Screening of hepatopulmonary syndrome (HPS) with CEUS and pulse-oximetry in liver cirrhosis patients eligible for liver transplant.

BACKGROUND AND AIM: The prevalence of hepatopulmonary syndrome (HPS) in the setting of cirrhosis ranges between 4%-47%. We aimed to detect a correlation between heart and lungs findings on contrast-enhanced ultrasound (CEUS)and pulse-oximetry, in order to early detect HPS and thus to improve patients referral to orthotopic liver transplantation(OLT). METHODS: We considered at risk for HPS all patients with delayed left ventricle (LV) enhancement of the contrast agent,at least 3 systolic beats after it appears in the right ventricle(RV). We correlated CEUS results with pulse-oximetry findings,considering to have a positive HPS diagnosis in all patients with both CEUS findings and SaO2 95%. RESULTS: From 186 patients diagnosed with liver cirrhosis, 56 patients (30.10%) had delayed LV enhancement of the contrast agent. Pulse-oximetry showed alterations, such as SaO2 95%and PaO2 70 mmHg in 62 patients (33.33%). Pearson index showed a good correlation between lung and heart CEUS findings and pulse-oximetry (r=0.99) in HPS diagnosis. CONCLUSIONS. Two non-invasive, simple and rapid methods such as CEUS and pulse-oximetry can easily diagnose HPS, a highly fatal complication of liver cirrhosis, and can also guide the future treatment by speeding up OLT recommendations.

Optimizing the indication for breast-conservative surgery (BCS) in patients with locally-advanced breast cancer.

BACKGROUND: The main benefit of neoadjuvant chemotherapy is a reduction in tumor size, which allows breast-conserving surgery (BCS) in patients who otherwise would have required a mastectomy. Breast magnetic resonance (MRI) has been proposed to evaluate tumor extent after neoadjuvant chemotherapy, to determine which patients have become eligible for BCS. AIM: The aim of our study was to determine how the association of breast MRI to routine clinical and radiologic assessment of the tumor at initial presentation, and after chemotherapy, affects the overall surgical decision process. MATERIAL AND METHODS: 54 women with stage IIB-IIIB breast cancer were prospectively enrolled in a study investigating the effects of MRI on the surgical decision. RESULTS: Surgical plan was changed from BCS to radical mastectomy in 6 cases (13.04%). As a result of using MRI in evaluating disease extent, 21.73% of valuable data were added by MRI (pectoralis major muscle and skin invasion, multifocal multicentric disease). Due to MRI examination 28 (60.86%) of the patients with operable breast cancer after neoadjuvant chemotherapy, were eligible for BCS. CONCLUSIONS: Our study demonstrates that MRI is the most accurate in determination of tumor size and extent, and in establishing eligibility for BCS.

Postherapeutic follow-up of colorectal cancer patients treated with curative intent.

BACKGROUND AND AIM: Based on published data showing that despite a curative intent treatment approximately 50% of colorectal cancer (CRC) patients will present with disease relapse, and on the results of meta-analysis which showed improved survival by using intense posttreatment follow-up programs, we aimed in the present study to evaluate the additional benefit of routine abdominal ultrasound in the follow-up program of CRC patients. MATERIAL AND METHOD: We conducted a prospective study, on 107 patients diagnosed with stage III CRC. Patients follow-up included: history and physical examination, CEA determination, and abdomino-pelvic US every 3 months. RESULTS: Recurrent disease was observed in 36% of cases after a median follow-up interval of 24 months. The liver was the most frequent isolated site of disease recurrence (62%). Serum CEA level increased in most patients (69%) with recurrent disease. Also, a high percentage of relapses was diagnosed by routine abdominal US (62%). CONCLUSIONS: Our study illustrates the benefit of intense follow-up (CEA, abdominal US) after curative treatment of CRC.