Percutaneous liver biopsy.

Percutaneous liver biopsy has been performed for more than 120 years, and remains an important diagnostic procedure for the management of hepatobiliary disorders. Modern biochemical, immunologic, and radiographic techniques have facilitated the diagnosis and management of liver diseases but have not made liver biopsy obsolete. This comprehensive review article will discuss the history of development of percutaneous liver biopsy, its indications, contraindications, complications and the various aspects of the biopsy procedure in detail.

Hepatic hydrothorax.

Hepatic hydrothorax is defined as significant pleural effusion (usually greater than 500 mL) in a cirrhotic patient, in the absence of underlying pulmonary or cardiac disease. The diagnosis of hepatic hydrothorax should be suspected in a patient with established cirrhosis and portal hypertension, presenting with unilateral pleural effusion, most commonly rightsided. Hydrothorax is uncommon, and is found in 4–6% of all patients with cirrhosis and up to 10% in patients with decompensated cirrhosis. Although ascites is usually present, hydrothorax can occur in the absence of ascites. Patients with hepatic hydrothorax usually have advanced liver disease with portal hypertension and most of them require liver transplantation. Current insight into the pathogenesis of this entity has led to improved treatment modalities such as portosystemic shunts (TIPS) and video-assisted thoracoscopy for closure of diaphragmatic defects. These modalities may provide a bridge towards transplantation.

Management of HCV infection: Current issues and future options.

Hepatitis C virus (HCV) is a common cause of chronic liver disease (CLD). Presently the standard regime comprises a combination of PEG-IFN and ribavirin. Sustained virologic response (SVR) is defined as the absence of HCV RNA in the serum six months after the end of treatment . With standard treatment, in patients with genotype1 infections, SVR lies between 42% to 56%, whereas for genotypes 2 and 3 the SVR is from 76% to 82%. Thus, a large percentage of patients fail to achieve SVR even with improvised standard treatment. Such patients may be divided initially into relapsers and nonresponders. The decision to re-treat should be based on the presence of clinical, virological and histological factors that predict the possibility of successful outcome with further therapy. Both the type of previous therapy and previous response are very important factors in guiding re-treatment. The development of new therapeutic agents is critical for further improvement in the management of chronic hepatitis C as current therapeutic options have rather low efficacy in certain subgroups, such as those with HCV genotype 1 or patients with advanced liver disease, and most probably in nonresponders and relapsers. Moreover, pegylated IFNa and/or ribavirin are associated with frequent side effects and have a negative impact on the patient’s quality of life. Therefore, the development of new effective and safe drugs is a matter of significant clinical importance.

A case of primary rectal non-Hodgkin's lymphoma treated with chemotherapy.

Primary rectal non-Hodgkin's lymphoma is a rare disease. Surgery has been proposed as the primary treatment modality for colorectal lymphomas. We report a case of rectal non-Hodgkin's lymphoma (B cell large cell type, Ann Arbor Stage 1E) who responded completely to systemic chemotherapy.

Inflammatory pseudotumour of the liver: a diagnostic dilemma.

Inflammatory pseudotumour is a rare, focal, benign inflammatory lesion of the liver parenchyma. It is largely a self-limiting entity and has favorable prognosis; it is thus important to preoperatively distinguish this lesion from malignancy, which it closely imitates. Inflammatory pseudotumour may present variously. We present the case of a 54-year old gentleman who presented with a three-month history of low-grade intermittent fever. Ultrasonography and computed tomography revealed a mass in the left lobe of the liver and the erythrocyte sedimentation rate was raised with coincident hypergammaglobulinaemia. A diagnostic laparotomy with left lateral hepatectomy was performed and histopathological evaluation of the specimen along with special staining and tissue culture revealed an inflammatory pseudotumour. On the second day post-operative the fever subsided and following an uneventful five days the patient was discharged and remains well at one-year follow up with no recurrence or relapse.

Spontaneous bacterial peritonitis in isolated splenic vein thrombosis with portal hypertension.

Spontaneous bacterial peritonitis (SBP) is a known complication of ascites due to cirrhosis; it has also been reported in some non-cirrhotic conditions with ascites. We report a 50-year-old lady with isolated splenic vein thrombosis who developed SBP due to E. coli .

Non-familial juvenile polyposis with histological evidence of adenomatous transformation.

A 14-year-old male presented with abdominal pain, diarrhoea and a sensation of something prolapsing through the anus during defecation, and was found to have diffuse colonic polyposis. There was no evidence of mucocutaneous hyperpigmentation and family history was negative, suggesting a diagnosis of non-familial juvenile polyposis. Histological analysis of multiple endoscopic biopsies showed features typical of juvenile or retention type (hamartomatous) lesions: dilated cystic glands lined by mucocus-secreting epithelium and prominent, inflamed and congested lamina propria. However, admixed with these features, focal areas of atypical adenomatous changes were recognized. Even the intervening normal-looking colonic mucosa showed some dysplastic changes. These findings indicate that hamartomatous and atypical adenomatous epithelial changes can co exist in non-familial juvenile polyposis and the latter may confer a risk of malignant transformation in this otherwise non-neoplastic disease.