Role of Endoscopy in the Diagnosis, Grading, and Treatment of Portal Hypertensive Gastropathy and Gastric Antral Vascular Ectasia.

Portal hypertensive gastropathy (PHG) and gastric antral vascular ectasia (GAVE) are 2 distinct gastric vascular abnormalities that may present with acute or chronic blood loss. PHG requires the presence of portal hypertension and is typically associated with chronic liver disease, whereas there is controversy about the association of GAVE with chronic liver disease and/or portal hypertension. Distinguishing between GAVE and PHG is crucial because their treatment strategies differ. This review highlights characteristic endoscopic appearances and the clinical features of PHG and GAVE, which, in turn, aid in their appropriate management.

The Value of Liver Biopsy and Histology in Liver Disease Diagnosis and Patient Care-a Pragmatic Prospective Clinical Practice Study.

GOALS: We aimed to examine the correlation of pre-biopsy clinical diagnosis with hepatic histopathology. BACKGROUND: Liver biopsy provides histologic information and informs physicians about the underlying clinical disease. We hypothesized that expert physicians' pre-biopsy clinical diagnoses may obviate the need for histopathological diagnosis. STUDY METHODS: Patients undergoing liver biopsy to investigate a liver diagnosis were prospectively identified. In the 80 patients included, an anonymous validated questionnaire inquiring about the most likely clinical diagnosis and liver disease stage was completed prospectively by hepatologists before biopsy performance. RESULTS: The most common pre-biopsy diagnoses were alcoholic liver disease (19 diagnoses), followed by non-alcoholic steatohepatitis and autoimmune hepatitis (18 each). Overall, the predicted histologic diagnosis was the same as the histologic diagnosis in 51/80 patients (64%), and thus a new liver disease diagnosis was made in 36% of patients. The diagnosis with the greatest pre-biopsy and post-biopsy diagnosis discrepancy was autoimmune hepatitis, with the correct diagnosis being predicted in 6/18 (33%) of patients (other diagnoses included the following: non-alcoholic steatohepatitis/non-alcoholic fatty liver disease (4), alcoholic liver disease (3), drug-induced liver injury (3), others (2)). For fibrosis staging, when grouped as no fibrosis (F0), fibrosis (F1-F3), or cirrhosis (F4), the fibrosis stage was correctly predicted in 68% of patients (54/80). Notably, 7 patients (9%) who were initially thought to have no or early-stage fibrosis had F4 fibrosis, and 6/80 (8%) patients who were considered to have a liver disease diagnosis before their biopsy had normal histology. CONCLUSIONS: Although hepatology experts often predict the correct underlying liver disease diagnosis, histopathological diagnoses different from expected are common.

Design, synthesis and antiproliferative screening of newly synthesized coumarin-acrylamide hybrids as potential cytotoxic and apoptosis inducing agents.

On the basis of the observed biological activity of coumarin and acrylamide derivatives, a new set of coumarin-acrylamide-CA-4 hybrids was designed and synthesized. These compounds were investigated for their cytotoxic activity against cancerous human liver cell line HepG2 cells using 5-fluorouracil (5-FU) as a reference drug. Compound 6e had promising antiproliferative activity with an IC50 value of 1.88 µM against HepG2 cells compared to 5-FU (IC50 = 7.18 µM). The results of ß-tubulin polymerization inhibition indicated that coumarin-acrylamide derivative 6e was the most active, with a percentage inhibition value of 84.34% compared to podophyllotoxin (88.19% ß-tubulin inhibition). Moreover, the active coumarin-acrylamide molecule 6e exerted cell cycle cession at the G2/M phase stage of HepG2 cells. In addition, this compound produced a 15.24-fold increase in apoptotic cell induction compared to no-treatment control. These observations were supported by histopathological studies of liver sections. The conducted docking studies illustrated that 6e is perfectly positioned within the tubulin colchicine binding site, indicating a significant interaction that may underlie its potent tubulin inhibitory activity. The main objective of the study was to develop new potent anticancer compounds that might be further optimized to prevent the progression of cancer disease.

