From diagnosis to treatment of hepatocellular carcinoma: An epidemic problem for both developed and developing world

Hepatocellular carcinoma(HCC) is the most frequent primary liver malignancy and the third cause of cancer-related death in the Western Countries. The well-established causes of HCC are chronic liver infections such as hepatitis B virus or chronic hepatitis C virus, nonalcoholic fatty liver disease, consumption of aflatoxins and tobacco smocking. Clinical presentation varies widely; patients can be asymptomatic while symptomatology extends from right upper abdominal quadrant paint and weight loss to obstructive jaundice and lethargy. Imaging is the first key and one of the most important aspects at all stages of diagnosis, therapy and follow-up of patients with HCC. The Barcelona Clinic Liver Cancer Staging System remains the most widely classification system used for HCC management guidelines. Up until now, HCC remains a challenge to early diagnose, and treat effectively; treating management is focused on hepatic resection, orthotopic liver transplantation, ablative therapies, chemoembolization and systemic therapies with cytotocix drugs, and targeted agents. This review article describes the current evidence on epidemiology, symptomatology, diagnosis and treatment of hepatocellular carcinoma.

Cytopathologic diagnosis of fine needle aspiration biopsies of thyroid nodules

Fine-needle aspiration(FNA) cytology is an important diagnostic tool in patients with thyroid lesions.Several systems have been proposed for the cyropathologic diagnosis of the thyroid nodules.However cases with indeterminate cytological findings still remain a matter of debate.In this review we analyze all literature regarding Thyroid Cytopathology Reporting systems trying to identify the most suitable methodology to use in clinical practice for the preoperative diagnosis of thyroid nodules.A review of the English literature was conducted,and data were analyzed and summarized and integrated from the authors' perspective.The main purpose of thyroid FNA is to identify patients with higher risk for malignancy,and to prevent unnecessary surgeries for benign conditions.The Bethesda System for Reporting Thyroid Cytopathology is the most widely used system for the diagnosis of thyroid FNA specimens.This system also contains guidelines for the diagnosis and treatment of indeterminate or suspicious for malignancy cases.In conclusion,patients who require repeated FNAs for indeterminate diagnoses will be resolved by repeat FNA in a percentage of 72%-80%.

Clinical considerations and therapeutic strategy for sigmoid volvulus in the elderly:A study of 33 cases

AIM: To evaluate different types of treatment for sigmoid volvulus and clarify the role of endoscopic intervention versus surgery. METHODS: A retrospective review of the clinical presentation and imaging characteristics of 33 sigmoid volvulus patients was presented, as well as their diagnosis and treatment, in combination with a literature review. RESULTS: In 26 patients endoscopic detorsion was achieved after the first attempt and one patient died because of uncontrollable sepsis despite prompt operative treatment. Seven patients had unsuccessful endoscopic derotation and were operated on. On two patients with gangrenous sigmoid, Hartmann's procedure was performed. In five patients with viable colon, a sigmoid resection and primary anastomosis was carried out. Three patients had a lavage "on table" prior to anastomosis, while in the remaining 2 patients a diverting stoma was performed according to the procedure of the first author. Ten patients were operated on during their first hospital stay (3 to 8 d after the deflation). All patients had viable colon; 7 patients had a sigmoid resection and primary anastomosis, 2 patients had sigmoidopexy and one patient underwent a near-total colectomy. Two patients (sigmoidectomy-sigmoidopexy) had recurrences of volvulus 43 and 28 mo after the initial surgery. Among 15 patients who were discharged from the hospital after non-operative deflation, 3 patients were lost to follow-up. Of theremaining 12 patients, 5 had a recurrence of volvulus at a time in between 23 d and 14 mo. All the five patients had been operated on and in four a gangrenous sigmoid was found. Three patients died during the 30 d postoperative course. The remaining seven patients were admitted to our department for elective surgery. In these patients, 2 subtotal colectomies, 3 sigmoid resections and 2 sigmoidopexies were carried out. One patient with subtotal colectomy died. Taken together of the results, it is evident that after 17 elective operations we had only one death (5.9%), whereas after 15 emergency operations 6 patients died, which means a mortality rate of 40%. CONCLUSION: Although sigmoid volvulus causing intestinal obstruction is frequently successfully encountered by endoscopic decompression, however, the principal therapy of this condition is surgery. Only occasionally in patients with advanced age, lack of bowel symptoms and multiple co-morbidities might surgical repair not be considered.

