Years of life that could be saved from prevention of hepatocellular carcinoma

BACKGROUND: Hepatocellular carcinoma (HCC) causes premature death and loss of life expectancy worldwide. Its primary and secondary prevention can result in a significant number of years of life saved. AIM: To assess how many years of life are lost after HCC diagnosis. METHODS: Data from 5346 patients with first HCC diagnosis were used to estimate lifespan and number of years of life lost after tumour onset, using a semi-parametric extrapolation having as reference an age-, sex- and year-of-onset-matched population derived from national life tables. RESULTS: Between 1986 and 2014, HCC lead to an average of 11.5 years-of-life lost for each patient. The youngest age-quartile group (18-61 years) had the highest number of years-of-life lost, representing approximately 41% of the overall benefit obtainable from prevention. Advancements in HCC management have progressively reduced the number of years-of-life lost from 12.6 years in 1986-1999, to 10.7 in 2000-2006 and 7.4 years in 2007-2014. Currently, an HCC diagnosis when a single tumour <2 cm results in 3.7 years-of-life lost while the diagnosis when a single tumour 65 2 cm or 2/3 nodules still within the Milan criteria, results in 5.0 years-of-life lost, representing the loss of only approximately 5.5% and 7.2%, respectively, of the entire lifespan from birth. CONCLUSIONS: Hepatocellular carcinoma occurrence results in the loss of a considerable number of years-of-life, especially for younger patients. In recent years, the increased possibility of effectively treating this tumour has improved life expectancy, thus reducing years-of-life lost

Study of the Oncotic e non Oncotic preperties of human Albumin in Patients with Cirrhosis and Ascites

L’albumina umana (HA) è usata per le sue proprietà oncotiche per ricostituire il volume circolante in pazienti critici e nella cirrosi epatica avanzata. Tuttavia, l’albumina non è solo semplice espansore plasmatico, ma è provvista anche di proprietà non oncotiche, quali, la capacità di legare e trasportare molecole insolubili in acqua, come metalli e farmaci, il suo potere antiossidante e di detossificazione di sostanze sia endogene che esogene. Il nostro studio, è stato progettato da un lato per dimostrare che il trattamento in cronico con albumina umana nei pazienti cirrotici con ascite è in grado di ridurre l’incidenza di ascite refrattaria, delle complicanze legate all’uso dei diuretici e la ricorrenza delle ospedalizzazioni (studio randomizzato), dall’altro per determinare se le alterazioni delle proprietà non oncotiche dell’albumina, possono rappresentare degli indicatori di un aumentato rischio di complicanze cliniche e di una prognosi sfavorevole di questi pazienti (studio di coorte). METODI Studio multicentrico, prospettico, randomizzato, in 440 pts cirrotici con ascite: due bracci di trattamento: t. medica standard vs t. medica standard + albumina; Studio di coorte con 110 cirrotici vs 50 individui sani, valutati mediante -analisi proteomica per individuare con le modifiche post-trascrizionali; - Cobalt Binding Albumina (ACB) per quantificare la quota di albumina modificata dall’ischemia e IMA-Ratio. RISULTATI Studio randomizzato: non è possibile trarre conclusioni, ma emerge un dato incoraggiante, cioè i pazienti del braccio standard hanno una maggiore tendenza a chiudere lo studio per tre paracentesi / mese; Studio Coorte:-IMA e IMA-R sono aumentati in cirrosi, ma non associate a complicanze della cirrosi, l'infezione batterica è associata ad un aumento IMA e IMA-R in cirrosi. CONCLUSIONE: Lo studio randomizzato è in corso ma i dati preliminari sono incoraggianti. Lo studio coorte, ha dimostrato che la cirrosi è associata da alterazioni post-trascrizionali che coinvolgono il N-terminale ed i siti di legame Cys-34.For the oncotic capacity, human albumin (HA) is mainly used in the clinical ground to replenish the circulating volume in critically-ill patients and in those with cirrhosis. However, HA is more than a simple plasma volume expander, being provided of other biological properties, such as binding, transport and detoxification of endo- and exo-genous substances, and antioxidant activity. Our study was designed on the one hand to demonstrate that the treatment of chronic HA in patients with cirrhosis and ascites is able to reduce the incidence of refractory ascites, complications related to the use of diuretics, the recurrence of hospitalizations (randomized study), secondly to determine whether these alterations do non oncotic properties, may represent indicators of an increased risk of clinical complications and a poor prognosis (cohort study). METHODS: Multicenter, prospective, randomized trial, on 440 cirrhotic with ascites: two groups, standard medical th (controls) vs standard medical th + albumin 2) Cohort study with 110 cirrhotic pts vs 50 healthy individuals comparable for age and sex. Assessment of functional binding sites: -the proteomic analysis will allow us to precisely identify the post-trascriptional modifications;- Albumin Cobalt Binding (ACB) to quantify the circulating ischemia-modified albumin (IMA); - IMA-R Ratio IMA/plasma albumin concentration. RESULTS: Randomized study: is not possible to draw conclusions but the most powerful that emerges is that the standard arm patients have a greater tendency to quit the study for three paracentesis/month compared to albumin arm. Cohort Study: -IMA and IMA-R are increased in cirrhosis, but not associated with complication of cirrhosis; bacterial infection is associated with increased IMA and IMA R in cirrhosis. CONCLUSION: Randomized study has yet to be concluded, but the preliminary data are encouraging. The Cohort study, has shown that cirrhosis is associated with post-transcriptional changes of albumin involving the N-terminus and the Cys-34 binding sites

