1,721,484 research outputs found
How should the patients with HCC managed in the waiting list: the hepatologist perspective.
No full textOperational tolerance in clinical liver transplantation: emerging developments.
No full textThere is still little understanding of the immune events that occur in transplant patients as they develop a relationship with their graft alloantigens. Though, there is an enormous interest and motivation in inducing specific unresponsiveness to organ allografts in order to allow minimization or complete withdrawal of immunosuppression in the recipient, given that life-long immunosuppressive treatment entails a high risk of infectious and metabolic complications, malignancies, and drug-specific toxicity. Clinical tolerance is defined as stable normal graft function in the total absence of a requirement for maintenance immunosuppression. Effective clinical tolerance has been reported more frequently in liver transplant recipients than after transplantation of other organs, as the liver is an immune-privileged organ for several mechanisms, most of which still remain unclear. According to the English medical literature, cautious, carefully supervised weaning of immunosuppressive drugs in controlled trials is not unreasonable, especially when monitored by protocol biopsies. The five centers in which the weaning has been attempted have reported a similar degree of success (1 out of 4 patients) and no harm to the patient over the short-term. Though, long-term follow-up has been lacking and, at present, there are no reliable immunological parameters that enable patients who can be withdrawn from immunosuppressants without the risk of rejection to be identified. To achieve that goal, appropriate collaboration and interaction between clinicians, immunologists and other basic scientists are desirable, as well as the creation of an international, maybe intercontinental, registry for tolerant patients
Liver transplantation in a patient with complete portal vein thrombosis, is there a surgical way out? A case report
Full text linkIntroduction: Due to the complexity of the surgical procedure portal vein thrombosis (PVT) has long been considered an absolute contraindication to liver transplantation (LT). The presence of a large splenorenal shunt (SRS) could make portal anastomosis a valid option.Presentation of case: We report the case of a 37-year-old female patient with Grade III PVT and a large SRS, who underwent orthotopic LT. Liver was implanted using a 1992-Belghiti piggyback technique and portal anastomosis was performed using the large spleno-renal shunt. We observed good graft reperfusion and postoperative Doppler ultrasound showed normal portal vein flow. She was discharged on postoperative day 7, with an excellent graft function. At six months follow-up, patient is alive with normal hepatic vascularization.Discussion: Due to paucity of reports, there is currently no consensus on the indication to LT and/or surgical technique. In the present case, once the transplant benefit was evaluated, the Grade III PVT was not considered a contraindication to LT.Conclusion: The presence of a Grade III PVT associated with a large SRS should not be considered a contraindication for LT, and the use of the shunt vein should be considered a feasible option to perform portal anastomosis. (C) 2016 The Author(s). Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd
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
Complications and risk factors of a large series of Percutaneous Liver Biopsies in patients with liver transplantation or liver disease
No full textBackground: Liver biopsy is a very important investigation in Hepatology. The aim of this retrospective study was to assess the occurrence of complications after Percutaneous Liver Biopsy (PLB), performed in two groups of patients with liver transplantation or with liver disease, to compare our results with those most representative of the literature and also to discuss about indications, advantages and disadvantages in relation to the different modes for the execution of this procedure, with particular regard to the use of ultrasound guidance.
Materials and Methods: We analyzed, retrospectively, the results of 847 PLB performed with the Menghini technique between January 2004 and December 2013 at the Transplant Unit of the University of Rome Tor Vergata. The indications for biopsy were: follow-up liver transplantation, HBV, HCV and HBV/HCV related liver disease, alcohol related liver disease and HIV coinfected with HBV or HCV. Our patients were classified into two groups according to specific indication: patients with liver transplantation (group A) and patients with liver disease (group B). The procedure was always performed in the Day Hospital regimen. After the biopsy, the patients remained in bed for about 4-6 hours. In absence of complications, they were then discharged in the same day.
Results: The most frequent complication was pain after biopsy (group A n.45, 7.9%; group B n.85, 30.9%), requiring analgesics administration, hypotension as a result of a vasovagal reaction resolved spontaneously (group A n.6, 1.0%; group B n.6, 2.2%), and bleeding (group A n.1, 0.2%; group B n.6, 2.2%), which, however, has never necessitated surgery, except in one case of hemothorax. Two cases of pneumothorax were resolved with chest tube. Other complications did not have a significant impact.
Conclusions: Liver biopsy is not replaceable investigation to diagnose several liver diseases and their course and also to monitor the condition of the hepatic parenchyma after transplantation. Among the various methods we preferred the Menghini technique with percutaneous transcostal approach, because less traumatic. This procedure presents low occurrence of various problems. We reviewed the literature regarding the major complications related to the technique and the use of ultrasound guidance. Based on our experience and data reported by the main Authors, we believe that ultrasound guidance is not decisive in the prevention of major complications. It is useful if done in the days or weeks prior to biopsy only in order to know any anatomical abnormalities or rather disease
Liver transplantation with a normothermic machine preserved fatty nonagenarian liver: A case report
No full textThe use of organs from expanded criteria donors for Liver Transplantation (LT) represents a major challenge. In the current era of Normothermic Machine Perfusion (NMP), donor age boundaries are often overcome and may contribute to reduce the gap between supply and demand of organs suitable for transplantation. We report on a unique case of nonagenarian liver successfully transplanted after NMP
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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