[Albumin mRNA and pCEA in the histopathologic diagnosis of hepatocellular carcinoma]. / mRNA dell'albumina e pCEA nella diagnosi istopatologica del carcinoma epatocellulare.

Extrahepatic neoplasms metastatic to the liver histologically are often indistinguishable from hepatocellular carcinoma (HCC). The differential diagnosis between HCC and metastatic liver tumours can be even more difficult in ultrasound guided fine-needle biopsies. Purpose of the present study was to investigate the utility of immunohistochemical staining with polyclonal anticarcinoembryonic antigen (pCEA) antibody and of in situ hybridization (ISH) revealing human albumin mRNA, with emphasis on tissues obtained via fine-needle procedure. Cases consisted of 52 primary HCC; 2 HCC metastatic to vertebral bones; 18 tumours metastatic to the liver; 24 non-hepatocellular tumours metastatic to the skin, lymph nodes and brain; 2 immature teratomas with areas of hepatoid differentiation. Forty-seven HCC (90%) and 7 liver metastases (38%) were obtained by ultrasound guided fine-needle biopsies (21 g needle was used). All the remaining cases were surgical specimens. All the cases were studied with immunohistochemistry for pCEA and ISH using a cRNA probe for human albumin mRNA. The immunohistochemical staining using pCEA showed a canalicular type of positivity in 37 cases of HCC (71%), in one HCC metastatic to vertebral bone and in the hepatoid areas of one immature teratoma. No canalicular type of positivity was obtained in non-hepatocellular neoplasms metastatic to the skin, brain, lymph-nodes and liver. Albumin mRNA was detected in 51 (98%) primary HCC, in both HCC bone metastases, and in the hepatoid areas of both immature teratomas. No positivity was obtained in non-hepatocellular tumours. The data here obtained indicate that immunostaining with pCEA and ISH revealing human albumin mRNA are markers of hepatocellular differentiation and confirm their diagnostic utility. Detection of albumin mRNA showed a higher sensitivity. In addition the cRNA probe here used seems more sensitive that the oligonucleotide probes employed in previous studies.

Lamivudine treatment for acute hepatitis B after liver transplantation.

BACKGROUND/AIMS: Acute hepatitis caused by recurrent or de novo hepatitis B virus (HBV) infection after liver transplantation frequently induces aggressive disease leading to liver failure. The aim of this study was to determine the efficacy and safety of lamivudine treatment in post-transplant acute hepatitis B. METHOD: Twelve patients with acute hepatitis B were started on lamivudine 100 mg p.o. daily within 8 weeks of the appearance of HBsAg. One patient was excluded after 1 month because of hepatocellular carcinoma recurrence. Patients were followed for an average of 68.6 weeks (range 32-108), and were clinically and biochemically evaluated on a monthly basis. They had a histological assessment at baseline, after at least 6 months, and whenever clinically indicated. RESULTS: Basal HBV-DNA ranged between 13 and 1288 pg/ml and serum alanine aminotransferase between 97 and 1036 U/l. HBV-DNA became undetectable within 8 weeks and transaminases normalized within 24 weeks in all cases. At the last visit, eight patients (73%) remained HBV-DNA negative by liquid hybridization and had normal or close to normal alanine aminotransferase. Five patients (45%) were also HBsAg negative and HBV-DNA negative by polymerase chain reaction. HBV-DNA and transaminase breakthrough occurred in three patients (27%). Histology after 6-9 months showed chronic hepatitis in seven patients. Lamivudine was well tolerated without serious adverse reactions. CONCLUSIONS: These results indicate that lamivudine treatment induces sustained inhibition of viral replication and normalization of transaminases in the majority of post-transplant patients with acute hepatitis B. HBsAg loss may be achieved in a considerable number of cases. Although viral resistance is relatively frequent, early initiation of lamivudine appears to be effective and safe.

A prospective randomized trial of sclerotherapy versus ligation in the elective treatment of bleeding esophageal varices.

BACKGROUND AND STUDY AIMS: Endoscopic ligation (EVL) and endoscopic variceal sclerotherapy (EVS) are known to be equally effective in eradicating bleeding esophageal varices in patients with hepatic cirrhosis, but the long-term safety and efficacy of the two techniques have not been clearly established. The aim of this study was to determine the relative frequency of rebleeding, recurrence of varices, and survival after treatment with the two techniques during a relatively long follow-up period. PATIENTS AND METHODS: A total of 111 patients without bleeding at the index endoscopy were randomly assigned to either EVL (n = 57) or EVS (n = 54). After eradication of the varices, the patients received endoscopic examinations every three months and for each episode of rebleeding. RESULTS: The mean follow-up periods were 534 +/- 42 days in the EVS group and 496 +/- 40 days in the EVL group. The two techniques were equally effective in eradicating varices (93% in EVL group and 92.5% in EVS group). The mean number of sessions required to obtain eradication was slightly lower (mean +/- SE) in the EVL group (3.5 +/- 0.1 vs. 4.0 +/- 0.1, P = 0.004), while the time required for eradication was longer (33.8 +/- 2.1 vs. 27.3 +/- 1.4, P = 0.01). The comparison of the Kaplan-Meier estimates of survival and time to first rebleeding did not show any statistically significant differences between the two groups. The rate of complications was significantly higher in the EVS group than in the EVL group (31% vs. 11%, P = 0.001), while the rate of recurrent varices during follow-up was higher in the EVL group (30% vs. 13%, P = 0.03). CONCLUSIONS: While the two techniques are equally effective, ligation treatment shows greater advantages in the short-term follow-up, but is associated with more frequent recurrence of varices in the longer term. These two aspects should be considered for evaluation in the cost-benefit ratio and quality of life analysis. All patients should have frequent endoscopic evaluations (every three or four months) throughout the first year of follow-up.