Rhamnetin, a nutraceutical flavonoid arrests cell cycle progression of human ovarian cancer (SKOV3) cells by inhibiting the histone deacetylase 2 protein.

Overexpression of HDAC 2 promotes cell proliferation in ovarian cancer. HDAC 2 is involved in chromatin remodeling, transcriptional repression, and the formation of condensed chromatin structures. Targeting HDAC 2 presents a promising therapeutic approach for correcting cancer-associated epigenetic abnormalities. Consequently, HDAC 2 inhibitors have evolved as an attractive class of anti-cancer agents. This work intended to investigate the anti-cancer abilities and underlying molecular mechanisms of Rhamnetin in human epithelial ovarian carcinoma cells (SKOV3), which remain largely unexplored. We employed various in vitro methods, including MTT, apoptosis study, cell cycle analysis, fluorescence microscopy imaging, and in vitro enzymatic HDAC 2 protein inhibition, to examine the chemotherapeutic sensitivity of Rhamnetin in SKOV3 cells. Additionally, we conducted in silico studies using molecular docking, MD simulation, MM-GBSA, DFT, and pharmacokinetic analysis to investigate the binding interaction mechanism within Rhamnetin and HDAC 2, alongside the compound's prospective as a lead candidate. The in vitro assay confirmed the cytotoxic effects of Rhamnetin on SKOV3 cells, through its inhibition of HDAC 2 activity. Rhamnetin, a nutraceutical flavonoid, halted at the G1 phase of the cell cycle and triggered apoptosis in SKOV3 cells. Furthermore, computational studies provided additional evidence of its stable binding to the HDAC 2 protein's binding site cavity. Based on our findings, we conclude that Rhamnetin effectively promotes apoptosis and mitigates the proliferation of SKOV3 cells through HDAC 2 inhibition. These results highlight Rhamnetin as a potential lead compound, opening a new therapeutic strategy for human epithelial ovarian cancer.Communicated by Ramaswamy H. Sarma.

Comparison of the Safety of Transjugular and Percutaneous Liver Biopsies.

PURPOSE: To compare adverse events (AEs) between the transjugular liver biopsy (TJLB) and percutaneous liver biopsy (PLB) approaches. MATERIALS AND METHODS: A total of 1,300 patients who underwent liver biopsy between July 1, 2014 and January 31, 2018, were examined, and bivariate and multivariate analyses were used to determine predictors of the biopsy method used and AEs. To reduce bias in the comparison of the AE rates between patients who had TJLB or PLB, propensity score matching was used to control for baseline disease severity. RESULTS: PLB and TJLB were performed in 601 and 699 patients, respectively. The mean Charlson Comorbidity Index score was 3 (±2), and antiplatelet or anticoagulation therapy at the time of biopsy was used in <10% of patients. Patients with suspected cirrhosis or portal hypertension (odds ratio [OR], 9.9), an international normalized ratio of >1.5 (OR, 5.9), or a platelet count of <100 × 103/mL (OR, 3.9) were more likely to undergo TJLB. After propensity matching, which identified a population of patients with a mean international normalized ratio of <1.5 and platelet count of >150 × 103/mL, the only difference in the AE rate was for pain, which was present in 8% and 10% of patients after TJLB and PLB, respectively (P < .001). Bleeding requiring transfusion occurred in 2 patients who underwent TJLB and 1 patient who underwent PLB. There was 1 case of death occurring after TJLB. CONCLUSIONS: Severe/life-threatening AEs occurring after liver biopsy were uncommon, and the 2 liver biopsy approaches appeared to have similar safety profiles for low-risk patients. After matching for underlying disease severity, pain was the AE that was more likely to occur in patients who underwent PLB.

The role of artificial intelligence in hepatology research and practice.

