Publications by authors named "Anna D"

99 Publications

Hypothetical mechanism of light action on nitric oxide physiological effects.

Lasers Med Sci 2020 Oct 26. Epub 2020 Oct 26.

Moscow State K.I. Skryabin Academy of Veterinary Medicine and Biotechnology, Moscow, Russia.

Nitric oxide is a universal cellular mediator. It is involved in many physiological processes, including those induced by light. The disability for complete analysis of the nitric oxide metabolites in tissues prevents the exact understanding of the role of NO in a particular process. The sensitivity and selectivity of an enzymatic sensor developed in our lab is based on the detection of all NO groups that carry a positive charge or acquire it in the chemical processes. Using this sensor, we have shown that dinitrosyl iron complexes (DNIC), being principal nitric oxide donors in most of living tissues, undergo transformations under light irradiation in the wavelength range of 400-700 nm. These changes are not associated with nitric oxide release to the environment. But a nitrosyl iron complex without thiol ligands (Fe(NO)n) is produced. Moreover, in the moment of the complex reorganization, the chemical bond between the NO group and other components apparently weakens and, in the presence of a substance possessing chemical affinity to the NO group, the latter acquires the ability of transition from the complex to this substance. Therefore, the efficiency of NO donors first of all depends on the existence of the NO target and its status including that under the action of light. The activation of a donor compound by light can facilitate the transfer of NO to the target. Transfer of NO from the donor to the target occurs without releasing NO, or with a minimum time of its stay in the unbound state.
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http://dx.doi.org/10.1007/s10103-020-03169-xDOI Listing
October 2020

Lead induced changes in phosphorylation of PSII proteins in low light grown pea plants.

Biometals 2015 Feb 10;28(1):151-62. Epub 2014 Dec 10.

Department of Molecular Plant Physiology, Faculty of Biology, Warsaw University, Miecznikowa 1, 02096, Warsaw, Poland.

Light-intensity and redox-state induced thylakoid proteins phosphorylation involved in structural changes and in regulation of protein turnover. The presence of heavy metal ions triggers a wide range of cellular responses including changes in plant growth and photosynthesis. Plants have evolved a number of mechanisms to protect photosynthetic apparatus. We have characterized the effect of lead on PSII protein phosphorylation in pea (Pisum sativum L.) plants grown in low light conditions. Pb ions affected only slightly photochemical efficiency of PSII and had no effect on organization of thylakoid complexes. Lead activated strongly phosphorylation of PSII core D1 protein and dephosphorylation of this protein did not proceed in far red light. D1 protein was also not degraded in this conditions. However, phosphorylation of LHCII proteins was not affected by lead. These results indicate that Pb(2+) stimulate the phosphorylation of PSII core proteins and by disturbing the disassembly of supercomplexes play a role in PSII repair mechanism. LHCII phosphorylation could control the distribution of energy between the photosystems in low light conditions. This demonstrates that plants may respond to heavy metals by induction different pathways responsible for protein protection under stress conditions.
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http://dx.doi.org/10.1007/s10534-014-9811-yDOI Listing
February 2015

The Evaluation of Dipeptidyl Peptidase (DPP)-IV, α-Glucosidase and Angiotensin Converting Enzyme (ACE) Inhibitory Activities of Whey Proteins Hydrolyzed with Serine Protease Isolated from Asian Pumpkin ().

Int J Pept Res Ther 2014 1;20(4):483-491. Epub 2014 Jun 1.

Department of Animal Products Technology and Quality Management, Wrocław University of Enviromental and Life Sciences, ul. Chełmońskiego 37/41, 51-630 Wrocław, Poland.

In the present study, whey protein concentrate (WPC-80) and β-lactoglobulin were hydrolyzed with a noncommercial serine protease isolated from Asian pumpkin (). Hydrolysates were further fractionated by ultrafiltration using membranes with cut-offs equal 3 and 10 kDa. Peptide fractions of molecular weight lower than 3 and 3-10 kDa were further subjected to the RP-HPLC. Separated preparations were investigated for their potential as the natural inhibitors of dipeptidyl peptidase (DPP-IV), α-glucosidase and angiotensin converting enzyme (ACE). WPC-80 hydrolysate showed higher inhibitory activities against the three tested enzymes than β-lactoglobulin hydrolysate. Especially high biological activities were exhibited by peptide fractions of molecular weight lower than 3 kDa, with ACE IC50 <0.64 mg/mL and DPP-IV IC50 <0.55 mg/mL. This study suggests that peptides generated from whey proteins may support postprandial glycemia regulation and blood pressure maintenance, and could be used as functional food ingredients in the diet of patients with type 2 diabetes.
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http://dx.doi.org/10.1007/s10989-014-9413-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210635PMC
June 2014

Morgagni hernia: technical variation in the laparoscopic treatment.

Ann Ital Chir 2012 Sep-Oct;83(5):415-20

Udine School of Medicine, Italy.

Introduction: Morgagni hernia is a rare entity that accounts for 3-5% of diaphragmatic hernias. They are mostly asymptomatic and discovered incidentally. Surgical treatment is indicated once diagnosis is made. Abdominal or thoracic accesses are possible using open or minimally invasive technique.

Methods: We report two cases of laparoscopic assisted repair of Morgagni hernia conducted by primary closure of the diaphragmatic defect with extracorporeal nonabsorbable sutures anchoring the diaphragmatic edge at the muscular fascia of the abdominal wall.

Results: Both patients had an uneventful postoperative recovery. The operative time was 90 and 60 minutes and the postoperative hospitalization was 4 and 2 days respectively.

Conclusions: Laparoscopic intervention for Morgagni hernia repair is easy, safe and less invasive compared to the open one, with reduced hospitalization time. Primary closure of the diaphragmatic defect with extracorporeal nonabsorbable sutures is an effective technique for Morgagni hernia; defects larger than 20-30 cm2 should be repaired using a prosthetic patch.
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November 2012

Non-erosive and uncomplicated erosive reflux diseases: Difference in physiopathological and symptom pattern.

