Although splenic involvement alone in hydatid disease is very rare, spleen is the third most common organ involved in hydatid disease. The rarity of splenic hydatid disease poses a diagnostic challenge for clinicians, particularly in non-endemic areas. As the hydatid cyst can present as a simple cyst without having the classic serological and imaging features, and later can lead to life-threatening complications like anaphylaxis, hydatid disease of spleen should be considered in differential in every patient in endemic areas with cystic lesion of spleen until proved otherwise. The author used the keyword “splenic hydatid cyst” in PubMed and reviewed the scientific literatures published from January 1965 to June 2012. The present review is to accentuate the incidence, classification, clinical and pathophysiological features, differential diagnosis, diagnostic modalities, and treatment choices of hydatid cyst of spleen along with follow-up strategy and newer treatment approaches.

This large study of CBTs demonstrates the value of preoperatively determining tumor dimensions and how far the tumor is located from the base of the skull. DTBOS and tumor volume, when used in combination with the Shamblin grade, better predict bleeding and cranial nerve injury risk. Furthermore, surgical resection before expansion toward the base of the skull reduces complications as every 1-cm decrease in the distance to the skull base results in 1.8 times increase in >250 mL of blood loss and 1.5 times increased risk of cranial nerve injury.

Alcoholic cirrhosis remains the second most common indication for liver transplantation. A comprehensive medical and psychosocial evaluation is needed when making a decision to place such patients on the transplant list. Most transplant centers worldwide need a minimum of 6 mo of alcohol abstinence for listing these patients. Patients with alcohol dependence are at high risk for relapse to alcohol use after transplantation (recidivism). These patients need to be identified and require alcohol rehabilitation treatment before transplantation. Recidivism to the level of harmful drinking is reported in about 15%-20% cases. Although, recurrent cirrhosis and graft loss from recidivism is rare, occurring in less than 5% of all alcoholic cirrhosis-related transplants, harmful drinking in the post-transplant period does impact the long-term outcome. The development of metabolic syndrome with cardiovascular events and de novo malignancy are important contributors to non liver-related mortality amongst transplants for alcoholic liver disease. Surveillance protocols for earlier detection of de novo malignancy are needed to improve the long-term outcome. The need for a minimum of 6 mo of abstinence before listing makes transplant a nonviable option for patients with severe alcoholic hepatitis who do not respond to corticosteroids. Emerging data from retrospective and prospective studies has challenged the 6 mo rule, and beneficial effects of liver transplantation have been reported in select patients with a first episode of severe alcoholic hepatitis who are unresponsive to steroids.

Background and Aim Auto-immune (AI) markers are reported in patients with steatohepatitis liver disease. However, their clinical significance is unclear. Methods Charts of patients due to alcohol (ALD) or non-alcoholic fatty liver disease (NAFLD) were stratified for anti-nuclear antigen (ANA>1:80), anti-smooth muscle antibody (ASMA>1:40), or anti-mitochondrial antibody (AMA>1:20). Study outcomes were patient survival and complications of liver disease. Results Of 607 patients (401 NAFLD), AI markers were available in 398 (mean age 50 ±15 y; 52% males; median body mass index (BMI) 38; 44% diabetic; 62% Nonalcoholic steatohepatitis (NASH) as type of Steatohepatitis; median MELD score 9). A total of 78 (19.6%) patients were positive for AI markers without differences for ALD vs. NAFLD, cirrhosis vs. no cirrhosis, and NASH vs. no NASH. There were no differences for age; gender; BMI; cirrhosis at presentation; MELD score; endoscopic findings; and histology based on AI markers. Serum ALT was higher among patients with AI markers (65±46 vs. 59±66 IU/l; P=0.048). Data remained unchanged on analyzing NAFLD patients. None of the 11 ANA positive patients (1:640 in 4) showed findings of AI hepatitis. Biopsy in 3 AMA positive patients showed mild bile duct damage in one patient. On median follow-up of about 3 years, there were no differences on liver disease outcomes (ascites, encephalopathy, variceal bleeding), Hepatocellular carcinoma transplantation, and survival. Conclusions Auto-immune markers are frequently present in steatohepatitis liver disease patients. Their presence is an epiphenomenon without histological changes of autoimmune hepatitis. Further, their presence does not impact clinical presentation and follow-up outcomes.

The aim of this study was to compare the safety and benefits of Soave's and Duhamel's pull-through procedures for the management of Hirschsprung's disease (HD). The patients consisted of 33 boys (85%) and six girls (15%), a ratio of 5.5:1. Their ages ranged from 1 day to 8 years. Rectal biopsy was performed to confirm the diagnosis of HD. Twenty-five patients (64%) underwent Soave's pull-through, and 13 patients (33%) underwent Duhamel's pull-through. Twenty children (80%) out of the 25 undergoing Soave's pull-through recovered uneventfully, compared with 11 out of the 13 (84%) undergoing Duhamel's pull-through. The complications following Soave's procedure included strictures in two patients (8%), enterocolitis in another two (8%), and anastomotic leakage in one (4%). Additional operations were required in two patients (8%). The complications following Duhamel's procedure included stricture in one patient (7.6%) and enterocolitis in another (7.6%). An additional operation was required in one patient (7.6%). The rate of constipation was 16% after the Soave's pull-through compared with 15% after the Duhamel's pull-through. There was no significant difference between the two procedures in postoperative surgical morbidity or in long-term risk of enterocolitis. In the light of present findings, both procedures appear comparable in terms of efficiency and associated complications.

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Complex aneurysm anatomy correlates with increased total cost and need for adjunctive procedures during EVAR. Preoperative assessment with ASG scores can delineate patients at greater risk for increased resource use. Patient comorbid factors are associated with anatomic complexity defined according to ASG. A critical examination of the relationship between anatomic complexity and finances is required within the context of aggressive endovascular treatment strategies and shifts toward value-based reimbursement.