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1Third-line rescue therapy for Helicobacter pylori infection显示文摘H pylori 胃的感染是世界范围的最流行的传染病之一。很上面的胃肠的疾病与 H pylori 感染有关能因此与抗菌素被对待的发现是重要医药进展。当前,首要的三倍的治疗被所有一致会议和指南基于质子泵禁止者(PPI ) 或加二抗菌素(clarithromycin 和 amoxicillin 或 nitroimidazole ) 的 ranitidine 枸橼酸铋(RBC ) 推荐。甚至与这药联合的正确使用,感染不能在多达 23% 病人被根除。因此,几第二线治疗被推荐了。7 d 四倍的治疗基于 PPI,铋,四圜素和灭滴灵,更多经常被接受。与第二线的治疗,然而,细菌的根除可以在多达 40% 盒子失败。当 H pylori 根除严格地被显示时,进一步的治疗的选择是争论的。当前,标准第三线的治疗正在缺乏,各种各样的协议被建议了。甚至在二连续失败以后,最近的文学数据证明了 H pylori 根除能在几乎所有病人被完成,甚至当抗菌素危险性没被测试时。实验治疗的不同可能性存在,可得到的第三线的策略此处被考察。Rossella Cianci Massimo Montalto Franco Pandolfi Giovan Battista Gasbarrini Giovanni Cammarota 2006World Journal of Gastroenterology2006,12,15:31
2Risk factors associated with pancreatic fistula after distal pancreatectomy, which technique of pancreatic stump closure is more beneficial?显示文摘AIM: To identify risk factors related to pancreatic fistula in patients undergoing distal pancreatectomy (DP) and to determine the effectiveness of using a stapled and a sutured closed of pancreatic stump. METHODS: Sixty-four patients underwent DP during a 10-year period. Information regarding diagnosis, operative details, and perioperative morbidity or mortality was collected. Eight risk factors were examined. RESULTS: Indications for DP included primary pancreatic disease (n = 38, 59%) and non-pancreatic malignancy (n = 26, 41%). Postoperative mortality and morbidity rates were 1.5% and 37% respectively; one patient died due to sepsis and two patients required a reoperation due to postoperative bleeding. Pancreatic fistula was developed in 14 patients (22%); 4 of fistulas were classified as Grade A, 9 as Grade B and only 1 as Grade C. Incidence of pancreatic fistula rate was significantly associated with four risk factors: pathology, use of prophylactic octreotide therapy, concomitant splenectomy, and texture of pancreatic parenchyma. The role that technique (either stapler or suture) of pancreatic stump closure plays in the development of pancreatic leak remains unclear. CONCLUSION: The pancreatic fistula rate after DP is 22%. This is reduced for patients with non-pancreatic malignancy, fibrotic pancreatic tissue, postoperative prophylactic octreotide therapy and concomitant splenectomy.Marco Pericoli Ridolfini Sergio Alfieri Stavros Gourgiotis Dario Di Miceli Fabio Rotondi Giuseppe Quero Roberta Manghi Giovanni Battista Doglietto 2007World Journal of Gastroenterology2007,13,38:24
3Clinical applications of hepatocyte transplantation显示文摘The shortage of organ donors is a problem worldwide, with approximately 15% of adult patients with lifethreatening liver diseases dying while on the waiting list. The use of cell transplantation for liver disease is an attempt to correct metabolic defects, or to support liver function as a bridge to liver transplantation and, as such, has raised a number of expectations. Most of the available studies briefly reported here focus on adult hepatocyte transplantation (HT), and the results are neither reproducible nor comparable, because the means of infusion, amount of injected cells and clinical variability differ among the studies. To better understand the specif ic role of HT in the management of end-stage liver disease, it is important that controlled studies, designed on the principles of evidence-based medicine, be done in order to guarantee the reproducibility of results.Giada Pietrosi Giovanni Battista Vizzini Salvatore Gruttadauria Bruno Gridelli 2009World Journal of Gastroenterology2009,15,17:23
4Genome and transcriptome analysis of the grapevine(Vitis vinifera L.) WRKY gene family显示文摘The plant WRKY gene family represents an ancient and complex class of zinc-finger transcription factors(TFs)that are involved in the regulation of various physiological processes,such as development and senescence,and in plant response to many biotic and abiotic stresses.Despite the growing number of studies on the genomic organisation of WRKY gene family in different species,little information is available about this family in grapevine(Vitis vinifera L.).In the present study,a total number of 59 putative grapevine WRKY transcription factors(VvWRKYs)were