HCV Therapy: Treat now or wait?

The combination of first generation protease inhibitors, telaprevir or boceprevir with pegylated interferon and ribavirin has significantly improved response rates when compared to pegylated interferon and ribavirin alone. While safe and effective for many patients, the potential of current DAA based therapy has been limited by tolerability, especially in those with extensive co-morbidities. Newer therapies, likely with improved efficacy and safety profiles are under development, however the timing of availability of these agents remains speculative. The choice to treat with currently available therapy or to wait for newer therapy is complex. These decisions require understanding of unique patient characteristics as well as safety and efficacy of both available therapy and new therapies undergoing investigation.     

HCV Eradication: Implications for Disease Resolution

Hepatitis C virus (HCV) is a leading cause of liver-related death worldwide. The evolution of hepatitis C therapy has made serologic eradication of HCV RNA a reality for many patients. Although it is debated whether undetectable virus in the serum represents a cure with complete clearance of viral RNA from the host, improved clinical outcomes have been shown after successful treatment in patients who achieve a sustained virologic response (SVR). Specifically, patients with SVR have longer survival, reduced progression and, in some cases, regression of fibrosis, decreased likelihood of developing hepatocellular carcinoma, and improvement of many extrahepatic manifestations of HCV. This review discusses viral kinetics on therapy leading to eradication, identification, and clinical significance of occult HCV infection and clinical outcomes after successful treatment.     

Expression of focal adhesion kinase and phosphorylated focal adhesion kinase in squamous cell carcinoma of the larynx

OBJECTIVES: Focal adhesion kinase (FAK) is overexpressed in a variety of human cancers including those derived from the oral cavity. The purpose of this work is to determine the expression patterns of FAK and its activated form, FAK pY397, in squamous cell carcinoma of the larynx and to correlate FAK expression with tumor differentiation and clinical parameters. STUDY DESIGN: A retrospective study using archival tissue. METHODS: Thirty-five paraffin embedded tissue specimens of laryngeal carcinoma were obtained from the Department of Pathology at the University of Florida College of Medicine. Immunohistochemical staining of the specimens for FAK and activated phospho-FAK (FAK pY397) was performed. Intensity of staining, distribution of staining, and percentage of cells stained was determined by one pathologist. RESULTS: There was a statistically significant correlation between FAK staining intensity and tumor differentiation. Poorly differentiated tumors stained more intensely than moderately differentiated tumors (P <.001). There was no correlation between FAK pY397 staining and differentiation (P =.163). However, FAK pY397 staining was unexpectedly found in the nuclei of many specimens. FAK was present in the basal layer of cells within nontransformed squamous mucosa derived from tonsillectomy specimens and in blood vessels. A small amount of FAK pY397 was also localized to blood vessels in nontransformed squamous mucosa. CONCLUSION: FAK and phospho-FAK are overexpressed in squamous cell carcinoma of the larynx. FAK expression correlates with differentiation. Future investigations will examine the potential of FAK and FAK pY397 expression both as a prognostic indicator and a point of therapeutic inhibition.     

Ueber den Ort der Wärmebildung in dem durch Gehirnstich erzeugten Fieber

Ohne Zusammenfassung     

Beitrag zum heutigen stand der bluttransfusionsfrage und deren gefahrenmomente

Ohne Zusammenfassung     

Calciphylaxis in end‐stage liver and renal disease patients before and after transplant

Calciphylaxis is a rare vascular disorder characterized by calcification of arterioles which causes tissue inflammation and necrosis. It is associated with the metabolic disturbances seen in end‐stage renal disease (ESRD) and has also been described in patients with cirrhosis with preserved kidney function. Characteristic calciphylaxis lesions are black eschars surrounded by retiform purpura, and the gold standard for diagnosis is skin biopsy. Reported 1‐year mortality rates range between 45% and 80%. No treatment modality has been evaluated in a prospective randomized trial, and reports of treatment efficacy vary. Kidney transplant has been reported as a successful therapy for calciphylaxis; however, cases exist of the initial onset of calciphylaxis following kidney transplant as well as simultaneous liver‐kidney (SLK) transplant. The decision to maintain a patient with end‐stage renal and liver disease on the waiting list for SLK transplant following the onset of calciphylaxis must consider the high 1‐year mortality associated with this condition. More research is necessary to understand how to allocate donor allografts to manage patients with calciphylaxis and ESRD and/or cirrhosis effectively.     

Herbal hepatoxicity from Chinese skullcap: A case report

The use of herbal supplements has increased considerably over the last decade. We report a case of an elderly woman who began taking Move Free Advanced for arthritis, which in addition to glucosamine and chondroitin, contained two herbal ingredients, Chinese skullcap and Black Catechu. Our patient presented with significant cholestasis and hepatitis which significantly improved after discontinuation of the supplement. Since neither the patient nor the treating physician recognized this supplement as a potential hepatotoxin, she resumed taking the supplement and again suffered from considerable hepatotoxicity. Liver biopsy at that time was consistent with acute drug induced liver injury. She, once again, recovered after discontinuation of the supplement. Review of the literature confirms that Chinese skullcap has been implicated as a possible hepatotoxic agent which was demonstrated in this case.     

Do Colorectal Cancer Patients Understand That Their Family Is at Risk?

Aim  

The aim of this study was to assess whether patients with colorectal cancer (CRC) are aware of the risk to family members and to test an educational intervention.