Acute hepatic failure and multi-system organ failure secondary to replacement of the liver with metastatic melanoma

BACKGROUND: Metastatic malignant melanoma to the liver resulting in fulminant hepatic failure is a rare occurrence. CASE PRESENTATION: A 46 year old man presented to hospital with massive hepatomegaly, elevated liver enzymes and increased lactate three weeks following resection of a malignant melanoma from his shoulder (Clark level 5). Initially stable, he decompensated 24 to 48 hours subsequent to presentation with respiratory failure requiring mechanical ventilation, distributive shock requiring high dose vasopressor infusion, coagulopathy refractory to plasma infusion, progressive rise in liver enzymes and severe metabolic abnormalities including hyperkalemia, acidosis, hyperphosphatemia, hyperuricemia and hypocalcemia. Refractory to aggressive physiologic support he received palliation. Autopsy revealed >80% liver infiltration by metastatic malignant melanoma. CONCLUSION: We report a case of fulminant hepatic failure secondary to metastatic malignant melanoma infiltration of the liver

Genetic diversity of natural cyclamen alpinum populations

The focus of this study was Cyclamen alpinum (formerly C. trochopteranthum). Habitat fragmentation, environmental degradation, and overharvesting of tubers have exerted pressure on native populations of this valuable ornamental species. Although the entire Cyclamen genus is in the Convention on International Trade in Endangered Species of Wild Fauna and Flora-Appendix II (CITES II), no species has yet been red-listed. Estimating the level and distribution of genetic variation in populations of rare and endemic species is important for conserving genetic diversity within a species in the context of well-developed conservation strategies. Currently, DNA markers are the most effective means used to infer genetic variation at the molecular level in conservation genetics. In this study, random amplified polymorphic DNA (RAPD) analysis was employed to assess the genetic diversity within and among 6 natural C. alpinum populations in the south and southwest of Turkey. A total of 190 loci were determined by using 15 polymorphic primers. Total genetic variation (HT) was 0.27 ± 0.02. A high proportion of this variation, 0.16 ± 0.01 (59.26%), was due to withinpopulation genetic variation (HS). The genetic differentiation coefficient (GST) was 0.41, and the level of gene flow (Nm) within a generation among the 6 populations studied was 0.73. As a result of these findings, we propose in situ combined withex situ conservation of all C. alpinum populations. In addition, our results support prior recommendations to add C. alpinum to the International Union for Conservation of Nature and Natural Resources (IUCN) Red List under the critically endangered (CR) category. © TÜBİTAK

Genetic diversity of natural Cyclamen alpinum populations

The focus of this study was Cyclamen alpinum (formerly C. trochopteranthum). Habitat fragmentation, environmental degradation, and overharvesting of tubers have exerted pressure on native populations of this valuable ornamental species. Although the entire Cyclamen genus is in the Convention on International Trade in Endangered Species of Wild Fauna and Flora-Appendix II (CITES II), no species has yet been red-listed. Estimating the level and distribution of genetic variation in populations of rare and endemic species is important for conserving genetic diversity within a species in the context of well-developed conservation strategies. Currently, DNA markers are the most effective means used to infer genetic variation at the molecular level in conservation genetics. In this study, random amplified polymorphic DNA (RAPD) analysis was employed to assess the genetic diversity within and among 6 natural C. alpinum populations in the south and southwest of Turkey. A total of 190 loci were determined by using 15 polymorphic primers. Total genetic variation (H-T) was 0.27 +/- 0.02. A high proportion of this variation, 0.16 +/- 0.01 (59.26%), was due to within-population genetic variation (H-S). The genetic differentiation coefficient (G(ST)) was 0.41, and the level of gene flow (Nm) within a generation among the 6 populations studied was 0.73. As a result of these findings, we propose in situ combined with ex situ conservation of all C. alpinum populations. In addition, our results support prior recommendations to add C. alpinum to the International Union for Conservation of Nature and Natural Resources (IUCN) Red List under the critically endangered (CR) category

Hemostatic Alterations in Patients With Cirrhosis: From Primary Hemostasis to Fibrinolysis.

In the setting of liver cirrhosis (LC), profound hemostatic changes occur, which affect primary hemostasis, coagulation, and fibrinolysis. They involve prohemorrhagic and prothrombotic alterations at each of these steps. Patients with cirrhosis exhibit multifactorial thrombocytopenia and in vitro thrombocytopathy, counterbalanced by increased von Willebrand factor. The resultant shift is difficult to assess, but overall these changes probably result in a rebalanced primary hemostasis. Concerning coagulation, the reduced activity of coagulation factors is counterbalanced by an increase in factor VIII (produced by liver sinusoidal endothelial cells), a decrease of the natural anticoagulants, and complex changes, including changes in circulating microparticles, cell-free DNA, and neutrophil extracellular traps. Overall, these alterations result in a procoagulant state. As for fibrinolysis, increased tissue-type and urokinase-type plasminogen activators, a relatively decreased plasminogen activator inhibitor 1, and decreased levels of thrombin-activatable fibrinolysis inhibitor and α2-antiplasmin are counterbalanced by decreased plasminogen and a decreased fibrin clot permeability. Whether and how these changes shift fibrinolysis remains to be determined. Overall, the current consensus is that in patients with cirrhosis, the hemostasis is shifted toward a procoagulant state. We review the published evidence for the concept of LC as a prothrombotic state, discuss discordant data, and highlight the impact of the underlying cause of LC on the resultant imbalance