Poor Access to Liver Transplantation and Survival of Children With Acute Liver Failure, Acute-on-chronic Liver Failure or Chronic Liver Disease.

We describe the survival of children with acute liver failure (ALF), chronic liver disease (CLD), or acute-on-chronic liver failure (ACLF) with poor access to liver transplantation (LT). A retrospective cohort study of 42 patients <18 years of age was conducted in the Hospital Civil de Guadalajara "Dr. Juan I. Menchaca". The median age was 76 months; 57.1% were female, 40.5% presented with ALF, 35.7% with CLD, and 23.8% with ACLF. Also, 38.1% (16/42) presented liver disease of unknown etiology. Death occurred in 45.2%; 14.3% were transferred to another hospital, and none received LT. Mortality in ALF, CLD, and ACLF was 76%, 0%, and 60%, respectively. In the survival analysis, within the first 20 months after diagnosis, the mortality rate was greater than 50% with ALF. The importance of having referral programs that perform liver transplantation is highlighted by the poor prognosis of the patients, despite conservative treatment.

Absceso hepático neonatal asociado a cateterización de vasos umbilicales / Neonatal liver abscess associated with an umbilical catheter

INTRODUCCIÓN. Los abscesos hepáticos piógenos en neonatos son una entidad rara con menos de cien casos reportados en la literatura mundial. El diagnóstico en esta edad es difícil porque tanto signos y síntomas son inespecíficos y se relacionan con sepsis. OBJETIVOS. Identificar la clínica y características patológicas del absceso hepático en neonatos y correlacionar al posicionamiento de catéter umbilical en hígado como factor de riesgo asociado para desarrollar absceso hepático en neonatos. MATERIALES Y MÉTODOS. Estudio retrospectivo, descriptivo, informes de casos, con una muestra y población conocida, de 5 pacientes recién nacidos. Criterios de Inclusión: neonatos de ambos sexos con edad gestacional mayor a las 34 semanas de gestación, con antecedentes de mal posicionamiento de catéteres umbilicales documentado mediante un examen de imagen "radiografía". Criterios de Exclusión: pacientes sin el antecedente de cateterización umbilical y/o que no se haya documentado mediante estudio de imagen con la evidencia del catéter colocado de manera errónea en tejido hepático. Se utilizó la base de datos registrada en los archivos del Servicio de Gastroenterología Pediátrica de las interconsultas solicitadas del Servicio de Neonatología y Unidad de Cuidados Intensivos Neonatales del, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca". Jalisco- México, en un tiempo de 5 años, desde Enero 2013 a 2018. RESULTADOS. Fueron cinco pre términos (n=5) entre 34 y 36 semanas, con edad gestacional media de 35 semanas y 2039 gr de peso al nacer. El promedio de días para el diagnóstico fue de 7,8. Cuatro pacientes tuvieron hepatomegalia 80,0% (4;5), el volumen de los abscesos fueron entre 2 y 12mm en lóbulo hepático derecho. CONCLUSIÓN. El absceso hepático es poco común pero su clínica debe sospecharse en un recién nacido con sepsis y antecedente de cateterismo umbilical. El manejo y evolución clínico favorable en el 100,0 % (5;5), de los neonatos y no se requirió resolución quirúrgica.

INTRODUCTION. Pyogenic liver abscesses in neonates are a rare entity with less than one hundred cases reported in the world literature. Diagnosis at this age is difficult because both signs and symptoms are nonspecific and are related to sepsis. OBJECTIVES. Identify the clinical and pathological characteristics of liver abscess in neonates and correlate to the positioning of umbilical catheters in the liver as an associated risk factor for developing liver abscess in neonates. MATERIALS AND METHODS. Retrospective, descriptive study, case reports, with a sample and known population, of 5 newborn patients. Inclusion Criteria: neonates of both sexes with gestational age over 34 weeks of gestation, with a history of poor positioning of umbilical catheters documented by an "x-ray" imaging exam. Exclusion Criteria: patients without a history of umbilical catheterization and / or who have not been documented by imaging study with evidence of the catheter incorrectly placed in liver tissue. The database registered in the archives of the Pediatric Gastroenterology Service of the requested interconsultations of the Neonatal and Neonatal Intensive Care Unit of the Civil Hospital of Guadalajara "Dr. Juan I. Menchaca ". Jalisco- Mexico, in a time of 5 years, from January 2013 to 2018. RESULTS. There were five pre terms (n = 5) between 34 and 36 weeks, with an average gestational age of 35 weeks and 2039 grams of birth weight. The average number of days for diagnosis was 7,8. Four patients had 80,0% hepatomegaly (4; 5), the volume of abscesses was between 2 and 12mm in the right hepatic lobe. CONCLUSION. Hepatic abscess is uncommon but its clinic should be suspected in a newborn with sepsis and a history of umbilical catheterization. Management and favorable clinical evolution in 100,0% (5; 5) of infants and no surgical resolution was required.

Adenoviral gene therapy in hepatocellular carcinoma: a review.

BACKGROUND: Hepatocellular carcinoma is the third leading cause of cancer death. Single or multiple mutations in genes related to growth control, apoptosis, invasion and metastasis have been determined; so a better understanding of the molecular genetic basis of malignant transformation, tumor progression and host interaction has led to significant progress in the development of new therapeutic agents. The ability of adenovirus vectors to deliver and express genes at high yields in HCC treatment has been demonstrated and well documented over the last few years. OBJECTIVE: To overview and provide an update of what has been accomplished in the field of adenoviral gene therapy and its application in hepatocellular carcinoma treatment. METHODS: Original articles were searched using Pubmed and other medical databases to get the most representative and actual information to establish the current state of the investigation of Ad vectors in HCC. RESULTS: Good results have been accomplished in preclinical models using new Ad vectors and especially AAV vectors, it is important to motivate further clinical trials to corroborate all the experience obtained. CONCLUSIONS: Ad and AAV must be considered as an opportunity to improve the quality of life and survival of HCC patients.