Hígado graso no alcohólico / Non-alcoholic fatty liver disease

La esteatosis hepática no alcohólica es la acumulación excesiva de grasa en el hígado, en ausencia de causas secundarias y constituye la etiología frecuente de enfermedad hepática crónica sin terapia efectiva demostrada. La enfermedad incluye esteatosis, inflamación, fibrosis/cirrosis y hepatocarcinoma. El fenómeno inicial ocurre en la grasa corporal, con hipertrofia adipocitaria, liberación de adipoquinas y citoquinas pro-inflamatorias, que inducirán resistencia a la insulina. Este fenómeno provocará liberación de ácidos grasos a la circulación, captados por hepatocitos. En su evaluación clínica existen diferentes algoritmos con múltiples variables, limitando la biopsia hepática solo a casos excepcionales. Es esencial modificar el estilo de vida y bajar de peso. En diabéticos, metformina y pioglitazona son de primera elección. Los bloqueadores de la angiotensina son útiles en hipertensos con EHNA. Para prevenir la progresión de la enfermedad y en pacientes no diabéticos, asociar vitamina E. Las estatinas pueden utilizarse dada la asociación con patología cardiovascular.

Nonalcoholic fatty liver disease is characterized by excessive hepatic fat accumulation in the abscence of secundary causes. It is the most common cause of chronic liver disease. The spectrum ranges from benign steatosis, steatohepatitis, cirrhosis and hepatocarcinoma. The initial event is the hyperthofied adipocytes, and the release of adipokines and chemokines, that induce insulin resistance, and then free fatty acids into the circulation that accumulate in the liver. Algorithms have been proposed to target liver biopsy only to select patients. Lifestyle modifications to achieve weight loss are essential for all patients with NAFLD. For diabetics treatment should be with metformin and pioglitazone if glycaemic control is not achieved. Angiotensin receptor blockers are the antihypertensive agent of choice in patients with nonalcoholic steatohepatitis (NASH). If lifestyle changes and metabolic syndrome are unsuccessful in preventing disease progression, vitami E should be considered, also in non-diabetic patients with advance (NASH).

Hepatitis B virus and HIV infection among patients with primary hepatocellular carcinoma in Kampala, Uganda.

BACKGROUND: Hepatitis B virus (HBV) is the commonest cause of primary hepatocellular (PHC) carcinoma worldwide. Co-infection with the HIV leads to more rapid progression of liver disease. OBJECTIVES: We described prevalence of HBV and HIV among patients with PHC admitted to Mulago Hospital, Kampala, Uganda. METHODS: We assessed all patients admitted to the gastrointestinal service of Mulago hospital with a diagnosis of PHC for HBV and HIV infection. RESULTS: From March to June 2008, we recruited 15 patients. Nine (60%) were male; the overall median age was 32 years (IQR 15 -67), with median ages for male and female 33 and 36 years respectively. Alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and AFP were all elevated with median values of 57.5 IU/L, 222 IU/L, 392 IU/L and 362 ng/ml respectively (IQR 14-145, 49-393, 165-1294 and 7-480). Eight (53%) patients were from North and Northeastern Uganda. The HBsAg was reactive in 13(87%) patients and HIV in 3(20%), all of whom were also co-infected with HBV. CONCLUSION: There is high prevalence of HBV and HBV/HIV co-infection among patients with PHC in Uganda with high mortality. Reduction in incidence and mortality due to PHC in Uganda will require urgent large scale HBV vaccination.

The hypothesis of an effective strategy for resistance of hepatocellular carcinoma to therapy-autophagy / La hipótesis de una estrategia efectiva para la resistencia del carcinoma hepatocelular a la terapia autofágica

Hepatocellular carcinoma (HCC) is one of the most common malignant tumours and its five-year survival rate remains low. Autophagy is a catabolic process conserved among all eukaryotes ranging from yeast to mammals. Recently, many studies show that tumour cells can utilize autophagy as a cellular defence mechanism when facing metabolic stress. Thus, we hypothesize that autophagy may play an important role in the resistance of hepatocellular carcinomas to therapy. Although the exact role of autophagy on tumour cells is still complex and further studies are needed to prove the impact of autophagy on HCC, it suggests that autophagy may be a new therapeutic target for the resistance to therapy of HCC.

