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2. PARENTERAL AND ENTERAL FEEDING IN HOSPITALS IN ITALY - A NATIONAL SURVEY

Author

BRAGA , MARCO, BOZZETTI F, DIONIGI P, RADRIZZANI D, IAPICHINO G, SALIS C, SCROCCARO G, GELIO S, MESSORI A, TOGNONI G, ZANELLO M, FERRARA F, CORTI A, FANCHINI P, VERNERO S, CONGEDO RM, DECICCO M, MORELLI M, CARRATA R, LADDAGA L, LATTARULO M, MARCHESI G, SEQUENZA S, STIVALA B, LANZONE L, SOZZI P, RAITANO A, FIACCHI M, PIERANGELI A, RUSSITO G, CAPORALI C, BITTASI P, SANNA P, SAVONA G, USAI C, ACCOGLI P, SELLI L, PUSCEDDU P, IASIELLO G, FAZIO S, BADOINO C, BURLON N, LOMBARDI M, BERTANA P, BARTAZZI D, PAOLUCCI R, TELLA GC, CALLEGARI R, TOFFOLETTO F, TORREGGIANI L, CAMPO S, MICHELETTI I, LIDESTRI G, ZANIN P, GIULIANO G, CHIOLDI G, PERLASCA F, GRANDE W, PINCELLI D, PACCAGNELLA A, FRANCESCONI R, DOMENICONI D, BERTOTTI G, CAMPI A, VIVARELLI R, DONATI D, SIBILLA C, CERVI R, VANNUCCI A, TONELLI F, BRAVO MT, FUSI D, PAGANI M, DESALVO L, AMALFITANO ME, ZUNINO, VANLIUT MT, PIROLA V, CAMPESTRINI G, AGOSTINI S, GALDIERI MT, SEVERINO A, CASULA C, AGUS G, FRANCESCHINI L, SARNI A, VENDRAME G, FRATTINI F, NARDI L, VALENTE F, RAMBELLI G, RUSCONI A, TADDEI G, BARBUSCIA M, COZZAGLIO L, REGALIA E, GIUDICI D, GIANOTTI L, BACCARI P, DALCIN S, MOLENE V, BIFFI R, GALLITELLI L, BIANCHI G, VECCHI G, VILLA E, BARZAN D, MAZZATO M, PIETROMAGGIORI F, CAMPISI M, PALOZZO A, INZALACO M, RICCI G, CASTELLUCCI MG, MAGGIORE E, SALVADORE C, GRUSOVIN MT, MEZZASALMA N, MASO G, PECORELLI O, FINCO C, SARTORI F, BUFFANO G, IACOVELLI W, FERRI T, ZERMANI R, ROVATI P, CEBRELLI T, PALLAVICINI FB, ALBERTARIO F, BOSCO A, OLIVI P, PAOLINI P, DALCANTO L, MARCONCINI F, LAZZARINI R, MALACRIDA A, AMBOLDI A, BONELLI S, FLORIANELLO F, BORIN F, VAGHI GM, FANELLI FR, MANCINI S, GIUSTI D, NANNI G, SANNELLA F, SGANGA G, FELLEGARA P, MOSCONI F, SIGNORELLI I, ORBAN D, CECCHERINI E, ORSINI A, GIULIANO P, ROSA F, ZANELLA A, CROATTO T, TOFFANIN D, BINOTTO F, MARCATO P, MENARDO G, FAUCCI L, SPOLDI L, MARSETTI M, DICOSMO L, FORNASETTI A, MANETTI A, SALVATORE A, ROSSI C, RINALDI S, DEANGELIS C, AZZOLA M, CONTE F, RIZZO V, BONA, MAZZEGO M, LEGGIERI A, CANINO V, PASTORE V, BOSCO R, DEBERNARDI, DISALVATORE A, DEGRAZIA R, MAZZON D, PAPADIA G, TOIGO G, ISCRA F, NEMEZ M, DROBINZ F, MESGEZ D, TRONCON MG, BACCO A, CATTARUZZI C, CINQUE A, PASQUETTO A, CARTEI G, DIBELLO B, MIANI P, CHIZZOLA A, BALDASSARRE M, BORGA P, BORGATO F, SCATTOLINI C, LAVEGGIO L, FRANCESCHINI F, TURTURO F, PORRETTO V, COATI M, NESI L, CARNER M, ZAMPIERI P, GABRIELLI G, TODESCHINI G, FALCONI, MASSIMO, FRATUCELLO G, DELGROSSI S, CITTERIO R, VILLA C, RIVOLTA A, MINUTO D, ORCALLI F, FERRERA