World J Gastrointest Pathophysiol 2011 Jun;2(3):42-8

Vittorio Bresadola, Gian Luigi Adani, Francesco Londero, Cosimo Alex Leo, Vittorio Cherchi, Dario Lorenzin, Anna Rossetto, Gianmatteo Vit, Umberto Baccarani, Giovanni Terrosu, Dino De Anna, Department of Surgery and Transplantation, University Hospital of Udine, P.le S.M. della Misericordia, Udine 33100, Italy.

Aim: To investigate differences in the physiopathological findings (manometry and pH monitoring) and symptoms between cases of non-erosive reflux disease (NERD) and erosive reflux disease (ERD) found positive at 24 h pH monitoring.

Methods: For a total of 670 patients who underwent 24 h pH monitoring, esophageal manometry and upper endoscopy were retrospectively evaluated, assessing the reflux symptoms, manometric characteristics of the lower esophageal sphincter (LES) and esophageal body and the presence or absence of esophagitis and hiatal hernia. Typical and atypical symptoms were also evaluated. For inclusion in the study, patients had to have NERD or ERD and be found positive on pH monitoring (NERD+). Patients with Gastroesophageal reflux disease (GERD) complicated by stenosis, ulcers or Barrett's esophagus were ruled out.

Results: 214 patients were involved in the study, i.e. 107 cases of NERD+ and 107 of ERD. There were no significant gender- or age-related differences between the two groups. The ERD group had more cases of hiatal hernia (P = 0.02) and more acid reflux, both in terms of number of reflux episodes (P = 0.01) and as a percentage of the total time with a pH < 4 (P = 0.00), when upright (P = 0.007) and supine (P = 0.00). The NERD+ cases had more reflux episodes while upright (P = 0.02) and the ERD cases while supine (P = 0.01). The LES pressure was higher in cases of NERD+ (P = 0.03) while the amplitude and duration of their esophageal peristaltic waves tended to be better than in the ERD group (P >0.05). The NERD+ patients presented more often with atypical symptoms (P = 0.01).

Conclusion: The NERD+ patients' fewer reflux episodes and the fact that they occurred mainly while in the upright position (unlike the cases of ERD) may be two factors that do not favor the onset of esophagitis. The frequently atypical symptoms seen in patients with NERD+ need to be accurately evaluated for therapeutic purposes because patients with GERD and atypical symptoms generally respond only partially to medical and surgical treatments.
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http://dx.doi.org/10.4291/wjgp.v2.i3.42DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3158890PMC
June 2011

Long-term outcomes of orthotopic liver transplantation in human immunodeficiency virus-infected patients and comparison with human immunodeficiency virus-negative cases.

Transplant Proc 2011 May;43(4):1119-22

Department of Surgery and Liver Transplantation Unit, University of Udine, Udine, Italy.

Human immunodeficiency virus (HIV) positivity is no longer a contraindication for orthotopic liver transplantation (OLT) due to the efficacy of antiretroviral therapy. The aim of this study was to compare OLT among HIV-positive and HIV-negative cohorts; the results were also stratified for hepatitis C virus (HCV) coinfection. Between 2004 and 2009, all HIV-infected patients undergoing OLT from heart-beating deceased donors (n=27) were compared with an HIV-negative cohort (n = 27). The pure HCV infection rate was similar between HIV-positive and HIV-negative subjects (63% each). HIV-positive recipients were younger (P=.013). The CD4 count for HIV-positive subjects was 376 ± 156 at transplantation. The mean model for end-stage liver disease (MELD) score at transplantation was 15 ± 7 in both groups (P=.92). No differences were observed for donor age (P=.72) or time on the waiting list (P=.56). The median follow-up was 26 (range, 1-64) and 27 months (range, 1-48) for HIV and non-HIV recipients, respectively (P=.85). The estimated 1-, 3-, and 5-year patient and graft survival rates were 88%, 83%, and 83% versus 100%, 73%, and 73% (P=.95), and 92%, 87%, and 87% versus 95%, 88%, and 88% (P=.59) for HIV and non-HIV cases, respectively. HIV/HCV-coinfected patients were younger, namely 47 (range, 40-53) versus 52 years (range, 37-68; P=.003), and displayed lower MELD scores at transplantation compared with HCV-mono-infected patients 10 (range, 7-19) versus 17 (range, 8-30) (P=.008). For HIV/HCV-coinfected and HCV-mono-infected cases the estimated 1-, 3-, and 5-year patients and graft survival rates were respectively 93%, 76%, and 76% versus 100%, 70%, and 60% (P=.99) and 93%, 84%, and 84% versus 100%, 70%, and 60% (P=.64), respectively. No difference was observed in the histological severity of HCV recurrence. In conclusion, under specific, well-determined conditions, OLT can be a safe, efficacious procedure in HIV patients.
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http://dx.doi.org/10.1016/j.transproceed.2011.01.124DOI Listing
May 2011

Sequential versus contemporaneous portal and arterial reperfusion during liver transplantation.

Transplant Proc 2011 May;43(4):1107-9

Department of Surgery & Transplantation, University Hospital, Udine, Italy.

