Cardio-metabolic Risk Profile in Women with Previous History of Pre-Eclampsia.

INTRODUCTION: Preeclampsia is one of the leading causes of maternal and neonatal morbidity and mortality. However there is growing evidence that there are differences during the post partum period between subjects with prior preeclampsia and prior uncomplicated pregnancy and women with a history of preeclampsia are more likely to develop cardiovascular disease later in life. The aim of our study was to assess the cardio- metabolic risk profile in women with previous history of pre-eclampsia and to their counterparts who had normal pregnancy. METHODS & MATERIAL: In a hospital based case-control study, 50 women aged 20-45 years who had history of preeclampsia and equal numbers of age matched women who had normal pregnancy were included. Apart from routine anthropometric and biochemical parameters, they were assessed for insulin resistance, Hs CRP (High sensitive C reactive protein) and flow mediated vasodilatation (FMD). RESULTS: Significant difference was noted with regard to BMI and waist circumference, systolic and diastolic blood pressures, and HOMA-IR which were higher and HDL and FMD were lower in women the previous preeclampsia than women with normal pregnancy. The prevalence of various cardio-metabolic risk factors increased in with increase in duration from index pregnancy. CONCLUSION: Women with previous history of preeclampsia had adverse cardio-metabolic profile than those who had normal pregnancy. They had higher insulin resistance and endothelial dysfunction. They also have high prevalence of chronic metabolic disorders with increased duration since index pregnancy.

A potential intraoperative disaster averted: Preduodenal portal vein compressing a preduodenal common bile duct.

Familiarity with the anatomy is paramount for conduct of safe surgery for a surgeon. Anomalies with the biliary and hepatic arterial system are common but portal vein anomalies are least common. A preduodenal portal vein has been reported in about 100 cases but a combination of preduodenal portal vein with preduodenal common bile duct is extremely rare with only 9 cases being reported. We report a one such case and discuss the embryological basis for the peculiar anatomy observed in our case which has never been reported earlier. We also reviewed the reported cases in literature.

Surgical dilemma: liver resection or liver transplantation for hepatocellular carcinoma and cirrhosis. Intention-to-treat analysis in patients within and outwith Milan criteria.

BACKGROUND: The optimal role of surgery in the management of hepatocellular carcinoma (HCC) is in continuous evolution. OBJECTIVE: The objective of this study was to analyse survival rates after liver resection (LR) and orthotopic liver transplantation (OLT) for HCC within and outwith Milan criteria in an intention-to-treat analysis. METHODS: During 1997-2007, 179 patients with cirrhosis and HCC either underwent LR (n= 60) or were listed for OLT (n= 119). Patients with incidental HCC after OLT, preoperative macrovascular invasion before LR, non-cirrhosis and Child-Pugh class C cirrhosis prior to OLT were eliminated, leaving 51 patients primarily treated with LR and 106 patients listed for primary OLT (84 of whom were transplanted) to be included in this analysis. A total of 66 patients fell outwith Milan criteria (26 LR, 40 OLT) and 91 continued to meet Milan criteria (25 LR, 66 OLT). RESULTS: The median length of follow-up was 26 months. The mean waiting time for OLT was 7 months. During that time, 21 patients were removed from the waiting list as a result of tumour progression. Probabilities of dropout were 2% and 13% at 6 and 12 months, respectively, for patients within Milan criteria, and 34% and 57% at 6 and 12 months, respectively, for patients outwith Milan criteria (P < 0.01). Tumour size >3 cm was found to be the independent factor associated with dropout (hazard ratio [HR] 6.0). Postoperative survival was slightly higher after OLT, but this was not statistically significant (64% for OLT vs. 57% for LR). Overall survival from time of listing for OLT or LR did not differ between the two groups (P= 0.9); for patients within Milan criteria, 1- and 4-year survival rates after LR were 88% and 61%, respectively, compared with 92% and 62%, respectively, after OLT (P= 0.54). For patients outwith Milan criteria, 1- and 4-year survival rates after LR were 69% and 54%, respectively, compared with 65% and 40%, respectively, after OLT (P= 0.42). Tumour size >3 cm was again found to be an independent factor for poor outcome (HR 2.4) in the intention-to-treat analysis. CONCLUSIONS: Survival rates for patients with HCC are similar in LR and OLT. Liver resection can potentially decrease the dropout rate and serve as a bridge for future salvage LT, particularly in patients with tumours >3 cm.