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Clinical applications of hepatocyte transplantation

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World Journal of Gastroenterology 2009年第17期15卷 2074-2077页

作者： Giada Pietrosi Giovanni Battista Vizzini salvatore gruttadauria Bruno Gridelli Department of Gastroenterology and Hepatology Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT) University of Pittsburgh Medical Center Palermo 90127 Italy Department of Surgery Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT) University of Pittsburgh Medical Center Palermo 90127 Italy

The shortage of organ donors is a problem worldwide, with approximately 15% of adult patients with lifethreatening liver diseases dying while on the waiting list. The use of cell transplantation for liver disease is an attempt to correct metabolic defects, or to support liver function as a bridge to liver transplantation and, as such, has raised a number of expectations. Most of the available studies briefly reported here focus on adult hepatocyte transplantation (HT), and the results are neither reproducible nor comparable, because the means of infusion, amount of injected cells and clinical variability differ among the studies. To better understand the specif ic role of HT in the management of end-stage liver disease, it is important that controlled studies, designed on the principles of evidence-based medicine, be done in order to guarantee the reproducibility of results.

关键词： Hepatocyte transplantation Metabolic dis-eases Chronic liver disease Liver failure Stem cells

Small-for-size syndrome in adult-to-adult living-related liver transplantation

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World Journal of Gastroenterology 2010年第40期16卷 5011-5015页

作者： salvatore gruttadauria Duilio Pagano Angelo Luca Bruno Gridelli Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione University of Pittsburgh Medical Center in Italy Department of Surgery University of Pittsburgh Medical Center

Small-for-size syndrome (SFSS) in adult-to-adult living-related donor liver transplantation (LRLT) remains the greatest limiting factor for the expansion of segmental liver transplantation from either cadaveric or living donors. Portal hyperperfusion, venous pathology, and the arterial buffer response signif icantly contribute to clinical and histopathological manifestations of SFSS. Here, we review the technical aspects of surgical and radiological procedures developed to treat SFSS in LRLT, along with the pathophysiology of this condition.

关键词： Adult-to-adult living-related liver transplantation Small-for-size syndrome Liver resection Liver transplantation

Liver transplantation for polycystic liver and massive hepatomegaly

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World Journal of Gastroenterology 2010年第11期16卷 1425-1426页

作者： salvatore gruttadauria Fabrizio di Francesco Bruno Gridelli Mediterranean Institute for Transplant and Advanced Specialized Therapies University of Pittsburgh Medical Center in Italy Bruno Gridelli Department of SurgeryUniversity of Pittsburgh

Liver tumor and other benign liver diseases such as polycystic liver disease can cause massive hepatomegaly and may represent an indication for liver transplantation(LT)in some *** this setting,LT can be extremely difficult and challenging due to its decreased mobility and access to vascular *** from either a right or a left partial liver resection during the transplant procedure has been advocated to safely accomplish the hepatectomy of the native *** we believe that partial hepatectomy adds some risk to intra-operative bleeding,we alternatively advise a different *** have a successful experience with LT in 6 massive hepatomegaly patients due to giant liver *** the transplant procedures were performed without intermediate partial liver resection,showing that selective use of veno-venous bypass can play a significant role in the treatment of massive hepatomegaly.

关键词： Liver transplantation Massive hepatomegaly Polycystic liver

Worldwide epidemiology of liver hydatidosis including the Mediterranean area

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World Journal of Gastroenterology 2012年第13期18卷 1425-1437页

作者： Giuseppe Grosso salvatore gruttadauria Antonio Biondi Stefano Marventano Antonio Mistretta Department"G.F.Ingrassia"Section of Hygiene and Public Health University of Catania95123 CataniaItaly Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione-University of Pittsburgh Medical Center in Italy 90127 PalermoItaly Section of General Surgery and Oncology Department of General SurgeryUniversity of Catania95123 CataniaItaly

The worldwide incidence and prevalence of cystic echinococcosis have fallen dramatically over the past several ***,infection with Echinococcus granulosus(***)remains a major public health issue in several countries and regions,even in places where it was previously at low levels,as a result of a reduction of control programmes due to economic problems and lack of *** distribution differs by country and region depending on the presence in that country of large numbers of nomadic or semi-nomadic sheep and goat flocks that represent the intermediate host of the parasite,and their close contact with the final host,the dog,which mostly provides the transmission of infection to *** greatest prevalence of cystic echinococcosis in human and animal hosts is found in countries of the temperate zones,including several parts of Eurasia(the Mediterranean regions,southern and central parts of Russia,central Asia,China),Australia,some parts of America(especially South America)and north and east *** is currently considered an endemic zoonotic disease in the Mediterranean *** most frequent strain associated with human cystic echinococcosis appears to be the common sheep strain(G1).This strain appears to be widely distributed in all *** purpose of this review is to examine the distribution of *** and the epidemiology of a re-emerging disease such as cystic echinococcosis.

