46 results on '"Sansalone, C"'
Search Results
2. Milan multicenter experience in liver transplantation for hepatocellular carcinoma
- Author
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VINCENZO MARIA MAZZAFERRO, Rondinara, G. F., Rossi, G., Regalia, E., Carlis, L., Caccamo, L., Doci, R., Sansalone, C. V., Belli, L. S., Armiraglio, E., Montalto, F., Galmarini, D., Belli, L., Gennari, L., Mazzaferro, V, Rondinara, G, Rossi, G, Regalia, E, De Carlis, L, Caccamo, L, Doci, R, Sansalone, C, Belli, L, Armiraglio, E, Montalto, F, Galmarini, D, and Gennari, L
- Subjects
Adult ,Male ,Analysis of Variance ,Transplantation ,Carcinoma, Hepatocellular ,Time Factors ,Adolescent ,Liver Neoplasms ,Middle Aged ,Disease-Free Survival ,Liver Transplantation ,Survival Rate ,Italy ,Humans ,Female ,Neoplasm Invasiveness ,Surgery ,Follow-Up Studies ,Neoplasm Staging - Published
- 1994
3. Hepatic adenoma and focal nodular hyperplasia: Diagnosis and criteria for treatment.
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De Carlis, L, Pirotta, V, Rondinara, G F, Sansalone, C V, Colella, G, Maione, G, Slim, A O, Rampoldi, A, Cazzulani, A, Belli, L, and Forti, D
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- 1997
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4. Is the use of marginal donors justified in liver transplantation? Analysis of results and proposal of modern criteria.
- Author
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DeCarlis, L., Sansalone, C. V., Rondinara, G. F., Colella, G., Slim, A. O., Rossetti, O., Aseni, P., Volpe, A. Della, Belli, L. S., Alberti, A., Fesce, R., and Forti, D.
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- 1996
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- View/download PDF
5. Rapid disappearance of hepatic adenoma after contraceptive withdrawal.
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Aseni, Paolo, Sansalone, Cosimo Vincenzo, Sammartino, Cinzia, Di Benedetto, Fabrizio, Carrafiello, Gianpaolo, Giacomoni, Alessandro, Osio, Chiara, Vertemati, Maurizio, Forti, Domenico, Aseni, P, Sansalone, C V, Sammartino, C, Benedetto, F D, Carrafiello, G, Giacomoni, A, Osio, C, Vertemati, M, and Forti, D
- Published
- 2001
- Full Text
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6. Liver transplantation for hepatocellular carcinoma: prognostic factors associated long-term survival.
- Author
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Colella, G., Rondinara, G.F., DeCarlis, L., Sansalone, C. V., Slim, A. O., Aseni, P., Rossetti, O., Gasperi, A. De, Minola, E., Bottelli, R., Belli, L. S., Ideo, G., and Forti, D.
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- 1996
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7. Liver transplantation for small HCC in cirrhosis.
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Romani, F., Sansalone, C. V., Rimoldi, P., Rondinara, G., de Carlis, L., Belli, L. S., Riolo, F., Pitotta, V., and Belli, L.
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- 1992
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8. Second Renal Allograft Transplants. Experience at a Single Institution.
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Touraine, J. L., Traeger, J., Bétuel, H., Dubernard, J. M., Revillard, J. P., Dupuy, C., Sansalone, C. V., Colella, G., Aseni, P., Meroni, A., Rondinara, G. F., De Carlis, L., Brunati, C., Brando, B., Minetti, E., Confalonieri, R., Slim, A. O., Goglia, P., Civati, G., and Forti, D.
- Abstract
Registry data of heart and liver retransplantation have revealed a pattern of patient survival that is significantly worse than results achieved by primary transplantation. To verify the trend of graft survival following renal retransplantation, we analyzed the results of 67 patients who received a second renal graft at Niguarda Hospital, Milan. Between March 1, 1984 and December 31, 1996, 67 second renal transplants (64 from cadaveric and 3 from living related donors) have been performed in 67 adult recipients (male 37) of mean age of 39 years. This series represented 8.5% of the 787 total renal transplants performed at our institution during the same period after the introduction of routine cyclosporine immunosuppression. In 51 (76.1%) of 67 patients, the cause of their primary renal graft failure was rejection (graft failure was defined by patient death or a return to dialysis). Nine of these 51 primary renal grafts were lost within 6 months of transplantation. Forty-nine (73.1%) had good function until after 5 years. The only contraindication to second transplantation was non-compliance with the medical regimen following a primary transplantation. Primary and second renal transplant patients received quadruple drug therapy (cyclosporine, azathioprine, anti-thymocyte globulin, steroids). Episodes of acute rejection were treated with methylprednisone boluses. [ABSTRACT FROM AUTHOR]
- Published
- 1998
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- View/download PDF
9. Early Pancreas Retransplantion for Vascular Thrombosis in Simultaneous Pancreas-Kidney Transplants.
- Author
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Touraine, J. L., Traeger, J., Bétuel, H., Dubernard, J. M., Revillard, J. P., Dupuy, C., Sansalone, C. V., Colella, G., De Carlis, L., Aseni, P., Slim, A. O., Di Benedetto, F., Rondinara, G. F., Goglia, P., Brunati, C., Meroni, A., Confalonieri, R., Follini, M. L., Civati, G., and Forti, D.
- Abstract
Vascular thrombosis is still the leading cause of nonimmunologic, technical pancreatic transplant graft failures and usually occurs in the early postoperative period. Little data exist regarding the issue of pancreas retransplantation although it has been described for chronic rejection in pancreas transplant alone with poor results. From October 1993 to December 1996, 16 patients with type I diabetes mellitus and end-stage renal disease underwent to SPK at our Dept. of General Surgery and Adominal Organ Transplantation. Twelve were males and 4 females with a mean age of 36.8 (range 25 to 56). Therteen had bladder drainage (BD) and 3 enteric drainage (ED). One patient in the BD group and 1 patient in the ED group had vascular thrombosis of their pancreas graft 7 and 3 days after SPK respectively. Both patients presented hematuria, abdominal tenderness, pain and oedema of the ipsilateral lower limb. At operation, hemorragic necrosis involving the whole pancreas with thrombosis of portal vein extended in the external and common iliac veins was seen. Pancreasectomy and throm-bectomy associated to pancreas retransplantion was performed in 1 patient in the same time while in the other, pancreas retransplant was performed 1 day later. The postoperative course was uneventful and both patients were discharged 16 and 23 days p.o. They are alive and well 6 and 11 months with functioning grafts. [ABSTRACT FROM AUTHOR]
- Published
- 1998
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10. Retransplantation of the Liver Graft: Indication and Results in a Single-Center Experience.
- Author
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Touraine, J. L., Traeger, J., Bétuel, H., Dubernard, J. M., Revillard, J. P., Dupuy, C., De Carlis, L., Sansalone, C. V., Colella, G., Aseni, P., Slim, A. O., Pirotta, V., Arcieri, K., Di Benedetto, F., Rondinara, G. F., and Forti, D.
