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8. Surgical management of acute pancreatitis in Italy: lessons from a prospective multicentre study

Author

De Rai, Paolo, Zerbi, Alessandro, Castoldi, Laura, Bassi, Claudio, Frulloni, Luca, Uomo, Generoso, Gabbrielli, Armando, Pezzilli, Raffaele, Cavallini, Giorgio, Di Carlo, Valerio, Agugiaro, S., Turri, L., Bartoli, A., Barberini, F., Cavazzoni, G., Bartolo, F., Della Papa, D., Bassi, N., Massani, M., Benedetti, A., Macarri, G., Piergallini, L., Briani, G., Bartolasi, L., Bugnano, L., Buonanno, G. M., Esposito, C., Cordovana, A., Cavina, E., Seccia, M., Lippolis, P., Musco, B., Barletta, M., Chilovi, E., De Guelfi, A., Chirletti, P., Caronna, R., Scozzafava, S., Cardi, M., Cirino, E., Buffone, A., Colangelo, E., Caracino, V., Cortese, F., Casentini, A., Costamagna, G., Trincali, A., Curzio, M., Clivio, S., Segato, S., D'Alessandro, A., Ambrosiani, V., D'Ambrosio, B., Chiodo, C., Dicillo, M., Reale, L., Grandolfo, A., Fabbrucci, P., Bruscino, A., Mugnaini, P., Ferrarese, S., Ugenti, I., Forte, G. B., Rocco, P., Franzè, A., Bertelè, A., Sereni, G., Friedman, Daniele, Mariani, L., Morelli, F., Gai, V., Antro, C., Garcea, D., Gardini, A., Lucci, E., Giulianotti, P. C., Sbrana, F., Balestracci, T., Giulini, S. M., Pellizzari, A., Ronconi, M., Cimaschi, S., Grassini, M., Lacignola, S., Calandro, L., Mazzitelli, L., Costarella, S. M., Egidio, A., Mello Teggia, P., Stefano, E., Cassini, P., Modica, G., Lupo, F., Giraci, G., Mosca, F., Del Chiaro, M., Mosella, G., Benassai, G., Nanni, M., D'Aristotile, A., Negro, P., Pirazzoli, A., Rabitti, P. G., Romano, C., Gerardi, G., Troianello, B., Russello, D., Di Stefano, A., Avelli, S., Salval, N., Bellini, N., Scalon, P., Staudacher, C., Parolini, D., Strazzabosco, M., Signorelli, S., Tedeschi, U., Testoni, P. A., Masci, E., Mariani, A., Torelli, E., Garcea, M. R., Lombardi, V., Lecconi, L., Valeri, L., Presenti, L., Alessio, F., Ventrucci, M., Virzi, S., Cipolla, A., De Rai, P, Zerbi, A, Castoldi, L, Bassi, C, Frulloni, L, Uomo, G, Gabbrielli, A, Pezzilli, R, Cavallini, G, Di Carlo, V, Proinf, Aisp, and Testoni, PIER ALBERTO

Subjects
Male, Time Factors, Pancreatitis, Alcoholic, medicine.medical_treatment, Acute pancreatitis, Surgery, Aged, Biliary Tract Diseases, Chi-Square Distribution, Cholangiopancreatography, Endoscopic Retrograde, Cholecystectomy, Laparoscopic, Female, Guideline Adherence, Humans, Italy, Pancreatitis, Pancreatitis, Acute Necrotizing, Practice Guidelines as Topic, Prospective Studies, Risk Assessment, Risk Factors, Severity of Illness Index, Treatment Outcome, Cholecystectomy, Jejunostomy, Pancreatectomy, Practice Patterns, Physicians', Hepatology, Gastroenterology, Physician's Practice Patterns, Practice Patterns, surgery, Endoscopic Retrograde, Medicine, Cholangiopancreatography, Laparoscopic, Acute Necrotizing, Alcoholic, Prospective cohort study, health care economics and organizations, acute pancreatitis, Corrigendum, Risk assessment, medicine.medical_specialty, education, Severity of illness, Intensive care medicine, Physicians', business.industry, General surgery, Original Articles, medicine.disease, business
Abstract

OBJECTIVE: This study aimed to evaluate the surgical treatment of acute pancreatitis in Italy and to assess compliance with international guidelines. METHODS: A series of 1173 patients in 56 hospitals were prospectively enrolled and their data analysed. RESULTS: Twenty-nine patients with severe pancreatitis underwent surgical intervention. Necrosectomy was performed in 26 patients, associated with postoperative lavage in 70% of cases. A feeding jejunostomy was added in 37% of cases. Mortality was 21%. Of the patients with mild pancreatitis, 714 patients with a biliary aetiology were evaluated. Prophylactic treatment of relapses was carried out in 212 patients (36%) by cholecystectomy and in 161 using a laparoscopic approach. Preoperative endoscopic retrograde cholangiopancreatography was associated with cholecystectomy in 83 patients (39%). Forty-seven patients (22%) were treated at a second admission, with a median delay of 31 days from the onset of pancreatitis. Eighteen patients with severe pancreatitis underwent cholecystectomy 37.9 days after the first admission. There were no deaths. DISCUSSION: The results indicate poor compliance with published guidelines. In severe pancreatitis, early surgical intervention is frequently performed and enteral feeding is seldom used. Only a small number of patients with mild biliary pancreatitis undergo definitive treatment (i.e. cholecystectomy) within 4 weeks of the onset of pancreatitis.

Published
2010
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10. Diagnostic assessment and outcome of acute pancreatitis in Italy: results of a prospective multicentre study. ProInf-AISP: Progetto informatizzato pancreatite acuta, Associazione Italiana Studio Pancreas, phase II

