34 research outputs found
Intraoperative Ultrasound of the Liver: Actual Status and Indications
Intraoperative liver ultrasound represents an essential component in the hepatobiliary surgery arsenal, having an essential role in describing liver lesions, their topography, and loco-regional extension. It also has an important role in establishing surgical strategy, in modulating the surgeon decisions, and thus in preventing postoperative complications. This chapter tries to make a synthetic review of principal indications for using ultrasound in liver surgical treatment, underlining the liver’s lesions characteristics and advantages brought by this method. Also, we wanted to underline the importance that ultrasound has for guiding the surgeon in interventional intraoperative techniques or in any anatomical liver resection. The role of enhanced contrast intraoperative ultrasound is put in front by the better diagnostic results obtained for both primary and metastatic tumors of the liver
Endovascular Stenting for Idiopathic Intracranial Hypertension
Transverse sinus stenosis (TSS) is often observed in patients with idiopathic intracranial hypertension (IIH). Studies show that all symptoms of IIH can be resolved by transverse sinus stent placement. We present a case of a 39-year-old woman diagnosed with IIH presented with papilledema and severe headaches. The consideration of interventional management was necessitated by the preceding failure of several months of medical treatment. Her vascular imaging demonstrated stenosis of the transverse sinus and her intracranial venous pressure measurements indicated elevated pressure with a high pressure gradient across the stenosis. She underwent transverse sinus stent placement across the stenotic segment. After this intervention, her symptoms improved and her intracranial pressure normalized. The imaging follow-up revealed efficacious patency of the stent. Based on a mathematical model, we suggest that a Starling-like resistor demonstrating a collapsible transverse sinus can permanently be replaced by a rigid-walled sinus upon employment of an endovascular stent in the stenotic transverse sinus, which should be considered as an alternative to other surgical procedures for IIH patients
Mechanisms of Oncogene Activation
The main modifications that characterize cancer are represented by alterations in oncogenes, tumor-suppressor genes, and non-coding RNA genes. Most of these alterations are somatic and the process is a multistep one. Tumors often arise from an initial transformed cell, and after subsequent genetic alterations different cytogenetically clones lead to tumor heterogeneity
Enhanced laser thermal ablation for the in vitro treatment of liver cancer by specific delivery of multiwalled carbon nanotubes functionalized with human serum albumin
The main goal of this investigation was to develop and test a new method of treatment for human hepatocellular carcinoma (HCC). We present a method of carbon nanotube-enhanced laser thermal ablation of HepG2 cells (human hepatocellular liver carcinoma cell line) based on a simple multiwalled carbon nanotube (MWCNT) carrier system, such as human serum albumin (HSA), and demonstrate its selective therapeutic efficacy compared with normal hepatocyte cells. Both HepG2 cells and hepatocytes were treated with HSA–MWCNTs at various concentrations and at various incubation times and further irradiated using a 2 W, 808 nm laser beam. Transmission electron, phase contrast, and confocal microscopy combined with immunochemical staining were used to demonstrate the selective internalization of HSA–MWCNTs via Gp60 receptors and the caveolin-mediated endocytosis inside HepG2 cells. The postirradiation apoptotic rate of HepG2 cells treated with HSA–MWCNTs ranged from 88.24% (for 50 mg/L) at 60 sec to 92.34% (for 50 mg/L) at 30 min. Significantly lower necrotic rates were obtained when human hepatocytes were treated with HSA–MWCNTs in a similar manner. Our results clearly show that HSA–MWCNTs selectively attach on the albondin (aka Gp60) receptor located on the HepG2 membrane, followed by an uptake through a caveolin-dependent endocytosis process. These unique results may represent a major step in liver cancer treatment using nanolocalized thermal ablation by laser heating
Selective ex-vivo photothermal ablation of human pancreatic cancer with albumin functionalized multiwalled carbon nanotubes
The process of laser-mediated ablation of cancer cells marked with
biofunctionalized carbon nanotubes is frequently called
“nanophotothermolysis”. We herein present a method of selective