- Abstract
Retransplantation of the liver (ReOLtx) is an outstanding challenge for both the patient and the surgeon. While acute ReOLTx, often a consequence of a primary graft non-function (PGNF) or a vascular accident, is a simple and rapid operation, the clinical conditions of the patients are generally critical and results of the procedure may be poor. On the other hand, ReOltx performed long after the first grafting, has commonly indications such as chronic rejection or recurrence of the initial disease (viral cirrhosis, PBC and others); in these cases the operation may be very difficult, time-consuming and bloody. Anyway, the results of ReOLTX are often unsatisfying and concern exist upon its wide application. [ABSTRACT FROM AUTHOR]
- Published
- 1998
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11. Serum lipid changes in liver transplantation: effect of steroids withdrawn in a prospective randomized trial under cyclosporine A therapy
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Antonino Alberti, Gianfranco Rondinara, C. V. Sansalone, Domenico Forti, G. Colella, V. Pirotta, Luca S. Belli, Abdallah Slim, F. Di Benedetto, L. De Carlis, Paolo Aseni, De Carlis, L, Belli, L, Colella, G, Rondinara, G, Slim, A, Alberti, A, Aseni, P, Sansalone, C, Pirotta, V, Di Benedetto, F, and Forti, D
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,medicine.drug_class ,Lipoproteins ,medicine.medical_treatment ,Azathioprine ,Liver transplantation ,Gastroenterology ,Drug Administration Schedule ,law.invention ,Postoperative Complications ,Randomized controlled trial ,Adrenal Cortex Hormones ,law ,Cholesterol ,Cyclosporine ,Female ,Follow-Up Studies ,Humans ,Immunosuppressive Agents ,Lipids ,Liver Transplantation ,Middle Aged ,Triglycerides ,Internal medicine ,medicine ,Transplantation ,Chemotherapy ,business.industry ,Ciclosporin ,Surgery ,Clinical trial ,Corticosteroid ,business ,medicine.drug - Published
- 1999
12. Enteric versus bladder drainage in pancreas transplantation: Initial experience at Niguarda Hospital, Milan
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F. Di Benedetto, A. Meroni, C. Brunati, G. Colella, Gianfranco Rondinara, L. De Carlis, Giuseppe Rombolà, M.L. Follini, Giovanni Civati, Abdallah Slim, C. V. Sansalone, Domenico Forti, O. Rossetti, Paolo Aseni, Sansalone, C, Aseni, P, Follini, M, Slim, A, Rossetti, O, Colella, G, Di Benedetto, F, Rondinara, G, De Carlis, L, Brunati, C, Meroni, A, Rombolà, G, Civati, G, and Forti, D
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Adult ,Male ,medicine.medical_specialty ,Urinary system ,medicine.medical_treatment ,Urinary Bladder ,Ileum ,Pancreas transplantation ,Exocrine secretion ,medicine ,Drainage ,Female ,Humans ,Middle Aged ,Pancreas Transplantation ,Bladder drainage ,Transplantation ,Urinary bladder ,business.industry ,Surgery ,medicine.anatomical_structure ,Pancreas ,business - Published
- 1998
13. Is the use of marginal donors justified in liver transplantation? Analysis of results and proposal of modern criteria
- Author
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O. Rossetti, Paolo Aseni, Abdallah Slim, Domenico Forti, A. Della Volpe, G. Colella, R. Fesce, L. DeCarlis, Gianfranco Rondinara, C. V. Sansalone, Luca S. Belli, Antonino Alberti, De Carlis, L, Sansalone, C, Rondinara, G, Colella, G, Slim, A, Rossetti, O, Aseni, P, Della Volpe, A, Belli, L, Alberti, A, Fesce, R, and Forti, D
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Adult ,medicine.medical_specialty ,Multivariate analysis ,Adolescent ,medicine.medical_treatment ,Liver transplantation ,Oliguria ,Internal medicine ,medicine ,Humans ,Child ,Aged ,Retrospective Studies ,Univariate analysis ,Transplantation ,business.industry ,Donor criteria ,Incidence (epidemiology) ,Univariate ,Middle Aged ,medicine.disease ,Tissue Donors ,Surgery ,Child, Preschool ,Liver donor selection ,Steatosis ,medicine.symptom ,business - Abstract
A discrepancy exists worldwide between the number of suitable liver donors and the increasing demand for transplantation. Thus many centers have considered widening their liver donor acceptance criteria and this may increase the incidence of primary dysfunction (PD) with negative effect on the results of transplantation. In order to reduce the incidence of PD and improve patient and graft survival it becomes important to identify those risk factors associated with its occurrence. In a retrospective univariate and multivariate analysis we evaluated several donor, preservation and recipient parameters and their correlation with PD. In our Department 282 orthotopic liver transplantations (OLT) were performed on 256 adult patients over a 10-year period. Excluded were 15 cases with early vascular problems and 4 intraoperative deaths. A complete series of donor, recipient and procedure-related data were analyzed. About 30% of donors showed abnormal values. In 70 cases of PD (26%) there was a 61.4% graft failure rate compared with 15% in the group with immediate function (P < 0.05). Univariate analysis showed donor age, steatosis, ischemia time, amines, oliguria, hypotension and ICU stay to be significantly associated with PD. Multivariate analysis showed steatosis, ischemia time and amine dosage to be independent risk factors for the development of primary non function. In conclusion, the acceptance of marginal donors worsened the results of transplantation, but the rejection of these donors would reduce by about 30% our transplant activity resulting in increased mortality in the waiting list. Combinations of risk factors when possible should be avoided, and ischemia time, as the only variable that can be controlled, should be kept as short as possible.
- Published
- 1996
14. Iliac artery graft interposition in liver transplantation: Our experience in 72 cases
- Author
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C V, Sansalone, G, Colella, G F, Rondinara, O, Rossetti, L, De Carlis, L S, Belli, A, Meroni, A, Della Volpe, C, Trojsi, L, Belli, Sansalone, C, Colella, G, Rondinara, G, Rossetti, O, De Carlis, L, Belli, L, Meroni, A, Della Volpe, A, and Trojsi, C
- Subjects
Adult ,Graft Rejection ,Reoperation ,Transplantation ,Anastomosis, Surgical ,Blood Loss, Surgical ,Middle Aged ,Iliac Artery ,Liver Transplantation ,Hepatic Artery ,Ischemia ,Acute Disease ,Chronic Disease ,Humans ,Prothrombin ,Surgery ,Aspartate Aminotransferases ,Morbidity ,Retrospective Studies - Published
- 1994
15. The role of spontaneous portosystemic shunts in the course of orthotopic liver transplantation
- Author
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Antonio Rampoldi, C. V. Sansalone, Bruno Zani, Giorgio Brambilla, Luciano De Carlis, Ernesto Del Favero, Lino Belli, Luca S. Belli, Alberto Cazzulani, Gianfranco Rondinara, De Carlis, L, Del Favero, E, Rondinara, G, Belli, L, Sansalone, C, Zani, B, Cazzulani, A, Brambilla, G, and Rampoldi, A
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Nephrology ,Adult ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,Portal venous pressure ,medicine.medical_treatment ,Liver transplantation ,Internal medicine ,Hypertension, Portal ,medicine ,Humans ,Transplantation ,business.industry ,portosystemic shunts-Portosystemic shunt ,Middle Aged ,Pathophysiology ,Surgery ,Radiography ,Portal System ,Female ,Hepatectomy ,business ,Perfusion ,Shunt (electrical) ,Liver Circulation - Abstract
Spontaneous portosystemic shunts are commonly found in cirrhotic patients. Not yet established is their role after orthotopic liver transplantation (OLTx), especially when an increase in portal pressure develops, as during early acute rejection. In this study, 34 cirrhotic patients in a series of 70 OLTx are considered. Each patient had preoperative angiographic assessment, and, in 21 (62%), large spontaneous portosystemic shunts were evident. In 12 cases the shunts were not affected by the surgical procedure and were present during the postoperative period; in 9 the hepatectomy itself involved interruption of the shunts. The patient population was divided into two groups: patients with postoperative shunts (n = 12) and those without (n = 22). The two groups were similar in age, sex, Child's stage, transplantation variables, and number and grade of rejection episodes. However, mean transaminases (AST) values in the first 2 weeks were significantly higher levels in shunt versus nonshunt patients (421 +/- 335 vs 183 +/- 126; P less than 0.025), and this was even more evident when rejection occurred (626 +/- 375 vs 195 +/- 129; P less than 0.001). Furthermore, during an acute rejection reaction, three cases showed a true "steal phenomenon" through the large reopened shunts with ischemic damage to the grafts. The data indicate a possible detrimental effect of the spontaneous shunts on graft perfusion and suggest the prophylactic surgical interruption of the residual shunts during the transplantation.