Author

Uomo, G, Pezzilli, R., Gabbrielli, A., Castoldi, L., Zerbi, A., Frulloni, L., De Rai, P., Cavallini, G., Di Carlo, V., Agugiaro, S., Turri, L., Bartoli, A., Barberini, F., Cavazoni, G., Bartolo, F., Della Papa, D., Bassi, C., Bassi, N., Massani, M., Benedetti, A., Macarri, G., Piergallini, L., Briani, G., Bartolasi, L., Brugnano, L., Buonanno, G. M., Esposito, C., Cardovana, A., Cavina, E., Seccia, M., Lipollis, P., Musco, B., Barletta, M., Chilovi, E., De Guelmi, A., Chirletti, P., Caronna, R., Scozzafava, S., Cardi, M., Cirrino, E., Buffone, A., Colangelo, E., Caracino, V., Cortese, F., Cosentini, A., Costamagna, G., Tringali, A., Curzio, M., Clivio, S., Segato, S., D'Alessandro, A., Ambrosini, V., D'Amborsio, B., Chiodo, C., Dicillo, M., Reale, L., Grandolfo, A., Fabbrucci, P., Bruscino, A., Mugnaini, P., Ferrarese, S., Ugenti, I., Forte, G. B., Rocco, P., Franzè, A., Bertelè, A., Sereni, G., Friedman, Daniele, Mariani, L. M., Murelli, Federica, Gai, V., Antro, C., Garcea, D., Gardini, A., Lucci, E., Giulianotti, P. C., Sbrana, F., Balestracci, T., Giulini, S. M., Pellizzari, A., Ronconi, M., Cimaschi, S., Grassini, M., Lacitignola, S., Caliandro, L., Mazzitelli, R., Costarella, S. M., Egidio, A., Mello Teggia, P., Stefano, E., Cassini, P., Modica, G., Lupo, F., Giraci, G., Mosca, F., Del Chiaro, M., Mosella, G., Benassai, G., Nanni, M., D'Aristotile, A., Negro, P., Pirazzoli, A., Rabitti, P. G., Romano, C., Gerardi, G., Troianello, B., Russello, D., Di Stefano, A., Avelli, S., Salvai, M., Bellini, N., Scalon, P., Staudacher, C., Parolini, D., Strazzabosco, M., Signorelli, S., Tedeschi, U., Testoni, P. A., Masci, E., Mariani, A., Torelli, E., Garcea, M. R., Lombardi, V., Cecconi, L., Valeri, A., Presenti, L., Alessio, F., Ventrucci, M., Virzì, S., and Cipolla, A.

Subjects
Adult, Male, Pancreatic necrosis, Severity of Illness Index, Body Mass Index, Acute Pancreatitis, Clinical outcome, Computed tomography, Diagnosis, Pancreatitis, Prognosis, Ultrasonography, Aged, Aged, 80 and over, Cholangiopancreatography, Endoscopic Retrograde, Creatinine, Female, Humans, Italy, Middle Aged, Prospective Studies, Treatment Outcome, Hepatology, Gastroenterology, Endoscopic Retrograde, 80 and over, treatment, Medicine (all), Cholangiopancreatography, acute pancreatitis, diagnosis
Abstract

Up till now, only one study providing practically complete information on acute pancreatitis in Italy has been published. The aim of this prospective study was to evaluate the clinical characteristics, in terms of diagnostic assessment and outcome, of a large series of patients affected by acute pancreatitis in Italy.The study involved 56 Italian centres, homogeneously distributed throughout the entire national territory. Each participating centre was furnished with an ad hoc software including 530 items along with subsequent collection, tabulation and quality control of the data.One thousand five hundred and forty case report forms of patients affected by acute pancreatitis were collected but 367 of them (24%) were subsequently eliminated from the final analysis. Therefore, 1173 patients (581 females and 592 males) were recruited. Mean age of patients was 62.0+/-18.2 years (95% confidence interval, 60.9-63.0). On the basis of Atlanta classification, 1006 patients (85.8%) were defined as mild and 167 (14.2%) as severe pancreatitis. Biliary forms represented the most frequent aetiological category (813 cases, 69.3%) while alcoholic forms only 6.6% (77 cases); the remaining aetiologies accounted for 7.1% (83 cases) while 200 cases (17.1%) remained without a definite aetiological factor. Complete recovery was achieved in 1016 patients (86.6%) whereas morphological sequelae were found in 121 patients (10.3%) and mortality in 36 patients (3.1%; 0.4% in mild and 19.2% in severe acute pancreatitis). Ultrasonography was largely utilised as a first line diagnostic tool in all patients, with valuable visualisation of the pancreas in 85% of patients. Computer tomography scan was also widely used, with 66.7% of exams in mild and 33.3% in severe pancreatitis. Patients affected by biliary pancreatitis presented more severe (p=0.004) and necrotizing forms (p=0.021). Mortality was significantly related (p0.001) with the extension of pancreatic necrosis and with an age of over 70 years. Body mass index presented significantly greater values in severe than in mild forms (p0.001).Association of creatinine serum level over 2mg/dl with an abnormal chest X-ray showed a high significant correlation with a more severe outcome in terms of morphological sequelae and mortality (p=0.0001). Acute pancreatitis in Italy more commonly presents biliary aetiology and favourable outcome with low rate of complications and mortality. From a cost-effectiveness standpoint, diagnostic approach to this disease needs to be better standardised.

Published
2007

11. A prospective multicentre survey on the treatment of acute pancreatitis in Italy

Author

Pezzilli, R, Uomo, G., Gabbrielli, A., Zerbi, A., Frulloni, L., De Rai, P., Castoldi, L., Cavallini, G., Di Carlo, V., Agugiaro, S., Turri, L., Bartoli, A., Barberini, F., Cavazoni, G., Bartolo, F., Della Papa, D., Bassi, C., Bassi, N., Massani, M., Benedetti, A., Macarri, G., Piergallini, L., Briani, G., Bartolasi, L., Brugnano, L., Buonanno, G. M., Esposito, C., Cardovana, A., Cavina, E., Seccia, M., Lipollis, P., Musco, B., Barletta, M., Chilovi, E., De Guelmi, A., Chirletti, Piero, Caronna, Roberto, Scozzafava, S., Cardi, Maurizio, Cirino, E., Buffone, A., Colangelo, E., Caracino, V., Cortese, F., Cosentini, A., Costamagna, G., Tringali, A., Curzio, M., Clivio, S., Segato, S., D'Alessandro, A., Ambrosini, V., D'Amborsio, B., Chiodo, C., Dicillo, M., Reale, L., Grandolfo, A., Fabbrucci, P., Bruscino, A., Mugnaini, P., Ferrarese, S., Ugenti, I., Forte, G. B., Rocco, P., Franzè, A., Bertelè, A., Sereni, G., Friedman, D., Mariani, L. M., Murelli, F., Gai, V., Antro, C., Garcea, D., Gardini, A., Lucci, E., Giulianotti, P. C., Sbrana, F., Balestracci, T., Giulini, S. M., Pellizzari, A., Ronconi, M., Cimaschi, S., Grassini, M., Lacitignola, S., Caliandro, L., Mazzitelli, R., Costarella, S. M., Egidio, A., Mello Teggia, P., Stefano, E., Cassini, P., Modica, G., Lupo, F., Giraci, G., Mosca, F., Del Chiaro, M., Mosella, G., Benassai, G., Nanni, M., D'Aristotile, A., Negro, P., Pirazzoli, A., Rabitti, P. G., Romano, C., Gerardi, G., Troianello, B., Russello, D., Di Stefano, A., Avelli, S., Salvai, M., Bellini, N., Scalon, P., Staudacher, C., Parolini, D., Strazzabosco, M., Signorelli, S., Tedeschi, U., Testoni, P. A., Masci, E., Mariani, A., Torelli, E., Garcea, M. R., Lombardi, V., Cecconi, L., Valeri, A., Presenti, L., Alessio, F., Ventrucci, M., Virzi, S., and Cipolla, A.