Although sequential portal and arterial revascularization (SPAr) is the most common method of graft reperfusion at liver transplantation (OLT), contemporaneous portal and hepatic artery revascularization (CPAr) has been used to reduce arterial ischemia to the bile ducts. The aim of this study was to prospectively compare SPAr (group 1; n=19) versus CPAr (group 2; n=21) among 40 consecutive OLT from heart-beating donors. There were no differences in the demographics characteristics, Model for End-stage Liver Disease scores, indication for OLT and donor parameters between the groups. OLT was performed using the piggyback technique. The biliary anastomosis was performed in all cases by a duct-to-duct technique with a T-tube in 32% versus 29% of cases without a T tube (P=.83). In the CPAr group, the liver was reperfused simultaneously via the portal vein and hepatic artery. CPAr showed a longer warm ischemia (66 ± 8 vs 37 ± 7 minutes; P<.001), while SPAr had a longer arterial ischemia 103 ± 42 vs 66 ± 8 minutes (P=.0004). Recovery of graft function was similar. There was no primary nonfunction and delayed graft function occurred among 10% versus 9%. Liver function tests were similar between the two groups up to 90 days case of follow-up- One-year graft and patient survivals were, respectively, 89% and 95% versus 94% and 100% (P=.29). At a median follow-up of 13 ± 6 versus 14 ± 7 months, biliary complications included anastomotic stenoses in 15% versus 19% (P=.78) and intrahepatic non-anastomotic biliary strictures in 26% versus none (P=.01) for SPAr and CPAr, respectively. CPAr was safe and feasible, reducing the incidence of intrahepatic biliary strictures by decreasing the duration of arterial ischemia to the intrahepatic bile ducts.
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http://dx.doi.org/10.1016/j.transproceed.2011.01.123DOI Listing
May 2011

Necrosis percentage of radiologically treated hepatocellular carcinoma at hepatectomy for liver transplantation.

Transplant Proc 2011 May;43(4):1095-7

Department of General Surgery & Transplantation, University Hospital of Udine, Udine, Italy.

Among a cohort of 414 liver transplantations (OLT) performed form 1996 to 2009, we analyzed 86 patients (20.7%) who were affected by hepatocellular carcinoma (HCC) superimposed on cirrhosis, including 82 with a preoperative diagnosis of tumor; 4 cases had the diagnosis established upon histologic examination after hepatectomy. The gender of 75 patients was male (91.5%), and female in 7 cases (8.5%). The median Model for End-Stage Liver Disease score was 10 (range, 6-23). The underlying liver disease was hepatitis C virus (HCV)-related cirrhosis (41.46%), hepatitis B virus (HBV)-related cirrhosis (15.6%), or alcohol-related cirrhosis (29.3%); cryptogenic; HCV+HIV; HBV+HIV; or HCV+HBV+HIV cirrhosis were present in an other few patients. The diagnosis of HCC and the preoperative staging were defined through radiologic evaluations, without biopsy confirmation in any case. All patients underwent pretransplant radiologic treatments to reduce the drop-out risk while a waiting OLT; OLT was performed for HCC patients within the Milan criteria. Upon histologic examination, the median HCC necrosis was 57 ± 36%; in 22 cases (26.8%), there were no necrotizing effects. Forty patients (48.8%) display a satisfying degree of disease control with 26 patients (31.7%) downstaged effect; 15 patients (18.3%) showed neoplastic progression with advanced neoplastic disease exceeding the Milan criteria at hepatectomy. One patient had nonevaluable necrosis (1.2%). Our experience showed preoperative radiologic treatments to be not curative but serving as a bridge to OLT.
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http://dx.doi.org/10.1016/j.transproceed.2011.01.151DOI Listing
May 2011

Contemporaneous Portal-Arterial Reperfusion during Liver Transplantation: Preliminary Results.

J Transplant 2011 31;2011:251656. Epub 2011 Mar 31.

Department of Surgery and Transplantation, University Hospital of Udine, 33100 Udine, Italy.

We prospectively compared sequential portal-arterial revascularization (SPAr, group 1 no. 19) versus contemporaneous portal-hepatic artery revascularization (CPAr, group 2 no. 21) in 40 consecutive liver transplantation (LT). There were no differences in the demographics characteristics, MELD score, indication to LT, and donor's parameters between the two groups. CPAr had longer warm ischemia 66 ± 8 versus 37 ± 7 min (P < .001), while SPAr had longer arterial ischemia 103 ± 42 min (P = .0004). One-year patient's and graft survival were, respectively, 89% and 95% versus 94% and 100% (P = .29). At median followup of 13 ± 6 versus 14 ± 7 months biliary complications were anastomotic stenosis in 15% versus 19% (P = .78), and intrahepatic nonanastomotic biliary strictures in 26% versus none (P = .01), respectively, in SPAr and CPAr. CPAr reduces the incidence of intrahepatic biliary strictures by decreasing the duration of arterial ischemia.
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http://dx.doi.org/10.1155/2011/251656DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3087889PMC
July 2011

Alterations in TP53, cyclin D2, c-Myc, p21WAF1/CIP1 and p27KIP1 expression associated with progression in B-CLL.

Folia Histochem Cytobiol 2010 Dec;48(4):534-41

Department of Clinical Genetics, Medical University of Lublin, Lublin, Poland.

B-cell chronic lymphocytic leukaemia (B-CLL) originates from B lymphocytes that may differ in the activation level, maturation state or cellular subgroups in peripheral blood. Tumour progression in CLL B cells seems to result in gradual accumulation of the clone of resting B lymphocytes in the early phases (G0/G1) of the cell cycle. The G1 phase is impaired in B-CLL. We investigated the gene expression of five key cell cycle regulators: TP 53, c-Myc, cyclin D2, p21WAF1/CIP1 and p27KIP1, which primarily regulate the G1 phase of the cell cycle, or S-phase entry and ultimately control the proliferation and cell growth as well as their role in B-CLL progression. The study was conducted in peripheral blood CLL lymphocytes of 40 previously untreated patients. Statistical analysis of correlations of TP53, cyclin D2, c-Myc, p21WAF1/CIP1 and p27KIP1 expressions in B-CLL patients with different Rai stages demonstrated that the progression of disease was accompanied by increases in p53, cyclin D2 and c-Myc mRNA expression. The expression of p27KIP1 was nearly statistically significant whereas that of p21 WAF1/CIP1 showed no such correlation. Moreover, high expression levels of TP53 and c-Myc genes were found to be closely associated with more aggressive forms of the disease requiring earlier therapy.
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http://dx.doi.org/10.2478/v10042-010-0048-5DOI Listing
December 2010

The length of peritoneal surgical manipulation correlates with serum CA 125 levels.

