No abstract

Most patients with hepatocellular carcinoma (HCC) also have cirrhosis, an independent cause of death. We considered an alternative definition of tumor-related death in patients with HCC and attempted to validate our definition. Two hundred thirty-seven HCC patients were diagnosed, followed, and died over a 12-year period and were evaluated every 2 months, including their last 6 months of life. We defined death by cancer if there was, in the last 6 months of life, a CT scan increase of >25% in the sum of tumor index lesions' cross-sectional areas or new onset of, or increase in, either vascular invasion or metastatic disease (Group 1). Patients with stable cancer were considered to have died from any other cause (Group 2). We found that 135 (57%) patients died from cancer progression (Group 1), whereas 102 (43%) patients did not (Group 2). There was a statistically significant difference between Group 1 and Group 2 patients in percentage with bilobar disease (P = 0.03), more than one tumor (P = 0.01), an increase in AFP (P = 0.04), vascular invasion (P = 0.001), and the presence of metastases (P = 0.01). We conclude that 57% of patients with unresectable HCC died as a direct result of cancer progression, but 43% did not. The latter died from complications of their cirrhosis, including sepsis, GI bleeds, and renal failure.

OBJECTIVE:Recent evidence suggests that non-alcoholic fatty liver disease is associated with diet. Our aim was to investigate the dietary patterns of a Brazilian population with this condition and compare them with the recommended diet.METHODS:A cross-sectional study was conducted on 96 non-alcoholic fatty liver disease patients before any dietetic counseling. All patients underwent abdominal ultrasound, biochemical tests, dietary evaluations, and anthropometric evaluations. Their food intake was assessed by a semi-quantitative food-frequency questionnaire and 24-hour food recall.RESULTS:The median patient age was 53 years, and 77% of the individuals were women. Most (67.7%) participants were obese, and a large waist circumference was observed in 80.2% subjects. Almost 70% of the participants had metabolic syndrome, and 62.3% presented evidence of either insulin resistance or overt diabetes. Most patients (51.5, 58.5, and 61.7%, respectively) exceeded the recommendations for energy intake, as well as total and saturated fat. All patients consumed less than the amount of recommended monounsaturated fatty acids, and 52.1 and 76.6% of them consumed less polyunsaturated fatty acids and fiber, respectively, than recommended. In most patients, the calcium, sodium, potassium, pyridoxine, and vitamin C intake did not meet the recommendations, and in 10.5-15.5% of individuals, the tolerable upper limit intake for sodium was exceeded. The patients presented a significantly high intake of meats, fats, sugars, legumes (beans), and vegetables and a low consumption of cereals, fruits, and dairy products compared with the recommendations.CONCLUSIONS:Although patients with non-alcoholic fatty liver disease exhibited high energy and lipid consumption, most of them had inadequate intake of some micronutrients. The possible role of nutrient-deficient intake in the development of non-alcoholic fatty liver disease warrants investigation.

The association between replicative CHB and schistosomal PF can be a risk factor for more severe liver disease, which can result in deleterious outcomes for patients from endemic areas.

No abstract

No abstract

No abstract

like HCC is a very rare form, which have been described only twice before in literature. We present the case of a 72 years-old man, otherwise in good health, known for a nonactive HCV infection. On routine follow-up, two hepatic lesions were found, in segment 8 (S8) and segment 2 (S2). A 4 cm lymph node was found in the coeliac region, retrospectively present since 3 years on previous imaging. Biopsy of the S8 lesion showed a classical trabecular HCC; while in the coeliac lymph node showed carcinoma cells. PET scan showed an important captation of lymph node and S2 lesion, while no captation was found in the S8 lesion. Considering the patient's good health, the presence of two different lesions, a possible low morbidity approach, a non-completely evidence-based minimally invasive treatment was decided, with chemoembolization of the S8 HCC lesion while the S2 lesion was resected laparoscopically with left lobectomy and complete lymphadenectomy of the hepatic pedicle and coeliac trunk. Final pathologic analysis revealed a medullary-like HCC pT1, pN1. A B-cell lymphoma of the marginal zone was found in hepatic pedicle and coeliac trunk nodes. In this patient we found three different tumours, of which one was a medullary-like HCC. This is the third case described in literature to our knowledge. Because of its unknown biological behaviour, a surgical approach seems reasonably justified in this particular case.