Management of nonparasitic hepatic cysts

We congratulate Mazza and colleagues for a comprehensive article on their 17-year experience treating nonparasitichepaticcysts (NPHC). Although some mention was made of malignant cystic neoplasms in their reference to the use of tumor markers in the diagnostic workup, as well as the radiologic appearance of irregular, thickened cystic walls, we feel that this important component of cystic hepatic lesions was not sufficiently emphasized. After all, the title of the article is "Management of NPHC," and the consequence of missing a malignant lesion can be catastrophic. Intrahepatic biliary cystadenoma (IBCA) is one of the most common premalignant cystic hepatic lesions, accounting for approximately 5% of all symptomatic cystic lesions. The typical ultrasonographic feature of an IBCA is that of a solitary, multiloculated cyst; whereas the computed tomography scan appearance reveals thin, internal septae. Magnetic resonance imaging shows gadolinium enhancement of the septae. Elevated levels of CA 19-9 in the cystic fluid has also been shown to differentiate between benign and malignant lesions. It would therefore be quite interesting to know the radiologic features of the 7 patients diagnosed with cystic neoplasms by Dr Mazza and his team and what specific measures they would recommend to exclude malignancy prior to embarking on definitive management.

Amino acid metabolism in protein-depleted rats following total evisceration

Eviscerated hepatectomised rats maintained on a protein-free diet are not able to reduce their oxidation of injected valine and mixed amino acids compared to rats given a high protein diet. This suggests that the extra-hepatic tissues in the protein-depleted rats are not able to adapt to protein depletion and this high oxidation may be implicated in the observed low levels of branched-chain amino acids found in the blood of protein-depleted rats(AU)