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Biomedical subjects

G Costa

Publications and source records attributed to G Costa.

At least 73 records · Page 4Linked to original sources

The need for antibiotic prophylaxis in elective laparoscopic cholecystectomy: a prospective randomized study.

HYPOTHESIS: The need for antibiotic treatment when performing elective laparoscopic cholecystectomy may not be as important as it is thought. This study assesses the real efficacy of antibiotic prophylaxis in elective laparoscopic cholecystectomy with respect to the postoperative infection rate. DESIGN: A prospective randomized study on the routine use of antibiotic prophylaxis in laparoscopic cholecystectomy. SETTING: University teaching hospital, La Sapienza, Italy. PATIENTS: Eighty-four patients randomly placed into 2 groups (A [n = 44] and B [n = 40]) immediately before undergoing laparoscopic cholecystectomy. METHODS: Before anesthesia was administered, group A received intravenously 2 g of cefotaxime sodium diluted in 100 mL of isotonic sodium chloride solution; group B, 10 mL of isotonic sodium chloride solution in 100 mL of saline. A gallbladder bile sample for culture was withdrawn intraoperatively from all patients. In both groups, age, sex, weight, duration of surgery, presence of diabetes, American Society of Anesthesiologists patient classification score, preoperative autologous blood donation, antibiotic administration, intraoperative gallbladder rupture, findings from bile culture positive for bacteria, episodes of colic within 30 days before surgery, length of postoperative hospital stay, and number of septic complications were recorded. All data were correlated by univariate and multivariate analyses with the onset of septic phenomena. RESULTS: In group A, 3 cases of wound infection, 1 case of subhepatic abscess from bile leakage, and 1 case of urinary tract infection were observed; group B, 4 cases of wound infection, 1 case of bronchopneumonia, and 2 cases of urinary tract infection. Comparison of data showed no statistically significant difference between the groups. Findings from bile examination in patients with sepsis complications were positive in 5 patients in group A and in 6 in group B (P = .91). Multivariate analysis showed diabetes mellitus and colic episodes within 30 days before surgery as independent factors significantly associated to the onset of infectious complications. CONCLUSIONS: In elective laparoscopic cholecystectomy, antibiotic treatment did not seem to affect the incidence and severity of infections or the degree of bile contamination.

Adult↗

Management of benign biliary strictures: biliary enteric anastomosis vs endoscopic stenting.

HYPOTHESIS: Although advances in endoscopic procedures have provided alternative options for relieving biliary obstructions, the overall chance of cure for patients with benign biliary stricture is the same using surgical or endoscopic treatment. DESIGN: Case-control study. SETTING: Tertiary care university hospital. PATIENTS: Of 163 patients referred for treatment with diagnoses of benign strictures of the common bile duct between January 1, 1975, and July 1, 1998, we studied 42 patients with postcholecystectomy stricture and a follow-up longer than 60 months. Twenty of these patients were treated with endoscopic stenting and 22 with surgery (hepaticojejunostomy, choledochojejunostomy, or intrahepatic cholangiojejunostomy). MAIN OUTCOME MEASURES: Postoperative mortality and morbidity and long-term outcome. The rate of restenosis was also determined. RESULTS: Morbidity occurred more frequently in patients treated with endoscopic procedures than with surgical ones (9 vs 2; P = .34). Hospital mortality was 0%. Surgery achieved excellent or good long-term outcome in 17 of 22 patients. Endoscopic biliary stenting was successful in 16 of 20 patients. Overall, excellent or good outcomes were achieved in 34 patients (81%). CONCLUSION: The ability to achieve steady, long-term results confirms hepaticojejunostomy as the best procedure in the treatment of benign biliary strictures, even if endoscopic procedures are gaining a new role in the treatment of a greater number of patients.

Anastomosis, Surgical↗

Prospective evaluation of omentoplasty in preventing leakage of colorectal anastomosis.