Subjects
Adult, Male, medicine.medical_specialty, ERCP, Pancreatitis, Pancreatitis acute necrotising, Aged, Aged, 80 and over, Analgesics, Anti-Bacterial Agents, Digestive System Surgical Procedures, Female, Histamine Antagonists, Humans, Italy, Middle Aged, Prospective Studies, Severity of Illness Index, Treatment Outcome, Medicine (all), Hepatology, Gastroenterology, Therapeutic approach, Internal medicine, Severity of illness, 80 and over, Medicine, Prospective cohort study, business.industry, medicine.disease, Surgery, medicine.anatomical_structure, Acute pancreatitis, Tramadol, business, Pancreas, medicine.drug
Abstract

The Italian Association for the Study of the Pancreas released a diagnostic and therapeutic algorithm for acute pancreatitis in 1999.This study focused on the analysis of the therapeutic approach for the treatment of acute pancreatitis in Italy.One thousand, one hundred and seventy-three patients were recruited: 1006 patients (85.8%) had mild acute pancreatitis (MAP) and 167 (14.2%) had the severe acute pancreatitis (SAP); 161 patients showed pancreatic necrosis at computed tomography; 121 patients (10.3%) had sequelae and 36 (3.1%) died.Non-steroidal anti-inflammatory drugs and tramadol were used more frequently in patients with the MAP whereas opioids and the association schedules were used more frequently in patients with the SAP (P0.001). Gabexate mesilate was utilised in 831 out of 1173 patients (70.8%); in particular, gabexate mesilate was used in 70.6% patients with MAP and in 73.1% of those with SAP (P=0.521). The duration of the drug administration was significantly shorter in those having MAP than in those having the SAP (P0.001). The antibiotics most frequently used for the prophylaxis against infection from pancreatic necrosis (43.1%) were carbapenems. Only a small number of patients received enteral nutrition (4.7%). Endoscopic retrograde cholangiopancreatography was carried out in 344 of the 1173 patients (29.3%). Surgery was performed in 48 with SAP (19 had elective biliary surgery and 29 had pancreatic surgery).The results of this survey indicate a lack of compliance with the guidelines which regard the indications mainly for interventional endoscopy and surgery.

Published
2007

13. Androgen receptor mRNA under-expression in poorly differentiated human hepatocellular carcinoma

Author

Tavian, D., Giuseppina De Petro, Pitozzi, A., Portolani, N., Giulini, S. M., and Barlati, S.

Subjects
AR mRNA, differential gene expression, human HCC, 6 - Ciencias aplicadas::61 - Medicina [CDU], Hepatocellular carcinoma, digestive system diseases, Tumoral differentiation
Abstract

Many studies suggest that hepatocellular carcinoma (HCC) is an androgen-dependent tumor with an incidence five times higher in males, but few data are available on the androgen receptor (AR) mRNA levels in different physiological classes of human liver specimens. In this study 108 human hepatic samples have been analyzed for AR mRNA expression by a comparative RT-PCR assay. These consisted of 35 non-tumoral hepatic samples (3 normal parenchymas, 4 steatosis, 10 hepatitis, 18 cirrhosis), 38 tumoral specimens derived from uninodular and multinodular HCCs and 35 peritumoral hepatic tissues. Normalized AR mRNA levels in tumoral and peritumoral liver tissues spanned from 0 to 146% and from 7 to 125% respectively. Only in a relatively small percentage of HCCs, the levels of expression of AR mRNA were higher than in the corresponding peritumoral tissues (16% of total HCCs). Although extremely variable, the AR mRNA levels were related to histological tumoral differentiation and proved to be lower in the highly dedifferentiated HCCs as compared to the well differentiated ones. Therefore, the evaluation of AR expression in HCC patients might be relevant for the planning of clinical studies on anti-androgen therapies, which might be useful only in the cases in which a high level of AR mRNA is detected, considering the high heterogeneity of AR mRNA levels which characterizes HCC samples. It is likely that the HCCs, expressing low or undetectable levels of AR mRNA, would not benefit by the antiandrogen therapy.

Published
2002

14. Phenotypic and functional characteristics of tumour-derived microvascular endothelial cells

Author

Alessandri G., Chirivi R. G. S., Fiorentini S., Dossi R., Bonardelli S., Giulini S. M., Zanetta G., Landoni F., Graziotti P. P., Turano A., Caruso A., Zardi L., Giavazzi R., Bani M. R., Alessandri, G, Chirivi, R, Fiorentini, S, Dossi, R, Bonardelli, S, Giulini, S, Zanetta, G, Landoni, F, Graziotti, P, Turano, A, Caruso, A, Zardi, L, Giavazzi, R, and Bani, M

Subjects
Vascular Endothelial Growth Factor A, Adhesion molecule, Mitogen, Endothelial Growth Factors, Endothelial Growth Factor, Antigens, CD, Lectins, Neoplasms, Proto-Oncogene Proteins, Tumour microvessel, von Willebrand Factor, Tumor Cells, Cultured, Humans, Receptors, Growth Factor, Endothelium, Cytokine, Platelet-Derived Growth Factor, Proto-Oncogene Protein, Lymphokines, Vascular Endothelial Growth Factor Receptor-1, Vascular Endothelial Growth Factors, Vascular Endothelial Growth Factor, Microcirculation, Interleukin-8, Receptor Protein-Tyrosine Kinases, Cadherins, VEGF, Receptor Protein-Tyrosine Kinase, Platelet Endothelial Cell Adhesion Molecule-1, Phenotype, Receptors, Vascular Endothelial Growth Factor, Cell Adhesion Molecule, Cadherin, Lymphokine, Neoplasm, Fibroblast Growth Factor 1, Fibroblast Growth Factor 2, Endothelium, Vascular, Mitogens, Plant Lectins, Lectin, Cell Adhesion Molecules, Cell Division, Human
Abstract

