Surgical management of calcified hydatid cysts of the liver.

Hydatid disease of the liver is still a major cause of morbidity in Greece. Beside the common complications of rupture and suppuration, calcification of the hepatic cysts represent a not well studied, less frequent and sometimes difficult surgical problem. In the present study 75 cases with calcified symptomatic liver echinococcosis were operated on in the 1st Propedeutic Surgical Clinic between 1964 to 1996. Twenty-eight patients were male and 47 female with ages from 23 to 78 years. The diagnosis was based mainly on the clinical picture and radiological studies. In 5 cases the operative method was cystopericystectomy. We performed evacuation of the cystic cavity and partial pericystectomy and primary closure of the residual cavity in 6 cases, omentoplasty or filling of the residual cavity with a piece of muscle of the diaphragm in 4 cases and external drainage by closed tube, in 60 cases. In 12 of those with drainage, after a period of time, a second operation with easy, removal of most of the calcareous wall plaques was performed. The mortality rate was 2%. Our results could be considered satisfactory. In the calcified parasitic cysts of the liver the proposed technique is cystopericystectomy. An alternative procedure is pericystectomy and drainage with a "planned" reoperation with a bloodless, due to intervening inflammation, chiseling of the calcification.

Hepatic tissue microcirculation, oxygenation and energy charge in ischemia-reperfusion subjected cirrhotic rat liver.

BACKGROUND/AIMS: The hemodynamic disturbances in the cirrhotic liver following severe variceal bleeding and subsequent restoration by blood transfusion is an ischemia/reperfusion injury event which represents the clinical situation of liver dysfunction. Therefore, the aim of this study was to evaluate the microcirculation, oxygenation and energy charge of the cirrhotic rat liver after ischemia/reperfusion. METHODOLOGY: In eight carbon tetrachloride-induced cirrhotic rats and an equal number of controls subjected to 30 minutes of ischemia and 60 minutes of reperfusion by hepatoduodenal ligament clamping, the following parameters were assessed: hepatic microcirculation by laser-Doppler fluxmetry, hepatic tissue oxygenation by a Clark-type electrode, hepatic energy charge by tissue sampling and adenine-nucleotides determination by means of high-performance liquid chromatography. RESULTS: At baseline, liver microcirculation was found to be significantly decreased in the cirrhotics versus controls groups. Ischemia led to a reduction in both groups, while reperfusion improved microcirculation, but not to the baseline level. Oxygenation was reduced during ischemia and restored after reperfusion in both groups. Hepatic energy charge was reduced in the cirrhotics versus controls at baseline, and significantly decreased during ischemia in both groups. At reperfusion, a further reduction was found in the cirrhotic group, while in the control group it was restored to baseline. CONCLUSION: Hepatic microcirculation, oxygenation and energy charge are subjected to different degrees of diminution after ischemia/reperfusion in the cirrhotic rat liver.

Prognostic variables in greek patients with stage II breast cancer: a Hellenic Cooperative Oncology Group study.

The independent effects of several patient, tumor and treatment-related prognostic factors on relapse-free survival (RFS) and overall survival (OS) were assessed by Cox multivariate regression analysis in 988 Greek patients with stage II breast cancer. At a median follow-up time of 83 (range 3.3-131+) months and after the evaluation of all patients together, the number of positive axillary nodes (p < 0.0001), tumor size (p = 0.0024) and tumor grade (p = 0.0008) were identified as significant prognostic factors for RFS. Also, the number of positive nodes (p < 0.0001), tumor size (p = 0.0002) and ER status (p = 0.0001) were found to be significant for OS. These short-term prognostic variables are similar to those reported for this group of patients in other European countries and in the USA.

Cyclophosphamide, mitoxantrone, fluorouracil versus conventional CMF as adjuvant treatment in node-positive breast cancer patients. A Hellenic Cooperative Oncology Group Study.

362 evaluable node-positive patients with stage II breast cancer were randomized, receiving either 6 cycles of conventional CMF or 6 cycles of the combination of cyclophosphamide (500 mg/m2), mitoxantrone (Novantrone 10 mg/m2), and fluorouracil (500 mg/m2; CNF). After a median follow-up of 51 months, 64 (36%) patients relapsed in the CMF group and 60 (33%) in the CNF group (p=0.8276). By Cox multivariate analysis, tumor size, menopausal status and number of involved nodes were retained as independently significant variables. Toxicities were remarkably similar in both groups. It appears that after a median follow-up of 51 months there is no significant difference in relapse-free survival between node-positive patients with breast cancer who received either 6 cycles of the conventional CMF or the CNF combination as adjuvant treatment.