identified based on the analysis of various genomic and proteomic grapevine databases.According to their structural and phylogentic features,the identified grapevine WRKY transcription factors were classified into three main groups.In order to shed light into their regulatory roles in growth and development as well as in response to biotic and abiotic stress in grapevine,the VvWRKYs expression profiles were examined in publicly available microarray data.Bioinformatics analysis of these data revealed distinct temporal and spatial expression patterns of VvWRKYs in various tissues,organs and developmental stages,as well as in response to biotic and abiotic stresses.To also extend our analysis to situations not covered by the arrays and to validate our results,the expression profiles of selected VvWRKYs in response to drought stress,Erysiphe necator(powdery mildew)infection,and hormone treatments(salicilic acid and ethylene),were investigated by quantitative real-time reverse transcription PCR(qRT-PCR).The present study provides a foundation for further comparative genomics and functional studies of this important class of transcriptional regulators in grapevine.Min Wang Alessandro Vannozzi Gang Wang Ying-Hai Liang Giovanni Battista Tornielli Sara Zenoni Erika Cavallini Mario Pezzotti Zong-Ming(Max)Cheng 2014Horticulture Research2014,1,1:19
5Hepatitis B in pregnancy显示文摘Chronic hepatitis B virus (HBV) infection affects about 350 million individuals worldwide. Management of HBV infection in pregnancy is difficult because of several peculiar and somewhat controversial aspects. The aim of the present review is to provide a tool that may help physicians to correctly manage HBV infection in pregnancy. This review focuses on (1) the effect of pregnancy on HBV infection and of HBV infection on pregnancy; (2) the potential viral transmission from mother to newborn despite at-birth prophylaxis with immunoglobulin and vaccine; (3) possible prevention of mother-to-child transmission through antiviral drugs, the type of antiviral drug to use considering their efficacy and potential teratogenic effect, and the timing of their administration and discontinuation; and (4) the evidence for the use of elective caesarean section vs vaginal delivery and the possibility of breastfeeding.Guglielmo Borgia Maria Aurora Carleo Giovanni Battista Gaeta Ivan Gentile 2012World Journal of Gastroenterology2012,18,34:16
6Acute hepatitis C virus infection in a nurse trainee following a needlestick injury显示文摘Hepatitis C virus(HCV) infection after biological accident(needlestick injury) is a rare event.This report describes the first case of acute HCV infection after a needlestick injury in a female nursing student at Padua University Hospital.The student nurse was injured on the second finger of the right hand when recapping a 23-gauge needle after taking a blood sample.The patient who was the source was a 72-year-old female with weakly positive anti-HCV test results.Three months after the injury,at the second step of followup,a relevant increase in transaminases with a low viral replication activity(350 IU/mL) was observed in the student,indicating HCV infection.The patient tested positive for the same genotype(1b) of HCV as the injured student.A rapid decline in transaminases,which was not accompanied by viral clearance,and persistently positive HCV-RNA was described 1 mo later.Six months after testing positive for HCV,the student was treated with pegylated interferon plus ribavirin for 24 wk.A rapid virological response was observed after 4 wk of treatment,and a sustained virological response(SVR) was evident 6 mo after therapy withdrawal,confirming that the patient was definitively cured.Despite the favourable IL28B gene(rs12979860) CC-polymorphism observed in the patient,which is usually predictive of a spontaneous clearance and SVR,spontaneous viral clearance did not take place;however,infection with this genotype was promising for a sustained virological response after therapy.Renzo Scaggiante Liliana Chemello Roberto Rinaldi Giovanni Battista Bartolucci Andrea Trevisan 2013World Journal of Gastroenterology2013,19,4:11
