The albumin-bilirubin grade uncovers the prognostic relationship between hepatic reserve and immune dysfunction in HIV-associated hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is a leading cause of liver-related mortality in people living with HIV, where co-infection with hepatotropic viruses accelerates the course of chronic liver disease. AIM: To evaluate whether the albumin-bilirubin (ALBI) grade, a more accurate marker of liver dysfunction in HCC, might identify patients with progressive liver dysfunction in the context of HIV/hepatitis co-infection. METHODS: Using uni- and multi-variable analyses, we studied the albumin-bilirubin grade as a predictor of overall survival (OS) in a large, multi-center cohort of patients with HIV-associated HCC recruited from 44 centres in 9 countries within the Liver Cancer in HIV study group. Patients who underwent liver transplantation were excluded. RESULTS: A total of 387 patients, predominantly HCV co-infected (78%) with balanced representation of all Barcelona Clinic Liver Cancer (BCLC) stages (A = 33%, B = 18%, C = 37%, D = 12%) were recruited. At HCC diagnosis, 84% had been on anti-retrovirals for a median duration of 8.8 years. The albumin-bilirubin grade identified significant differences in median survival of 97 months for grade 1 (95% CI 13-180 months), 17 months for grade 2 (95% CI 11-22 months) and 6 months for grade 3 (95% CI 4-9 months, P < .001). A more advanced albumin-bilirubin grade correlated with lower CD4 counts (464/373/288 cells/mm3 for grades 1/2/3) and higher HIV viraemia (3.337/8.701/61.845 copies/mL for grades 1/2/3, P < .001). CONCLUSIONS: In this large, multi-center retrospective study, the albumin-bilirubin grade highlights the interplay between liver reserve and immune dysfunction as prognostic determinants in HIV-associated HCC.

High HCV subtype heterogeneity in a chronically infected general population revealed by high-resolution hepatitis C virus subtyping.

OBJECTIVES: This study aimed to characterize the chronically infected general hepatitis C virus (HCV) population in Barcelona using a highly sensitive subtyping method that can identify the 67 recognized HCV subtypes and diagnose mixed infection by various genotypes/subtypes in a single individual. The resulting information has implications for selecting optimal direct-acting antiviral (DAA) treatment for each patient and establishing public healthcare policies in our setting. METHODS: Consecutive HCV patients (treatment-naïve or interferon-based failures) attending Vall d'Hebron Hospital outpatient clinics from February 2015 to May 2016 (N=1473) were included in the study. Patient samples were characterized using HCV subtyping by next-generation ultra-deep pyrosequencing. RESULTS: The following genotypes (G) were found: G1 (1126/1473 (76.4%)), G4 (145/1473 (9.8%)), G3 (135/1473 (9.2%)), G2 (51/1473 (3.5%)), and G5 (1/1473 (0.1%)). Twenty-two subtypes were seen: 1b (790/1473 (53.6%)), 1a (332/1473 (22.5%)), 3a (133/1473 (9.0%)), 4d (105/1473 (7.1%)), 4a (29/1473 (2.0%)), and 2c (25/1473 (1.7%)), with 16 low-prevalence subtypes accounting for the remaining 3.0% (44/1473). There was a worrisome 1.0% (15/1473) of mixed infections. G2 (51/1473 (3.5%)) showed a high level of heterogeneity. Analyses by age groups showed a predominance of G1b over G1a (428/506 (84.6%) vs. 24/506 (4.7%)) in patients born before 1950 (N=506/1473), and similar percentages of these subtypes in those born between 1951 and 1975 (N=834/1473) (315/834, 37.8% vs. 266/834, 31.9%) and after 1976 (N=133/1473) (47/133, 35.3% vs. 42/133, 31.6%). CONCLUSIONS: Subtype distribution showed a higher level of heterogeneity than was expected, particularly for G2. Prevalence of mixed infections was around 1%. HCV subtype distribution related to patient age group suggested that patients born from 1936 to 1975 in our setting should undergo screening for the infection. Next-generation sequencing enabled better classification of candidates for DAA-based treatment.

Decrease in the volume of white matter lesions with improvement of hepatic encephalopathy.

MR imaging has found abnormalities compatible with low-grade edema in the brain of patients with cirrhosis that have been related to hepatic encephalopathy. We present 3 patients with hepatic encephalopathy who exhibit supratentorial focal or diffuse white matter lesions compatible with small-vessel brain disease. The volume and number of white matter lesions reduced with the improvement of hepatic encephalopathy, suggesting the participation of the blood-brain barrier in the pathogenesis of brain edema in hepatic encephalopathy.

[The phenomenon of obstructive uropathy with minimal or no dilatation]. / El fenómeno de la uropatía obstructiva con nula o mínima dilatación.

Obstructive anuria does not necessarily show a marked dilatation of the urinary tract on evaluation with imaging techniques. A case with acute renal failure of this type is presented. We discuss why this condition is caused and how diagnosis can be made quickly. Likewise, we discuss the length of time we can defer renal diversion before rupture of the collecting system supervenes and, consequently, urinary extravasation.

[Primary superficial bladder carcinoma. Prognostic factors for recurrence]. / Carcinoma vesical superficial primario. Factores pronósticos de recidiva.

