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Biomedical subjects

A Cavallari

Publications and source records attributed to A Cavallari.

At least 73 records · Page 4Linked to original sources
PubMed1997

Aberrant dipeptidyl peptidase IV (DPP IV/CD26) expression in human hepatocellular carcinoma.

BACKGROUND/AIMS: Diagnosis of small nodular lesions in the liver is often difficult because polarization of hepatocytes under pathological conditions is not as easily determined as for glandular or squamous epithelia. The aim of the present study was to investigate whether the bile canalicular enzyme dipeptidyl peptidase IV (DPP IV) would be useful to assess the pattern of hepatocellular surface polarity in liver sections. METHODS: Expression of DPP IV activity was determined by enzymatic cytochemistry and image cytometry in 25 human hepatocellular carcinomas and five cirrhotic livers removed at transplantation. Samples from the central and/or peripheral portion of neoplastic nodules and from surrounding tissue were analyzed in each case. Control specimens were obtained from normal liver of seven patients who underwent surgery for non-neoplastic conditions. RESULTS: In normal liver, DPP IV activity was confined to the bile canalicular plasma membrane with a zone 3 predominance in the hepatic acinus. This was also the case in the majority of pathological non-neoplastic livers, but the cell distribution pattern of DPP IV was altered in all hepatocellular carcinomas: 2/25 cases were completely devoid of DPP IV activity and in the remaining 23 DPP IV expressing hepatocellular carcinomas, three different patterns were observed that deviated distinctly from the typical canalicular pattern: (i) canaliculi were distorted and convoluted and contained an abnormally high DPP IV activity; (ii) canalicular activity was lost and enzymatic activity was restricted to isolated spots; (iii) pseudoacinar structures of hepatocytes with both basolateral and apical DPP IV expression appeared. CONCLUSIONS: It is concluded that DPP IV is a useful bile canalicular enzyme to assess the functional polarization of hepatocytes and that aberrant DPP IV expression occurs in human hepatocellular carcinoma.

Bile Canaliculi↗
PubMed1996

Liver transplantation in HBsAg-positive HBV-DNA--negative cirrhotics: immunoprophylaxis and long-term outcome.

The presence of a positive hepatitis B surface antigen (HBsAg) has been considered a highly questionable indication for orthotopic liver transplantation. We report our experience in the treatment of HBsAg-positive HBV-DNA-negative cirrhotics with liver transplantation, whether or not followed by passive prophylaxis with specific immunoglobulins. Of the 123 cirrhotics who received transplants at our institution since May 1986, 39 (31.7%) were HBsAg positive; of these, 1 was HBV-DNA positive, and 4 were hepatitis Be antigen (HBeAg) positive. Since April 1991, 25 HBsAg-positive HBV-DNA-negative cirrhotics have undergone an original protocol with the periodical intramuscular administration of 5,000 IU of specific immunoglobulins starting in the anhepatic phase and lasting for at least 1 year. There were no differences among cirrhotics in terms of operative mortality and long-term survival with respect to the presence of the HBsAg. Of the 35 HBsAg-positive HBV-DNA-negative patients having a follow-up of 1 month or longer, 12 (34.3%) developed HBsAg recurrence; of them, 4 (33.3%) had received a complete prophylaxis, whereas 8 (66.7%) had not. The recurrence rate was 80% (8 out of 10) in the group of patients who had not received the prophylaxis and 16% (4 out of 25) in the group who had received the prophylaxis (P = .0003). The actuarial recurrence rate in the treated patients was 20.2% and 20.2% after 1 and 3 years, respectively, whereas in the untreated group it was 60.0% and 70.0% (P < .01). The hazard of recurrence of treated patients was reduced to 24.9% compared with untreated patients. Liver transplantation can be performed in HBsAg-positive HBV DNA negative patients without an increase in the operative risk or a worsening of long-term results. Immunoglobulin prophylaxis seems to be effective in preventing hepatitis recurrence after transplantation.