7Role of endoscopic ultrasonography in the loco-regional staging of patients with rectal cancer显示文摘The prognosis of rectal cancer(RC) is strictly related to both T and N stage of the disease at the time of diagnosis. RC staging is crucial for choosing the best multimodal therapy: patients with high risk locally advanced RC(LARC) undergo surgery after neoadjuvant chemotherapy and radiotherapy(NAT); those with low risk LARC are operated on after a preoperative short-course radiation therapy; finally, surgery alone is recommended only for early RC. Several imaging methods are used for staging patients with RC: computerized tomography, magnetic resonance imaging, positron emission tomography, and endoscopic ultrasound(EUS). EUS is highly accurate for the loco-regional staging of RC, since it is capable to evaluate precisely the mural infiltration of the tumor(T), especially in early RC. On the other hand, EUS is less accurate in restaging RC after NAT and before surgery. Finally, EUS is indicated for follow-up of patients operated on for RC, where there is a need for the surveillance of the anastomosis. The aim of this review is to highlight the impact of EUS on the management of patients with RC, evaluating its role in both preoperative staging and follow-up of patients after surgery.Pietro Marone Mario de Bellis Valentina D'Angelo Paolo Delrio Valentina Passananti Elena Di Girolamo Giovanni Battista Rossi Daniela Rega Maura Claire Tracey Alfonso Mario Tempesta 2015World Journal of Gastrointestinal Endoscopy2015,7,7:11
8Reliability in endoscopic diagnosis of portal hypertensive gastropathy显示文摘AIM: To analyze reliability among endoscopists in diagnosing portal hypertensive gastropathy (PHG) and to determine which criteria from the most utilized classifications are the most suitable. METHODS: From January to July 2009, in an academic quaternary referral center at Santa Casa of S o Paulo Endoscopy Service, Brazil, we performed this singlecenter prospective study. In this period, we included 100 patients, including 50 sequential patients who had portal hypertension of various etiologies; who were previously diagnosed based on clinical, laboratory and imaging exams; and who presented with esophageal varices. In addition, our study included 50 sequentialpatients who had dyspeptic symptoms and were referred for upper digestive endoscopy without portal hypertension. All subjects underwent upper digestive endoscopy, and the images of the exam were digitally recorded. Five endoscopists with more than 15 years of experience answered an electronic questionnaire, which included endoscopic criteria from the 3 most commonly used Portal Hypertensive Gastropathy classifications (McCormack, NIEC and Baveno) and the presence of elevated or flat antral erosive gastritis. All five endosco- pists were blinded to the patients' clinical information, and all images of varices were deliberately excluded for the analysis. RESULTS: The three most common etiologies of portal hypertension were schistosomiasis (36%), alcoholic cirrhosis (20%) and viral cirrhosis (14%). Of the 50 patients with portal hypertension, 84% were Child A, 12% were Child B, 4% were Child C, 64% exhibited previous variceal bleeding and 66% were previously endoscopic treated. The endoscopic parameters, presence or absence of mosaic-like pattern, red point lesions and cherry-red spots were associated with high inter-observer reliability and high specificity for diagnosing Portal Hypertensive Gastropathy. Sensitivity, specificity and reliability for the diagnosis of PHG (%) were as follows: mosaic-like pattern (100; 92.21; High); fine pink speckling (56; 76.62; Unsatisfactory); superficial reddening (69.57; 66.23; Unsatisfactory); red-point lesions (47.83; 90.91; High); cherry-red spots (39.13; 96.10; High); isolated red marks (43.48; 88.31; High); and confluent red marks (21.74; 100; Unsatisfactory). Antral elevated erosive gastritis exhibited high reliability and high specificity with respect to the presence of portal hypertension (92%) and the diagnosis of portal hypertensive gastropathy (88.31%). CONCLUSION: The most suitable endoscopic criteria for the diagnosis of PHG were mosaic-like pattern, redpoint lesions and cherry-red spots with no subdivisions,which were associated with a high rate of inter-observer reliability.George Fred Soares de Macedo Fabio Gon alves Ferreira Maurício Alves Ribeiro Luiz Arnaldo Szutan Mauricio Saab Assef Lucio Giovanni Battista Rossini 2013World Journal of Gastrointestinal Endoscopy2013,5,7:9