In Vivo 2011 Jan-Feb;25(1):105-9

Department of Surgical Sciences, Faculty of Medicine and Surgery, University of Udine, P.le Santa Maria della Misericordia 15-33100 Udine, Italy.

Background: Peritoneal recovery after uncomplicated serum manipulation usually lasts 7 days and high values of serical CA 125 are measured following abdominal surgery. The aim of this study was to assess a possible correlation between peritoneal manipulation and serical CA 125 levels following abdominal surgery for benign diseases.

Patients And Methods: Twenty-eight patients with abdominal benign disease were operated on. They were pooled into three groups of low, intermediate and high peritoneal manipulation, according to the extent of laparotomy and length of surgical peritoneal manipulation. Venous blood samples (5 ml) were taken from each patient 24-48 hours before surgery, 12-24 hours after surgery and on the 4th and 7th postoperative day. CA 125 levels were quantified by microparticle enzyme immunoassay.

Results: After surgery, patients having high peritoneal manipulation showed significantly higher levels of CA 125 compared to the preoperative levels. In particular, the length of peritoneal manipulation was correlated with increasing levels of the marker (p<0.0001).

Conclusion: Peritoneal manipulation was significantly correlated to serum CA 125 levels; therefore its role as marker of peritoneal surgical injury should be considered.
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May 2011

Cardiovascular risk factors and immunosuppressive regimen after liver transplantation.

Transplant Proc 2010 Sep;42(7):2576-8

Department of Surgery and Transplantation, University Hospital, Udine, Italy.

Cardiovascular and metabolic diseases represent important long-term complications after liver transplantation (LT), impairing long-term and disease-free survivals. A few mechanisms underlie the development of those complications, but the role of immunosuppressive drugs is major. Although several patients develop temporary metabolic diseases, which normalize after a short postoperative period and do not need long-term drug therapy, the incidences of de novo long-lasting arterial hypertension, hyperlipidemia, and diabetes mellitus are high during the first year after LT. The aim of this retrospective study was to evaluate new-onset arterial hypertension, hyperlipidemia, or diabetes among 100 LT patients at a single institution. We used chi-square statistical analysis to compare incidences during tacrolimus versus cyclosporine therapy. Hypertension did not seem to be more strongly related to tacrolimus than to cyclosporine, nor did diabetes, whereas there was a difference for the development of hyperlipidemia.
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http://dx.doi.org/10.1016/j.transproceed.2010.05.160DOI Listing
September 2010

[Lack of prognostic predictive value of hepatic agobiopsy in a group of patients operated of hepatic resection for hepatocellular carcinoma].

Ann Ital Chir 2009 Nov-Dec;80(6):439-44

Clinica Chirurgica, Azienda Ospedaliero Universitaria di Udine.

Aim: To determine prior to surgery whether a fine needle biopsy is able to define a hepatocellular carcinoma grading, or not.

Material Of Study: Thirty patients, who all underwent liver resection for HCC. In every case a fine needle biopsy of the neoplasm was taken prior to surgery, and after the operation a complete microscopic assessment of tumor grade according to Edmondson and Steiner classification was taken.

Results: We found no correlation between fine needle biopsy grading and post surgical one. We also found no correlation between fine needle grading and other relevant elements, alpha-fetoprotein levels and number of neoplastic nodules.

Discussion: Considering the small number of patients in the study, fine needle biopsy seems to be unfit to determine HCC grading before surgery, this is probably due to the different levels of neoplastic differentiation present into every single nodule and to the characteristics of Edmondson and Steiner classification. In Literature there is at least one study, similar to ours, showing problems in the correct attribution of grading level using this classification. Other authors consider the possibility to modify the scale from a 4-levels one to a 3-levels one.

Conclusions: In spite of these discouraging results, and with a strict follow up monitoring any tumor seeding, we think fine needle biopsy is still fundamental for controversial cases, and for new studies on hepatocellular carcinoma, like those over vascular invasion or the molecular profile of the neoplasm.
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July 2010

Nrf3-deficient mice are not protected against acute lung and adipose tissue damages induced by butylated hydroxytoluene.

FEBS Lett 2010 Mar 18;584(5):923-8. Epub 2010 Jan 18.

Lady Davis Institute for Medical Research, Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada.

We found that both wild type and Nrf3 (NF-E2-related factor 3) deficient mice are sensitive to BHT single administration exhibiting respiratory distress and considerably lose body weight following treatment. At time of sacrifice, the BHT-treated Nrf3-/- mice had lost significantly more body weight than their WT counterparts. In the lung, transcript levels of the transcription factors Nrf1, Nrf2 and Nrf3 were differentially regulated by BHT treatment. In addition, genes implicated in adipogenesis were repressed following BHT exposure in the white adipose tissue. Together, our data provide the first evidence that BHT exposure not only affects lung function but also leads to impaired adipogenesis in adipocytes.
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http://dx.doi.org/10.1016/j.febslet.2010.01.028DOI Listing
March 2010

Steatosis of the hepatic graft as a risk factor for post-transplant biliary complications.

Clin Transplant 2010 Sep-Oct;24(5):631-5

Department of Tissue & Organ Transplantation, University Hospital of Udine, Udine, Italy.

Background: Despite recent advances in organ preservation, immunosuppression, and surgical techniques, the biliary tree is still considered the Achilles' heel of liver transplantation. The aim of this study is to retrospectively analyze the incidence of biliary complications and identify risk factors that might predispose to the development of biliary problems.

Methods: From January 2004 to December 2007, 117 consecutive liver transplantations were retrospectively analyzed for the development of biliary complications by the review of medical records. Patients were divided into group 1 with biliary complications (n = 43) and group 2 without biliary complications (n = 74).