We recently developed a method for the isolation and purification of tumour-derived endothelium. In this study the phenotypic and functional properties of human tumour-derived microvascular endothelial cells (TdMEC) were examined. Endothelium obtained from human adrenal gland specimens (HAMEC) was used as a reference microvascular endothelial cell population. TdMEC formed a confluent monolayer with the typical morphological appearance of endothelium and were positive for endothelial markers such as Ulex-1 lectin, CD31 antigen, von Willebrand Factor and VE-cadherin. The addition of acidic Fibroblast Growth Factor (aFGF), basic FGF (bFGF) or Vascular Endothelial Growth Factor (VEGF) substantially improved proliferation of TdMEC; and kidney carcinoma derived endothelial cells were more responsive to FGFs, whereas glioblastoma derived endothelial cells greatly responded to VEGF. TdMEC expressed high levels of the VEGF receptors, KDR/flk-1 and Flt-1, as shown by northern blot analysis. TdMEC expressed the adhesion molecules ICAM-1, VCAM-1 and E-selectin that could be further increased by exposing TdMEC culture to interleukin-1. All the TdMEC expressed interleukin-8 mRNA. These findings show that TdMEC in vitro maintain several of the features described for microvasculature. Thus, TdMEC represent a useful tool to study markers for tumor vasculature

Published
2000

17. Imipenem/cilastatin (1.5 g daily) versus meropenem (3.0 g daily) in patients with intra-abdominal infections: Results of a prospective, randomized, multicentre trial

Author

Basoli, Antonio, Chirletti, Piero, Paolo, Mazzocchi, Vincenzo, Speranza, Lezoche, E., Guerrieri, M., Marrano, D., Minni, F., Giulini, S. M., Nodari, F., Brotzu, G., Loddo, P., Latteri, F., Scuderi, Gianluca, Rodolico, G., Cavallaro, L., Donini, I., Sortini, A., Tonelli, F., Spini, S., Natale, C., Musto, V., Vio, A., Verdecchia, G., Morgagni, D., Mariani, L., Montefusco, A., Gerosa, E., Tiberio, G., Nardone, A., Mazzeo, F., Benassai, G., D'Amico, D., Tropea, A., Piervittori, M., Becelli, S., Cazzaniga, M., Stagnitti, F., Crucitti, F., Pacelli, F., Gargiulo, A., Panichi, Giovanni, DI ROSA, Roberta, Porzio, R., Lombardi, U., Stipa, V., Chirletti, P., De Anna, D., Pisano, I., Armenio, S., Salvestrini, E., Baglioni, A., Iafrate, G., Donadio, F., Paron, L., Saccia, A., Di Girolamo, P., A., Basoli, E. Z., Meli, P., Mazzocchi, V., Speranza, E., Lezoche, M., Guerrieri, D., Marrano, F., Minni, S. M., Giulini, F., Nodari, G., Brotzu, P., Loddo, F., Latteri, G., Scuderi, G., Rodolico, L., Cavallaro, I., Donini, A., Sortini, F., Tonelli, S., Spini, C., Natale, V., Musto, A., Vio, G., Verdecchia, D., Morgagni, L., Mariani, A., Montefusco, E., Gerosa, G., Tiberio, Nardone, GERARDO ANTONIO PIO, F., Mazzeo, Benassai, Giacomo, D., Damico, A., Tropea, M., Piervittori, S., Becelli, M., Cazzaniga, F., Stagnitti, F., Crucitti, F., Pacelli, A., Gargiulo, G., Panichi, R., Dirosa, R., Porzio, U., Lombardi, V., Stipa, P., Chirletti, D., Deanna, I., Pisano, S., Armenio, E., Salvestrini, A., Baglioni, G., Iafrate, F., Donadio, L., Paron, A., Saccia, and P., Digirolamo

Subjects
Adult, Male, Microbiology (medical), Imipenem, Meropenem, law.invention, Randomized controlled trial, law, Abdomen, polycyclic compounds, medicine, Humans, Protease Inhibitors, Prospective Studies, Infusions, Intravenous, Prospective cohort study, APACHE, Aged, General Immunology and Microbiology, Cilastatin, business.industry, Imipenem/cilastatin, Bacterial Infections, General Medicine, Middle Aged, biochemical phenomena, metabolism, and nutrition, bacterial infections and mycoses, Anti-Bacterial Agents, Clinical trial, Treatment Outcome, Infectious Diseases, Tolerability, Anesthesia, Female, Thienamycins, business, medicine.drug
Abstract

30 citazioni su Scopus. 46 citazioni su GoogleScholar. ------ http://www.scopus.com/record/display.url?eid=2-s2.0-0347771343&origin=resultslist&sort=plf-f&src=s&sid=1BklTwBDkRxWaxt9FLi7YAz%3a70&sot=aut&sdt=a&sl=37&s=AU-ID%28%22Benassai%2c+Giacomo%22+6602920646%29&relpos=11&relpos=11&searchTerm=AU-ID(\"Benassai, Giacomo\" 6602920646) ------ An open-label prospective, randomized, parallel multicentre study was undertaken to compare the efficacy and tolerability of 1.5 g/day intravenous imipenem/cilastatin with 3 g/day intravenous meropenem in the treatment of intra-abdominal infections, A total of 287 patients mere enrolled; 201 patients, divided between the 2 treatment groups, were evaluable. Clinical outcome, bacteriological outcome, untoward microbiological effects, and clinical and laboratory adverse experiences mere evaluated, 98% of patients receiving imipenem/cilastatin therapy mere cured, with 96% showing eradication of infection, 95% of those on meropenem mere cured, with 98% showing eradication. These differences in clinical and bacteriological outcome between the 2 treatments were not statistically significant, Two patients receiving imipenem/cilastatin and 5 receiving meropenem had untoward microbiological effects. There mas a 0.7% frequency (1/139 patients) of possibly or probably drug-related clinical or laboratory adverse experiences with imipenem/cilastatin and a 2.7% frequency (4/148) with meropenem, The mean time to defervescence was significantly less for patients in the imipenem/cilastatin treatment group than for those receiving meropenem. This study shows that 1.5 g/day of imipenem/cilastatin is equivalent to 3.0 g/day meropenem in clinical and bacteriological outcome, as well as in incidence of side effects.

Published
1997

18. Surgery for obstructive lesions of the main trunk of the renal artery. A review of the literature and personal experience of 41 operated patients

Author

Giulini, S. M., Bonardelli, Stefano, Cangiotti, L., Nodari, F., Benzi, F., Portolani, Nazario, Tiberio, Guido Alberto Massimo, Coniglio, Arianna, and Tiberio, G.