El carcinoma hepatocelular (CHC) es uno de los tumores malignos más comunes, y su tasa de super-vivencia a los cinco años sigue siendo baja. La autofagia es un proceso catabólico conservado en todos los eucariotas, que abarca desde las levaduras hasta los mamíferos. Recientemente, numerosos estudios han demostrado que las células tumorales pueden utilizar la autofagia como un mecanismo celular de defensa frente al estrés metabólico. De este modo, sostenemos la hipótesis de que la autofagia puede desempeñar un papel importante en la resistencia de los carcinomas hepatocelulares a la terapia. Aunque el papel exacto de la autofagia en las celulares tumorales sigue siendo complejo, y se requieren más estudios a fin de probar el impacto de la autofagia en el CHC, hay indicios de que la autofagia puede ser un nuevo objetivo terapéutico para la resistencia a la terapia del CHC.

Metástasis cerebral de un carcinoma hepatocelular fibrolamelar: reporte de un caso y revisión de la literatura / Brain metastasis of a fibrolamellar hepatocellular carcinoma: case report and literature review

El carcinoma hepatocelular fibrolamelar(CHF) es un tumor hepático maligno, poco frecuente, con características clínicas, histológicas e imagenológicas que lo diferencian del carcinoma hepatocelular. Se le consideraba de mejor pronóstico que el hepatocarcinoma, sin embargo, estudios recientes han demostrado altas tasas de recidivas y metástasis. Presentamos el caso clínico de un paciente con diagnóstico de CHF, el que evoluciona con desarrollo de metástasis cerebral, sin reportes similares en la literatura.

Fibrolamellar hepatocellular carcinoma (FHC) is an infrequent liver tumor with clinical, histological and radiological features that makes it distinguishable from hepatocellular carcinoma. It has been considered to have a better prognosis compared to hepatocarcinoma, but recent studies have shown a worst outcome than initially assumed, with a high rate of relapse and metastasis. We present a case of FHC that developed brain metastases, which has not been previously described in the literature.

Quimioembolización intraarterial hepática supraselectiva transitoria en pacientes con hepatocarcinoma o metástasis a hígado con primario controlado / Liver intraarterial transient supraselective chemoembolization in patients with primary liver cancer or liver metastasic cancer with primary controlled

Antecedentes: No existe tratamiento estándar para adversos fueron mínimos, transitorios y de fácil manejopacientes con carcinoma hepatocelular o metástasis médico, sin presencia de efectos hematológicos. Solo unhepática no erradicable con primario controlado pero que paciente presentó síndrome postquimioembolización. Elhan fallado al tratamiento sistémico. Se presenta la tiempo medio de de seguimiento fue de 11.2 meses, conexperiencia del tratamiento con quimioembolización mediana de sobrevida de 16 meses y sobrevida a 2 años deintraarterial hepática supraselectiva (QEIAHS) realizado en 27%. En todos los pacientes desapareció el dolor,la Unidad de Oncología del Hospital Universitario de mantuvieron estado funcional grado 0 y 1, permaneciendoSantander, Bucaramanga, Colombia. Metodología: Se activos y con buenos niveles de autocuidado durante elrevisaron las historias clínicas de los pacientes atendidos periodo de sobrevida, estando generalmente asintomáticos.entre marzo de 2000 a marzo de 2007...

Background: There is no standard treatment for patients patient presented postchemoemboembolization syndrome.with unresectable primary liver carcinoma or liver Average follow-up time was 11.2 months, and medianmetastasic cancer with controlled primary and failed survival time was 16 months, with global survival to twosystemic treatment. Methodology: Review charts from six years of 27%. Functional states remained between 0 and 1patients treated with liver intraarterial transient degree, being generally asymptomatic. In all patientssupraselective chemoembolization (LITSC) in the Oncology abdominal pain disappear, performance status had grade 0Unit, University Hospital of Santander, Bucaramanga, and 1, all remain active and with good levels of self-care andColombia between March 2000 to March 2007...

