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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

Completely obstructed colorectal anastomosis: A new non-electrosurgical endoscopic approach before balloon dilatation

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World Journal of Gastroenterology 2010年第37期16卷 4751-4754页

作者： Gabriele Curcio Marco Spada fabrizio di francesco Ilaria Tarantino Luca Barresi Gaetano Burgio Mario Traina Department of Gastroenterology IsMeTT UPMC

Benign stricture is a relatively common complication of colorectal anastomosis after low anterior resection. On occasion, the anastomosis may close completely. A variety of endoscopic techniques have been described, but there is a lack of data from controlled prospective trials as to the optimal approach. Through-the-scope balloon dilatation is well known and easy to perform. Some case reports describe different endoscopic approaches, including endoscopic electrocision with a papillotomy knife or hook knife. We report a case of a colorectal anastomosis web occlusion, treated without electrocision. Gastrografin enema and sigmoidoscopy showed complete obstruction at the anastomotic site due to the presence of an anastomotic occlusive web. In order to avoid thermal injuries, we decided to use a suprapapillary biliary puncture catheter. The Artifon catheter was inserted into the center of the circular staple line at the level of the anastomosis, and fluoroscopic identification of the proximal bowel was obtained with dye injection. A 0.025-inch guidewire was then passed through the catheter into the colon and progressive pneumatic dilatation was performed. The successful destruction of the occlusive web facilitated passage of the colonoscope, allowing evaluation of the entire colon and stoma closure after three months of follow-up. The patient tolerated the procedure well, with no complications. This report highlights an alternative non-electrosurgical approach that uses a new device that proved to be safe and useful.

关键词： Anastomosis dilation Balloon Obstructed Artifon

Analysis of surgical and perioperative complications in seventy-five right hepatectomies for living donor liver transplantation

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World Journal of Gastroenterology 2008年第20期14卷 3159-3164页

作者： Salvatore Gruttadauria James Wallis Marsh Giovan Battista Vizzini fabrizio di francesco Angelo Luca Riccardo Volpes Amadeo Marcos Bruno Gridelli Department of Abdominal Transplant Surgery Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione Department of Abdominal Transplant Surgery University of Pittsburgh Medical Center

AIM: To present an analysis of the surgical and perioperative complications in a series of seventy- five right hepatectomies for living-donation (RHLD) performed in our center. METHODS: From January 2002 to September 2007, we performed 75 RHLD, defined as removal of a portion of the liver corresponding to Couinaud segments 5-8, in order to obtain a graft for adult to adult living-related liver transplantation (ALRLT). Surgical complications were stratified according to the most recent version of the Clavien classification of postoperative surgical complications. The perioperative period was defined as within 90 d of surgery. RESULTS: No living donor mortality was present in this series, no donor operation was aborted and no donors received any blood transfusion. Twenty- three (30.6%) living donors presented one or more episodes of complication in the perioperative period. Seven patients (9.33%) out of 75 developed biliary complications, which were the most common complications in our ***: The need to define, categorize and record complications when healthy individuals, such as living donors, undergo a major surgical procedure, such as a right hepatectomy, reflects the need for prompt and detailed reports of complications arising in this particular category of patient. Perioperative complications and post resection liver regeneration are not influenced by anatomic variations or patient demographic.

关键词： Right hepatectomy Surgery Living-relatedliver transplantation Surgical complications

Early graft dysfunction following adult-to-adult livingrelated liver transplantation:Predictive factors and outcomes

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World Journal of Gastroenterology 2009年第36期15卷 4556-4560页

作者： Salvatore Gruttadauria fabrizio di francesco Giovanni Battista Vizzini Angelo Luca Marco Spada Davide Cintorino Sergio Li Petri Giada Pietrosi Duilio Pagano Bruno Gridelli Department of Surgery University of PittsburghCoordinator Abdominal Adult Transplant.ISMETT (Mediterranean Institute for Transplant and Advanced Specialized TherapiesUniversity of Pittsburgh Medical Center in Italy)Via E. Tricomi N.190127 PalermoItaly Thomas Starzl Transplantation Institute University of Pittsburgh Medical CenterPittsburgh15213 PAUnited States

AIM:To describe a condition that we define as early graft dysfunction(EGD)which can be identified preoperatively. METHODS:Small-for-size graft dysfunction following living-related liver transplantation(LRLT)is characterized by EGD when the graft-to-recipient body weight ratio(GRBWR)is below 0.8%.However, patients transplanted with GRBWR above 0.8%can develop dysfunction of the *** 73 recipients of LRLT(GRBWR>0.8%),we identified 10 patients who developed *** main measures of outcomes analyzed were overall mortality,number of re-transplants and length of stay in days(LOS).Furthermore we analyzed other clinical pre-transplant variables,intraoperative parameters and post transplant ***:A trend in favor of the non-EGD group(3-mo actuarial survival 98%vs 88%,P=0.09;3-mo graft mortality 4.7%vs 20%,P=0.07)was observed as well as shorter LOS(13 d vs 41.5 d;P=0.001)and smaller requirement of peri-operative Units of Plasma (4 vs 14;P=0.036).Univariate analysis of pre- transplant variables identified platelet count,serum bilirubin,INR and Meld-Na score as predictors of EGD. In the multivariate analysis transplant Meld-Na score (P=0.025,OR:1.175)and pretransplant platelet count(P=0.043,OR:0.956)were independently associated with EGD. CONCLUSION:EGD can be identified preoperatively and is associated with increased morbidity after LRLT. A prompt recognition of EGD can trigger a timely treatment.

