Multicentre study of liver metastases from colorectal cancer in pathological livers

Objectives

Resection of colorectal cancer (CRC) liver metastases (LM) in pathological liver (PL) patients (with cirrhosis or hepatopathy) is extremely rare. The aim of this study was to perform a multicentre, retrospective analysis of epidemiology, surgical techniques and outcomes in patients with PL who underwent hepatic resection for CRC-LM.

Methods

A retrospective, multicentre questionnaire was distributed to 15 hepatopancreatobiliary surgical units.

Results

Only six of 15 (40%) HPB units reported any experience in the surgical resection of CRC-LM in patients with PL. Of the 20 patients identified, 10 had underlying cirrhosis and 10 had chronic hepatopathy. Their median age was 66 years (range: 49–81 years). Thirteen patients were male. Liver dysfunction was known preoperatively in 18 patients. All patients had Child–Pugh class A disease. Six patients had synchronous disease. There were a total of 38 lesions among the 20 patients, distributed at a median of one lesion per patient (range: 1–4 lesions). The median size of the lesions was 3.0 cm (range: 1.5–9.0 cm). Preoperative median carcinoembryonic antigen (CEA) was 32.3 ng/ml (range: 1–184 ng/ml). The surgical procedures performed included: sub-segmentectomy (n = 12); left lateral sectionectomy (n = 6); segmentectomy (n = 4); radiofrequency ablation (n = 3), and exploratory laparotomy (n = 4). Morbidity occurred in four patients (Clavien grades I [n = 1], II [n = 2] and IVa [n = 1]). Mortality was nil. An R0 resection margin was achieved in 15 of 16 patients. Twelve patients did not receive chemotherapy. In resected patients, 10 presented with relapse. The median disease-free and overall survival periods were 12.2 and 22.3 months, respectively.

Conclusions

When feasible, liver resection is the best option for CRC-LM in PL patients.     

Gallbladder tuberculosis： False-positive PET diagnosis of gallbladder cancer

ulceration or there may be typical tuberculosis nodules in the wall of varied size and numbers.A wide spectrum of symptoms have been described in patients with GT,including abdominal pain in right hypochondrium,weight loss,fever,anorexia,diarrhea,nausea,v…     

Isolation of enterovirus 70 (EV70) from patients with acute haemorrhagic conjunctivitis in two areas of Saudi Arabia

This is the first epidemic of acute haemorrhagic conjunctivitis (AHC) reported from Saudi Arabia in which enterovirus 70 (EV70) was implicated as aetiological agent. EV70 was isolated from 5 of 29 conjunctival scrapings from patients with AHC. Two human diploid cell lines, human skin fibroblast (HSF) and human embryonic lung fibroblast (MRC-5), were quite sensitive for the isolation of this virus. The relatively high isolation rate could also be attributed to the timing of collection of specimens and perhaps to the fact that conjunctival scrapings contained more virus particles than did eye swabs.     

Genotypes of hepatitis C virus (HCV) among positive Lebanese patients: comparison of data with that from other Middle Eastern countries

Recently we identified hepatitis C virus (HCV) genotype 4 as the principle genotype among Lebanese thalassaemics. In an attempt to confirm the predominance of genotype 4 in Lebanon and perhaps in the Middle East, genotyping was attempted on 142 HCV-infected Lebanese patients from five different hospitals in the country. These included 38 HCV-positive patients with symptomatic liver disease who were referred to gastroenterologists and 104 HCV-positive patients with no symptoms of liver disease: 27 patients with thalassaemia, 30 patients on haemodialysis, 32 multi-transfused and 15 intravenous drug users. HCV genotyping was performed on PCR HCV RNA-positive samples using a commercial line probe assay (LiPA; Innogenetics, Ghent, Belgium). HCV genotype 4 is found to be the predominant genotype among HCV-infected Lebanese patients (ranging from 34.2% to 53.3%) followed by 1a (ranging from 12.5% to 43.3%) and 1b (ranging from 8.0% to 34.4%). In patients with symptomatic liver disease, however, genotype 4 (34.2%) was preceded by genotype 1a (39.5%). The predominance of HCV genotype 4 in our population (45.7%) confirms the predominance of HCV genotype 4 in Lebanon and most of the Arab countries in the Middle East but contrasts with data reported from non-Arab Middle Eastern Countries as can be seen from the literature review. Implications of genotyping for clinical outcome of HCV infection, response to treatment as well as for vaccine development are discussed.     

