Role of pre-transplant 18F-FDG PET/CT in predicting hepatocellular carcinoma recurrence after liver transplantation

The last two decades have seen a paradigm shift in the selection of patients with hepatocellular carcinoma (HCC) for liver transplantation. Microvascular invasion and differentiation have been the most significant factors affecting post-transplant recurrence; however, because of inherent disadvantages of pre-transplant biopsy, histological criteria never gained popularity. Recently, the selection criteria evolved from morphological to biological criteria, such as biomarkers and response to loco-regional therapy. With the introduction of multimodality imaging, combination of computed tomography with nuclear medicine imaging, particularly, 18F-fluorodeoxyglucose positron emission tomography fulfilled an unmet need and rapidly became a critical component of HCC management. This review article will focus on the use of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography in the pre-transplant evaluation of HCC patients with special discussion on its ability to predict HCC recurrence after liver transplantation.     

Dermatoglyphic features in patients with multiple sclerosis

Objective:

To examine dermatoglyphic features to clarify implicated genetic predisposition in the etiology of multiple sclerosis (MS).

Methods:

The study was conducted between January and December 2013 in the Departments of Anatomy, and Neurology, Cumhuriyet University School of Medicine, Sivas, Turkey. The dermatoglyphic data of 61 patients, and a control group consisting of 62 healthy adults obtained with a digital scanner were transferred to a computer environment. The ImageJ program was used, and atd, dat, adt angles, a-b ridge count, sample types of all fingers, and ridge counts were calculated.

Results:

In both hands of the patients with MS, the a-b ridge count and ridge counts in all fingers increased, and the differences in these values were statistically significant. There was also a statistically significant increase in the dat angle in both hands of the MS patients. On the contrary, there was no statistically significant difference between the groups in terms of dermal ridge samples, and the most frequent sample in both groups was the ulnar loop.

Conclusions:

Aberrations in the distribution of dermatoglyphic samples support the genetic predisposition in MS etiology. Multiple sclerosis susceptible individuals may be determined by analyzing dermatoglyphic samples.Multiple sclerosis (MS) is the most frequent neurological disease of the CNS that causes permanent disability in young adults. The disease is characterized with chronic inflammation and demyelination of the CNS. The etiology of the disease is still not fully understood. However, in epidemiologic and genetic studies, heredity and environmental factors are suspected in the disease pathogenesis.1-3 Dermatoglyphics are specific patterns made by the epidermis ridges on the fingertips, palms, and soles. They are formed in the ectoderm between the eleventh and twenty-fourth weeks of intrauterine life and remain unchanged. In the same period, the CNS begins to occur from the ectoderm. During this period, any genetic disorder that affects the nervous system also leads to changes in dermatoglyphs. Thus, aberrations observed in dermatoglyphic samples indicate a hereditary disorder in the intrauterine period.4,5 In dermatoglyphic studies, the dermatoglyphic features of the society gains importance. There is a lack of research studying the dermatoglyphic features of MS patients. Therefore, to explore the genetic predisposition of MS etiology, the fingertip, and palm dermatoglyphic samples of patients with MS were compared with a control group and reviewed with the relevant literature.     

Characteristics of Patients With Spontaneous Splenic Rupture

In the present study, we aim to share our clinical experience in patients with spontaneous splenic rupture. Splenic rupture without trauma is known as spontaneous splenic rupture. The major problems in the management of spontaneous splenic rupture are missed or delayed diagnosis due to the lack of trauma in most cases. The records of all patients, who were admitted to Cerrahpaşa Medical Faculty, Istanbul University, were retrospectively reviewed from January 2000 to March 2013. Twelve patients were admitted to the emergency department and they were diagnosed with spontaneous splenic rupture. The mean age was 47.6 years. All patients had complaints of abdominal pain. The mean hematocrit value was 22%. Radiologic assessment revealed hemoperitoneum and/or subcapsular hematoma in 8 patients while splenic abscess was diagnosed in 2 patients. Eleven patients underwent splenectomy whereas one was managed conservatively. The most common cause of spontaneous splenic rupture was determined to be use of anticoagulants. Etiology was considered to be idiopathic in 1 patient. Two patients died in the postoperative period. Although rare, spontaneous splenic rupture must be suspected in emergency patients who have used especially anticoagulants and antiaggregants and who have had no recent history of trauma. One of the important causes of mortality is missed or delayed diagnosis.Key words: Spontaneous, Atraumatic, Splenic rupture, Drug use, MortalityAlthough splenic rupture often occurs in association with the trauma, it may appear due to causes other than trauma, and has a fatal course. Ruptures occurring without trauma are often called spontaneous or atraumatic splenic rupture in the literature.^1,2 They are extremely rare and the frequency remains unclear. A study reported the plausible incidence to be 0.1–0.5%.³ It usually develops due to a pathologic cause such as malignancy or infection. It may develop less frequently in a normal spleen without being associated with any pathology and refers to idiopathic splenic rupture.⁴ It is an important problem because it delays the definitive diagnosis in patients without the history of trauma, resulting in disastrous consequences.The data are poor on the characteristics of the patients, etiology, and incidence of the disease. This study aims to identify the characteristics, etiology, and the diagnostic and therapeutic processes of patients with splenic rupture occurring in the absence of trauma and to highlight our approach to less commonly encountered cases.     

