1,721,036 research outputs found
The "hanging maneuver" technique during pancreaticoduodenectomy: The result of a technical evolution to approach the superior mesenteric artery.
Full text linkNo abstract available.Image: “Hôpital de Hautepierre”. Strasbourg, France
Are the Hangzhou criteria adaptable to hepatocellular carcinoma patients for liver transplantation in Western countries?
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Biologic characterization of colorectal cancer : the surgeon’s point of view
No full textArticolo in esteso
Incisional hernia repair after liver transplantation: role of the mesh.
No full textPatients undergoing orthotopic liver transplantation (OLT) show a high risk of developing an incisional hernia. The aim of this retrospective study was to establish the incidence and the factors influencing the outcomes of this complication.We reviewed 450 consecutive OLT performed in 422 adult recipient between January 2000 and December 2005. Herniae were analysed with aspect to localization, classification, repair technique, and recurrence. All treated herniae were followed for a median of 50.5 months.Incisional herniae occurred in 36 patients (8.5\%, Group 1). Their mean age OLT was 51.4 years with 94.4\% male subjects. No significant difference was observed between affects and unaffected individuals for age, OLT indication, Child-Pugh score, albumin, comorbidities, operative time, transfusions, immunosuppressant regimen, and graft rejection episodes as well as for the incisional approach and hospital stay. Gender, body mass index (BMI), preoperative ascites, and pulmonary complications after OLT were significantly different (P 10 cm; n = 2). Herniorrhaphy techniques included primary suture repair in 5 (13.9\%) and mesh repair in 31 (86.1\%) cases. In 3 patients with a primary repair and 1 patient with a mesh repair there were recurrences.Preoperative ascites, gender, BMI, and pulmonary complications after OLT seemed to have significant influences on the formation of incisional herniae. Polypropylene mesh may be a first choice for the surgical treatment of there transplant recipients
Causes of sirolimus discontinuation in 97 liver transplant recipients.
No full textSirolimus is a potent immunosuppressant with a mechanism of action different from calcineurin inhibitors (CNIs). It has increasing importance for liver transplant (OLT) patients, in particular if when there is decreased renal function. We evaluated the efficacy and the causes for discontinuation of sirolimus-based immunosuppression among OLT recipients.We retrospectively analyzed 97 liver transplanted patients who were prescribed sirolimus as the principal immunosuppressant. Of these, 61 patients discontinued treatment. Herein we have reported the causes, the timing, and the effects of sirolimus discontinuation.The overall patient survival at 3 years follow-up was 89\%. Hepatotoxicity and blood disorders were the most frequent, severe reported side effects. Acute cellular rejection episodes appeared in seven patients and was relieved in 1 to 2 weeks after the sirolimus administration. In 10 patients, the cholestasis associated with chronic rejection was sharply reduced after the introduction of sirolimus. No increase in vascular thrombosis and/or poor wound healing were reported.Sirolimus given alone or in combination with CNIs appears to be an effective primary immunosuppressant regimen for OLT patients. However, in the late postoperative period (>3 months) the drug is associated with a relatively high rate of side effects
Does arterialisation time influence biliary tract complications after orthotopic liver transplantation?
No full textIn the cardiac death donor era, many reports deal with biliary tract complications and concerns about ischemic reperfusion injury owing to the exclusive arterial vascularization of the biliary tree, the warm ischemia time has been implicated as responsible for biliary lesions during organ procurement. We defined the arterialization time as the second warm ischemia time. Our purpose was to study the correlation between the arterialization time during liver implantation and the appearance of biliary lesions.We retrospectively collected data from the last 5-years of orthotopic liver transplantation: namely, indications, cold perfusion fluid, cold ischemia time, operative procedure times, and acute rejection events. We excluded split-liver transplantations, retransplantations, pediatric patients, transplantations for cholestatic disease, cases where hepatic artery thrombosis happened before biliary complications, or patients with posttransplant cytomegalovirus infection. We defined 2 groups: A) without biliary complications; and B) with biliary complications. We compared the mean arterialization time using Student t test to define whether the warm ischemic time during implantation was responsible for biliary tract complications. A P value of <.05 was considered to be significant.Between 2004 and the end of 2008, we grafted 402 patients among whom 243 met the inclusion criteria: 198 in group A and 45 in group B. Only the cold ischemia time was significantly different between the 2 groups (P = .039).After the anhepatic time, the surgeon may take time for the arterial anastomosis without fearing increased biliary damage
Metachronous occurrence of gastric carcinoma after gastric stromal tumor. Considerations on therapeutic strategy.
No full textEndovascular treatment for bleeding gastroduodenal pseudoaneurysm after acute pancreatitis
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