Time course of antioxidant enzyme activities in liver transplant recipients

Reactive oxygen species (ROS) play a central role in ischemia-reperfusion injury after organ transplantation. They are degraded by endogenous radical scavengers such as antioxidant enzymes. The purpose of this study was to evaluate the temporal variations of antioxidant enzyme activities in liver transplant recipients. The study was performed in 13 liver transplant patients (11 men and 2 women). Blood samples were obtained pre- and postsurgical intervention: before transplant (T(0)), and 1, 6, 12, 24, 48, and 72 hours, as well as 5 and 7 days thereafter. We determined total and specific superoxide dismutase (SOD) activity, catalase (CAT), glutathione peroxidase (GPX), and glutathione reductase (GR) activities as well as malondialdehyde (MDA) and low-density lipoproteins (LDL). The results showed increased SOD and mainly GPX activities after liver transplantation, which correlated with MDA levels. Total SOD activity was mainly represented by Mn-SOD (75%) and Cu,Zn-SOD (25%), whereas Fe-SOD was not detected. In conclusion, the enhanced antioxidant enzyme activities reported in this study indicated a control of oxidative stress generated in liver transplantation. In this sense, although MDA levels showed an enormeous increase at 1 hour after transplantation, the lipid peroxidation was compensated for by GPX activity.     

Evaluation of the antioxidant capacity of a milk protein matrix in vitro and in vivo in women aged 50–70 years

Bovine milk proteins have emerged as a novel, dairy-based source of dietary antioxidants and a component of a nutritional strategy to maintain muscle mass during ageing. The aim of this study was to characterise the in vitro antioxidant capacity (AOC) of a milk-based protein matrix (MPM) before and after simulated gastrointestinal digestion (SGID) and determine whether plasma AOC was similarly modified in vivo following acute ingestion of the MPM in healthy 50–70 years old women. To achieve this, the AOC of the MPM was measured by the oxygen radical absorbance capacity (ORAC) assay prior to and following SGID. In parallel, plasma obtained from women prior to and for 3?h following ingestion of the MPM was analysed ex vivo for change in AOC to evaluate the translation in vivo. SGID of the MPM increased AOC by ～35% (27,365?±?2152 versus 42,592?±?2299?μmol TE/100?g dw; p?ex vivo, ingestion of the MPM increased fasting plasma AOC by ～23% (10,952?±?751 to 13,519?±?800?μmol TE/L; p?in vitro and the change in plasma AOC following ingestion of the MPM sampled ex vivo from healthy elderly women.     

Hepatitis C Virus Antibodies in High-Risk Saudi Groups

The recombinant-based enzyme immunoassay developed by Ortho Diagnostic System for the detection of antibodies of hepatis C virus (HCV) was used to determine the extent of exposure to HCV in healthy Saudi subjects (500 males; 260 females) without liver disease and with no history of percutaneous exposure to blood and in Saudis who are considered at high risk for contracting the disease: hemophiliacs (28), thalassemics (78), hemodialysis patients with renal failure (65) and patients with sexually transmitted diseases (STD) (220). The results show that HCV is endemic in the Saudi population with an overall frequency of 5.3% in healthy Saudi adults which is at least 5 times higher than what has been reported from Western Europe and the United States. Seropositivity rate in the high-risk groups ranges from 15.9% in patients with STD to 78.6% in hemophiliacs. These data underscore the urgent need for routine anti-HCV screening of blood donations in order to reduce the frequency of postransfusion non-A, non-B hepatitis and its sequelae in the Saudi population.     

Delta agent infection in Riyadh, Saudi Arabia

Blood samples from 186 HBsAg-positive Saudis and 42 HBsAg-positive Philippino blood donors were tested for anti-delta using the radioimmunoassay technique. The high prevalence of anti-delta in Saudis with liver disease (32%) contrasted sharply with that in Saudis with illness other than liver disease (13%) and in apparently healthy Saudis (5.4%). Together with the high prevalence of anti-delta in Philippino blood donors (9.5%), these results suggest that foci of endemic delta infection other than Italy probably exist.