Papers by giorgio enrico gerunda
PubMed, May 6, 2003
The outcome of the laparoscopic technique, that in the first years needed to be applied in non co... more The outcome of the laparoscopic technique, that in the first years needed to be applied in non complicated situations, imposed a more frequent use of ERCP preoperatively; this procedure was originally confined to a handful of European and American centers, but later spread to almost all large hospitals. Improvements in the techniques and materials have gone side by side with more specific indications and the assessment of complications. The purpose of the present study was to analyze the experience of a General Surgery Unit in terms of acquiring and developing skills in treating biliary stones by ERCP.
Journal of Hepatology, Apr 1, 2002
We evaluated the incidence, the prevalence of the microorganisms isolated and the impact on the s... more We evaluated the incidence, the prevalence of the microorganisms isolated and the impact on the survival of the bloodstream infections in two groups of patients: recipients of orthotopic liver transplant from cadaveric donor and from living donor
Fusarium species sono responsabili di severe infezioni fungine in pazienti affetti da patologie o... more Fusarium species sono responsabili di severe infezioni fungine in pazienti affetti da patologie onco-ematologiche e sottoposti a trapianto di midollo. Tuttavia, solo di rado tali infezioni sono state riportate in altre condizioni di immunodepressione. Descriviamo il caso di una fusariosi disseminata in una paziente sottoposta a ritrapianto di fegato, con revisione dei casi di infezione da Fusarium spp. in soggetti trapiantati di organo solido
Hepato-gastroenterology
Liver tumors may be unresectable for volumetric reasons; the post-hepatectomy future remaining li... more Liver tumors may be unresectable for volumetric reasons; the post-hepatectomy future remaining liver (FRL) will be too small to ensure survival. In some cases, preoperative selective portal vein embolization (PSPVE) of the tumorous part of the liver can permit the induction of hypertrophy of the FRL and convert patients from an unresectable to a resectable status. Analysis of the efficiency of PSPVE in changing the volume of the FRL and in permitting curative hepatectomy was performed in a retrospective study of 28 initially unresectable (for volumetric reasons), consecutive cases treated from September 1987 to September 1995. Fifty percent of the cases had damaged liver parenchyma. PSPVE was performed in various locations, according to the site of the tumor and impairment of the liver parenchyma. Twenty-five PSPVE (89%) successfully induced sufficient hypertrophy of the FRL. Explanations could be found retrospectively for the 3 failures. For the 28 cases, the mean increase in the F...
Transplantation proceedings, 1994
Chirurgia italiana, 1994
The staging of pancreatic cancer still represents a challenge for surgeons involved in this field... more The staging of pancreatic cancer still represents a challenge for surgeons involved in this field; radiological diagnostic methods used routinely (CT, NMR, angiography) may under-estimate this neoplasm; in fact, the presence of peritoneal or subglissonian hepatic micrometastasis (< 2 cm) is a frequent surprise at laparotomy and force the surgeon to undertake a palliative procedure. This policy need not be followed because it is possible to perform non-surgical palliation of jaundice or pain respectively by percutaneous radiological stent insertion and coeliac alcoholisation. Pre-operative staging thus acquires an important role in the correct treatment, surgical or medical. Laparoscopy allows us to overcome the understaging of the more common diagnostic methods and view directly the coelomatic space and the surface of the abdominal viscera; moreover during this procedure it is possible to perform a peritoneal wash to obtain other information on the cancer stage. We judged 56 pati...
