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Outcome following Resection of Biliary Cystadenoma: A Single Centre Experience and Literature Review 胆道囊腺瘤切除术后的预后:单中心经验及文献回顾
IF 1.8 Q3 Medicine Pub Date : 2015-12-29 DOI: 10.1155/2015/382315
M. Pitchaimuthu, G. Aidoo-Micah, C. Coldham, R. Sutcliffe, J. Roberts, P. Muiesan, J. Isaac, Darius F. Mirza, R. Marudanayagam
Background. Biliary cystadenomas (BCAs) are rare, benign, potentially malignant cystic lesions of the liver, accounting for less than 5% of cystic liver tumours. We report the outcome following resection of biliary cystadenoma from a single tertiary centre. Methods. Data of patients who had resection of BCA between January 1993 and July 2014 were obtained from liver surgical database. Patient demographics, clinicopathological characteristics, operative data, and postoperative outcome were analysed. Results. 29 patients had surgery for BCA. Male : female ratio was 1 : 28. Clinical presentation was abdominal pain (74%), jaundice (20%), abdominal mass (14%), and deranged liver function tests (3%). Cyst characteristics included septations (48%), wall thickening (31%), wall irregularity (38%), papillary projections (10%), and mural nodule (3%). Surgical procedures included atypical liver resection (52%), left hemihepatectomy (34%), right hemihepatectomy (10%), and left lateral segmentectomy (3%). Median length of stay was 7 (IQ 6.5–8.5) days. Two patients developed postoperative bile leak. No patients had malignancy on final histology. Median follow-up was 13 (IQ 6.5–15.7) years. One patient developed delayed biliary stricture and one died of cholangiocarcinoma 11 years later. Conclusion. Biliary cystadenomas can be resected safely with significantly low morbidity. Malignant transformation and recurrence are rare. Complete surgical resection provides a cure.
背景。胆道囊腺瘤(bca)是一种罕见的、良性的、潜在恶性的肝脏囊性病变,占囊性肝肿瘤的不到5%。我们报告从单一三级中心切除胆道囊腺瘤后的结果。方法。1993年1月至2014年7月间行BCA切除术的患者资料来源于肝脏外科数据库。分析患者人口统计学、临床病理特征、手术资料和术后结果。结果:29例患者行BCA手术治疗。男女比例为1:28。临床表现为腹痛(74%)、黄疸(20%)、腹部肿块(14%)和肝功能紊乱(3%)。囊肿特征包括分隔(48%)、壁增厚(31%)、壁不规则(38%)、乳头状突起(10%)和壁结节(3%)。手术包括非典型肝切除术(52%)、左半肝切除术(34%)、右半肝切除术(10%)和左外侧节段切除术(3%)。平均住院时间为7天(IQ 6.5-8.5)。2例患者术后发生胆漏。最终组织学检查无恶性肿瘤。中位随访时间为13年(IQ 6.5-15.7)。一名患者发展为迟发性胆管狭窄,一名患者在11年后死于胆管癌。结论。胆道囊腺瘤可以安全切除,发病率低。恶性转化和复发罕见。完全手术切除可以治愈。
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引用次数: 10
Growing Up: Not an Easy Transition—Perspectives of Patients and Parents regarding Transfer from a Pediatric Liver Transplant Center to Adult Care 成长:一个不容易的过渡-关于从儿童肝移植中心转移到成人护理的患者和家长的观点
IF 1.8 Q3 Medicine Pub Date : 2015-11-22 DOI: 10.1155/2015/765957
S. Chandra, Shannon Luetkemeyer, R. Romero, N. Gupta
The transition from pediatric to adult care is a critical time when children with chronic illness sustain high morbidity and mortality. Transition services need to be focused on the adolescents' needs, which may differ from those perceived by healthcare providers. In this study, a survey of 31 patients with chronic liver disease and/or liver transplant who were “transferred” to adult services within the last 3 years was conducted. Patients were asked about their current health status and their perceptions of the overall transfer process. The mean age at transfer was 19.81 (18–21) years. Almost half the patients (47%) were not seen at the adult facility until 2–6 months after leaving the Children's hospital and 20% were not seen until 6–12 months. About 20% had their first contact with adult services through an emergency room visit. About 19% reported being out of medication during transition. Of the transplanted patients, 19% were being evaluated for a retransplant. The majority (82%) felt that an increased emphasis on promoting independence and “letting go” both by parents and by pediatric care providers was critical in their transition to independence and adult care services. This study provides thought-provoking insights, which are critical in designing the ideal transition program for children with chronic diseases.
