Two-Stage Liver Transplantation with Temporary Porto-Middle Hepatic Vein Shunt

Two-stage liver transplantation (LT) has been reported for cases of fulminant liver failure that can lead to toxic hepatic syndrome, or massive hemorrhages resulting in uncontrollable bleeding. Technically, the first stage of the procedure consists of a total hepatectomy with preservation of the recipient's inferior vena cava (IVC), followed by the creation of a temporary end-to-side porto-caval shunt (TPCS). The second stage consists of removing the TPCS and implanting a liver graft when one becomes available. We report a case of a two-stage total hepatectomy and LT in which a temporary end-to-end anastomosis between the portal vein and the middle hepatic vein (TPMHV) was performed as an alternative to the classic end-to-end TPCS. The creation of a TPMHV proved technically feasible and showed some advantages compared to the standard TPCS. In cases in which a two-stage LT with side-to-side caval reconstruction is utilized, TPMHV can be considered as a safe and effective alternative to standard TPCS

Laparoscopic resection vs laparoscopic radiofrequency ablation for the treatment of small hepatocellular carcinomas: A single-center analysis

AIM To compare survival and recurrence after laparoscopic liver resection (LLR) and laparoscopic radiofrequency ablation (LRFA) for the treatment of small hepatocellular carcinoma (HCC). METHODS Between June 1, 2005 and November 30, 2010, 46 patients (62.26 \ub1 8.55 years old; female/male: 12/34) treated for small HCC were enrolled following strict criteria. Patients with better liver function and larger tumors were referred for LLR (n = 24), while those with poorer liver function and multiple tumors were referred for LRFA (n = 22), and they were then followed for similar durations (44.74 \ub1 21.3 mo for LLR vs 40.27 \ub1 30.8 mo for LRFA). RESULTS The LLR and LRFA groups were homogeneous with regard to age, sex, etiology of liver cirrhosis, and AFP levels. The overall survival (OS) and disease- free survival (DFS) probability was 0.354 and 0.260, respectively. A significantly higher OS was observed in the LLR group (LLR: 0.442; LRFA: 0.261; P = 0.048), whereas no statistical difference was found for DFS (LLR: 0.206; LRFA: 0.286; P = 0.205). In the LRFA group was treated a greater number of nodules (LLR: 1.41 \ub1 0.77; LRFA: 2.72 \ub1 1.54; P < 0.001). Cox regression analysis found the number of intraoperative HCC nodules as the unique variable statistically significant for OS (hazard ratio: 2.225; P < 0.001). The rank-hazard plot showed a steeper increase of relative hazard for intraoperative nodules > 2. CONCLUSION Our preliminary results confirm the superiority of hepatic resection on thermoablation in the treatment of small HCC in selected patients, when both approaches are made laparoscopically. LLR showed better results compared to LRFA in terms of OS. These data need to be confirmed by further studies on a larger number of patients

Radiation-Tolerant SoC and Application-Specific Processors for On-Detector Programmability and Data Processing in Future High-Energy Physics Experiments

The High Energy Physics (HEP) community faces new challenges in designing modern ASICs due to their increasing size and complexity, as well as the use of advanced semiconductor fabrication processes. This has led to a need for a more abstract design methodology that emphasizes the use of modular design techniques and programmable components to speed up the design and verification process. To address these challenges, two complementary approaches are proposed. The first uses a RISC-V based System-on-Chip (SoC) platform employing a radtolerant variant of the AMBA APB bus interconnect, primarily targeting control and monitoring applications. A demonstrator ASIC utilizing this radiation-tolerant SoC platform is presented. The second approach uses Application-Specific Instruction set Processors (ASIPs) to design data path elements for on-detector data processing applications. An integrated workflow is demonstrated using a commercial ASIP Designer EDA tool to define, benchmark, and optimize an ASIP for a specific use case, starting from a general-purpose processor

A multistep cytological approach for patients with jaundice and biliary strictures of indeterminate origin

