Approach to persistent ascites after liver transplantation

Persistent ascites (PA) after liver transplantation (LT), commonly defined as ascites lasting more than 4 wk after LT, can be expected in up to 7% of patients. Despite being relatively rare, it is associated with worse clinical outcomes, including higher 1-year mortality. The cause of PA can be divided into vascular, hepatic, or extrahepatic. Vascular causes of PA include hepatic outflow and inflow obstructions, which are usually successfully treated. Regarding modifiable hepatic causes, recurrent hepatitis C and acute cellular rejection are the leading ones. Considering predictors for PA, the presence of ascites, refractory ascites, hepato-renal syndrome type 1, spontaneous bacterial peritonitis, hepatic encephalopathy, and prolonged ischemic time significantly influence the development of PA after LT. The initial approach to patients with PA should be to diagnose the treatable cause of PA. The stepwise approach in evaluating PA includes diagnostic paracentesis, ultrasound with Doppler, and an echocardiogram when a cardiac cause is suspected. Finally, a percutaneous or transjugular liver biopsy should be performed in cases where the diagnosis is unclear. PA of unknown cause should be treated with diuretics and paracentesis, while transjugular intrahepatic portosystemic shunt and splenic artery embolization are treatment methods in patients with refractory ascites after LT.     

Advantages and limitations of the autofluorescent diagnostics of the laryngeal cancer and precancerosis

Any endoscopic diagnostic procedure that is capable of giving exact information on laryngeal lesions without damaging the tissue has essential advantages over standard biopsy. Tissue autofluorescence is defined as a natural ability of tissue to fluoresce when exposed to a certain light wavelength. This feature is a consequence of the presence of fluorophores in the tissues, which are activated by a narrow wavelength range. However, due to their biochemical and biophysical characteristics, laryngeal precancerosis and cancer do not fluoresce when exposed to blue light. In the present study, we used Pentax’s System of Autofluorescent Endoscopy (SAFE 1000) to detect autofluorescence disturbances from laryngeal mucosa. Diagnostic parameters (sensitivity and specificity) of the microlaryngoscopy (MLS) and SAFE 1000 in the diagnosis of laryngeal precancerosis and carcinoma were compared and discussed. We have found that SAFE had a better sensitivity with regard to mentioned laryngeal pathology, but MLS had better specificity than SAFE. The overall diagnostic sensitivity in the diagnostics of laryngeal atypical hyperplasia and cancer with SAFE was 89%, as opposed to 73% with MLS. Diagnostic specificity of SAFE for all cases of laryngeal carcinomas and atypical hyperplasia was 78%. The specificity of MLS in diagnostics of laryngeal carcinomas cases was 98%, while that for cases of atypical hyperplasia was 100%. Many other conditions that have impact on autofluorescent features of laryngeal mucosa were also discussed.     

Relationship between enterogastric reflux estimated by scintigraphy and the presence of Helicobacter pylori.

The aim of the study is assessment of the relationship between enterogastric reflux and the presence of Helicobacter pylori infection as factors that cause gastritis, peptic ulcer and adenocarcinoma ventriculi. The study was performed in 52 patients with different digestive disorders, using gamma camera, during 90 min (1 frame/min) after intravenous injection of 185 MBq 99mTc-dietil IDA in the cubital vein. According to time/activity curves from the region of hepatobiliary system and stomach, index of enterogastric reflux (EGR) was assessed. There was no correlation between the presence of Helicobacter pylori and EGR (r = 0.181, df = 52, p > 0.05). However, Helicobacter pylori was present more frequently in the patients with positive EGR (p < 0.01), but there were no significant differences (p > 0.05) in reflux value in patients with either positive or negative findings of Helicobacter pylori.     

Polycystic ovary syndrome and autoimmunity

Polycystic ovary syndrome (PCOS) is characterized by laboratory and/or clinical features consisting of hyperandrogenism with chronic anovulation and is currently one of the most common endocrinopaties in women of fertile age. PCOS is associated with a variety of endocrine and metabolic disturbances. It was demonstrated that the prevalence of autoimmune thyroiditis is high among these patients. Recent studies reveal a higher incidence of autoantibodies such as anti-histone, anti-dsDNA presented in systemic autoimmune disease, however their clinical significance is still unknown. According to results of current research the syndrome could be possibly associated with some autoimmune diseases.Further studies are required to determine the role of organ-specific and non-specific autoantibodies in patients with PCOS.     

The analysis of clinical characteristics of the chronic rhinosinusitis: complicated and uncomplicated form