Study on Inhibition Effects of Freeze-thawing Leech Extract on HepG2 Cells / 中国中医药信息杂志

Objective To study the inhibition effect of leech extract on HepG2 cells. Methods Human hepatocellular cancer cell line HepG2 were treated with different concentrations of leech extracts which were extracted by method of freeze-thawing with liquid nitrogen and contrasted with that by method of water extracting and ethanol precipitating. The inhibition effects and cell morphous were examined by MTT assay and Acridine orange (AO) fluorescent staining method respectively. Result The 6～15 mg/mL drug concentrations of leech extract by method of freeze-thawing with liquid nitrogen had an obvious inhibition on proliferation of HepG2 cells in a dose-dependent manner, and the effect was better than that by method of water extracting and ethanol precipitating (P

Risk Factors of Morbidity and Mortality Following Surgical Resection for Hepatocellular Carcinoma / 대한간학회지

BACKGROUND/AIMS: Recently, mortality following surgical resection for hepatocelluar carcinoma has been reduced significantly. Morbidity, however, is still significant. This study evaluated the risk factors leading to morbidity and mortality. METHODS: 510 patients who had a hepatic resection form Nov. 1994 to Dec. 2001 were included. The patient demographics showed a mean age of 51.6 years with a male to female ratio of 4:1. The HBsAg was positive in 76.0% and the anti-HCV was positive in 8.2%. The mean tumor size was 5.2 cm, 26.2% of patients had preoperative transcatheter arterial embolization (TAE), and 8.7% had preoperative percutaneous transhepatic portal embolization (PTPE). Limited resection was performed in 259 cases (50.7%), and major resection was conducted in 251 cases (49.1%). Risk factors included age, sex, laboratory findings (liver function test, prothrombin time, albumin, glucose, alpha-fetoprotein, ICG test), preoperative TAE, PTPE, operation type, operation time, intraoperative transfusion, tumor size, and cirrhosis. RESULTS: The morbidity was 10.5% (54 cases). Operative death occurred in 5 cases (1.0%). Hospital death, including operative death, occurred in 6 cases (1.2%). Five cases were associated with hepatic failure and 1 case was associated with aspiration pneumonia accompanying hepatic failure. Transfusion (P=0.002), glucose (P=0.002), and prothrombin time (P=0.038) were significantly related to morbidity. Age (P=0.028), glucose (P=0.011), and TAE (P=0.046) were significantly related to mortality. CONCLUSIONS: Intraoperative transfusion, which is mainly related to intraoperative bleeding, should be reduced if possible to decrease morbidity. Diabetes mellitus patients and the elderly need careful perioperative management.

Cytokine-induced killer cell for interventional chemotherapy of hepatocellular carcinoma / 介入放射学杂志

Objective To evaluate the clinical effect of hepatocellular carcinoma treatment with a combination therapy of transcather arterial super liquefied lipiodol embolization and cytokine-induced killer cell(CIK) infusion.Methods There were 3 groups in this study,group 1:38 cases of HCC patients treated with a combination therapy of transcather arterial super liquified lipiodol embolization and CIK infusion;group 2:80 cases of HCC patients treated with a combination therapy of transcather arterial super liquefied lipiodol embolization and percutaneous intratumoral ethanol injection;group 3:134 cases of HCC patient treated with transcather arterial super liquefied embolization.Finally,the outcomes of the 3 groups were compared.Results The short term effective rates of group 1,2 and 3 were 76.1%,41.3% and 14.9% respectively,simultaneously with significant difference of changes concerning AFP value among the three groups especially in group 1 the AFP decrease to normal level while those of the other two groups still remain in higher levels.Conclusions The living quality and survival rate of HCC patients could be improved by a combination therapy of transcather arterial super liquefied lipiodal embolization and CIK infusion.(J Intervent Radiol,2007,16:235-239)