Transient idiopathic central diabetes insipidus: is severe sepsis a possible cause?

Idiopathic central diabetes insipidus (CDI) is a disorder characterized by hypotonic polyuria and polydipsia, without any identified etiology. Here we report a case of a 57-year-old woman, with idiopathic CDI, admitted to our department with severe sepsis and acute kidney failure. After clinical and radiological investigations, she was diagnosed with idiopathic CDI. In this case report the findings suggest that severe sepsis could be the trigger for this disease. In addition, we hypothesise that apelin, a diuretic neuropeptide, plays a role in such a process. Apelin levels are known to increase during severe sepsis, which in turn counteracts vasopressin actions through inhibition of vasopressin neuron activity and vasopressin release

Massive splenic infarction in a patient with pneumococcal septic shock and unknown celiac disease

Splenic infarction (SI) is a rare event occurring when the splenic artery or its branches become occluded by embolus or by in situ thrombosis. Many SI events are a result of embolic sources either cardiac or aortic. Massive splenic infarction (MSI) results from compromised blood flow to more than half of the spleen. In this paper we describe a case of a previously healthy patient who presented with pneumococcal sepsis who, upon investigation, revealed an unknown celiac disease and a MSI. Abdominal ultrasound with contrast agent was a useful tool for a diagnosis and follow up of this patient

How albumin administration for cirrhosis impacts on hospital albumin consumption and expenditure

AIM: To assess the impact of guidelines for albumin prescription in an academic hospital, which is a referral center for liver diseases

Pulmonary scintigraphy as a method to investigate gastrobronchial communication in tracheostomized patients

Amyotrophic Lateral Sclerosis (ALS) is a degeneration of somatic motor neurons extending from upper motor cortical pyramidal neurons to lower motor neurons of the brainstem and cord. During the course of the disease patients require invasive procedures for nutrition and ventilation. Percutaneous Endoscopic Gastrostomy (PEG), performed in patients with impaired swallowing, is a safe procedure for the administration of Enteral Nutrition (EN). In the advanced stages of the disease patients develop a ventilatory failure due to muscolar weakness in these case they need a permanent tracheal tube with mechanical ventilation. Here we reported a case of a patient with Amyotrophic Lateral Sclerosis (ASL) who developed an increased gastric endocavitary pressure after a Percutaneous Endoscopic Gastrostomy (PEG)

Effect of liver transplantation on tuftsin activity and phagocytic activity of neutrophil granulocytes in patients with liver cirrhosis

Background: Tuftsin activity (TA) is reduced in cirrhosis. This contributes to the defective phagocytic activity (PA) of neutrophil granulocytes and is related to the impairment of splenic function. Orthotopic liver transplantation (OLT) cures cirrhosis and might restore TA. This study was aimed at determining if OLT restores TA and PA. Methods: We measured in 9 cirrhotic patients, before and after successful OLT, TA by a bioassay and PA by chemiluminescence in which neutrophils of the patient were tested with both autologous (PA1) and pooled sera from healthy subjects (PA2). Splenic function was assayed by the pitted red cell count. Results: Before OLT, TA was reduced in 7 patients, and PA1 in all the patients. Pitted cell count was elevated in all the patients. After OLT (median 39 months; range 21-49), TA improved in all cases [median: from 8% (5-16%) to 20% (9-22%), p &lt; 0.008], normalizing in 5 out of the 7 patients with low values. PA1 improved in all the patients [from 102 cpm (65-128 cpm) to 235 cpm (78-280 cpm), p &lt; 0.008], normalizing in 5. Pitted red count decreased in 7 patients and normalized in 3 [from 3.3% (2.1-6.0%) to 2.4% (1.4-2.8%), p &lt; 0.021]. Platelet count [from 55 × 103 (30-100) to 185 × 103 (93-286), p &lt; 0.008] and leucocyte count [from 3.60 × 103 (1.81-5.23) to 5.53 × 10 3 (3.31-6.71), p &lt; 0.008] also improved. Conclusions: OLT improves TA and PA of cirrhotic patients. This effect is associated with an improvement of both functional hyposplenism and haematological hypersplenism. The restoration of natural defences against infections may mitigate the adverse effect of immunosuppressive treatment. Copyright © 2005 S. Karger AG