An alternative surgical approach to a difficult case of Mirizzi syndrome: A case report and review of the literature

Mirizzi syndrome (MS) is an uncommon complication of gallstone disease and occurs in approximately 1% of all patients suffering from cholelithiasis. The syndrome is characterized by extrinsic compression of the common hepatic duct frequently resulting in clinical presentation of intermittent or constant jaundice. Most cases are not identifi ed preoperatively. Surgery is the indicated treat- ment for patients with MS. We report here a 71-year- old male patient referred to the surgical outpatient department for diffuse upper abdominal pain and mild jaundice (bilirubin rate: 4.2 mg/dL). Ultrasound examina- tion revealed a stone in the cystic duct compressing the common hepatic duct. The patient had a history of gas- trectomy for gastric ulcer 30 years ago. MRCP revealed a stone impacted in the cystic duct causing obstruction of the common hepatic duct by extrinsic compression. With these fi ndings the preoperative diagnosis was indicative of MS. At laparotomy a moderately shrunken gallbladder was found embedded in adhesions containing a large stone which was palpable in the common bile duct. The anterior wall of the body of the gallbladder was opened by an incision which extended longitudinally along the gallbladder towards the common bile duct. The stone measuring 3.0 cm in diameter, was then removed set- ting astride a large communication with the common bile duct. A Roux-en-Y cholecysto-choledocho-jejunostomy was performed. The subhepatic region was drained. The patient had an uneventful recovery. He was discharged eleven days after operation and remained well after a 30-mo follow-up.

Insights on augmenter of liver regeneration cloning and function

肝的激发器物质(HSS ) 是被指了一肝特定但是种类非特定的生长因素。HSS 蛋白质的坡度纯化和顺序分析显示它包含了肝新生(ALR ) 的 augmenter，也作为 hepatopoietin (HPO ) 知道。ALR，充当一个 hepatotrophic 生长因素，象肝细胞瘤细胞在试管内一样的有教养的 hepatocytes 的明确地刺激的增长，支持的肝新生和损坏 hepatocytes 和救的尖锐肝的失败在活体内的恢复。ALR 属于新 Erv1/Alr 蛋白质家庭，哪个从酵母在更低、更高的优核质被发现到人并且甚至在一些双 stranded DNA 病毒的成员。现在的评论文章集中于 ALR 的分子的生物学，检验从酵母的 ALR 基因和它到人和 ALR 蛋白质的生物功能的表示。ALR 蛋白质似乎是 non-liver-specific 作为，增加必要性扩大关于在处于正常、反常的细胞的生长的条件的不同纸巾，机关和发展阶段的哺乳动物的 ALR 蛋白质的研究是以前相信了。

Development of a quantum-dot-labelled magnetic immunoassay method for circulating colorectal cancer cell detection

