Prognostic factors for survival in patients with early-intermediate hepatocellular carcinoma undergoing non-surgical therapy: comparison of Okuda, CLIP, and BCLC staging systems in a single Italian centre.

BACKGROUND: Several prognostic models have been developed to stage hepatocellular carcinoma (HCC) but there is no general consensus on which is the most reliable. We compared three prognostic indices (Okuda, CLIP, and BCLC scoring systems) in a large series of cirrhotic patients with HCC undergoing non-surgical treatment in terms of their ability to classify patients into different risk groups METHODS: We retrospectively studied 268 Italian patients with HCC. A total of 146 patients were treated with ablation, 132 with percutaneous ethanol injection, and 14 with radiofrequency ablation; 103 underwent transcatheter arterial chemoembolisation and 19 had supportive care alone. Factors determining survival were analysed by univariate and multivariate analysis using the Kaplan-Meier method and Cox proportional hazard regression models. Okuda, CLIP, and BCLC scores evaluated before treatment were applied. RESULTS: Median survival was 25.7 months. In a multivariate analysis, portal vein thrombosis, alpha fetoprotein, total bilirubin, and tumour size were significant predictors of survival. Okuda, CLIP, and BCLC scores were all able to predict survival (p<0.001). They identified two, four, and six risk groups, respectively, with a median survival ranging from 27 to 19 months for Okuda, 30 to 5 months for CLIP, and 43 to 7 months for BCLC. CONCLUSIONS: Both CLIP and BCLC scores were more effective than the Okuda score in stratifying patients into different risk groups with early-intermediate HCC. However, the BCLC scoring system gave a better prediction of prognosis in patients with disease diagnosis at a very early stage.

Non-alcoholic steatohepatitis induced by carbamazepine and variegate porphyria.

A 42-year-old woman presented with acute bullous skin lesions and angio-oedema that had developed 3 months after initiation of treatment with carbamazepine for epilepsy. Chromatographic analysis of urinary porphyrins was compatible with variegate porphyria. This was manifested initially by neurological symptoms that were mistaken for epilepsy and later by cutaneous symptoms also. Histological findings excluded hepatic porphyria, but revealed severe fatty changes thought to be caused by idiosyncratic metabolism of carbamazepine. While the porphyrinogenicity of carbamazepine is well known, the presence of variegate porphyria has not been reported. The toxic hepatic effects of the drug on hepatic cytochrome P-450, which is involved in haem metabolism, could have aggravated the pre-existent porphyria, provoking the onset of skin lesions.

Liver metastases of endocrine tumour associated with multiple endocrine neoplasia type 1: a sustained response to interferon therapy or a peculiar benign course?

The authors describe the case of a 51-year-old male with Zollinger-Ellison syndrome manifested by epigastralgia, nausea, vomiting, hypergastrinemia and multiple endocrine neoplasia type 1. History included a Billroth II procedure for a perforated duodenal ulcer. Multiple metastatic liver lesions were found that were gastrin-negative and chromogranin-positive. Endoscopy revealed a large ulcerated gastro-jejuno-colonic fistula which was surgically repaired. Pre- and postoperative imaging studies, including the highly sensitive somatostatin-receptor scintigraphic scan using In-pentetreotide, have consistently failed to disclose other tumors. Recent reports indicate that most Zollinger-Ellison syndrome-associated gastrinomas are small, easily overlooked lesions located in the proximal duodenum rather than in the pancreas as formerly believed. In the present patient therapy with omeprazole and alpha-interferon has produced complete remission of the Zollinger-Ellison syndrome and a stabilization of tumor growth has occurred during the last 7 years, allowing the patient to live a normal life. This peculiar response to therapy is discussed.

Plasma levels of fibronectin in patients with chronic viral and alcoholic liver disease.

BACKGROUND/AIMS: Plasma fibronectin levels are reportedly decreased in patients with cirrhosis, while increases are associated with acute and chronic hepatitis. We studied 101 patients with chronic liver disease to determine the relationship between disease etiology and plasma fibronectin levels. METHODOLOGY: Plasma fibronectin levels and standard liver function parameters were measured in all patients and 11 healthy controls. Antipyrine metabolism was also evaluated in 39 patients. Results were analyzed according to etiology (HBV, HCV, alcohol abuse) and histological findings (chronic active hepatitis (CAH) with/without fibrosis, steatosis, cirrhosis). RESULTS: The fibronectin levels were similar in patients with HBV, HCV and alcohol-related disease. Analysis of the groups based on histological features showed that fibronectin levels in cirrhotics (mean 270.69 microg/ml) were significantly lower than those of the control (mean 372.00 microg/ml) and other patient groups (steatosis: 470.37 microg/ml; CAH: 417.93 microg/ml; CAH and fibrosis: 426.72 microg/ml). Plasma fibronectin displayed a positive correlation with antipyrine metabolism and parameters of hepatic synthesis. CONCLUSIONS: Plasma fibronectin appears to be an index of hepatic parenchymal function but shows no relation to the etiology of the liver disease.