Subjects
Adult, Aged, Angioplasty, Balloon, Female, Follow-Up Studies, Humans, Hypertension, Renovascular, Kidney Failure, Chronic, Male, Middle Aged, Renal Artery Obstruction, Time Factors, Hypertension, Renovascular, Kidney Failure, Chronic, Angioplasty, Balloon
Abstract

Today, surgical revascularization of the renal artery seems to maintain interest in the therapy of renovascular hypertension and chronic ischemic nephropathy because both medical therapy and angioplasty show limits and inconveniences. The authors present here their experience of 45 revascularized renal arteries in 41 patients and they discuss early and late morphological and functional results related to isolated arterial renal pathology (Group 1 of 23 patients) and associated to aorto-iliac pathology (Group 2 of 18 patients). Mortality related to arterial renal reconstruction was nil. There were 3/45 arteries (6.6%) with early thromboses and 4/32 (9.3%) with late thromboses. Early functional results, with respect to renovascular hypertension and/or chronic ischaemic renal insufficiency, showed 16/41 (39%) healed patients, 16/41 (39%) improved patients and 9/41 (22%) unvariated patients. Late results among 28 observed patients (average follow up at 49 months, range from 18 to 144 months) showed 14/28 (50%) healed patients, 11/28 (39%) improved patients and 3/28 (11%) unvariated patients. Results of the Group I were significantly better than results of Group 2 with regards to healed patients (p0.01) but not summarizing healed and improved cases. These data have been discussed in comparison with the Literature review of 46 references.

Published
1995

19. [Indications and short and medium time results of crossover bypasses in the treatment of obstructive arteriopathies of the lower limbs]

Author

Bonardelli, Stefano, Tiberio, Guido Alberto Massimo, Cangiotti, L., Coniglio, Arianna, Pulcini, G., Nodari, F., Codignola, C., Giulini, S. M., and Tiberio, G.

Subjects
Adult, Aged, 80 and over, Male, Leg, Time Factors, Polyethylene Terephthalates, Age Factors, Angiography, Arterial Occlusive Diseases, Middle Aged, Iliac Artery, Aged, 80 and over, Blood Vessel Prosthesis, Female, Femoral Artery, Follow-Up Studies, Humans, Polytetrafluoroethylene
Abstract

The authors evaluate the indications, the hemodynamical aspects, the short and medium term results over their track record of 49 crossover bypass (44 dacron and 5 PTFE grafts) performed between 1981 and 1993. Crossover bypass grafts were mainly inserted for unilateral iliac arterial disease in order to avoid aortic manipulation. This procedure was particularly selected when in presence of: young patients (60 years old), high surgical risk, poor run-off, high risk of prosthetic infection, thrombosis and/or infection of orthotopic grafts. 3 ilio-iliac, 27 iliofemoral, 18 femorofemoral and 1 femoropopliteal bypass have been performed. The postoperative resting pressure Index increase was highly significant in recipient limbs. There wasn't perioperative mortality; during the follow up (mean 24.4 months) no amputation of recipient limb was observed. 4 patients died of A.M.I. and 1 of neoplastic disease. Late cumulative patency rate was 81% at 2 years and 67.3% at 3 years. These values rise to 97.2% and 86.1% respectively when considering patients with "ideal" indication (excluding 7 patients operated on for complications of previous bypass grafts and 6 with extremely poor run-off). An accurate evaluation of the lesion topography and haemodynamic pattern of donor and recipient iliofemoral districts are stressed as key points for a correct surgical indication.

Published
1995

21. CLOSE RELATIONSHIP BETWEEN MEDIA TO LUMEN RATIO OF SUBCUTANEOUS SMALL ARTERIES AND WALL TO LUMEN RATIO OF RETINAL ARTERIOLES EVALUATED NON INVASIVELY BY SCANNING LASER DOPPLER FLOWMETRY

Author

Rizzoni, D., primary, De Ciuceis, C., additional, Porteri, E., additional, La Boria, E., additional, Duse, S., additional, Semeraro, F., additional, Costagliola, C., additional, Sebastiani, A., additional, Danzi, P., additional, Tiberio, G. A. M., additional, Giulini, S. M., additional, Agabiti Rosei, C., additional, Sarkar, A., additional, Avanzi, D., additional, and Agabiti Rosei, E., additional

Published
2011
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22. Phenotypic and functional characteristics of tumour-derived microvascular endothelial cells

Author

Alessandri, G, Chirivi, R, Fiorentini, S, Dossi, R, Bonardelli, S, Giulini, S, Zanetta, G, Landoni, F, Graziotti, P, Turano, A, Caruso, A, Zardi, L, Giavazzi, R, Bani, M, Alessandri G., Chirivi R. G. S., Fiorentini S., Dossi R., Bonardelli S., Giulini S. M., Zanetta G., Landoni F., Graziotti P. P., Turano A., Caruso A., Zardi L., Giavazzi R., Bani M. R., Alessandri, G, Chirivi, R, Fiorentini, S, Dossi, R, Bonardelli, S, Giulini, S, Zanetta, G, Landoni, F, Graziotti, P, Turano, A, Caruso, A, Zardi, L, Giavazzi, R, Bani, M, Alessandri G., Chirivi R. G. S., Fiorentini S., Dossi R., Bonardelli S., Giulini S. M., Zanetta G., Landoni F., Graziotti P. P., Turano A., Caruso A., Zardi L., Giavazzi R., and Bani M. R.

Abstract

We recently developed a method for the isolation and purification of tumour-derived endothelium. In this study the phenotypic and functional properties of human tumour-derived microvascular endothelial cells (TdMEC) were examined. Endothelium obtained from human adrenal gland specimens (HAMEC) was used as a reference microvascular endothelial cell population. TdMEC formed a confluent monolayer with the typical morphological appearance of endothelium and were positive for endothelial markers such as Ulex-1 lectin, CD31 antigen, von Willebrand Factor and VE-cadherin. The addition of acidic Fibroblast Growth Factor (aFGF), basic FGF (bFGF) or Vascular Endothelial Growth Factor (VEGF) substantially improved proliferation of TdMEC; and kidney carcinoma derived endothelial cells were more responsive to FGFs, whereas glioblastoma derived endothelial cells greatly responded to VEGF. TdMEC expressed high levels of the VEGF receptors, KDR/flk-1 and Flt-1, as shown by northern blot analysis. TdMEC expressed the adhesion molecules ICAM-1, VCAM-1 and E-selectin that could be further increased by exposing TdMEC culture to interleukin-1. All the TdMEC expressed interleukin-8 mRNA. These findings show that TdMEC in vitro maintain several of the features described for microvasculature. Thus, TdMEC represent a useful tool to study markers for tumor vasculature

