ALPPS for primary and secondary liver tumors

Introduction: To report our experience on associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in patients with liver tumors. Methods: ALPPS is a surgical technique that allows hepatic resection after rapid liver hypertrophy. Results: Thirteen operations were performed: 8 for hepatocellular carcinoma (HCC) with liver cirrhosis (LC) and 5 for colorectal liver metastases (CRLM, n = 3) and cholangiocarcinoma (CC, n = 2) in normal livers (NL). Of the 11 men (85%), the median age was 60 years (range 36-74). Six (75%) HCC patients had BCLC stage C and 2 (25%) had BCLC stage B disease. The median % future liver remnant (FLR) volume increase was 71.7% in patients with LC and 64.8% in NL (p = 0.44). Twelve patients achieved a sufficient FLR growth after the first stage (92.3% efficacy). Four right trisectorectomies and 9 right hepatectomies were performed. All patients completed the second stage (100% feasibility). R0 resection was achieved in all cases. The 90-day mortality rate was 23.1% (12.5% for HCC patients with LC vs 40% for CRLM and CC patients with NL, p = 0.13). After the first stage the overall morbidity rates were 62.5% and 80% (p = 0.61), whereas after the second stage they were 87.5% and 80% in patients with LC and NL respectively (p = 0.99). At a median follow-up of 15 months (range 1-27), the median DFS was 9 months (CI95% 6-12), and the 1yr-DFS was 42%. The median survival was 25 months (CI95% 10-40), and the 1-yr overall survival was 74%. Conclusions: ALPPS induced a considerable and comparable FLR growth in HCC patients with liver cirrhosis and patients with CRLM and CC with normal liver parenchyma. HCC patients who underwent ALPPS had a high rate of macrovascular tumor involvement. A high rate of R0 resection is expected in properly selected patients

Cystic lymphoepithelial lesions of the parotid gland in HIV-1 infection

The benign cystic lymphoepithelial lesion (BLL) of the parotid gland is a rare disorder affecting HIV-1-infected patients. Here we describe the clinical and histopathological features of 10 cases of BLL, who presented to our observation between November 1992 and December 1996, before the combination antiretroviral therapy was introduced

ALPPS for primary and secondary liver tumors

Introduction: To report our experience on associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in patients with liver tumors. Methods: ALPPS is a surgical technique that allows hepatic resection after rapid liver hypertrophy. Results: Thirteen operations were performed: 8 for hepatocellular carcinoma (HCC) with liver cirrhosis (LC) and 5 for colorectal liver metastases (CRLM, n = 3) and cholangiocarcinoma (CC, n = 2) in normal livers (NL). Of the 11 men (85%), the median age was 60 years (range 36-74). Six (75%) HCC patients had BCLC stage C and 2 (25%) had BCLC stage B disease. The median % future liver remnant (FLR) volume increase was 71.7% in patients with LC and 64.8% in NL (p = 0.44). Twelve patients achieved a sufficient FLR growth after the first stage (92.3% efficacy). Four right trisectorectomies and 9 right hepatectomies were performed. All patients completed the second stage (100% feasibility). R0 resection was achieved in all cases. The 90-day mortality rate was 23.1% (12.5% for HCC patients with LC vs 40% for CRLM and CC patients with NL, p = 0.13). After the first stage the overall morbidity rates were 62.5% and 80% (p = 0.61), whereas after the second stage they were 87.5% and 80% in patients with LC and NL respectively (p = 0.99). At a median follow-up of 15 months (range 1-27), the median DFS was 9 months (CI95% 6-12), and the 1yr-DFS was 42%. The median survival was 25 months (CI95% 10-40), and the 1-yr overall survival was 74%. Conclusions: ALPPS induced a considerable and comparable FLR growth in HCC patients with liver cirrhosis and patients with CRLM and CC with normal liver parenchyma. HCC patients who underwent ALPPS had a high rate of macrovascular tumor involvement. A high rate of R0 resection is expected in properly selected patients

Changes in host cell molecules acquired by circulating HIV-1 in patients treated with highly active antiretroviral therapy and interleukin-2