9Analysis of surgical and perioperative complications in seventy-five right hepatectomies for living donor liver transplantation显示文摘AIM: To present an analysis of the surgical and perioperative complications in a series of seventy- five right hepatectomies for living-donation (RHLD) performed in our center. METHODS: From January 2002 to September 2007, we performed 75 RHLD, defined as removal of a portion of the liver corresponding to Couinaud segments 5-8, in order to obtain a graft for adult to adult living-related liver transplantation (ALRLT). Surgical complications were stratified according to the most recent version of the Clavien classification of postoperative surgical complications. The perioperative period was defined as within 90 d of surgery. RESULTS: No living donor mortality was present in this series, no donor operation was aborted and no donors received any blood transfusion. Twenty- three (30.6%) living donors presented one or more episodes of complication in the perioperative period. Seven patients (9.33%) out of 75 developed biliary complications, which were the most common complications in our series.CONCLUSION: The need to define, categorize and record complications when healthy individuals, such as living donors, undergo a major surgical procedure, such as a right hepatectomy, reflects the need for prompt and detailed reports of complications arising in this particular category of patient. Perioperative complications and post resection liver regeneration are not influenced by anatomic variations or patient demographic.Salvatore Gruttadauria James Wallis Marsh Giovan Battista Vizzini Fabrizio di Francesco Angelo Luca Riccardo Volpes Amadeo Marcos Bruno Gridelli 2008World Journal of Gastroenterology2008,14,20:7
10Clinical outcomes of ERCP-related retroperitoneal perforations显示文摘Endoscopic retrograde cholangiopancreatography(ERCP)-related perforations represent rare but often severe conditions. While lesions with intraperitoneal perforation have an almost imperative indication to surgery, whether or not to manage retroperitoneal perforations surgically is still an area of debate. The aim of the present work was to review the available clinical evidence on the operatively and medi cally treated ERCP-related retroperitoneal perforations. From MEDLINE/Pub Med databases 137 patients with retroperito neal perforation were included from 12 studies that met the selection criteria for data investigation and analysis. Twenty four patients were treated by prompt surgery; 113 were primarily managed conservatively and about 20% of these patients required surgery subsequently. Overall, the morbid ity and mortality were 15.4% and 6.6%, respectively. Although most patients with retroperitoneal perforation may benefit from a non-operative management, a considerable number of patients fail to respond to medical treatment and require sur gery afterwards. Identifying those patients who are at highest risk of poor outcome after conservative treatment should be considered a research priority.Francesco Guerra Giuseppe Giuliani Diego Coletta Stefano Amore Bonapasta Giovanni Battista Levi Sandri 2017Hepatobiliary & Pancreatic Diseases International2017,16,2:7
11Synergistic effect of interleukin-10-receptor variants in a case of early-onset ulcerative colitis显示文摘AIM:To investigated the molecular cause of very early-onset ulcerative colitis(UC)in an 18-mo-old affected child.METHODS:We analysed the interleukin-10(IL10)receptor genes at the DNA and RNA level in the proband and his relatives.Beta catenin and tumor necrosis factor-α(TNFα)receptors were analysed in the proteins extracted from peripheral blood cells of the proband,his relatives and familial adenomatous polyposis(FAP)and PTEN hamartoma tumor syndrome(PHTS)patients.Samples were also collected from the proband’s inflamed colorectal mucosa and compared to