AIMS. Fluorescence in situ hybridisation (FISH) increases the sensitivity for detecting pancreatobiliary tract cancer over routine cytology. In this study, diagnostic accuracy and costs of cytology and FISH in detecting cancer in patients with jaundice with biliary strictures were assessed. METHODS. Brushing specimens from 109 patients with jaundice were obtained during endoscopic retrograde cholangiopancreatography and examined by cytology and FISH. The specimens were considered FISH-positive for malignancy if at least five polysomic cells or 10 cells with homozygous or heterozygous 9p21/p16 deletion were detected. Definitive diagnosis of the stricture as benign or malignant relied on surgical pathology (45 cases) or clinical-radiological follow-up >18\u2005months (64 cases). We calculated costs of cytology and FISH based on the reimbursement from the Piedmont region, Italy (respectively, \u20ac33 and \u20ac750). RESULTS. Ninety of 109 patients had evidence of malignancy (44 pancreatic carcinomas, 36 cholangiocarcinomas, 5 gallbladder carcinomas, 5 other cancers), while 19 had benign strictures. Routine cytology showed 42% sensitivity, but 100% specificity for the diagnosis of malignancy, while FISH-polysomy showed 70% sensitivity with 100% specificity and FISH-polysomy plus homozygous or heterozygous 9p21/p16 deletion showed 76% sensitivity with 100% specificity. The cost per additional correct diagnosis of cancer obtained by FISH, in comparison with cytology, was \u20ac1775 using a sequential cytological approach (ie, performing FISH only in patients with negative or indeterminate cytology). CONCLUSIONS. FISH should be recommended as the second step in detecting cancer in patients with jaundice with pancreatobiliary tract strictures and cytology negative or indeterminate for malignancy

Laparoscopic liver resection for hepatocellular carcinoma in cirrhotic patients. Feasibility of nonanatomic resection in difficult tumor locations

BACKGROUND: Surgical resection for hepatocellular carcinoma (HCC) in cirrhotic patients remains controversial because of high morbidity and recurrence rates. Laparoscopic resection of liver tumors has recently been developed and could reduce morbidity. The aim of this study was to evaluate retrospectively our results for laparoscopic liver resection (LLR) for HCC including lesions in the posterosuperior segments of the liver in terms of feasibility, outcome, recurrence and survival. MATERIALS AND METHODS: Between June 2005 and February 2009, we performed 20 LLR for HCC. Median age of the patients was 66 years. The underlying cirrhosis was staged as Child A in 17 cases and Child B in 3. RESULTS: LLR included anatomic resection in six cases and nonanatomic resection in 14. Eleven procedures were associated in nine (45%) patients. Median tumor size and surgical margins were 3.1 cm and 15 mm, respectively. A conversion to laparotomy occurred in one (5%) patient for hemorrhage. Mortality and morbidity rates were 0% and 15% (3/20). Median hospital stay was 8 days (range: 5-16 days). Over a mean follow-up period of 26 months (range: 19-62 months), 10 (50%) patients presented recurrence, mainly at distance from the surgical site. Treatment of recurrence was possible in all the patients, including orthotopic liver transplantation in three cases. CONCLUSIONS: LLR for HCC in selected patients is a safe procedure with good short-term results. It can also be proposed in tumor locations with a difficult surgical access maintaining a low morbidity rate and good oncological adequacy. This approach could have an impact on the therapeutic strategy of HCC complicating cirrhosis as a treatment with curative intent or as a bridge to liver transplantation

Sister Joseph's nodule in a liver transplant recipient: Case report and mini-review of literature.

none11BACKGROUND: Umbilical metastasis is one of the main characteristic signs of extensive neoplastic disease and is universally referred to as Sister Mary Joseph's nodule. CASE PRESENTATION: A 59-years-old Caucasian female underwent liver transplant for end stage liver disease due to hepatitis C with whole graft from cadaveric donor in 2003. After transplantation the patient developed multiple subcutaneous nodules in the umbilical region and bilateral inguinal lymphadenopathy. The excision biopsy of the umbilical mass showed the features of a poorly differentiated papillary serous cystadenocarcinoma. Computed tomographic scan and transvaginal ultrasonography were unable to demonstrate any primary lesion. Chemotherapy was start and the dosage of the immunosuppressive drugs was reduced. To date the patient is doing well and liver function is normal. CONCLUSIONS: The umbilical metastasis can arise from many sites. In some cases, primary tumor may be not identified; nonetheless chemotherapy must be administrated based on patient's history, anatomical and histological findings.Articolo indicizzato su PubMed (PMID: 15651984), Journal Citation Report (JCR) - ISI Web of Knowledge e Scopus.PANARO F; ANDORNO E; DI DOMENICO S; MORELLI N; BOTTINO G; MONDELLO R; MIGGINO M; JARZEMBOWSKI TM; RAVAZZONI F; CASACCIA M; VALENTE UPanaro, F; Andorno, E; DI DOMENICO, S; Morelli, N; Bottino, G; Mondello, R; Miggino, M; Jarzembowski, Tm; Ravazzoni, F; Casaccia, Marco; Valente, Umbert

Is hepatitis C recurrence more severe after split liver graft compared to whole size graft?