Benign regressing histiocytosis of the liver.

A case of benign regressing histiocytosis of the liver is reported. The patient, an adult male, presented with fever and diarrhoea and on abdominal echography multiple nodules were present in the liver. Histologically and immunohistochemically the lesions had features of Langerhans' cell histiocytosis. The nodules regressed within four months, without therapy, and the patient is free of disease 29 months after presentation.

[Observations on dietary intake of iron in young adults of the city of Bologna and evaluation of the risk of iron deficiency]. / Osservazioni sull'apporto alimentare di ferro in giovani adulti della città di Bologna e valutazioni sul rischio delle carenze marziali.

The dietary iron intake was studied in 50 volunteers sample of young adults in Bologna neighbourhood; thirty men, mean age 28.9, and 20 women, mean age 30.4. A structured questionnaire was proposed individually by a skilled dietary interviewer. The mean dietary iron daily intake results similar to that found in western industrialised countries, as reported in previous studies, respectively 15.1 mg and 14.0 in men and women. This study reveals a lower percentage of animal origin dietary iron than in northern and central Europe in both sexes, as previously reported (male: 32.8%; female: 27.3%), furthermore the iron intake per kcal was markedly lower (male: 4.91/1000 kcal, female: 5.97) than the level of 7 mg/1000 kcal reported for those countries. The authors argue that the described dietary habit can lead to iron loss balance, mostly in women whose iron intake is far lower than one recommended by LARN (Recommended daily dietary allowances by National Nutrition Italian Institute). It is considered the increasing chance of iron therapy need in women, particularly during long-lasting hypocaloric diets.

[Transcatheter arterial chemoembolization technique in cirrhotic patients with hepatocarcinoma. Considerations on the procedure and evaluation of survival]. / Chemioembolizzazione arteriosa trans-catetere dell'epatocarcinoma su cirrosi con tecnica globale. Considerazioni sul procedimento e valutazione della sopravvivenza.

Two hundred and eight cirrhotic patients with HCC underwent TACE with a standardized technique. Kaplan-Meier survival rates and 12, 24 at 36 months were 62%, 44% and 25%, respectively. Compared with 407 untreated patients, our series had a longer life expectancy, i.e., from 15 months after treatment on. Life experience was statistically different with the L-R test between the groups selected by Child-Pugh cirrhosis staging (p = 0.00000); all 8 Child-Pugh C patients died within 7 months; a high statistical difference was found between Child-Pugh A and B groups (p = 0.00012). Life experience was statistically different with the L-R test between the four groups selected by tumor size and spread (p = 0.012); statistical significance was not reached between contiguous groups in group vs. group comparisons. The patients with monofocal tumors, regardless of size, survive longer than those with multifocal and infiltrative (p = 0.0010) and those with multifocal (p = 0.0029) lesions. Hazard analysis, according to the stratified Cox model, proved tumor-size and Child-Pugh staging to be prognostic factors (p = 0.00027; p = 0.00000) which exhibit a highly significant correlation with each other (p = 0.00000). With the proportional hazard Cox model, tumor characteristics and Child-Pugh stage resulted to be highly significant independent prognostic factors (p = 0.013 and p = 0.000, respectively). Patient survival rates were graphically plotted against literature rates in 407 untreated patients classified by tumor size and by the Child-Pugh method: the two-year survival rates were higher in the subgroups of patients submitted to TACE. To conclude, TACE is an effective treatment not only for multifocal HCCs, but also for large monofocal and infiltrative HCCs. In contrast, TACE is quite useless in the patients with Child-Pugh C cirrhosis.

[Seroprevalence rate of HIV in pregnant women in Bologna]. / Sieroprevalenza dell'infezione da HIV nelle partorienti a Bologna.

The aim of the present study was to estimate the seroprevalence rate of HIV in pregnant women at the moment of labor in order to evaluate the need of a generalized HIV testing on all pregnant women. The research has been accomplished by Epidemiologic Observatory in Bologna in cooperation with the gynaecological divisions of public and private hospitals. All pregnant women, between September 1990 and July 1991, were interviewed by doctors of Epidemiologic Observatory and examined on voluntary basis. In the considered period, 2398/2450 interviewed pregnant women accepted to undergo HIV testing. Blood samples were collected from the umbilical cord of pregnant women at the moment of labor and antibody testing for HIV was performed by standard enzyme-linked immunosorbent assay. All initial positive tests were confirmed by Western Blot analysis. The results showed 9 HIV positive women (seroprevalence rate: 0.37%; 95% confidence interval: 0.1.6%-0.68%). Eight out of the 9 women were already aware of their seropositive status. From the present findings, it's possible to get opposite indications about the utility of prenatal HIV screening and instead it's more opportune the gynaecologist offers HIV testing to all women with risk factors for HIV infection at the beginning of the pregnancy.