G., Braga, Marco, Bozzetti, F, Dionigi, P, Radrizzani, D, Iapichino, G, Salis, C, Scroccaro, G, Gelio, S, Messori, A, Tognoni, G, Zanello, M, Ferrara, F, Corti, A, Fanchini, P, Vernero, S, Congedo, Rm, Decicco, M, Morelli, M, Carrata, R, Laddaga, L, Lattarulo, M, Marchesi, G, Sequenza, S, Stivala, B, Lanzone, L, Sozzi, P, Raitano, A, Fiacchi, M, Pierangeli, A, Russito, G, Caporali, C, Bittasi, P, Sanna, P, Savona, G, Usai, C, Accogli, P, Selli, L, Pusceddu, P, Iasiello, G, Fazio, S, Badoino, C, Burlon, N, Lombardi, M, Bertana, P, Bartazzi, D, Paolucci, R, Tella, Gc, Callegari, R, Toffoletto, F, Torreggiani, L, Campo, S, Micheletti, I, Lidestri, G, Zanin, P, Giuliano, G, Chioldi, G, Perlasca, F, Grande, W, Pincelli, D, Paccagnella, A, Francesconi, R, Domeniconi, D, Bertotti, G, Campi, A, Vivarelli, R, Donati, D, Sibilla, C, Cervi, R, Vannucci, A, Tonelli, F, Bravo, Mt, Fusi, D, Pagani, M, Desalvo, L, Amalfitano, Me, Zunino, Vanliut, Mt, Pirola, V, Campestrini, G, Agostini, S, Galdieri, Mt, Severino, A, Casula, C, Agus, G, Franceschini, L, Sarni, A, Vendrame, G, Frattini, F, Nardi, L, Valente, F, Rambelli, G, Rusconi, A, Taddei, G, Barbuscia, M, Cozzaglio, L, Regalia, E, Giudici, D, Gianotti, L, Baccari, P, Dalcin, S, Molene, V, Biffi, R, Gallitelli, L, Bianchi, G, Vecchi, G, Villa, E, Barzan, D, Mazzato, M, Pietromaggiori, F, Campisi, M, Palozzo, A, Inzalaco, M, Ricci, G, Castellucci, Mg, Maggiore, E, Salvadore, C, Grusovin, Mt, Mezzasalma, N, Maso, G, Pecorelli, O, Finco, C, Sartori, F, Buffano, G, Iacovelli, W, Ferri, T, Zermani, R, Rovati, P, Cebrelli, T, Pallavicini, Fb, Albertario, F, Bosco, A, Olivi, P, Paolini, P, Dalcanto, L, Marconcini, F, Lazzarini, R, Malacrida, A, Amboldi, A, Bonelli, S, Florianello, F, Borin, F, Vaghi, Gm, Fanelli, Fr, Mancini, S, Giusti, D, Nanni, G, Sannella, F, Sganga, G, Fellegara, P, Mosconi, F, Signorelli, I, Orban, D, Ceccherini, E, Orsini, A, Giuliano, P, Rosa, F, Zanella, A, Croatto, T, Toffanin, D, Binotto, F, Marcato, P, Menardo, G, Faucci, L, Spoldi, L, Marsetti, M, Dicosmo, L, Fornasetti, A, Manetti, A, Salvatore, A, Rossi, C, Rinaldi, S, Deangelis, C, Azzola, M, Conte, F, Rizzo, V, Bona, Mazzego, M, Leggieri, A, Canino, V, Pastore, V, Bosco, R, Debernardi, Disalvatore, A, Degrazia, R, Mazzon, D, Papadia, G, Toigo, G, Iscra, F, Nemez, M, Drobinz, F, Mesgez, D, Troncon, Mg, Bacco, A, Cattaruzzi, C, Cinque, A, Pasquetto, A, Cartei, G, Dibello, B, Miani, P, Chizzola, A, Baldassarre, M, Borga, P, Borgato, F, Scattolini, C, Laveggio, L, Franceschini, F, Turturo, F, Porretto, V, Coati, M, Nesi, L, Carner, M, Zampieri, P, Gabrielli, G, Todeschini, G, Falconi, Massimo, Fratucello, G, Delgrossi, S, Citterio, R, Villa, C, Rivolta, A, Minuto, D, Orcalli, F, Ferrera, G., Braga, M, Congedo, R, Tella, G, Bravo, M, Amalfitano, M, Vanliut, M, Galdieri, M, Castellucci, M, Grusovin, M, Pallavicini, F, Vaghi, G, Fanelli, F, Troncon, M, Falconi, M, and Ferrera, G