关键词： Small-for-size graft dysfunction Livingrelated liver transplantation Graft-to-recipient bodyweight ratio Partial liver transplantation Allograftdysfunction

Therapeutic advances in neural regeneration for Huntington’s disease

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Neural Regeneration Research 2024年第9期19卷 1991-1997页

作者： francesco D’Egidio Vanessa Castelli Giorgia Lombardozzi fabrizio Ammannito Annamaria Cimini Michele d’Angelo Department of Life Health and Environmental SciencesUniversity of L’AquilaL’AquilaItaly

Huntington’s disease is a neurodegenerative disease caused by the expansion mutation of a cytosine-adenine-guanine triplet in the exon 1 of the HTT gene which is responsible for the production of the huntingtin (Htt) protein. In physiological conditions, Htt is involved in many cellular processes such as cell signaling, transcriptional regulation, energy metabolism regulation, DNA maintenance, axonal trafficking, and antiapoptotic activity. When the genetic alteration is present, the production of a mutant version of Htt (mHtt) occurs, which is characterized by a plethora of pathogenic activities that, finally, lead to cell death. Among all the cells in which mHtt exerts its dangerous activity, the GABAergic Medium Spiny Neurons seem to be the most affected by the mHtt-induced excitotoxicity both in the cortex and in the striatum. However, as the neurodegeneration proceeds ahead the neuronal loss grows also in other brain areas such as the cerebellum, hypothalamus, thalamus, subthalamic nucleus, globus pallidus, and substantia nigra, determining the variety of symptoms that characterize Huntington’s disease. From a clinical point of view, Huntington’s disease is characterized by a wide spectrum of symptoms spanning from motor impairment to cognitive disorders and dementia. Huntington’s disease shows a prevalence of around 3.92 cases every 100,000 worldwide and an incidence of 0.48 new cases every 100,000/year. To date, there is no available cure for Huntington’s disease. Several treatments have been developed so far, aiming to reduce the severity of one or more symptoms to slow down the inexorable decline caused by the disease. In this context, the search for reliable strategies to target the different aspects of Huntington’s disease become of the utmost interest. In recent years, a variety of studies demonstrated the detrimental role of neuronal loss in Huntington’s disease condition highlighting how the replacement of lost cells would be a reasonable strategy to o

关键词： cell therapy exosomes extracellular vesicles Huntingtin Huntington’s disease medium spiny neurons neurodegenerative disease neurogenesis neuronal loss stem cells

Huge extrahepatic portal vein aneurysm as a late complication of liver transplantation

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World Journal of Hepatology 2010年第5期2卷 201-202页

作者： fabrizio di francesco Salvatore Gruttadauria Settimo Caruso Bruno Gridelli Mediterranean Institute for Transplant and Advanced Specialized Therapies University of Pittsburgh Medical Center Department of Surgery University of Pittsburgh Medical Center

A 60-year-old male underwent orthotopic liver trans- plantation because of hepatitis C virus related cirrhosis. After 12 d,the patient underwent re-transplantation due to primary graft non *** year later the patient developed a thrombosis of the main portal vein needing a surgical *** 11 years the patient was operated on because of a clinical picture of intestinal *** an incidental finding,a large aneurysm of the main portal vein was *** incidence of intra-and extrahepatic Portal vein aneurysms(PVAs) is not *** the best of our knowledge,only one case of intrahepatic PVA in a liver transplant has been reported in the *** addition,we have found no documented cases of extrahepatic PVAs in liver transplanted patients.

关键词： Portal vein aneurysm Late complication Liver transplantation Portal hypertension Doppler ultrasound

Selective internal radiation therapy segmentectomy:A new minimally invasive curative option for primary liver malignancies?

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World Journal of Gastroenterology 2024年第18期30卷 2379-2386页

作者： Riccardo Inchingolo francesco Cortese Antonio Rosario Pisani fabrizio Acquafredda Roberto Calbi Riccardo Memeo Fotis Anagnostopoulos Stavros Spiliopoulos Unit of Interventional Radiology “F.Miulli”Regional General HospitalBari 70021Italy Interdisciplinary Department of Medicine Section of Nuclear MedicineUniversity of Bari“Aldo Moro”Bari 70121Italy Department of Radiology General Regional Hospital“F.Miulli”Acquaviva delle Fonti 70021Italy Unit of Hepato-Pancreatic-Biliary Surgery “F.Miulli”Regional General HospitalBari 70021Italy The Second Radiology Department National and Kapodistrian University of AthensChaidari Athens 12461Greece

Transarterial radioembolization or selective internal radiation therapy(SIRT)has emerged as a minimally invasive approach for the treatment of *** percutaneous technique involves the local,intra-arterial delivery of radioactive microspheres directly into the *** employed as a palliative measure for liver malignancies,SIRT has gained traction over the past decade as a potential curative option,mirroring the increasing role of radiation *** latest update of the BCLC hepatocellular carcinoma guidelines recognizes SIRT as an effective treatment modality comparable to other local ablative methods,particularly well-suited for patients where surgical resection or ablation is not *** segmentectomy is a more selective approach,aiming to deliver high-dose radiation to one to three specific hepatic segments,while minimizing damage to surrounding healthy *** research efforts in radiation segmentectomy should prioritize optimizing radiation dosimetry and refining the technique for super-selective administration of radiospheres within the designated hepatic segments.