Published
1999

23. Primary Aldosteronism May Induce Pronounced Changes in the Extracellular Matrix in Human Subcutaneous Small Resistance Arteries

Author

De Ciuceis, C., primary, Paiardi, S., additional, Rodella, L., additional, Rizzoni, D., additional, Porteri, E., additional, Rezzani, R., additional, Boari, G. E.M, additional, Zani, F., additional, Miclini, M., additional, Tiberio, G. A.M, additional, Giulini, S. M., additional, Bianchi, R., additional, and Rosei, E. Agabiti, additional

Published
2005
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26. Complete In Vitro Prosthesis Endothelialization Induced by Artificial Extracellular Matrix.

Author

Pollara, P., Alessandri, G., Bonardelli, S., Simonini, A., Cabibbo, E., Portolani, N., Tiberio, G. A. M., Giulini, S. M., and Turano, A.

Subjects
ENDOTHELIAL seeding, BLOOD vessel prosthesis
Abstract

This report presents our research on the conditions necessary to substain optimal in vitro prosthetic endothelialization using human endothelium cultures. Human vein endothelial cells were seeded at a concentration of 3 105/cm2 in a gelatinized Dacron patch graft coated with a commercial collagen film, using a solution of fibrin glue. Endothelium adhesion, proliferation, and survival were measured by \[3H]thymidine incorporation, after 7 days of incubation. Finally, the morphology of prosthetic endothelialization was analyzed by scanning electron microscopy. We observed that the Dacron patch grafts coated with collagen film were able to promote endothelialization better than the prostheses coated with highly concentrated collagen solution or gelatin. We therefore concluded that the collagen film that supports endothelial cell adhesion and proliferation uniformly covers the entire synthetic endoluminal surface of the Dacron graft, thus preventing endothelial cell alterations induced by direct contact with the synthetic prosthetic surface. [ABSTRACT FROM AUTHOR]

Published
1999
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27. Value and Limits of "Critical Auscultation" of Neck Bruits.

Author

Floriani, M., Giulini, S. M., Bonardelli, S., Portolani, N., Benvenuti, M., Pouchè, A., and Tiberio, G.

Subjects
AUSCULTATION, BLOOD pressure, BLOOD circulation disorders, NECK blood-vessels, PHYSICAL diagnosis, SYMPTOMS, CEREBROVASCULAR disease
Abstract

Within a group of 2,000 patients evaluated, most of them with symptoms of cerebrovascular insufficiency, 441 had a monolateral or bilateral cervical bruit. The 627 sides with an audible bruit were divided into main groups (A) symptomatic (TIA and/or stroke homolateral to the bruit), (B) possibly symptomatic (non-side-related symptoms), (C) asymptomatic (Cl, in totally asymptomatic patients; C2, in patients with symptoms dependent on the hemisphere contralateral to the cervical bruit). Each patient was studied by means of clinical (history, blood pressure in both upper limbs, phonoendoscopic auscultation at various levels) and noninvasive instrumental examinations (CW Doppler spectrum analysis). An apparently primitive cervical bruit corresponded to a lesion of the carotid bifurcation in 61% of the cases (positive predictive value) whereas a normal bifurcation was detected in 70% of the cases in which the cervical bruit was considered as secondary (negative predictive value); the diagnostic accuracy of the "critical auscultation" has a value therefore of 63%, with a sensitivity of 84% and a specificity of 40%. The results obtained in the different groups of patients (symptomatic or asymptomatic) were not significantly different (chisquare). Even though maintaining the value of a cervical bruit as a sign of carotid stenosis or occlusion and consequently conforming the importance of neck auscultation, the authors conclude that the critical auscultation as commonly performed is not capable of excluding the presence of a carotid lesion with sufficient reliability, even in totally asymptomatic patients. [ABSTRACT FROM AUTHOR]

Published
1988
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28. Arterial spontaneous rhythmic contractile activity in humans and rats: spectral analysis and regulatory mechanisms.

Author

Rizzoni, Damiano, Castellano, Maurizio, Porteri, Enzo, Bettoni, Giorgio, Muiesan, Paolo, Muiesan, Maria Lorenza, Giulini, Stefano Maria, Cinelli, Angelo, Salvetti, Massimo, Rosei, Enrico Agabiti, Rizzoni, D, Castellano, M, Porteri, E, Bettoni, G, Muiesan, P, Muiesan, M L, Giulini, S M, Cinelli, A, Salvetti, M, and Agabiti Rosei, E

Published
1995
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30. Blunt Trauma Injury of the Caval Junction A Case Treated with PTFE Patch Angioplasty.

Author

Cangiotti, L., Muiesan, P., Maffeis, R., Nodari, F., Giulini, S. M., and Tiberio, G.

Subjects
ILIAC artery, THROMBOSIS, BLOOD coagulation, BLUNT trauma, ABDOMEN, THROMBOEMBOLISM
Abstract

A case report of caval bifurcation injury associated with right common iliac artery thrombosis sustained after a blunt trauma to the abdomen is presented. Different problems are encountered in the management of this type of lesions. These are related to transportation, resuscitation techniques, and diagnosis and, in the operating room, to an adequate exposure, control of hemorrhage, and vascular reconstruction. A repair of the caval junction has been performed successfully using a polytetrafluoroethylene patch, avoiding stenosis of the lumen, and restoring blood flow in the vena cava. No complications such as thromboembolism have been reported and patency has been verified at a four month follow-up. [ABSTRACT FROM AUTHOR]

Published
1994
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31. Lymphatic endothelial cells derived from metastatic and non-metastatic lymph nodes of human colorectal cancer reveal phenotypic differences in culture

Author

Garrafa, E., Maria Antonia De Francesco, Solaini, L., Giulini, S. M., Bonfanti, C., Ministrini, S., Caimi, L., Tiberio, G. A. M., Garrafa, E, De Francesco, M, Solaini, L, Giulini, S M, Bonfanti, C, Ministrini, S, Caimi, L, and Tiberio, G A M

