Little is known about the prognostic ability of post-liver transplantation (LT) model for end-stage liver disease (MELD) score measurement in assessing long-term outcomes. The aim of the present study was to investigate this possible relationship.In this retrospective cohort study, the medical records of LT recipients operated under a LT program were reviewed. The accuracy of post-operation MELD score for predicting mortality was evaluated based on receiver operating characteristic (ROC) curves. Univariate and Cox proportional hazard regression models were used to assess the risk factors associated with mortality.Eight hundred twenty-six consecutive LT recipients were included in the study. The areas under the ROC curve on postoperative days (POD) 5 and 9 for predicting 1-year mortality were 0.712 (95% confidence interval [CI] 0.614-0.811) and 0.682 (95%CI 0.571-0.798), respectively. A cutoff point of 14.5 was obtained for MELD score on POD5 that significantly differentiated between survivors and non-survivors with a sensitivity of 69.8% (95%CI 50.7-83.1) and a specificity of 57.2% (95%CI 50.6-63.6). In the Cox multivariate analysis, factors including MELD score on POD5 (hazard ratio [HR] 1.83, 95%CI 1.07-3.12; P=0.026), pre-transplant MELD (HR 1.064, 95%CI 1.025-1.104; P=0.001) and operation duration (min) (HR 1.004, 95%CI 1.003-1.006; P=0.013) were identified as independent risk factors for predicting overall survival.The immediate postoperative MELD scores after LT may be of value in predicting mortality and could be used as a tool for postoperative risk assessment of patients.
Background and Purpose: The best access for hemodialysis is an autologous arteriovenous fistula (AVF). The most helpful way for vasodilation in the upper limb is stellate ganglion block. We aim to evaluate the effect of stellate ganglion block on outcome of vascular access for dialysis. Materials and Methods: Some 105 hemodialysis patients were randomly allocated to three groups: In group 1, stellate ganglion block was performed before fistula surgery. Group 2 had stellate ganglion block after surgery and group 3 was control group without any block. Primary outcome for all groups was functional dialysis, which is defined as successful hemodialysis for 1 month. Results: The three groups were similar in age, gender, and underlying diseases. Stellate ganglion block before operation had a meaningful increase in successful hemodialysis rate, when compared with the other groups (p = 0.02). Conclusion: Stellate ganglion block before arteriovenous fistula surgery in the upper limbs improves hemodialysis success rate.
Oesophageal cancer is endemic in some regions of the Islamic Republic of Iran and efforts have been made to find factors that play a role in its prognosis.We retrospectively examined the correlation of serum alkaline phosphatase (ALP) levels with several clinicopathological characteristics of 207 cases of oesophageal carcinoma.The mean ALP level in patients with lymph node involvement was significantly higher [141 (SD 77) U/L] than with node negative cancers [116 (SD 63) U/L].Patients with ALP levels > 165 U/L were 3.29 times more likely to have lymph node involvement than patients with ALP levels ≤ 165 U/L.There was no statistically significant correlation between ALP level and sex, age, tumour histological type, site and size of tumour, depth of penetration, distant metastasis, degree of differentiation, presence of lymphatic invasion and presence of simultaneous multiple cancers.Elevated ALP in patients with oesophageal cancer may predict lymph node involvement.
The tumour markers CEA, AFP, CA 125 and CA 199 were analyzed in a group of apparently healthy subjects in Kuwait. The sample (n = 394) included both genders in the population with a mean age of 38 (S.d. 12.0) years. The distribution of CEA levels values was significant different (Mann-Whitney U test) between Kuwaiti and non-Kuwaiti. The distribution of AFP levels was found to be the same in all groups. The distribution of CA 125 levels was significantly higher in females than in males, both in Kuwaiti and non-Kuwaiti. The distribution of CA 19-9 values was found to be significantly higher in the Kuwaiti female group when compared to the males. The upper reference level was defined as the 95 percentile of the normal values in each group. In the total population the reference level of AFP was 5.6 micrograms/l and of CA 19.9 43 kU/l. The reference level of CA 125 was 16 U/l in males and 24 kU/l in females, respectively. The CEA reference level in Kuwaitis was 6.9 micrograms/l and in non-Kuwaitis 4.4 micrograms/l. The results indicated the importance of determining the reference levels of tumour markers for each individual laboratory. It was also emphasized that care should be taken on the impact of 95 percentiles of normal and benign disease groups.
ackground: During the pandemic of COVID-19, the overwhelm of infected patients created an exponential surge for ICU and ward beds. As a result, a major proportion of elective surgeries was postponed. However, various emergency and urgent procedures were allowed. Due to the mortality complications of hepatopancreatobiliary issues, we decided to afford urgent procedures under intensive protective arrangements. Method and results: In our ward (liver transplant), 4 ICU beds and 16 ward beds were allocated to non-COVID-19 patients. A total of 36 hepatopancreatobiliary procedures were managed for one month. All the surgeries were afforded under personal protective equipment and other intensive protective arrangements for personnel and patients. During 6 weeks following the surgery, all patients were followed up through telemedicine and no new case of COVID-19 was detected. Conclusion: In general, it appears that intensive protections could significantly reduce the number of COVID-19 incidence among patients with co-morbidities who undergo invasive procedures.
