No abstract available.

No Abstract Available.
Hepatitis C, Chronic* ; Hepatitis, Chronic*

No abstract availalbe.
Carcinoma, Hepatocellular* ; Gastroenterology* ; Portography*

No abstract available.
Humans

Prospective validation of the Barcelona Clinic Liver Cancer staging system. Cillo U, Vitale A, Grigoletto F, Farinati F, Brolese A, Zanus G, Neri D, Boccagni P, Srsen N, D'Amico F, Antonio Ciarleglio F, Bridda A, D'Amico DF. [Abstract reproduced by permission of J Hepatol 2006;44:723-31] BACKGROUND/AIMS: The Barcelona Clinic Liver Cancer (BCLC) classification offers a prognostic stratification of patients with hepatocellular carcinoma (HCC). We recently demonstrated the BCLC's peculiar prognostic ability in a retrospective cohort of HCC patients. The aim of this study was to evaluate the BCLC system prospectively in a subsequent separate group of HCC patients enrolled at the same surgically oriented liver unit. METHODS: One hundred and ninety- five consecutive HCC patients were prospectively enrolled and their liver disease was staged before therapy. Unlike the BCLC treatment protocol, nodule size and number were not used as absolute exclusion criteria for radical treatment. Predictors of survival were identified using the Cox model. RESULTS: The median survival time was 23 months overall, and 53, 16, 7 and 3 months, respectively, for BCLC categories A, B, C, and D. In our cohort, BCLC had the best independent predictive power for survival when compared with the Okuda, CLIP, UNOS-TNM, and JIS prognostic systems (linear trend x2=43.01, likelihood x2=57.94, AIC 885.98). Moreover, the BCLC classification showed a better prognostic ability than the AJCC-TNM 2002 system in surgical patients. CONCLUSIONS: The discriminating power of BCLC staging was prospectively assessed in an Italian cohort of HCC patients treated mainly with radical therapies.
Survival Analysis ; Prospective Studies ; Proportional Hazards Models ; Prognosis ; Neoplasm Staging/*methods ; Liver Neoplasms/mortality/*pathology ; Humans ; Carcinoma, Hepatocellular/mortality/*pathology

No abstract available.
Aeromonas/isolation & purification ; *Drug Resistance, Bacterial ; Gram-Negative Bacteria/drug effects/isolation & purification ; Humans ; Korea ; Methicillin Resistance ; Peritonitis/drug therapy/*microbiology

PURPOSE: To investigate the safety and usefulness of Lipiodol-percutaneous transhepatic ethanolinjection(L-PEI) and to determine the appropriate concentration of Lipiodol during L-PEI. This was achieved byevalvating CT findings and histopathologic changes according to the concentration of Lipiodol, amount of ethanol,and the time interval after injection into normal rabbit liver. MATERIALS AND METHODS: This experimental studyinvolved 18 New Zealand rabbits under US guidance. They were divided into five groups according to injectedmaterials; two rabbits with 0.4cc of normal saline(group I), six with 0.4cc of ethanol in the left hepaticlobe(group II), and 0.4cc of Lipiodol in the right hepatic lobe(group III), five rabbits with 5%Lipiodol-ethanol(5% vol. of Lipiodol+95% vol. of ethanol), 0.2cc in the right hepatic lobe, and 0.4cc in theleft(group IV); and five rabbits with 10% Lipiodol-ethanol as per group IV(group V). CT was performed immediately,one week, two weeks, and three-four weeks after injection, and pathologic specimens were obtained on the thirdday(acute phase) and during the third or fourth week(chronic phase) after injection. RESULTS: On CT, intrahepaticlocalization of the L-PEI injection site was well demonstrated as a focal high attenuated area which graduallydecreased in attenuation on follow up CT. The opacification of the inferior vena cava by Lipiodol, the lineardistribution of Lipiodol along portal veins or fissures, and peritoneal leakage were clearly demonstrated ingroups III-V, though the effects gradually disappeared during follow-up CT. There was no remarkable difference ingross CT attenuation between group IV and group V. The main pathologic findings during the acute phase of group IIwere coagulation necrosis surrounded by macrophage, inflammatory reaction, and early periportal and subcapsularfibrosis. The findings in group IV and V were similar to those in group II and additional fat vacuoleaccumulations in the necrotic area were also seen. During the chronic phase of group II, areas of necrosis wereabsent or smaller and were surrounded or replaced by more organized fibrosis, macrophage or multinucleated giantcell infiltration. Periportal, subcapsular fibrosis was also found. In group IV and V, the findings were similarto those of group II, though additional fat vacuoles in fibrotic or necrotic areas, foreign body reaction to fatvacuole, regenerating nodule and calcification were also observed. CONCLUSION: L-PEI is more useful for thedetection by CT of an injection site than PEI alone, and with regard to CT and histopathologic findings, there wasno significant difference between the 5% and 10% Lipiodol-ethanol groups. Compared to PEI, L-PEI provoked nosighificant additional hepatic injury; only fatty change and foreign body reaction were noted. Thus, L-PEI is moreuseful than PEI for the management of HCC.
Animals ; Contrast Media ; Ethanol* ; Ethiodized Oil* ; Fibrosis ; Follow-Up Studies ; Foreign-Body Reaction ; Liver* ; Macrophages ; Necrosis ; Portal Vein ; Rabbits ; Vacuoles ; Vena Cava, Inferior

