Surgical management of complicated hydatid cysts of the liver.

The most significant complications of hydatid cyst of the liver are rupture and suppuration with an incidence of 6-19%. Rupture into the biliary tract was the most frequent complication and comprised 170 out of 222 complicated hydatid cysts of the liver in the author's series. These jaundiced patients were managed both by obliteration of the residual cavity and restoration of the patency of the biliary tract which was obstructed by daughter cysts of remnants of the laminated membrane. Rupture into the bronchi requires immediate treatment due to bronchopulmonary complications which might ensue. Rupture into blood vessels and into the free peritoneal cavity is accompanied by severe anaphylactic shock which does not readily respond to corticosteroids. The former complication is accompanied by a high mortality rate, while the postoperative mortality of patients experiencing anaphylactic shock amounts to 1.8%.

Protein expression of bax, bcl-2, and p53 in patients with non-Hodgkin's gastric lymphoma: prognostic significance.

The biologic significance of bcl-2, bax, and p53 gene expression in patients with non-Hodgkin's gastric lymphoma is unknown. We examined the prognostic value of these genes in 36 patients with gastric lymphoma treated in our clinic between 1990 and 1995. Paraffin-embedded specimens from 36 patients who underwent primary resection of the stomach for gastric lymphoma were analyzed immunohistochemically for p53, bax, and bcl-2 gene expression. Expression of bax was seen in 24 of 36 patients (66.7%), p53 expression was found in 8 of 36 tumors (22.2%), and bcl-2 cytoplasmic staining was detected in 6 of 36 patients (16.7%). We performed a univariate analysis to examine the possible correlation between the expression of these genes and the survival of our patients. Expression of bax protein proved to be a statistically significant prognostic factor (p = 0.049). Protein expression of p53 and bcl-2 did not statistically correlate with survival. In the bcl-2-negative (-) patient group (30 patients), those who were bax-positive had a statistically significant better survival than those who were bax-negative (63.3% vs. 36.7%, p = 0.03). There was also a statistically significant correlation between p53 expression and the grade of the tumor (p = 0.0014). P53 protein expression increased along with the grade. Expression of bax is a significant prognostic factor in patients with gastric lymphoma. Its prognostic value increases significantly when studied in bcl-2-negative patients; but expression of bax failed to be an independent prognostic factor. Expression of bcl-2 and p53 has no prognostic significance. Expression of p53 seems to represent a marker for loss of differentiation.