Results: The overall biliary complication rate was 36.8% (leakage 6% and stricture 30.8%). Univariate analysis indicated that significant predictors of biliary complications were the time interval between portal and arterial reperfusion (p = 0.037) and macrovacuolar steatosis of the graft > 25% (p = 0.004). Stepwise logistic regression model demonstrated that a macrosteatosis of the graft > 25% (OR = 5.21 CI 95% [1.79-15.15], p = 0.002) was the only independent risk factor predicting biliary complications after liver transplantation. No differences in patient's and graft's survival were noted between the two groups.

Conclusion: According to our experience, transplanting a liver with > 25% of steatosis is a risk factor for the development of biliary complication.
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http://dx.doi.org/10.1111/j.1399-0012.2009.01128.xDOI Listing
February 2011

Elderly versus young liver transplant recipients: patient and graft survival.

Transplant Proc 2009 May;41(4):1293-4

Department of Surgery & Transplantation, Udine University Hospital, Udine, Italy.

The indications for organ transplantation continue to broaden with advances in perioperative care and immunosuppression. The elderly have especially benefited from this progress; advanced age is no longer considered a contraindication to transplantation at most centers. Although numerous studies support the use of renal allografts in older patients, only a few centers have addressed this issue as it pertains to liver transplantation. Published studies have revealed that operative course, length of hospitalization, and incidence of perioperative complications among patients older than 60 years of age are comparable with their younger adult counterparts. In our study we analyzed the clinical experiences of two centers with primary cadaveric orthotopic liver transplantations comparing patients older than 63 with patients younger than 40 years of age, suggesting no difference in unadjusted survival with age stratification. Now age cannot be considered to be a contraindication to liver transplantation.
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http://dx.doi.org/10.1016/j.transproceed.2009.03.080DOI Listing
May 2009

Graft vessel wall pathology in a case of hepatic artery pseudo-aneurysm in a liver transplant recipient.

Transplant Proc 2008 Dec;40(10):3800-3

Department of Surgery, Udine University School of Medicine, Udine, Italy.

Pseudo-aneurysms (PAs) of the hepatic artery are rare complications of liver transplantation, which are characterized by a high mortality rate. The majority occur within the first 2 months after orthotopic liver transplantation. They become clinically manifest with sudden hypotension, gastrointestinal bleeding, and abnormal liver function test results. Early diagnosis and treatment are essential to prevent life-threatening hemorrhage. Conventional treatment consists of surgical resection and vascular reconstruction, but a feasible treatment option involves an angiographic approach with the positioning of a stent or transarterial coil embolization followed by revascularization. We report a case of posttransplantation hepatic artery PA (HA-PA) with bleeding into the duodenum, diagnosed using abdominal computed tomography (CT). Arterial kinking prevented a covered stent graft from being inserted successfully using X-ray angiography, so the patient underwent emergency surgery in an attempt to exclude the PA and revascularize the organ via an aorto-hepatic bypass with an iliac vascular graft obtained from the donor. The surgical procedure failed due to progressive macroscopic dissection of the HA wall up to the bifurcation. The patient underwent retransplantation but died 25 days later due to multiple-organ failure. Histopathology of the first liver graft confirmed arterial graft dissection and pathological changes in the donor HA wall.
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http://dx.doi.org/10.1016/j.transproceed.2008.06.095DOI Listing
December 2008

Laparoscopic reconstruction after esophageal resection for perforation: a new surgical approach.

Surg Laparosc Endosc Percutan Tech 2008 Oct;18(5):498-501

Bresadola Vittorio Department of Surgery, P. le S. M. della Misericordia 15 (Pad. Petracco), Udine, Italy.

The authors present 2 cases of esophageal perforation treated using a new 2-step approach, consisting of esophageal resection and delayed reconstruction of the digestive tract after laparoscopic preparation and transposition of the stomach. The method is characterized by the minimally invasive insertion of a gastric tube through the precardial esophageal stump for postoperative enteral nutrition, and by the use of a laparoscopic method in the reconstruction step for gastrolysis and transposition of the stomach. The benefits lie in the opportunity for enteral feeding preparatory to the reconstruction, with no need for any gastrostomy or jejunostomy, and with fewer complications and a better recovery after reconstruction surgery thanks to the use of a laparoscopic method instead of a laparotomy.
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http://dx.doi.org/10.1097/SLE.0b013e318173aa85DOI Listing
October 2008

Duplex ultrasound changes in the great saphenous vein after endosaphenous laser occlusion with 808-nm wavelength.

J Vasc Surg 2008 Nov 9;48(5):1262-71. Epub 2008 Aug 9.

Postgraduate School of Vascular Surgery, University of Udine, Udine, Italy.

Background: Endosaphenous laser ablation is used in the treatment of great saphenous vein insufficiency with various methods, with and without surgical interruption. However, its mode of action and indications are not yet clear.

Methods: To verify the mode of action of endosaphenous laser ablation by duplex ultrasound (DUS) follow-up, with the support of histologic observations of eight cases, 44 of 182 affected limbs (CEAP C2 to C6) were selected for intravenous laser ablation of the great saphenous vein. Saphenofemoral junction incompetence was treated by surgical interruption. An 808-nm diode laser (Eufoton, Trieste, Italy) was used (variable pull-back velocity, 1 to 3 mm/s; power, 12 to 15 W; energy, 30 to 40 J/cm). In eight limbs the venous fragments were studied under light microscopy at 5 minutes and after 1 and 2 months. In 44 limbs DUS and clinical examinations were performed from 7 days to 1, 2, 6, and 12 months.

Results: Variously organized thrombi containing necrotic inclusions and patent areas were observed in the vein lumen. Neither neovascularization nor thrombus extension were detected at the groin by DUS examination. Progressive venous diameter decrease and thrombus fibrotic transformation up to the hypotrophic venous disappearance at 12 months were followed up (P < .00001). Not occluded (18.8%), recanalized short segments (22.7%), two entirely recanalized saphenous veins with varicose recurrence (4.5%), and postoperative phlebitis (13.6%) were observed. Nonocclusions and phlebitis prevailed in the larger veins (P < .05).

