Liver transplantation is the treatment of choice for end stage liver disease, but availability of liver grafts is still the main limitation to its wider use. Extended criteria donors(ECD) are considered not ideal for ...Liver transplantation is the treatment of choice for end stage liver disease, but availability of liver grafts is still the main limitation to its wider use. Extended criteria donors(ECD) are considered not ideal for several reasons but their use has dramatically grown in the last decades in order to augment the donor liver pool. Due to improvement in surgical and medical strategies, results using grafts from these donors have become acceptable in terms of survival and complications; nevertheless a big debate still exists regarding their selection, discharge criteria and allocation policies. Many studies analyzed the use of these grafts from many points of view producing different or contradictory results so that accepted guidelines do not exist and the use of these grafts is still related to non-standardized policies changing from center to center. The aim of this review is to analyze every step of the donationtransplantation process emphasizing all those strategies, both clinical and experimental, that can optimize results using ECD.展开更多
Lymphoepithelioma-like hepatocellular carcinoma(LELHCC) is a rare form of undifferentiated carcinoma of the liver characterized by the presence of an abundant lymphoid infiltrate. Here,a case of LEL-HCC is described. ...Lymphoepithelioma-like hepatocellular carcinoma(LELHCC) is a rare form of undifferentiated carcinoma of the liver characterized by the presence of an abundant lymphoid infiltrate. Here,a case of LEL-HCC is described. An 81-year-old woman with a chronic hepatitis C infection was referred to the general surgery department of our hospital in August 2013 with a diagnosis of HCC. A past ultrasound examination had revealed a 60 mm-diameter nodular lesion in the third segment of the liver. After a needle biopsy,the lesion was diagnosed as HCC. The patient underwent surgery with a liver segmentectomy. Two additional nodes on the gastric wall were detected during the surgical operation. The histology of the removed specimen showed a poorly differentiated HCC with significant lymphoid stroma. Immunohistochemical studies revealed that the epithelial component was reactive for CK CAM5.2,CK8,CK18,CEA(polyclonal) and was focally positive for hepar-1 and that the lymphoid infiltrate was positive for CD3,CD4 and CD8. The tumor cells were negative for Epstein-Barr virus. The gastric nodes were ultimately determined to be two small gastrointestinal stromal tumors(GISTs).The synchronous occurrence of HCC and GIST is another very uncommon finding rarely described in the literature. Here,we report the clinicopathological features of our case,along with a review of the few cases present in the literature.展开更多
AIM To build a regional database of chronic patients to define the clinical epidemiology of hepatitis B virus(HBV)-infected patients in the Tuscan public health care system.METHODS This study used a cross-sectional co...AIM To build a regional database of chronic patients to define the clinical epidemiology of hepatitis B virus(HBV)-infected patients in the Tuscan public health care system.METHODS This study used a cross-sectional cohort design.We evaluated chronic viral hepatitis patients with HBV referred to the outpatient services of 16 hospital units.Information in the case report forms included main demographic data,blood chemistry data,viral hepatitis markers,instrumental evaluations,and eligibility for treatment or ongoing therapy and liver transplantation.RESULTS Of 4015 chronic viral hepatitis patients,1096(27.3%)were HBV infected.The case report form was correctly completed for only 833 patients(64%males,36%females;mean age 50.1±15.4).Of these HBV-infected patients,73%were Caucasian,21%Asian,4%Central African,1%North African and 1%American.Stratifying patients by age and nationality,we found that 21.7%of HBV-infected patients were aged<34 years(only 2.8%were Italian).The most represented routes of transmission were nosocomial/dental procedures(23%),mother-to-child(17%)and sexual transmission(12%).The most represented HBV genotypes were D(72%)and A(14%).Of the patients,24.7%of patients were HBe Ag positive,and 75.3%were HBe Ag negative.Of the HBV patients 7%were anti-HDV positive.In the whole cohort,26.9%were cirrhotic(35.8%aged<45 years),and 47%were eligible for or currently undergoing treatment,of whom 41.9%were cirrhotic.CONCLUSION Only 27.3%of chronic viral hepatitis patients were HBV infected.Our results provide evidence of HBV infection in people aged<34 years,especially in the foreign population not protected by vaccination.In our cohort of patients,liver cirrhosis was also found in young adults.展开更多
文摘Liver transplantation is the treatment of choice for end stage liver disease, but availability of liver grafts is still the main limitation to its wider use. Extended criteria donors(ECD) are considered not ideal for several reasons but their use has dramatically grown in the last decades in order to augment the donor liver pool. Due to improvement in surgical and medical strategies, results using grafts from these donors have become acceptable in terms of survival and complications; nevertheless a big debate still exists regarding their selection, discharge criteria and allocation policies. Many studies analyzed the use of these grafts from many points of view producing different or contradictory results so that accepted guidelines do not exist and the use of these grafts is still related to non-standardized policies changing from center to center. The aim of this review is to analyze every step of the donationtransplantation process emphasizing all those strategies, both clinical and experimental, that can optimize results using ECD.
