Hepatic artery thrombosis and liver malignancy in pediatric liver transplantation

BackgroundHepatic artery thrombosis (HAT) remains a significant cause of graft failure and mortality after pediatric liver transplantation. Conditions not associated with hepatic failure, such as liver tumors, may be more prone to thrombotic problems after transplant. We hypothesized that liver transplant for hepatic malignancies may be associated with increased rates of HAT in the posttransplant period.MethodsWe conducted a retrospective review of pediatric patients (age, 0-21 years) who underwent primary liver transplantation at a free-standing children's hospital from 1990 to 2009. We reviewed cause of underlying liver disease, age, sex, weight, occurrence of HAT, use of antiplatelets and anticoagulants perioperatively, as well as reintervention, retransplant, and death.ResultsA total of 129 children underwent 146 liver transplants, and 15 (12%) patients developed HAT. Nine liver transplants were performed for hepatic malignancy, and 4 (44%) of these patients developed HAT (relative risk, 4.85; 95% confidence interval, 1.9-12.2; P = .0015). All 4 children with hepatic malignancy and HAT required reintervention, including 3 retransplants (75%). One of these patients died.ConclusionsHepatic artery thrombosis occurs approximately 5 times more often and appears to be more morbid in children with hepatic malignancy after transplantation. Prospective evaluation of prophylactic anticoagulation regimens in the setting of hepatic malignancy requiring transplantation is warranted.     

Carotid body tumour - an experience of 8?years at SSKM Hospital, IPGME& R, Kolkata, India

Objective

To review our experience of management of carotid body tumours at SSKM hospital, IPGME&R, Kolkata, India.

Material and methods

Seven patients who were operated between years 2003 and 2011 form the basis for this study. Their data was analyzed retrospectively from the hospital records. Diagnosis was made on history, physical examination and investigations such as Colour Doppler, Computed Tomography (CT) Angiography and Magnetic Resonance Imaging (MRI) scan of brain

Results

The most common age for presentation was third to fifth decade. Four patients were male and 3 female. Right side was commonly involved (five of seven). Most common presentation was a painless swelling. Five patients were in Shamblin grade II and two patients in grade III. In two patients external carotid artery was ligated and one patient had injury to internal carotid artery during surgery necessitating repair. In all of the cases internal carotid artery was preserved. No patient suffered cerebral stroke and all were discharged in good general condition.

Conclusion

Carotid body tumour is an uncommontumour. It commonly presents as a slow growing mass, usually on right side of the neck and surgery is the treatment of choice. Meticulous subadventitial dissection and excision is a good technique with low morbidity and mortality. The diagnosis of the tumours at an early stage reduces the risks and complications, associated with increased Shamblin grading of the tumour and allows good post operative results.     

Treatment of plantar hyperhidrosis with botulinum toxin type A

BACKGROUND: Hyperhidrosis (excessive, uncontrollable sweating) can be embarrassing and disabling, significantly impacting social and professional performance and quality of life. Treatments aim to reduce sweating, but few are effective, often carrying the risk of significant side-effects. The aims of this study were to evaluate the efficacy and safety of botulinum toxin type A (BTX-A) for plantar hyperhidrosis and to investigate the role of the Dermojet as a potential injection technique. METHODS: Ten adult patients (five men, five women), aged 19-51 years, with severe, previously unresponsive, plantar hyperhidrosis, were recruited to this single-center, open-label, noncomparative study. The hyperhidrotic area of each foot was injected over 15-20 sites without analgesia with 50 U BTX-A + 5 mL sterile saline using a Dermojet. Patients were followed up for 8 months with monthly sweat reduction assessments using Minor's iodine-starch test. Patients provided a treatment self-assessment after completion of follow-up. RESULTS: Within 7 days post-treatment, eight patients reported significantly decreased sweating, and seven patients were symptom free for up to 5 months. Patient self-assessment showed that seven of the 10 patients were satisfied with their treatment. One minor adverse event was reported comprising a temporary localized hematoma (one patient). CONCLUSIONS: Intracutaneous BTX-A injection using the Dermojet offers a simple, safe, and effective alternative for treatment of plantar hyperhidrosis.     

Occult hepatitis B virus infection as a cause of posttransfusion hepatitis in patients with cancers

Background

Prevalence of hepatitis B virus (HBV) infection is increased in patients of cancer with increased mortality. Multiple transfusions of blood and blood-related products are a potential source.

Aims

This study aims to assess the incidence of hepatitis B surface antigen (HBsAg) seroconversion in cancer patients receiving transfusion of blood or blood-related products and identify possible reasons for infection in these patients.

Material and Methods

Patients of cancer receiving blood products, who were HBsAg-, anti-hepatitis B core (HBc)-, and HBV DNA-negative prior to transfusion, were tested for HBsAg by ELISA at 6, 12, and 24 weeks after the last transfusion. Blood donors were screened for HBsAg by ELISA.

Results

Twenty of 3,600 (0.56 %) blood donors tested positive for HBsAg and were rejected. Nine of 150 (6 %) cancer patients became HBsAg-positive posttransfusion which included seven patients who presented with acute hepatitis B and other two patients who remained HBsAg-positive without hepatitis. In 6/9 (66.6 %) patients, HBsAg positivity was related to blood transfusion as their corresponding blood donors on retesting the stored samples were positive for anti-HBc antibody and HBV DNA. In other three patients, the cause of their HBsAg positivity could not be ascertained.

Conclusion

Occult HBV infection in blood donors is a potential source of posttransfusion HBV infection in recipients. Anti-HBc antibody and HBV DNA should be tested in blood donors especially when blood is given to cancer patients receiving chemotherapy.     