healthy and tumour mucosa collected from a FAP patient and patients affected by sporadic colorectal cancer(CRC).Finally,we examined mesalazine and azathioprine effects on primary fibroblasts stabilised from UC and FAP patients.RESULTS:Our patient was a compound heterozygote for the IL10RB E47K polymorphism,inherited from his father,and for a novel point mutation within the IL10RA promoter(the-413G->T),inherited from his mother.Beta catenin and tumour necrosis factorαreceptors-Ⅰ(TNFRI)protein were both over-expressed in peripheral blood cells of the proband’s relatives more than the proband.However,TNFRII was over-expressed only in the proband.Finally,both TNFα-receptors were shown to be under-expressed in the inflamed colon mucosa and colorectal cancer tissue compared to healthy colon mucosa.Consistent with this observation,mesalazine and azathioprine induced,in primary fibroblasts,IL10RB and TNFRII over-expression and TNFRI and TNFαunder-expression.We suggest thatβ-catenin and TNFRI protein expression in peripheral blood cells could represent molecular markers of sub-clinical disease in apparently healthy relatives of patients with early-onset UC.CONCLUSION:A synergistic effect of several variant alleles of the IL10 receptor genes,inherited in a Mende-lian manner,is involved in UC onset in this young child.Martina Galatola Erasmo Miele Caterina Strisciuglio Lorella Paparo Daniela Rega Paolo Delrio Francesca Duraturo Massimo Martinelli Giovanni Battista Rossi Annamaria Staiano Paola Izzo Marina De Rosa 2013World Journal of Gastroenterology2013,19,46:7
12Laparoscopic left liver lobectomy for hepatocellular carcinoma in a cirrhotic patient: a video report显示文摘We present a video case of a 51-year-old man admitted to our surgical and liver transplantation unit for hepatocellular cancer(HCC). Patient has a HCV cirrhosis with portal hypertension and esophageal varices F1. Child Pugh score was B7 and model of end staged liver disease(MELD) was 11. Body mass index(BMI) was 26.7 and ASA score was 2. No previous abdominal surgery. According with our multidisciplinary group we suggest a laparoscopic left lobectomy for the patient. Pringle manoeuvre was not performed. Operation time was 193 min and blood loss estimation was 100 cc. No transfusion was required. Postoperative course was uneventful, grade I of Clavien-Dindo Classification. Patient was discharged in day 8. In our experience laparoscopic resection in cirrhotic liver should be performed in selected patients and in an experienced team.Giovanni Battista Levi Sandri Giovanni Vennarecci Roberto Santoro Pasquale Lepiane Marco Colasanti Giuseppe Maria Ettorre 2014Chinese Journal of Cancer Research2014,26,6:6
13Inflammatory bowel diseases and human reproduction:A comprehensive evidence-based review显示文摘To evaluate the effects of inflammatory bowel diseases(IBDs)on human reproduction,we reviewed the current literature using a systematic search for published studies(articles and/or abstracts)without limits for English language.We searched on Medline(through PubMed),the Institute for Scientific Information,the Web of Science and the websites for the registration of controlled trials(http://controlled-trials.com/).Bibliographies of retrieved articles,books,expert opinion review articles and reviewed bibliographies from subject experts were manually searched.Titles and abstracts were screened initially,and potential relevant articles were identified and reviewed.Whenever possible,data were analyzed by comparing IBD patients vs healthy controls,and patients with active IBDs vs those with disease in remission.The effects of IBDs on female fertility,fertility in infertile couples,pregnancy and male infertility were examined separately.Patients with IBDs in remission have normal fertility.At the moment,there is no established guideline for the preservation of fertility in women with IBD undergoing surgery.Further data are needed regarding guidelines for the management of these patients.Data regarding IBDs and infertility are currently completely lacking.Considering the prevalence of intestinal pathology in young adults of childbearing age,this field is of great scientific and clinical