Conclusion: The healing process is based on vein thrombosis, fibrosis, and venous atrophy. Saphenofemoral interruption makes venous occlusion easier and prevents potential thrombotic complications and recurrence by recanalization. DUS monitoring makes possible to follow-up the thrombus involution and perform early retreatment. The 808-nm endosaphenous laser should be mainly applied to veins of <10 mm in diameter.
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http://dx.doi.org/10.1016/j.jvs.2008.06.004DOI Listing
November 2008

A comparative study of the transhiatal laparoscopic approach versus laparoscopic gastric mobilisation and right open transthoracic esophagectomy for esophageal cancer management.

J Gastrointestin Liver Dis 2007 Dec;16(4):395-401

Department of General Surgery, School of Medicine, University of Udine, Italy, 33100 Udine, Italy.

Aim: Regarding the surgical treatment of esophageal cancer, a question was raised by the introduction of minimally invasive surgery, because of the technical complexity of the techniques involved and its uncertain benefits. We evaluated the impact of laparoscopic esophagectomy on the surgical approach to esophageal cancer.

Patients And Methods: From January 2002 to March 2006, 22 non-randomized patients were recruited to undergo esophagectomy for neoplastic disease. The esophagectomy and esophagogastroplasty were performed using the laparoscopic transhiatal technique (THE) in 9 cases, while a combined laparoscopic gastric mobilisation and right transthoracic incision (TT/LE) was performed in the other 13.

Results: Mean follow up was 21+/-3.23 months, range 2-46 months. Overall cumulative survival was 84.0% at 12 months, 61.3% at 24 months, 51.0% at 36 months. THE achieved better results than TT/LE on the ground with regard to the time it took to complete the procedure (p=0.046) and the hospital stay times (p=0.039), and the time in ICU, postoperative oral feeding resumption, number of retrieved lymph nodes.

Conclusion: The clinical benefits of minimally invasive techniques regard the time it takes to complete the procedure, the time in ICU, postoperative oral feeding resumption and the hospital stay times. Minimally invasive surgery might be not less curative and effective than open surgical procedures, as found in our small non-randomzed series of patients. Larger series should confirm these results.
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December 2007

Superiority of transplantation versus resection for the treatment of small hepatocellular carcinoma.

Transpl Int 2008 Mar 20;21(3):247-54. Epub 2007 Nov 20.

Department of Surgery and Transplantation, University Hospital of Udine, Udine, Italy.

The best therapy for hepatocellular carcinoma (HCC) is still debated. Hepatic resection (HR) is the treatment of choice for single HCC in Child A patients, whereas liver transplantation (LT) is usually reserved for Child B and C patients with single or multiple nodules. The aim of this study was to compare HR and LT for HCC within the Milan criteria on an intention-to-treat basis. Forty-eight patients were treated by LT and 38 by HR. The median time on the waiting list for transplantation was 118 days. The estimated overall survival was significantly higher (P = 0.005) in the LT group than in the HR one. The estimated freedom from recurrence was also significantly higher (P < 0.0001) for LT patients than for HR ones. Indeed, the probability of HCC recurrence after resection was higher than after transplantation achieving 31% and 76% for HR and 2% and 2% for LT at 3 and 5 years after surgery. Multivariate analysis confirmed that transplantation was superior to resection in terms of patient's survival and risk of HCC recurrence. We conclude that LT is superior to HR for small HCC in cirrhotic patients assuming that LT should be performed within 6-10 months after listing to reduce the dropouts for reasons of tumor progression.
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http://dx.doi.org/10.1111/j.1432-2277.2007.00597.xDOI Listing
March 2008

The role of pancreatic leakage on rising of postoperative complications following pancreatic surgery.

J Surg Res 2008 Oct 2;149(2):272-7. Epub 2007 Oct 2.

Department of Surgery, University of Udine, School of Medicine, Udine, Italy.

Introduction: The variations in methods of pancreatic stump management and the volume of literature available on both main pancreatic duct and pancreaticoenetric anastomosis leak indicates the concern associated with the leak and the continuing efforts to prevent it. Herein we analyzed the role of pancreatic leakage followed by pancreatic surgery on the incidence of postoperative morbidity.

Patients And Methods: From 1989 to 2005, we performed 76 pancreaticoduodenectomy (PD) and 26 distal pancreatectomy (DP), assumed as control case). During DP the parenchymal transection was performed with a linear stapler. The surgical reconstruction after PD was as follows: 11 manual nonabsorbable stitch closure of the main duct, 24 closure of the main duct with linear stapler, 17 temporary occlusion of the main duct with neoprene glue, and 24 duct-to-mucosa anastomosis.

Results: In the PD group, morbidity rate was 60%, caused by pancreatic leakage, with an incidence of 48%, hemorrhagic complication, occurred in 10% of patients following surgical procedure and infectious complication, with an incidence of 15%. After distal pancreatectomy we recorded 80, 7% no complications, 3, 9% leakage, 15, 4% hemoperitoneum. By multivariate analysis bleeding complications, biliary anastomosis leakage, and infectious complications were consequences of pancreatic leakage (P = 0.025, P = 0.025, and P = 0.025, respectively). A significant statistical difference was recorded analyzing re-operation rates between closure of the main duct with linear stapler versus temporary occlusion of the main duct with neoprene glue (t = 0.049) and closure of the main duct with linear stapler versus duct-to-mucosa anastomosis (t = 0.003).

Conclusions: On the ground of our results of bleeding complication, biliary anastomosis leakage and infectious complication were consequences of pancreatic leakage: failure of a surgical anastomosis has serious consequences, particularly in case of anastomosis of the pancreas to the small bowel, because of the digestive capacities of activated pancreatic secretions.
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http://dx.doi.org/10.1016/j.jss.2007.09.002DOI Listing
October 2008

Treatment of recurrent symptomatic lymphocele after kidney transplantation with intraperitoneal Tenckhoff catheter.