PURPOSE: The aim of this study was to investigate the role of omentoplasty, by means of intact omentum, in preventing anastomotic leakages after rectal resection. METHODS: Between 1992 and 1997 a total of 112 patients (64 males) with a mean age of 64.7 (range, 39-83) years were randomly assigned to undergo omentoplasty (Group A) or not (Group B) to reinforce the colorectal anastomosis after anterior resection for rectal cancer. The primary end point was anastomotic leakage; the secondary end point included morbidity and mortality related to omentoplasty. RESULTS: The two groups were comparable in terms of preoperative and intraoperative characteristics. Staple-ring disruption at plain abdominal radiographs was detected in seven instances in Group A and in ten in Group B patients (P = not significant). Two leakages were evident clinically in Group A and seven in Group B (P < 0.05). Three leaks were documented radiologically in Group A and eight in Group B (P = not significant). No complications related to omentoplasty were observed in Group A. There were two repeat operations for anastomotic leakage in Group B. At followup, one stricture developed in Group A and three in Group B (P = not significant) CONCLUSIONS: Despite a similar incidence of staple-ring defects, a strikingly lower rate of clinically and radiologically detected leaks developed in patients submitted to omentoplasty. Although not affecting the incidence of anastomotic disruption, omentoplasty seems to contain the severity of anastomotic leakage.

Adenocarcinoma↗

Effects of superoxide anion generators and thiol modulators on nitrergic transmission and relaxation to exogenous nitric oxide in the sheep urethra.

The effects of superoxide anion generators, the nitric oxide (NO) scavenger 2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoine-1-oxyl 3-oxide (carboxy-PTIO), the specific guanylate cyclase inhibitor 1H-[1,2,4]-oxadiazole-[4,3-a]-quinoxalin-1-one (ODQ), and thiol modulating agents were investigated on relaxations induced by nitrergic stimulation and exogenous NO addition in the sheep urethra. Methylene blue (MB, 10 microM), pyrogallol (0.1 mM) and xanthine (X, 0.1 mM)/xanthine oxidase (XO, 0.1 u ml(-1)) inhibited NO-mediated relaxations, without affecting those induced by nitrergic stimulation. This resistance was not diminished following inhibition of endogenous Cu/Zn superoxide dismutase (Cu/Zn SOD) with diethyldithiocarbamic acid (DETCA, 3 mM), which almost abolished tissue SOD activity. Carboxy-PTIO (0.1 - 0.5 mM) inhibited NO-mediated relaxations but had no effect on responses to nitrergic stimulation, which were not changed by treatment with ascorbate oxidase (2 u ml(-1)). Relaxations to NO were reduced, but not abolished, by ODQ (10 microM), while nitrergic responses were completely blocked. The thiol modulators, ethacrynic acid (0.1 mM), diamide (1.5 mM), or 5,5'-dithio-bis (2-nitrobenzoic acid) (DTNB, 0. 5 mM), and subsequent treatment with dithiothreitol (DTT, 2 mM) had no effect on responses to nitrergic stimulation or NO. In contrast, N-ethylmaleimide (NEM, 0.2 mM) markedly inhibited both relaxations. L-cysteine (L-cys, 0.1 mM) had no effect on responses to NO, while it inhibited those to nitrergic stimulation, in a Cu/Zn SOD-independent manner. Our results do not support the view that the urethral nitrergic transmitter is free NO, and the possibility that another compound is acting as mediator still remains open. British Journal of Pharmacology (2000) 129, 53 - 62

Animals↗

Working and health conditions of Italian air traffic controllers.

The paper summarises some studies carried out in recent years on Italian air traffic controllers. Work stress appeared related mainly to mental charge, aggravated by time pressure and high responsibility. Shiftwork was not considered highly stressful, thanks to the good shift schedules adopted. The disorders most frequently complained of had a prevalent psychosomatic component, concerning the digestive, neuropsychic, and cardiovascular systems. However, their prevalence was lower than, or similar to, that recorded in general population. The controllers engaged in regional centres showed slightly worse health conditions than those engaged in airport towers; the same was found in the radar controllers compared to those working in non-radar positions.

Adult↗

Hepatotoxicity of camptothecin derivatives in a primary culture system of rat hepatocytes.

