The prior liver cancer associated with chronic viral liver diseases

In issue the experience of treatment in 67 patients with the prior liver cancer is presented. The hepatocellular cancer was diagnosed in 62 cases (92,5%), cholangiocellular cancer in the rest 5 patients. Viral hepatitis B was evaluated in 28 cases, viral hepatitis C in 19. Surgical treatment was performed in 34, in 22 resection of liver was carried out in cases with chronical viral hepatitis and cirrhosis. 16 (47,1%) patients had complications in postoperative period, hepatocellular insufficiency developed more often in patients with viral lesions. Postoperative mortality was in 17,6%. The 5-year survival was 47±7,2%. 49,3% patients got regional chemotherapy – chemoembolization or chemoinfusion in hepatic artery. Mediana was 19,4 and 10,2 months, consequently. So, patients with viral hepatitis and cirrhosis have more complications in postoperative period after liver resections. Surgical approach needs very careful evaluation of cancer dissemination and liver dysfunction in this category of patients

ПЕРВИЧНЫЙ РАК ПЕЧЕНИ, АССОЦИИРОВАННЫЙ С ХРОНИЧЕСКИМИ ВИРУСНЫМИ ЗАБОЛЕВАНИЯМИ ПЕЧЕНИ

In issue the experience of treatment in 67 patients with the prior liver cancer is presented. The hepatocellular cancer was diagnosed in 62 cases (92,5%), cholangiocellular cancer in the rest 5 patients. Viral hepatitis B was evaluated in 28 cases, viral hepatitis C in 19. Surgical treatment was performed in 34, in 22 resection of liver was carried out in cases with chronical viral hepatitis and cirrhosis. 16 (47,1%) patients had complications in postoperative period, hepatocellular insufficiency developed more often in patients with viral lesions. Postoperative mortality was in 17,6%. The 5-year survival was 47±7,2%. 49,3% patients got regional chemotherapy – chemoembolization or chemoinfusion in hepatic artery. Mediana was 19,4 and 10,2 months, consequently. So, patients with viral hepatitis and cirrhosis have more complications in postoperative period after liver resections. Surgical approach needs very careful evaluation of cancer dissemination and liver dysfunction in this category of patients.Представлен опыт лечения 67 больных первичным раком печени. Гепатоцеллюлярный рак диагностирован у 62 (92,5%) пациентов, холангиоцеллюлярный рак у 5. Вирусный гепатит В имел место у 28 больных, вирусный гепатит С – 19. Оперативное лечение злокачественного новообразования печени предпринято у 34 пациентов, из них в 22 наблюдениях резекция органа выполнялась на фоне сопутствующего хронического гепатита или цирроза печени. Осложненный послеоперационный период имел место у 16 (47,1%) больных. У пациентов с хроническим вирусным заболеванием печени гораздо чаще в послеоперационном периоде встречалось прогрессирование гепатоцеллюлярной недостаточности. Послеоперационная летальность составила 17,6%. Пятилетняя выживаемость составила 47,±7,2%. У 49,3% с нерезектабельным гепатоцеллюлярным раком выполнена лечебная регионарная химиотерапия – масляная химиоэмболизация или химиоинфузия печеночной артерии. Медиана выживаемости составила 19,4 и 10,2 месяцев соответственно. Выполнение резекции печени у пациентов на фоне сопутствующего хронического вирусного заболевания сопровождается более тяжелым послеоперационным течением. Хирургическая тактика у больных первичным раком печени и хроническим гепатитом или циррозом печени требует детальной оценки распространенности опухолевого поражения и выраженности гепатоцеллюлярной дисфункции

A family outbreak of tinea capitis due to Trichophyton violaceum in Michigan. Its control with griseofulvin

An outbreak of tinea capitis caused by Trichophyton violaceum in five siblings of a family of eight in Michigan and its control with griseofulvin are described.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43276/1/11046_2005_Article_BF02145740.pd

POSSIBILITIES OF ENDOVASCULAR INTERVENTIONS IN TREATMENT OF BUDD-CHIARI SYNDROME

The article presents the results of endovascular treatment of 35 patients with Budd-Chiari syndrome. An analysis of efficacy of modern interventions was made. There were shown the possibilities of balloon dilatation of stenosis of renal veins, the balloon dilatation and stenting with metal self-expansible stents of stenosis an occlusion of intrahepatic section of the postcava and results of transhepatic portsystemic bypass surgery

Quantitative assessment of hepatic function by indocyanine green clearance test

The purpose of the investigation was to study the informative and prognostic values of a dynamic hepatic function test using indocyanine green (ICG) in cirrhotic patients. The investigation covered 149 patients with hepatic cirrhosis (a study group) and 20 patients without signs of liver disease (a control group). The plasma ICG elimination rate (PICGER) was significantly lower in the study group (7.6±3.4 and 22.9±4.2% per min in the study and control groups, respectively; p < 0.001). With the progression of hepatocellular dysfunction revealed by the ChildPugh criteria, the indocyanine clearance values became progressively worse. In cirrhotic patients, PICGER correlated with the levels of total bilirubin (r = -0.501; p < 0.001), albumin (r = 0.494; p < 0.001), international normalized ratio (r = 0.475; p < 0.001), and the histological activity index of the necroinflammatory process in the hepatic parenchyma (r =-0.579; p < 0.001). In these patients, median survival was significantly higher in cases with prompter ICG elimination and, at a PICGER of > 7, 5 to 7, and <5% per min, it was 20, 11.5, and 6 months (χ2  = 51.9; p<0,001). Analysis of ROC curves demonstrated a greater prognostic value of the ICG clearance test than the Child-Pugh and MELD criteria (statisticPER, 0.852±0.032; c-statisticCHILD, 0.767±0.039, с-statisticMELD, 0.758±0.041; p < 0.001). The sensitivity and specificity of the clearance test in the prediction of annual survival were 86.5 and 76.8%, respectively. Thus, the determination of ICG clearance is a highly informative and specific dynamic test that estimates hepatic functional reserves. The inclusion of this criterion into the existing scales for rating the severity of hepatocellular dysfunction permits improvement of the diagnostic and prognostic efficiency of their use