ABSTRACT A prognosis calculator was implemented (www.D-MELD.com) using determinants obtained on a... more ABSTRACT A prognosis calculator was implemented (www.D-MELD.com) using determinants obtained on a national retrospective Italian Liver Transplant (LT) database (5946 LTs, 2002-2009). D-MELD (donor age x biochemical MELD) and other factors were evaluated. Differences among D-MELD deciles allowed their regrouping into 3 D-MELD classes (A &lt;338, B 338-1628, C &gt;1628). At 3 years, the odds ratio (OR) for death was 2.03 (95%CI, 1.44-2.85) in D-MELD class C versus B; the OR was 0.40 (95%CI 0.24-0.66) in class A versus B. Other predictors were HCV (OR=1.42; 95%CI 1.11-1.81), HBV (OR=0.69; 95%CI 0.51-0.93), re-transplant (OR=1.82; 95%CI 1.16-2.87) and low-volume Center (OR=1.48; 95%CI 1.11-1.99). The practical advantage of the D-MELD approach is that cases previously judged as risky, because of extreme-high MELD, can present a down-leveling of their risk when a young donor is matched (i.e., MELD=40, donor age=20 -&gt; D-MELD=800); in the same way, when a extreme-high donor age is matched to a low- MELD candidate the risk wi
Transplantation Proceedings, 2010
Disorders in lipoprotein metabolism do not contraindicate liver procurement and transplantation (... more Disorders in lipoprotein metabolism do not contraindicate liver procurement and transplantation (LT). In this circumstance, LT provides an intriguing opportunity to assess the in vivo contribution of the liver to the synthesis and degradation of genetically polymorphic plasma proteins. Apolipoprotein (APO) E exists with several common phenotypic differences due to gene polymorphism. Some authors have shown that the APOE phenotype of the recipient was virtually completely converted to that of the donor, providing evidence that &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;90% of plasma APOE arises from the liver. Homozygosis for APOE2 (E2-E2) is related to an increased incidence of type III hyperlipoproteinemia (HLP). Recently, some authors have identified 4 new APOE mutations that are strongly linked to a unique entity of renal lipidosis called lipoprotein glomerulopathy (LPG). At present, 65 cases of LPG have been reported worldwide, although most patients have been discovered in Japan and other East Asian countries. We have herein reported a case of LT in a patient with advanced hepatocarcinoma who received a liver from a caucasian donor affected by type III HLP due to homozygous E2-E2. The LPG was due to a novel genetic mutation in APOE. After the LT, the recipient, developed de novo severe lipid abnormalities despite good graft function. To our knowledge this is the first report of an LT using a graft from a non Asian donor with homozygous E2-E2 with the presence of a novel APOE mutation.
Transplantation Proceedings, 2010
Most transplant centers consider severe pulmonary hypertension (PHT) to be an absolute contraindi... more Most transplant centers consider severe pulmonary hypertension (PHT) to be an absolute contraindication for orthotopic liver transplantation (OLT). We retrospectively examined the outcome of 24 patients with PHT (group 1) who underwent OLT compared with 24 matched patients (group 2) without PHT, who also underwent OLT. Based on right cardiac catheterization measurements made after the induction of anesthesia for OLT, PHT was defined as mild or moderate-to-severe if the mean pulmonary arterial pressure exceeded 25 or 35 mm Hg, respectively. The incidence of PHT was 9.8% (24/244); 21/24 PHT patients showed mild and 3/24 moderate PHT. Kaplan-Meier survival analysis did not show a significant difference between the two groups. The incidence of pulmonary infections was significantly greater in group 1 (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). The duration of ventilation and intensive care unit stay was similar in the two groups. Echocardiography detected only the three moderate cases of PHT and not the twenty-one cases of mild PHT. Our analysis suggested that mild PHT was common and did not affect patient outcomes after OLT; moderate or severe PHT was uncommon. The two patients with moderate PHT survived OLT and did not succum to PHT during long-term follow-up.
Transplantation Proceedings, 2008
Introduction. Anemia after orthotopic liver transplantation (OLT) is a common complication due to... more Introduction. Anemia after orthotopic liver transplantation (OLT) is a common complication due to several reasons. Immunosuppressive drugs play an important role in anemia occurring at 1 month or more after OLT. Several studies describe myelosuppression immunosuppressants such as the mammalian target of rapamycin inhibitors. Methods. We performed a single-center, prospective trial consisting of a short 30-day course of cyclosporine (CsA) associated with everolimus (EVL) from postoperative day 10 (Group EVL) versus a CsA immunosuppressive regimen (Group CsA) in de novo OLT patients. We explored the influence of immunosuppressive drugs on hematological parameters comparing EVL versus CsA. Results. Twenty-eight patients were enrolled in the EVL and 12 in the CsA Groups. After OLT, hemoglobin (Hb), hematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), white blood cell (WBC), platelets (PLT), transferrin staturation (TSAT), iron, ferritin, and transferrin did not differ significantly between the 2 groups at any time point. Among the patients who reached 6-months of follow-up, 5 (41.7%) EVL and 4 (80%) CsA subjects were anemic (P ϭ not significant [NS]). Only anemia in patients enrolled in Group EVL showed a trend toward the features of microcytic, hypochromic anemia. Discussion. Our results demonstrated that de novo anemia in OLT patients treated with EVL monotherapy showed the same incidence as in patients treated with CsA. Hb values remained similar during the entire follow-up. Moreover, overall myelosuppression in the EVL Group was not significantly different from patients in the CsA Group.