PURPOSE OF REVIEW: The use of artificial intelligence (AI) in examining large data sets has recently gained considerable attention to evaluate disease epidemiology, management approaches, and disease outcomes. The purpose of this review is to summarize the current role of AI in contemporary hepatology practice. RECENT FINDINGS: AI was found to be diagnostically valuable in the evaluation of liver fibrosis, detection of cirrhosis, differentiation between compensated and decompensated cirrhosis, evaluation of portal hypertension, detection and differentiation of particular liver masses, preoperative evaluation of hepatocellular carcinoma as well as response to treatment and estimation of graft survival in patients undergoing liver transplantation. AI additionally holds great promise in examination of structured electronic health records data as well as in examination of clinical text (using various natural language processing approaches). Despite its contributions, AI has several limitations, including the quality of existing data, small cohorts with possible sampling bias and the lack of well validated easily reproducible models. SUMMARY: AI and deep learning models have extensive applicability in assessing liver disease. However, multicenter randomized controlled trials are indispensable to validate their utility.

Chronic Intrathoracic Gastric Volvulus Management: Could Less Be More?

Gastric volvulus is a rare medical condition that necessitates a high suspicion index to diagnose. Acute gastric volvulus will often present with nonspecific but severe symptoms of abdominal pain, nausea, vomiting, and in some instances, evidence of organ ischemia. In this case report, we present an 88-year-old woman who was admitted after a mechanical fall. On the third day of hospitalization, she complained of new-onset epigastric pain, nausea, and vomiting. Imaging demonstrated nonobstructed intrathoracic organo-axial gastric volvulus. Given the patient's significant comorbidities, surgical and endoscopic interventions were deemed high-risk (high risk of anesthesia and gastric perforation, respectively). This report evaluates the role of noninterventional conservative management in high-risk surgical patients with symptomatic acute and acute-on-chronic intrathoracic gastric volvulus. The present case and the current literature review suggest that supportive management may be appropriate to control disease symptoms, although it does not alter the disease's natural history, progression, and recurrence.

Accurate Identification of Patients with Cirrhosis and Its Complications in the Electronic Health Record.

BACKGROUND: Cirrhosis represents a significant health burden; administrative data provide an important tool for research studies. AIMS: We aimed to understand the validity of current ICD-10 codes compared to previously used ICD-9 codes to identify patients with cirrhosis and its complications. METHODS: We identified 1981 patients presenting to MUSC between 2013 and 2019 with a diagnosis of cirrhosis. To validate the sensitivity of ICD codes, we reviewed the medical records of 200 patients for each associated ICD 9 and 10 codes. Sensitivity, specificity, and positive predictive value for each ICD code (individually or when combined) were calculated and univariate binary logistic models, for cirrhosis and its complications, predicted probabilities were used to calculate C-statistics. RESULTS: Single ICD 9 and 10 codes were similarly insensitive for detection of cirrhosis, with sensitivity ranging from 5 to 94%. However, ICD-9 code combinations (when used as either/or) had high sensitivity and specificity for the detection of cirrhosis, with the combination of either 571.5 (or 456.21) or 571.2 codes having a C-statistic of 0.975. Combinations of ICD-10 codes were only slightly less sensitive and specific than ICD-9 codes for detection of cirrhosis (K76.6, or K70.31, plus K74.60 or K74.69, and K70.30 had a C-statistic of 0.927). CONCLUSIONS: ICD-9 and ICD-10 codes when used alone were inaccurate for identifying cirrhosis. ICD-10 and ICD-9 codes had similar performance characteristics. Combinations of ICD codes exhibited the greatest sensitivity and specificity for detection of cirrhosis, and thus should be used to accurately identify cirrhosis.

Brunner Gland Hamartomas-Uncommon Presentations and Endoscopic Management.

Brunner gland hamartoma (BGH) is a rare condition that requires a high clinical suspicion to diagnose. Large hamartomas may initially present with iron deficiency anemia (IDA) or symptoms suggesting intestinal obstruction. Barium swallow may demonstrate the lesion, but endoscopic evaluation is the acceptable first line management unless a concern for underlying malignancy. The present case report and literature review highlight the uncommon presentations and endoscopic role in large BGHs management. Internists should consider BGH in their differential, especially in patient with occult bleeding, IDA, or obstruction, which can be treated with endoscopic resection of large sized tumors by trained experts.

