Cysto-biliary communication in liver hydatidosis

Background

Liver hydatidosis is a severe health problem in endemic areas. Due to migration from these countries to other zones, now it is a worldwide problem. Liver hydatidosis can provoke many complications (abscess, fistula to adjacent organs, migration, etc.), but the most frequent and one of the most severe complication is the communication between the cyst and the biliary tree.

Aim

The aim of this study is to perform a review on the epidemiology, clinical features, diagnostic methods, and therapeutic options to treat the communication between the cyst and the biliary tree.

Results

Due to the lack of randomized clinical trial or meta-analysis on this topic, we performed a classical review and included our personal algorithm.

Conclusions

The communication between the cyst and the biliary tree varies from a small communication to a frank intrabiliary rupture. The percentage of patients with the communication between the cyst and the biliary tree is not well known because there is no accepted definition. The therapeutic options are multiple and related to the size of the communication, the location of the cyst, and the experience of the hepatobiliary surgeon. ERCP is now an important tool for the treatment of the communication between the cyst and the biliary tree.     

Liver metastasis of endometrial stromal sarcoma

Resection of liver metastases from gynaecological tumours is uncommon.Endometrial stromal sarcomas(ESS) are low incidence gynecological tumours which can originate in previous sites of endometriosis or following metaplasia of the pelvic peritoneal wall,and which are exceptionally associated with liver metastasis.We present a 68-year-old woman with a ESS and metachronic liver metastasis treated by liver resection.There is very little literature on clinical management about liver metastasis from ESS,but extrapolating the data obtained with liver metastasis from sarcomas and uterine tumours,we should recommend resection as this is considered a resectable extrauterine metastasis.In cases with more sites of extrauterine disease,liver resection should also be performed if the other sites are resectable.     

Indications and therapeutical options in hepatolithiasis.

OBJECTIVE: to present our experience with the treatment of hepatolithiasis. PATIENTS AND METHODS: EXPERIMENTAL DESIGN: a retrospective study. Every patient operated on during 2002-2004. RESULTS: mean age was 68.2 years. All patients were male. Two patients had been operated on before. The other three suffered from: monolobar Caroli s disease (1), cholangiocarcinoma (1), and hepatolihtiasis without clear etiologic factors (1). All of them had intrahepatic and extrahepatic litihiasis. Clinical signs included: pain in RUQ, fever, and jaundice. Bilirubin was 3.5 mg/dl (min: 1.7, max: 5.9), GGT: 676.2 IU/l (min: 29, max: 2039), and alkaline phosphatase: 400 IU/l (min: 100, max: 1136). Abdominal ultrasounds always correctly diagnosed HL. CT (3 patients) only diagnosed one case. ERCP (3 patients) and cholangio-MRI (2 patients) always diagnosed HL correctly. Surgical procedures were: hepatojejunostomy with lavage of bile duct (2 cases) and hepatectomy (3 cases) -both right (1) and left (2). We always performed an intraoperative ultrasonography and choledoscopy. Morbidity was: biliary fistula (1 case) treated by percutaneous drainage. No mortality occurred. Median stay was 8.8 days. Mean follow-up is 12 months (min: 11, max: 20). No relapse has been observed. CONCLUSIONS: HL is infrequent in Spain. Surgical treatment, usually liver resection, obtains good results with low morbidity and mortality.     

The role of trypsin in plaque formation by simian rotavirus SA-11

The role of trypsin in plaque production by simian rotavirus SA-11 monolayers of MA-104 cells are investigated. Initial trypsin treatment of the virus alone or its presence only during the early phases of virus-cell interaction was found to be insufficient for plaque production by the virus. Presence of trypsin (5 microgram/mL) in the agar overlay throughout the five day incubation period was essential for the optimal development of the virus plaques. Production of plaques by the incorporation of trypsin in the overlay was not due to the enzymatic degradation of any plaque-inhibitors in the agar used. Experiments using high (4 PFU/cell) and low (35 PFU/10(6) cells) multiplicities of infection suggest that trypsin added to fluid maintenance medium facilitates the cell-to-cell spread of progeny virus particles. Therefore, the enzyme incorporated in the agar overlay appears to play a similar role thereby assisting in the formation of SA-11 plaques.     

The Effect of Pseudomonas Aeruginosa on the Immunogenicity of Enterobacterial Common Antigen

Pseudomonas aeruginosa produces a factor (PF) which alters the enterobacterial common antigen (ECA). Its effect on the immunogenicity of two types of immunogenic ECA, namely, the ethanol-soluble preparation freed of lipopolysaccharide and the LPS-coupled form from the R-mutant E. coli 014 was investigated. The antibody response following intravenous immunization was determined by means of the hemagglutination test. It is shown that PF abolishes the immunogenicity of the former but not of the latter. PF obtained from a strain of P. maltophilia yielded the same results. Antiserum against Pseudomonas aeruginosa of types 1 and 6 neutralizes PF produced by either type. These results suggest that PF alters the lipid part and not the haptenic determinant of ECA and that this activity is neutralized by P. aeruginosa antiserum of either type 1 or type 6. This interpretation is compatible with the identification of PF as a lipase.     

Early postoperative response of cytokines in liver transplant recipients

We evaluated the early postoperative response of several cytokines (IL-2, IL-4, IL-6, IL-10, TNF-alpha, IFN-gamma) prior to liver transplantation (T(0)) as well as 1, 6, and 12 hours and 1, 2, 3, 5, and 7 days afterward. Cytokine concentrations were correlated with serum levels of bilirubin as a predictor of postoperative complications. Cytokine levels were determined in plasma samples from 16 liver transplant recipients (13 men, 3 women) aged 43 to 61 years. IL-6 and IL-10 reached their maximum concentrations 1 hour after transplantation. Each increase in IL-6 correlated to a rise in IL-10. IL-2, IL-4, TNF-alpha, and IFN-gamma had a particular time-course for each patient studied. Bilirubin fell to almost normal values but not in cases of postoperative complications, where IL-6 showed values four times higher compared to those of liver transplant recipients who did not show postoperative complications. IL-6 and IL-10 plasma concentrations and serum bilirubin level might be useful as a predictive factor of postoperative complications in liver transplant recipients.     

Hepatocarcinoma in noncirrhotic liver

Hepatocellular carcinoma (HCC) usually develops in patients with liver cirrhosis or chronic liver disease. These tumors are highly infrequent in patients without precipitating factors. We present a series of four patients with nonfibrolamellar HCC arising in healthy liver. None of the patients had viral infection, or showed alcohol abuse and/or hemochromatosis. Three patients underwent surgery. The clinical characteristics, therapeutic options, and survival and recurrence rates in this type of tumor are discussed.