Liver transplantation in children with hepatocellular carcinoma. Do Milan criteria apply to pediatric patients?

HCC constitutes 25-30% of primary malignant liver tumors in children. Conventional surgical excision is not possible in more than 50% of patients. LTx has recently become an important therapeutic option for adults and children with primary liver tumors. The aim of this study was a retrospective analysis of the clinical and pathological data of children with HCC treated with LTx in relation to Milan criteria assessed at diagnosis and then immediately before transplantation, in comparison with a group of patients treated conventionally. Between 1990 and 2007 we have treated 21 children diagnosed with HCC. Patients were divided into two groups: group I, 10 children treated conventionally and group II, 11 children treated with LTx regardless of previous therapy. The outcome of our patients treated conventionally with resection and chemotherapy is very poor--the disease-free survival rate is 30%. In contrast, despite that only 3 children having fulfilled adult Milan criteria, early clinical results of LTx are much superior. Total hepatectomy followed by LTx is the main treatment option for the majority of children with HCC. Decisions on the type of surgical treatment is made individually, but very early in the course of treatment.

Prevention of de novo hepatitis B virus infection by vaccination and high hepatitis B surface antibodies level in children receiving hepatitis B virus core antibody-positive living related donor liver: case reports.

Transmission of hepatitis B virus (HBV) infection from donors negative for hepatitis B surface antigen (HBsAg) but positive for antibody to hepatitis B core antigen (anti-HBc) have been reported. The aim of our study was to evaluate the outcomes of recipients who received liver grafts from living related donors with serological evidence of previous exposure to hepatitis B virus (HBsAg-negative/anti-HBc-positive) after recipient vaccination against HBV before and after liver transplantation.

Lack of Impact of Presence of Positive C4d Staining in Capillaries in Myocardial Biopsies on Long-term Survival of Heart Transplant Patients.

BACKGROUND: The long-term survival of 209 consecutive patients (mean age, 46 ± 15 years) from a single center with ≥1 diagnostic myocardial biopsy after heart transplantation was analyzed. METHODS: Patients were considered as C4d positive if a capillary staining (immunohistochemistry in paraffin samples) was observed in ≥1 myocardial biopsy. Data were analyzed according to pathologic consensus of antibody mediated rejection definition of C4d+ positivity: 2004 definition in group A and the 2013 definition in group B and compared with their respective controls, composed of patients who do not meet those criteria. Age, follow-up time, and number of biopsies were comparable between patients with C4d+ and controls in both groups. Follow-up was 100% complete with mean of observation time 2143 days. RESULTS: During the follow-up period, 62 patients died (group A: C4d+ 32% vs controls 29%; group B: C4d+ 36% vs controls 29% [P = NS]). There were no differences in survival between patients with positive staining and without C4d+ staining when Kaplan-Meier survival curves were compared. CONCLUSIONS: The presence of C4d positive staining in myocardial capillaries of heart biopsies of patients after heart transplantation, as an isolated finding, was not related to worse long-term survival.

Multifocal central nervous system glioma--a case history.

A case history of the multifocal brain glioma in 13-year-old girl is reported. Numerous neoplasmatic foci were found using MRI within the vermis and cerebellar hemisphere and, later, also within the brain stem, cervical spinal cord and both brain hemispheres. Bioptical examination of the tumors revealed the structure of anaplastic astrocytoma with oligodendromatous component. The authors suggest that the foci may be considered as multiple metastases from the primary cerebellar astrocytoma and the neoplastic cells might have been transported within CNS through cerebrospinal fluid.

Autoimmune hepatitis in transplanted liver.

Liver transplantation is recognized as the appropriate treatment for end-stage liver disease. Four patients undergoing liver transplantation for classical end-stage liver disease developed de novo autoimmune hepatitis (AIH) in the graft. Recurrence of AIH after orthotopic liver transplantation and after reduction in immunosuppressive treatment is reported in one other patient. Markedly elevated serum transaminases were observed, together with an elevated serum IgG and/or globulin fraction and histological feature typical of AIH on liver biopsy.

[Multiple pleomorphic xanthoastrocytoma tumors in a 12-year-old girl]. / Przypadek mnogich guzów xanthoastrocytoma pleomorphicum u 12-letniej dziewczynki.

This report presents a case of multiple bilateral hemispheric tumours (pleomorphic xanthoastrocytoma) in a practically asymptomatic 12-years-old girl. The tumours were removed radically in a staged procedure, with a favorable clinical outcome. Clinical history and neuropathologic findings are described. A review of pertinent literature is included.

[Hippel-Lindau disease. Description of 2 cases]. / Choroba Hippel-Lindau'a. Opis 2 przypadków.

The authors describe two cases of Hippel-Lindau's disease, one of them associated with numerous morphological changes. The authors discuss the diagnostic criteria of this disease and certain aspects of its inheritance, therapeutic management and prognosis.

[Needle testicular biopsy in the diagnosis of male infertility]. / Iglowa biopsja jader w diagnostyce nieplodnosci meskiej.