nanophotothermolisys of pancreatic cancer (PC) using multiwalled carbon
nanotubes (MWCNTs) functionalized with human serum albumin (HSA). With the
purpose of testing the therapeutic value of these nanobioconjugates, we have
developed an ex-vivo experimental platform. Surgically resected specimens from
patients with PC were preserved in a cold medium and kept alive via
intra-arterial perfusion. Additionally, the HSA-MWCNTs have been
intra-arterially administered in the greater pancreatic artery under ultrasound
guidance. Confocal and transmission electron microscopy combined with
immunohistochemical staining have confirmed the selective accumulation of
HSA-MWCNTs inside the human PC tissue. The external laser irradiation of the
specimen has significantly produced extensive necrosis of the malign tissue
after the intra-arterial administration of HSA-MWCNTs, without any harmful
effects on the surrounding healthy parenchyma. We have obtained a selective
photothermal ablation of the malign tissue based on the selective
internalization of MWCNTs with HSA cargo inside the pancreatic adenocarcinoma
after the ex-vivo intra-arterial perfusion
Challenges and controversies in open pancreatoduodenectomies
Duodenopancreatectomia cefalopancreatica este o procedura intricata, ce necesita o inalta precizie datorita proximitatii structurilor
vitale, sustinuta prin expertiza. O data cu evolutia chirurgiei si aparitia de instrumente inovatoare, mortalitatea a scazut sub 5%, dar
morbiditatea a ramas la 30%, in special datorita fistulelor de anastomoza si a evenimentelor hemoragice. In acest sens, chirurgia
deschisa confera rezultate mai bune, cu o curba de invatare rezonabila. Cu atat mai mult, cu cat efectuarea de trialuri clinice este
dificila in acest domeniu, atat in chirurgia deschisa, cat si minim invaziva, pentru a obtine evidente valoroase, astfel subiectul ramane
unul de dezbatere.Whipple procedure is intricate and demands high precision due to the proximity of critical structures, which requires an achieved
expertise. With the innovative instruments and evolution of surgery, the perioperative morbidity still stands at 30% with a mortality
lower than 5%, primary because of anastomotic leaks and haemorrhagic events. Therefore open surgery provides better outcomes
with a decent learning curve. Furthermore, it is challenging to conduct clinical trials in the field of pancreatic surgery both open or
minimally-invasive to obtain high-level evidence, remaining a subject open to debate
Family trios analysis of common polymorphisms in the obestatin/ghrelin, BDNF and AGRP genes in patients with Anorexia nervosa: Association with subtype, body-mass index, severity and age of onset.
Anorexia nervosa (AN) affects 0.3% of young girls with a mortality of 6%/decade and is strongly familial with genetic factors. Ghrelin is an upstream regulator of the orexigenic peptides NPY and AgRP and acts as a natural antagonist to leptin's effects on NPY/AgRP-expressing neurons, resulting in an increase in feeding and body weight. Obestatin which counteracts ghrelin action on feeding is derived from the same propeptide than ghrelin. BDNF has been involved in body weight regulation and its Val66Met polymorphism associated with AN. We therefore re-investigated the association between AN and the Leu72Met and Gln90Leu polymorphisms of the prepro-ghrelin/obestatin gene, the Ala67Thr polymorphism of AgRP and the Val66Met polymorphism of BDNF taking into account clinical subtypes (restrictive-ANR-and bingeing/purging-ANB-subtypes). Family trios study of these 4 single nucleotide polymorphisms were performed in 114 probands with AN and both their parents recruited in two specialized French centres. A transmission disequilibrium was observed for the Leu72Met SNP of the preproghrelin gene and for the Ala67Thr SNP of the AgRP gene. When stratified by clinical subtype, these two polymorphisms were preferentially transmitted for the trios with a bingeing/purging proband. An excess of transmission of the Gln90Leu72 preproghrelin/obestatin haplotype in patients with AN was observed. These results do not provide evidence for a preferential transmission of the 66Met allele of BDNF but support the hypothesis that ghrelin and AGRP polymorphisms confers susceptibility to AN. Further simultaneous analysis of genetic variants of the biological determinants of energy metabolism and feeding behaviour in very large populations should contribute to the understanding of the high degree of heritability of eating disorders and to the description of pathophysiological patterns leading to life-threatening conditions in a highly redundant system