Campylobacter jejuni: A brief overview on pathogenicity-associated factors and disease-mediating mechanisms

Campylobacter jejuni has long been recognized as a cause of bacterial food-borne illness, and surprisingly, it remains the most prevalent bacterial food-borne pathogen in the industrial world to date. Natural reservoirs for this Gram-negative, spiral-shaped bacterium are wild birds, whose intestines offer a suitable biological niche for the survival and dissemination of C. jejuni Chickens become colonized shortly after birth and are the most important source for human infection. In the last decade, effective intervention strategies to limit infections caused by this elusive pathogen were hindered mainly because of a paucity in understanding the virulence mechanisms of C. jejuni and in part, unavailability of an adequate animal model for the disease. However, recent developments in deciphering molecular mechanisms of virulence of C. jejuni made it clear that C. jejuni is a unique pathogen, being able to execute N-linked glycosylation of more than 30 proteins related to colonization, adherence, and invasion. Moreover, the flagellum is not only depicted to facilitate motility but as well secretion of Campylobacter invasive antigens (Cia). The only toxin of C. jejuni, the so-called cytolethal distending toxin (CdtA,B,C), seems to be important for cell cycle control and induction of host cell apoptosis and has been recognized as a major pathogenicity-associated factor. In contrast to other diarrhoea-causing bacteria, no other classical virulence factors have yet been identified in C. jejuni. Instead, host factors seem to play a major role for pathogenesis of campylobacteriosis of man. Indeed, several lines of evidence suggest exploitation of different adaptation strategies by this pathogen depending on its requirement, whether to establish itself in the natural avian reservoir or during the course of human infection.     

Impact of new genomic tools on the practice of clinical genetics in consanguineous populations: the Saudi experience

Consanguinity is practiced by around one tenth of the world population but its global distribution is far from uniform. In countries where consanguinity is common, a corresponding increase in the frequency of autosomal recessive diseases is usually observed owing to increased risk of homozygosity for ancestral haplotypes (autozygosity or identity by descent) that harbor pathogenic alleles. The burden of these diseases becomes more apparent as the healthcare system makes gains in its fight against communicable diseases in these countries. Recent advances in molecular genetics make it possible to leverage the mechanism by which consanguinity predisposes to the occurrence of autosomal recessive diseases in order to uncover the causal mutations at an efficient and cost‐effective way compared to outbred populations. The identification of these mutations at an unprecedented scale has the potential to significantly reshape the practice of clinical genetics in these populations and to offer opportunities for innovative public health policies. This review discusses the impact that new genomic tools have had on a sample patient population and how they can inform future public health policies in ways that might be relevant to other consanguineous populations.     

Continuous‐Flow Left Ventricular Assist Device Therapy in Patients With Preoperative Hepatic Failure: Are We Pushing the Limits Too Far?

The purpose of this study was to evaluate the effects and outcome of continuous‐flow left ventricular assist device (cf‐LVAD) therapy in patients with preoperative acute hepatic failure. The study design was a retrospective review of prospectively collected data. Included were 42 patients who underwent cf‐LVAD implantation (64.3% HeartMate II, 35.7% HeartWare) between July 2007 and May 2013 with preoperative hepatic failure defined as elevation of greater than or equal to two liver function parameters above twice the upper normal range. Mean patient age was 35 ± 12.5 years, comprising 23.8% females. Dilated cardiomyopathy was present in 92.9% of patients (left ventricular ejection fraction 17.3 ± 5.9%). Mean support duration was 511 ± 512 days (range: 2–1996 days). Mean preoperative laboratory parameters for blood urea nitrogen, serum creatinine, total bilirubin, and alanine aminotransferase were 9.5 ± 5.4 mg/dL, 110.3 ± 42.8 μmol/L, 51.7 ± 38.3 mmol/L, and 242.1 ± 268.6 U/L, respectively. All parameters decreased significantly 1 month postoperatively. The mean preoperative modified Model for Endstage Liver Disease excluding international normalized ratio score was 16.03 ± 5.57, which improved significantly after cf‐LVAD implantation to 10.62 ± 5.66 (P < 0.001) at 7 days and 5.83 ± 4.98 (P < 0.001) at 30 days postoperatively. One‐year and 5‐year survival was 75.9 and 48.1%, respectively. 21.4% of the patients underwent LVAD explantation for myocardial recovery, 16.7% were successfully transplanted, and 7.1% underwent LVAD exchange for device failure over the follow‐up period. Patients with preexisting acute hepatic failure are reasonable candidates for cf‐LVAD implantation, with excellent rates of recovery and survival, suggesting that cf‐LVAD therapy should not be denied to patients merely on grounds of “preoperative elevated liver enzymes/hepatopathy.”     

The Effect of Oncogene Proteins of Human Papillomaviruses on Apoptosis Pathways in Prostate Cancer

The ability of host cells to activate apoptosis is perhaps the most potent weapon for helping cells eliminate viruses.Human papillomaviruses (HPV) activate several pathways, enabling the infected cells to avoid extrinsic andintrinsic apoptosis pathways. The incapacity of prostatic epithelial cells to induce apoptosis leads to the invasivedevelopment of prostate cancer. For the pathogenesis of prostate cancer, several risk factors have been reported;for example, some viruses and infectious diseases have been proposed as causative agents for their relation toprostate diseases. According to several studies, high-risk human papillomaviruses cause malignancy by interferingwith the apoptotic and inflammatory pathways; these viruses, such as HPV16 and HPV18, block apoptotic pathways and result in prostate cancer. This review is dedicated to presenting a summary of oncogenes (E5, E6, andE7) HR-HPVs’ functions on signaling pathways, inflammation in prostate tumorigenesis, and emphasizing thelink between these oncogenes with apoptosis and prostate cancer.