Subjects
Pediatrics, medicine.medical_specialty, Nutrition and Dietetics, business.industry, medicine.medical_treatment, Insulin, Abdominal distension, Critical Care and Intensive Care Medicine, Enteral administration, Gastroenterology, Discontinuation, Parenteral nutrition, Internal medicine, Intensive care, Medicine, enteral feeding, medicine.symptom, business, Complication, Central venous catheter
Abstract

A multicentre prospective survey on the use of artificial nutrition (AN) and its complications has been carried out on 1657 hospitalised patients including 7.8% in surgical departments, 7.1% in medical departments and 59.9% in intensive care units. Gastrointestinal diseases and cancer were the most frequent pathologies among patients requiring AN. Parenteral nutrition (PN) alone was employed in 1103 (66.5%) patients. In 267 (16.1%) PN was associated with enteral nutrition (EN). 287 (17.3%) patients were fed by the enteral route alone. The average daily energy intake was 35 kcal/kg for central PN, 26 kcal/kg for peripheral PN and 33 kcal/kg for EN. The mean daily nitrogen intake was 0.19 g/kg for central PN, 0.17 g/kg for peripheral PN and 0.20 g/kg for EN. In 10% of patients PN was electrolyte free and in only 50% all the main electrolytes were added. Trace elements were added in 48% of formulations, mainly as multiple combination. Insulin was added in 61% of PN patients, while albumin was given with PN in 20% of patients. Adverse reactions were observed in 10.9% of PN patients and in 11.5% of EN patients. The most frequent complications occurring in parenterally fed patients were infections of the central venous catheter and metabolic alterations (severe electrolyte abnormalities, liver or renal dysfunction, hypo or persistent hyperglycemia). In enterally fed patients the frequent complications were abdominal distension, cramps and diarrhoea. Adverse reactions were responsible for discontinuation of AN in 2.2% of parenterally supported patients and in 5.7% of enterally fed patients.

Published
1994

3. Contribution to the knowledge of the Flora of Mt. Paganuccio (Furlo Mts., Pesaro),Contributo alla conoscenza della flora del Monte Paganuccio (M.ti del Furlo, Pesaro)

Author

Angiolini, C., Baiocco, M., Brilli-Cattarini, A. J. B., Caporali, C., Capotorti, G., Simona Casavecchia, Cerroni, M., Corazzi, G., Fratini, S., Frondoni, R., Galli, P., Gallo, A. M., Gallozzi, M. R., Gubellini, L., Lattanzi, E., Mazzerioli, M., Milanese, A., Morrocchi, D., Ortolani, S., Pacini, A., Papini, A., Paradisi, L., Pignattelli, S., Pinzi, M., Presti, G., Raponi, M., Riccucci, C., Scarici, E., Scoppola, A., Silvi, B., Stagnari, M., and Tanfulli, M.