OBJECTIVES: Evaluation of testicular tissue is very important diagnostic procedures in cryptozoospermia and azoospermia. It is verified the patient for treatment (stimulation spermatogenesis), for micromanipulation ICSI or for insemination donor semen procedure. Surgical biopsy is very popular between andrologist and urologist, but needle biopsy seems to be easier and safer. DESIGN: The authors present their experience with needle testicular biopsy during the diagnosis patients with azoospermia or cryptozoospermia and the men with paraplegia after trauma and without ejaculation. MATERIAL AND METHODS: The study group included 63 biopsies in 58 men with azoospermia and severe oligoasthenozoospermia (cryptozoospermia) and 2 with paraplegia. The specimens were taken from 125 testes under general anesthesia (i.v-Diprivan, Propofol, Zeneca and Fentanyl) using biopsy needle from Hepafix B. Braun Melsungen, Germany. All procedures were performed as a day case. RESULTS: In 95% specimens were adequate for histopathological investigations and for planning the treatment. Only one complication (0, 8%) -small haematoma testis was observed. CONCLUSIONS: The needle biopsy of testicular tissue is sufficiency in histopathological examination, safe for patients and easy for urologists. The total cost is much more lower than cost of surgical biopsy.

[Tubulointerstitial nephritis related to immunotherapy and immunostimulation: a report of two cases]. / Sródmiazszowe zapalenie nerek zwiazane ze stosowaniem immunoterapii i leków immunostymulujacych--opis 2 przypadków.

Two cases of tubulointerstitial nephritis (TIN) with renal failure related to immunotherapy (case 1) and immunostimulation (case 2) have been described. Case 1: 18 years old male patient with hay fever was admitted because of rapid increase of serum creatinine from 1.1 mg/dl to 5.5 mg/dl, fever, weight loss and anemia which developed during 6 months after second course of immunotherapy. Case 2: 12 years old boy was admitted because of fever, weight loss and rapid progression to renal failure after treatment of pharyngitis with antibiotics and immunostimulant drug. In both patients renal biopsy was performed and TIN with huge lymphocytes T infiltrates was diagnosed. After 6 months treatment with corticosteroids renal function turned back to previous levels in both patients. Pathogenesis and treatment of TIN is discussed.

[Successful treatment with alpha-interferon of HBV and HDV coinfection. Case report of a 4-year-old boy]. / Zakazenie HBV i HDV. Opis skutecznego leczenia interferonem alfa u 4-letniego chlopca.

The authors present a case of chronic active hepatitis due to HBV and HDV coinfection. Because of high biochemical and histopathological activity with coexisting hepato- and splenomegaly, treatment with alpha interferon was initiated. HBe/anti-HBe seroconversion and normalisation of biochemical and patomorphological paramethers were achieved.

First experience using navigation-guided radiofrequency kyphoplasty for sacroplasty in sacral insufficiency fractures.

PURPOSE: To evaluate the efficacy and safety of navigation-guided radiofrequency kyphoplasty for sacroplasty in patients with sacral insufficiency fractures. METHODS: In this single-center retrospective observational study, four consecutive patients with sacral insufficiency fractures were treated with navigation-guided radiofrequency kyphoplasty for sacroplasty between April 2010 and May 2012. Symptom characteristics, pain duration and pain intensity were recorded for each patient. Cement extravasation was evaluated in thin-sliced and triplanar reconstructed CT scans of the sacrum. RESULTS: Four female patients with painful sacral insufficiency fractures and extensive osteopenic areas significantly improved from an average pre-treatment VAS score of 8.3 ± 0.5 to 2.3 ± 1.0 (p < 0.001) on the first postoperative day and to 1.3 ± 1.9 (p < 0.004) at follow-up (mean, 20.1 weeks). Slight cement extravasations were observed without evidence of being symptomatic. No major complications or procedure-related morbidity were noted. CONCLUSION: From the limited experience in four patients, navigation-guided radiofrequency kyphoplasty appears to be a safe and effective treatment option for sacral insufficiency fractures even though asymptomatic cement extravasation was noted. The use of navigation based on intraoperative 3 D images simplifies the positioning of the navigated bone needles via the long axis approach. The radiofrequency kyphoplasty system provides the possibility to administer a sufficient amount of bone cement with a well-defined viscosity over the entire period of the procedure leading to high security and low cement extravasation. Sacroplasty provides rapid and enduring pain relief and facilitates prompt mobilization.

Liver transplantation for severe hepatic graft-versus-host disease in two children after hematopoietic stem cell transplantation.

Chronic graft-versus-host disease (GVHD) is a frequent complication of bone marrow transplantation (BMT). After the skin, the liver is the second, most frequent target of GVHD, which presenting with hyperbilirubinemia, elevated liver enzymes, and coagulopathy. Progressive destruction of small intrahepatic bile ducts causes vanishing bile duct syndrome and leads to end-stage liver disease. We report 2 successful cases of orthotopic liver transplantation performed in children with severe GVHD after hematopoietic stem cell transplantation from a matched unrelated donor (HSCT-MUD).

Vascularization and morphology of carotid bodies in patients with essential hypertension.

