Pulmonary Resection for Metastasis of Hepatocellular Carcinoma Recurring After Liver Transplant : An Italian Multicenter Experience

Background and aim: Liver transplantation (LT) is a validated treatment for hepatocellular carcinoma (HCC). HCC recurrence occurred between 8 and 20% of patients and lung is the most frequent site. Pulmonary metastases resection (PMR) prolongs survival, however in LT-setting the impact on survival is unclear. To give new lights on this issue, we report the experience of three Italian LT Centers. Methods: All consecutive HCC transplanted patients in three Italian LT Centers, who developed pulmonary metastasis from HCC (PM-HCC), as first metastasis, from 2008 to 2018, were included whenever treated with PMR. Results: Twenty-five patients were enrolled (median age 58 yrs, 84% male, 3% cirrhotics). HCC recurred after 34 months (9\u2013306) since LT and PMR was performed after 2.4 months (0\u201343.1). A total of 28 PMR (19 single resections; 9 multiple resections; 16 right; 2 left) have been performed on 24 patients while in one case percutaneous microwave ablation (MWA) was preferred. Four patients have been re-operated due to pulmonary HCC-recurrence after surgery. The majority of surgical resection type was wedge resection (26, 89%). Surgical access was: video-assisted thoracic surgery (VATS) in 17 cases (59%); thoracotomy in 11 (38%); MWA in 1 (3%). The 48% of nodule was in right lower lobe. Perioperative in-hospital mortality and 30 days mortality were nil; median surgical time 90 min (50\u2013365); median post-operative overall stay 5 days (2\u201311). Post-operative ICU treatment was necessary in 1 case (3%) for 3 days; blood transfusions in 2 cases (7%). Overall, 5 complications (2 bleeding; 1 AKI; 1 major cardiac; 1 wound dehiscence) occurred, with an overall complications rate of 23%. Eight (32%) patients died during a follow-up after HCC recurrence of 32 months (7\u2013213): 7 for HCC progression, 1 for severe liver failure due to chronic rejection. The 1 and 5 year cumulative probability of OS from recurrence were 100 and 43% (95%CI 12\u201374), respectively, with a median OS of 51 months (95%CI 24\u201378). Conclusion: Selected patients with isolated pulmonary HCC-recurrence after LT and with preserved hepatic function showed that a pulmonary metastasectomy could be efficacious in managing a PM-HCC and could give an opportunity for long-term survival

Desarrollo tecnológico con aplicación en terapias fotodinámicas para el tratamiento de lesiones de la piel

La terapia fotodinámica es un tratamiento de primera línea para ciertas lesiones de la piel como la queratosis actínica (QA). Con tales fines se emplean emisores de luz con alto costo de adquisición y mantenimiento. El Departamento de Bioingeniería, del Centro de Microscopía Electrónica de la Facultad de Ciencias Médicas, Universidad Nacional de Córdoba (UNC), desarrolló una nueva versión de dispositivo emisor, de bajo costo de fabricación, que emite luz pulsada intensa y es capaz de irradiar luz roja (630 nm) y azul (405 nm). Este dispositivo es potencialmente útil en el tratamiento de QA y carcinoma basocelular. Por otra parte el Departamento de Farmacia de la Facultad de Ciencias Químicas, UNC, ha formulado el compuesto basado en el ácido α- aminolevulínico (ALA) que es el precursor del agente fotosensibilizador protoporfirina IX, habilitado por la ANMAT en presentaciones similares, y la Farmacia Central del Hospital Nacional de Clínicas (HNC) de la UNC, efectuó la preparación del medicamento como formulación magistral y extemporánea al 20%. Todas estas dependencias internas de la UNC articularon en la ejecución de un proyecto de Innovación Tecnológica, financiado por la SECYT-UNC, a los fines de completar las etapas de desarrollo y los estudios necesarios, para poder utilizar el equipamiento y el medicamento para terapias en el mencionado hospital. El presente trabajo aborda de manera particular, los resultados preliminares obtenidos en el estudio clínico, realizado en el área de Dermatología del HNC. Cabe destacar que como parte del proyecto, se pretende la construcción en serie del dispositivo emisor a través de la Institución Contraparte participante del proyecto, que es una reconocida empresa local fabricante de equipamiento médico.publishedVersio

Resistencia a la compresión de Biodentine®: mezcla manual vs. Mecánica

INTRODUCCIÓN: La incorporación de innovaciones tecnológicas en determinados materiales dentales, especialmente aquellos que requieren de aparatología específica para su uso y/o cuya pre-dosificación implica el descarte de una porción de su contenido, está condicionada por la relación costo-beneficio del producto. Según las instrucciones del fabricante, las cápsulas del silicato tricálcico Biodentine® (Septodont) deben activarse mediante el uso de mezcladores mecánicos luego de adicionar las proporciones exactas del líquido ad-hoc, utilizando la totalidad de cada cápsula de polvo y su respectiva ampolla del líquido, con un excedente de material considerable, según su indicación. Si bien es posible realizar la mezcla del cemento en forma manual prescindiendo de un amalgamador, una modificación en las recomendaciones del fabricante podría alterar las propiedades del material. OBJETIVO: Determinar si existen diferencias en la resistencia compresiva de Biodentine® según el método de mezcla utilizado: con activación mecánica y con mezcla manual. MATERIALES Y METODOS: Se confeccionaron probetas cilíndricas de 6 mm de alto por 4 mm de diámetro (n=6) para los dos grupos de estudio A) Biodentine® / Mezcla manual y B) Biodentine® / Mezcla mecánica. Las muestras fueron sometidas a la aplicación de una fuerza continua en máquina universal de ensayos Digimess RS-8000-5 a una velocidad de carrera de 1 mm/min hasta su ruptura. Se compararon los valores obtenidos entre los grupos mediante test de Student, determinando diferencias significativas para valores de p>0,05. RESULTADOS: Los valores medios obtenidos y su desviación estándar fueron A) 52.6 (16.3) MPa y B) 65.7 (30.6) MPa respectivamente. La distribución de valores de resistencia a la compresión según el grupo de estudio fue levemente superior en el grupo B, aunque las diferencias no fueron significativas (p=3,77). CONCLUSIONES: La mezcla manual no disminuye significativamente la resistencia a la compresión de Biodentine® en comparación al cemento mezclado mecánicamente

Diverting loopileostomy after restorative proctocolectomy: predictors of poor outcome and badpoor of life.