AIM:To detect of colorectal cancer(CRC) circulating tumour cells(CTCs) surface antigens,we present an assay incorporating cadmium selenide quantum dots(QDs) in these paper.METHODS:The principle of the assay is the immunomagnetic separation of CTCs from body fluids in conjunction with QDs,using specific antibody biomarkers:epithelial cell adhesion molecule antibody,and monoclonal cytokeratin 19 antibody.The detection signal was acquired from the fluorescence signal of QDs.For the evaluation of the performance,the method under study was used to isolate the human colon adenocarcinoma cell line(DLD-1) and CTCs from CRC patients' peripheral blood.RESULTS:The minimum detection limit of the assay was defined to 10 DLD-1 CRC cells/mL as fluorescence was measured with a spectrofluorometer.Fluorescenceactivated cell sorting analysis and Real Time RT-PCR,they both have also been used to evaluate the performance of the described method.In conclusion,we developed a simple,sensitive,efficient and of lower cost(than the existing ones) method for the detection of CRC CTCs in human samples.We have accomplished these results by using magnetic bead isolation and subsequent QD fluorescence detection.CONCLUSION:The method described here can be easily adjusted for any other protein target of either the CTC or the host.

Benign multicystic peritoneal mesothelioma: A case report and review of the literature

Benign multicystic peritoneal mesothelioma (BMPM) is a rare tumor that occurs mainly in women in their reproductive age. The pathogenesis of BMPM is unclear and a controversy regarding its neoplastic and reactive nature exists. The biological behavior of BMPM is characterized by its slowly progressive process and high rate of recurrence after surgical resection. In addition this lesion does not present a strong tendency to transform into malignancy. Today approximately 130 cases have been reported. We here report a 62-year-old woman who had diffuse abdominal pain, nausea and vomiting. Physical examination revealed a painful mass in her upper abdomen. She reported a mild dehydration, but the vital signs were normal. Peristaltic rushes, gurgles and high- pitched tinkles were audible. Upright plain abdominal film revealed small bowel loops with air-fluid levels. She was diagnosed having an incarcerated incisional hernia that resulted in intestinal obstruction. The patient underwent surgery during which a cystic mass of the right ovary measuring 6 cm x 5 cm x 4 cm, four small cysts of the small bowel (1 cm in diameter) and a cyst at the retroperitoneum measuring 11 cm x 10 cm x 3 cm were found. Complete resection of the lesion was performed. The patient had an uneventful recovery and had no recurrence two years after surgery.

Primary melanoma of the gallbladder: Does it exist? Report of a case and review of the literature

与文学和这的结果研究的我们考察了的胆囊，看起来主要，的│恶性黑瘤的一个案例的场合是胆囊的主要黑瘤仍然是一个可疑医药实体。仅仅主要、变形的胆囊黑瘤的很少案例到目前为止被报导了，并且唯一的同意是外科是支柱治疗。为主要、变形的疾病的辅助化疗，激素疗法或免疫疗法的角色仍然保持未定义。

Role of platelet-rich plasma in ischemic heart disease: An update on the latest evidence

Myocardial infarction is the most common cause of congestive heart failure. Novel strategies such as directly reprogramming cardiac fibroblasts into cardiomyocytes are an exciting area of investigation for repair of injured myocardial tissue. The ultimate goal is to rebuild functional myocardium by transplanting exogenous stem cells or by activating native stem cells to induce endogenous repair. Cell-based myocardial restoration, however, has not penetrated broad clinical practice yet. Plateletrich plasma, an autologous fractionation of whole blood containing high concentrations of growth factors, has been shown to safely and effectively enhance healing and angiogenesis primarily by reparative cell signaling. In this review, we collected all recent advances in novel therapies as well as experimental evidence demonstrating the role of platelet-rich plasma in ischemic heart disease, focusing on aspects that might be important for future successful clinical application.

Implication of gut microbiome in immunotherapy for colorectal cancer

Colorectal cancer(CRC) constitutes the third most frequently reported malignancy in the male population and the second most common in women in the last two decades. Colon carcinogenesis is a complex, multifactorial event, resulting from genetic and epigenetic aberrations, the impact of environmental factors, as well as the disturbance of the gut microbial ecosystem. The relationship between the intestinal microbiome and carcinogenesis was relatively undervalued in the last decade. However, its remarkable effect on metabolic and immune functions on the host has been in the spotlight as of recent years. There is a strong relationship between gut microbiome dysbiosis, bowel pathogenicity and responsiveness to anti-cancer treatment;including immunotherapy. Modifications of bacteriome consistency are closely associated with the immunologic response to immunotherapeutic agents. This condition that implies the necessity of gut microbiome manipulation. Thus, creatingan optimal response for CRC patients to immunotherapeutic agents. In this paper, we will review the current literature observing how gut microbiota influence the response of immunotherapy on CRC patients.

