPostoperative hepatic failure is a dreadful complication after major hepatectomy and carries high morbidity and mortality rates. In this study, we assessed the accuracy of the 50/50 criteria (bilirubin >2.9 mg/dL and international normalized ratio >1.7 on postoperative day 5) and the Mullen criteria (bilirubin peak >7 mg/dL on postoperative days 1-7) in predicting death from hepatic failure in patients undergoing right hepatectomy only. In addition, we identified prognostic factors linked to intra-hospital morbidity and mortality in these patients
The Future Challenge in the MELD Era: How to Match Extended-Use Donors and Sick Recipients.
No full textNo abstract availabl
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