1,721,004 research outputs found
Massive haemoptysis after living donor liver transplantation
Full text linkA 27 year old man with hereditary haemorrhagic telangiectasia who developed progressive liver dysfunction underwent living related right lobe transplantation. Pulmonary arteriography did not reveal arteriovenous malformation or abnormal intrapulmonary venous channels. The postoperative course was characterised by persistent hypoxaemia and respiratory failure developed. On day 6, a massive haemoptysis developed and the patient died shortly thereafter. The native liver showed a nodular pseudocirrhotic transformation, with highly dilated and irregularly interconnected vein-like or arterial-like structures in the fibrous septa. Pathological examination of both lungs showed irregular thickening of the wall of the arteries, secondary to eccentric and/or concentric myointimal hyperplasia. This case suggests that massive haemoptysis can develop even when arteriovenous malformations are undetectable by pulmonary arteriography, and it questions the role and the appropriateness of living donor liver transplantation in high risk patients
Liver transplantation in man : morphometric analysis of the parenchymal alterations following cold ischaemia and warm ischaemia/reperfusion
Full text linkIschaemia and reperfusion phases represent critical events during liver transplantation. The purpose of this study was to describe morphological alterations of both vascular and parenchymal compartments after ischaemia and reperfusion and to evaluate the possible relationship between morphometric parameters and biochemical/clinical data. Three needle biopsies were drawn from 20 patients who underwent orthotopic liver transplantation. The first biopsy was taken before flushing with preservation solution, and the second and the third to evaluate respectively the effects of cold ischaemia and of warm ischaemia/reperfusion. Biopsies were examined by an image analyser and morphometric parameters related to the liver parenchyma were evaluated. At the second biopsy we observed a decrease of the endothelium volume fraction while the same parameter referred to the sinusoidal lumen achieved a peak value. The hepatocytes showed a lower surface parenchymal/vascular sides ratio. This parameter was reversed at the end of the reperfusion phase; furthermore the third biopsy revealed endothelial swelling and a decreased volume fraction of the sinusoidal lumen. The results quantify the damage to the sinusoidal bed which, as already known, is one of the main targets of cold ischaemia; warm ischaemia and reperfusion accentuate endothelial damage. The end of transplantation is characterised by damage chiefly to parenchymal cells. Hepatocytes show a rearrangement of their surface sides, probably related to the alterations of the sinusoidal bed. In addition, the fluctuations of morphometric parameters during ischaemia/reperfusion correlate positively with biochemical data and clinical course of the patients
Histological and immunohistochemical pattern of hepatocellular cytokeratin 7-positive and negative : Comparison by computerized morphometry
No full textObjective: To investigate by computerized morphometric the morphological features in HCC expressing CyK7 (CyK7-positive) and in HCCs CyK7-negative.
Study Design: This study included 15 HCC CyK7-positive and 18 HCC CyK7-negative from patients submitted to LTx for HCV-related cirrhosis at the Niguarda Hospital in Milan. All specimens were stained with hematoxylin-eosin and immunohistochemically for CD34 to assess the degree of sinusoidal capillarization, reticulin to assess the cell plate architecture and Ki67 to identify neoplastic cells that are actively dividing. We generated a computerized morphometric model to evaluate the volume fractions occupied by hepatocyte nuclei and cytoplasm, sinusoids, portal triads, capillarised sinusoids and tumor cells actively dividing. Lastly, the surface fraction occupied by reticulin was calculated. Moreover, tumor cells expressing both CyK7 and Ki67 in HCC CyK7 positive were also identified. Ten high-grade dysplastic nodules from resection specimens of HCV-related cirrhotic livers were also used as control group.
Results: On H&E stains, the features most discriminatory between HCCs CyK7-positive and CyK7-negative were volume fractions of sinusoids and of fibrosis and inflammatory infiltrate, which were significantly highest in HCCs CyK7-positive. On immunohistochemistry, volume fractions of capillarised sinusoids and of Ki67 cells were significantly highest in HCCs CyK7-positive.
Conclusion: Our morphometric model is an objective method of quantification of the morphologic features in both CyK7-positive and CyK7-negative HCCs and it could be applied in studies involving histological evaluation of the different subtypes of HCC arising in the cirrhotic liver according to their CyK7 expression
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Kaposi's sarcoma in liver transplant recipients : morphological and clinical description
No full textThe clinical course and outcome of 5 adult patients who underwent orthotopic liver transplantation (OLT) and developed Kaposi's sarcoma (KS) is reported. From October 1986 to July 2000, a total of 459 patients underwent 499 OLTs at our hospital. The immunosuppressive regimen consisted of cyclosporine, azathioprine, prednisone, and antithymocyte globulin. Tacrolimus was administered only in selected patients. Five patients developed KS, and the pathological diagnosis was established months 9 to 23 after OLT. Four of 5 patients died of KS, surviving 0 to 6 months after pathological diagnosis. The fifth patient, with KS confined to the skin, is disease free 6 months after diagnosis. All patients were treated with reduction of immunosuppressive therapy and/or chemotherapy. Retrospective molecular investigation by polymerase chain reaction for human herpesvirus type 8 DNA detected specific viral sequences in histological specimens of tissues involved by KS. In our experience with adult liver transplant recipients, we registered a slightly lower prevalence of KS compared with other reported data, but observed a high rate of graft involvement and mortality
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