The topoisomerase I inhibitors are a new class of antineoplastic agents currently under clinical development. Among these compounds there are some camptothecin (CPT) derivatives with improved toxicity profiles and antitumor activity: irinotecan (CPT-11) and topotecan (TPT), particularly active against colon, lung and ovarian cancer. The aim of this study was to evaluate the cytotoxicity of CPT, CPT-11, its metabolite SN38 and TPT in a primary culture system of rat hepatocytes. Cytotoxicity was evaluated by measuring the leakage of lactate dehydrogenase (LDH) into the medium and by assessing cell viability in terms of tetrazolium salts (MTT) reduction by mitochondrial dehydrogenase activity. Our results showed that cytotoxicity was limited in the case of short drug exposure. There was a significant and time-dependent increase in LDH leakage and a significant time- and dose-dependent decrease in MTT reduction after 3 h of incubation (p<0.01). In the treatments with doses related to peak plasma levels, CPT-11 was less responsible for the observed in vitro hepatotoxicity than its metabolite SN38; TPT had lower LDH leakage compared to SN38 and CPT-11 but showed significant and early (3 h) decrease in MTT reduction: this may mean a different mechanism of cellular damage. These results demonstrate that CPT derivatives are directly toxic to liver cells in a distinct time- and dose-related response.

Animals↗

Effects of calcium and magnesium on urinary oxalate excretion after oxalate loads.

PURPOSE: Urinary oxalate is a primary determinant of the level of calcium oxalate saturation and the formation of calcium oxalate crystals, a key event in kidney stone formation. The primary objective of this study was to compare the effects of calcium carbonate and magnesium oxide on oxalate absorption. MATERIALS AND METHODS: An experimental model was used that allowed differentiation between endogenously and oxalate load-derived urinary oxalate. Twenty-four healthy subjects (10 males, 14 females) participated in three oxalate load (OL) tests: control (OL alone), calcium carbonate (OL with concomitant calcium carbonate ingestion), and magnesium oxide (OL with concomitant magnesium oxide ingestion). Oxalate loads consisted of 180 mg. unlabeled and 18 mg. 1,2[13C2] oxalic acid. Timed urine samples were collected after the OL for analysis of oxalate, calcium, magnesium, and creatinine. RESULTS: Both the calcium carbonate and magnesium oxide treatments were associated with significantly lower load-derived oxalate levels at all time points within the initial 24-hour post-oxalate ingestion period compared with levels observed for the control treatment. There were no treatment effects on endogenous oxalate levels. The efficiency of oxalate absorption for the calcium carbonate (5.1%) and magnesium oxide (7.6%) treatments was significantly lower than that for the control treatment (13.5%). CONCLUSIONS: The results suggested that magnesium was nearly as effective as calcium in reducing oxalate absorption and urinary excretion. Higher levels of urinary oxalate, calcium, and magnesium in males appeared to be largely a function of body size since gender differences either disappeared or were reversed when a correction was made for urinary creatinine excretion.

Adult↗

Cystacanths of Bolbosoma vasculosum in the black scabbard fish Aphanopus carbo, oceanic horse mackerel Trachurus picturatus and common dolphin Delphinus delphis from Madeira, Portugal.

Cystacanths of the acanthocephalan, Bolbosoma vasculosum Rudolphi 1819, were found to be encapsulated in the connective tissues of the viscera of the black scabbard fish, Aphanopus carbo and oceanic horse mackerel, Trachurus picturatusfrom Madeira, Atlantic Ocean. Juvenile worms were obtained from the intestine of a stranded common dolphin, Delphinus delphis, also from Madeira. Cystacanths were 11-15 mm long, with a proboscis of 18-19 longitudinal rows, eight hooks per row, and two sets of trunk spines. Overall, the morphology and dimensions of the proboscis, neck and trunk corresponded to previous descriptions. Scanning electron microscopy of the proboscis structures and trunk spines is provided for the first time. The prevalence of B. vasculosum in A. carbo increased with fish length. There were no statistical differences in the prevalence and intensity of infection between seasons. The intensity of infection was similar for male and female fishes, but there were significant differences in relation to length, longer fishes having heavier infections. Aphanopus carbo from Madeira represents a new host record and a new geographic location for B. vasculosum.

Acanthocephala↗

[Biphasic hypopharyngeal synovial sarcoma: ultrastructural, cytofluorometric and immunohistochemical study and brief review of the literature].

