model of end-stage liver disease [MELD] score in predicting postoperative liver failure after hepatic resection of hepatocellular carcinoma in cirrhotic patients: the Tunisian experience

Hepatocellular carcinoma [HCC] is one of the most frequent cancers in the world. Factors associated with prognosis following resection remain ill defined. The model for end-stage liver disease [MELD] is considered as an index of hepatic functional reserve. This study evaluates the reliability of the MELD score in the prediction of liver failure after hepatic resection for HCC in cirrhotic patients. A retrospective chart review was undertaken of patients with HCC and cirrhosis undergoing hepatic resection between January 1991 and December 2007. A total of 26 cirrhotic patients underwent curative hepatic resection for HCC at our department. Patient information included demographic features, American Society of Anesthesiologists [ASA] class, etiology of cirrhosis, laboratory test results, type of surgical procedure, duration of hospitalization, and Child-Turcotte-Pugh and MELD score. Six patients [23.1%] developed postoperative liver failure. AS much as 66.66% of liver failures were seen in patients who have had major hepatectomy. Using receiver operating characteristic curve analysis, we identified that a MELD score equal to or above 9.5 is the best cut-off value for predicting postoperative liver failure. Patients were divided into two groups: MELD below 9.5 [group A] and MELD equal to or above 9.5 [group B]. The highest prevalence of postoperative liver failure of 83.33% was observed in group B. MELD score >/= 9.5 and low serum sodium are strongly predictive of increased postoperative liver failure in patients with cirrhosis undergoing hepatic resection of HCC. The presence of liver cirrhosis is an important factor that affects the prognosis of patients with hepatocellular carcinoma [HCC]. Cirrhotic patients with a high MELD score are at high risk of postoperative liver failure and complications and should be referred for non-surgical treatment

Isolated adenomatous polyposis of the appendix. Report of two cases

Adenomas are rarely diagnosed in the appendix and may be isolated or may coexist with other neoplasms in the gastrointestinal tract. This emphasizes the need for postoperative colonoscopy when a polyp of the appendix is found. Moreover, the polyps are considered to be premalignant lesions. Report two new cases of adenomas of the appendix. We report the cases of 23-year-old and 22-year-old men, for whom appendicectomy performed for acute appendicitis. In both cases, histologic studies revealed adenomas in moderate dysplasia colonoscopy did not reveal any polyps

[About a uncommen trichoepithelioma: the giant solitary trichoepithelioma]

A case of giant solitary trichoepithelioma of the perianal region is described so to drow attention to this rare benign neoplasme and to discuss its clinical and histopathologycal caracteristics

[Concurrent occurrence of a gasteric cancer with a hepatocellulary carcinoma: report of a case: incidental or causal association?]

Little information regarding synchronous gastric cancer associated with hepatocellular carcinoma is available and has been sporadically reported. We report a new case of 60 years old patient operated for gastric carcinoma. The radiological investigations revealed a hepatic nodule which correspond to a hepatocellular carcinoma on histological examination. The aim of this study is to clarify the clinicopathologic and therapeutic features of this association