Résumé
There is increased prevalence of hepatocellular carcinoma [HCC] among African Americans [AA]. Multicenter studies have shown advanced presentation, underutilization of treatment and decreased survival following liver transplantation [LT] among AA. However outcomes from single centers are not well reported. To determine the outcome of AA undergoing LT for HCC at Cleveland Clinic, Cleveland, Ohio, between May 2007 and December 2009. 245 consecutive patients undergoing evaluation and treatment for HCC within the mentioned time frame were studied, retrospectively. 80% of patients were male, 75.5% were Caucasian, 16.7% were AA and 7.8% were other ethnic groups. Compared to other ethnicities, AA subjects with HCC were more commonly female and were more likely to have hepatitis C virus [HCV] [83% vs. 51%, p<0.001]. There were higher occurrence of HCV genotype 1 among AA compared to others among patients with this information [100% vs. 65%, p<0.001]. In contrast to previous reports, there was no significant difference between the groups in terms of clinical presentation or management. 27% of AA underwent liver transplantation compared to 28% of the rest [p=0.88]. Of the 68 patients who had LT, 9% died with no difference in post-LT survival between the two groups. HCV [and genotype 1] is a significant risk factor for HCC in the AA population. LT results in similar survival compared to other ethnicities. AA patients with HCC benefit equally from LT compared to other ethnicities
Résumé
Over the last 50 years, significant progress has been made in the surgical repair of thoracoabdominal aortic aneurysms [TAAA]. Improvements in perioperative care and surgical techniques have resulted in reductions in complication and mortality rates. Adjunctive use of distal aortic perfusion and cerebrospinal fluid drainage has been especially helpful, reducing the incidence of neurological deficits to 2.4%. Current research is aimed at improving organ preservation. This review focuses on the current diagnosis and management of TAAA