Evaluation of the Liver Function of Cirrhotic Patients. Based on the Formation of Monoethylglycine Xylidide (MEGX) from Lidocaine

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Il carcinoma pancreatico. Supporto e palliazione: Il ruolo della Chirurgia.

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Solitary fibrous tumor of the liver: a case report.

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Evaluation of the liver function of cirrhotic patients based on the formation of Monoethylglycine Xylidide (Megx) from Lidocaine

Determination of the functional hepatic reserve is still controversial. Many tests have been proposed, but the assay based on formation of the lidocaine metabolite, monoethylglycine xylidide, seems to offer a promising approach to this problem. In this study we evaluated the effectiveness of the monoethylglycine xylidide test in the clinical evaluation of 31 cirrhotic patients submitted to three different therapeutic options (sclerotherapy, transjugular intrahepatic protosystemic shunt and surgical procedures) and in 1 patient submitted to right hepatectomy for giant hepatic angioma. We found a statistically significant difference between Child A and C patients and between Child B and C patients. The test did not differentiate Child A from Child B patients. We found no correlation between the Child-Pugh score, serum bilirubin, albumin and prothrombin time. There were no differences among the three groups of patients that could be statistically related to their therapy. The monoethylglycine xylidide test seems to be an attractive alternative to previous methods for the evaluation of the functional hepatic reserve, but further studies are necessary to assess the prognostic value of the test in cirrhotics, to separate the independent contribution of portosystemic shunting and hepatocyte dysfunction to monoethylglycine xylidide formation, and to evaluate the test as a prognostic index in cirrhotic patients submitted to general surgery

[The perforation of a para-Vater's duodenal diverticulum (a report of 2 clinical cases)].

Duodenal diverticulum is not a rare disease, with a frequency of 1-3\% in radiologic review and of 2.8-20\% in pathology review; The spontaneous perforation of a perivaterian duodenal diverticulum is a rare complication, with about 100 cases reported in the literature. The post-traumatic perforation of a perivaterian diverticulum is an exceptional event, reported in single cases of the oriental literature. The authors report their personal experience about two cases of diverticular duodenal perforation, one spontaneous, the other post-traumatic, discussing the surgical problems that this rare complication present

Dosaggio del MEGX (Monoetilglicina Xilidide nella valutazione clinica di pazienti cirrotici

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[Palliative treatment of pancreatic adenocarcinoma].

Carcinoma of the pancreas is the fourth leading cause of cancer related death in Western Countries. The 5-year survival for resectable tumors is 15-25\%, while patients with unresectable neoplasms survive a median of 7 months. Only 30\% of carcinomas of the head of pancreas and 10\% of the body and tail are resectable for cure. Therefore, palliation of symptoms, namely obstructive jaundice, duodenal obstruction and pain, involve 80-90\% of cases. Jaundice is frequent in tumors of the head. Palliative biliary decompression can be achieved by non surgical methods-endoscopically placed endoprostheses or percutaneous biliary drainage- or surgically. The former are indicated in patients with metastatic disease, high operative risk and short life expectancy. Surgical palliation which includes choledocho-duodenostomy, cholecystoduodenostomy, cholecystojejunostomy, hepato or choledocho-jejunostomy offers the advantage of providing a simple procedure that can treat or prevent all of the major symptoms: jaundice, duodenal obstruction and pain. Mechanical obstruction of the duodenum occurs in about 30\% of cases in association with jaundice at the time of presentation and in 13-21\% of patients previously subjected to biliary bypass after 8 months. Actual obstruction can be relieved by gastro-jejunostomy. Significant controversy remains concerning the role of prophylactic gastro-jejunostomy in patients requiring biliary diversion without signs of duodenal obstruction. Pain, which sooner or later affects the majority of patients, can be relieved by splanchnicectomy, either surgically or percutaneously

Il trattamento palliativo dell\u2019adenocarcinoma pancreatico

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Transjugular intrahepatic portosystemic shunt (TIPS): Our personal experience.

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The variations of MEGX in cirrhotic patients submitted to TIPS.

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