The objective of our study was to analyze the intensity of subjective symptoms and objective findings of endoscopy and CT scanning in chronic rhinosinusitis, in the groups with and without nasal polyps. To evaluate the intensity of subjective symptoms visual analogue scale (VAS) was used, while scores were obtained by adding grades. Endoscopic finding was given in scores recommended by Lanza and Kennedy and CT results were presented by Lund-Mackay scoring system. The study included 90 consecutive adult patients, 47 males (52%) and 43 females (48%), mean age 45 years. The group with chronic rhinosinusitis without nasal polyps (uncomplicated form) consisted of 30 patients, while the group with polyps (complicated form) included 60 patients. Comparing mean intensity values of all subjective symptoms between these two groups we found out that nasal obstruction, nasal secretion and hyposmia were significantly more manifested in the polyp group (P < 0.01). Facial congestion was also more manifested in the polyp group (P < 0.05). Mean score value of major symptoms was 35.55 in the polyp group, and 23.13 in the group without polyps (P < 0.01). Mean value of total symptom scores was 48.68 in the polyp group, and 35.00 in the group without polyps (P < 0.01). Endoscopic score was approximately 9.03 in the polyp group, and 2.43 in the group without polyps (P < 0.01). CT score was 16.05 on an average in the polyp group, and 4.37 in the group without polyps (P < 0.01). Chronic rhinosinusitis complicated by nasal polyposis is characterized by higher degree of nasal obstruction, nasal secretion, hyposmia and facial congestion, which results in higher score of major and total score of symptoms, respectively. This form is also characterized by worse objective findings, which is reflected in higher endoscopic and CT scores.     

Comparative tumorigenicity of picene and dibenz[a,h]anthracene in the mouse

The carcinogenic activity of the two polycyclic aromatic hydrocarbons (PAHs), picene (benzo[a]chrysene) and dibenz[a,h]anthracene (DBA), was determined in NMRI mice by five different experimental protocols in order to find out if picene is a carcinogen as predicted by recent quantum mechanical calculations in contrast to earlier observations which could not confirm any carcinogenic activity of picene. Single s.c. treatment of adult mice with picene or DBA (308 nmol/animal, each) led to the formation of fibrosarcomas in 63.3% of treated animals regardless of the PAH used. Chronic epicutaneous application of both PAHs (total dose 1.36 mumol) to the back of mice resulted in the development of papillomas with a tumor rate of 22% in the case of picene and of 32% in the case of DBA. When newborn mice were s.c. treated once on day 2 of their life with each of the two PAHs (400 nmol/animal), 27.8% of treated animals developed lung adenomas after 40 weeks in the case of picene compared to 92.1% in the case of DBA. Histopathological examination of the tumors in the three experimental models revealed no difference in the type of tumor between picene and DBA. Epicutaneous application of both PAHs (600 nmol/animal) followed by chronic treatment with 12-O-tetradecanoyl-phorbol-13-acetate for 24 weeks led to the formation of papillomas in 93% of animals treated with DBA while picene showed no tumorigenic activity at all. Initiation of tumorigenesis in the two-stage tumor model with 7,12-dimethylbenz[a]anthracene (1 mumol/animal) and chronic treatment with picene (total dose 4.8 mumol) for 24 weeks was equally ineffective in producing tumors in NMRI mice. This rare biological property of picene, which is a complete carcinogen, yet at most a very weak tumor initiator, is explained in terms of its inefficient biotransformation to mutagenic and carcinogenic metabolites as compared to the strong tumor initiator DBA.     

肝恶性肿瘤射频消融术后黏附电极的组织的组织病理学与免疫组化特点有助于预测局部肿瘤进展:初步结果

目的探讨肝恶性肿瘤射频消融术后黏附电极的组织的组织病理学与免疫组化特点是否有助于预测局部肿瘤进展(LTP)。材料与方法本研究免除学术审查委员会批准     

Heart and liver disease in 32 patients undergoing biopsy of both organs, with implications for heart or liver transplantation

OBJECTIVE: To determine underlying conditions in patients undergoing both heart and liver biopsies. PATIENTS AND METHODS: Our study group consisted of 32 patients at the Mayo Clinic in Rochester, Minn, who underwent both endomyocardial and nonsurgical liver biopsies and who underwent at least one of these procedures between January 1,1981, and December 31,2000. Patients were categorized as having (1) heart disease affecting the liver, (2) liver disease affecting the heart, (3) the same disease affecting both organs, or (4) different diseases affecting each organ independently. RESULTS: Among 32 patients, cardiac dysfunction was present in 28 (19 systolic, 9 diastolic), and hepatic dysfunction was present in 31. In group 1, 3 of 4 patients had cardiac amyloidosis with secondary hepatic congestion. In group 2, all 3 patients had cirrhosis with cirrhotic cardiomyopathy. Group 3 included 5 patients with hemochromatosis, 3 with alcoholism, and 1 with amyloidosis. In group 4, 8 of 16 patients had idiopathic cardiomyopathy, and 8 had hepatitis. Overall, of 8 patients with hemochromatosis, 3 without cardiac iron had improved cardiac function after phlebotomy, and 1 with cardiac iron had no cardiac dysfunction. Among 7 patients with alcoholism, 3 had alcoholic liver and heart disease. Of 5 patients with cardiac amyloidosis, 1 had hepatic amyloid. Ten patients underwent transplantation (6 liver, 3 heart, and 1 heart and liver). CONCLUSIONS: In one half of the patients in the study group, heart and liver diseases had independent causes. In patients with hemochromatosis, there was little correlation between cardiac iron and systolic dysfunction. In patients with chronic alcoholism, liver and heart disorders often had nonalcoholic causes. With cardiac amyloidosis, hepatic dysfunction was generally due to congestion. Specific disease in one organ did not necessarily imply similar involvement in the other. Thus, heart or liver biopsy may be useful in patients being evaluated for liver or heart transplantation, respectively.