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16. Anterior approach to the spine. Role of the general surgeon, techniques and surgical complications. The 10-year experience of the Niguarda Hospitals.
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Sansalone CV, Soldano S, Poli C, Tripepi M, D'Aliberti GA, and Rossetti O
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- Adolescent, Adult, Aged, Female, Humans, Incidence, Lumbar Vertebrae surgery, Male, Middle Aged, Orthopedic Procedures methods, Retrospective Studies, Thoracic Vertebrae surgery, Intervertebral Disc surgery, Orthopedic Procedures adverse effects, Postoperative Complications epidemiology, Spinal Cord surgery, Spine surgery
- Abstract
Aim: The aim of the study was to present the incidence of early and late surgical complications in a group of patients treated with anterior approach for spine lesions. The study was also focused on technical aspects for lesions of D1-D2 and L5-S1 segments and results on a group of patients underwent adjunctive surgical procedures at the same time of spinal surgery., Methods: This was a retrospective study based on our database from April 1998 to December 2008. The study enrolled 120 consecutive patients (M/F 73/47; mean age 43.1 years; range 15-70 years) who underwent spinal surgery for trauma (92 patients), primitive or metastatic cancer (12 patients), benign lesion (2 patients), degenerative disc disease (6 patients) and infection disease (8 patients). This work describes the anterior approach to the spine., Results: No death was recorded. Thirty-two patients (26.6%) presented postoperative complications: persistent urinary tract infections in 19 (15.9%), pneumonia in 6 (5%), pleural effusion in 3 (2.5%), wound infection in 2 (1.6%), retro-peritoneal abscess in 1 (0.8%) and haemorrhage in 1 (0.8%). During the follow-up (mean 3.8 years; range 2 months-10 years) 1 patient (0.8%) required two further surgical procedures for tuberculosis abscess recurrences., Conclusion: Anterior approach to the spine is effective and safe. Surgical complications do not negatively affect patient survival and spine stabilization included patients with D1-D2 and L5-S1 lesion and patients who receive adjunctive surgery at the same time of spine procedure.
- Published
- 2011
17. Combined heart and kidney transplantation: long-term analysis of renal function and major adverse events at 20 years.
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Bruschi G, Botta L, Colombo T, Busnach G, Pedrazzini G, Cannata A, Trunfio S, Macera F, Turazza F, Oliva F, Sansalone CV, Paino R, Frigerio M, and Martinelli L
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- Adult, Female, Follow-Up Studies, Graft Rejection, Heart Diseases complications, Heart Failure complications, Heart Failure surgery, Heart Transplantation pathology, Humans, Hypertension complications, Hypertension surgery, Kidney Diseases complications, Kidney Failure, Chronic complications, Kidney Failure, Chronic surgery, Kidney Transplantation pathology, Male, Middle Aged, Patient Selection, Tissue Donors, Treatment Outcome, Heart Diseases surgery, Heart Transplantation statistics & numerical data, Kidney Diseases surgery, Kidney Transplantation statistics & numerical data
- Abstract
Background: Combined heart-kidney transplantation (HKTx) is an accepted therapeutic option for patients with end-stage heart disease associated with severely impaired renal function. We report our long-term follow-up with this combined procedure., Patients and Methods: Between April 1989 to November 2009, nine patients underwent combined simultaneous (HKTx) at our center. Seven patients were males (mean age 45.2 +/- 10.12 years); seven patients were on dialysis at the time of transplantation., Results: Surgical procedures were uneventful in all patients. One patient died in the intensive care unit 41 days after transplantation. During long-term follow-up, three patients died: one due to infection and multiorgan failure 148 months after HKTx, one due to a lung neoplasm after 6 years, and one, a cerebral stroke at 34 months after transplantation. Only one patient experience renal allograft failure secondary to hypertension and cyclosporine nephrotoxicity at 10 years after HKTx with the need for renal replacement therapy. Last estimated glomerular filtration rates of all other patients was 61.3 +/- 17.4 mL/min., Conclusions: In selected patients, with coexisting end-stage cardiac and renal failure, combined HKTx with an allograft from the same donor proved to give satisfactory short- and long-term results, with a low incidence of both cardiac and renal allograft complications., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)
- Published
- 2010
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18. Renal grafts from elderly donors: histological studies and long-term results.
- Author
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Rossetti O, Soldano S, Aseni P, Colombo V, Roselli E, De Gasperi A, and Sansalone CV
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- Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Creatinine blood, Graft Rejection epidemiology, Humans, Immunosuppressive Agents therapeutic use, Kidney Transplantation mortality, Length of Stay, Middle Aged, Prospective Studies, Survival Analysis, Treatment Outcome, Aging physiology, Kidney Transplantation physiology, Tissue Donors statistics & numerical data
- Abstract
To satisfy the increasing requests for renal grafts, elderly donors are increasingly accepted for kidney transplant at many centers. The main unresolved question is the long-term effect on graft survival of potential histological lesions due to donor age. We present a prospective histological study performed from January 1997 to December 2001 on 184 consecutively transplanted renal grafts in which the only criterion for graft acceptance was a normal value of serum creatinine upon admission to the intensive care unit independent of donor age. At the end of the study, 57 recipients (31%) of mean age 55 years (range 39 to 67 years) received a renal graft from donors aged more than 60 years (mean age 66 years; range 60 to 75 years), this cohort denoted as older donor kidney transplant group (ODKTG) and 127 recipients (69%) with a mean age of 49 years (range 21 to 63 years) received a renal graft from donors whose age was lower than 60 years (mean age 49 years; range 16 to 59 years), a cohort denoted as the younger donor kidney transplant group (YDKTG). The two groups were comparable for time of dialysis, cold ischemia time, immunosuppression therapy, grading of histological damage. At the end of the study with a mean follow-up of 5.6 years (range 3.5 to 7.5 years), primary graft nonfunction and delayed graft function were significantly more represented in the ODKTG than the YDKTG. Cumulative patient and graft survival was 84.3% and 79.4% in the ODKTG, respectively, and 93.8% and 85.9% in the YDKTG, respectively (P = NS). Cumulative serum creatinine values were 1.98 mg/100 mL in ODKTG and 1.65 mg/100 mL in YDKTG (P = NS). In conclusion, renal grafts from older donors presented histological damage comparable to that seen among renal grafts from younger donors.
