Purpose African Americans (AAs) have the highest incidence of colorectal cancer (CRC) compared to other US populations and more proximal CRCs. The objective is to elucidate the basis of these cancer disparities. . Experimental design 566 AA and 328 Non-Hispanic White (NHW) CRCs were ascertained in five Chicago hospitals. Clinical and exposure data were collected. Microsatellite instability and BRAF (V600E) and KRAS mutations were tested. Statistical significance of categorical variables was tested by Fisher's exact test or logistic regression and age by Mann-Whitney U test. Results Over a ten-year period, the median age at diagnosis significantly decreased for both AAs (68 to 61; P<0.01) and NHWs (64.5 to 62; P=0.04); more AA patients were diagnosed before age 50 than NHWs (22% vs 15%; P=0.01). AAs had more proximal CRC than NHWs (49.5% vs. 33.7%; P<0.01), but overall frequencies of microsatellite instability, BRAF and KRAS mutations were not different nor were they different by location in the colon. Proximal CRCs often presented with lymphocytic infiltrate (P<0.01) and were diagnosed at older ages (P=0.02). Smoking, drinking, and obesity were less common in this group, but results were not statistically significant. Conclusions Patients with CRC have gotten progressively younger. The excess of CRC in AAs predominantly consists of more proximal, microsatellite stable tumors, commonly presenting lymphocytic infiltrate and less often associated with toxic exposures or a higher BMI. Younger AAs had more distal CRCs than older ones. These data suggest two different mechanisms driving younger age and proximal location of CRCs in AAs.

Acute liver failure (ALF) is a condition that can rapidly progress to multiorgan failure. This article focuses on the diagnosis and management of ALF. We provide a detailed review of the common etiologies of ALF, including acetaminophen overdose, viral hepatitis, drug-induced liver injury, Wilson's disease, and autoimmune hepatitis. The article then addresses how to recognize ALF and reviews the role of common laboratory and imaging tests in establishing this diagnosis. The remainder of the article details the management of hepatic and extrahepatic organ dysfunctions in ALF. The article concludes with a discussion regarding the prognostication of patients with ALF and the criteria for considering liver transplantation.

AIMTo compare features of hepatocellular carcinoma (HCC) in Hispanics to those of African Americans and Whites.METHODSPatients treated for HCC at an urban tertiary medical center from 2005 to 2011 were identified from a tumor registry. Data were collected retrospectively, including demographics, comorbidities, liver disease characteristics, tumor parameters, treatment, and survival (OS) outcomes. OS analyses were performed using Kaplan-Meier method.RESULTSOne hundred and ninety-five patients with HCC were identified: 80.5% were male, and 22% were age 65 or older. Mean age at HCC diagnosis was 59.7 ± 9.8 years. Sixty-one point five percent of patients had Medicare or Medicaid; 4.1% were uninsured. Compared to African American (31.2%) and White (46.2%) patients, Hispanic patients (22.6%) were more likely to have diabetes (P = 0.0019), hyperlipidemia (P = 0.0001), nonalcoholic steatohepatitis (NASH) (P = 0.0021), end stage renal disease (P = 0.0057), and less likely to have hepatitis C virus (P < 0.0001) or a smoking history (P < 0.0001). Compared to African Americans, Hispanics were more likely to meet criteria for metabolic syndrome (P = 0.0491), had higher median MELD scores (P = 0.0159), ascites (P = 0.008), and encephalopathy (P = 0.0087). Hispanic patients with HCC had shorter OS than the other racial groups (P = 0.020), despite similarities in HCC parameters and treatment.CONCLUSIONIn conclusion, Hispanic patients with HCC have higher incidence of modifiable metabolic risk factors including NASH, and shorter OS than African American and White patients.

No abstract

EDITORIAL COMMENT: We accepted this paper for publication to remind readers of the savage toll on maternal life that can be claimed by eclampsia when there is inadequate antenatal care in the detection and management of cases of preeclampsia. In the 22 years from 1971-1993 there were 108,476 deliveries and 60 cases of eclampsia at the Mercy Hospital for Women, an incidence of 0.06% or I in 1,808 deliveries and the maternalmortality rate was5% (3 of 60). In this IaReseries from India of 271 cases, the maternal mortality rate was 7.8% and the incidence of eclampsia was I in 115 deliveries (0.87%). The authors refer to other series of eclampsia in India where the incidences of eclampsia were as high as 4.6% of all deliveries. These high incidences of eclampsia are largely explained by referral of complicated cases to major centres and expectedly the series reported here contains a very high proportion of cases of antepartum ecIampsia. Where antenatal care facilities are better most cases of eclampsia occur intrapartum and the distribution of the 60 cases at the Mercy Hospital for Women was 19 (32%) antepartum, 14 (23 %) intrapartum and 27 (45%) postpartum whereas in the series from India the distribution was 128 {47%) antepartum, 85 {31%) intrapartum and 58 (22%) postpartum. The causes of death in these cases of eclampsia were similar to those which occur in developed countries. The takeaway message for readers is that we must continue our antenatal vigilance to detect the signs of preclampsia and manage these patients appropriately.