Adolescent↗
PubMed1996

Transfer factor as an adjuvant to non-small cell lung cancer (NSCLC) therapy.

The rationale for using transfer factor (TF) in lung cancer patients is that the possibility of improving their cell-mediated immunity to tumour associated antigens (TAA) may improve their survival. From Jan 1984 to Jan 1995, 99 non-small cell lung cancer (NSCLC) resected patients were monthly treated with TF, extracted from the lymphocytes of blood bank donors. In the same period, 257 NSCLC resected patients were considered as non-treated controls. The survival rates of the TF treated group appear significantly improved both for patients in stages 3a and 3b, and patients with histological subtype "large cell carcinoma" (P < 0.02). Survival of TF treated patients is also significantly higher (P < 0.02) for patients with lymph node involvement (N2 disease). The results of this study suggest that the administration of TF to NSCLC resected patients may improve survival.

Adjuvants, Immunologic↗
PubMed1996

Factors affecting recurrence in Crohn's disease. Results of a prospective audit.

It has been suggested that certain clinical and morphological features can modify the outcome of Crohn's disease, particularly regarding recurrence after surgery. A series of 233 patients was followed prospectively. They underwent a resectional surgical procedure for both primary and recurrent Crohn's disease during a fifteen-year period with a minimum follow-up of eighteen months. Possible risk factors for recurrence were studied. They included duration of disease before primary surgery, the type of clinical presentation at onset (whether "Perforating" or "Non-perforating"), the initial anatomical location, the presence of microscopic disease at the resection edges, the type of surgical procedure (anastomosis vs stoma), post-operative surgical complications and the age of the patient. The duration of the disease before the initial operation was the only significant factor related to the recurrence rate.

Adult↗
PubMed1996

[Portosystemic shunts in the treatment of bleeding esophageal varices in cirrhotic patients: between sclerotherapy and transplantation].

In view of the proven efficacy of endoscopic sclerotherapy and the even improving results of liver transplantation, the present role of porto-systemic shunt should be reconsidered. From 1986 (when our liver transplant program began), to March 1994, 59 cirrhotic patients (males = 40, females = 19, mean age 53.17 +/- 12.04) underwent a porto-systemic shunt, 22 under emergency conditions and 37 in an elective setting. Patients were subdivided according to age, emergency or elective surgery, type of operation, and liver function. In the emergency procedures previous sclerotherapy and time between admission and surgery were also considered in the assessment. Mean follow-up was 46.49 +/- 31.48 months. Overall 5-year actuarial survival was 62.5%. In the emergency porto-systemic shunts the worst short-term results were obtained in patients over 55 years of age (p < 0.05) and when operations were performed within the first 24 hours after admission (p < 0.005). Long-term survival was not significantly influenced by the variables considered although patients over 55 years of age and patients with reduced liver function (Child B and C) seemed to have a more dismal outcome. Those patients under 55 years of age, with no portal thrombosis, considered as potential liver transplant candidates, had a better short-term survival rate (p < 0.05) than that of the rest of the patient population studied, mainly because of the better outcome after emergency surgery. Our data confirm the efficacy of porto-systemic shunt procedures in preserving the patient from variceal bleeding. They have a definite role in the complex treatment strategy of portal hypertension, and they must not be considered only a rescue procedure. However, liver transplantation remains the best option to resolve both portal hypertension and the underlying liver disease.

Actuarial Analysis↗
PubMed1995

Fatal necrotizing pancreatitis caused by hepatitis B virus infection in a liver transplant recipient.

A 32-year-old man who had undergone liver transplantation for fulminant hepatitis due to HBV infection developed fatal acute necrotizing pancreatitis on the 60th post-transplant day, while showing signs of intense viral replication. Immunohistochemistry and in situ hybridization of the pancreas following autopsy showed the presence of HBsAG and HBV-DNA in the cytoplasm of acinar cells, together with the picture of necrotizing pancreatitis. Clinical and histological features seem to indicate that pancreatitis was directly caused by HBV infection.