- Published
- 2007
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19. The lingual splint: an often forgotten method for fixating pediatric mandibular fractures.
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Binahmed A, Sansalone C, Garbedian J, and Sándor GK
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- Child, Humans, Male, Fracture Fixation instrumentation, Jaw Fixation Techniques instrumentation, Mandibular Fractures therapy, Splints
- Abstract
Maxillofacial fractures are uncommon in the pediatric population, and their treatment is unique due to the psychological, physiological, developmental and anatomical characteristics of children. We present the case of a boy who was treated in an outpatient dental clinic using a lingual splint for the reduction, stabilization and fixation of a mandibular body fracture. This technique is a reliable, noninvasive procedure that dentists may consider in selected cases by referral to an oral and maxillofacial surgeon. It also limits the discomfort and morbidity that can be associated with maxillomandibular fixation or open reduction and internal fixation in pediatric patients.
- Published
- 2007
20. Early and late residual renal function and surgical complications in living donors: a 15-year experience at a single institution.
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Sansalone CV, Maione G, Aseni P, Rossetti O, Mangoni I, Soldano S, De Roberto A, Minetti ME, Perrino ML, and Civati G
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- Follow-Up Studies, Hemorrhage etiology, Humans, Laparoscopy adverse effects, Laparoscopy methods, Nephrectomy methods, Postoperative Complications classification, Reoperation, Retrospective Studies, Time Factors, Treatment Outcome, Kidney physiology, Kidney Function Tests, Living Donors, Nephrectomy adverse effects, Tissue and Organ Harvesting adverse effects
- Abstract
Living donation in the field of renal transplantation has increased over time as well as the use of laparoscopic nephrectomy. We present a 15-year experience on 162 living donors (105 women, 57 men; mean age, 46.7 years; range, 31-74 years) who underwent nephrectomy using different surgical approaches as open lombotomic nephrectomy (OLN), open transperitoneal nephrectomy (OTN), and laparoscopic hand-assisted nephrectomy (LHAN). We collected data on residual donor and recipient renal function, as well as early versus late medical and surgical complications. With a mean follow-up of about 8 years, we observed normal residual renal function in all donors and similar results of early and late graft function independent of the surgical procedure. Long-term incidence of hypertension and noninsulin-dependent diabetes in living donors was similar to the general population. OLN and OTN donors showed higher incidences of early and late complications, readmissions, and reoperations than LHAN donors. Our results confirmed that living donor nephrectomy is a safe procedure without serious side effects in terms of renal function and long-term quality of life. LHAN should be the preferred technique because of a lower incidence of early and late complications.
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- 2006
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21. Pancreas retransplantation: ideal timing and early and late results.
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Sansalone CV, Maione G, Rossetti O, Aseni P, Soldano S, De Roberto A, and Civati G
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- Graft Survival, Humans, Pancreas Transplantation physiology, Postoperative Period, Reoperation statistics & numerical data, Retrospective Studies, Treatment Failure, Treatment Outcome, Pancreas Transplantation methods, Pancreas Transplantation statistics & numerical data
- Abstract
Surgical complications are the leading cause of pancreatic graft loss among diabetic patients who undergo pancreas transplantation alone (PTA), or combined with kidney transplantations (PK) or after kidney transplantations (PAK). Therapeutic effects on secondary complications of diabetes justify pancreas retransplantation (re-PT) when the first graft is lost. However, the appropriate timing for retransplant and related problems is not known. We present our initial experience on re-PT performed on seven diabetic patients who lost their first pancreas grafts (PK) due to surgical complications (venous thrombosis in five and enteric fistula in two). Five re-PT were performed a few days after the first PT without a second course of induction therapy, while two patients received re-PT some months later with reinduction therapy. In the early re-PT group, one patient died some hours after the second surgical procedure due to pulmonary embolism, while four patients lost their second grafts due to accelerated rejection within 2 years from re-PT. In the late re-PT group, both patients have good graft function without signs of rejection. Our initial experience showed discouraging results in the group of early re-PT, due to accelerated rejection episodes leading to a high incidence of graft loss. Late re-PT accompanied by reinduction therapy seemed to have better results.
- Published
- 2006
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22. Surgical complications are the main cause of pancreatic allograft loss in pancreas-kidney transplant recipients.
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Sansalone CV, Maione G, Aseni P, Mangoni I, De Roberto A, Soldano S, Minetti E, Broggi ML, and Civati G
- Subjects
- Adult, Drainage methods, Female, Graft Survival, Humans, Male, Middle Aged, Pancreas Transplantation adverse effects, Pancreas Transplantation mortality, Patient Selection, Retrospective Studies, Survival Analysis, Tissue Donors, Treatment Failure, Urinary Bladder surgery, Diabetes Mellitus, Type 1 surgery, Diabetic Nephropathies surgery, Intraoperative Complications epidemiology, Kidney Failure, Chronic surgery, Kidney Transplantation adverse effects, Kidney Transplantation mortality, Kidney Transplantation physiology, Pancreas Transplantation physiology
- Abstract
We examined surgical complications among a group of diabetic type 1 patients (IDDM) with end-stage renal disease (ESRD) who had undergone pancreas-kidney transplantations (PK). Between October 1993 and August 2004, 70 SPK were performed using bladder (n = 14) or enteric (n = 56) drainage. Donors were selected according to standard criteria (mean age, 27.6 years; range, 17-49). All patients received cyclosporine-based immunosuppression. All pancreata functioned immediately, whereas 2 patients needed postoperative dialysis. Four patients (5.7%) lost their pancreatic graft due to vascular thrombosis; both patients underwent urgent allograft pancreaectomy and pancreas retransplantation (re-PT). One of them (1.4%) experienced a venous thrombosis and died due to a pulmonary embolism at 12 hours after re-PT. The other 3 patients had uneventful postoperative courses and were discharged with good pancreatic and renal function. Three patients in the bladder group (21.4%) had an anastomotic leak, which resolved with a bladder catheter. Four patients in the enteric group (7.1%) who experienced an anastomotic leak needed a second surgical procedure but in 3 of them allograft pancreatectomy was necessary. Relaparotomy was required in the other 3 patients due to hemorrhage (1 patient) or occlusion (2 patients). Acute rejection episodes, which occurred in 16 patients (22.8%), were treated with steroid boluses. With a mean follow-up of 72 months (range, 3-129), 2 patients have died at 8 and at 36 months, respectively, after SPK due to acute myocardial infarction (2.9%). Chronic rejection was the leading cause of pancreatic failure in 5 patients (7.1%) and of renal failure in 2 patients (2.8%). Patient, kidney, and pancreas survival rates were 95.8%, 92.9%, and 81.5%, respectively. Surgical complications were the leading cause of pancreatic allograft loss in IDDM and ESRD patients submitted to SPK.
- Published
- 2005
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23. Laparosopic hand-assisted living donor nephrectomy: the Niguarda experience.