interest,opening up important future perspectives.Another important and as yet unexplored point is the response to treatments for infertility in patients with IBDs.In particular,the question is whether the reproductive outcomes(clinical and biological)can be influenced by the IBD of one of the partners.The goals for successful reproductive outcomes in IBD population are correct counseling and disease remission.IBDs significantly affect several reproductive aspects of human(female,male,couple)reproduction.Further data are needed to develop guidelines for the clinical management of subjects of reproductive age with IBDs.Stefano Palomba Giuliana Sereni Angela Falbo Marina Beltrami Silvia Lombardini Maria Chiara Boni Giovanni Fornaciari Romano Sassatelli Giovanni Battista La Sala 2014World Journal of Gastroenterology2014,20,23:6
14Colon cancer stem cells:Controversies and perspectives显示文摘Tumors have long been viewed as a population in which all cells have the equal propensity to form new tumors,the so called conventional stochastic model.The cutting-edge theory on tumor origin and progression,tends to consider cancer as a stem cell disease.Stem cells are actively involved in the onset and maintenance of colon cancer.This review is intended to examine the state of the art on colon cancer stem cells(CSCs),with regard to the recent achievements of basic research and to the corresponding translational consequences.Specific prominence is given to the hypothesized origin of CSCs and to the methods for their identification.The growing understanding of CSC biology is driving the optimization of novel anti-cancer targeted drugs.Maria Ausiliatrice Puglisi Valentina Tesori Wanda Lattanzi Giovanni Battista Gasbarrini Antonio Gasbarrini 2013World Journal of Gastroenterology2013,19,20:5
15Thrombotic risk factors in patients with liver cirrhosis: Correlation with MELD scoring system and portal vein thrombosis development显示文摘Maria Assunta Zocco Enrico Di Stasio Raimondo De Cristofaro Marialuisa Novi Maria Elena Ainora Francesca Ponziani Laura Riccardi Stefano Lancellotti Angelo Santoliquido Roberto Flore Maurizio Pompili Gian Lodovico Rapaccini Paolo Tondi Giovanni Battista G 2009Journal of Hepatology2009,,4:5
16Berberine behind the thriller of marked symptomatic bradycardia显示文摘Berberine is used in traditional Chinese medicine for the treatment of congestive heart failure, hypertension, diabetes, and dyslipidaemia and has a good safety profile. We report a case of a 53-year-old sportsman referred to our hospital for the onset of fatigue and dyspnoea upon exertion after he started berberine to treat hypercholesterolaemia. An electrocardiogram showed sinus bradycardia (45 bpm), first-degree atrioventricular block, and competitive junctional rhythm. An ergometric stress test showed slightly reduced chronotropic competence and the presence of runs of competitive junctional rhythm, atrial tachycardia, and sinus pauses in the recovery. After 10 d of wash-out from berberine, the patient experienced a complete resolution of symptoms, and an ergometric stress test showed good chronotropic competence. An electrocardiogram Holtershowed a latent hypervagotonic state. This is the first case report that shows that berberine could present certain side effects in hypervagotonic people, even in the absence of a situation that could cause drug accumulation. Therefore, berberine's use should be carefully weighed in hypervagotonic people due to the drug's bradycardic and antiarrhythmic properties, which could became proarrhythmic, exposing patients to potential health risks.Margherita Cannillo Simone Frea Cristina Fornengo Elisabetta Toso Giancarlo Mercurio Stefania Battista Fiorenzo Gaita 2013World Journal of Cardiology2013,5,7:3
17Laparoscopic approach for hepatocellular carcinoma: where is the limit?显示文摘Hepatocellular cancer(HCC)is the sixth most common malignant tumor worldwide and the most common primary liver cancer(1).Liver resection or liver transplantation is the therapeutic gold standards in patient with HCC.Giuseppe Maria Ettorre Giovanni Battista Levi Sandri 2014Chinese Journal of Cancer Research2014,26,3:3