文摘Lymphoepithelioma-like hepatocellular carcinoma(LELHCC) is a rare form of undifferentiated carcinoma of the liver characterized by the presence of an abundant lymphoid infiltrate. Here,a case of LEL-HCC is described. An 81-year-old woman with a chronic hepatitis C infection was referred to the general surgery department of our hospital in August 2013 with a diagnosis of HCC. A past ultrasound examination had revealed a 60 mm-diameter nodular lesion in the third segment of the liver. After a needle biopsy,the lesion was diagnosed as HCC. The patient underwent surgery with a liver segmentectomy. Two additional nodes on the gastric wall were detected during the surgical operation. The histology of the removed specimen showed a poorly differentiated HCC with significant lymphoid stroma. Immunohistochemical studies revealed that the epithelial component was reactive for CK CAM5.2,CK8,CK18,CEA(polyclonal) and was focally positive for hepar-1 and that the lymphoid infiltrate was positive for CD3,CD4 and CD8. The tumor cells were negative for Epstein-Barr virus. The gastric nodes were ultimately determined to be two small gastrointestinal stromal tumors(GISTs).The synchronous occurrence of HCC and GIST is another very uncommon finding rarely described in the literature. Here,we report the clinicopathological features of our case,along with a review of the few cases present in the literature.
文摘AIM To build a regional database of chronic patients to define the clinical epidemiology of hepatitis B virus(HBV)-infected patients in the Tuscan public health care system.METHODS This study used a cross-sectional cohort design.We evaluated chronic viral hepatitis patients with HBV referred to the outpatient services of 16 hospital units.Information in the case report forms included main demographic data,blood chemistry data,viral hepatitis markers,instrumental evaluations,and eligibility for treatment or ongoing therapy and liver transplantation.RESULTS Of 4015 chronic viral hepatitis patients,1096(27.3%)were HBV infected.The case report form was correctly completed for only 833 patients(64%males,36%females;mean age 50.1±15.4).Of these HBV-infected patients,73%were Caucasian,21%Asian,4%Central African,1%North African and 1%American.Stratifying patients by age and nationality,we found that 21.7%of HBV-infected patients were aged<34 years(only 2.8%were Italian).The most represented routes of transmission were nosocomial/dental procedures(23%),mother-to-child(17%)and sexual transmission(12%).The most represented HBV genotypes were D(72%)and A(14%).Of the patients,24.7%of patients were HBe Ag positive,and 75.3%were HBe Ag negative.Of the HBV patients 7%were anti-HDV positive.In the whole cohort,26.9%were cirrhotic(35.8%aged<45 years),and 47%were eligible for or currently undergoing treatment,of whom 41.9%were cirrhotic.CONCLUSION Only 27.3%of chronic viral hepatitis patients were HBV infected.Our results provide evidence of HBV infection in people aged<34 years,especially in the foreign population not protected by vaccination.In our cohort of patients,liver cirrhosis was also found in young adults.