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Maione G, Sansalone CV, Aseni P, De Roberto A, Soldano S, Mangoni I, Perrino L, Minetti E, and Civati G
- Subjects
- Adult, Blood Loss, Surgical, Female, Humans, Male, Middle Aged, Pain, Postoperative prevention & control, Patient Selection, Retrospective Studies, Safety, Laparoscopy methods, Living Donors, Nephrectomy methods
- Abstract
Perioperative donor morbidity, a barrier to living organ donation, may be mitigated by the laparoscopic approach. From September 2002 to September 2004, 15 living donors, of ages ranging from 36 to 59 years, underwent laparoscopic nephrectomy. We used a hand-assisted device to increase the safety of the procedure. The average operating time was 200 minutes. The average blood loss was about 100 mL. The patients resumed oral intake and started walking within 1 day. The average postoperative hospital stay was 6 days. Although laparoscopic operating times were longer than those for traditional surgery, we showed benefits to the laparoscopic donor to be less postoperative pain, better cosmesis, shorter recovery time, and faster return to normal activities. We therefore consider laparoscopic nephrectomy a good alternative to traditional surgery for selected patients. Despite a lack of strong evidence, such as large prospective randomized studies, laparoscopic donor nephrectomy is likely to become the gold standard for donor nephrectomy in the near future.
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- 2005
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24. Advantages of short-time ureteric stenting for prevention of urological complications in kidney transplantation: an 18-year experience.
- Author
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Sansalone CV, Maione G, Aseni P, Mangoni I, Soldano S, Minetti E, Radaelli L, and Civati G
- Subjects
- Female, Graft Rejection epidemiology, Humans, Incidence, Kidney Transplantation mortality, Male, Postoperative Complications epidemiology, Retrospective Studies, Risk Factors, Survival Analysis, Urinary Bladder surgery, Urinary Tract Infections epidemiology, Kidney Transplantation methods, Postoperative Complications prevention & control, Stents, Ureter surgery, Urologic Diseases prevention & control
- Abstract
We retrospectively studied the incidence of urological complications in a consecutive series of 590 patients (group B) who received a kidney transplant (KT) with a ureteral stent from January 1994 to December 2002. The ureteral stent was sewn to the bladder catheter during the surgical procedure and left in situ for a mean time of 10 days (range 8 to 12 days). The results were compared to a consecutive series of 414 patients who received a KT from March 1986 to December 1993 without a ureteral stent (group A). The two groups were comparable in terms of donor and recipient gender, ischemia time, delayed graft function, and chronic rejection incidence, but differed in mean donor age (44.1 vs 36.0 years), mean recipient age (45.4 vs 39.1 years), living/cadaveric donor rate (19.8% vs 11.9%), arterial lesions and bench reconstruction rate (11.1 vs 3.5%), as well as acute rejection episodes (11.7% vs 29.2%). Complications were seen in nine patients in group B (1.5%) and 17 patients in group A (4.1%) (P < .0001). Urinary leaks presented in two patients in group B (0.3%) and 11 patients in Group A (2.6%; P < .0001), while stenosis was present in six patients in group B (1.5%) and 7 in group A (1.2%) (P = NS). Urological complications such as urinary tract infection and macroscopic hematuria were similar in both groups. Time to presentation of a leak was within 2 weeks from KT in 10 patients (92.3%), while stenosis presented early in four patients (one in group B and four in group A). Of the stenoses, 69.3% presented late (beyond 12 weeks) in five patients in group B and three in Group A. In conclusion, our data suggest that routine use of double pigtail ureteral stent significantly decreased the incidence of leaks and early stenoses, but it did not modify late stenosis incidence. In the last decade, risk factors for urological complications have been increasing over time, namely, older donors and older recipients, living donation, length of dialysis, and the use of grafts with arterial lesions. Therefore we believe that a ureteral stent should be routinely considered to afford the advantage to protect the urinary anastomosis in the early postoperative period when the incidence of complications is highest, without the need of cystoscopy for its removal.
- Published
- 2005
- Full Text
- View/download PDF
25. Is lymphocele in renal transplantation an avoidable complication?
- Author
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Sansalone CV, Aseni P, Minetti E, Di Benedetto F, Rossetti O, Manoochehri F, Vertemati M, Giacomoni A, Civati G, and Forti D
- Subjects
- Adult, Age Factors, Anastomosis, Surgical adverse effects, Anastomosis, Surgical methods, Female, Graft Rejection classification, Graft Survival, Hospitalization, Humans, Iliac Artery surgery, Iliac Vein surgery, Incidence, Length of Stay, Lymphocele etiology, Lymphocele surgery, Male, Peritoneum surgery, Polycystic Kidney Diseases surgery, Prospective Studies, Time Factors, Tissue Donors, Tissue Preservation, Kidney Transplantation adverse effects, Lymphocele prevention & control
- Abstract
Background: This study evaluated the impact of surgery in the incidence of lymphocele after kidney transplantation (KTx)., Methods: A prospective randomized study was conducted during a 6-year period on a group of patients undergoing KTx and operated on by the same surgeon (CVS). A total of 280 patients undergoing KTx were randomly allocated into two groups: (1) group C (control group) was 140 patients who were submitted to KTx with standard technique: implantation of the kidney in the controlateral iliac fossa with vascular anastomoses on the external iliac vessels; and (2) group M (modified technique group) was 140 patients who underwent a modified technique with a cephalad implantation of the graft in the ipsilateral iliac fossa and vascular anastomoses in the common iliac vessels. Both groups were comparable for age, cold ischemia time, incidence of rejection episodes, presence of adult polycystic kidney disease, and source of donor graft., Results: Group M showed an incidence of lymphocele production (3 patients, 2.1%) significantly lower than group C (12 patients, 8.5%). Eight patients (1 in group M and 7 in group C) required surgical treatment by peritoneal fenestration. No allograft or recipient was lost as a result of fluid collection but the hospitalization was shorter in group M than in group C., Conclusions: A cephalad implantation of the renal graft in the ipsilateral iliac fossa has been associated with a lower incidence of lymphocele, probably because vascular anastomoses on the common iliac vessels cause less lymphatic derangement than those performed on the external iliac vessels.
- Published
- 2000
- Full Text
- View/download PDF
26. Marginal donors in liver transplantation: the role of donor age.
- Author
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De Carlis L, Colella G, Sansalone CV, Aseni P, Rondinara GF, Slim AO, Di Benedetto F, Giacomoni A, Fesce R, and Forti D
- Subjects
- Adolescent, Adult, Aged, Analysis of Variance, Bile metabolism, Child, Child, Preschool, Drug Therapy, Combination, Female, Histocompatibility Testing, Humans, Immunosuppressive Agents therapeutic use, Liver, Liver Transplantation immunology, Liver Transplantation mortality, Male, Middle Aged, Multivariate Analysis, Organ Preservation, Regression Analysis, Reoperation, Retrospective Studies, Survival Rate, Age Factors, Graft Survival, Liver Transplantation physiology, Tissue Donors statistics & numerical data
- Published
- 1999
- Full Text
- View/download PDF
27. Serum lipid changes in liver transplantation: effect of steroids withdrawn in a prospective randomized trial under cyclosporine A therapy.