BACKGROUND: Recent interest in the use of normothermic blood cardioplegia is based on theoretical advantages over the traditional method of hypothermic myocardial protection. These reported advantages are a decrease in intraaortic balloon pump use, greater incidence of return to normal sinus rhythm, greater immediate cardiac outputs, and less time weaned from bypass after removal of the aortic cross-clamp. In addition to these advantages, normothermic blood cardioplegia offers the promise to resuscitate the ischemic myocardium and reduce the morbidity and mortality for patients with high-risk disease. This study was designed to compare the effects of cold crystalloid and normothermic blood cardioplegia on the postoperative recovery. METHODS: To evaluate the efficacy of cold versus normothermic cardioplegia, forty-four patients scheduled to undergoing valvular replacement surgery were selected to receive intermittent cold(4degrees C) crystalloid cardioplegia(n=22), group I or continuous normothermic(37degrees C) blood cardioplegia(n=22), group II. Cardiopulmonary bypass(CPB) and aortic cross-clamp(ACC) times were measured during the operation and patients were evaluated postoperatively for serum electrolytes, arterial blood gas analysis, blood pressure, heart rate, complications, ventilator periods and ICU stay. RESULTS: The ACC and CPB times were significantly longer in group II(165.9+/-44.8 min, 210.9+/-60.2 min) compared with group I(121.2+/-38.7 min, 149.7+/-38.1 min)(p<0.01). Group II patients had significantly higher serum potassium level(5.2+/-0.8 mEq/L) than group I(4.3+/-0.4 mEq/L) on the first postoperative day(p<0.01). ICU stay and ventilator period were not significantly different in two groups. There was no significant difference in postoperative complications and mortality rates between two groups. CONCLUSIONS: These results suggest that the continuous normothermic blood cardioplegia may be useful in myocardial protection during cardiac operation.
Blood Gas Analysis ; Blood Pressure ; Cardiac Output ; Electrolytes ; Heart Arrest, Induced* ; Heart Rate ; Heart* ; Humans ; Incidence ; Mortality ; Myocardium ; Postoperative Complications ; Potassium ; Thoracic Surgery* ; Ventilators, Mechanical

To evaluate the results of cardiac anesthesia during open heart surgery using cardiopulmonary bypass, the cases of 100 patients from December 1986 to May 1989 were reviewed. The results were as follows: 1) There were 56 patients with congenital heart disease (male 32, female 24) and 44 patients with acquired heart disease (male 14, female 30). 2) The mean age of patients with congenital heart disease was 17.0+/-10.0 years and the mean age of patients with acquired heart disease was 41.2+/-14.6 years. 3) There were 54 cases of acyanotic heart disease and 2 cases of cyanotic heart disease among congenital heart disease, and 41 cases of valvular heart disease. 4) Glycopyroolate and hydroxyzine were mostly used as premedicants and morphine was used in some cases of acquired heart disease. 5) Anesthesia was induced by morphine and diazepam mostly while ketamine was used in some congenital heart disease. 6) The periods of cardiopulmonary bypass and aortic cross clamp in acquired heart disease were twice as long as in congenital heart disease. 7) The lowest body temperature during cardiopulmonry bypass was 26.7+/-2.5 degrees C in congenital heart disease and 24.1+/-3.6 degrees C in acquired heart disease while mean arterial pressure was maintained between 50-80 mmHg. 8) There were 33 cases of complications in 19 patients in which wound infection and arrythmia were most predominant. Four fatalities resulted from 3 cases of low cardiac output syndrome and 1 case of cerebrovascular disease.
Anesthesia* ; Arrhythmias, Cardiac ; Arterial Pressure ; Body Temperature ; Cardiac Output, Low ; Cardiopulmonary Bypass ; Diazepam ; Female ; Heart Defects, Congenital ; Heart Diseases ; Heart Valve Diseases ; Heart* ; Humans ; Hydroxyzine ; Ketamine ; Morphine ; Thoracic Surgery* ; Wound Infection

Bezoars are conglomerates of nondigestible matter in the gastrointestinal tract that may or may not be accompanied by gastrointestinal manifestations. Bezoars develop in patients with previous gastric surgery or in those patients with delayed gastric emptying that is due to gastroparesis caused by hypothyroidism or diabetes mellitus. Small bowel obstruction due to a gastric bezoar is rare, but it can lead to severe complications such as intestinal perforation, compression necrosis etc. A female patient came to our department complaining of upper abdominal pain and she was diagnosed as having a bezoar that was causing afferent loop syndrome and pancreatitis. We attempted to manage the patient by inserting a nasogastric tube, performing gastrofibroscopy and implementing percutaneous transhepatic biliary drainage, but the patient's condition worsened and deteriorated into a septic condition. An operation was planned, but the patient showed improvement owing to the migration of the bezoar. Herein, we report on a case of afferent loop syndrome due to bezoar and this was complicated by acute pancreatitis.
Abdominal Pain ; Afferent Loop Syndrome ; Bezoars ; Diabetes Mellitus ; Drainage ; Female ; Gastric Emptying ; Gastrointestinal Tract ; Gastroparesis ; Humans ; Hypothyroidism ; Intestinal Perforation ; Necrosis ; Pancreatitis ; Porphyrins