Transarterial Embolization and Percutaneous Ethanol Injection as an Effective Bridge Therapy before Liver Transplantation for Hepatitis C-Related Hepatocellular Carcinoma

Background. Transarterial chemoembolization alone or in association with radiofrequency ablation is an effective bridging strategy for patients with hepatocellular carcinoma awaiting for a liver transplant. However, cost of this therapy may limit its utilization. This study was designed to evaluate the outcomes of a protocol involving transarterial embolization, percutaneous ethanol injection, or both methods for bridging hepatocellular carcinomas prior to liver transplantation. Methods. Retrospective review of all consecutive adult patients who underwent a first liver transplant as a treatment to hepatitis C-related hepatocellular carcinoma at our institution between 2002 and 2012. Primary endpoint was patient survival. Secondary endpoint was complete tumor necrosis. Results. Forty patients were analyzed, age 58 ± 7 years. There were 23 males (57.5%). Thirty-six (90%) out of the total 40 patients were within Milan criteria. Complete necrosis was achieved in 19 patients (47.5%). One-, 3-, and 5-year patient survival were, respectively, 87.5%, 75%, and 69.4%. Univariate analysis did not reveal any variable to impact on overall patient survival. Conclusions. Transarterial embolization, ethanol injection, or the association of both methods followed by liver transplantation comprises effective treatment strategy for hepatitis C-related hepatocellular carcinoma. This strategy should be adopted whenever transarterial chemoembolization and/or radiofrequency ablation are not available options

Influência da morfina na carcinogênese esofágica induzida pela dietilnitrosamina em ratos – resultados preliminares

OBJECTIVE: In northern Iran, the high incidence of esophageal cancer was associated to opium. Diethylnitrosamine (DEN) is one of the nitrosamines that presents high risk for experimental cancer of the esophagus. Morphine, the largest alkaloid of opium, has been reported to increase the ethylation of esophageal DNA through DEN and to reduce first-passage hepatic metabolism, when administered in high doses to rats. Our objective was to study the effect of joint administration of morphine and DEN on esophageal carcinogenesis in rats. MATERIAL AND METHODS: For 23 weeks, we studied the effect of joint administration of morphine and DEN on the esophageal carcinogenesis in rats. RESULTS: The animal models that received only DEN presented a higher incidence of tumors than those that received DEN and morphine. CONCLUSION: We concluded that morphine did not influence esophageal carcinogenesis induced by DEN in rats.OBJETIVOS: A alta incidência de câncer esofagiano no norte do Irã foi associada ao ópio. A dietilnitrosamina (DEN) é uma das nitrosaminas com maior potencial de produzir câncer experimental no esôfago. Morfina, o maior alcalóide do ópio, quando administrada em altas doses a ratos, aumentou a etilação do DNA esofágico pela DEN e reduziu seu metabolismo hepático de primeira passagem. O presente trabalho objetivou estudaro efeito da administração conjunta de morfina e DEN na carcinogênese esofágica. MATERIAIS E MÉTODOS: Durante 23 semanas, estudamos o efeito da administração conjunta de morfina e DEN na carcinogênese esofágica em ratos. RESULTADOS: Encontrou-se maior incidência tumoral nos animais que receberam somente DEN em relação aos que receberam DEN e morfina. CONCLUSÃO: Concluiu-se que a morfina não apresentou influência sobre a carcinogênese esofágica induzida pela DEN em ratos

Indução de aderência intrabdominal por prótese de retícula de polipropileno:: estudo experimental em ratos