Transplantation Proceedings, 2008
Introduction. In liver transplantation (OLT) a porto-caval shunt is a well-defined technique prac... more Introduction. In liver transplantation (OLT) a porto-caval shunt is a well-defined technique practiced by many surgeons in several centers. Methods. We considered 186 cadaveric OLT patients who underwent a cavo-cavostomytype reconstruction; they were divided into two groups: those in whom we performed a porto-caval shunt (group A) and those in whose we did not (group B). We evaluated several variables: warm and total ischemia time, intraoperative blood and fresh frozen plasma transfusions, crystalloid and colloid requirements, blood loss, operative duration, hemodynamic intraoperative changes and diuresis, length of hospital stay, and creatinine values at days 1 and 2, and at discharge day. Results. Total and warm ischemic time differed significantly between the two groups. Infusion of blood, fresh frozen plasma, colloid, and crystalloid did not significantly differ. Blood loss was lower, and intraoperative diuresis was not significantly increased in group A subjects. Postoperative hospitalizations were 16.5 and 17.8 days and operative times, 504 and 611 minutes in the two groups. Both cardiac index and ejection fraction values during the anhepatic phase were significantly greater among group A than group B patients. PAD at the two phases was greater in group B. The PAS was significantly different only at reperfusion time. Creatinine values were significantly different at discharge. Better survival was shown for group A patients over group B subjects. Conclusion. The results presented herein confirmed that a porto-caval shunt during OLT was a safe, useful expedient contributing to an improved hemodynamic status and a better time distribution in the various phases of liver transplantation.
Transplantation Journal, 2012
Introduction. Since 1999, a new immunosuppressive drug was administered to renal transplant patie... more Introduction. Since 1999, a new immunosuppressive drug was administered to renal transplant patients. The SRL molecule acts by blocking post-receptor signal transduction of interleukin-2 (IL-2) interacting with a family of intracellular binding proteins termed immunophilins FKBPs. Among these FKBPs, FK506 12-kd binding protein is the most relevant. SRL is an immunosuppressive drug. Therefore it can inhibit the immune system; at the same time the drug is not nephrotoxic, neurotoxic, and without diabetogenic effects. Methods. Among 285 patients who underwent liver transplantation, 27 took Sirolimus as monotherapy. Immunosuppressive treatment upto cyclosporine (CsA) or tacrolimus (FK) associated with steroids (methylprednisolone) and mycophenolate Mofetil (MMF) was initiated among subjects with pre-transplant renal failure. SRL was administered as monotherapy for patients who developed nephrotoxicity, or neurotoxicity, or diabetes. Moreover, patients affected by multifocal HCC who did not meet the Milan criteria or patients who developed Kaposi's Sarcoma were prescribed SRL monotherapy. Results. Nephrotoxicity occurred in 14 patients with mean serum creatinine level 2.2 mg/dl. Eleven patients with real failure showed significant improvements after a mean period of 28 days of SRL monotherapy (range: 6-45 days). The mean creatinine serum level after treatment with SRL monotherapy was 1.0 mg/dl (range: 0.7-1.2 mg/dl). Neurotoxicity occurred in 4 patients with tremor, confusion, and agitation. Each patient had complete improvement of symptoms after a few days of Sirolimus monotherapy. Among Three patients who developed Kaposi's Sarcoma, two underwent remission. One patient had diabetes due to calcineurin inhibitors, and one showed arterial hypertension not treatable with drugs. After the switch, we treated these patients with medications. Another important indication was HCC not meeting the Milan criteria. Conclusion. SRL monotherapy may be used to manage complication of calcineurin inhibitors or Kaposi's Sarcoma.
Journal of Hepatology, 2013
Journal of Hepatology, 1998
International Journal of Surgical Pathology, 2008
The term adenocarcinoid was first coined by Warkel et al in 1978 to describe a group of uncommon ... more The term adenocarcinoid was first coined by Warkel et al in 1978 to describe a group of uncommon low-grade malignant appendiceal tumors with morphologic and histochemical evidence of both glandular (adenocarcinoma) and neuroendocrine (carcinoid) differentiation for which several terms have been used in the past. Although the appendix is the most frequent site of this tumor, similar neoplasms have been reported also in other sites, such as colon, gallbladder, Vater's ampulla, and stomach. The biologic and clinical behavior of adenocarcinoid is still unclear. Provided that it can metastasize, a recent meta-analysis on appendiceal adenocarcinoids showed that right hemicolectomy is not required when the tumor is completely excised and there is no cecal involvement. In this article, the clinicopathologic features of an adenocarcinoid tumor occurring in the extrahepatic biliary tract with infiltration of the common hepatic duct wall that, to the best of our knowledge, represents the f...
