72 research outputs found
Air bubbles in the rectus abdominis muscle
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Liver transplantation in man : morphometric analysis of the parenchymal alterations following cold ischaemia and warm ischaemia/reperfusion
Ischaemia and reperfusion phases represent critical events during liver transplantation. The purpose of this study was to describe morphological alterations of both vascular and parenchymal compartments after ischaemia and reperfusion and to evaluate the possible relationship between morphometric parameters and biochemical/clinical data. Three needle biopsies were drawn from 20 patients who underwent orthotopic liver transplantation. The first biopsy was taken before flushing with preservation solution, and the second and the third to evaluate respectively the effects of cold ischaemia and of warm ischaemia/reperfusion. Biopsies were examined by an image analyser and morphometric parameters related to the liver parenchyma were evaluated. At the second biopsy we observed a decrease of the endothelium volume fraction while the same parameter referred to the sinusoidal lumen achieved a peak value. The hepatocytes showed a lower surface parenchymal/vascular sides ratio. This parameter was reversed at the end of the reperfusion phase; furthermore the third biopsy revealed endothelial swelling and a decreased volume fraction of the sinusoidal lumen. The results quantify the damage to the sinusoidal bed which, as already known, is one of the main targets of cold ischaemia; warm ischaemia and reperfusion accentuate endothelial damage. The end of transplantation is characterised by damage chiefly to parenchymal cells. Hepatocytes show a rearrangement of their surface sides, probably related to the alterations of the sinusoidal bed. In addition, the fluctuations of morphometric parameters during ischaemia/reperfusion correlate positively with biochemical data and clinical course of the patients
Advantage of endoscopic-ultrasound-fine-needle aspiration associated to Sendai clinical guidelines in detecting the malignant risk in patients with undetermined pancreatic cysts: Long-term follow-up
Aims: Contradictory information exists on whether different clinical guidelines are effective in detecting the malignant risk in patients with pancreatic cysts. We have retrospectively evaluated the accuracy and the long-term outcome in patients with pancreatic cysts with
a diameter 65 2 cm when indication for surgery was established by clinical evaluation of their malignant risk according to Sendai Clinical
Guidelines associated to endoscopic-ultrasoundfine-needle aspiration. Methods: Patients with pancreatic cysts with a diameter 652 cm were
evaluated for their potential malignant risk by endoscopic-ultrasound-fine-needle aspiration associated to the clinical evaluation by Sendai
Clinical Guidelines. Long-term outcome and comparison in patients survival as well as the accuracy in detecting malignancies were
evaluated with the combined clinical and endoscopic evaluation. Results: Two hundred eighteen patients with pancreatic cysts were
observed during a 9-year period of the study and 74 of them (33.9%) presenting with a pancreatic cyst 65 2 cm were eligible for the study.
Fourteen malignant neoplasms (18.9%) were detected. The accuracy in detecting malignancy of combined clinical and endoscopic evaluation
was very high (0.99). The five-year survival rates for patients who underwent surgery with benign and malignant pancreatic cysts and
for patients in observational follow-up were similar (70% and 85%). The cohort of patients with malignant pancreatic cysts with ductal
adenocarcinoma showed a five-year survival rate of 41%. Conclusion: Endoscopic ultrasound fineneedle aspiration associated to Sendai clinical guidelines showed a high accuracy in detecting malignant risk in patients with pancreatic cysts with a diameter 65 2 cm. allowing appropriate selection for surgical treatment with satisfactory long-term survival
Metabolic changes in rats with porto-caval shunt and liver arterialization
The aim of the study is to characterize the metabolic profile with special reference to hepatic function in a group of porto-caval shunted rats with liver arterialization. Forty-five male Wistar rats weighing 280-320 gm were divided into 3 groups: 15 rats were submitted to end-to-side porto-caval shunt; 15 rats received end-to-end porto-caval shunt plus liver arterialization using right renal artery; 15 rats represented the control group. All the animals were sacrificed 30 days after surgery and 7 biochemical parameters were evaluated in each group: alkaline phosphatase, cholinesterase, GOT, GPT, prothrombin activity, NH3, platelet count. The results of the present investigation clearly evidence that arterialization of the portal stump by right renal artery in healthy rats can prevent the functional hepatic deterioration induced by porto-caval shunt. All the biochemical parameters considered were significantly better in the arterialized group when compared with porto-caval shunted rats; nonetheless not all evidenced a trend to normalization
Histological and immunohistochemical pattern of hepatocellular cytokeratin 7-positive and negative : Comparison by computerized morphometry
Objective: To investigate by computerized morphometric the morphological features in HCC expressing CyK7 (CyK7-positive) and in HCCs CyK7-negative.
Study Design: This study included 15 HCC CyK7-positive and 18 HCC CyK7-negative from patients submitted to LTx for HCV-related cirrhosis at the Niguarda Hospital in Milan. All specimens were stained with hematoxylin-eosin and immunohistochemically for CD34 to assess the degree of sinusoidal capillarization, reticulin to assess the cell plate architecture and Ki67 to identify neoplastic cells that are actively dividing. We generated a computerized morphometric model to evaluate the volume fractions occupied by hepatocyte nuclei and cytoplasm, sinusoids, portal triads, capillarised sinusoids and tumor cells actively dividing. Lastly, the surface fraction occupied by reticulin was calculated. Moreover, tumor cells expressing both CyK7 and Ki67 in HCC CyK7 positive were also identified. Ten high-grade dysplastic nodules from resection specimens of HCV-related cirrhotic livers were also used as control group.
Results: On H&E stains, the features most discriminatory between HCCs CyK7-positive and CyK7-negative were volume fractions of sinusoids and of fibrosis and inflammatory infiltrate, which were significantly highest in HCCs CyK7-positive. On immunohistochemistry, volume fractions of capillarised sinusoids and of Ki67 cells were significantly highest in HCCs CyK7-positive.
Conclusion: Our morphometric model is an objective method of quantification of the morphologic features in both CyK7-positive and CyK7-negative HCCs and it could be applied in studies involving histological evaluation of the different subtypes of HCC arising in the cirrhotic liver according to their CyK7 expression
Massive haemoptysis after living donor liver transplantation
A 27 year old man with hereditary haemorrhagic telangiectasia who developed progressive liver dysfunction underwent living related right lobe transplantation. Pulmonary arteriography did not reveal arteriovenous malformation or abnormal intrapulmonary venous channels. The postoperative course was characterised by persistent hypoxaemia and respiratory failure developed. On day 6, a massive haemoptysis developed and the patient died shortly thereafter. The native liver showed a nodular pseudocirrhotic transformation, with highly dilated and irregularly interconnected vein-like or arterial-like structures in the fibrous septa. Pathological examination of both lungs showed irregular thickening of the wall of the arteries, secondary to eccentric and/or concentric myointimal hyperplasia. This case suggests that massive haemoptysis can develop even when arteriovenous malformations are undetectable by pulmonary arteriography, and it questions the role and the appropriateness of living donor liver transplantation in high risk patients
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