- Author
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De Carlis L, Belli LS, Colella G, Rondinara GF, Slim AO, Alberti A, Aseni P, Sansalone CV, Pirotta V, Di Benedetto F, and Forti D
- Subjects
- Adrenal Cortex Hormones therapeutic use, Adult, Azathioprine therapeutic use, Cholesterol blood, Cyclosporine pharmacokinetics, Drug Administration Schedule, Female, Follow-Up Studies, Graft Rejection blood, Graft Rejection prevention & control, Humans, Immunosuppressive Agents pharmacokinetics, Lipoproteins blood, Liver Transplantation immunology, Male, Middle Aged, Postoperative Complications classification, Triglycerides blood, Adrenal Cortex Hormones administration & dosage, Cyclosporine therapeutic use, Immunosuppressive Agents therapeutic use, Lipids blood, Liver Transplantation physiology
- Published
- 1999
- Full Text
- View/download PDF
28. Enteric versus bladder drainage in pancreas transplantation: initial experience at Niguarda Hospital, Milan.
- Author
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Sansalone CV, Aseni P, Follini ML, Slim AO, Rossetti O, Colella G, Di Benedetto F, Rondinara GF, De Carlis L, Brunati C, Meroni A, Rombolà G, Civati G, and Forti D
- Subjects
- Adult, Drainage, Female, Humans, Male, Middle Aged, Ileum surgery, Pancreas Transplantation methods, Urinary Bladder surgery
- Published
- 1998
- Full Text
- View/download PDF
29. Early pancreas retransplantation for vascular thrombosis in simultaneous pancreas-kidney transplants.
- Author
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Sansalone CV, Aseni P, Follini ML, Rossetti O, Slim AO, Colella G, Di Benedetto F, Rombolà G, Rondinara GF, De Carlis L, Brunati C, Meroni A, Confalonieri R, Civati G, and Forti D
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Postoperative Complications surgery, Time Factors, Diabetes Mellitus surgery, Kidney Transplantation, Pancreas Transplantation, Thrombosis surgery
- Published
- 1998
- Full Text
- View/download PDF
30. Left thoracic approach for cancer of cardia: early and late results.
- Author
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De Carlis L, Zurleni F, Ballabio A, Pirotta V, Rondinara G, Sansalone CV, Colella G, Slim AO, Meroni A, Belli L, and Forti D
- Subjects
- Adenocarcinoma mortality, Adult, Aged, Aged, 80 and over, Cardia surgery, Female, Follow-Up Studies, Humans, Lymph Node Excision, Male, Middle Aged, Neoplasm Staging, Postoperative Complications, Retrospective Studies, Stomach Neoplasms mortality, Survival Analysis, Thoracotomy methods, Adenocarcinoma surgery, Gastrectomy methods, Stomach Neoplasms surgery
- Abstract
Background: The surgical treatment of cancer of the cardia is controversial and results are often disappointing. Concern exists not only with regards to the surgical approach but also to the extent of the resection. The authors analyze their experience over a 20-year period adopting almost exclusively a "limited" esophagogastrectomy with a wide regional lymphadenectomy through a left thoracotomy. The aim of the study is to determine if this approach actually plays a role in the treatment of this tumor., Methods: 148 patients were evaluated for cardial cancer. Of these 22 (14.8%) were not resectable and 6 (4%) received other types of resections for technical reasons. 120 patients are the basis of the present analysis. More than 75% of patients were in stage III or IV. Follow-up was completed in 92.5% of cases; all surviving patients had at least 5 years of follow-up., Results: Four (3.3%) patients died in the postoperative period. In 6 cases (5%) an anastomotic leakage occurred and this caused the death of 2 patients. Nine (7.5%) patients had severe pulmonary complications. Dysphagia was relieved in all non complicated patients. 13 (10.8%) patients had anastomotic recurrence. Overall survival rate after 5 years was 25.62 +/- 6.1%. A significant difference in survival was noted in patients at stages II and III after 5 years (61.3% vs 18.6, p < 0.02)., Conclusions: This operation has proved to be a good option providing satisfying long-term results and a lower incidence of complications if compared with more extended procedures. It can be performed in the majority of patients with carcinoma of the cardia with a low mortality and morbidity and with excellent palliation of dysphagia. In our opinion it remains an optimum treatment for cardial cancer.
- Published
- 1997
31. Is hepatocellular carcinoma in cirrhosis an actual indication for liver transplantation?
- Author
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Colella G, De Carlis L, Rondinara GF, Sansalone CV, Belli LS, Aseni P, Slim AO, Gelosa F, Iamoni GM, Corti A, Mazza E, Arcieri K, Giacomoni A, Minola E, Ideo G, and Forti D
- Subjects
- Actuarial Analysis, Adult, Carcinoma, Hepatocellular complications, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular pathology, Cause of Death, Female, Humans, Liver Cirrhosis mortality, Liver Cirrhosis surgery, Liver Neoplasms complications, Liver Neoplasms mortality, Liver Neoplasms pathology, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Retrospective Studies, Survival Rate, Time Factors, Carcinoma, Hepatocellular surgery, Liver Cirrhosis complications, Liver Neoplasms surgery, Liver Transplantation mortality
- Published
- 1997
- Full Text
- View/download PDF
32. Early steroid withdrawal in liver transplant patients: final report of a prospective randomized trial.
- Author
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De Carlis L, Belli LS, Rondinara GF, Alberti A, Sansalone CV, Colella G, Aseni P, Slim AO, and Forti D
- Subjects
- Adult, Cholesterol blood, Diabetes Mellitus epidemiology, Drug Administration Schedule, Female, Graft Rejection epidemiology, Humans, Hypertension epidemiology, Immunosuppressive Agents therapeutic use, Liver Diseases surgery, Male, Middle Aged, Patient Selection, Postoperative Complications epidemiology, Prospective Studies, Steroids therapeutic use, Immunosuppressive Agents administration & dosage, Liver Transplantation immunology, Steroids administration & dosage
- Published
- 1997
- Full Text
- View/download PDF
33. Is the use of marginal donors justified in liver transplantation? Analysis of results and proposal of modern criteria.
- Author
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De Carlis L, Sansalone CV, Rondinara GF, Colella G, Slim AO, Rossetti O, Aseni P, Della Volpe A, Belli LS, Alberti A, Fesce R, and Forti D
- Subjects
- Adolescent, Adult, Aged, Child, Child, Preschool, Humans, Middle Aged, Retrospective Studies, Liver Transplantation, Tissue Donors
- Abstract
A discrepancy exists worldwide between the number of suitable liver donors and the increasing demand for transplantation. Thus many centers have considered widening their liver donor acceptance criteria and this may increase the incidence of primary dysfunction (PD) with negative effect on the results of transplantation. In order to reduce the incidence of PD and improve patient and graft survival it becomes important to identify those risk factors associated with its occurrence. In a retrospective univariate and multivariate analysis we evaluated several donor, preservation and recipient parameters and their correlation with PD. In our Department 282 orthotopic liver transplantations (OLT) were performed on 256 adult patients over a 10-year period. Excluded were 15 cases with early vascular problems and 4 intraoperative deaths. A complete series of donor, recipient and procedure-related data were analyzed. About 30% of donors showed abnormal values. In 70 cases of PD (26%) there was a 61.4% graft failure rate compared with 15% in the group with immediate function (P < 0.05). Univariate analysis showed donor age, steatosis, ischemia time, amines, oliguria, hypotension and ICU stay to be significantly associated with PD. Multivariate analysis showed steatosis, ischemia time and amine dosage to be independent risk factors for the development of primary non function. In conclusion, the acceptance of marginal donors worsened the results of transplantation, but the rejection of these donors would reduce by about 30% our transplant activity resulting in increased mortality in the waiting list. Combinations of risk factors when possible should be avoided, and ischemia time, as the only variable that can be controlled, should be kept as short as possible.
