Hepato Gastroenterol
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Hepato Gastroenterol · Nov 2003
Case ReportsDelayed massive arterial hemorrhage after pancreaticoduodenectomy for cancer. Management of a life-threatening complication.
Delayed massive arterial hemorrhage from the operating field occurs in 1-4% of cases after pancreaticoduodenectomy, with a mortality rate up to 50%. The purpose of this study was to define diagnostic and treatment methodologies to maximize survival. ⋯ Early diagnosis and management of pancreatic leak represents the only means to prevent a delayed massive arterial hemorrhage. Transarterial embolization or surgical ligation of the hepatic artery proximal to the celiac axis represents the procedure of choice to control the bleeding. Taking down the pancreatic anastomosis and oversewing the pancreatic stump is safe and effective. Extensive drainage of the operating field should always be associated to prevent multisystem organ failure.
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Hepato Gastroenterol · Nov 2003
Case ReportsSpleen-preserving distal pancreatectomy with preservation of the splenic artery and vein for intraductal papillary-mucinous tumor (IPMT): three interesting cases.
Preservation of the spleen at distal pancreatectomy has recently attracted considerable attention. Since our first trial and success with spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein for tumors of the pancreas and chronic pancreatitis, this procedure has been performed more frequently. Three patients with intraductal papillary-mucinous tumor underwent spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. ⋯ Severe complications were not found in any of the three cases and the postoperative course was uneventful. The patients have been followed as outpatients without any recurrence. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein is easy and safe, and should be performed for some patients with intraductal papillary mucinous tumor of the pancreas.
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Hepato Gastroenterol · Nov 2003
Type-2 hepatorenal syndrome and refractory ascites: role of transjugular intrahepatic portosystemic stent-shunt in eighteen patients with advanced cirrhosis awaiting orthotopic liver transplantation.
TIPS (transjugular intrahepatic portosystemic stent-shunt) has been used increasingly in the management of refractory variceal bleeding. Its role in the management of refractory ascites and hepatorenal syndrome still awaits further prospective studies. Type-2 hepatorenal syndrome is a moderate steady renal impairment. It arises spontaneously and it is the main mechanism of refractory ascites. Precipitating factors may lead to type-1 hepatorenal syndrome. Hepatorenal syndrome is a common complication of advanced cirrhosis with a 3-month mortality of more than 90% unless treated by orthotopic liver transplantation. However, because of the short survival of patients with hepatorenal syndrome and the limited availability of organs, only a small percentage of patients with hepatorenal syndrome can actually reach orthotopic liver transplantation. That is why awaiting orthotopic liver transplantation we have submitted some suitable patients to a TIPS setting. ⋯ We can notice how the setting of TIPS, at least in the presented case, has allowed the treatment of ascites and, furthermore, has lead to improvement of the renal functional parameters. It all implies the enormous advantage of a better management of the patient waiting for orthotopic liver transplantation and, most of all, the advantage of preparing the patient for the surgical intervention with normal renal functional parameters: in fact, it is well known that the increase of serum creatinine influences the pre- and post-orthotopic liver transplantation course, and in particular can modify the mortality rate of the patient list. The lack of effective alternative treatment modalities and the almost universally fatal outcome of hepatorenal syndrome make TIPS an attractive option in the treatment of hepatorenal syndrome as a bridge to orthotopic liver transplantation.
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The liver is the most common injured intraabdominal organ after trauma. This retrospective study was designed to analyze the results of the surgical treatment of 244 cases of liver trauma operated between 1973 and 2001. ⋯ We concluded that the injury grade and the type of trauma influence the mortality rate. Careful clinical assessment and close radiological monitoring of the patients with minor hepatic injuries, may prevent unnecessary laparotomies.
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Hepato Gastroenterol · Nov 2003
Significance of inflammatory cytokines in the progression of colorectal cancer.
Circulating levels of inflammatory cytokines are associated with the disease status of cancer patients. Our purpose was to determine whether the profile of serum levels of interleukin-1 -2, -6, and -8, and tumor necrosis factor in patients with colorectal cancer correlated with tumor stages and survival. ⋯ Elevation of serum cytokines, such as interleukin-6, may be related to the development and progression of colorectal cancer. Interleukin-6 level is associated with the clinical outcome, but is not an effective prognostic predictor.