Objective: To analyse cell membrane proteins (CMP) acquired by HIV-1 present in the plasma of asymptomatic patients, and their modifications after a cycle of highly active antiretroviral therapy (HAART) and interleukin (IL)-2. Design and methods: Plasma samples from eight drug-naive asymptomatic subjects underwent immobilized antibody capture (IAC) to detect CMP on the surface of circulating HIV-1. The CMP considered were lymphocyte subset markers (CD45RA, CD45RO), activation markers (HLA-DR), adhesion molecules (LFA-3), costimulatory proteins (B7-2), lymph-node homing receptors (CD62L) and pro-apoptosis molecules (FasL). This analysis was repeated after one cycle of HAART + IL-2, after virus rebound. Results: LFA-3, followed by CD45RO and HLA-DR, are the most represented CMP on the surface of circulating virions in naive asymptomatic patients; CD45RA, CD62L, B7-2 and FasL are detected only occasionally. After rebound, a significant reduction of CD45RO and HLA-DR, but not of LFA-3, is observed on virions, whereas CD45RA and CD62L, as well as other molecules, are not affected, remaining almost undetectable. Conclusions: Assuming that CMP on HIV-1 reflect the cellular origin of virions, activated T cells expressing CD45RO, HLA-DR, and LFA-3 may be the main source of HIV-1 in asymptomatic patients. After a cycle of HAART + IL-2, followed by therapy interruption, CD45RA and CD62L are detected on virions rarely, indicating that even during virus rebound, expanded naive T cells do not become a major target of virus replication. Furthermore, the presence of HLA-DR on rebound HIV-1 is decreased, consistent with decreased activation of the HIV-producing cells. More extensive investigation may clarify the significance of these findings with respect to pathogenesis. © 2001 Lippincott Williams & Wilkins

Multimodal evoked potentials in HIV-1-seropositive patients: Relationship between the immune impairment and the neurophysiological function

Multimodal evoked potentials (PRVEP, BAEP, mSEP) were recorded in 56 HIV-1 seropositive outpatients free from opportunistic CNS pathologies and/or overt HIV-1 encephalopathy. EPs were altered in 17 of 39 (43.6%) seropositive subjects without AIDS (group A) and in 13 of 17 (76.5%) patients with AIDS (group B). A high incidence of subclinical alterations (30.8%) were found in group A patients. Significant BAEP (I-III, III-V, I-V) interpeak latency and mSEP (N9-N13, N9-N20) conduction time prolongations were found in group a and B patients. PRVEP P100 was significantly prolonged only in group B. An inverse relationship between BAEP interpeak latencies and CD4 count was found. Our findings support the hypothesis of an important role of immunodepression in the development of neurophysiologic abnormalities, together with a preferential involvement of acoustic pathways, in the course of HIV-1 infection

A Prospective Multicentre Study of the Epidemiology and Outcomes of Bloodstream Infection in Cirrhotic Patients

OBJECTIVE: The aim of this study was to describe the current epidemiology of BSI in patients with cirrhosis, analyse predictors of 30-day mortality, and risk factors for antibiotic resistance. METHODS: Cirrhotic patients developing a BSI episode were prospectively included at 19 centres in five countries from September 2014 to December 2015. The discrimination of mortality risk scores for 30-day mortality were compared by area under the receiver operator-risk and Cox-regression models. Risk factors for multidrug-resistant organisms (MDRO) were assessed with a logistic regression model. RESULTS: We enrolled 312 patients. Gram-negative bacteria, Gram-positive bacteria and Candida spp. were the cause of BSI episodes in 53%, 47% and 7% of cases, respectively. The 30-day mortality rate was 25% and best predicted by the SOFA and CLIF-SOFA score. In a Cox-regression model, delayed (>24h) antibiotic treatment [HR 7.58 (95%CI 3.29-18.67), P<.001], inadequate empirical therapy [HR 3.14 (95%CI 1.93-5.12), P<.001] and CLIF-SOFA score [HR 1.35 (95%CI 1.28-1.43), P<.001] were independently associated with 30-day mortality. Independent risk factors for MDRO (31% of BSIs) were previous antimicrobial exposure [OR 2.91 (95%CI 1.73-4.88), P<.001] and previous invasive procedures [OR 2.51 (95%CI 1.48-4.24), P=.001], whereas spontaneous bacterial peritonitis as BSI source was associated with a lower odds of MDRO [OR 0.30 (95%CI 0.12-0.73), P=.008). CONCLUSIONS: MDRO account for nearly one-third of BSI in cirrhotic patients and often resulting in delayed or inadequate empirical antimicrobial therapy and increased mortality rates. Our data suggest that improved prevention and treatment strategies for MDRO are urgently needed in the liver cirrhosis patients

Use of hydroxychloroquine in hospitalised COVID-19 patients is associated with reduced mortality: Findings from the observational multicentre Italian CORIST study

Hydroxychloroquine (HCQ) was proposed as potential treatment for COVID-19