Totally laparoscopic left hepatectomy using the Torsional Ultrasonic Scalpel

Minimal invasive techniques have allowed for major surgical advances.We report our initial experience of performing total laparoscopic left hepatectomy(segmentsⅡ-Ⅳ)with the Lotus(laparoscopic operation by torsional ultrasound)Ultrasonic Scalpel.The perioperative and postoperative courses of the young female patient were uneventful and she is in a good general condition without complaints 18 mo after surgery.To the best of our knowledge,this is the first total laparoscopic hemihepatectomy to be performed in Greece,as well as the first laparoscopic liver resection using Lotus shears.

Indications,limitations and maneuvers to enable extended hepatectomy:Current trends

The liver is a solid organ with a wide variety of primary benign or malignant tumors as well as metastatic lesions.Surgical resection of these tumors remains the only curative modality.Several limitations,however,do not allow the performance of these operations.This review evaluates the indications and limitations regarding these extended hepatic resections,as well as describing all the manipulations that increase the candidates for such operations.A thorough review of the literature was performed in order to define indications for extended hepatectomy,as well as to present all methods that contribute to increasing the volume of the future remnant liver.The role of portal vein ligation,portal vein embolization,two-stage hepatectomy,and in situ liver transection are evaluated in the setting of indications and results.Extended hepatectomies are a necessity due to oncological reasons.All methods developed in order to increase the volume of the remnant liver are safe and efficient.in situ liver transection is a novel and revolutionary two-step procedure for extended hepatic resections.Further clinical studies are required to estimate long-term results and the oncological basis of this technique.

Hepatocellular carcinoma in patients co-infected with hepatitis C virus and human immunodeficiency virus

Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) share a common route of transmission so that about one third of HIV infected individuals show HCV coinfection. Highly active antiretroviral therapy has offered a longer and better life to infected patients. While has removed AIDS-related diseases from the list of most common causes of death their place has been taken by complications of HCV infection, such as cirrhosis, end stage liver disease and hepatocellular carcinoma (HCC). HIV/HCV co-infection requires complex management, especially when HCC is present. Co-infected patients with HCC undergo the same therapeutic protocol as their mono-infected counterparts, but special issues such as interaction between regimens, withdrawal of therapy and choice of immunosuppressive agents, demand a careful approach by specialists. All these issues are analyzed in this minireview.

Small intestine diverticula:Is there anything new?

AIM:To globally approach the clinical entity of small bowel diverticulosis and, at the same time, set out the treatment options. METHODS: We analysed 77 cases of diverticula located in the duodenum, jejunum and ileum that were treated in our department, evaluating the symptoms, diagnostic approach and offered treatment. RESULTS: Almost half of the diverticula (46.7%) were incidentally discovered and Meckel's diverticula represented the majority (43%) that were actually the only true diverticula. A high complication rate (53%) which included inflammation with or without perforation (22%), bleeding (10%) or obstructive ileus (12%) due to small bowel diverticulosis was reported. The preoperative diagnosis was often impossible (44% of complicated cases). CONCLUSION: Although small bowel diverticulosis has a low incidence, it should be in the clinician's mind in order to avoid misdiagnosis.

Amyand's hernia: A case report

在腹股沟疝的蚓状的附录的存在是稀罕的并且作为 Amyand 的脱肠被知道。我们报导 Amyand 的脱肠，在附录 90 二年在一具男死尸在正确腹股沟疝被发现的地方。