Fatal Clostridial necrotizing enterocolitis in a term infant with gastroschisis

AbstractNecrotizing enterocolitis (NEC) is most often a disease of preterm infants, but can develop in full term infants with gastroschisis. The latter cases typically present later and have a milder clinical course; we present the first case of fatal Clostridium perfringes-associated NEC in a full term infant with gastroschisis. Our case highlights the need for a high index of clinical suspicion for Clostridial NEC when there is rapid progression of disease and/or evidence of hemolysis. When Clostridial NEC is suspected, we recommend treatment with penicillin G and clindamycin, as well as prompt, aggressive surgical intervention

Multidisciplinary perspective of hepatocellular carcinoma: A Pacific Northwest experience

Hepatocellular carcinoma (HCC) is the most rapidly increasing type of cancer in the United States. HCC is a highly malignant cancer, accounting for at least 14000 deaths in the United States annually, and it ranks third as a cause of cancer mortality in men. One major difficulty is that most patients with HCC are diagnosed when the disease is already at an advanced stage, and the cancer cannot be surgically removed. Furthermore, because almost all patients have cirrhosis, neither chemotherapy nor major resections are well tolerated. Clearly there is need of a multidisciplinary approach for the management of HCC. For example, there is a need for better understanding of the fundamental etiologic mechanisms that are involved in hepatocarcinogenesis, which could lead to the development of successful preventive and therapeutic modalities. It is also essential to define the cellular and molecular bases for malignant transformation of hepatocytes. Such knowledge would: (1) greatly facilitate the identification of patients at risk; (2) prompt efforts to decrease risk factors; and (3) improve surveillance and early diagnosis through diagnostic imaging modalities. Possible benefits extend also to the clinical management of this disease. Because there are many factors involved in pathogenesis of HCC, this paper reviews a multidisciplinary perspective of recent advances in basic and clinical understanding of HCC that include: molecular hepatocarcinogenesis, non-invasive diagnostics modalities, diagnostic pathology, surgical modality, transplantation, local therapy and oncological/target therapeutics