4. Neoangiogenesis-related genes are hallmarks of fast-growing hepatocellular carcinomas and worst survival. Results from a prospective study

Author

Mariagrazia Del Buono, Paola Loria, Teresa Pollicino, Stefano Colopi, Elena Bertolini, Guido Marzocchi, Stefano Ballestri, Cristian Caporali, Calogero Cammà, Barbara Lei, Aimilia Karampatou, Gianluigi Giannelli, Fabiola Milosa, Erica Villa, Giuseppe Cabibbo, Marco Enea, Elena Turola, Rosina Maria Critelli, Umberto Cillo, Giorgio Enrico Gerunda, Patrizia Pontisso, Nicola De Maria, María L. Martínez-Chantar, Paola Todesca, Luisa Losi, Livia Maccio, Filippo Schepis, Villa E., Critelli R., Lei B., Marzocchi G., Camma C., Giannelli G., Pontisso P., Cabibbo G., Enea M., Colopi S., Caporali C., Pollicino T., Milosa F., Karampatou A., Todesca P., Bertolini E., Maccio L., Martinez-Chantar M.L., Turola E., Dal Buono M., De Maria N., Ballestri S., Schepis F., Loria P., Gerunda G.E., Losi L., and Cillo U.

Subjects
Adult, Male, 0301 basic medicine, medicine.medical_specialty, Time Factors, Carcinoma, Hepatocellular, Time Factor, Microarray, Hepatocellular carcinoma, molecular carcinogenesis, Gastroenterology, liver imaging, HEPATOCELLULAR CARCINOMA, LIVER IMAGING, MOLECULAR CARCINOGENESIS, MOLECULAR ONCOLOGY, Aged, Aged, 80 and over, Disease Progression, Female, Humans, Liver Neoplasms, Middle Aged, Neovascularization, Pathologic, Prospective Studies, Survival Rate, Tumor Burden, Medicine (all), 03 medical and health sciences, molecular oncology, 0302 clinical medicine, Hepatocellular carcinoma, liver imaging, molecular carcinogenesis, molecular oncology, Internal medicine, medicine, Carcinoma, Doubling time, Prospective cohort study, Survival rate, business.industry, Proportional hazards model, medicine.disease, Prospective Studie, 030104 developmental biology, Quartile, Liver Neoplasm, 030220 oncology & carcinogenesis, business, Human
Abstract

Objective The biological heterogeneity of hepatocellular carcinoma (HCC) makes prognosis difficult. We translate the results of a genome-wide high-throughput analysis into a tool that accurately predicts at presentation tumour growth and survival of patients with HCC.Design Ultrasound surveillance identified HCC in 78 (training set) and 54 (validation set) consecutive patients with cirrhosis. Patients underwent two CT scans 6 weeks apart (no treatment in-between) to determine tumour volumes (V-0 and V-1) and calculate HCC doubling time. Baseline-paired HCC and surrounding tissue biopsies for microarray study (Agilent Whole Human Genome Oligo Microarrays) were also obtained. Predictors of survival were assessed by multivariate Cox model.Results Calculated tumour doubling times ranged from 30 to 621 days (mean, 107 +/- 91 days; median, 83 days) and were divided into quartiles: = 111 days (n= 19). Median survival according to doubling time was significantly lower for the first quartile versus the others (11 vs 41 months, 42, and 47 months, respectively) (p< 0.0001). A five-gene transcriptomic hepatic signature including angiopoietin-2 (ANGPT2), delta-like ligand 4 (DLL4), neuropilin (NRP)/tolloid (TLL)-like 2 (NETO2), endothelial cell-specific molecule-1 (ESM1), and nuclear receptor subfamily 4, group A, member 1 (NR4A1) was found to accurately identify rapidly growing HCCs of the first quartile (ROC AUC: 0.961; 95% CI 0.919 to 1.000; p< 0.0001) and to be an independent factor for mortality (HR: 3.987; 95% CI 1.941 to 8.193, p< 0.0001).Conclusions The hepatic five-gene signature was able to predict HCC growth in individual patient and the consequent risk of death. This implies a role of this molecular tool in the future therapeutic management of patients with HCC.

