Systematic review: the effects of autologous stem cell therapy for patients with liver disease.

BACKGROUND: As morbidity and mortality from liver disease continues to rise, new strategies are necessary. Liver transplantation is not only an expensive resource committing the patient to lifelong immunosuppression but also suitable donor organs are in short supply. Against this background, autologous stem cell therapy has emerged as a potential treatment option. AIM: To evaluate if it is possible to make a judgement on the safety, feasibility and effect of autologous stem cell therapy for patients with liver disease. METHODS: MEDLINE and EMBASE were searched up until July 2013 to identify studies where autologous stem cell therapy was administered to patients with liver disease. RESULTS: Of 1668 studies identified, 33 were eligible for inclusion evaluating a median sample size of 10 patients for a median follow-up of 6 months. Although there was marked heterogeneity between studies with regards to type, dose and route of delivery of stem cell, the treatment was shown to be safe and feasible largely when a peripheral route of administration was used. Of the studies which also looked at biochemical outcome, statistically significant improvement in liver function tests was seen in 16 studies post-treatment. CONCLUSION: Although autologous stem cell therapy is a much needed possibility in the treatment of liver disease, further robust clinical trials and collaborative protocols are required.

Outcomes following a dedicated period of research during surgical training.

With recent 'working-time'-related changes to surgical training structure, the value of dedicated research during surgical training has been questioned. Online survey examining career and academic outcomes following a period of surgically related dedicated research at a Scottish University between 1972 and 2007. Of 58 individuals identified, contact details were available for 49 and 43 (88%) responded. Ninety-five percent (n = 41) of respondents continue to pursue a career in surgery and 41% (n = 17) are currently in academic positions. Ninety-one percent (n = 39) had published one or more first-author peer-reviewed articles directly related to their research, with 53% (n = 23) publishing three or more. Respondents with a clinical component to their research published significantly more papers than those with purely laboratory-based research (P = 0.04). Eighty-one percent (n = 35) thought that research was necessary for career progression, but only 42% (n = 18) felt research should be integral to training. In conclusion, the majority of surgical trainees completing a dedicated research period, published papers and continued to pursue a surgical career with a research interest. A period of dedicated research was thought necessary for career progression, but few thought dedicated research should be integral to surgical training.

Systematic review and meta-analysis of survival following extracorporeal liver support.

BACKGROUND: Extracorporeal liver support (ELS) systems offer the potential to prolong survival in acute and acute-on-chronic liver failure. However, the literature has been unclear on their specific role and influence on mortality. This meta-analysis aimed to test the hypothesis that ELS improves survival in acute and acute-on-chronic liver failure. METHODS: Clinical trials citing MeSH terms 'liver failure' and 'liver, artificial' were identified by searching MEDLINE, Embase and the Cochrane registry of randomized controlled trials (RCTs) between January 1995 and January 2010. Only RCTs comparing ELS with standard medical therapy in acute or acute-on-chronic liver failure were included. A predefined data collection pro forma was used and study quality assessed according to Consolidated Standards of Reporting Trials (CONSORT) criteria. Risk ratio was used as the effect size measure according to a random-effects model. RESULTS: The search strategy revealed 74 clinical studies including 17 RCTs, five case-control studies and 52 cohort studies. Eight RCTs were suitable for inclusion, three addressing acute liver failure (198 participants) and five acute-on-chronic liver failure (157 participants). The mean CONSORT score was 14 (range 11-20). Overall ELS therapy significantly improved survival in acute liver failure (risk ratio 0·70; P = 0·05). The number needed to treat to prevent one death in acute liver failure was eight. No significant survival benefit was demonstrated in acute-on-chronic liver failure (risk ratio 0·87; P = 0·37). CONCLUSION: ELS systems appear to improve survival in acute liver failure. There is, however, no evidence that they improve survival in acute-on-chronic liver failure.

Pseudo-recurrence following laparoscopic ventral and incisional hernia repair.

PURPOSE: Laparoscopic mesh repair is an established alternative to the open repair of herniae of the antero-lateral abdominal wall. However, a definition in the literature of "recurrence" is lacking. This study reviews the phenomenon of pseudo-recurrence in patients who describe recurrent symptoms despite an apparently successful laparoscopic ventral or incisional hernia repair (LVIHR). METHODS: Cases of LVIHR from 1st January 2004 to 31st December 2007 were identified from the Lothian Surgical Audit database. Patients were contacted by telephone after a minimum of 11 months following operation. Pseudo-recurrences were identified by history and clinical examination, together with radiological investigation if the diagnosis remained in doubt. RESULTS: One hundred and forty-three repairs were performed in the study period. One hundred and twenty-one patients were contacted (63 incisional and 58 other ventral herniae). Twenty possible recurrences were reported (16.5%). Four were true recurrences and two more were new incisional herniae. There were 14 pseudo-recurrences, arising after 12 incisional and two other ventral hernia repairs. These were due to mesh bulge (10), seroma (3) and retained hernia contents (1). CONCLUSION: True recurrences after LVIHR do occur but should be preventable with good surgical technique. Pseudo-recurrences are more common and may mimic true recurrence. We recommend computed tomography (CT) to clarify the diagnosis and determine the indication for revisional surgery.