AIM: Diverting loop ileostomy is used to minimize the impact of anastomotic complication after restorative proctocolectomy (RPC). However, the ileostomy itself may have complications and therefore affect quality of life (QOL). The aim of this study was to analyse the predictors of complications of the ileostomy formation and closure and of the QOL of these patients. METHOD: Forty-four consecutive patients who underwent RPC were enrolled. Records of the ileostomy follow-up were retrieved from a prospectively collected database and QOL was assessed with the Stoma-QOL questionnaire. Ileostomy site coordinates were measured. Univariate and multivariate analysis were performed. RESULTS: In this series, three patients experienced peristomal herniae, two ileostomy stenosis, seven ileostomy retraction and fourteen peristomal dermatitis. Emergency surgery was the only predictor of parastomal hernia (P = 0.017). Stenosis correlated with the distance from the umbilicus (tau = 0.24, P = 0.021). Use of standard rod and retraction were independent predictors of peristomal dermatitis (P = 0.049 and P = 0.001). Stoma-QOL was directly correlated to the age of the patients and to the occurrence of parastomal hernia (P = 0.001 and P = 0.021, respectively). After stoma closure, two patients reported wound sepsis and seven suffered obstructive episodes. CONCLUSION: The predictors of negative outcome after construction of a diverting loop ileostomy after RPC were urgent surgery, use of standard rod, the distance of the stoma site from the umbilicus, parastomal herniae and the older age of patients

Intestinal surgery for crohn's disease: predictors of recovery, quality of life and costs

Abstract INTRODUCTION: The aim of this prospective study was to analyze the impact of different surgical techniques on patients undergoing intestinal surgery for Crohn's disease (CD) in terms of recovery, quality of life, and direct and indirect costs. PATIENTS AND METHODS: Forty-seven consecutive patients admitted for intestinal surgery for CD were enrolled in this prospective study. Surgical procedures were evaluated as possible predictors of outcome in terms of disability status (Barthel's Index), quality of life (Cleveland Global Quality of Life score), body image, disease activity (Harvey-Bradshaw Activity Index), and costs (calculated in 2008 Euros). Univariate and multivariate analyses were performed. RESULTS: Significant predictors of a long postoperative hospital stay were the creation of a stoma, postoperative complications, disability status on the third post-operative day, and surgical access (R (2) = 0.59, p < 0.01). Barthel's index at discharge was independently predicted by laparoscopic-assisted approach, ileal CD, and colonic CD (R (2) = 0.53, p < 0.01). The disability status at admission showed to be an independent predictor of quality of life score at follow-up. The overall cost for intestinal surgery for CD was 12,037 (10,117-15,795) euro per patient and stoma creation revealed to be its only predictor (p = 0.006). CONCLUSIONS: Laparoscopy was associated with a shorter postoperative length of stay; stoma creation was associated with a long and expensive postoperative hospital stay, and stricturoplasty was associated with a slower recovery of bowel function

Selvicoltura nei boschi di montagna

Il rapporto finale sul progetto di selvicoltura di montagna realizzato dalla Confederazione dal 1980 al 1987 e apparso per la prima volta nel 1987 \ue8 ormai disponibile in italiano. Esso si rivolge ai servizi forestali a tutti i livelli, allo scopo di offrire loro basi decisionali e materiale di sostegno al loro perfezionamento nell'ambito della gestione delle foreste di montagna, secondo il principio della continuit\ue0. La guida offre metodi di lavoro per l'impianto di foreste in stazioni estreme, per la cura e la rinnovazione di foreste di montagna tipiche e di soprassuoli in trasformazione. Contiene anche conoscenze di dettaglio e suggerimenti pratici per l'attivit\ue0 del servizio forestale di montagna

Risk Factors for Early Mortality in Liver Transplant Patients

Background. Liver transplantation (LT) is an established treatment for patients with end-stage liver disease. The significant advances in surgical technique, immunosuppression therapy, and anesthesiological management have dramatically improved short- and long-term outcomes. The aim of this study is to correlate specific surgical and anesthesiological variables with causes of early death in LT recipients. Methods. A retrospective observational analysis of adult patients who underwent LT in the period 2012 to 2016 and died within 90 days following LT was conducted. Exclusion criteria were intraoperative death, split liver, and domino transplant. Death was considered a dependent variable and classified into 3 different groups: death by sepsis, vascular events not related to the graft, and primary non-function. Donor and recipient variables were considered and analyzed using Fisher's exact test. Results. Statistically significative associations (P value < .05) were found between renal function support, retransplantation, and the number of fresh frozen plasma units transfused in one group and early death due to sepsis in the other. Conclusions. This study identified some risk factors associated with the specific cause of early death in liver transplantation. The clinical implications of these findings are the ability to stratify patients at high risk of early death by planning more intensive and accurate management for them