To evaluate the risk of tumor recurrence, we have studied the prognostic significance of the clinical features and chemoprophylaxis following transurethral resection (TUR) in 155 patients with primary superficial bladder carcinoma (Ta, T1, Tis). Thiotepa, adriamycin and cisplatin instillations in the bladder were utilized. The mean follow-up was 44 months (range 6-106). Considering the first tumor recurrence as an indication of failure of chemoprophylactic therapy, thiotepa was shown to afford better control. The significance of each variable (age, sex, drug, tumor stage, grade, number and size) was determined for each individual patient relative to the risk of recurrence after TUR and prophylactic treatment and the significant variables were then subjected to multivariant analyses (multiple logistic linear regression). Tumor number, stage and the drug utilized were shown to be significant prognostic factors (p = 0.04, 0.04 and 0.008, respectively). Based on the results of the multivariant analyses, mathematical models of prediction were assigned combining the more favourable individual prognostic values. The use of the mathematical models obtained to calculate the recurrence risk for each individual patient allowed us to classify these cases as being at high, medium or low risk for tumor recurrence.

[Value of bone gammagraphy and pain in the follow-up of carcinoma of the prostate]. / Valor de la gammagrafía ósea y el dolor en el seguimiento del carcinoma prostático.

We reviewed 382 bone scans from 161 patients with prostatic adenocarcinoma submitted to scintigraphic evaluation over the period 1980 to 1988. Each patient had a mean of 2.37 bone scans (1 to 9 scans). Seventy-three patients had positive scans (64 initially and 9 in the course of patient follow-up). Sixty-four presented bone pain (56 initially and 8 in the course of the disease). The remaining 17 patients were asymptomatic throughout follow-up; however, bone metastasis was undemonstrable. In our view, pain is a reliable indicator of the appearance or progression of bone metastasis. Routine follow-up bone scans are unnecessary in patients with positive or negative scintiscans who remain asymptomatic.

[Parathyroid adenoma and renal lithiasis. Report of a case]. / Adenoma paratiroideo y litiasis renal. Presentación de un caso.

A case is presented of nephrolithiasis in a patient with no other symptoms than the urological ones and in which considerable hypercalcemia led to a study being carried out on his phospho-calcium metabolism and the diagnosis reached was primary hyperparathyroidism caused by a parathyroid adenoma. Surgical treatment was performed on the lithiasis and the adenoma as a result of which the symptoms completely disappeared and the biochemical readings returned to normal.

[Seminal vesicular cysts associated with renal agenesis, ipsilateral ureter and hemitrigone. Report of a case]. / Quiste de vesícula seminal asociado a agenesia renal, ureter y hemitrigono ipsilaterales. Presentación de un caso.

A case is presented of seminal vesicular cyst associated with kidney agenesia, ipsilateral ureter and hemitrigon; this is the 17th case presented in the world literature reviewed. A study is made of all the cases published and the authors recommend deferento-vesiculography as the best means of diagnosis and total excision of the cyst as the most effective treatment.

[Seminal infection and male sterility]. / Infección seminal e infertilidad masculina.

A study is made of 25 patients suffering from a vesicular prostate pathology causing sterility. We have assessed the age, profession, symptoms, genital exploration and ejaculation study including the amount, pH, visocity, fructose, ascorbic acid, count, motility and morphology of the sperms and the high leukocyte reading. A seminal liquid culture has been carried out on 21 patients, alone or in association with cultures of prostate and urine secretion following prostate massaging with positive results in 16 of them (76%). Treatment was begun on 22 patients, in 13 of whom the results are known. Spermiogram readings became normal in 5 (38%) with one pregnancy; there was an associated pathology in the wife in 3 cases. As antibacterians we have basically used trimetoprim-sulphametoxazol associated with erythromycin or not and sometimes, according to the antibogram, with other antibiotics, as well as drugs to clear the prostate area. The best results were obtained in astenozoospermias. The effectiveness of the treatment was equally due to the use of TMP-SMZ on its own or along with erythromycin. The other drugs have not improved the results, except for minocyclin which megativated a sperm culture. As a preliminary result the author presented three patients with sperm infection produced by E. coli at whom the titer of antibodies in serum was investigated.

[Carcinoma of the penis: review of our cases]. / Carcinoma de pene: revision de nuestra casuística.

A review is made of 36 carcinomas of the penis treated in the Urology Department of the "La Fe" Hospital. The most frequent decade for their appearance is the fifties. We establish their link with restricted hygiene and with fimosis, Queyrat's erythroplasia, leukoplasia and accuminated condyloma. The treatment given depends essentially on the clinical stage. We feel that within stage A, with minimum prepuce lesions, the ideal treatment is local excision and circumcision plus radiotherapy; in the case of minimal gland lesions radiotherapy; in the rest and when the former forms of therapy fail, partial amputation of the penis. We currently treat this stage with cryosurgery although we cannot give any results because of the limited period of development of the same. In stage B, we indicate amputation plus bilateral, ilio-inguinal lymphadenectomy plus radiotherapy. In stages C and D the treatment is palliative, on the basis of polychemotherapy.