- Published
- 1996
- Full Text
- View/download PDF
34. Milan multicenter experience in liver transplantation for hepatocellular carcinoma.
- Author
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Mazzaferro V, Rondinara GF, Rossi G, Regalia E, De Carlis L, Caccamo L, Doci R, Sansalone CV, Belli LS, and Armiraglio E
- Subjects
- Adolescent, Adult, Analysis of Variance, Carcinoma, Hepatocellular pathology, Disease-Free Survival, Female, Follow-Up Studies, Humans, Italy, Liver Neoplasms pathology, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Survival Rate, Time Factors, Carcinoma, Hepatocellular surgery, Liver Neoplasms surgery, Liver Transplantation mortality
- Published
- 1994
35. Iliac artery graft interposition in liver transplantation: our experience in 72 cases.
- Author
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Sansalone CV, Colella G, Rondinara GF, Rossetti O, De Carlis L, Belli LS, Meroni A, Della Volpe A, Trojsi C, and Belli L
- Subjects
- Acute Disease, Adult, Anastomosis, Surgical, Aspartate Aminotransferases blood, Blood Loss, Surgical, Chronic Disease, Graft Rejection epidemiology, Hepatic Artery surgery, Humans, Ischemia, Liver Transplantation mortality, Liver Transplantation physiology, Middle Aged, Morbidity, Prothrombin analysis, Reoperation, Retrospective Studies, Iliac Artery transplantation, Liver Transplantation methods
- Published
- 1994
36. Pattern of recurrence of hepatocellular carcinoma after liver transplantation: Milan multicenter experience.
- Author
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Regalia E, Sansalone C, Mazzaferro V, Reggiani P, Rondinara GF, Lucianetti A, Pulvirenti A, De Carlis L, Paone G, and Belli L
- Subjects
- Adrenal Gland Neoplasms pathology, Adrenal Gland Neoplasms secondary, Bone Neoplasms pathology, Bone Neoplasms secondary, Brain Neoplasms pathology, Brain Neoplasms secondary, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular pathology, Follow-Up Studies, Humans, Italy, Liver Neoplasms mortality, Liver Neoplasms pathology, Lung Neoplasms pathology, Lung Neoplasms secondary, Middle Aged, Neoplasm Recurrence, Local, Neoplasm Staging, Survival Rate, Time Factors, Carcinoma, Hepatocellular surgery, Liver Neoplasms surgery, Liver Transplantation mortality, Liver Transplantation pathology
- Published
- 1994
37. Right hepatic artery replacement from superior mesenteric artery in combined liver-whole pancreas procurement. Technical problems and liver graft artery reconstruction.
- Author
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Sansalone CV, De Carlis L, Rondinara GF, Colella G, Rossetti O, Slim AO, Aseri P, Pirotta V, Meroni A, and Ballabio A
- Subjects
- Acute Disease, Adult, Aspartate Aminotransferases, Blood Loss, Surgical, Chronic Disease, Graft Rejection epidemiology, Humans, Liver Transplantation physiology, Pancreas, Retrospective Studies, Tissue Donors, Anastomosis, Surgical, Hepatic Artery surgery, Liver Transplantation methods, Mesenteric Arteries surgery
- Published
- 1994
38. Modified duct-to-duct reconstruction after orthotopic liver transplantation: early and long-term results in 230 procedures.
- Author
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De Carlis L, Rondinara GF, Arcidiacono R, Rossi A, Sansalone CV, Rossetti O, Romani F, Ballabio A, Colella G, and Belli LS
- Subjects
- ABO Blood-Group System, Adult, Anastomosis, Surgical, Cholangiography, Follow-Up Studies, Humans, Immunosuppression Therapy methods, Retrospective Studies, Time Factors, Bile Ducts surgery, Liver Transplantation methods, Postoperative Complications epidemiology
- Published
- 1994
39. Orthotopic liver transplantation for primary biliary tumors: Milan multicenter experience.
- Author
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Sansalone CV, Colella G, Caccamo L, Rondinara GF, Fassati LR, Rossetti O, De Carlis L, Galmarini D, Aseni P, and Mazzaferro V
- Subjects
- Actuarial Analysis, Adult, Analysis of Variance, Carcinoma, Hepatocellular pathology, Cholangiocarcinoma pathology, Disease-Free Survival, Female, Follow-Up Studies, Gallbladder Neoplasms pathology, Humans, Italy, Liver Neoplasms pathology, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Invasiveness, Survival Rate, Time Factors, Carcinoma, Hepatocellular surgery, Cholangiocarcinoma surgery, Gallbladder Neoplasms surgery, Liver Neoplasms surgery, Liver Transplantation mortality
- Published
- 1994
40. Cyclosporin monotherapy (after 3 months) in liver transplant patients: a prospective randomized trial.
- Author
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Romani F, Belli LS, De Carlis L, Rondinara GF, Alberti A, Sansalone CV, Bellati G, Zavaglia C, Fesce E, and Ideo G
- Subjects
- Acute Disease, Adult, Chronic Disease, Cyclosporine adverse effects, Female, Graft Rejection epidemiology, Humans, Immunosuppression Therapy adverse effects, Incidence, Liver Transplantation mortality, Male, Middle Aged, Survival Rate, Cyclosporine therapeutic use, Liver Transplantation immunology, Steroids therapeutic use
- Published
- 1994
41. Prospective randomized trial of steroid withdrawal in liver transplant patients: preliminary report.
- Author
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Belli LS, De Carlis L, Rondinara GF, Romani F, Alberti A, Pirotta V, Sansalone CV, Riolo F, Rossetti O, Slim OA, Aseni P, Ideo G, and Belli L
- Subjects
- Adult, Antilymphocyte Serum therapeutic use, Azathioprine therapeutic use, Cyclosporine blood, Cyclosporine therapeutic use, Drug Administration Schedule, Drug Therapy, Combination, Female, Follow-Up Studies, Glucocorticoids administration & dosage, Glucocorticoids therapeutic use, Humans, Liver Transplantation mortality, Male, Methylprednisolone administration & dosage, Middle Aged, Postoperative Complications, Prednisone administration & dosage, Prospective Studies, Survival Rate, Time Factors, Immunosuppressive Agents therapeutic use, Liver Transplantation immunology, Methylprednisolone therapeutic use, Prednisone therapeutic use
- Abstract
Although steroid withdrawal has been successfully performed in heart and kidney transplant recipients, no controlled studies of SW have been carried out in liver transplant patients. To evaluate this possibility a prospective controlled study was carried out in 46 liver transplant recipients operated on after may 1991. They all received a sequential quadruple immunosuppression consisting of 3 mg/kg antithymocyte globulins (RATG) for the first 5 postoperative days, cyclosporin A (starting from day 3-5 and maintaining parenteral whole-blood trough levels at 200-300 ng/ml during the first month and at 150-250 thereafter), azathioprine (1 mg/kg per day for the first month) and steroids. Prednisone was started at a dose of 200 mg per day 1 and then tapered to 20 mg/day over the first posteroperative week; this dose was maintained until day 90 when the patients were randomly allocated either to long-term steroid therapy (0.1 mg/kg per day) or to steroid withdrawal. Minimum follow-up after randomization was 6 months (6-27 months). Liver biochemistry was checked at regular intervals throughout the follow-up period. Liver biopsies were performed whenever clinically indicated and also in the first 19 patients during readmission for annual review. The incidence ot acute and chronic rejection 90 days from liver transplantation was 2.5% in patients maintained on long-term therapy. No patient in the steroid-withdrawal group had experienced either an acute or a chronic rejection episode so far. Steroid-related complications did not differ significantly between the two groups. The most recent interim analysis showed that steroid withdrawal is a safe undertaking in liver transplant recipients and may be successfully accomplished in almost all patients.