Prevalencia de bocio en escolares (6 a 14 años) de la ciudad de Mar del Plata / Goiter prevalence in school children (6 to 14 years) of Mar del Plata city

El objetivo de este trabajo fue determinar la prevalencia de bocio en escolares de la ciudad de Mar del Plata. Se seleccionó una muestra entre alumnos de 6 a 14 años de edad de escuelas urbanas y periurbanas de la ciudad de Mar del Plata; la muestra se realizó por conglomerados y posteriormente por métodos aleatorios. Se encuestaron 889 alumnos, 54,1 por ciento de sexo masculino y 45,9 por ciento del femenino, y se recolectó orina en un 8,7 por ciento de los varones. Se detectó un 17,2 por ciento del nivel Ia, 1,7 por ciento Ib y 0,1 por ciento II Total = 19 por ciento (según clasificación OPS). No se observaron diferencias significativas respecto al sexo y edad, ni a la provisión de agua corriente y/o de pozo ni a residencia urbana o rural. Si se observó diferencia significativa entre escuelas Estatales y Privadas : 21,2 por ciento y 11,6 por ciento respectivamente. Dado las diferencias observadas entre los distintos equipos de trabajo (todos los profesionales intervinientes con experiencia en palpación de tiroides), se resolvió efectuar ecografía a un 20 por ciento de los positivos más un 10 por ciento de normales : los resultados de las ecografías avalan ampliamente los hallazgos palpatorios. De las 53 muestras de orina procesadas, se observó un promedio de 21,1 mcg/dl de iodo con un desvío standar de 6,7 mcg/dl (es decir, iodurias altamente satisfactorias). Se ha decidido profundizar la investigación, determinando anticuerpos TPO y medición TSH, para destacar tiroiditis crónica e hipotiroidismo subclínico

Prevalencia de bocio en escolares (6 a 14 años) de la ciudad de Mar del Plata / Goiter prevalence in school children (6 to 14 years) of Mar del Plata city

El objetivo de este trabajo fue determinar la prevalencia de bocio en escolares de la ciudad de Mar del Plata. Se seleccionó una muestra entre alumnos de 6 a 14 años de edad de escuelas urbanas y periurbanas de la ciudad de Mar del Plata; la muestra se realizó por conglomerados y posteriormente por métodos aleatorios. Se encuestaron 889 alumnos, 54,1 por ciento de sexo masculino y 45,9 por ciento del femenino, y se recolectó orina en un 8,7 por ciento de los varones. Se detectó un 17,2 por ciento del nivel Ia, 1,7 por ciento Ib y 0,1 por ciento II Total = 19 por ciento (según clasificación OPS). No se observaron diferencias significativas respecto al sexo y edad, ni a la provisión de agua corriente y/o de pozo ni a residencia urbana o rural. Si se observó diferencia significativa entre escuelas Estatales y Privadas : 21,2 por ciento y 11,6 por ciento respectivamente. Dado las diferencias observadas entre los distintos equipos de trabajo (todos los profesionales intervinientes con experiencia en palpación de tiroides), se resolvió efectuar ecografía a un 20 por ciento de los positivos más un 10 por ciento de normales : los resultados de las ecografías avalan ampliamente los hallazgos palpatorios. De las 53 muestras de orina procesadas, se observó un promedio de 21,1 mcg/dl de iodo con un desvío standar de 6,7 mcg/dl (es decir, iodurias altamente satisfactorias). Se ha decidido profundizar la investigación, determinando anticuerpos TPO y medición TSH, para destacar tiroiditis crónica e hipotiroidismo subclínico

Investigacion de contactos en enfermos de sifilis en Mar del Plata, Argentina. / Research on syphilis patients' contacts in Mar del Plata, Argentina

Este estudio trata sobre la importancia del control de contactos en un programa de control de enfermedades de transmision sexual y en el se evalua la actividad como mecanismo de busqueda de casos. Se analiza el material recogido al respecto en el Instituto Nacional de Epidemiologia de Mar del Plata en el periodo de 1971 a 1980