Does a Short Period of Maxillomandibular Fixation Decrease Complications in Open Reduction Internal Fixation of Mandibular Angle Fractures?

PURPOSE: A short duration of postoperative maxillomandibular fixation (MMF) has the potential to reduce complications following open reduction and internal fixation (ORIF) of mandibular angle fractures. The purpose of this study was to determine if a short duration of MMF is associated with a reduced rate of postoperative inflammatory complications (POICs) in patients with mandibular angle fractures undergoing ORIF. METHODS: The authors conducted a retrospective cohort study consisting of patients treated with ORIF for mandibular angle fractures from August 1, 2015 to May 31, 2020 at an urban, level 1 trauma center. Patients under the age of 18 years, bilateral angle fractures, those with MMF periods of more than 3 weeks, and those patients without documentation of the duration of MMF were excluded from the study. The primary predictor variable was the use of a short duration (less than 2 weeks) of postoperative MMF. The outcome variable of interest was the presence of POICs. Categorical covariates were compared using Fisher's exact tests, while continuous variables were compared using Wilcox rank-sum tests. Multivariable logistic regression adjustment was also performed. RESULTS: There were 307 patients included in the study, 84.4% of which were men. The average age was 32.5 years. Patients with a short duration of MMF had a POIC rate of 8.3% compared to 18.2% for no MMF (P = .08). In the adjusted analysis, patients with a short duration of MMF time had a significant decrease in POIC risk compared to no MMF (adjusted odds ratio [aOR] = 0.32, 95% confidence interval [CI] = 0.11 to 0.97). Other significant variables in the regression analysis included plating type and noncompliance. Inferior border rigid fixation was associated with decreased POIC risk compared to ladder plates and lateral border plates (aOR 5.8, 95% CI = 1.8 to 18.4 and aOR 5.1, 95% CI = 1.4 to 18.7, respectively). CONCLUSION: The findings from our study suggest that a short duration of postoperative MMF may reduce POICs following ORIF of mandibular angle fractures.

An AI Approach for Identifying Patients With Cirrhosis.

GOAL: The goal of this study was to evaluate an artificial intelligence approach, namely deep learning, on clinical text in electronic health records (EHRs) to identify patients with cirrhosis. BACKGROUND AND AIMS: Accurate identification of cirrhosis in EHR is important for epidemiological, health services, and outcomes research. Currently, such efforts depend on International Classification of Diseases (ICD) codes, with limited success. MATERIALS AND METHODS: We trained several machine learning models using discharge summaries from patients with known cirrhosis from a patient registry and random controls without cirrhosis or its complications based on ICD codes. Models were validated on patients for whom discharge summaries were manually reviewed and used as the gold standard test set. We tested Naive Bayes and Random Forest as baseline models and a deep learning model using word embedding and a convolutional neural network (CNN). RESULTS: The training set included 446 cirrhosis patients and 689 controls, while the gold standard test set included 139 cirrhosis patients and 152 controls. Among the machine learning models, the CNN achieved the highest area under the receiver operating characteristic curve (0.993), with a precision of 0.965 and recall of 0.978, compared with 0.879 and 0.981 for the Naive Bayes and Random Forest, respectively (precision 0.787 and 0.958, and recalls 0.878 and 0.827). The precision by ICD codes for cirrhosis was 0.883 and recall was 0.978. CONCLUSIONS: A CNN model trained on discharge summaries identified cirrhosis patients with high precision and recall. This approach for phenotyping cirrhosis in the EHR may provide a more accurate assessment of disease burden in a variety of studies.

Adenovirus Hepatitis in Immunocompetent Adults.

A 35-year-old female with no medical history presented with fever. Laboratory work was normal except for elevated liver function test (LFT): alkaline phosphatase (AP) (296), aspartate transaminase (AST) (343), alanine transaminase (ALT) (378), and international normalized ratio (INR) (1.23). Ultrasound liver was normal. Infectious workup was negative for hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis E virus (HEV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), Herpes simplex virus (HSV), and COVID-19. Similarly, autoimmune hepatitis, Wilson, and alpha-1 antitrypsin workup were negative. She reported taking Yogi-Kanthika (ayurvedic-proprietary medicine) on/off for seasonal sore throat, yet RUCAM-score was 2 (unlikely a drug induced injury). Respiratory-viral-panel came positive for adenovirus. With supportive treatment, symptoms and LFT trended down, thus, liver biopsy decision was deferred. We believe this is the first reported case of adenovirus hepatitis in an immunocompetent adult. Hence, we suggest that clinicians should consider a refined differential diagnosis for elevated LFT (that includes adenovirus).

