Cắt gan trung tâm ở trẻ 6 tháng tuổi bị u nguyên bào đã điều trị hóa chất

TÓM TẮT Bệnh nhi 6 tháng tuổi được chẩn đoán u nguyên bào gan, ban đầu được xem là không thể cắt bỏ được vì khối u có kích thước lớn và lan tỏa. Bệnh nhân được điều trị 4 đợt hóa chất cisplatin với thời gian cách nhau 2 tuần. Kết quả chụp cắt lớp vi tính sau 4 đợt hóa trị cho thấy khối u đã thu nhỏ lại và có thể cắt bỏ. Khối u đã được cắt bỏ bằng phương pháp phẫu thuật cắt gan trung tâm. Bệnh nhân đã có thể ăn uống trở lại vào ngày thứ tư và xuất viện vào ngày thứ bảy sau mổ. Bác sĩ chuyên khoa nhi ung bướu đã theo dõi bệnh nhân bằng siêu âm gan, alpha - fetoprotein và tiếp tục điềutrị thêm 2 chu kỳ cisplatin. ABSTRACT CENTRAL HEPATECTOMY IN A 6 - MONTH - OLD CHILD WITH HEPATOBLASTOMA FOLLOWING CHEMOTHERAPY A hepatoblastoma in a 6 - month - old child was initially considered unresectable because of diffuse liver involvement. The patient received 4 courses of cisplatin with an interval time of 2 weeks. A computed tomography scan after 4 courses of chemotherapy showed shrinking of the tumor, which made it resectable, and the tumor was removed by central hepatectomy. The patient was able to eat a regular diet on the fourth day and was sent discharge on the seventh day, after the operation. The pediatric oncologist followed the patient with liver ultrasonography and alpha - fetoprotein and administered 2 more cycles of cisplatin. Keywords: Central Hepatectomy, Hepatoblastoma, children.

Central Hepatectomy in a 6-Month-Old Child with Hepatoblastoma following Chemotherapy

A hepatoblastoma in a 6-month-old child was initially considered unresectable because of diffuse liver involvement. The patient received 4 courses of cisplatin with an interval time of 2 weeks. A computed tomography scan after 4 courses of chemotherapy showed shrinking of the tumor, which made it resectable, and the tumor was removed by central hepatectomy. The patient was able to eat a regular diet on the fourth day and was sent home on the seventh day, after the operation. The pediatric oncologist followed the patient with liver ultrasonography and alpha-fetoprotein and administered 2 more cycles of cisplatin.

Non-Alcoholic Fatty Liver in Patients with Chylomicronemia

Non-alcoholic fatty liver disease (NAFLD) is frequent in patients with features of the metabolic syndrome (MetS), obesity, or type 2 diabetes. Lipoprotein lipase (LPL) is the main driver of triglyceride (TG) hydrolysis in chylomicrons and very-low density lipoproteins (VLDL). In some patients with MetS, dysfunction of this pathway can lead to plasma TG values > 10 mmol/L (multifactorial chylomicronemia or MCS). Chylomicronemia also characterizes LPL deficiency (LPLD), a rare autosomal recessive disease called familial chylomicronemia syndrome (FCS), which is associated with an increased risk of recurrent pancreatitis. This study aims to investigate the expression of NAFLD, as assessed by transient elastography, in MCS and FCS subjects. Data were obtained from 38 subjects with chylomicronemia; 19 genetically confirmed FCS and 19 sex- and age-matched MCS. All participants underwent liver ultrasonography and stiffness measurement after a 4-h fast using transient elastography (FibroScan®, Echosens, Waltham, MA, USA). NAFLD (controlled attenuation parameter (CAP) > 280 dB/m) was observed in 42.1% of FCS and 73.7% of MCS subjects (p = 0.05). FCS subjects had lower body mass index (BMI) than MCS. Only 25% of FCS subjects with NAFLD had a BMI ≥ 30 compared to 64.3% in MCS (p = 0.004). In FCS, NAFLD occurred even in the presence of very low (≤18 kg/m2) BMI. In both FCS and MCS, CAP was negatively associated with acute pancreatitis risk. In this study, NAFLD was commonly observed in both FCS and MCS subjects and occurred independently of the BMI and fasting glucose values in FCS; NAFLD was associated with a lower occurrence of acute pancreatitis episodes.

Studies on Biomarkers of Hepatic Lipidosis in Transition Cows with Special Reference to Liver Ultrasonograhy, Liver Specific Enzymes and Acute Phase Proteins

Background: Use of novel biomarkers is the need of hour for prediction and early diagnosis of bovine production diseases such as hepatic lipidosis (HL). Liver ultrasonography and estimation of liver specific enzymes activities have been successfully used for diagnosis of HL. However, use of inflammatory mediator like tumor necrosis factor-á (TNF–á) or acute phase proteins (APPs) like C reactive protein (CRP), serum amyloid A (SAA) and haptoglobin (Hp) as biomarkers of HL has not been elucidated. The present study was therefore designed to evaluate liver ultrasonography and serum APPs concentrations as early predictive biomarkers of bovine HL. Methods: This study included one hundred one (101) multiparous crossbred cows in advanced pregnancy from dairy farm in Punjab, India. The cows were grouped according to their transition stage i.e., Far off dry (FOD), close up dry (CUD) and Fresh (F). Liver ultrasonography along with hemato-biochemical analysis and estimation of acute phase proteins was carried out during different stages of transition period. Result: This study included 101 cows, of which 71 (70.3%) had ultrasonographic features of normal liver and 30 (29.7%) had ultrasonographic features of HL (Grade I, 10 cows; Grade II, 12 cows; Grade III, 8 cows). Cows with HL had significantly lower levels of hemoglobin (Hb), packed cell volume (PCV), total erythrocyte count (TEC), total plasma protein (TPP), glucose, total calcium (Ca) and zinc (Zn) and significantly higher levels of plasma urea nitrogen (PUN), non-esterified fatty acid (NEFA), beta hydroxyl butyric acid (BHBA), alkaline phosphatase (ALP), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), glutamate dehydrogenase (GDH), lactate dehydrogenase (LDH), TNF–á, CRP, SAA and Hp compared to the negative controls. The APPs, liver ultrasonography, liver enzymes along with NEFA and BHBA could be used as biomarkers for prediction and early diagnosis of HL in cows.