Published
2015

5. Under-dilated TIPS Associate With Efficacy and Reduced Encephalopathy in a Prospective, Non-randomized Study of Patients With Cirrhosis

Author

Tommaso Di Maira, Stefano Fagiuoli, Rita Golfieri, Umberto Arena, Fabio Marra, Stefano Gitto, Stefano Colopi, Alessandro Cannavale, Filippo Schepis, Pietro Torricelli, Luca S. Belli, Pietro Quaretti, Giacomo Laffi, Angelo Luca, Cristian Caporali, Roberto Agazzi, Roberto Miraglia, Federico Banchelli, Nicola De Maria, Guido Marzocchi, Ilaria Fiorina, Roberto Nani, Antonio Rampoldi, Erica Villa, Mario De Santis, Raffaele Bruno, Lorenzo Paolo Moramarco, Guadalupe Garcia-Tsao, Aldo Airoldi, Francesco Vizzutti, Fabrizio Fanelli, L. Rega, Matteo Renzulli, Cristina Mosconi, Fabrizio Di Benedetto, Schepis, F, Vizzutti, F, Garcia-Tsao, G, Marzocchi, G, Rega, L, De Maria, N, Di Maira, T, Gitto, S, Caporali, C, Colopi, S, De Santis, M, Arena, U, Rampoldi, A, Airoldi, A, Cannavale, A, Fanelli, F, Mosconi, C, Renzulli, M, Agazzi, R, Nani, R, Quaretti, P, Fiorina, I, Moramarco, L, Miraglia, R, Luca, A, Bruno, R, Fagiuoli, S, Golfieri, R, Torricelli, P, Di Benedetto, F, Belli, L, Banchelli, F, Laffi, G, Marra, F, Villa, E, Schepis, Filippo, Vizzutti, Francesco, Garcia-Tsao, Guadalupe, Marzocchi, Guido, Rega, Luigi, De Maria, Nicola, Di Maira, Tommaso, Gitto, Stefano, Caporali, Cristian, Colopi, Stefano, De Santis, Mario, Arena, Umberto, Rampoldi, Antonio, Airoldi, Aldo, Cannavale, Alessandro, Fanelli, Fabrizio, Mosconi, Cristina, Renzulli, Matteo, Agazzi, Roberto, Nani, Roberto, Quaretti, Pietro, Fiorina, Ilaria, Moramarco, Lorenzo, Miraglia, Roberto, Luca, Angelo, Bruno, Raffaele, Fagiuoli, Stefano, Golfieri, Rita, Torricelli, Pietro, Di Benedetto, Fabrizio, Belli, Luca Saverio, Banchelli, Federico, Laffi, Giacomo, Marra, Fabio, and Villa, Erica

Subjects
Male, medicine.medical_specialty, Cirrhosis, medicine.medical_treatment, Liver, liver, portal hypertensive bleeding, portal hypertensive complications, treatment, vascular disease, Hemodynamics, Inferior vena cava, 03 medical and health sciences, 0302 clinical medicine, Model for End-Stage Liver Disease, Vascular Disease, Ascites, medicine, Humans, Prospective Studies, Aged, Hepatology, Vascular disease, business.industry, Incidence, Gastroenterology, Stent, Middle Aged, medicine.disease, Fibrosis, Surgery, Treatment, Treatment Outcome, Italy, Portal Hypertensive Bleeding, medicine.vein, Hepatic Encephalopathy, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Portasystemic Shunt, Transjugular Intrahepatic, medicine.symptom, business, Transjugular intrahepatic portosystemic shunt
Abstract