Synovial sarcomas account for 7-10% of all soft tissue malignancies and the rare head and neck region location accounts for an average 5% of them. A brief review of the data in the Literature has shown that not more than one hundred cases of cervical-facial synovial sarcoma have been reported. In the head and neck locations this form of tumor is significantly less aggressive, with a higher survival rate and a recurrence rate much lower than the 60-70% shown for other locations in the limbs. After a brief review of the Literature, Authors present a rare clinical case of hypopharyngeal synovial sarcoma which recently came under observation. Despite the accurate diagnostic procedure, after surgical removal of the tumor by CO2 laser microlaryngoscopy, diagnosis required the use of histological and ultrastructural techniques. CT and NMR of the neck using contrast medium showed that the structure of the neoformation was similar to that of the soft tissues, it was 3-4 cm in diameter, located in the hypopharynx and had an extensive surface in contact with the left glossoepiglottic groove. The lesion appeared to involve the free edge of the aryepiglottic fold, coming into contact with the free edge of the epiglottis; it could not be dissociated form the epiglottis and obliterated both the homolateral glossoepiglottic vallecula and the pyriform sinus. Structural analysis after radiography with a contrast medium showed a marked impregnation of the lesion, indicative of high degree of vascolarization. Ultrastructural, cytofluormetric and immunohistochemical analyses were performed on the neoplasm in order to process all these data together with the clinical parameters; in other words a multi-parameter evaluation was performed, as suggested by other Authors, to determine the therapy and arrange more accurate monitoring of this patient, victim of a neoplasm with a high potential for metastases.

Adolescent↗

Extracorporeal liver perfusion system for successful hepatic support pending liver regeneration or liver transplantation: a pre-clinical controlled trial.

BACKGROUND: There is a well recognized need for a system capable of providing effective support for patients with hepatic failure pending liver regeneration or liver transplantation. Recent attempts of using bioartificial liver containing encapsulated porcine hepatocytes, the deployment of emergency whole liver, or hepatocyte transplantation are complex and not consistently successful. The technique of ex vivo hepatic perfusion developed and used clinically by Abouna in the 1970s, has now been redesigned in a perfusion circuitry that mimics the physiological conditions of a normal liver. Before clinical application of this system, a preclinical trial was carried out in dogs with induced hepatic failure. METHODS: Acute hepatic failure was induced in dogs by an end-to-side porto caval shunt, followed 24 hr later, by a 2-hr occlusion of the hepatic artery. All animals (n=18) were medically supported and were divided into three groups. In the control group (n=6) only medical support was used. In the experimental group (n=12) the animals were connected to the ex vivo liver support apparatus during acute hepatic failure via an AV shunt using a dog liver (n=6) or calf liver (n=6) (after a temporary extracorporeal bovine kidney transplant to remove preformed xeno antibody). Hepatic perfusion was carried out at 37 degrees C through the hepatic artery and portal vein at physiological pressures, and blood flow rate for 6-8 hr. RESULTS: All control animals died of progressive hepatic failure at 14-19 hr after clamping the hepatic artery. The animals treated with ex vivo liver showed remarkable clinical and biochemical improvement. Five animals survived for 36-60 hr. Another seven animals recovered completely and became long-term survivors with biochemical and histological evidence of regeneration of their own liver. Biopsy of the allogeneic ex vivo liver at the end of perfusion showed some interstitial edema. Similar biopsy of the xenogeneic calf liver showed only mild and delayed xenograft rejection, which was most likely due to removal of preformed xeno antibody by temporary transplantation of the calf kidney before liver perfusion. CONCLUSIONS: The observations and results obtained in this trial strongly confirm that extracorporeal perfusion through a whole liver, using the system described, is very successful and cost effective for the treatment of acute, but reversible hepatic failure, as well as serving as a bridge to liver transplantation. The time has come for this form of liver support technology to be reintroduced and widely used.

Animals↗

In situ hybridization analysis of preprotachykinin-A mRNA levels in young and old rats.

The present study examined the effects of ageing on preprotachykinin-A (PPT-A) mRNA levels in discrete regions of the rat brain. Semiquantitative analysis of silver grains revealed a 16% statistically significant decrease in PPT-A mRNA in the shell of the nucleus accumbens (AcbSh), a 27.6% statistically significant lower level of PPT-A mRNA in the olfactory tubercle (Tu), a 19.2% and 31. 5% statistically significant decrease in PPT-A mRNA in the dorsal and ventral caudate-putamen (d-CPu) (v-CPu), respectively, a 30% statistically significant lower expression of PPT-A mRNA in the bed nucleus of the stria terminalis (BNST), a 33.7% statistically significant decrease in PPT-A mRNA in the habenula (Hb) and a 30% statistically significant decrease of PPT-A mRNA levels in the postero-dorsal part of the medial amygdala (MePD). No changes in PPT-A mRNA levels were found in the nucleus accumbens, core (AcbC), in the islands of Calleja (Icj), and in the medial preoptic area (mPOA). These results show that ageing of the central nervous system (CNS) is associated with widespread changes in tachykinin gene expression, suggesting that alteration in the tachykinergic system may have implications in the physio-pathology of the elderly.