Acute Disease↗
PubMed1995

Ruptured hepatocellular carcinoma: an important cause of spontaneous haemoperitoneum in Italy.

OBJECTIVE: To evaluate the incidence of rupture of the tumour with intraperitoneal bleeding in a series of patients with hepatocellular carcinoma and its relative incidence as a cause of spontaneous haemoperitoneum, and to evaluate the results of the surgical treatment of a consecutive series of patients who presented with spontaneous haemoperitoneum caused by ruptured hepatoma. DESIGN: Retrospective study. SETTING: University hospital, Italy. SUBJECTS: 8 patients whose hepatocellular carcinoma ruptured (out of a total of 518) and caused spontaneous haemoperitoneum, and 34 patients who were admitted with spontaneous haemoperitoneum. INTERVENTIONS: Seven hepatic resections; in one case direct haemostasis was attempted because of the poor hepatic reserve. RESULTS: Rupture of the tumour with intraperitoneal bleeding occurred in 8/518 (2%) of cases of hepatocellular carcinoma. Ruptured hepatocellular carcinoma was the second most common cause of spontaneous haemoperitoneum (8/34; 24%), after gynaecological diseases (15/34; 44%). Of the 7 patients who presented with ruptured hepatocellular carcinoma and were treated by hepatic resection, 3 are alive (one with a recurrent disease) after a mean follow-up of six months (range 3 to 12 months) and 4 died of carcinomatosis within 12 months. The patient for whom resection was not feasible died immediately postoperatively of irreversible shock. CONCLUSIONS: Rupture of hepatocellular carcinoma is a relatively common cause of spontaneous haemoperitoneum. Diagnosis at the onset of symptoms has important therapeutic implications: as the results of surgical treatment are unsatisfactory, other procedures with the limited goal of achieving satisfactory haemostasis can be considered if the hepatocellular carcinoma has been diagnosed.

Adult↗
PubMed1994

[The intraperitoneal bleeding of hepatocellular carcinoma].

Intraperitoneal bleeding due to spontaneous rupture of hepatocellular carcinoma (HCC) is often a life-threatening condition as well as a poor prognostic sign in terms of the spread of neoplastic disease. Up to 12% of the patients with HCC are reported to develop this complication in Asia, while few cases have been observed to date in western countries, even in areas such as Italy where incidence of hepatocellular carcinoma is high. There is a lack of specific symptoms, therefore a correct diagnosis can be made only if the possibility of hepatocellular carcinoma rupture is taken into account in case of spontaneous hemoperitoneum and if imaging procedures are carefully focused on the liver. Once the presence of the malignant liver neoplasm is demonstrated, non surgical management, aimed solely at controlling the hemorrhage, can be considered. Herein we report 8 cases of spontaneous intraperitoneal bleeding observed in our Department. Our experience confirms that an exact diagnosis is rarely made before laparotomy and that long-term prognosis is poor even after surgical resection of the tumor: 5 of 7 patients who had hepatic resection developed an early recurrence and 4 of them died within one year.

Adult↗
PubMed1994

Early and late changes in fasting and absorptive plasma amino acids and ammonia after distal splenorenal shunt in cirrhosis.

