Case Report: Laparoscopic hepatectomy in an elderly patient with major comorbidities

Surgeons have been hesitant to proceed to hepatectomy in elderly patients, due to the higher rate of comorbidities and the reduced reserves. An 81-year-old male with hepatocellular carcinoma in the segment VI of the liver and several major cardiovascular, pulmonary and metabolic comorbid illnesses was referred to our department for treatment. He underwent transarterial chemoembolization of the liver tumor and afterwards he underwent laparoscopic resection of the hepatic segment VI, with an uneventful postoperative course. This case indicates that laparoscopic liver resections could be applied even to elderly patients with major comorbidities after optimization of their medical status. © 2017 Sotiropoulos GC et al

Pneumocystis Jirovecii pneumonia in liver transplant recipients: A systematic review

Background: Pneumocystis jirovecii is a fungus that causes pneumonia in immunocompromised patients, such as liver transplant recipients. Methods: We searched the Medline database in September 2013 for articles referring to infections from P. jirovecii in liver transplant recipients, using the terms "liver transplantation" and "pneumocystis." Our search yielded 60 articles, 35 of which were used for our review. Results: P. jirovecii pneumonia (PJP) has an incidence of 1%e11% in liver transplant recipients without prophylaxis and mortality rates of 7%e88%. Most cases occur within the first 7 months after transplantation. When prophylactic treatment with oral trimethoprim-sulfamethoxazole is used, its incidence is only 0%e3%. The duration of its use varies from 3 months to 1 year after the liver transplantation. Conclusions: PJP has relatively high incidence and high mortality rates in liver transplant recipients without prophylactic treatment, which diminishes or even eliminates its occurrence. Therefore, oral trimethoprim-sulfamethoxazole should be used as prophylaxis for 1 year after the liver transplantation in this population. © 2014 by Elsevier Inc. All rights reserved

Giant liver tumor causing dyspnea upon exertion

Asymptomatic elevation of the right hemidiaphragm should always raise suspicion of a silent hepatic tumor. Prompt multimodality imaging plays a critical role in the identification of this entity; high clinical suspicion is the key element for diagnosis of a possible hepatic tumor. © 2018 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd