"Very early" intrahepatic cholangiocarcinoma in cirrhotic patients: should liver transplantation be reconsidered in these patients?

A retrospective cohort multicenter study was conducted to analyze the risk factors for tumor recurrence after liver transplantation (LT) in cirrhotic patients found to have an intrahepatic cholangiocarcinoma (iCCA) on pathology examination. We also aimed to ascertain whether there existed a subgroup of patients with single tumors ≤2 cm ("very early") in which results after LT can be acceptable. Twenty-nine patients comprised the study group, eight of whom had a "very early" iCCA (four of them incidentals). The risk of tumor recurrence was significantly associated with larger tumor size as well as larger tumor volume, microscopic vascular invasion and poor degree of differentiation. None of the patients in the "very early" iCCA subgroup presented tumor recurrence compared to 36.4% of those with single tumors >2 cm or multinodular tumors, p = 0.02. The 1-, 3- and 5-year actuarial survival of those in the "very early" iCCA subgroup was 100%, 73% and 73%, respectively. The present is the first multicenter attempt to ascertain the risk factors for tumor recurrence in cirrhotic patients found to have an iCCA on pathology examination. Cirrhotic patients with iCCA ≤2 cm achieved excellent 5-year survival, and validation of these findings by other groups may change the current exclusion of such patients from transplant programs.

[Early diagnosis of primary liver cancer: imaging versus genetics]. / Diagnóstico precoz del cáncer primario de hígado: imagen versus genética.

Early diagnosis of hepatocellular carcinoma (HCC) in nodules smaller than 2 cm detected by screening ultrasounds becomes essential given that, at that stage, no vascular invasion is usually detected and treatment is associated with a high rate of long-term survival. Improvements in imaging techniques in the last few years have allowed a conclusive diagnosis of HCC in these small nodules without invasive procedures. However, a conclusive diagnosis of HCC by imaging is not always possible and, in more than half of cases, biopsy is needed. On the other hand, histological confirmation of HCC in such tiny nodules is very complex, and in most cases impossible because of the limited sample obtained. In addition, serum tumor markers currently available show low accuracy and are useless for early diagnosis. Progress in the knowledge of molecular mechanisms associated with malignant transformation will allow the use of new techniques that will facilitate diagnosis for HCC in very early stages.

[Cell-mediated and humoral immunity in ulcerative colitis. Acute phase reactants (author's transl)]. / Inmunidad celular y humoral en colitis ulcerosa. Reactantes de fase aguda.

Many findings suggest that the alterations in immune response observed in intestinal inflammatory diseases may play a part in their pathogenesis. This observation led us to study 22 patients with chronic ulcerative colitis, of whom seven were in the acute stage and the other 15 were asymptomatic. The T and B lymphocyte populations were determined as well as the serum levels of immunoglobulins and acid alpha-1-glycoprotein as acute phase reactants. The results were compared with those obtained from a control group of 10 normal individuals. No statistically significant differences were observed in the percentages and absolute values of T and B lymphocytes as compared with the controls. nor in relation to the activity of the lesions. Neither were there any observable variations in the serum concentrations of immunoglobulins. On the other hand, analysis of the acid alpha-1-glycoprotein showed highly significant values as related to the degree of activity of the inflammatory lesion (p less than 0.005). Our results confirmed the value of determining serum acid alpha-1-glycoprotein levels as an index of inflammatory activity. The immunitary parameters under study did not vary in the different stages of the disease.

Laparoscopic diagnosis of tuberculous ascites.

We report 14 patients with tuberculous peritonitis presenting as persistent and exudative ascites. We found a primary site of tuberculous infection in only 10% of the patients. PPD test was positive in 9 patients. Ascitic fluid showed a protein content in excess of 3.5 g/dl. and more than 300 cells/mm3, mainly lymphocytes, in all patients, Ziehl stain and the culture for Tb. bacilli were negative in all cases. The confirmatory diagnosis was made by laparoscopy and peritoneal biopsy. Good views were obtained on all occasions, and there was no morbidity. Appearances were similar in all cases. Multiple white tubercles were scattered over the parietal and visceral peritoneum. filmy adhesions were present. Four patients had cirrhotic liver disease confirmed by laparoscopy. The biopsy specimen showed caseating granulomata, and the auramine stain was positive in four cases. We conclude that laparoscopy and biopsy is a safe and effective method of obtaining an early diagnosis in patients with tuberculous ascites, especially if they also have cirrhosis.