Role of Liver Biopsy in Assessment of Radiologically Identified Liver Masses.

BACKGROUND: Despite improvements in imaging techniques that have enhanced the ability to diagnose hepatocellular carcinoma (HCC), histopathological evaluation of many other types of liver masses is critical. AIMS: To evaluate the utility of liver biopsy in patients with radiologically undiagnosed liver masses. METHODS: We retrospectively analyzed 293 consecutive patients who had a liver biopsy for evaluation of an undiagnosed liver mass between January 2014 and January 2018. RESULTS: Out of 293 biopsies, 246 patients were found to have malignancy (84%), including 210 (72%) patients with metastatic malignancy and 36 with primary hepatic malignancies (20 HCC and 16 others). In the 47 patients without malignancy, 17 patients had necrotic abscess/granuloma, 16 patients had normal histology, eight patients had hepatic fibrosis/cirrhosis without malignant foci, and six patients had benign tumors. The most common primary lesion in patients with liver metastasis was breast carcinoma (32/293, 11%), followed by colon and pancreas (31 (each)/293, 11%), and lung (9%) adenocarcinomas. Histopathological analysis confirmed the presence of metastasis in 165/200 (83%) patients with a history of oncological malignancy and in 45/93 (48%) patients who had no malignancy history. CONCLUSIONS: In patients with a radiologically identified liver mass of unclear etiology, liver biopsy/histology made a diagnosis in 95% (277/293) of patients, including 84% (246/293) found to have an oncological malignancy. Liver biopsy/histology also identified malignancy in a high proportion of patients without known underlying cancer. We conclude that liver biopsy is valuable for evaluation of radiologically identified liver masses of unclear etiology.

The natural history of patients with compensated cirrhosis and elevated hepatic venous pressure gradient.

Aims: Portal hypertension is a major complication of liver cirrhosis. Hepatic venous pressure gradient (HVPG) appears to be one of the best surrogates of clinical outcomes. However, the utility of elevated HVPG in predicting subsequent clinical decompensation is unclear. Methods: We analyzed 410 patients who underwent HVPG assessment between 2014 and 2018. Of these, we identified and analyzed 20 patients with HVPG >12 mmHg without evidence of clinical decompensation (defined as ascites, non-bleeding esophageal varices or bleeding esophageal varices, hepatic encephalopathy, hepato-pulmonary syndrome, or hepatic hydrothorax). Additionally, we compared this group to 40 randomly selected cirrhotic patients with HVPG >12 mmHg with signs of clinical decompensation. Clinical events were subsequently assessed (mean = 33 months) after HVPG measurement. Results: Patients with high HVPG without evidence of clinical decompensation had significantly lower model for end stage liver disease (MELD) scores (8 ± 4) compared to decompensated patients (13 ± 8, P = 0.05). HVPG measurements were similar in compensated (17 ± 6 mmHg) and decompensated (18 ± 4 mmHg) patients. Over follow-up for 33 months, 8/20 compensated patients had a decompensating event and neither MELD (8 and 8, respectively) nor HVPG (17 mmHg and 18 mmHg, respectively) differentiated patients who remained compensated vs. those that decompensated. Serum albumin at the time of HVPG measurement was significantly higher in patients who remained compensated than those with a decompensating event (3.5 g/dL vs. 2.6 g/dL, respectively, P = 0.05). Conclusions: A small, unique, population of cirrhotic patients with substantially elevated HVPG appear to remain free of complications over long term follow-up.

A Rare Case of Synchronous Esophageal and Pancreatic Malignancy.