Hepatitis C virus (HCV) is the most common indication for liver transplantation (LT).Recently, reports from some centers have suggested that partial liver transplants and moreover living related liver transplantation (LRLT) may be associated with an increased risk for HCV recurrence.The aim of this study is to compare HCV recurrence in adult recipient after in situ Split Liver Transplantation (SLT) versus Whole Liver Transplant (WLT).From June 1998 to February 2004, whitin our institution 220 first liver transplants were performed for adult recipients. Of these 153 (69.5%) were WLT, 56 (25.4%) Adult to Paediatric SLT (SLT A/P) and 11(5%) adult to adult SLT (SLT A/A).Overall HCV cirrhosis accounted for 43.6%; of those we considered the first 64 recipients who recived a LT for HCV-induce liver disease from June 6,1998, to October 10, 2002. Of these 18 (28.1%) received a right liver graft from SLT A/P and 46 (71.8%) received WLT. The mean follow-up was 50.4 months.Donor and recipients patterns were comparable. P value were significant only for increased donor age (P=0.000013) and shorter cold ischemic times (P=0.033) in WLT. The mean Graft recipient weight ratio in SLT group was 1.79.During follow-up HCV RNA resulted positive in 45 (97.8%) of 46 patients undergoing WLT and in all (100%) patients undergoing SLT (P=0.532) Where clinical indicated a liver biopsy were performed and proven histologic recurrence (Ishak Score System) in the two groups were: WLT, 67.3%; SLT, 61.1% (P=0.637). Severe recurrence (SR) presented with clinical decompensation associated or not to biopsy-proven cirrhosis were: 11/64 (24%) in the patients transplanted with WLT and 4/18 (22.2%) of SLT (P=0.853). Re transplantation was needed in 5.5% of SLT group and in 6.5% WLT (P=0.887). At a follow-up period of 50.4 months, in our experience there is no difference in HCV recurrence rate between WLT and SLT groups

Histologic retrieval rate of a newly designed side-bevelled 20G needle for EUS-guided tissue acquisition of solid pancreatic lesions

Innovative approaches to improve diagnostic yield of endoscopic ultrasound-guided tissue acquisition (EUS-TA) have focused on needle design with development of fine-needle biopsy (FNB) needles with microcore-acquisition technology. Recently, a 20-gauge (20G) antegrade-cutting-side-bevelled biopsy needle (ProCore\uae) was developed for EUS-TA, but data about its diagnostic performance and histological capability are scant

Split-liver transplantation with pediatric donors: a multicenter experience

Background. Outcomes of split-liver transplantation (SLT) with pediatric donors have never been specifically reported. Methods. A prospective multicenter study on SLT using donors younger than 15 years was conducted. Thirty-nine split-liver procedures generating a left lateral segment (LLS) and, an extended right graft (ERG) were performed. In three cases, no recipient was found for ERG. In all but one case, the celiac trunk was maintained with LLS. Data were available for 67 grafts (90% of the total): 38 LLSs and 9 ERGs transplanted into 46 children and 20 ERGs transplanted into 20 adults. Sixty-two (93%) grafts were used for primary transplants and five (7%) for retransplantation. SLT were performed with. 15 donors 10 years of age and less and with 24 between 11 and 15 years. Results. Median follow-up was 24 months. Two-year patient and graft survival were 87% and 82%. Patient and graft survivals were not significantly different between pediatric and adult recipients, between recipients from donors 10 years of age and less and those between I I and 15 years, and between recipients of LLS and ERG. Arterial complications occurred in 6% of cases (8% in the &LE; 10 year donors group, 5% in the 11-15 year donors group). The incidence of other complications was similar between groups. Conclusions. SLT with pediatric donors, even younger than 10 years, provided results comparable with those achievable using adult donors. The similar incidence of arterial complications among patients receiving LLS or ERG suggests that maintenance of the celiac trunk with LLS is not detrimental for right-sided grafts