Urology 2007 Oct;70(4):659-61

Department of Surgery and Transplantation, Udine University School of Medicine, Udine, Italy.

Objectives: The incidence of lymphocele after kidney transplantation ranges from 0.6% to 16%. The management of lymphocele is still controversial. Percutaneous needle aspiration and external drainage, with or without the injection of sclerosing solutions, are associated with high recurrence and complication rates. Open or laparoscopic intraperitoneal marsupialization requires hospital admission, general anesthesia, and, sometimes, extensive surgical dissection.

Methods: We report our experience treating recurrent symptomatic lymphocele with intraperitoneal drainage using a Tenckhoff catheter on an outpatient basis in 7 consecutive patients. In all cases, the lymphocele was diagnosed by abdominal ultrasonography 26 to 90 days after kidney transplantation. The mean diameter of the lymphocele was 14 +/- 6 cm. Percutaneous drainage was the initial approach, which was also used to differentiate between urinoma and lymphocele and to rule out infection. The lymphocele recurred within 1 month in all cases. The recurrent lymphoceles were treated on an outpatient basis using intraperitoneal drainage with a Tenckhoff catheter inserted into the lymphocele under ultrasound guidance. After administration of local anesthesia, two 1-cm vertical incisions were performed: one to access the lymphocele and the other to access the peritoneal cavity. A Tenckhoff catheter was inserted in the lymphocele and tunneled into the peritoneal cavity.

Results: All procedures were completed on an outpatient basis without any complications. The catheter was removed 6 months later with no evidence of recurrent lymphocele at ultrasound follow-up in all cases.

Conclusions: This outpatient surgical approach using ultrasound-guided intraperitoneal drainage with a Tenckhoff catheter appears to be a simple, effective, and safe method for treating unilobular recurrent symptomatic lymphocele after renal transplantation.
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http://dx.doi.org/10.1016/j.urology.2007.05.018DOI Listing
October 2007

Treatment of perforation in the healthy esophagus: analysis of 12 cases.

Langenbecks Arch Surg 2008 Mar 17;393(2):135-40. Epub 2007 Oct 17.

Department of Surgery, University Hospital Udine, Udine, Italy.

Background: Perforation of the esophagus still carries high morbidity and mortality rates, and there is no gold standard for the surgical treatment of choice.

Materials And Methods: We reviewed the records of patients treated for esophageal perforation in the last decade at the General Surgery Unit of the University of Udine. Patients suffering from perforation secondary to surgical procedures or neoplastic disease were ruled out.

Results: Eight males (66.7%) and four females (33.3%) met the inclusion criteria. The cause of perforation was iatrogenic in seven cases (58.3%) and spontaneous in five (41.7%). The perforation was in the cervical esophagus in five cases (41.7%) and at thoracic level in the other seven (58.3%). Two patients (16.7%) with cervical lesions were treated conservatively; two (16.7%) underwent primary closure and the insertion of a drainage tube; one patient with a distal cervical lesion underwent diversion esophagostomy; six patients had resection of the entire thoracic esophagus and terminal cervical esophagostomy; one had segmental resection of the distal thoracic esophagus and lateral diversion esophagostomy. In the five patients whose reconstruction was postponed, esophagogastroplasty surgery was performed with an anastomosis at cervical level in four cases and at thoracic level in one. The global mortality rate was 25%. Late diagnosis-more than 24 h after the perforation event-seems to be the only factor correlated with fatal outcome (p = 0.045).

Conclusions: The choice of treatment for perforation in a healthy esophagus depends mainly on the site and size of the lesion. Cervical lesions may be amenable to conservative treatment or require primary surgical repair, while thoracic lesions with associated sepsis or major loss of substance demand an aggressive approach, with esophageal resection and delayed reconstruction seeming to be the safest option.
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http://dx.doi.org/10.1007/s00423-007-0234-xDOI Listing
March 2008

[Uretero-vescical anastomosis during kidney transplantation. Preliminary results of two surgical techniques].

Minerva Urol Nefrol 2007 Sep;59(3):217-22

Clinica Chirurgica, Centro Trapianti Fegato, Rene e Pancreas, Università degli Studi di Udine, Udine, Italy.

Aim: The most frequent urologic complications after renal transplantation involve the uretero-vescical anastomosis (leakage, stenosis, and reflux), with a frequency of 1% to 30% in different series.

Methods: We present our results in a prospective randomized trial performed from October 2004 to September 2005, in a cohort of 36 patients, who underwent renal transplantation from cadaveric donor at our institution. A uretero-vescical anastomosis according to Lich-Gregoir was used in 18 cases (group A), whereas an anastomosis according to Knechtle was performed in other 18 patients (group B), respectively. The groups were comparable for donors and recipients characteristics. The mean donor age was 46.3 years vs 44.9 years, and the mean duration of cold ischemia was 1 086+/-296 min vs 1 100+/-381 min for group A and for group B respectively. The mean recipient age was 47.5 years vs 46.1 for group A and group B, respectively.

Results: No differences were evidenced between the two uretero-vescical anastomosis in term of surgical complications, infections or patient and graft survival at one year of follow-up. Stenosis and leakage involved 2 patients for each group respectively. Numbers of infections, days of antibiotic therapy were similar between the two groups.

Conclusion: Our early experience does not evidence differences between the two types of uretero-vescical anastomosis.
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September 2007

Survey assessment of worker dermal exposure and underlying behavioral determinants.