INTRODUCTION: The correction of groin hernias using a transperitoneal videolaparoscopic method with a polypropylene mesh is becoming increasingly common. This could lead to an increased incidence of adhesion formation.MATERIALS AND METHODS: The incidence of adhesions induced by mesh placement and by reperitonization was observed in 40 male adult Wistar rats, randomlyallocated to four groups of 10 rats (Group A = no mesh, no reperitonization; B = no mesh, reperitonization; C = mesh, no reperitonization; D = mesh and reperitonization). After opening the abdominal cavity, the iliac fossa was identified and a peritoneal opening, measuring about 2 by 2 cm, was done on the parietal wall. In the rats in which a polypropylene prosthesis was used, a piece of Marlex mesh, measuring about 1.5 by 1.5 cm was placed on the peritoneal opening. A simple suture was performed in the animals submitted to reperitonization, using a 5.0 monofilamentar polypropylene thread on a cardiovascular (atraumatic) needle. The animals were killed 15 days after the operation. Macroscopic analysis was done by an investigator blinded to intervention group. Fisher’s exact test and the c2 test were used for statistical analysis of the results. A P < 0.05 was considered as significant.RESULTS: Adhesions were significantly more common in the groups in which the prosthesis was placed (59% vs. 95%; P = 0.01), as well as in the groups in whichreperitonization was performed (58% vs. 100%; P = 0.03).CONCLUSIONS: The results suggest that polypropylene mesh placement and reperitonization are each independent factors that have a role in inducing the formationof adhesions.INTRODUÇÃO: A correção de hérnias na virilha através de um método videolaparoscópico transperitoneal está se tornando cada vez mais comum. Contudo,este método poderia levar a um aumento na incidência de formação de aderências.MATERIAIS E MÉTODOS: A incidência de aderências induzidas pela colocação de retícula e pela reperitonização foram observadas em 40 ratos Wistar adultos, machos, divididos aleatoriamente em quatro grupos com 10 ratos cada um (Grupo A = sem retícula, sem reperitonização; B = sem retícula, com reperitonização; C = com retícula, sem reperitonização; D = retícula e reperitonização). Após a abertura da cavidade abdominal, a fossa ilíaca foi identificada e fez-se uma abertura de aproximadamente 2 x 2 cm na parede parietal. Nos ratos em que uma prótese de polipropileno foi utilizada, uma retícula Marlex com 1,5 x 1,5 cm foi colocada sobre a abertura peritoneal. Nos outros animais, a reperitonização foi feita com sutura simples, utilizando-se fio de polipropileno monofilamentar 5.0 com uma agulha cardiovascular (atraumática). Os animais foram sacrificados 15 dias depois da operação. A análise macroscópica foi realizada por um investigador cego quanto ao grupo de origem dos animais. A análise estatística utilizou o teste exato de Fisher e o c2. Um P < 0,05 foi considerado significativo.RESULTADOS: As aderências foram significativamente mais comuns nos grupos nos quais a prótese foi utilizada (59% vs. 95%; P = 0,01), assim como nos gruposnos quais foi feita a reperitonização (58% vs. 100%; P = 0,03).  CONCLUSÕES: Os resultados sugerem que a retícula de polipropileno e a reperitonização são fatores independentes entre si quanto à indução de formaçãode aderências

Liver allografts from donors with peritoneal contamination: report of two cases

Organs from deceased donors with traumatic abdominal injury, peritoneal contamination and open abdomen are usually discarded due to risks of transmission of severe infections to the recipient. There are no specific recommendations regarding organ utilization from these donors, but they might be an unexplored source able to attenuate organ shortage. Herein, the first successful report of a case involving liver transplantation using a liver allograft procured from a deceased donor with an open abdomen is outlined. This donor was a young trauma patient in which peritoneal contamination had occurred following a gunshot wound. Also included in this the report is liver transplant from a donor, who also was a trauma victim with an enteric perforation. The decision-making process to accept liver allografts from donors with a greater risk of peritoneal infection involved the absence of uncontrolled sepsis or visible contamination of the cavity. Appropriate donor-recipient matching and adequate anti-infectious management might have contributed to a favorable outcome, which suggest that these donors can be used as alternatives to reduce organ shortage

HEPATOCELLULAR CARCINOMA: DIAGNOSIS AND OPERATIVE MANAGEMENT

<div><p>ABSTRACT Introduction: Hepatocellular carcinoma is an aggressive malignant tumor with high lethality. Aim: To review diagnosis and management of hepatocellular carcinoma. Methods: Literature review using web databases Medline/PubMed. Results: Hepatocellular carcinoma is a common complication of hepatic cirrhosis. Chronic viral hepatitis B and C also constitute as risk factors for its development. In patients with cirrhosis, hepatocelular carcinoma usually rises upon malignant transformation of a dysplastic regenerative nodule. Differential diagnosis with other liver tumors is obtained through computed tomography scan with intravenous contrast. Magnetic resonance may be helpful in some instances. The only potentially curative treatment for hepatocellular carcinoma is tumor resection, which may be performed through partial liver resection or liver transplantation. Only 15% of all hepatocellular carcinomas are amenable to operative treatment. Patients with Child C liver cirrhosis are not amenable to partial liver resections. The only curative treatment for hepatocellular carcinomas in patients with Child C cirrhosis is liver transplantation. In most countries, only patients with hepatocellular carcinoma under Milan Criteria are considered candidates to a liver transplant. Conclusion: Hepatocellular carcinoma is potentially curable if discovered in its initial stages. Medical staff should be familiar with strategies for early diagnosis and treatment of hepatocellular carcinoma as a way to decrease mortality associated with this malignant neoplasm.</p></div

