Comparison of Resection and Liver Transplant in Treatment of Hepatocellular Carcinoma.

OBJECTIVES: Hepatic resection and liver transplant are regarded as 2 potentially curative treatments for hepatocellular carcinoma. Here, we compared both options in patients with hepatocellular carcinoma secondary to cirrhosis seen at a single center over 12 years. MATERIALS AND METHODS: We evaluated early complications and survival of patients with hepatocellular carcinoma treated with liver transplant (57 patients) or hepatic resection (36 patients) at our center between 1998 and 2010. RESULTS: The 34-month mean follow-up period was similar for both treatment groups. The liver transplant group had a longer hospital stay than the hepatic resection group (P ⟨ .001). Patients with Child-Turcotte-Pugh A stage were treated by hepatic resection more than by liver transplant (P ⟨ .001),with Child-Turcotte-Pugh B stage patients treated by liver transplant more than by hepatic resection (P = .03). All patients with Child-Turcotte-Pugh C stage had liver transplant. Both treatment groups had similar postoperative complications and early postoperative mortality rates, but liver transplant resulted in longer overall (P = .001) and higher event-free (P = .001) survival than hepatic resection. Among the liver transplant group, 57.8% of patients met the Milan criteria. Patients who met Milan criteria were treated by liver transplant statistically more than hepatic resection, and these patients had longer overall survival (P = .01) and higher event-free survival (P ⟨ .001) than patients who had hepatic resection. Hepatocellular carcinoma recurrence rates were higher after hepatic resection (P = .232). CONCLUSIONS: In patients with hepatocellular carcinoma, hospital stay was longer after liver transplant, but morbidity and mortality rates for liver transplant versus hepatic resection were similar. However, overall and event-free survival rates were better after liver transplant than after hepatic resection. These results suggest that liver transplant should be considered as the primary treatment option for patients with hepatocellular carcinoma secondary to cirrhosis.

Changes in serum lipid levels after laparoscopic sleeve gastrectomy in morbidly obese dyslipidemic and normolipidemic patients.

BACKGROUND: This study investigated the effect of laparoscopic sleeve gastrectomy (LSG) performed for morbid obesity on serum lipid levels of dyslipidemic and normolipidemic patients. METHODS: 141 patients who underwent LSG between September 2014 and January 2016 were included in the study. RESULTS: The patients' mean body mass index was 46.27 ± 6.79 kg/m2 preoperatively, 31.60 ± 5.37 kg/m2 in the 6th month postoperatively and 27.80 ± 4.25 kg/m2 in the 12th month (p < .001). Preoperatively and 12 months after the operation, mean total cholesterol (TC) levels and mean LDL cholesterol, mean HDL cholesterol, and mean triglyceride (TG) levels were statistically significantly decreased (p < .01). Comparing TC levels in the 12th month with preoperative levels, dyslipidemic patients showed a statistically more significant decrease than normolipidemic patients. LDL cholesterol levels were significantly decreased in both the groups. HDL cholesterol levels increased significantly in both groups while mean TG levels decreased significantly in patients with high preoperative TG levels, but not in patients with normal preoperative TG levels. CONCLUSIONS: Although this technique exerts its effect primarily by reducing gastric volume, besides its metabolic and hormonal effects, it also improves serum lipid levels (decreasing TC, LDL cholesterol and TG levels, and increasing HDL cholesterol levels). It therefore contributes to decreasing cardiovascular diseases.

Five years with a rectal foreign body: A case report.

INTRODUCTION: Rectal foreign bodies are rare colorectal emergencies. They are important for the complications that may occur. Delayed response causes a wide range of complications or may even result in death. PRESENTATION OF CASE: A 22 years old male patient was seen at our hospital with anal pain, discharge, and complaining of incontinence. The patient stated that a bottle of beverage was placed into his anal canal in an inverted manner for sexual satisfaction 5 years previously. DISCUSSION: After clinical and radiological assessment under general anaesthesia in the lithotomy position the object was removed by a laparotomy. He was advised to seek legal help and he received psychiatric treatment in the postoperative period prior to his discharge. CONCLUSION: Complications such as abscess, perianal fistula complicated by severe pelvic sepsis and osteomyelitis were expected complications in this case. As in this case, a surgical approach may eliminate dissection planes, increasing morbidity and mortality related to the injuring of surrounding bodies during object extraction.

Expression and activity levels of matrix metalloproteinase-7 and in situ localization of caseinolytic activity in colorectal cancer.

OBJECTIVES: Matrix metalloproteinase-7 is capable of degrading several ECM and non-ECM molecules and contributes to colorectal cancer progression and metastasis. Here, we examined the significance of MMP-7 in colorectal tumors by detecting active and latent MMP-7 levels and localization of its caseinolytic activity. DESIGN AND METHODS: We investigated expression levels, localization, and proteolytic activity of MMP-7 and local caseinolytic activity in colorectal tumor and paired normal tissues by using real time PCR, casein zymography, immunohistochemistry and in situ casein zymography, respectively. In addition the results were compared with clinicopathological variables. RESULTS: Real time PCR and immunohistochemistry showed that MMP-7 expressions were higher in colorectal tumor tissues than in normal tissues. Also, mRNA expressions of MMP-7 were positively correlated with tumor and pathological stages and negatively correlated with age. Furthermore, MMP-7 mRNA expression had a sensitivity of 81.3% and a specificity of 81.2% at a cut-off value of 0.0006, making it a potential marker for diagnosis of colorectal cancer. According to casein zymography, pro- and active MMP-7 levels were also elevated in tumor tissues. In addition, we assessed local caseinolytic activity using in situ casein zymography. Increased immunoreactivity of MMP-7 and local caseinolytic activity were found in neoplastic cells but not in stromal cells. CONCLUSION: We emphasized the significant role of MMP-7 in diagnosis and progression and/or development of colorectal cancer.