Subjects
tumor lymphatic endothelium, Endothelial Cell, lymphatic endothelial cells, tumor lymphatic endothelium, colorectal cancer, lymph node, metastasis, Lymphangiogenesi, Endothelial Cells, Lymphatic Metastasi, colorectal cancer, Colorectal Neoplasm, Cell Separation, lymph node, Intercellular Adhesion Molecule-1, Phenotype, lymphatic endothelial cells, Cell Movement, Lymphatic Metastasis, metastasis, Cytokines, Humans, Lymphangiogenesis, Colorectal Neoplasms, Cytokine, Cells, Cultured, Chemokine CCL2, Human
Abstract

Colorectal cancer is one of the most frequent causes of death in Western countries. Most patients develop metastasis traveling through the lymphatic system, and regional lymph node metastasis is considered a marker for dissemination, increased stage, and worse prognosis. Despite rapid advances in tumor biology, the processes that underpin lymphatic invasion and lymph node metastasis remain poorly understood. The aim of this study was to establish an easy protocol for isolation of pure tumor lymphatic endothelial cells derived from lymph nodes to study differences compared with normal endothelial cells of uninvolved tissue from the same patients. Cells were isolated with very high purity via magnetic cell sorting and express the specific lymphatic markers Prox-1 and Lyve-1. They show differences in expression of adhesion molecules, chemokines, and growth factor secretion, and capability to form capillaries when seeded on basal membrane, thereby, revealing important differences between the two cell type. These cultures may provide a promising platform for the comparative analysis of both cell types at the molecular and biological level and to optimize treatment strategies.

32. [Bilateral breast carcinoma. Considerations on 11 treated cases]

Author

Cervi, G. C., Coniglio, Arianna, Vittoria, A., Marini, G., Giulini, S. M., Biasca, F., and Tiberio, G.

Subjects
Adult, Adenocarcinoma, Scirrhous, Intraductal, Carcinoma, Breast Neoplasms, Adenocarcinoma, Middle Aged, Prognosis, Noninfiltrating, Carcinoma, Intraductal, Noninfiltrating, Scirrhous, Humans, Female, Mastectomy
Published
1983

38. Clinical strategies for the management of intestinal obstruction and pseudo-obstruction

Author

Costa, G., Ruscelli, P., Balducci, G., Buccoliero, F., Lorenzon, L., Frezza, B., Chirletti, P., Stagnitti, F., Miniello, S., Stella, F., Agresta, F., Ansaloni, L., Basile, G., Bellanova, G., Blandamura, V., Buonanno, G. M., Calderale, S. M., Caronna, R., Casciaro, G., Catena, F., Ceci, F., Chiara, O., Chiarugi, M., Cimbanassi, S., Coccolini, F., Gianfranco Cocorullo, Manzoni, G., Di Grezia, G., Frego, M., Fusco, B., Giulini, S. M., Greco, M., Gulotta, G., Lippolis, P. V., Mandala, V., Marini, P., Martino, A., Marzaioli, R., Mecarelli, V., Mingoli, A., Mirabella, A., Morelli, M. M., Padalino, P., Picardi, N., Portolani, N., Ribaldi, S., Ricci, G., Salamone, G., Sartelli, M., Staudacher, C., Tonelli, P., Tricarico, F., Trojaniello, B., Tugnoli, G., Valeri, A., Venezia, P., Zago, M., and Obow-Sicut, The Collaborative Study Group

40. Metachronous occurrence of gastric carcinoma after gastric stromal tumor. Considerations on therapeutic strategy

Author

Gian Luca BAIOCCHI, Ronconi, M., Piardi, T., Villanacci, V., Tiberio, G. A., Portolani, N., and Giulini, S. M.

Subjects
Neoplasms, Multiple Primary, Male, Gastrointestinal Stromal Tumors, Multiple Primary, Stomach Neoplasms, Neoplasms, Humans, Adenocarcinoma, Aged
Abstract

To our knowledge, the metachronous occurrence of a stromal and epithelial gastric tumour has not been previously reported in the Literature.A 73-year-old man underwent open resection of a gastric stromal tumour located in the posterior antrum wall. The maximum size of the tumour was 5 cm, and final histological examination diagnosed it as a primary gastrointestinal autonomic nerve tumour (the so-called GAN tumour); mitotic index was intermediate (10 x 50 HPF). Twelve months later, during endoscopic follow-up, a small ulcerated adenocarcinoma was found at the gastric angulus and subtotal gastrectomy with D2 lymphadenectomy was performed. Final pathological stadiation was T1smN0. The patient is alive and disease free 50 months later. Since he has had two tumours, it would appear that this patient has a tendency to develop neoplasia. However, no risk factor was found being consistent with an aetiological role in both tumours, if we exclude the presence of chronic atrophic gastritis with intestinal metaplasia in the gastric mucosa around both tumours.In those cases of gastric stromal tumours, of intermediate size and mitotic index, in whom a wedge gastric resection may be proposed, a radical gastrectomy should be considered as a valid alternative, especially when, as in the described patient, chronic atrophic gastritis with intestinal metaplasia is associated.

45. Lymphatic endothelial cells derived from metastatic and non-metastatic lymph nodes of human colorectal cancer reveal phenotypic differences in culture.

Author

Garrafa E, De Francesco M, Solaini L, Giulini SM, Bonfanti C, Ministrini S, Caimi L, and Tiberio GA

Subjects
Cell Movement, Cell Separation, Cells, Cultured, Chemokine CCL2 analysis, Cytokines metabolism, Humans, Intercellular Adhesion Molecule-1 analysis, Lymphangiogenesis, Lymphatic Metastasis, Phenotype, Colorectal Neoplasms pathology, Endothelial Cells physiology
Abstract

Colorectal cancer is one of the most frequent causes of death in Western countries. Most patients develop metastasis traveling through the lymphatic system, and regional lymph node metastasis is considered a marker for dissemination, increased stage, and worse prognosis. Despite rapid advances in tumor biology, the processes that underpin lymphatic invasion and lymph node metastasis remain poorly understood. The aim of this study was to establish an easy protocol for isolation of pure tumor lymphatic endothelial cells derived from lymph nodes to study differences compared with normal endothelial cells of uninvolved tissue from the same patients. Cells were isolated with very high purity via magnetic cell sorting and express the specific lymphatic markers Prox-1 and Lyve-1. They show differences in expression of adhesion molecules, chemokines, and growth factor secretion, and capability to form capillaries when seeded on basal membrane, thereby, revealing important differences between the two cell type. These cultures may provide a promising platform for the comparative analysis of both cell types at the molecular and biological level and to optimize treatment strategies.