Background & Aims: Portosystemic encephalopathy (PSE) is a major complication of trans-jugular intrahepatic porto-systemic shunt (TIPS) placement. Most devices are self-expandable polytetrafluoroethylene-covered stent grafts (PTFE-SGs) that are dilated to their nominal diameter (8 or 10 mm). We investigated whether PTFE-SGs dilated to a smaller caliber (under-dilated TIPS) reduce PSE yet maintain clinical and hemodynamic efficacy. We also studied whether under-dilated TIPS self-expand to nominal diameter over time. Methods: We performed a prospective, non-randomized study of 42 unselected patients with cirrhosis who received under-dilated TIPS (7 and 6 mm) and 53 patients who received PTFE-SGs of 8 mm or more (controls) at referral centers in Italy. After completion of this study, dilation to 6 mm became the standard and 47 patients were included in a validation study. All patients were followed for 6 months; Doppler ultrasonography was performed 2 weeks and 3 months after TIPS placement and every 6 months thereafter. Stability of PTFE-SG diameter was evaluated by computed tomography analysis of 226 patients with cirrhosis whose stent grafts increased to 6, 7, 8, 9, or 10 mm. The primary outcomes were incidence of at least 1 episode of PSE grade 2 or higher during follow up, incidence of recurrent variceal hemorrhage or ascites, incidence of shunt dysfunction requiring TIPS recanalization, and reduction in porto-caval pressure gradient. Results: PSE developed in a significantly lower proportion of patients with under-dilated TIPS (27%) than controls (54%) during the first year after the procedure (P =.015), but the proportions of patients with recurrent variceal hemorrhage or ascites did not differ significantly between groups. No TIPS occlusions were observed. These results were confirmed in the validation cohort. In an analysis of self-expansion of stent grafts, during a mean follow-up period of 252 days after placement, none of the PTFE-SGs self-expanded to the nominal diameter in hemodynamically relevant sites (such as portal and hepatic vein vascular walls). Conclusions: In prospective, non-randomized study of patients with cirrhosis, we found under-dilation of PTFE-SGs during TIPS placement to be feasible, associated with lower rates of PSE, and effective.

Published
2018

6. Study of a CVD diamond detector for absorbed dose measurement in photon beams with small field sizes

Author

R F Laitano, Gennaro Conte, Maria Pimpinella, A.S. Guerra, C. Caporali, Dössel O., Schlegel W.C., Caporali, C., Conte, G., Guerra, A. S., Laitano, R. F., and Pimpinella, M.

Subjects
Reproducibility, Materials science, Optics, business.industry, CVD diamond detector, single crystal diamonds, radiation detector, radiotherapy, Monte Carlo simulation, Absorbed dose, Detector, Monte Carlo method, Laser beam quality, Chemical vapor deposition, business, Single crystal, Particle detector
Abstract

A new diamond detector to perform absorbed-dose- to-water measurement in radiotherapy photon beams with small field sizes is being developed in the framework of the EURAMET/EC FP7 project “External Beam Cancer Therapy”. An objective of the project is to obtain detectors capable of ensuring traceability of absorbed dose measurements in radiotherapy photon beams with field size down to 1 cm x 1 cm. To this end the CVD diamond detectors up to now developed were found not adequate. The present project requires detectors with high spatial resolution, good stability and low energy dependence. Diamond detectors were chosen for their high spatial resolution and good tissue equivalence (Z = 6). The detector studied in this work is based on a single crystal CVD diamond with dimensions 3 mm x 3 mm x 0.5 mm on which 0.2 μm electrodes were thermally evaporated. Particular care was addressed to ensure the tissue-equivalence of the detector by using appropriate materials. A thorough analysis of the priming procedure, stability and signal reproducibility was carried out in a Co-60 gamma beam at dose rates in the range from 0.3 Gy min− 1 to 1.38 Gy min− 1. Moreover the detector response was studied by Monte Carlo calculations as a function both of the beam quality, from Co-60 to 10 MV photon beams, and field size, from 10 cm x 10 cm to 1 cm x 1 cm. The perturbation due to the non-water equivalence of electrodes was also determined by Monte Carlo simulations.

Published
2009

7. Enoxaparin Prevents Portal Vein Thrombosis and Liver Decompensation in Patients With Advanced Cirrhosis

Author

Cristian Caporali, Cristina Tata, Monica Luongo, Ramona Zecchini, Aimilia Karampatou, Elena Turola, Barbara Lei, Stefano Gitto, Mariagrazia Del Buono, Beatrice Zambotto, Salvatore Petta, Ranka Vukotic, Marco Marietta, Anna Ferrari, Rosina Maria Critelli, Giovanni Fornaciari, Filippo Schepis, Stefano Colopi, Veronica Bernabucci, Calogero Cammà, Dominique Valla, Luisa Simoni, Erica Villa, Nicola De Maria, Susanna Schianchi, Villa, E, Camma', C, Marietta, M, Luongo, M, Critelli, R, Colopi, S, Tata, C, Zecchini, R, Gitto, S, Petta, S, Lei, B, Bernabucci, V, Vukotic, R, De Maria, N, Schepis, F, Karampatou, A, Caporali, C, Simoni, L, Del Buono, M, Zambotto, B, Turola, E, Fornaciari, G, Schianchi, S, Ferrari, A, and Valla, D