关键词： Epidemiology, Echinococcus granu/osus Cystic echinococcosis

Imaging in liver transplantation

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World Journal of Gastroenterology 2009年第6期15卷 675-683页

作者： Settimo Caruso Roberto Miraglia Luigi Maruzzelli salvatore gruttadauria Angelo Luca Bruno Gridelli Department of Diagnostic and Interventional Radiology Mediterranean Institute for Transplantation and Advanced Specialized Therapies(IsMeTT)University of Pittsburgh Medical Center ItalyVia Tricomi 1Palermo 90127Italy Department of Transplantation Surgery Mediterranean Institute for Transplantation and Advanced Specialized Therapies(IsMeTT) University of Pittsburgh Medical Center ItalyVia Tricomi 1 Palermo 90127Italy

The aim of this study was to illustrate the role of noninvasive imaging tools such as ultrasonography,multidetector row computed tomography,and magnetic resonance imaging in the evaluation of pediatric and adult liver recipients and potential liver donors,and in the detection of potential complications arising from liver transplantation.

关键词： Complications Liver donor Liver transplantation Magnetic resonance Multi detector computed tomography

Different modalities of arterial reconstruction in hepatic retransplantation using right partial graft

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World Journal of Gastroenterology 2009年第26期15卷 3322-3323页

作者： salvatore gruttadauria Fabrizio di Francesco Marco Spada Mariapina Milazzo Bruno Gridelli Mediterranean Institute for Transplant and Advanced Specialized Therapies University of Pittsburgh Medical Center in Italy

Though split-liver and living-related transplantation are routinely performed,they are done almost exclusively for primary liver transplantation because of potential surgical *** difficulties are generally related to arterial revascularization,particularly if there is hepatic artery *** to UNOS data,of the hepatic retransplantations performed between 1996 and 2007,only 8.7% were done using right or extended right grafts from deceased donors,and 14.3% using right grafts from live *** we report our experience with 5 hepatic retransplantations in which right partial grafts resulting from conventional in situ splits,and one right lobe resulting from an adult-toadult living-related transplant,were successfully used with different modalities of graft arterialization.

关键词： Hepatic artery Liver transplantation Split liver Living related transplantation Hepatic retransplantation

Transjugular intrahepatic portosystemic shunt with accidental diagnosis of persistence of the left superior vena cava

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World Journal of Gastroenterology 2010年第9期16卷 1158-1160页

作者： Ioannis Petridis Roberto Miraglia Gianluca Marrone salvatore gruttadauria Angelo Luca Giovanni Battista Vizzini Bruno Gridelli Department of Gastroenterology and Hepatology Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT)University of Pittsburgh Medical Center Department of Diagnostic and Interventional Radiology Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT)University of Pittsburgh Medical Center Department of Abdominal Surgery and Organ Transplantation Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT)University of Pittsburgh Medical Center

Transjugular intrahepatic portosystemic shunt (TIPSS) is considered a valid therapeutic option for the treatment of portal hypertension and its *** guidelines for this procedure have already been established on the basis of the normal vascular anatomy and of various technical radiological *** some few rare cases,diagnosis of a congenital vascular anomaly can be made accidentally by interventional radiologists,making the procedure of the TIPSS placement extremely difficult or in some cases technically *** report describes a rare vascular malformation characterized by the absence of the right superior vena cava and persistence of the left superior vena cava in a patient with a diagnosis of advanced liver cirrhosis who needed a TIPSS placement in order to control refractory ascites.