Published
2015

46. Metachronous hepatic metastases from gastric carcinoma: a multicentric survey.

Author

Tiberio GA, Coniglio A, Marchet A, Marrelli D, Giacopuzzi S, Baiocchi L, Roviello F, de Manzoni G, Nitti D, and Giulini SM

Subjects
Aged, Combined Modality Therapy, Female, Gastrectomy methods, Humans, Lymphatic Metastasis, Male, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local therapy, Neoplasm Staging, Patient Selection, Prognosis, Proportional Hazards Models, Retrospective Studies, Risk Factors, Stomach Neoplasms surgery, Survival Rate, Liver Neoplasms secondary, Liver Neoplasms therapy, Neoplasms, Second Primary pathology, Neoplasms, Second Primary therapy, Stomach Neoplasms pathology
Abstract

Background: The treatment of hepatic metastases from gastric cancer is controversial, due to biologic aggressiveness of the disease., Objective: To survey the clinical approach to the subset of patients presenting with metachronous hepatic metastases as sole site of recurrence after curative resection of gastric cancer, focusing on the results achieved by different therapies and to investigate the prognostic factors of major clinical relevance., Methods: Retrospective multi-center chart review evaluating 73 patients, previously submitted to D >or= 2 gastrectomy for gastric cancer, who developed exclusive hepatic recurrence. Prognostic factors related to the patient, to the gastric malignancy and its treatment, and to the metastatic disease and its therapy were evaluated., Results: Forty-five patients received supportive care, 17 were submitted to chemotherapy, and 11 to hepatic resection. Survival was independently influenced by the variables T (p=0.019), N (p=0.05) and G (p=0.018) of the gastric primary and by the therapeutic approach to the metastases (p<0.005). In particular, T4 gastric cancer, presence of lymph-node metastases and G3 tumor displayed a negative prognostic value. Therapeutic approach to the metastases was the principal prognostic variable: 1, 2, and 3 years survival rates were 22.2%, 4.4% and 2.2%, respectively, for patients without specific treatment; 44.9%, 12.8% and 6.4% after chemotherapy (p=0.08) and 80.8%, 30.3% and 20.2% after surgical resection (p<0.001)., Conclusions: Our data suggest some clinical criteria that may facilitate selection of therapy for patients with hepatic recurrence after primary gastric cancer resection. The best survival rates are associated with surgical treatment, which should be chosen whenever possible.

Published
2009
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47. Isolation, purification, and heterogeneity of human lymphatic endothelial cells from different tissues.

Author

Garrafa E, Trainini L, Benetti A, Saba E, Fezzardi L, Lorusso B, Borghetti P, Bottio T, Ceri E, Portolani N, Bonardlli S, Giulini SM, Annibale G, Corradi A, Imberti L, and Caruso A

Subjects
Biomarkers analysis, Cells, Cultured, Endothelial Cells physiology, Humans, Immunohistochemistry, Phenotype, Cell Separation, Endothelial Cells cytology, Lymphatic System cytology
Abstract

Relatively few attempts have been made in the past to isolate and expand lymphatic endothelial cells (LECs). Recently this task has become feasible thanks to the identification of new lymphatic markers such as Podoplanin, Lyve-1, Prox-1 and D2-40. Using a two-step purification method based on the sorting of endothelial cells with Ulex Europaeus Agglutinin 1-coated beads followed by purification with monoclonal antibody D2-40, we were able to purify and in vitro expand human derived LECs from tissues such as lymph node, spleen, thymus, palatine tonsil and iliac lymphatic vessels. The isolated LECs were expanded on collagen type 1 and fibronectin coated flasks for up to 8-10 passages and then analyzed for phenotypic and functional properties. LECs were able to form a capillary like network, when seeded on Cultrex BME, indicating their capability to form lymphatic vessels in vitro. Comparative studies were performed, and we found that specific lymphatic and vascular markers were differentially expressed by LECs prepared from different sources, clearly demonstrating the phenotypic heterogeneity of LECs from different organs and different segments of the lymphatic vasculature. We here propose a new technique to make available ready sources of abundant well-characterized human LECs to examine normal profiles and behavior to compare with abnormal conditions.

Published
2005

48. [Results of elective open surgery for juxtarenal aortic aneurysms].

Author

Bonardelli S, Maffeis R, Tiberio GA, De Lucia M, Nodari E, Coniglio A, Cervi E, Pandolfo G, Viotti E, and Giulini SM

Subjects
Adult, Aged, Aged, 80 and over, Elective Surgical Procedures adverse effects, Female, Humans, Male, Middle Aged, Postoperative Complications epidemiology, Survival Rate, Vascular Surgical Procedures adverse effects, Vascular Surgical Procedures methods, Aortic Aneurysm, Abdominal surgery
Abstract

Review of the most significant surveys (data base: Pub Med on September 2003) of elective open surgery for Juxtarenal aneurysms and personal results of 106 cases (9.3% of AAA consecutively operated in the last 11 yrs.) are reported. Mortality and morbidity are discussed related to: technique of aortic cross-clamping; protective measures on splanchnic and renal perfusion; risks from previous CAD and chronic renal failure. Over all, the main predictive factor is the accuracy of the selected technique, without any difference among different approaches, and the same results of infrarenal aneurysms can be obtained.

Published
2004

50. A surgical solution to extrahepatic portal thrombosis and portal cavernoma: the splanchnic-intrahepatic portal bypass.

Author

Audet M, Baiocchi GL, Portolani N, Becmeur F, Caga M, Giulini SM, Cinqualbre J, Jaeck D, and Wolf P

Subjects
Adolescent, Child, Preschool, Female, Humans, Hypertension, Portal diagnostic imaging, Hypertension, Portal physiopathology, Hypertension, Portal surgery, Liver diagnostic imaging, Portal Vein pathology, Portal Vein physiopathology, Portal Vein surgery, Splanchnic Circulation physiology, Ultrasonography, Doppler, Color, Venous Thrombosis diagnostic imaging, Venous Thrombosis physiopathology, Liver blood supply, Liver surgery, Portacaval Shunt, Surgical, Venous Thrombosis surgery
Abstract

Three cases of prehepatic portal vein thrombosis, complicated by the clinical manifestations of portal hypertension, were successfully treated by surgically created splanchnic-intrahepatic portal bypass. Two out of three patients had been previously submitted to liver transplantation. No significant morbidity was observed and long-term Doppler evaluations proved the patency of the venous grafts. Together with the technical aspects of the procedures, the possible role of this technique, primarily proposed by De Ville de Goyet in 1992, is discussed in relation to the available therapies for the extrahepatic portal vein thrombosis.

Published
2003
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