从儿科到成人护理的过渡是慢性病儿童保持高发病率和死亡率的关键时期。过渡服务需要侧重于青少年的需求,这些需求可能不同于保健提供者所认为的需求。在这项研究中,对31名慢性肝病和/或肝移植患者进行了调查,这些患者在过去3年内被“转移”到成人服务机构。患者被问及他们目前的健康状况和他们对整个转移过程的看法。转移时平均年龄为19.81岁(18-21岁)。几乎一半的患者(47%)直到离开儿童医院后2-6个月才在成人医院就诊,20%直到6-12个月才在成人医院就诊。大约20%的人是通过急诊室第一次接触成人服务的。约19%的人报告在过渡期间停药。在接受移植的患者中,19%正在接受再次移植的评估。大多数人(82%)认为,父母和儿科护理提供者越来越重视促进独立和“放手”,这对他们向独立和成人护理服务过渡至关重要。这项研究提供了发人深省的见解,这对于设计理想的慢性疾病儿童过渡方案至关重要。
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引用次数: 19
Acalculous Acute Cholecystitis in Previously Healthy Children: General Overview and Analysis of Pediatric Infectious Cases 既往健康儿童无结石性急性胆囊炎:儿科感染病例的总体概况和分析
IF 1.8 Q3 Medicine Pub Date : 2015-11-11 DOI: 10.1155/2015/459608
D. Poddighe, M. Tresoldi, A. Licari, G. Marseglia
Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder, which does not appear to be associated with the presence of gallstones. AAC is estimated to represent more than 50% of cases of acute cholecystitis in the pediatric population. Although this pathology was initially described in critically ill patients, actually most pediatric cases have been observed during several infectious diseases. Particularly, here we reviewed pediatric infectious acute acalculous cholecystitis and analyzed the pathophysiological and clinical aspects of bacterial and viral forms.
急性无结石性胆囊炎(AAC)是胆囊的一种炎症,它似乎与胆结石的存在无关。据估计,AAC占小儿急性胆囊炎病例的50%以上。虽然这种病理最初是在危重患者中描述的,但实际上大多数儿科病例都是在几种传染病中观察到的。特别地,这里我们回顾了小儿感染性急性无结石性胆囊炎,并分析了细菌和病毒形式的病理生理和临床方面。
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引用次数: 37
Serum Adiponectin, Vitamin D, and Alpha-Fetoprotein in Children with Chronic Hepatitis C: Can They Predict Treatment Response? 慢性丙型肝炎儿童血清脂联素、维生素D和甲胎蛋白:它们能预测治疗反应吗?
IF 1.8 Q3 Medicine Pub Date : 2015-11-10 DOI: 10.1155/2015/617623
M. Khedr, A. Sira, M. Saber, G. Raia
Background & Aims. The currently available treatment for chronic hepatitis C (CHC) in children is costly and with much toxicity. So, predicting the likelihood of response before starting therapy is important. Methods. Serum adiponectin, vitamin D, and alpha-fetoprotein (AFP) were measured before starting pegylated-interferon/ribavirin therapy for 50 children with CHC. Another 21 healthy children were recruited as controls. Results. Serum adiponectin, vitamin D, and AFP were higher in the CHC group than healthy controls (p < 0.0001, p = 0.071, and p = 0.87, resp.). In univariate analysis, serum adiponectin was significantly higher in responders than nonresponders (p < 0.0001) and at a cutoff value ≥8.04 ng/mL it can predict treatment response by 77.8% sensitivity and 92.9% specificity, while both AFP and viremia were significantly lower in responders than nonresponders, p < 0.0001 and p = 0.0003, respectively, and at cutoff values ≤3.265 ng/mL and ≤235,384 IU/mL, respectively, they can predict treatment response with a sensitivity of 83.3% for both and specificity of 85.7% and 78.6%, respectively. In multivariate analysis, adiponectin was found to be the only independent predictor of treatment response (p = 0.044). Conclusions. The pretreatment serum level of adiponectin can predict the likelihood of treatment response, thus avoiding toxicities for those unlikely to respond to therapy.
