Invasive Aspergillosis in Transplant Recipients

Patients with hematological malignancies and recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT) as well as solid organ transplant recipients are the groups of patients with the highest risk of invasive fungal infections (IFI). Neutropenia, lymphopenia, chemotherapy of malignancies, radiation therapy, immunosuppressive therapy, administration of glucocorticosteroids, use of central venous catheters, dialysis therapy, liver and kidney failure, and diabetes are diseases and medical conditions which foster invasive fungal infections. In recent years, it has been observed that the most common etiological agents of these infections are yeast-like fungi of the genus Candida, and the second most common is moulds Aspergillus spp. Antifungal agent recommended for therapy of IFI caused by Aspergillus is voriconazole, according to the present guidelines. A combined therapy using voriconazole and caspofungin may not be effective. According to numerous publications, in case of infections caused by strains resistant to voriconazole, a therapeutic success is possible after a switch to the liposomal form of amphotericin B. Due to nonspecific clinical symptoms of IFI caused by Aspergillus spp., histopathological as well as mycological and serological tests, echocardiographic examination, magnetic resonance imaging (MRI) and computer tomography (CT) may contribute to an early and reliable diagnosis of invasive aspergillosis

Hilar cholangiocarcinoma – long-term results of radical and palliative treatment

Introduction. Hilar cholangiocarcinoma (HC) is the tumor that requires multidisciplinary approach and treatment. The 3- and 5- year survivals of HC patients treated with surgery and palliative methods were evaluated in the study. Material and methods. A study covered 368 patients treated between 2000–2014. Of them, 137 patients were categorized for surgery (RT group), and 231 for palliative treatment (PT group). The overall 3- and 5- year survivals were determined by the log rank test. Cox hazard regression model revealed the relative prognostic factors. Results. The 3- and 5- year survival rates accounted for 38% and 21% after surgery, but 13% and 0 after palliative treatment (p < 0.0001). Radical tumor resection, negative lymph nodes, and early tumor T stage were the factors conducive to survival. Conclusions. Surgery, if the radical tumor resection is possible, offers a chance for long-term survival. The positive effects of surgery treatment are lost against most of the majority of palliative patient

The role of MR cholangiography in the detection of biliary complications after orthotopic liver transplantation

Background: To assess the usefulness of magnetic resonance cholangiography (MRC) in the diagnostics of biliary complications after liver transplantation. Material/Methods: In 40 patients (17 men, 23 women) 51 MRC examinations were performed, from 1 to 58 months (mean-12) after liver transplantation. Studies were performed with 1.5 T unit. The imaging protocol consisted of tree hydrographic TSE sequences: 2D, 3D and single-slice technique. The results were compared with ERCP (n=10), percutaneous cholangiography (n=4), T-tube cholangiography (n=1), T-tube cholangiography and percutaneous cholangiography (n=1), T-tube cholangiography and ERCP (n=1), fistulography (n=2) and histopathology (n=3). In remaining patients other imaging studies (US, CT), laboratory liver functions tests and clinical status were evaluated. Results: In 46 cases (90%) abnormalities of biliary tract were depicted. Following biliary complications were diagnosed: dilatation of biliary tree (n=29), biliary strictures located beside anastomosis site (n=19), anastomotic biliary strictures (n=17), intrahepatic strictures (n=7), biliary obstruction (n=2), biliary stones/sludge (n=14), bile leak (n=12). In 5 cases (10%) MRC was normal. In 50 cases (98%) there was concordance between MRC results and the standard of reference, 1 remaining case (2%) of bile duct ischemia was not confirmed by other studies. Conclusions: MRC is a noninvasive modality, providing accurate assessment of biliary complications in patients after liver transplantation

The role of MR cholangiography in the detection of biliary complications after orthotopic liver transplantation

Background: To assess the usefulness of magnetic resonance cholangiography (MRC) in the diagnostics of biliary complications after liver transplantation. Material/Methods: In 40 patients (17 men, 23 women) 51 MRC examinations were performed, from 1 to 58 months (mean-12) after liver transplantation. Studies were performed with 1.5 T unit. The imaging protocol consisted of tree hydrographic TSE sequences: 2D, 3D and single-slice technique. The results were compared with ERCP (n=10), percutaneous cholangiography (n=4), T-tube cholangiography (n=1), T-tube cholangiography and percutaneous cholangiography (n=1), T-tube cholangiography and ERCP (n=1), fistulography (n=2) and histopathology (n=3). In remaining patients other imaging studies (US, CT), laboratory liver functions tests and clinical status were evaluated. Results: In 46 cases (90%) abnormalities of biliary tract were depicted. Following biliary complications were diagnosed: dilatation of biliary tree (n=29), biliary strictures located beside anastomosis site (n=19), anastomotic biliary strictures (n=17), intrahepatic strictures (n=7), biliary obstruction (n=2), biliary stones/sludge (n=14), bile leak (n=12). In 5 cases (10%) MRC was normal. In 50 cases (98%) there was concordance between MRC results and the standard of reference, 1 remaining case (2%) of bile duct ischemia was not confirmed by other studies. Conclusions: MRC is a noninvasive modality, providing accurate assessment of biliary complications in patients after liver transplantation

MTARC1 and HSD17B13 Variants Have Protective Effects on Non-Alcoholic Fatty Liver Disease in Patients Undergoing Bariatric Surgery