The incidence of double primary tumors has been rising over the past few decades. Synchronous pancreatic and esophageal carcinomas are rarely reported in the literature. In this case report, we present an 86-year-old man who developed synchronous double cancers of the pancreas and esophagus. He has a past medical history of hypertension and prior nicotine dependence and was admitted for abdominal pain and weight loss. Laboratory data on admission were normal except for the serum carbonic anhydrase 19-9 (54 U/mL, reference range: 0-34 U/mL) and carcinoembryonic antigen (712.4 ng/mL, reference range: less than <5.0 ng/mL). Abdominal ultrasonography revealed a 2.3 cm lesion at the head of the pancreas. A CT scan with contrast was highly suspicious for pancreatic head malignancy. The patient underwent endoscopical ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) that showed a large non-obstructing ulcerating mass at the gastroesophageal junction (GEJ) as well as a pancreatic head mass. Histological findings from the obtained tissue demonstrated pancreatic adenocarcinoma and intestinal-type adenocarcinoma of the esophagus with an invasion of lamina propria, and diagnosis of double cancers of the pancreas and esophagus was made. In conclusion, our case report represents the fifth documented case of dual primary malignancy of the esophagus and pancreas. This highlights that, despite their rarity, primary distant malignancies in patients with pancreatic cancer is an entity that clinicians should be more cognizant about especially among the male smoker/ex-smoker patient population, specifically given that the current data demonstrate that the prognosis of double cancers primarily depends on the prognosis of the pancreatic carcinoma.

The Utility of Liver Biopsy in the Evaluation of Liver Disease and Abnormal Liver Function Tests.

OBJECTIVES: We aimed to assess the value of liver biopsy in the evaluation of abnormal liver tests. METHODS: We analyzed consecutive liver biopsy specimens performed for evaluation of unexplained abnormal liver tests from 2014 to 2018. Diagnoses were categorized histologically and clinically. We determined whether histologic examination led to a specific diagnosis and whether prebiopsy laboratory variables predicted the underlying etiology. RESULTS: Among the 383 liver biopsy specimens included, chronic hepatitis was the most common histologic (25%) and clinical (17%) diagnosis. Liver biopsy led to a clinical diagnosis in 87% of patients. The most likely clinical diagnoses were autoimmune hepatitis, nonalcoholic fatty liver disease, and drug-induced liver injury (38, 33, and 32 patients, respectively). Using sensitivity, specificity, and positive and negative predictive values, we found that liver tests were not predictive of a specific diagnosis. In patients with no history of liver disease or clinical features of portal hypertension, biopsy specimens revealed histologic cirrhosis in 5% of patients. CONCLUSIONS: Histopathologic diagnoses were made in 85% of patients undergoing liver biopsy for investigation of unexplained liver tests, leading to a clinical diagnosis in 87% of patients. However, neither liver tests themselves nor their patterns were useful in predicting histologic or clinical diagnoses.

Lower Gastrointestinal Bleeding in Patients With Cirrhosis-Etiology and Outcomes.

BACKGROUND: Lower gastrointestinal bleeding (LGIB) is a common clinical problem, and may be more prevalent among patients with cirrhosis, especially in the setting of portal hypertension and coagulopathy. However, there is extremely little data available on the subject of LGIB in patients with cirrhosis. Therefore, the primary objective of this study was to better understand the etiology and outcomes of cirrhotic patients hospitalized with LGIB. MATERIALS AND METHODS: We analyzed 3,735 cirrhotic patients admitted to the Medical University of South Carolina between January 2011 and September 2018, and identified patients admitted with a primary diagnosis of hematochezia or bright red blood per rectum. RESULTS: Thirty patients with cirrhosis and LGIB were included in the cohort. The mean age was 56 ± 13 years, with 30% women. The mean model of end stage liver disease score was 22, and Child-Pugh (CP) scores were C: 41%, B: 33% and A: 26%. The mean Charlson Comorbidity Index was 5.6. Twenty-four (80%) patients had a clinical decompensating event (hepatic encephalopathy, ascites, esophageal varices); the mean hepatic venous pressure gradient was 14.1 mm Hg (n = 8). In 33% of patients, LGIB was considered significant bleeding that necessitated blood transfusion. The most common cause of LGIB was hemorrhoids (11 patients, 37%), followed by portal hypertensive enteropathy or colopathy (7 patients, 23%). Hemoglobin levels on admission were lower in patients with CP B/C cirrhosis than in those with CP A (P < 0.001). The length of stay was 9 ± 10 days, and 5 patients died (mortality, 17%). CONCLUSIONS: Despite being uncommon, LGIB in cirrhotic patients is associated with a high mortality rate.

