[Hepatocellular carcinoma: treatment of 23 cases]

In this study, we compared the clinical aspects of the patients with hepatocarcinoma treated in the Clinical and Surgical Gastroenterology Division, Federal University of São Paulo Medical School. Thirty three patients with hepatocarcinoma were treated between 1989 and 1997, 23 were treated surgically or by chemotherapy. Ten of them, in bad clinical conditions, were treated only with supportive treatment. Among the 23 treated patients, 12 were treated surgically, 10 with transcatheter arterial chemoembolization and one with systemic chemotherapy. The liver nodes size varied from 2.6 to 20 cm, being 82% greater than 5 cm. The mean survival was 14.8 months for the surgical treated patients and 9.8 months for the transcatheter arterial chemoembolization treated patients. These differences were not significant by the Kaplan-Meyer curve. The patients with liver nodes under 5 cm had better survival (P < 0.05). We can conclude that independent of the clinical stage, the size of the liver node is an important factor on prognosis. Patients with live nodes smaller than 5 cm have better survival than the others with greater tumors.

[Microcrystals and biliary sludge: pathogenesis and clinical significance]

Review of the literature concerning the pathogenesis and the clinical significance of microcrystals and biliary sludge. In addition, the advantages and limitations of the available methodology of identification of these microscopic precipitates and the clinical conditions in which the investigation of the bile composition, with respect to the presence of cholesterol and calcium bilirubinate microcrystals, are discussed. In conclusion, algorithms for treatment of bileopancreatic diseases caused by microcrystals and/or biliary sludge are proposed.