Effects of nimodipine and pentoxyfylline in prevention of hepatic ischemic damage in rats at normal and hypothermic conditions

Hepatic ischemia should be considered in serious liver injury, liver tumor resection and liver transplantation. There are other conditions that decrease hepatic blood flow and cause hepatic ischemia, such as hemorrhagic shock, sepsis, hepatic artery ligation, trauma, and certain vascular lesions. In this study, effects of nimodipine (a calcium channel blocker) and pentoxyfylline (a derivative of methylxanthine) on duration and degree of hepatic ischemia in rats at normothermic and hypothermic conditions are investigated. This study was performed on 6 groups of Wistar Albino type rats, each group consisting of 7 rats. Groups were separated into normothermic (A) and hypothermic (B) conditions AI-Control group, AII-Nimodipine group and AIII-Pentoxyfylline group, B IV-Control group, BV-Nimodipine group and BVI-Pentoxyfylline group respectively. After hepatic pedicle occlusion lasting 45 min, blood samples were drawn from the rats for evaluation of alanine aminotransferase (ALT), aspartate transaminase (AST) and lactate dehydrogenase (LDH) values. Moreover, hepatic biopsies were taken to assess pathological changes under electron microscopy. These changes were evaluated through a grading system. As a result; it has been shown that both nimodipine and pentoxyfylline delayed effects of hepatic ischemia in a statistically significant manner in comparison with the control group and these effects were found to be more significant in hypothermic conditions.     

Large atherosclerotic left main coronary aneurysm: a case report and review of literature

Left main coronary aneurysm is a very rare disorder. Aneurysm may be single or multiple, saccular or fusiform. Atherosclerosis, mucocutaneous lymph node syndrome, trauma, angioplasty, atheroctomy, laser procedures, systemic lupus erythematosus, periarteritis nodosa or types of arteritis, dissection, syphilis, mycotic emboli may lead to coronary aneurysms. The main complications of coronary aneurysms are: thrombosis, distal embolisation, rupture and calcification. Operative therapy should be necessary for large left main coronary aneurysms because of their predisposition to thrombosis and embolism. The coexisting significant obstructive CAD may be important in making a decision for the operative treatment in patients with the left main coronary aneurysm. The proper type of operation is not clear.     

Percutaneous Transhepatic Removal of Bile Duct Stones: Results of 261 Patients

Purpose

To determine the effectiveness of percutaneous transhepatic removal of bile duct stones when the procedure of endoscopic therapy fails for reasons of anatomical anomalies or is rejected by the patient.

Methods

Between April 2001 and May 2010, 261 patients (138 male patients and 123 female patients; age range, 14–92 years; mean age, 64.6 years) with bile duct stones (common bile duct [CBD] stones = 248 patients and hepatolithiasis = 13 patients) were included in the study. Percutaneous transhepatic cholangiography was performed, and stones were identified. Percutaneous transhepatic balloon dilation of the papilla of Vater was performed. Then stones were pushed out into the duodenum with a Fogarty balloon catheter. If the stone diameter was larger than 15 mm, then basket lithotripsy was performed before balloon dilation.

Results

Overall success rate was 95.7%. The procedure was successful in 97.5% of patients with CBD stones and in 61.5% of patients with hepatolithiasis. A total of 18 major complications (6.8%), including cholangitis (n = 7), subcapsular biloma (n = 4), subcapsular hematoma (n = 1), subcapsular abscess (n = 1), bile peritonitis (n = 1), duodenal perforation (n = 1), CBD perforation (n = 1), gastroduodenal artery pseudoaneurysm (n = 1), and right hepatic artery transection (n = 1), were observed after the procedure. There was no mortality.

Conclusion

Our experience suggests that percutaneous transhepatic stone expulsion into the duodenum through the papilla is an effective and safe approach in the nonoperative management of the bile duct stones. It is a feasible alternative to surgery when endoscopic extraction fails or is rejected by the patient.