Histopathological study of chronic hepatitis B: a comparative study of Ishak and METAVIR scoring systems

Ishak and METAVIR scoring systems are among the most commonly used histopathological systems to evaluate chronic hepatitis. To assess the level of agreement between these two scoring systems in patients with chronic hepatitis B. Liver biopsy samples taken from 92 patients with chronic hepatitis B were considered as the training set; 57 more biopsy specimens were used as the validation set. In the training set, grade of necroinflammation and stage of fibrosis for each liver biopsy specimen were determined by two expert liver pathologists using both Ishak and METAVIR systems. Inter-observer variability between the two pathologists was evaluated. Biopsy specimens of the validation set were seen and scored by a third expert pathologist. In the training set, criteria were developed to categorize Ishak grading and staging systems separately to best fit with the METAVIR scoring system. The criteria found in the training set, was then tested in the validation set. The level of agreement between the two scoring systems was assessed by weighted kappa statistics. For the training set, agreement between the two pathologists was excellent. Using our proposed criteria in the training set, there was excellent level of agreement in grading [Kappa = 0.89] and staging [Kappa = 0.99] between Ishak and METAVIR systems. In the validation set, the criteria led to substantial correlation [Kappa = 0.61] in grading, and excellent correlation [Kappa = 0.94] in staging between the two systems. Using our proposed criteria, excellent or at least substantial concordance between Ishak and METAVIR scoring systems can be achieved for the degree of both necro-inflammatory changes and fibrosis

[Bacterial contamination at ANH autologous transfusion]

In Acute Normovolemic Hemodilution [ANH] which is practiced in operating room, whole blood is removed from a patient [while restoring the circulating blood volume with simultaneous infusions of suitable volume] shortly before or after the induction of anesthesia. This method is devoid of the major complications of homologous transfusion especially infectious diseases, except for the risk of bacterial contamination. This study aimed to evaluate the rate of blood contamination in ANH autologous transfusion. In a cross sectional study, prevalence rates of bacterial contamination at ANH autologous transfusions on 71 patients in two separate centers in Tehran were compared. From each patient, 1-3 blood bags were taken from arterial line. Before transfusion, 10 ml of the blood was sampled and cultured in "Brain Heart Infusion Broth". After inspecting the cultures, the bacterial contamination rate was calculated. There were 96 samples but no positive culture was reported. The mean peri-operation bleeding of 7 patients [9.8%] was 2457 ml and their Hb counts was low [<10].It is while they received on average only 1.4 bags of homolougus blood, the mean Hb counts before operation and after were 14.53 and 12.44, respectively. In this study which was performed at two separate medical centers no bacterial contamination due to ANH transfusion was observed showing ANH safety as far as bacterial contamination is concerned

[ study of morphologic criteria and prognosis in serous ovarian tumors]

Background: the borderline or low malignant potential category of ovarian tumors was established because of the observation that a group of proliferative epithelial ovarian tumors lacking invasion that generally behaved in a benign fashion. The purpose of this study is determined the effects of different prognostic factors on survival and relapse of serous borderline tumors that is the most common histologic type

Materials and Methods: 15 patients with previous diagnosis of SBTs enter a survival study and evaluated for the presence or absence of necrosis, associated inflammation, micropapillary/cribriform, FIGO stage and treatment procedure on two clinical conditions of overall survival and disease free survival

Results: the mean age at the time of diagnosis was 35 years [range, 16-68]. The histopathological diagnosis was typical SBTs in 6 patients [40%], SBTs-IEC in 4 patients [20%], SBTs-Mp in 4 patients [26%] and finally SBTs-mi in 2 patients [13.3%]. Statistically difference in the age [P- Value = 0/58] and size [P-Value 0.68] were not found to be significant. Thirteen patients have stage=1 [87%], two patients [13%] had stage>1. The recurrence rate was found in 7% [1 case]. The overall survival was 100% and the disease free survival was 93%. After analysis just a statistically significant relation between high stage, necrosis and mitotic index 10/HPF and disease free survival were obtained [P-value = 0/016]. We did not achieve to statistically significant relation between others histologic feature and disease free survival and In conclusion overall survival

Conclusion: serous low malignant potential tumors have excellent survival and the patients can be treated safely by conservative surgery. The effect of FIGO on survival is consensus when the effects of others factors there are many controversies in the literature. Thus due to imitation of our number of case in each subgroup studies with adequate samples and long follow-up is recommended