背景与目的目前可用于儿童慢性丙型肝炎(CHC)的治疗费用昂贵且毒性大。因此,在开始治疗前预测反应的可能性是很重要的。方法。50例CHC患儿在开始聚乙二醇干扰素/利巴韦林治疗前测定血清脂联素、维生素D和甲胎蛋白(AFP)。另外21名健康儿童作为对照。结果。CHC组血清脂联素、维生素D和甲胎蛋白高于健康对照组(p < 0.0001, p = 0.071, p = 0.87)。在单因素分析中,有反应者血清脂联素显著高于无反应者(p < 0.0001),在临界值≥8.04 ng/mL时,预测治疗反应的敏感性为77.8%,特异性为92.9%,而有反应者的AFP和病毒血症均显著低于无反应者,分别为p < 0.0001和p = 0.0003,临界值分别为≤3.265 ng/mL和≤235,384 IU/mL。它们预测治疗反应的敏感性为83.3%,特异性分别为85.7%和78.6%。在多变量分析中,脂联素被发现是治疗反应的唯一独立预测因子(p = 0.044)。结论。预处理血清脂联素水平可以预测治疗反应的可能性,从而避免那些不太可能对治疗反应的毒性。
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引用次数: 2
Evaluation of Serum Cystatin C as a Marker of Early Renal Impairment in Patients with Liver Cirrhosis 血清胱抑素C作为肝硬化患者早期肾功能损害指标的评价
IF 1.8 Q3 Medicine Pub Date : 2015-10-13 DOI: 10.1155/2015/309042
Mahmoud Omar, W. Abdel-Razek, Gamal Abo-Raia, M. Assem, G. El-Azab
Background. Serum cystatin C (CysC) was proposed as an effective reflection of the glomerular filtration rate (GFR). However, its role in patients with liver cirrhosis has not been extensively verified especially in the detection of early RI. Patients and Methods. Seventy consecutive potential candidates for living donor liver transplantation with serum creatinine (Cr) <1.5 mg/dL were included. CysC, Cr, and estimated GFR [creatinine clearance (CCr), Cockcroft-Gault formula (C-G), MDRD equations with 4 and 6 variables, CKD-EPI-Cr, CKD-EPI-CysC, and CKD-EPI-Cr-CysC] were all correlated to isotopic GFR. Early RI was defined as GFR of 60–89 mL/min/1.73 m2. Results. Patients were 25.7% and 74.3% Child-Pugh classes B and C, respectively. GFR was ≥90, 60–89, and 30–59 mL/min/1.73 m2 in 31.4%, 64.3%, and 4.3% of the patients, respectively. All markers and equations, except C-G, were significantly correlated to GFR with CKD-EPI-Cr-CysC formula having the highest correlation (r = 0.474) and the largest area under the ROC curve (0.808) for discriminating early RI. At a cutoff value of 1.2 mg/L, CysC was 89.6% sensitive and 63.6% specific in detecting early RI. Conclusion. In patients with liver cirrhosis, CysC and CysC-based equations showed the highest significant correlation to GFR and were measures that best discriminated early RI.