The prevalence and risk factors on different degrees of non-alcoholic fatty liver disease in Shanghai

[Background and aims]NAFLD is a common chronic liver disease. The purpose of this study is to carry out a current large-scale epidemiological survey and analyse factors related to the incidence and the severity of NAFLD.[Methods]Three communities of Shanghai were selected by stratified random sampling in 2019.The residents older than 18 years old underwent medical history taking, physical examination, laboratory examination and liver ultrasonography examination. The prevalence of different degrees of NAFLD, the prevalence of metabolic factors, and factors associated with the severity of NAFLD was analysed. [Results]A total of 19250 subjects were enrolled. The total prevalence of NAFLD in Shanghai was 45.55%, 62.00% in males and 27.54% in females. Age, FLI, BMI, WC, ALT, AST, AKP, GGT, CR, FPG, UA, TC, TG and LDL in NAFLD patients were higher than those in non-NAFLD people. The distribution of NAFLD prevalence was different in different age groups. The prevalence of diabetes, obesity and hypertriglyceridemia in the NAFLD group were higher than that in the non-NAFLD group. In males, FLI, weight, WC, ALT, UA, TG, GGT and metabolic syndrome were positively correlated with the severity of NAFLD; while HDL was negatively correlated with it. In females, age, FLI, weight, WC, ALT, FPG, UA, TG, LDL, GGT, AKP and metabolic syndrome were positively correlated with the severity of NAFLD; while HDL was negatively correlated with it.[Conclusions]The prevalence of NAFLD in Shanghai is high. The distribution of NAFLD prevalence was different in different age groups. Many factors are related to the incidence of NAFLD and the severity of NAFLD.

Baseline staging imaging for distant metastasis in women with stage I, II, and III breast cancer

Background In Ontario, there is no clearly defined standard of care for staging for distant metastasis in women with newly diagnosed and biopsy-confirmed breast cancer whose clinical presentation is suggestive of early-stage disease. This guideline addresses baseline imaging investigations for women with newly diagnosed primary breast cancer who are otherwise asymptomatic for distant metastasis. Methods The medline and embase databases were systematically searched for evidence from January 2000 to April 2019, and the best available evidence was used to draft recommendations relevant to the use of baseline imaging investigation in women with newly diagnosed primary breast cancer who are otherwise asymptomatic. Final approval of this practice guideline was obtained from both the Staging in Early Stage Breast Cancer Advisory Committee and the Report Approval Panel of the Program in Evidence-Based Care. Recommendations These recommendations apply to all women with newly diagnosed primary breast cancer (originating in the breast) who have no symptoms of distant metastasis Staging tests using conventional anatomic imaging [chest radiography, liver ultrasonography, chest–abdomen– pelvis computed tomography (ct)] or metabolic imaging modalities [integrated positron-emission tomography (pet)/ct, integrated pet/magnetic resonance imaging (mri), bone scintigraphy] should not be routinely ordered for women newly diagnosed with clinical stage i or stage ii breast cancer who have no symptoms of distant metastasis, regardless of biomarker status. In women newly diagnosed with stage iii breast cancer, baseline staging tests using either anatomic imaging (chest radiography, liver ultrasonography, chest–abdomen–pelvis ct) or metabolic imaging modalities (pet/ct, pet/ mri, bone scintigraphy) should be considered regardless of whether the patient is symptomatic for distant metastasis and regardless of biomarker profile.

Is ultrasonography useful for population studies on schistosomiasis mansoni? An evaluation based on a survey on a population from Kome Island, Tanzania

Background Observation of characteristic alterations at liver ultrasonography in clinical schistosomiasis mansoni cases has initiated utilization of this examination method in population surveys in areas where this disease is endemic. Purpose To present results of liver ultrasonography and their relation to epidemiological data of a population in an area endemic for S. mansoni, to estimate the precision of classification of periportal anatomy changes known as periportal fibrosis (PPF), and to evaluate the relevance of ultrasonography in epidemiological studies on S. mansoni. Material and Methods A total of 459 inhabitants on Kome Island, Lake Victoria, Tanzania were examined by ultrasound with image documentation by locally trained personnel. A subsample of this population, 116 individuals, was subject to ultrasonography by two examiners independently. Separately, the images were classified for PPF according to the Managil protocol, twice for the subsample. Results PPF could be classified for 458 individuals; 64% and 36% were classified as I or II, respectively; none was classified as 0; only one as III. Results were similar for the subsample examined twice. Comparing the two separate classifications of all 232 sets of images of the subsample gave a Kappa (K) value of 0.50. When comparing the classifications of each of the two different examinations of the same individuals of the subsample, K values of 0.29 and 0.34 for the first and second classification, respectively, were obtained. Conclusion Ultrasonography does not appear to correlate well with disease stage. Presently, it should not be utilized for staging of schistosoma mansoni-related liver damage in population surveys.