A retrospective analysis of 1.011 percutaneous liver biopsies performed in patients with liver transplantation or liver disease: ultrasonography can reduce complications?

Objective: In the last decades, liver biopsy was the reference procedure for the diagnosis and follow-up of liver disease. Aim of present retrospective analysis was to assess the prevalence of complications and risk factors after Percutaneous Liver Biopsy (PLB) performed for diagnosis and staging in patients with chronic liver disease and for monitoring the graft in liver transplanted patients Patients and methods: Data were collected from a total of 1.011 PLB performed with the Menghini technique between January 2004 and December 2014 at the Hepatology and Transplant Units of the University of Rome Tor Vergata. The indications for biopsy were: follow-up of liver transplantation, chronic Hepatitis B Virus (HBV) or Hepatitis C Virus (HCV), with or without Human Immunodeficiency Virus (HIV) and alcohol-related liver disease. Our patients were divided into two groups according to the biopsy indication: follow-up of liver transplantation (Group A) and chronic liver disease (Group B). All the procedures were performed in Day Hospital regimen. After the biopsy, patients remained in bed for about 4-6 hours. In the absence of complications, they were then discharged on the same day. Results: The most frequent complication after biopsy was pain (Group A n. 57, 8.8%; Group B n. 105, 29.0%), hypotension as a result of a vasovagal reaction resolved spontaneously (Group A n. 7, 1.1%; Group B n. 6, 1.7%), and intrahepatic bleeding resolved with conservative therapy (Group A n. 1, 0.2%; Group B n. 6, 1.7%). Two cases of pneumothorax in the Group A (0.3%) were treated with a chest tube. Other complications did not have a significant impact. Also, we did not observe statistically significant differences in patients who underwent PLB without and with ultrasound guidance. Conclusions: Liver biopsy is not a replaceable tool in diagnosis and follow-up of several chronic liver diseases. The Menghini technique with the percutaneous trans costal approach, might be preferred because less traumatic and related with a low occurrence of minor and major complications. According to our case load and comparing our findings with the previous published data, we speculate that ultrasound guidance is not crucial in the prevention of major complications

More Nature in the City

According to projects and practices that the Italian botanists and ecologists are carrying out for bringing \u201cmore nature in the city\u201d, new insights for a factual integration between ecological perspectives and more consolidated aesthetic and agronomic approaches to the sustainable planning and management of urban green areas are provided

Iterated Greedy

Iterated greedy is a search method that iterates through applications of construction heuristics using the repeated execution of two main phases, the partial destruction of a complete candidate solution and a subsequent reconstruction of a complete candidate solution. Iterated greedy is based on a simple principle, and methods based on this principle have been proposed and published several times in the literature under different names such as simulated annealing, iterative flattening, ruin-and-recreate, large neighborhood search, and others. Despite its simplicity, iterated greedy has led to rather high-performing algorithms. In combination with other heuristic optimization techniques such as a local search, it has given place to state-of-the-art algorithms for various problems. This paper reviews the main principles of iterated greedy algorithms, relates the basic technique to the various proposals based on this principle, discusses its relationship with other optimization techniques, and gives an overview of problems to which iterated greedy has been successfully applied.SCOPUS: ch.binfo:eu-repo/semantics/publishe