Aging↗

Rectal cancer and inguinal metastases: prognostic role and therapeutic indications.

PURPOSE: The aim of this study was to analyze the outcome of patients with inguinal metastases from rectal cancer. METHODS: Clinical records and data concerning the follow-up of patients referred to our institution for rectal cancer were reviewed retrospectively. Patients were divided into four groups based on the time interval between first admission and appearance of inguinal metastases. All patients were followed up until death. Age, gender, tumor stage, and disease-free intervals were examined to assess their impact on prognosis. RESULTS: Patients with rectal adenocarcinoma (N = 863) were observed from 1965 to 1990. In 21 patients the biopsy-proven diagnosis was of adenocarcinoma metastasizing to the inguinal nodes. Of these 21 patients, 15 were males. The mean age was 69.3 (range, 52-84) years. Primary lesions were exclusively T3, and no patient was found to have negative mesorectal lymph nodes. Survival from the time of diagnosis of inguinal metastases ranged from 2 to 42 (mean, 14.8) months. Patients with a disease-free interval of 12 months or more had a statistically significant longer survival time. CONCLUSIONS: Inguinal lymph-node metastases from rectal carcinoma occur as a consequence of locally advanced primary tumors or recurrent pelvic malignancy. Because of the frequency of distant metastases and the consequent poor prognosis, only systemic chemotherapy and radiotherapy should be considered. In patients who seem to be free of local recurrence and distant metastases, groin dissection is suggested for debulking and control of disease.

Abdominal Neoplasms↗

Differential mechanisms of urethral smooth muscle relaxation by several NO donors and nitric oxide.

We have examined the mechanisms of action of a broad spectrum of nitric oxide (NO) donors, including several S-nitrosothiols, sodium nitroprusside (SNP) and nitroglycerine (GTN), in relation to their relaxant activity of urethral smooth muscle. For all the compounds examined, NO release (in solution and in the presence of urethral tissue), relaxation responses, elevations in cGMP levels and the effect of thiol modulators were evaluated and compared with the effect of NO itself. Whilst all NO donors, except GTN, released NO in solution due to photolysis or chemical catalysis, this release was not correlated with their relaxant activity in sheep urethral preparations, which were furthermore not affected by the NO scavenger 2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl 3-oxide (cPTIO; 0.3 mM). A substantial NO-generating activity was found for S-nitroso-L-cysteine (CysNO) and S-nitroso-N-acetyl-D,L-penicillamine (SNAP) in the presence of urethral cytosolic fractions, suggesting metabolic activation to NO in the cytosol of the target tissue. In contrast, NO generation from S-nitroso-N-acetyl-L-cysteine (N-ac-CysNO), S-nitrosoglutathione (GSNO) and SNP were reduced by the presence of urethral homogenate and/or subcellular fractions, suggesting direct NO transfer to tissue constituents. NO donors and NO gas induced dissimilar degrees of cGMP accumulation in urethral tissue, while they were essentially equipotent as urethral relaxants. Furthermore, 1H-[1,2,4] -oxadiazole-[4,3-a]-quinoxalin-1-one (ODQ; 10 microM) inhibited both relaxation and cGMP accumulations, but with different potency for the different compounds. Oxidation of sarcolemmal thiol groups with 5-5'-dithio-bis[2-nitrobenzoic acid] (DTNB; 0.5 mM) enhanced relaxations to GSNO, an effect that was reversed by dithiotreitol (DTT; 1 mM), suggesting a direct effect through nitrosylation/oxidation reactions at the cell membrane, while relaxations to NO and to all the other compounds were not affected by these treatments. Finally, photodegradation of SNP induced the formation of a stable intermediate that still evoked NO-cGMP-mediated relaxations. This indicates that the assumption that SNP is fully depleted of NO by exposure to light should be revised. It can be concluded that important differences exist in the mechanisms by which distinct NO donors relax urethral smooth muscle and they cannot be regarded simply as NO-releasing prodrugs.