- Published
- 1994
- Full Text
- View/download PDF
42. Splenic artery steal syndrome after orthotopic liver transplantation: diagnosis and treatment.
- Author
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De Carlis L, Sansalone CV, Rondinara GF, Belli LS, Rimoldi P, Romani F, Puttini M, Meroni A, Riolo F, and Rossetti O
- Subjects
- Graft Rejection pathology, Humans, Postoperative Complications therapy, Reoperation, Retrospective Studies, Syndrome, Vascular Diseases etiology, Liver Transplantation pathology, Postoperative Complications diagnosis, Spleen blood supply, Splenic Artery, Vascular Diseases diagnosis, Vascular Diseases therapy
- Published
- 1993
43. The role of spontaneous portosystemic shunts in the course of orthotopic liver transplantation.
- Author
-
De Carlis L, Del Favero E, Rondinara G, Belli LS, Sansalone CV, Zani B, Cazzulani A, Brambilla G, Rampoldi A, and Belli L
- Subjects
- Adult, Female, Humans, Hypertension, Portal diagnostic imaging, Hypertension, Portal physiopathology, Liver Circulation physiology, Liver Cirrhosis diagnostic imaging, Liver Cirrhosis physiopathology, Liver Cirrhosis surgery, Male, Middle Aged, Portal System diagnostic imaging, Radiography, Liver Transplantation physiology, Portal System physiopathology
- Abstract
Spontaneous portosystemic shunts are commonly found in cirrhotic patients. Not yet established is their role after orthotopic liver transplantation (OLTx), especially when an increase in portal pressure develops, as during early acute rejection. In this study, 34 cirrhotic patients in a series of 70 OLTx are considered. Each patient had preoperative angiographic assessment, and, in 21 (62%), large spontaneous portosystemic shunts were evident. In 12 cases the shunts were not affected by the surgical procedure and were present during the postoperative period; in 9 the hepatectomy itself involved interruption of the shunts. The patient population was divided into two groups: patients with postoperative shunts (n = 12) and those without (n = 22). The two groups were similar in age, sex, Child's stage, transplantation variables, and number and grade of rejection episodes. However, mean transaminases (AST) values in the first 2 weeks were significantly higher levels in shunt versus nonshunt patients (421 +/- 335 vs 183 +/- 126; P less than 0.025), and this was even more evident when rejection occurred (626 +/- 375 vs 195 +/- 129; P less than 0.001). Furthermore, during an acute rejection reaction, three cases showed a true "steal phenomenon" through the large reopened shunts with ischemic damage to the grafts. The data indicate a possible detrimental effect of the spontaneous shunts on graft perfusion and suggest the prophylactic surgical interruption of the residual shunts during the transplantation.
- Published
- 1992
- Full Text
- View/download PDF
44. Massive hemorrhagic hepatic graft necrosis secondary to diversion of portal blood flow during a rejection reaction: report of a case.
- Author
-
Del Favero E, De Carlis L, Rondinara GF, Belli LS, Sansalone CV, Romani F, Tommasini DC, Brambilla G, Rampoldi A, and De Gasperi A
- Subjects
- Adult, Carcinoma, Hepatocellular surgery, Humans, Liver Neoplasms surgery, Liver Transplantation immunology, Male, Necrosis, Graft Rejection, Hemorrhage etiology, Liver Transplantation pathology, Portal System
- Published
- 1990
45. Selection criteria for liver transplantation: preliminary experience of Niguarda Hospital, Milan.
- Author
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De Carlis L, Belli LS, Romani F, Aseni P, Baticci F, Sansalone CV, Zurleni F, Riolo F, Forti D, and Rondinara GF
- Subjects
- Follow-Up Studies, Humans, Italy, Liver Diseases surgery, Liver Neoplasms surgery, Mortality, Liver Transplantation
- Published
- 1989
46. Portal thrombosis in cirrhotics. A retrospective analysis.
- Author
-
Belli L, Romani F, Sansalone CV, Aseni P, and Rondinara G
- Subjects
- Adult, Aged, Angiography, Esophageal and Gastric Varices complications, Female, Gastrointestinal Hemorrhage complications, Humans, Hypertension, Portal etiology, Liver Cirrhosis, Alcoholic complications, Male, Middle Aged, Portasystemic Shunt, Surgical, Recurrence, Retrospective Studies, Rupture, Spontaneous, Thrombosis diagnosis, Thrombosis surgery, Liver Cirrhosis complications, Portal System, Thrombosis etiology
- Abstract
The development of thrombotic obstruction in the portal bed of cirrhotic patients presents special problems in diagnosis and treatment. In the cirrhotic population treated for portal hypertension at our Surgical Department during the period 1967-1983 (512 patients), the incidence of thrombosis in the portal bed was 16.6% (85 patients). Bleeding was the main presenting symptom (70/85), with a mean of four episodes prior to treatment. Careful angiographic studies and intraoperative evaluation are fundamental steps to determine the exact anatomical involvement, the presence of recanalized veins or fresh occluding clots, and the applicability of shunt procedures. A massive portosplenomesenteric involvement often associated with poor surgical possibilities was found in 19 patients (22.3%). The presence of partially recanalized veins and fresh occluding clot suitable for disobliterative techniques prior to shunt was found in 16 patients, and out of 73 operated patients a total of 55 shunt procedures could be performed. Fifty-three patients who bled from varices could be followed up to 5 years: 39 underwent a shunt procedure with a 51.2% 5-year survival rate, while only one of 14 nonshunted or nonoperated survived up to 3 years, and a lethal bleeding was the cause of death in all but one. Disobliterative techniques (Fogarty thrombectomy and endovenectomy of intimal fibrotic thickenings) prior to shunting provided a good long-term patency rate with a 50% protection from lethal bleeding recurrences. Nonshunt procedures and the extensive involvement of the portal bed are associated with bad prognosis. Also, endoscopic sclerotherapy, attempted in patients with massive thrombosis, could not prevent recurrences and death from bleeding. Despite a 30% failure rate in our study, shunting surgery should be considered the only therapeutical possibility of preventing further thrombotic recurrences and consequent life threatening bleeding episodes.
- Published
- 1986
- Full Text
- View/download PDF
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