Levels of plasma amino acids, ammonia, glucagon and insulin and their 5-hr responses to a protein feeding were evaluated before and sequentially (3 mo and 1 yr) after distal splenorenal shunt in 10 patients with cirrhosis belonging to Child-Pugh's class A or B. An index of glucagon effectiveness (plasma glucose/glucagon) was also calculated. These parameters were related to liver test results, portal vein diameter and mental state, and they were compared with those found in seven patients undergoing sclerotherapy of esophageal varices with comparable liver function (control group). Liver test results and levels of plasma insulin did not change in either group. Shunt significantly increased levels of fasting tyrosine, methionine, ornithine, arginine, histidine, ammonia and glucagon with respect to the control group; it also significantly decreased levels of leucine, valine, glucagon effectiveness and portal vein diameter. The elevation of levels of tyrosine, ammonia and the sum of arginine and ornithine was correlated directly with the increase in glucagon and inversely with the decline in glucagon effectiveness. Tyrosine increase was also correlated with the reduction of portal vein diameter. One shunted patient showed mild hepatic encephalopathy. Protein feeding did not worsen the mental state of patients before and after the operation. Surgery significantly increased the 5-hr response to the meal of gluconeogenic amino acids; its rise was again correlated with the changes in glucagon plasma levels and effectiveness. Although the absorptive levels of plasma ammonia were significantly higher 1 yr after surgery, its 5-hr response barely rose. In cirrhotic patients with a relatively preserved liver function, distal splenorenal shunt progressively worsened the fasting plasma profile of nitrogen compounds and the response to protein ingestion of gluconeogenic amino acids. The decline of portal blood flow and glucagon effectiveness may be causal factors. Despite this, the "cerebral" tolerance to a moderate oral load of protein was not reduced by surgery.

Adult↗
PubMed1993

[Early thrombosis of the portal vein after orthoptic liver transplantation. A case report].

We report on a case of early portal vein thrombosis occurring after liver transplantation in a patient with alcoholic cirrhosis. Although this complication is usually accompanied by acute graft failure and/or gastroesophageal bleeding, in this patient the portal thrombosis occurred with the appearance of general dropsy and encephalopathy, serum protein deficiency and a slight rise in liver function test values. Echo-Doppler and arteriography showed portal thrombosis, arterial hyperflow and the persistence of a large spontaneous spleno-renal shunt, identified before the transplant had taken place. Endoscopy did not reveal gastroesophageal varices. Since there was no sign of serious ischemic damage or of a serious deterioration of liver function, the patient was treated non-operatively. Some particular hemodynamic aspects implicated in the appearance of portal thrombosis in our case are discussed. However, the authors consider that spontaneous portal-systemic shunt, in the presence of advanced cirrhosis, inverted portal flow, without gastroesophageal varices, can be considered as a surgical total diverting shunt and should be taken as a risk for portal thrombosis after transplantation.

Diabetes Mellitus, Type 1↗
PubMed1993

Surgical experience with 168 primary liver cell carcinomas treated with hepatic resection.

Liver resections were performed in 168 patients with hepatocellular carcinoma (HCC) over the past 10 years; 116 were cirrhotics. Operative mortality was 7.7% (8.6% in the cirrhotic group and 5.8% in non-cirrhotics). In the years 1987-1992 the operative mortality decreased from 15.6% to 4.9% (P < .05). A statistical analysis of survival was made with the data of 155 patients with a follow-up of more than 1 month after curative resection: 56 (36.1%) died, while 99 (63.8%) are currently alive, with a follow-up varying from 2 to 76 months. The actuarial survival rate is 56.7% after 3 years and 36.3% after 5 years (59% and 35.2% for cirrhotics; 52.2% and 37.7% for non-cirrhotics, respectively). Satisfactory results can be obtained after liver resections in HCC, even in the presence of cirrhosis. Further efforts are needed in the early diagnosis of HCC, to prevent the formation of satellite nodules and the intrahepatic tumoral spread, which represent the major cause of exclusion from surgical therapy.

Adolescent↗
PubMed1992

Bleeding esophageal varices: today's role of portosystemic shunts.

Emergency portosystemic shunting has once again become a significant option in the management of bleeding esophageal varices and portal hypertension. The decision to perform such a shunt and the choice of shunt procedure requires a rational assessment of the pathophysiology and hepatoportal hemodynamics of the patient's disease and the manner in which it is anticipated that the selected procedure may alter portal flow. Since shunt surgery may interfere with hepatic transplantation, the patient's suitability as a future transplant recipient must also be considered in choosing a shunt procedure. Furthermore, if a shunt is to be performed on an emergency basis to control acute bleeding, this procedure must be done before the patient's condition deteriorates sufficiently to represent a prohibitive surgical risk.

Emergencies↗