关键词： Left superior vena cava persistence Liver cirrhosis Refractory ascites Transjugular intrahepatic portosystemic shunt

Hepatic echinococcosis:Clinical and therapeutic aspects

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World Journal of Gastroenterology 2012年第13期18卷 1448-1458页

作者： Giuseppe Nunnari Marilia R Pinzone salvatore gruttadauria Benedetto M Celesia Giordano Madeddu Giulia Malaguarnera Piero Pavone Alessandro Cappellani Bruno Cacopardo Department of Clinical and Molecular Biomedicine Division of Infectious DiseasesUniversity of Catania95125 CataniaItaly Department of Microbiology and Immunology Jefferson Medical CollegeThomas Jefferson University19107 PhiladelphiaUnited States Department of Surgery University of Catania95100 CataniaItaly Department of Clinical Experimental and Oncological MedicineDivision of Infectious DiseasesUniversity of Sassari07100 SassariItaly Department of Biomedical Sciences University of Catania95100 CataniaItaly Department of Pediatrics and Pediatric Neurology Azienda Ospedaliera Universitaria OVE-PoliclinicoUniversity of Catania95100 CataniaItaly Department of Surgery General Surgery and Senology UnitUniversity of Catania95100 CataniaItaly

Echinococcosis or hydatid disease （HD） is a zoonosis caused by the larval stages of taeniid cestodes belong- ing to the genus Echinococcus. Hepatic echinococcosis is a life-threatening disease, mainly differentiated into alveolar and cystic forms, associated with Echinoc- cus multilocularis （E. multi/ocular/s） and Echinococcus granulosus （E. granulosus） infection, respectively. Cys- tic echinococcosis （CE） has a worldwide distribution, while hepatic alveolar echinococcosis （AE） is endemic in the Northern hemisphere, including North America and several Asian and European countries, like France, Germany and Austria. E. granulosus young cysts are spherical, unilocular vesicles, consisting of an internal germinal layer and an outer acellular layer. Cyst expansion is associated with a host immune reaction and the subsequent development of a fibrous layer, called the per/cyst; old cysts typically present internal septa- tions and daughter cysts. E. multilocularis has a tumor-like, infiltrative behavior, which is responsible for tissue destruction and finally for liver failure. The liver is the main site of HD involvement, for both alveolar and cystic hydatidosis. HD is usually asymptomatic for a long period of time, because cyst growth is commonly slow; the most frequent symptoms are fatigue and abdominal pain. Patients may also present jaundice, hepatomegaly or anaphylaxis, due to cyst leakage or rupture. HD diagnosis is usually accomplished with the combined use of ultrasonography and immunodiagnosis; furthermore, the improvement of surgical techniques, the introduction of minimally invasive treatments [such as puncture, aspiration, injection, re-aspiration （PAIR）] and more effective drugs （such as benzoimidazoles） have deeply changed life expectancy and quality of life of patients with HD. The aim of this article is to provide an up-to-date review of biological, diagnostic, clinical and therapeutic aspects of hepatic echinococcosis.

关键词： Hydatidosis Cystic echinococcosis Alveolarechinococcosis Liver PAIR Albendazole Treatment Diagnosis

Multidisciplinary imaging of liver hydatidosis

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World Journal of Gastroenterology 2012年第13期18卷 1438-1447页

作者： Gianluca Marrone Francesca Crino' Settimo Caruso Giuseppe Mamone Vincenzo Carollo Mariapina Milazzo salvatore gruttadauria Angelo Luca Bruno Gridelli Department of Diagnostic and Interventional Radiology Mediterranean Institute for Transplantation and Advanced Specialized TherapiesUniversity of Pittsburgh Medical Center Italy90127 PalermoItaly Department of Transplantation Surgery Mediterranean Institute for Transplantation and Advanced Specialized TherapiesUniversity of Pittsburgh Medical Center Italy90127 PalermoItaly

Liver hydatidosis is a parasitic endemic disease affecting extensive areas in our planet, a significant stigma within medicine to manage because of its incidence, possible complications, and diagnostic involvements. The diagnosis of liver hydatidosis should be as fast as possible because of the relevant complications that may arise with disease progression, involving multiple organs and neighboring structures causing disruption, migration, contamination. The aim of this essay is to illustrate the role of imaging as ultrasonography （US）, multi detector row computed tomography, and magnetic resonance imaging （MRI） in the evaluation of liver hydatidosis： the diagnosis, the assessment of extension, the identification of possible complications and the monitoring the response to therapy. US is the screening method of choice. Computed tomography （CT） is indi-cated in cases in which US is inadequate and has high sensitivity and specificity for calcified hydatid cysts. Magnetic resonance is the best imaging procedure to demonstrate a cystic component and to show a biliary tree involvement. Diagnostic tests such as CT and MRI are mandatory in liver hydatidosis because they allow thorough knowledge regarding lesion size, location, and relations to intrahepatic vascular and biliary structures, providing useful information for effective treatment and decrease in post-operative morbidity. Hydatid disease is classified into four types on the basis of their radiologic appearance.

关键词： Liver hydatidosis Hepatic cyst Daughtercysts Calcified cyst Pericyst