背景。血清胱抑素C (CysC)被认为是肾小球滤过率(GFR)的有效反映。然而,其在肝硬化患者中的作用尚未得到广泛证实,特别是在早期RI的检测中。患者和方法。纳入了70例血清肌酐(Cr) <1.5 mg/dL的活体肝移植候选患者。CysC、Cr和估计GFR[肌酐清除率(CCr)、Cockcroft-Gault公式(C-G)、4变量和6变量的MDRD方程、CKD-EPI-Cr、CKD-EPI-CysC和CKD-EPI-Cr-CysC]都与同位素GFR相关。早期RI定义为GFR 60-89 mL/min/1.73 m2。结果。Child-Pugh B级和C级分别占25.7%和74.3%。GFR≥90、60-89和30-59 mL/min/1.73 m2的患者分别占31.4%、64.3%和4.3%。除C-G外,所有标记物和方程均与GFR显著相关,其中CKD-EPI-Cr-CysC公式鉴别早期RI的相关性最高(r = 0.474), ROC曲线下面积最大(0.808)。在1.2 mg/L的临界值下,CysC检测早期RI的敏感性为89.6%,特异性为63.6%。结论。在肝硬化患者中,CysC和基于CysC的方程与GFR的相关性最高,是鉴别早期RI的最佳指标。
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引用次数: 28
Mystery of hepatitis e virus: recent advances in its diagnosis and management. 戊型肝炎病毒之谜:其诊断和治疗的最新进展。
IF 1.8 Q3 Medicine Pub Date : 2015-01-01 Epub Date: 2015-01-19 DOI: 10.1155/2015/872431
Aftab Ahmed, Ijlal Akbar Ali, Hira Ghazal, Javid Fazili, Salman Nusrat

Mysterious aspects of the long presumed to be well-known hepatitis E virus (HEV) have recently surfaced that distinguish it from other hepatotropic viruses. It is a cause of chronic hepatitis in immunosuppressed patients. It has human to human transmission through blood and mantains high seroprevalence in blood donors. HEV has also been found to occur more frequently in the West in those without a history of travel to endemic countries. It has varied extrahepatic manifestations and has multiple non-human reservoirs including pigs and rats. Considering these recent discoveries, it appears odd that HEV is not sought more frequently when working up acute and chronic hepatitis patients. The disease is particularly severe among pregnant women and has a high attack rate in young adults. What adds to its ambiguity is the absence of a well-established diagnostic criteria for its detection and that there is no specific antiviral drug for hepatitis E, except for isolated cases where ribavirin or pegylated interferon alpha has been used with occasional success. This review paper discusses the recent advances in the knowledge of the virus itself, its epidemiology, diagnostic approach and prevention, and the treatment options available.

长期以来被认为是众所周知的戊型肝炎病毒(HEV)的神秘方面最近浮出水面,将其与其他嗜肝病毒区分开来。它是免疫抑制患者慢性肝炎的一个原因。它通过血液在人与人之间传播,并在献血者中保持较高的血清阳性率。还发现,在西方没有去过流行国家旅行史的人群中,戊型肝炎更常发生。它有多种肝外表现,并有多种非人类宿主,包括猪和大鼠。考虑到这些最近的发现,在研究急性和慢性肝炎患者时,没有更频繁地寻找HEV似乎很奇怪。这种疾病在孕妇中特别严重,在年轻人中发病率很高。戊型肝炎缺乏完善的检测诊断标准,除了个别病例使用利巴韦林或聚乙二醇化干扰素偶有成功外,没有针对戊型肝炎的特异性抗病毒药物,这增加了其模糊性。这篇综述文章讨论了病毒本身的最新进展,它的流行病学,诊断方法和预防,以及治疗方案。
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引用次数: 51
The value of serum midkine level in diagnosis of hepatocellular carcinoma. 血清midkine水平在肝细胞癌诊断中的价值。
IF 1.8 Q3 Medicine Pub Date : 2015-01-01 Epub Date: 2015-02-08 DOI: 10.1155/2015/146389
Karim Y A Shaheen, Abeer I Abdel-Mageed, Eslam Safwat, Ashraf M AlBreedy

Background and Aim. Identification of sensitive biomarkers to improve early diagnosis of HCC is needed. We aimed to evaluate serum midkine (MDK) as a biomarker for HCC diagnosis. Patients and Methods. 40 HCCs, 30 liver cirrhosis patients, and 30 healthy subjects were enrolled. Serum MDK using ELISA was measured in all included subjects. Results. Serum MDK was significantly elevated in HCC group compared to cirrhotic and healthy control groups (0.625 versus 0.15 and 0.125 ng/mL), respectively. No significant association was found between MDK and either BCLC stage, tumor diameter, tumor number, or AFP level. Receiver operating characteristic curve showed that best cutoff for MDK and AFP was 0.387 and 88.5 ng/mL, respectively. Area under the curve of MDK was significantly larger than that of AFP (0.941 versus 0.671). The sensitivity of MDK at 0.387 ng/mL for HCC diagnosis was significantly higher than that of AFP at cutoffs 20, 88.5, and 200 ng/mL (92.5 versus 62.5, 40, and 25%), respectively. Sensitivity of MDK reached 93.3% in patients with AFP <20 ng/mL. Moreover, MDK at 0.387 ng/mL had significant better sensitivity than AFP at 20 ng/mL in distinguishing HCC from BCLC 0/A (90 versus 40%). Conclusion. Serum MDK might be a potential diagnostic marker for HCC particularity in its early stages.

