Haemostatic treatment of a bleeding hepatocarcinoma by polypropylene mesh wrapping in a cirrhotic patient

Spontaneous rupture of hepatocarcinoma (HCC) in a cirrhotic patient is a serious complication with a high incidence of mortality. The pathogenesis of this complication is unknown. Several hypotheses have been proposed in the literature worldwide. The diagnosis, in the absence of specific symptoms, is made by ultrasound, sometimes followed by a CT scan, and finally by exploratory paracentesis. An angiogram is performed to locate the site of the bleeding and possibly allow transcatheter arterial chemo-embolisation. Therapeutic options include one-stage or delayed resection, packing for sub-diaphragmatic bleeding HCC's, and hepatic artery ligation. Suture ligation of the bleeding source is usually impossible due to the friability of the tumor. No sizeable experience with the use of alcoholisation for haemostasis has been reported to date. We report a case of HCC bleeding from segment VI successfully treated by manual compression and placement of a polypropylene mesh (Biomesh P1, Cousin Biotech).     

Lamivudine and alpha-interferon in combination long term for precore mutant chronic hepatitis B

BACKGROUND/AIMS: Alpha-interferon (alpha-IFN) and lamivudine are the two licensed drugs for patients with chronic hepatitis B, however, their efficacy in precore mutant chronic hepatitis B is limited. The aim of this study was to investigate the efficacy of 1 year alpha-IFN-lamivudine combination therapy for anti-HBe/hepatitis B virus- (HBV)-DNA positive patients. METHODS: Between 1997 and 1999, 29 consecutive anti-HBe/HBV-DNA positive patients entered this prospective pilot study. Patients received 100mg lamivudine orally daily and alpha-IFN 6 million units (MU) three times weekly for 52 weeks. All patients were followed-up for 12 months after stopping therapy. Primary end points were loss of serum HBV-DNA and alanine transaminase normalization at week 52. RESULTS: Overall, the end-treatment biochemical and virological response was 93% while the sustained response at week 104 was 14%. HBV-DNA negative patients did not experience a viral breakthrough during treatment; no tyrosine-methionine-aspartate-aspartate amino acid motif of HBV polymerase (YMDD) variant emerged. At week 52, 46% of patients with paired liver biopsies slides available, showed an histological improvement (histological activity index > or =2). CONCLUSIONS: Combination of lamivudine and interferon for 1 year is followed by high end-treatment virological and biochemical response rates, by improvement of liver histology and by the prevention of the emergence of YMDD mutation; however, the sustained response rate remains low.     

Sialocintigraphy versus ultrasonography of the salivary glands in patients first diagnosed with Sjögren's syndrome

Sj?gren's syndrome (SjS) is an autoimmune disease characterized by distraction of particularly salivary and lacrimal glands. The aim of the present study was to compare salivary gland scintigraphy (SGS) and salivary gland ultrasonography (SUS) in identifying salivary gland function in patients first diagnosed with SjS. We recruited 20 such patients with SjS (5 male, 15 female, aged from 35 to 65 y, mean age 52, standard deviation: +/-5 y. All patients were submitted to SUS and SGS longitudinal and transverse images. Before the scintiscan, patients fasted for 6 h. Technetium-99m pertechnetate ((99m)Tc-PT) 110 MBq was injected intravenously (i.v.) and simultaneous multi-frames dynamic acquisition was performed for 30 min. In two patients who had discordant results between SUS and US, labial biopsy was performed. Dynamic acquisition curves for 30 sec for the parotid and the submandibular glands were generated. For each gland we have calculated: (a) the maximum uptake (MU): the ratio between the mean counts in the gland at 20 min and the background activity and (b) the outflow efficiency (OE): the ratio between the minimum counts after lemon juice stimulation at 30 min and the counts at 20 min. The results showed abnormal scintiscans with low MU and high OE in one or more of the glands, in 17/20 patients. These results were confirmed by SUS in 15 cases and in two cases labial biopsy confirmed the diagnosis made by SGS while SUS was negative. In the remaining 3/20 cases of SjS both tests, SUS and SGS, showed normal results. Discrepancies between SGS findings and labial biopsy as found in two of our cases have been reported by others and may be due among other causes to early lymphocytic infiltration in SjS. Normal findings of SGS have also been reported. In conclusion, in cases first diagnosed with SjS, the function of the parotid and the submandibular glands was better identified by the SGS as compared to SUS. Although SGS is a more complex and expensive examination, it should be preferred to SUS as more sensitive and indicating the stage of SjS.     

Postmortem CT pulmonary findings in SARS-CoV-2-positive cases: correlation with lung histopathological findings and autopsy results

International Journal of Legal Medicine - Postmortem computed tomography (PMCT) is a valuable tool for analyzing the death of patients with SARS-CoV-2 infection. The purpose of this study was to...     

Subtotal splenectomy for large splenic cyst

Fulminant sepsis described in childhood has long stimulated surgeons to attempt partial or total preservation of the spleen when possible. Persistence of splenic tissue ensures preservation of the immunological competence of the organ. Total splenectomy ought to be avoided in the first 10 years of life; in subsequent years an attempt to partially preserve the organ is to be recommended. A segmental arterial vascularization with avascular interlobar planes has been demonstrated in the spleen allowing partial resection of the organ. We report a case of a voluminous epithelial splenic cyst in a teenager removed by subtotal splenectomy.     

Helping persons with mild or moderate Alzheimer's disease recapture basic daily activities through the use of an instruction strategy

Purpose. The present three pilot studies assessed the effectiveness of verbal instructions, presented automatically through simple technology, in helping persons with mild-to-moderate Alzheimer's disease recapture basic daily activities. The activities were morning bathroom routine, dressing, and table-setting.

Method. The studies that focused on morning bathroom routine and on table-setting included three participants each, while the study that focused on dressing involved four participants. A non-concurrent multiple baseline design across participants was used for each study. The instructions and technology were available only during the intervention phases.

Results. Data showed that the intervention strategy involving verbal instructions for the single activity steps presented automatically through technology was effective in helping all participants on each of the activities. The participants' mean percentages of correct steps across activities raised from 13 – 54 during the baseline periods to above 80 or 90 during the intervention periods.

Conclusions. The results suggest that the intervention strategy reported may represent a suitable approach for helping persons with mild or moderate Alzheimer's disease to recapture basic daily activities. New research should target other activities and check maintenance and generalization issues.