The utility of liver biopsy in 2020.

PURPOSE OF REVIEW: Over the past decade, imaging modalities and serological tests have emerged as important tools in the evaluation of liver diseases, in many cases supplanting the use of liver biopsy and histological examination. Nonetheless, the accuracy and diagnostic value of these methods may not always be conclusive and the assessment of liver histology often remains the gold standard for diagnostic evaluation. The purpose of this review is to summarize the current role of liver biopsy in contemporary hepatology practice. RECENT FINDINGS: Technical factors were found to influence the diagnostic value of liver biopsy and histological examination of the liver, including specimen number and size (preferably ≥3 nonfragmented specimens of >20 mm in length), needle diameter (1.6 mm Menghini), number of passes (mean 2.5), imaging-guidance, and operator experience. Liver biopsy was demonstrated to be diagnostically valuable in the evaluation of persistently abnormal liver tests of unclear cause, with histology pointing to a specific diagnosis in 84% of patients. Although coagulation abnormalities continue to be an important concern when performing liver biopsy, their influence on complication risk remains unclear. Implementation of less stringent preprocedural coagulation thresholds decreased preprocedural transfusions without increasing the bleeding rate. Serious complications associated with percutaneous liver-biopsy (PLB) and transjugular liver-biopsy are similar, but pain appears to be more common with PLB. SUMMARY: Histopathological evaluation continues to be fundamentally important in assessing hepatic disease, and liver histology remains the most accurate approach to assess fibrosis and assign prognosis.

Small Bowel Obstruction due to Meckel's Diverticulum: A Case Report.

Meckel's diverticulum is the most common congenital anomaly of the small intestine. Common complications related to Meckel's diverticulum include hemorrhage, intestinal obstruction and inflammation. Small bowel obstruction due to mesodiverticular band of Meckel's diverticulum is a rare complication. Herein, we report the diagnosis and management of a small bowel obstruction occurring due to the mesodiverticular band of a Meckel's diverticulum.

Vascular endothelial growth factor and interleukin-8 are associated with poor prognosis in epithelial ovarian cancer patients.

BACKGROUND: Ovarian cancer represents an important problem in gynecologic oncology. A growing tumor induces the host endothelial cells to proliferate and supply the requisite vascular support allowing tumor development. Vascular endothelial growth factor (VEGF) and interleukin-8 (IL-8) have been demonstrated to induce angiogenesis in epithelial tumors in vivo. PATIENTS AND METHODS: This study included 24 tumors from patients with epithelial ovarian cancer in different stages, in addition to 20 tissue samples of benign ovarian lesions as a control group. VEGF has been measured in the cytosolic fractions using enzyme immunoassay and confirmed by Western blot analysis. Tissue IL-8 mRNA was assessed using reverse transcriptase polymerase chain reaction and immunohistochemistry for its protein. RESULTS: VEGF mean rank was significantly higher in ovarian cancer tumors compared to benign lesions (P < 0.001). Moreover, it was increased with advanced stages (P < 0.05) and in patients with poor survival (P < 0.05). Eight samples were positive for IL-8 mRNA, seven of them were in malignant group, with highest frequency in stages III and IV of the disease (6/12, 50%). IL-8 correlated with poor survival of the patients (P < 0.05). Log rank of Kaplan-Meier survival analysis was significant for FIGO stage, VEGF, and IL-8 (P < 0.05). CONCLUSION: These results indicate that VEGF and IL-8 are related to the malignant transformation process and can be considered as indicators of poor prognosis in epithelial ovarian cancer patients.