Il trapianto di fegato a Verona: Esperienza iniziale.

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Anastomosi Cavo-cavale laterolaterale nel trapianto di fegato, senza by pass venoso e senza shunt porto-cavale temporaneo. Esperienza prospettica del centro trapianti di fegato della Universit\ue0 di Verona.

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Early laparoendoscopic rendezvous for acute biliary pancreatitis: preliminary results.

INTRODUCTION: Early restored patency of the papilla has been hypothesized to reduce complications and mortality of acute biliary pancreatitis. The aim of this study was to evaluate the role of urgent laparoscopic cholecystectomy with intraoperative cholangiography and rendezvous when necessary in acute biliary pancreatitis natural history. PATIENTS AND METHODS: Patients observed in the early stage of an acute biliary pancreatitis were included in the study. Operative risk assessment based on American Society of Anesthesiologists (ASA) score allowed the performance of urgent laparoscopic cholecystectomy within 72 h from onset of symptoms in 55 patients and a delayed intervention during the same admission in 21 patients. Intraoperative cholangiography was performed in all cases, and clearance of common bile duct was performed by flushing when possible, or rendezvous when necessary. Evolution of pancreatitis was evaluated with clinical and radiological monitoring. RESULTS: Urgent laparoscopic cholecystectomy was performed in all cases without conversion. At intraoperative cholangiography common bile duct was free in 25 patients, a papillary spasm was observed in 9, and common bile duct stones in 21 patients. Patency of the papilla was restored by flushing in 13 patients, while a rendezvous was necessary in 17 patients. The rate of organ failure and pancreatic necrosis was 1.8%, overall mortality was 1.8%, and overall morbidity 21.8%. No infectious complications of peripancreatic collections were observed. CONCLUSION: Urgent laparoscopic cholecystectomy with selective intraoperative rendezvous may be considered as a treatment option in the early stage of acute biliary pancreatitis

Prognostic Factors for survival after RFA of HCC. Third International Meeting on Hepatocellular Carcinoma Eastern and Western Experiences.

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Viral infections and liver transplantation

Viral infections after liver transplantation represent a major cause of morbidity and mortality. These agents may be introduced into the patient through the allograft, infusion of blood, blood products, and intravenous lines... Reactivation of latent viruses related to immunosuppression is also frequently observed after liver transplantation. Finally, a persistent infection due to hepatitis B, C or D viruses frequently occurs after liver transplantation and still presents serious problems when evaluating the therapeutic benefits of liver grafting. In this review, the clinical, biochemical, and histological characteristics of most frequent viral pathogens observed after liver transplantation are described. Particular features of each of these viruses are underlined

Rapid progression of hepatocellular carcinoma after Radiofrequency Ablation.

AIM: To report the results of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) in cirrhotic patients and to describe the treatment related complications (mainly the rapid intrahepatic neoplastic progression). METHODS: Eighty-seven consecutive cirrhotic patients with 104 HCC (mean diameter 3.9 cm, 1.3 SD) were submitted to RFA between January 1998 and June 2003. In all cases RFA was performed with percutaneous approach under ultrasound guidance using expandable electrode needles. Treatment efficacy (necrosis and recurrence) was estimated with dual phase computed tomography (CT) and alpha-fetoprotein (AFP) level. RESULTS: Complete necrosis rate after single or multiple treatment was 100%, 87.7% and 57.1% in HCC smaller than 3 cm, between 3 and 5 cm and larger than 5 cm respectively (P = 0.02). Seventeen lesions of 88(19.3%) developed local recurrence after complete necrosis during a mean follow up of 19.2 mo. There were no treatment-related deaths in 130 procedures and major complications occurred in 8 patients (6.1 %). In 4 patients, although complete local necrosis was achieved, we observed rapid intrahepatic neoplastic progression after treatment. Risk factors for rapid neoplastic progression were high preoperative AFP values and location of the tumor near segmental portal branches. CONCLUSION: RFA is an effective treatment for hepatocellular carcinoma smaller than 5 cm with complete necrosis in more than 80% of lesions. Patients with elevated AFP levels and tumors located near the main portal branch are at risk for rapid neoplastic progression after RFA. Further studies are necessary to evaluate the incidence and pathogenesis of this underestimated complication