Vascularization and morphology of carotid bodies in 100 necropsies of patients with essential hypertension in comparison with the 83 normotensives were studied. The statistically significant differences between the two groups were found. The carotid bodies of hypertensive subjects were vascularized by a lower number of arteries than those of the normotensives. This difference seems to be genetically determined. The mean combinated mass of carotid bodies of hypertensive subjects was higher than this of normotensive ones. The hyperplasia of the type I cells in carotid bodies of hypertensives was found. The subjects with a lower number of glomic arteries are more susceptible to disturbation of blood flow to the carotid body, overstimulation of carotid chemoreceptors and consequent hypertension. The results of study done may support the concept of the possible role of carotid body in the pathogenesis of essential hypertension.

[Disorders of myocardial function in patients with normal coronary angiography]. / Myokardfunktionsstörungen bei Patienten mit normalem Koronarogramm.

An attempt is made to estimate the value of intraventricular injection of contrast media in the procedure of angiocardiography for registration of a latent disease of the myocardium. For this purpose the parameter of the cardial function of 350 patients are analysed depending on the severity of the coronary heart disease. Under resting conditions the left ventricular end-diastolic pressure (LVEDP) of patients with coronary heart disease was 19.9 +/- 7.98 mmHg. The LVEDP of patients with the angina pectoris syndrome but normal epicardial coronary arteries was 15.6 +/- 5.45 mmHg. The LVEDP of the most of the patients rose after injecting contrast medium in the left ventricle independent of the resting level. Patients with coronary heart disease had a LVEDP of 23.7 +/- 9.48 mmHg after injecting the contrast media, while patients with normal coronary arteries had a LVEDP of 19.2 +/- 7.21 mmHg. The left ventricular systolic pressure and the parameters of contractility did not change significantly after injecting contrast media. The injection of contrast medium into the left ventricle--i.e. the ventriculography--is in a qualified sense a volume stress to the left ventricle. That means an increase of a normal LVEDP after an injection of contrast medium uncovers a preclinical disease of the left ventricular myocardium.

[QT dispersion in surface ECG and QT dynamics in long-term ECG in patients with coronary heart disease in the chronic post-infarct stage with and without ventricular tachyarrhythmias--correlation with other risk parameters]. / QT-Dispersion im Oberflächen-EKG und QT-Dynamik im Langzeit-EKG bei Patienten mit koronarer Herzerkrankug im chronischen Postinfarktstadium mit und ohne ventrikuläre Tachyarrhythmien--Korrelationen mit anderen Risikoparametern.

QT-dispersion (QTD) in 12-lead surface-ECG and QT-dynamics in Holter-ECG, defined as the time-course of the frequency corrected QT-interval (mQTc), were determined in 42 patients with coronary artery disease in chronic postinfarction stadium without ventricular tachyarrhythmias (CAD/VTA-) and in 24 CAD patients with ventricular tachyarrhythmias (CAD/VTA+). 14 healthy volunteers served as control group (CG). Correlations with hemodynamic data (LVEF, severity of CAD) and with other risk-parameters (ventricular late potentials, short-time heart rate variability) were calculated. QTD in CAD/VTA-was significantly higher compared to CG (48.4 ms+/- 19.6 vs 31.4 ms +/- 9.8, p < 0.05). There were no intergroup differences in QT-dynamics. CAD/VTA+ patients showed the highest QTD-values (59.5 ms +/- 31.1, p < 0.05 compared to CG/CAD/VTA0) and a significantly altered QT-dynamics compared to CG/CAD/VTA- (mQTc: 431.3 ms +/- 38.8 vs 400.8 ms +/- 25.5 vs 406.3 ms +/- l0.6, p < 0.05). Only parameters of QTD were significantly correlated to severity of CAD (r = +0.41, p < 0.01) and to LVEF (r = 0.43, p < 0.01). We did not find significant correlations between the parameters of QT-dispersion/QT-dynamics among one another and to the risk-parameters. These results indicate that the QT-dispersion in CAD-patients also in chronic post-infarction stadium is elevated and that CAD-patients with VTA are characterized by an altered QT-dynamics. Parameters of both methods are independent of other validated risk-parameters. So the measurement of QT-dispersion and QT-dynamics as markers of inhomogenous repolarization could contribute to an improvement of risk-stratification of CAD-patients.

Radial arm maze performance of mice: acquisition and atropine effects.

CD-1 mice were successfully trained in a six-arm radial maze in which half of the arms were baited, a procedure which had been used to differentiate between reference and working memory. Stable performance was achieved following eight daily training sessions, as measured by decreasing running time and number of errors. This finding strengthens the foraging hypothesis as a basis for the performance of rodents in the radial maze. Acute subcutaneous administration of the cholinergic antagonist atropine sulfate (1-6 mg/kg) to trained mice produced dose-related increases in running time and working memory errors, with a slight decrease in reference memory errors. This is in agreement with other studies on the role of the cholinergic system in memory processes. The peripheral cholinergic blocker, atropine methyl nitrate (4 mg/kg), somewhat increased running time without decreasing performance accuracy. In contrast to the prolonged pharmacological and physiological effects of atropine, behavioral decrements disappeared within 3 hr. It is concluded that mice trained in the radial arm maze may be used for screening of the effects of drugs on cognitive function.