: Solitary fibrous tumors (SFTs) are mesenchymal tumors that mostly occur in the pleural cavity. Extra-thoracic location is rare and hepatic origin is extremely rare. Most lesions are benign, 10% - 15% show aggressive behavior and few metastasizing SFTs have been reported. Imaging features of solitary fibrous tumors of the liver (SFTLs) are nonspecific and definite diagnosis usually needs histopathological and immunohistochemistry evaluation. We report ultrasound, CT and MRI features of such a rare malignant SFTL in a 47-year-old man who came with vague abdominal symptoms in detail along with reviewing literature considering imaging features which is valuable for radiologists. The lesion seen as a huge dominantly cystic lesion on ultrasound was initially misinterpreted as hydatid. On CT scan it was seen as a large encapsulated mass with arterial hyper-enhancement and delayed contrast retention and multiple cystic spaces. On MRI, solid components showed iso-intensity to adjacent liver on T1 and T2 images, small areas of restriction on diffusion weighted imaging (DWI) and few hemorrhagic cystic components beside enhancement pattern and multiple large cystic components similar to CT scan. Our patient was admitted for resection of huge hepatic mass and experienced an episode of altered mental status due to hypoglycemia during hospital admission, which is a rare finding in SFTL. The patient underwent right hepatectomy and solitary fibrous tumor was confirmed on pathologic examination of the resected tumor. Hypoglycemic episodes were resolved and the patient was asymptomatic in 28 months follow-up.
Objectives: To investigate the feasibility, safety, and efficacy of percutaneous sclerotherapy using intralesional bleomycin injection in reducing the symptoms and volume of the Giant Liver Hemangiomas. Methods: This prospective study was conducted from April 2016 to June 2019. Patients with persistent abdominal pain or discomfort directly caused by hemangioma (confirmed by computed tomographic scan) who refused surgical option were included. Patients with any coagulopathy states (platelet count <100,000 or international normalized ratio >1.5) were excluded. All demographic variables and laboratory tests as well as patients' symptoms and complaints during this period were recorded. All procedures were performed in an outpatient setting under local anesthesia. Patients underwent percutaneous intralesional sclerotherapy using bleomycin-lipiodol mixture under fluoroscopic guidance. All early and late complications, if any, were recorded. GLH volume and three-dimensional diameters as well as pain severity (according to visual analog scale [VAS]) were documented before and 36 months after the procedure. Results: Five patients (4 [80%] females, mean age: 43.8 years, range 33–51) were recruited for the current survey. Mean GLH volume was 378.60 ± 229.80 cc before the sclerotherapy, which was dropped to 143.20 ± 165.54 cc (71.3% ± 19.9%) on the 36-month follow-up (P < 0.001). Mean GLH's longest diameter before the procedure was 108.60 ± 18.76 mm, which was declined to 64.60 ± 33.71 mm (42.6% ± 20.5%) (P = 0.035). Patients' VAS score before the procedure was 8.60 ± 0.89, which was decreased to 4.40 ± 1.14 on the follow-up (P = 0.002). Liver function tests revealed no abnormalities before the procedure, 1 day after the treatment, and on the 36-month follow-up. No allergic reaction was observed. One of our patients had self-limiting intraperitoneal hemorrhage which led to a 3-day hospital stay and then was discharged with stable condition. No other early or late complication was detected. Conclusion: Percutaneous sclerotherapy is a relatively safe and effective method in GLH treatment. Further investigations in larger samples and in comparison with control group (in clinical trial setting) are required to confirm the current findings.
Hepatitis B immunoglobulin prophylaxis in combination with antiviral drugs is recommended for prevention of hepatitis B virus reinfection after liver transplant. However, there is no consensus on a standard prophylactic method, and controversy exists over the duration, dose, and route of administration. We conducted a prospective study to evaluate the safety and effectiveness of intramuscular hepatitis B immunoglobulin in combination with lamivudine and/or tenofovir and discontinuation of hepatitis B immunoglobulin after 1 year for prevention of hepatitis B virus reinfection.Patients with hepatitis Brelated liver cirrhosis who had undergone primary liver transplants were enrolled. The prophylactic protocol involved intraoperative intramuscular hepatitis B immunoglobulin at 10 000 IU, tapering to 5000 IU daily for the first 6 days, weekly for a month, every 2 weeks for the next month, and monthly for a year after liver transplant, in combination with antiviral drugs.From January 2002 until March 2014, two hundred sixty-eight liver transplants were performed. Forty-four patients (16.4%) who underwent liver transplants due to hepatitis B-related liver failure were enrolled. Five patients had hepatocellular carcinoma; 20 had both hepatitis D and hepatitis B virus infection. The median age was 47 years (range, 26-59 y) with a median model for end stage liver disease score of 20. Thirty-three patients were men (76%). Sixty-one percent of patients were negative for hepatitis B virus DNA at the time of transplant. The median follow-up was 13.6 months (range, 0-142 mo). Only 1 patient (2.3%) experienced hepatitis B virus reinfection (at 44.7 months posttransplant), which was successfully treated with tenofovir. Five patients died (11.4%) during the follow-up from nonhepatitis B causes.Intramuscular hepatitis B immunoglobulin in combination with lamivudine or tenofovir and discontinuation of hepatitis B immunoglobulin after 1 year posttransplant may provide safe and cost-effective protection against posttransplant hepatitis B reinfection.
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