18Comparison of alternative arterial anastomosis site during liver transplantation when the recipient’s hepatic artery is unusable显示文摘Background:Few studies have analyzed outcomes of liver transplantation(LT)when the recipient hepatic artery(HA)was not usable.Methods:We retrospectively evaluated the outcomes of LT performed using the different alternative sites to HA.Results:Between 2002 and 2017,1,677 LT were performed in our institution among which 141(8.4%)with unusable recipient HA were analyzed.Four groups were defined according to the site of anastomosis:the splenic artery(SA group,n=26),coeliac trunk(CT group,n=12),aorta using or not the donor’s vessel(Ao group,n=91)and aorta using a vascular prosthesis(Ao-P group,n=12)as conduit.The median number of intraoperative red blood cell transfusions was significantly increased in the Ao and Ao-P groups(5,5,8.5 and 16 for SA,CT,Ao and Ao-P group respectively,P=0.002),as well as fresh frozen plasma(4.5,2.5,10,17 for the SA,CT,Ao and Ao-P groups respectively,P=0.001).Hospitalization duration was also significantly increased in the Ao and Ao-P groups(15,16,24,26.5 days for the SA,CT,Ao and Ao-P groups respectively,P<0.001).The occurrence of early allograft dysfunction(EAD)(P=0.07)or arterial complications(P=0.26)was not statistically different.Level of factor V,INR,bilirubin and creatinine during the 7th postoperative days(POD)was significantly improved in the SA group.No difference was observed regarding graft(P=0.18)and patient(P=0.16)survival.Conclusions:In case of unusable HA,intraoperative and postoperative outcomes are improved when using the SA or CT compared to aorta.Jean Marie Beaurepaire Francesco Orlando Giovanni Battista Levi Sandri Caroline Jezequel Edouard Bardou-Jacquet Christophe Camus Mohamed Lakehal Veronique Desfourneaux Aude Merdrignac Elodie Gaignard Alexandre Thobie Damien Bergeat Bernard Meunier Michel Rayar 2022Hepatobiliary Surgery and Nutrition2022,11,1:3
19Early graft dysfunction following adult-to-adult livingrelated liver transplantation:Predictive factors and outcomes显示文摘AIM:To describe a condition that we define as early graft dysfunction(EGD)which can be identified preoperatively. METHODS:Small-for-size graft dysfunction following living-related liver transplantation(LRLT)is characterized by EGD when the graft-to-recipient body weight ratio(GRBWR)is below 0.8%.However, patients transplanted with GRBWR above 0.8%can develop dysfunction of the graft.In 73 recipients of LRLT(GRBWR>0.8%),we identified 10 patients who developed EGD.The main measures of outcomes analyzed were overall mortality,number of re-transplants and length of stay in days(LOS).Furthermore we analyzed other clinical pre-transplant variables,intraoperative parameters and post transplant data.RESULTS:A trend in favor of the non-EGD group(3-mo actuarial survival 98%vs 88%,P=0.09;3-mo graft mortality 4.7%vs 20%,P=0.07)was observed as well as shorter LOS(13 d vs 41.5 d;P=0.001)and smaller requirement of peri-operative Units of Plasma (4 vs 14;P=0.036).Univariate analysis of pre- transplant variables identified platelet count,serum bilirubin,INR and Meld-Na score as predictors of EGD. In the multivariate analysis transplant Meld-Na score (P=0.025,OR:1.175)and pretransplant platelet count(P=0.043,OR:0.956)were independently associated with EGD. CONCLUSION:EGD can be identified preoperatively and is associated with increased morbidity after LRLT. A prompt recognition of EGD can trigger a timely treatment.Salvatore Gruttadauria Fabrizio di Francesco Giovanni Battista Vizzini Angelo Luca Marco Spada Davide Cintorino Sergio Li Petri Giada Pietrosi Duilio Pagano Bruno Gridelli 2009World Journal of Gastroenterology2009,15,36:2
20腹腔镜下左肝叶切除术:1例肝细胞癌合并肝硬化患者的视频报道显示文摘视频中的患者是1名51岁因肝细胞癌收治于外科和肝移植病房的患者。该患者合并HCV感染引起的肝硬化并门静脉高压形成及食管曲张形态为F1。Child-Pugh评分为B级7分,终末期肝病模型评分为11分,BMI指数为26.7,ASA评分为2分。既往无腹部手术史。多学科诊疗团队意见是为患者实施腹腔镜下左肝叶切除术。术中未采用Pringle法行肝门阻断。手术时间为193 min,失血量约为100 mL,术中无输血。患者术后恢复平稳,Clavien-Dindo分级为1级,并于术后第8天出院。笔者的经验是有经验的手术团队可以在需要手术的肝硬化患者中适当地实施腹腔镜手术。Giovanni Battista Levi Sandri Giovanni Vennarecci Roberto Santoro Pasquale Lepiane Marco Colasanti Giuseppe Maria Ettorre 2015中国普通外科杂志2015,24,1:2
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