Acute pancreatitis in hepatitis A infection.

Hepatitis viruses are an uncommon cause of acute pancreatitis. We present the case of a boy with acute pancreatitis complicating viral hepatitis with satisfactory recovery. The finding of IgM-anti HAV antibodies implicates hepatitis A virus as the cause.

Loss of suppressor T cell function and circulating immune complexes in alcoholic cirrhosis.

In the present work Concanavalin-A-induced T suppressor function has been studied in 28 patients with active alcoholic cirrhosis and 22 patients with inactive cirrhosis. Control subjects were 14 alcoholics without liver disease and 70 healthy individuals with normal liver function tests. Suppressor T cell function was decreased in active alcoholic cirrhosis whereas this change was not observed in inactive cirrhosis nor in alcoholics without liver disease. The suppressor T cell activity of normal individuals was inhibited by heat-inactivated serum pretreatment of patients with alcoholic cirrhosis. The data suggest that there is some kind of serum factor in alcoholic cirrhosis able to affect lymphocyte suppressor activity. No linear correlation could be established between serum level of circulating immune complexes (CIC), determined by solid-phase C1q-binding assay, and suppressor T cell function. There were no differences between sera of alcoholic cirrhosis patients with or without CIC regarding their inhibition of suppressor T cell activity of normal individuals. These results suggest that these serum factors are not related to the presence of CIC.

Role of prostaglandins on lymphocyte transformation in Crohn's disease.

We analyzed the response to phytohemagglutinin (PHA) of peripheral blood (PBL), intraepithelial (IEL) and lamina propia (LPL) lymphocytes in eight patients with Crohn's disease (CD). We also studied the effect of indomethacin, a prostaglandin synthetase inhibitor, and monocyte depletion on mitogen-induced stimulation of these cells. The blastic stimulation index was significantly lower in PBL and intestinal mucosa lymphocytes of CD than in controls (p less than 0.001). This index increased after addition of indomethacin in PBL and LPL and after monocyte depletion in PBL. The suppressor index on blastic stimulation, obtained when indomethacin had been added to the cultures was higher in PBL and intestinal mucosa lymphocytes of patients with CD than in controls. After monocyte depletion, this suppressor index decreased significantly in PBL and did not change in controls. These data suggest that prostaglandins could be one of the responsible factors for hyporesponsiveness of lymphocytes in CD.

Could alpha 1 antitrypsin deficiency have any role in the development of celiac sprue after gastric operations?

We report a 50-year-old woman with alpha 1 antitrypsin deficiency (PiSZ phenotype) who developed clinical features of malabsorption after vagotomy and pyloroplasty. The intestinal biopsy demonstrated total villous atrophy with hypertrophy of the crypts. After gluten withdrawal, digestive function and the appearance of the intestinal biopsy returned to normal. We raise the possibility of an association between alpha 1 antitrypsin deficiency and celiac sprue.

Intestinal and peripheral blood lymphocyte subpopulations in Crohn's disease.

Cellular immunity has been implicated in the pathogenesis of Crohn's disease. In the present work, we have studied T-lymphocytes subsets in peripheral blood and intestinal mucosa of eight patients with active disease, using monoclonal antibodies. Intraepithelial and lamina propia OKT-3 +ve cells were significantly lower than in peripheral blood (p less than 0.001). We have found an increase of B cells and OKT-8 +ve cells in intestinal mucosa with a significant decrease in helper/suppressor ratio. These findings are in accordance with a high suppressor-cytotoxic function in patients with active diseases.