Subjects
medicine.medical_specialty, Cirrhosis, Intention-to-treat analysis, Hepatology, business.industry, cirrhosis, Gastroenterology, Portal vein trombosis, Enoxaparin, enoxaparin, cirrhosis, portal thrombosis, medicine.disease, Surgery, Portal vein thrombosis, law.invention, Spontaneous bacterial peritonitis, Model for End-Stage Liver Disease, Randomized controlled trial, law, Hepatocellular carcinoma, Medicine, Portal hypertension, business
Abstract

BACKGROUND & AIMS: We performed a randomized controlled trial to evaluate the safety and efficacy of enoxaparin, a low-molecular-weight heparin, in preventing portal vein thrombosis (PVT) in patients with advanced cirrhosis. METHODS: In a nonblinded, single-center study, 70 outpatients with cirrhosis (Child-Pugh classes B7-C10) with demonstrated patent portal veins and without hepatocellular carcinoma were assigned randomly to groups that were given enoxaparin (4000 IU/day, subcutaneously for 48 weeks; n = 34) or no treatment (controls, n = 36). Ultrasonography (every 3 months) and computed tomography (every 6 months) were performed to check the portal vein axis. The primary outcome was prevention of PVT. Radiologists and hepatologists that assessed outcomes were blinded to group assignments. Analysis was by intention to treat. RESULTS: At 48 weeks, none of the patients in the enoxaparin group had developed PVT, compared with 6 of 36 (16.6%) controls (P = .025). At 96 weeks, no patient developed PVT in the enoxaparin group, compared with 10 of 36 (27.7%) controls (P = .001). At the end of the follow-up period, 8.8% of patients in the enoxaparin group and 27.7% of controls developed PVT (P = .048). The actuarial probability of PVT was lower in the enoxaparin group (P = .006). Liver decompensation was less frequent among patients given enoxaparin (11.7%) than controls (59.4%) (P < .0001); overall values were 38.2% vs 83.0%, respectively (P < .0001). The actuarial probability of liver decompensation was lower in the enoxaparin group (P < .0001). Eight patients in the enoxaparin group and 13 controls died. The actuarial probability of survival was higher in the enoxaparin group (P = .020). No relevant side effects or hemorrhagic events were reported. CONCLUSIONS: In a small randomized controlled trial, a 12-month course of enoxaparin was safe and effective in preventing PVT in patients with cirrhosis and a Child-Pugh score of 7-10. Enoxaparin appeared to delay the occurrence of hepatic decompensation and to improve survival.

Published
2012

8. VIATORR endoprosthesis do not self-expand to their nominal diameters in cirrhotic livers: new evidence toward the risk reduction of post-TIPS hepatic encephalopathy

Author

Schepis, Filippo, Vizzutti, Francesco, Marzocchi, Guido, Quaretti, Pietro, Rampoldi, Antonio G., Agazzi, Roberto, Golfieri, Rita, Luca, Angelo, Fanelli, Fabrizio, Caporali, Cristian, Colopi, Stefano, Rega, Luigi, Arena, Umberto, Fiorina, Ilaria, Moramarco, Lorenzo, Airoldi, Aldo, Nani, Roberto, Renzulli, Matteo, Mosconi, Cristina, Bruno, Raffaele, Fagiuoli, Stefano, Cannavale, Alessandro, Di Maira, Tommaso, Stefano Gitto, Villa, Erica, and Schepis F, Vizzutti F, Marzocchi G, Quaretti P, Rampoldi AG, Agazzi R, Golfieri R, Luca A, Fanelli Fabrizio, Caporali C, Colopi S, Rega L, Arena U, Fiorina I, Moramarco L, Airoldi A, Nani R, Renzulli M, Mosconi C, Bruno R, Fagiuoli S, Cannavale A, Di Maira T, Gitto S, Villa E

Subjects
Nitinol-based ePTFE-covered endoprosthesis (VIATORR©) represent, TIPS, cirrhotic patients

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