背景和目的。鉴别敏感的生物标志物以提高HCC的早期诊断是必要的。我们的目的是评估血清midkine (MDK)作为HCC诊断的生物标志物。患者和方法:纳入40例hcc患者、30例肝硬化患者和30例健康受试者。采用ELISA法测定所有受试者的血清MDK。结果。与肝硬化和健康对照组相比,HCC组血清MDK显著升高(分别为0.625、0.15和0.125 ng/mL)。MDK与BCLC分期、肿瘤直径、肿瘤数量或AFP水平均无显著相关性。受试者工作特征曲线显示MDK和AFP的最佳截止值分别为0.387和88.5 ng/mL。MDK曲线下面积显著大于AFP(0.941比0.671)。MDK在0.387 ng/mL时对HCC诊断的敏感性显著高于AFP在20、88.5和200 ng/mL时的敏感性(分别为92.5比62.5、40和25%)。AFP患者MDK敏感性达93.3%
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引用次数: 49
Factors That Could Impact on Liver Fibrosis Staging by Transient Elastography. 可能影响瞬态弹性成像肝纤维化分期的因素
IF 1.8 Q3 Medicine Pub Date : 2015-01-01 Epub Date: 2015-12-06 DOI: 10.1155/2015/624596
Hugo Perazzo, Valdilea G Veloso, Beatriz Grinsztejn, Chris Hyde, Rodolfo Castro

Transient elastography (TE) based on liver stiffness measurement (LSM) is one of the most validated noninvasive methods for liver fibrosis staging in patients with chronic liver diseases. This method is painless, has no potential complications, is rapid (<10 min), and can be performed at the patient's bedside. However, several points should be considered when interpreting TE results. This review aims to discuss the critical points that might influence liver stiffness and TE results. Spectrum bias and the impact of the prevalence of fibrosis stages should be taken into account when interpreting the studies that validated this method using liver biopsy as a gold-standard. LSM might be influenced by nonfasting status, flare of transaminases, heart failure, extrahepatic cholestasis, presence of steatosis, aetiology of liver disease, type and position of probe, and operator's experience. In addition, interobserver variability can impact on the management of patients with chronic liver diseases. TE should be performed by an experienced operator (>100 exams), in a 3-hour fasting status, and its results should be handled by specialist clinicians that are aware of the limitations of this method.

基于肝脏硬度测量(LSM)的瞬态弹性成像(TE)是对慢性肝病患者进行肝纤维化分期最有效的无创方法之一。该方法无痛苦、无潜在并发症、快速(100 次检查)、空腹 3 小时,其结果应由了解该方法局限性的专业临床医生处理。
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引用次数: 0
Chronic Hepatitis C: An Overview of Evidence on Epidemiology and Management from a Brazilian Perspective. 慢性丙型肝炎:从巴西视角看流行病学和管理证据概述。
IF 1.8 Q3 Medicine Pub Date : 2015-01-01 Epub Date: 2015-11-29 DOI: 10.1155/2015/852968
Rodolfo Castro, Hugo Perazzo, Beatriz Grinsztejn, Valdilea G Veloso, Chris Hyde

Chronic hepatitis C remains one of the main causes of chronic liver disease worldwide and presents a variable natural history ranging from minimal changes to advanced fibrosis and cirrhosis and its complications, such as development of hepatocellular carcinoma. Approximately, 1.45 million people are estimated to be infected by HCV in Brazil representing a major public health issue. The aim of this paper was to review the epidemiology and management of chronic hepatitis C from a Brazilian perspective. The management of chronic hepatitis C has been challenged by the use of noninvasive methods to stage liver fibrosis as an alternative to liver biopsy and the high cost of new interferon-free antiviral treatments. Moreover, the need of cost-effectiveness analysis in hepatitis C and the recent changes in treatment protocols were discussed.