The severity of hepatic steatosis is modulated by genetic variants, such as patatin-like phospholipase domain containing 3 (PNPLA3) rs738409, transmembrane 6 superfamily member 2 (TM6SF2) rs58542926, and membrane-bound O-acyltransferase domain containing 7 (MBOAT7) rs641738. Recently, mitochondrial amidoxime reducing component 1 (MTARC1) rs2642438 and hydroxysteroid 17-beta dehydrogenase 13 (HSD17B13) rs72613567 polymorphisms were shown to have protective effects on liver diseases. Here, we evaluate these variants in patients undergoing bariatric surgery. A total of 165 patients who underwent laparoscopic sleeve gastrectomy and intraoperative liver biopsies and 314 controls were prospectively recruited. Genotyping was performed using TaqMan assays. Overall, 70.3% of operated patients presented with hepatic steatosis. NASH (non-alcoholic steatohepatitis) was detected in 28.5% of patients; none had cirrhosis. The increment of liver fibrosis stage was associated with decreasing frequency of the MTARC1 minor allele (p = 0.03). In multivariate analysis MTARC1 was an independent protective factor against fibrosis ≥ 1b (OR = 0.52, p = 0.03) and ≥1c (OR = 0.51, p = 0.04). The PNPLA3 risk allele was associated with increased hepatic steatosis, fibrosis, and NASH (OR = 2.22, p = 0.04). The HSD17B13 polymorphism was protective against liver injury as reflected by lower AST (p = 0.04) and ALT (p = 0.03) activities. The TM6SF2 polymorphism was associated with increased ALT (p = 0.04). In conclusion, hepatic steatosis is common among patients scheduled for bariatric surgery, but the MTARC1 and HSD17B13 polymorphisms lower liver injury in these individuals

Postępowanie diagnostyczno-terapeutyczne u chorych na czerniaki oka – zalecenia Polskiego Towarzystwa Onkologicznego

Czerniak błony naczyniowej oka jest najczęstszym złośliwym nowotworem gałki ocznej, rozwijającym się z melanocytów błony naczyniowej oka, który istotnie różni się od czerniaka spojówki, błon śluzowych i skóry. Postępowanie w tej chorobie różni się więc od postępowania w pozostałych postaciach czerniaka. Choroba najczęściej ograniczona jest do oka, a jej leczenie miejscowe obejmuje radioterapię i chirurgię. U części chorych pomimo skutecznego leczenia miejscowego dochodzi do wystąpienia przerzutów odległych, najczęściej zlokalizowanych w wątrobie. Przedstawione tutaj wytyczne obejmują zasady diagnostyki, oceny rokowania oraz leczenia zarówno choroby ograniczonej do gałki ocznej, jak i choroby w stadium z przerzutami. Omówiono również zasady postępowania w czerniaku spojówki. Zalecenia powstały w oparciu o przegląd piśmiennictwa oraz opinie ekspertów i są zaopatrzone w ocenę siły i wiarygodności

Fat and Sugar—A Dangerous Duet. A Comparative Review on Metabolic Remodeling in Rodent Models of Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is a common disease in Western society and ranges from steatosis to steatohepatitis to end-stage liver disease such as cirrhosis and hepatocellular carcinoma. The molecular mechanisms that are involved in the progression of steatosis to more severe liver damage in patients are not fully understood. A deeper investigation of NAFLD pathogenesis is possible due to the many different animal models developed recently. In this review, we present a comparative overview of the most common dietary NAFLD rodent models with respect to their metabolic phenotype and morphological manifestation. Moreover, we describe similarities and controversies concerning the effect of NAFLD-inducing diets on mitochondria as well as mitochondria-derived oxidative stress in the progression of NAFLD

Hepatocellular carcinoma - diagnosis and treatment

Rak wątrobowo-komórkowy najczęściej jest następstwem wirusowego zapalenia wątroby. W ciągu ostatnich dekad wskaźniki zachorowalności i umieralności zwiększają się. U większości chorych nowotwór rozpoznaje się w zaawansowanym stadium. Możliwość określenia populacji o zwiększonym ryzyku wystąpienia nowotworu uzasadnia prowadzenie u chorych z marskością programu wczesnego wykrywania za pomocą obrazowania wątroby w odstępach 6-miesięcznych. Rozpoznanie powinno być oparte na ocenie stanu klinicznego łącznie z obrazowaniem i badaniem mikroskopowym. Resekcja jest leczeniem z wyboru u chorych z ograniczeniem choroby do jednej okolicy wątroby i jej prawidłową czynnością oraz nieobecnością cech wrotnego nadciśnienia. Przeszczepienie wątroby stanowi najlepszą metodę w przypadku niewielkich zmian stwierdzonych w przebiegu marskości wątroby. Chemioembolizacja i termoablacja są skutecznymi metodami postępowania w przypadku niewielkich zmian o średnicy do 3 cm w przypadku braku możliwości ich resekcji lub przed transplantacją wątroby. Systemowa chemioterapia ma niewielką wartość, natomiast zastosowanie sorafenibu - drobnocząsteczkowego inhibitora angiogenezy - może przedłużyć czas przeżycia u wybranych chorychHepatocellular carcinoma usually is a consequence of underlying viral hepatitis. Both, the incidence and mortality rates have increased in recent decades. The majority of patients are still diagnosed with advanced disease. The identifiable population at risk of development malignancy makes early detection a realistic possibility and every 6 months liver imaging is currently recommended for patients with cirrhosis. The diagnosis should be based on clinical findings together with radiologic imaging and microscopic examination. Resection is preferred treatment for patients with the disease confined to one region of the liver and preserved hepatic function with no evidence of portal hypertension. Liver transplantation is the best option for small lesions found in cirrhosis. Chemoembolization and thermoablation are effective methods of treatment of small - up to 3 cm in diameter - lesions in patients who otherwise are not candidates for resection or as a bridge to liver transplantation. Systemic chemotherapy is of marginal value, whereas the use of sorafenib - a small-molecule angiogenesis inhibitor - may prolong survival in well-selected patients