Alkylation↗

A process model of shiftwork and health.

The authors developed and tested a process model of adaptation to shiftwork, which hypothesizes that various individual and situational variables influence the development of sleep and social and domestic disturbances. Both types of disturbances trigger various types of coping behavior, leading to several proximal outcomes. The end result is the development of chronic health problems in the form of digestive and cardiovascular symptoms. The model was tested with survey data collected from 2 samples of nurses (N = 1,532) in the United Kingdom and was cross-validated against a 3rd sample of industrial workers (N = 370). Results indicate support for the model across the 3 samples, although some sample-specific and subgroup effects were found. Results have direct implications for the development of shiftwork theory and interventions.

Adaptation, Psychological↗

Changes in somatosensory evoked potentials following forebrain ischemia in the gerbils: effects of felbamate.

Somatosensory evoked potentials (SEPs) as well as change following transient cerebral ischemia in the gerbil were characterized in this study. SEPs were measured in each gerbil before ischemia (day -1), during ischemia, 10 min, 2, 4, 8, 24, 48 h and 8 days after recirculation. During bilateral carotid occlusion, SEP amplitude was dramatically reduced and central conduction time was significantly increased. During recirculation these values showed an improvement when compared to ischemic but not to control values. Moreover at 8 days of recirculation they were still statistically different from control values. Felbamate administration at the dose of 150 mg kg(-1), immediately after recirculation was shown to ameliorate neurophysiological recovery following cerebral ischemia.

Animals↗

Occupational class and ischemic heart disease mortality in the United States and 11 European countries.

OBJECTIVES: Twelve countries were compared with respect to occupational class differences in ischemic heart disease mortality in order to identify factors that are associated with smaller or larger mortality differences. METHODS: Data on mortality by occupational class among men aged 30 to 64 years were obtained from national longitudinal or cross-sectional studies for the 1980s. A common occupational class scheme was applied to most countries. Potential effects of the main data problems were evaluated quantitatively. RESULTS: A north-south contrast existed within Europe. In England and Wales, Ireland, and Nordic countries, manual classes had higher mortality rates than nonmanual classes. In France, Switzerland, and Mediterranean countries, manual classes had mortality rates as low as, or lower than, those among nonmanual classes. Compared with Northern Europe, mortality differences in the United States were smaller (among men aged 30-44 years) or about as large (among men aged 45-64 years). CONCLUSIONS: The results underline the highly variable nature of socioeconomic inequalities in ischemic heart disease mortality. These inequalities appear to be highly sensitive to social gradients in behavioral risk factors. These risk factor gradients are determined by cultural as well as socioeconomic developments.

Adult↗

Socioeconomic inequalities in mortality among women and among men: an international study.

OBJECTIVES: This study compared differences in total and cause-specific mortality by educational level among women with those among men in 7 countries: the United States, Finland, Norway, Italy, the Czech Republic, Hungary, and Estonia. METHODS: National data were obtained for the period ca. 1980 to ca. 1990. Age-adjusted rate ratios comparing a broad lower-educational group with a broad upper-educational group were calculated with Poisson regression analysis. RESULTS: Total mortality rate ratios among women ranged from 1.09 in the Czech Republic to 1.31 in the United States and Estonia. Higher mortality rates among lower-educated women were found for most causes of death, but not for neoplasms. Relative inequalities in total mortality tended to be smaller among women than among men. In the United States and Western Europe, but not in Central and Eastern Europe, this sex difference was largely due to differences between women and men in cause-of-death pattern. For specific causes of death, inequalities are usually larger among men. CONCLUSIONS: Further study of the interaction between socioeconomic factors, sex, and mortality may provide important clues to the explanation of inequalities in health.

Adult↗

[Rare locations of hydatid disease].

The authors report their experience with uncommon hydatid cyst locations. Between 1970 and 1995 a total of 16 patients suffering from hydatid cysts located in various organs other than liver and lungs were observed. There were 7 women and 9 men with a mean of 53.3 years. In 10 cases uncommon locations were found to be isolated and in 6 associated to contemporary or previously treated hepatic cystic disease. Pathogenesis of these uncommon locations, whether being primary or secondary, as well as specific items of diagnosis and surgery are discussed.

Adult↗