Hepatology, 1996
impedance indices significantly decreased compared The spleen plays a pivotal role in the pathoge... more impedance indices significantly decreased compared The spleen plays a pivotal role in the pathogenesis with other cirrhotic patients (RI and PI P õ .0001). In and maintenance of portal hypertension. Few data exist patients who underwent liver transplantation, splenic about splenic hemodynamics evaluated by duplex soimpedance indices were the same as those in controls. nography in this condition. Twenty-six normal subjects, In 23 of the 52 patients surgically treated (surgical shunt 207 patients with portal hypertension of various causes, or liver transplantation), impedance indices were evaluand in different splenoportal hemodynamic conditions, ated both before and after surgical treatment. All these and 31 patients with liver transplantation were evalupatients showed a decrease in splenic impedance indices ated. In each patient the splenic resistive index (RI (RI and PI, P õ .0001) after surgical treatment. RI and Å peak systolic 0 end diastolic velocity/peak systolic ve-PI values were higher in patients with large esophageal locity) and pulsatility index (PI Å peak systolic 0 end varices as compared with patients without or with small diastolic velocity/mean velocity) were measured. In 17 varices (P õ .02 and P õ .01). RI and PI values were cirrhotic patients, splenic indices were compared with not related to age, mean arterial pressure, sex, Childportal hemodynamics as invasively evaluated by hepatic Turcotte-Pugh score, presence of ascites, or cause. A sigvein catheterization. In the various groups, RI and PI nificant correlation was found between splenic impedwere respectively: normal subjects, 0.51 { 0.05 and 0.72 ance indices and portal resistance as evaluated by { 0.11; cirrhotic patients with hepatopetal portal blood hepatic vein catheterization (r Å .80, P õ .001 for RI flow (n Å 167), 0.64 { 0.08 and 1.03 { 0.24; cirrhotic pavalues; r Å .87, P õ .001 for PI values). In conclusion, this tients with hepatofugal portal flow (n Å 3), 0.74 { 0.08 study shows that splenic impedance indices are inand 1.27 { 0.08; cirrhotic patients with portal vein creased in cirrhotic patients, and seems to demonstrate thrombosis (n Å 9), 0.74 { 0.08 and 1.36 { 0.34; patients that in patients with cirrhosis these indices reflect porwith noncirrhotic obstruction of the portal system (n tal vein blood flow resistance. (HEPATOLOGY 1996;23: Å 7), 0.69 { 0.11 and 1.16 { 0.28; cirrhotic patients with 1035-1040.) surgical decompression of splenic vein system (n Å 21), 0.54 { 0.07 and 0.76 { 0.15; patients with liver transplantation (n Å 31), 0.50 { 0.08 and 0.70 { 0.15. Both RI The introduction of duplex Doppler ultrasonography and PI were significantly higher in cirrhotic patients with hepatopetal portal flow compared with controls (P (DDU) has been an important breakthrough in the õ .0001), and even higher in cirrhotic patients with porevaluation of splanchnic hemodynamics. This new tal vein thrombosis (P õ .004 and P õ .001 in comparison technique is being widely used, particularly for the aswith RI and PI values of cirrhotic patients). In patients sessment of portal hypertension. 1,2 with noncirrhotic portal vein thrombosis, splenic imped-Since the introduction of DDU, new splanchnic heance indices were higher than those in controls (RI and modynamic parameters of portal hypertension have PI P õ .0001). Cirrhotic patients who underwent surgery been introduced: at first portal blood flow velocity and for the therapy of portal hypertension showed splenic the congestion index of the portal vein, 1,3-6 and more recently, the arterial hemodynamic parameters, i.e., the so-called impedance or resistance indices. 7-9 The Abbreviations: DDU, duplex Doppler ultrasonography; PI, pulsatility index; evaluation of these indices could be relevant, because RI, resistive index; PBV, portal blood flow mean velocity; PBF, portal blood splanchnic arterial resistance is involved in the deterflow volume; HVPG, hepatic venous pressure gradient.
European Journal of Cancer Prevention, 1993
Several biochemical events accompany and mediate the development of chronic liver disease and its... more Several biochemical events accompany and mediate the development of chronic liver disease and its evolution into cancer. Low plasma zinc and high copper levels have been observed in various liver diseases, such as liver cirrhosis and viral hepatitis, while increased oestradiol levels have been documented in chronic liver damage and hepatocellular carcinoma. We administered CCL4 intragastrically to 10 female Sprague Dawley rats for 30 weeks. All animals developed cirrhosis and four also developed hepatocellular carcinoma. Plasma levels of zinc, copper and oestradiol were significantly higher in the latter group than in animals with simple cirrhosis. Progesterone, AST and bilirubin showed a trend toward significant differences whereas testosterone and ALP levels were unchanged. These findings add to the evidence that sex hormones and trace elements are involved in the process of the development of chronic liver damage and carcinogenesis.
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Papers by giorgio enrico gerunda