关键词： Transarterial radioembolization Selective internal radiation therapy Radiation segmentectomy Hepatocellular carcinoma Primary liver malignancies Personalised dosimetry

Liver resections for liver transplantations

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World Journal of Gastrointestinal Surgery 2010年第3期2卷 51-56页

作者： Salvatore Gruttadauria fabrizio di francesco Duilio Pagano Sergio Li Petri Davide Cintorino Marco Spada Bruno Gridelli Mediterranean Institute for Transplantation and High Specialization Therapies University of Pittsburgh Medical Center in ItalyPalermo 90127Italy Department of Surgery University of PittsburghPittsburghPA 15213United States

Split-Liver and living-related donor liver transplantation are the newest and both technically and ethically most challenging developments in liver transplantation and have contributed to a reduction in donor *** report the technical aspects of surgical procedures performed to achieve a partial graft from a cadaveric and a live donor.

关键词： Living-related liver transplantation Split liver transplantation Liver resections Liver transplantation Liver surgery

Transperineal laser ablation of the prostate as a treatment for benign prostatic hyperplasia and prostate cancer: The results of a Delphi consensus project

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Asian Journal of Urology 2024年第2期11卷 271-279页

作者： Andrea Cocci Marta Pezzoli Fernando Bianco Franco Blefari Pierluigi Bove Francois Cornud Gaetano De Rienzo Paolo Destefanis Danilo di Trapani Alessandro Giacobbe Luca Giovanessi Antonino Laganà Giovanni Lughezzani Guglielmo Manenti Gianluca Muto Gianluigi Patelli Novello Pinzi Stefano Regusci Giorgio I.Russo Juan I.M.Salamanca Matteo Salvi Luigi Silvestri fabrizio Verweij Eric Walser Riccardo GBertolo Valerio Iacovelli Alessandro Bertaccini Debora Marchiori Hugo Davila Pasquale ditonno Paolo Gontero Gennaro Iapicca Theo M De Reijke Vito Ricapito Pierluca Pellegrini Andrea Minervini Sergio Serni francesco Sessa Department of Urology Careggi HospitalUniversity of FlorenceFlorenceItaly Urology Section University of FlorenceFlorenceItaly Urological Research Network MiamiFLUSA Urology Section Prato HospitalPratoItaly Torvergata Oncoscience Research Centre of Excellence TORDepartment of Experimental MedicineUniversity of Rome Tor VergataRomeItaly Department of Urology San Carlo di Nancy HospitalRomeItaly Department of Radiology Hôpital CochinParis Descartes UniversityParisFrance Urology and Andrology Unit II Department of Emergency and Organ TransplantationUniversity of BariBariItaly Unit of Urology Cittàdella Salute e della Scienza HospitalUniversity of TurinTurinItaly Urology Unit Buccheri La Ferla Fatebenefratelli HospitalPalermoItaly Department of Urology Humanitas Gradenigo HospitalTurinItaly Urology Unit Surgical DepartmentFondazione Poliambulanza Istituto OspedalieroBresciaItaly Departement of Urology “S.Giovanni Evangelista”HospitalTivoliItaly Humanitas Clinical and Research CentereIRCCS Department of UrologyRozzanoItaly Department of Biomedical Sciences Humanitas UniversityPieve EmanueleItaly Department of Biomedicine and Prevention University of Rome“Tor Vergata”RomeItaly Department of diagnostic Imaging and Interventional Radiology University of Rome“Tor Vergata”RomeItaly Department of Interventional Radiology Pesenti-Fenaroli Hospital-ASST Bergamo EstAlzano LombardoItaly Department of Urology University of SienaSienaItaly Swiss International Prostate Center GenevaSwitzerland Clinique Générale Beaulieu GenevaSwitzerland Department of Urology University of CataniaItaly Department of Urology Puerta de Hierro-Majadahonda University HospitalMadridSpain Lyx Institute of Urology Universidad Francisco de VitoriaMadridSpain Department of Medico-Surgical Sciences and Biotechnologies Sapienza University of RomeFaculty of Pharmacy and MedicineUrology Unit ICOTLatinaItaly Department of Urology European Institute of Oncology(IEO)IRCCSMilanItaly Department of Radiology D

Objective: To evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the Delphi consensus ***: Italian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and ***: Thirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser® TPLA as a treatment of BPH in patients with ample range of prostate volume, from 80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading t

关键词： Transperineal laser ablation Prostatecancer Benignprostatic hyperplasia Delphi consensus