ESTIMATING BASAL ENERGY EXPENDITURE IN LIVER TRANSPLANT RECIPIENTS: THE VALUE OF THE HARRIS-BENEDICT EQUATION

ABSTRACT Background: Reliable measurement of basal energy expenditure (BEE) in liver transplant (LT) recipients is necessary for adapting energy requirements, improving nutritional status and preventing weight gain. Indirect calorimetry (IC) is the gold standard for measuring BEE. However, BEE may be estimated through alternative methods, including electrical bioimpedance (BI), Harris-Benedict Equation (HBE), and Mifflin-St. Jeor Equation (MSJ) that carry easier applicability and lower cost. Aim: To determine which of the three alternative methods for BEE estimation (HBE, BI and MSJ) would provide most reliable BEE estimation in LT recipients. Methods: Prospective cross-sectional study including dyslipidemic LT recipients in follow-up at a 735-bed tertiary referral university hospital. Comparisons of BEE measured through IC to BEE estimated through each of the three alternative methods (HBE, BI and MSJ) were performed using Bland-Altman method and Wilcoxon Rank Sum test. Results: Forty-five patients were included, aged 58±10 years. BEE measured using IC was 1664±319 kcal for males, and 1409±221 kcal for females. Average difference between BEE measured by IC (1534±300 kcal) and BI (1584±377 kcal) was +50 kcal (p=0.0384). Average difference between the BEE measured using IC (1534±300 kcal) and MSJ (1479.6±375 kcal) was -55 kcal (p=0.16). Average difference between BEE values measured by IC (1534±300 kcal) and HBE (1521±283 kcal) was -13 kcal (p=0.326). Difference between BEE estimated through IC and HBE was less than 100 kcal for 39 of all 43patients. Conclusions: Among the three alternative methods, HBE was the most reliable for estimating BEE in LT recipients

Influência da morfina na carcinogênese esofágica induzida pela dietilnitrosamina em ratos – resultados preliminares

OBJECTIVE: In northern Iran, the high incidence of esophageal cancer was associated to opium. Diethylnitrosamine (DEN) is one of the nitrosamines that presents high risk for experimental cancer of the esophagus. Morphine, the largest alkaloid of opium, has been reported to increase the ethylation of esophageal DNA through DEN and to reduce first-passage hepatic metabolism, when administered in high doses to rats. Our objective was to study the effect of joint administration of morphine and DEN on esophageal carcinogenesis in rats. MATERIAL AND METHODS: For 23 weeks, we studied the effect of joint administration of morphine and DEN on the esophageal carcinogenesis in rats. RESULTS: The animal models that received only DEN presented a higher incidence of tumors than those that received DEN and morphine. CONCLUSION: We concluded that morphine did not influence esophageal carcinogenesis induced by DEN in rats.OBJETIVOS: A alta incidência de câncer esofagiano no norte do Irã foi associada ao ópio. A dietilnitrosamina (DEN) é uma das nitrosaminas com maior potencial de produzir câncer experimental no esôfago. Morfina, o maior alcalóide do ópio, quando administrada em altas doses a ratos, aumentou a etilação do DNA esofágico pela DEN e reduziu seu metabolismo hepático de primeira passagem. O presente trabalho objetivou estudaro efeito da administração conjunta de morfina e DEN na carcinogênese esofágica. MATERIAIS E MÉTODOS: Durante 23 semanas, estudamos o efeito da administração&nbsp;conjunta de morfina e DEN na carcinogênese esofágica em ratos. RESULTADOS: Encontrou-se maior incidência tumoral nos animais que receberam somente DEN em relação aos que receberam DEN e morfina. CONCLUSÃO: Concluiu-se que a morfina não apresentou influência sobre a carcinogênese esofágica induzida pela DEN em ratos