J Occup Environ Hyg 2007 Nov;4(11):809-20

Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

Within the workplace, there is less reliance on engineering controls for dermal exposure protection and more reliance on the worker's motivation and training in use of personal protective equipment. Behavior thus becomes a significant determinant of dermal exposure, and its assessment paramount in examining and understanding factors influencing exposure. The main objectives of this study were to: (i) assess worker knowledge, attitudes, and perceptions (KAP) of workplace dermal hazards using a self-complete questionnaire and to examine KAP associations with behavior and exposure; (ii) compare worker and manager scores to identify potential gaps in KAP between the two groups; (iii) utilize a semiquantitative observational DeRmal Exposure Assessment Methodology (DREAM) to evaluate worker dermal exposure; and (iv) identify potential behavioral factors underlying exposure using DREAM and KAP. Nineteen industries across the Baltimore, Md. and Lancaster, Pa., regions participated in the study including a total of 89 workers and 17 managers. The scales within the KAP questionnaire that served as the outcome measure included knowledge, training, behavior, behavior beliefs, information beliefs, self-efficacy, and overall beliefs. DREAM scores ranged from 0.15 to 545 with a median of 8 and a mean (SD) of 22 (62.5). Whereas worker self-efficacy with respect to PPE use, and the group "workers with 10-20 years of experience" were marginally positively associated with protective behavior (p < 0.08 and p < 0.06, respectively), a question related to barriers to PPE use was negatively associated with precautionary behavior (p < 0.01). Dermal exposure was positively associated with workers in the age group 40-49 years as compared with those less than 40 years of age (OR = 4.86, 95% CI = 0.93, 25.62). There were no statistically significant associations between KAP and DREAM. This is one of the first studies to begin to elucidate worker knowledge, attitudes, and perceptions that underlie behaviors that lead to occupational dermal exposures. Results of the KAP questionnaire can inform strategies to improve awareness and protective practices in the workplace through factors such as increased worker dermal hazard knowledge, well-informed company PPE selection and availability, and improved worker training.
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http://dx.doi.org/10.1080/15459620701612722DOI Listing
November 2007

Surgery in hepatic and extrahepatic colorectal metastases.

G Chir 2007 Aug-Sep;28(8-9):307-11

Universitá degli Studi di Udine, Clinica de Chirurgia Generale.

Extrahepatic disease (EHD) has been considered a contraindication to hepatectomy. Over the last few years, some series reported interesting 5-year survival rates after resection with hepatic colorectal metastases and EHD free margins. Between August 1989 and October 2005, 116 patients underwent liver resection for colorectal metastases at Surgical Department of the University of Udine, Italy. Among these, we reviewed the data of 5 patients affected by EHD. In 3 patients there were also an anastomotic recurrence of the primary tumor, in 3 patients diaphragm was infiltrated by contiguous liver metastases. We performed in all the patients minor liver resections. We have associated the radiofrequence ablation of a lesion not surgically resectable with liver resection in one case. The surgical procedure was always considered as curative. We observed no case of operative mortality. The mean survival of the entire cohort is 23.2 months (range 4-42 months). Our study, even if based upon a limited number of patients, supports the thesis that extrahepatic disease in patients affected by colorectal cancer with hepatic metastases should not be considered as an absolute contraindication to liver resection especially for the cases in with local radical cure exeresis is achievable.
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January 2008

Hematopoietic stem cell transplantation in peripheral T-cell lymphomas.

Leuk Lymphoma 2007 Aug;48(8):1496-501

Department of Hematology, Istituto Nazionale per lo Studio e la Cura dei Tumori, University of Milano, Italy.

Peripheral T-cell lymphomas (PTCL) are a rare entity with a dismal outcome. After conventional chemotherapy they showed a worse prognosis compared with B-cell non-Hodgkin's lymphoma (NHL), except for anaplastic lymphoma-kinase (ALK)-positive anaplastic large cell lymphomas (ALCL). High-dose chemotherapy followed by autologous stem cell transplantation (SCT) has been evaluated in relapsed patients as well as in the upfront setting. Available data showed an advantage for patients who received transplant as first line treatment whereas results of autografting at relapse have been satisfactory only for ALK-positive ALCLs compared to other PTCL subtypes. Based upon preliminary results, allogeneic SCT can be also considered as an alternative strategy in these lymphomas. Whether or not the postulated graft-versus-lymphoma effect may overcome the poor prognosis of T-cell NHL patients has to be established.
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http://dx.doi.org/10.1080/10428190701435275DOI Listing
August 2007

Comparison of two techniques of arterial anastomosis during adult cadaveric liver transplantation.

Transplant Proc 2007 Jul-Aug;39(6):1879-80

Department of Surgery & Transplantation, University of Udine, Italy.

Arterial complications are a major source of morbidity and mortality after orthotopic liver transplantation (OLT). The incidence of hepatic artery thrombosis (HAT) ranges from 1.6% to 8%, with a mortality rate that ranges from 11% to 35%. We have described herein a technique of arterial anastomosis aiming to perform the anastomosis as straight as possible to avoid any kinking, redundancy, or malposition of the artery when the liver is released in its final position. We compared this technique with the traditional technique of arterial anastomosis using an aortic Carrel patch, namely, 198 OLT (group A) with the traditional technique and 117 OLT (group B) with the modified technique. An aorto-hepatic bypass was necessary in 25% of the cases in group A and in 21% of the cases in group B (P = .33). Vascular anomalies were present in 20% of cases in group A and in 27.5% in group B (P = .14). Fourteen cases (7%) of HAT developed in group A versus 0 cases in group B (P = .003). In group B, we experienced 2 (1.7%) late arterial stenoses that were successfully treated using percutaneous transluminal angioplasty. The 14 cases of HAT occurring in group A were successfully managed using immediate surgical revascularization with graft salvage in 6 cases (43%), whereas the remaining 8 cases needed urgent retransplantation. We suggest that a technique of arterial anastomosis aimed at avoiding kinking, redundancy, or malposition of the artery may be a viable option to reduce the risk of HAT after OLT.
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http://dx.doi.org/10.1016/j.transproceed.2007.05.008DOI Listing
October 2007