慢性丙型肝炎仍然是全球慢性肝病的主要病因之一,其自然病史各不相同,从轻微变化到晚期纤维化、肝硬化及其并发症,如肝细胞癌的发展。据估计,巴西约有 145 万人感染了丙型肝炎病毒,这是一个重大的公共卫生问题。本文旨在从巴西的角度回顾慢性丙型肝炎的流行病学和管理。慢性丙型肝炎的管理面临的挑战包括:使用非侵入性方法对肝纤维化进行分期,以替代肝活检;不含干扰素的新型抗病毒治疗费用高昂。此外,会议还讨论了对丙型肝炎进行成本效益分析的必要性以及近期治疗方案的变化。
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引用次数: 0
Histological Characterization of Biliary Intraepithelial Neoplasia with respect to Pancreatic Intraepithelial Neoplasia. 胆道上皮内瘤变与胰腺上皮内瘤变的组织学特征。
IF 1.8 Q3 Medicine Pub Date : 2014-01-01 Epub Date: 2014-04-10 DOI: 10.1155/2014/678260
Yasunori Sato, Kenichi Harada, Motoko Sasaki, Yasuni Nakanuma

Biliary intraepithelial neoplasia (BilIN) is a precursor lesion of hilar/perihilar and extrahepatic cholangiocarcinoma. BilIN represents the process of multistep cholangiocarcinogenesis and is the biliary counterpart of pancreatic intraepithelial neoplasia (PanIN). This study was performed to clarify the histological characteristics of BilIN in relation to PanIN. Using paraffin-embedded tissue sections of surgically resected specimens of cholangiocarcinoma associated with BilIN and pancreatic ductal adenocarcinoma associated with PanIN, immunohistochemical staining was performed using primary antibodies against MUC1, MUC2, MUC5AC, cyclin D1, p21, p53, and S100P. For mucin staining, Alcian blue pH 2.5 was used. Most of the molecules examined here showed similar expression patterns in BilIN and PanIN, in which their expression tended to increase along with the increase in atypia of the epithelial lesions. Significant differences were observed in the increase in mucin production and the expression of S100P in PanIN-1 and the expression of p53 in PanIN-3, when compared with those in BilIN of a corresponding grade. These results suggest that cholangiocarcinoma and pancreatic ductal adenocarcinoma share, at least in part, a common carcinogenic process and further confirm that BilIN can be regarded as the biliary counterpart of PanIN.

胆道上皮内瘤变(BilIN)是肝门/肝门周围和肝外胆管癌的前体病变。胆道上皮内瘤变(PanIN)与胆道上皮内瘤变(BilIN)相对应。本研究旨在阐明与PanIN相关的BilIN的组织学特征。使用手术切除的胆管癌(胆管癌合并BilIN)和胰管腺癌(胰管腺癌合并PanIN)标本的石蜡包埋组织切片,使用MUC1、MUC2、MUC5AC、cyclin D1、p21、p53和S100P的一抗进行免疫组织化学染色。粘蛋白染色采用pH 2.5的阿利新蓝染色。大多数分子在BilIN和PanIN中表现出相似的表达模式,它们的表达倾向于随着上皮病变非典型性的增加而增加。与相应级别的BilIN相比,PanIN-1中黏液蛋白的产生、S100P的表达以及PanIN-3中p53的表达均有显著差异。这些结果表明胆管癌和胰腺导管腺癌至少部分地共享一个共同的致癌过程,并进一步证实BilIN可被视为PanIN的胆道对应物。
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引用次数: 36
期刊
International Journal of Hepatology
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