Multimodality treatment of hepatocellular carcinoma : How field practice complies with international recommendations

Background: Management of hepatocellular carcinoma (HCC) is framed within standardized protocols released by Scientific Societies, whose applicability and efficacy in field practice need refining. Aim: We evaluated the applicability and effectiveness of guidelines for the treatment of HCC of the American Association for the Study of the Liver (AASLD). Methods: 370 consecutive cirrhotic patients with de-novo HCC in different stages (253 BCLC A, 66 BCLC B, 51 BCLC C) received treatment through a multidisciplinary team (MDT) decision and were followed until death or end of follow-up. Results: Adherent treatment to AASLD recommendations was in 205 (81%) BCLC A patients, 36 (54%) BCLC B, and 27 (53%) BCLC C. Radiological complete response was achieved in 165 (45%) patients after the first-line treatment, in 22 (19%) after a second-line and in 9 (23%) after a third line treatment. Adherence to AASLD recommendation allowed a lower yearly mean mortality rate in BCLC A patients compared to other treatment (5.0% vs 10.4% p = 0.004), whereas upward treatment stage migration compared to the standard of care was associated to reduced yearly mortality in BCLC B (8.6% vs 20.7%, p = 0.029) and BCLC C (42.6% vs 59.0%, p = 0.04) patients.Conclusions: HCC multimodality treatment including other than first-line therapy is common in clinical practice and impact on the achievement of complete response. Personalized treatment was able to provide survival benefits to patients whose profile is not accounted for by international recommendations, which need to be amended

Magnetic resonance imaging of rectal volume in patients with irritable bowel syndrome

BACKGROUND: Extreme stool forms (1 and 2, or 6 and 7 of the Bristol stool scale) are frequent in patients with irritable bowel syndrome and are associated with colonic transit, but it is not known whether these alterations influence rectal reservoir function. AIMS: To investigate rectal reservoir function by assessing magnetic resonance imaging reconstructions of rectal volume in healthy subjects and patients with irritable bowel syndrome, and to establish whether it varies depending on the bowel habits of the patients. METHODS: Twelve healthy subjects and 20 patients with irritable bowel syndrome (with constipation, diarrhoea, mixed or undefined bowel habit according to the Rome III criteria) underwent pelvic magnetic resonance imaging in the absence of rectal sensations. T2 sagittal images were used to calculate rectal volume by multiplying inter-slice thickness by rectal area, and summing the inter-slice volumes. RESULTS: Stool form was significantly different in the irritable bowel syndrome patients with diarrhoea or constipation, and bowel movements were more frequent in the irritable bowel syndrome patients than in the healthy subjects. Rectal volume was significantly smaller in the irritable bowel syndrome patients (27\ub113mL vs 44\ub121mL; P=0.04), with no significant differences between the bowel habit sub-types. CONCLUSION: The reduced rectal volume in irritable bowel syndrome patients suggests that rectal tone is increased and that, at least in the absence of rectal sensations, the rectum is not over-distended by stools