Spontaneous rupture of hepatocellular carcinoma: a case report and review of literature

Hepatocellular carcinoma (HCC) has a tendency for fatal spontaneous rupture leading to massive haemorrhage. A 64-year-old man presented with sudden, severe epigastric pain for 6 h. Systolic blood pressure was 80/50 mmHg, and pulse rate was 100/min. The patient's history did not reveal any operation or disease up to date. Contrast enhancement-axial computed tomography (CT) scan showed a tumoral lesion with a necrotic centre measuring 6 x 5 cm within 6th segment of the liver and a fluid collection (haemoperitoneum) at the periphery of the liver. At exploratory laparotomy, the liver was found to be cirrhotic, and an actively bleeding tumour confirmed in 6th segment of the liver. The tumour was resected. Post-operative recovery was unremarkable, and the patient was discharged on the 14th post-operative day. Ruptured HCC should be included in the differential diagnosis of non-traumatic intra-abdominal haemorrhage.

The effect of short-term treatment with atorvastatin on E-selectin levels in severely burned patients

Cellular adhesion molecules are expressed by activated endothelial cells in severe bum. The release of these molecules can lead to organ damage. We measured E-selectin levels in the blood of 20 severe-burn patients. Then the patients were divided into two groups of 10 patients each. In the study group, atorvastatin 20 mg/day was administered orally for 14 days. In the control group, an equal volume of placebo was administered orally for 14 days. In both groups, following the last dose of the agents, serum E-selectin levels were measured again. Mean burn size and the percentage of third-degree bums of total burned area were not significantly different between the groups. Serum E-selectin level obtained at the beginning of the treatment was 23.69 +/- 2.71 ng/ml in the atorvastatin group and 18.08 +/- 0.97 ng/ml in the control group. Serum E-selectin level obtained at the end of the treatment was 10.86 +/- 1.36 ng/ml in the atorvastatin group and 21.69 +/- 2.11 ng/ml in the control group. The difference between the two groups was statistically significant (p < 0.05). In the comparison of early and late serum E-selectin levels in the atorvastatin group, a significant decrease was obtained (p < 0.05). In the control group, serum E-selectin levels were found to be increased in the late period. However, the difference between the early and late values was nonsignificant (p > 0.05). We concluded that atorvastatin is effective in the prevention of E-selectin release in severely burned patients.

Primary tuberculous liver abscess. A case report and review of literature

Tuberculous liver abscess (TLA) is an extremely rare condition, even in the country where tuberculosis is an alarming public health problem. Primary TLA, with no evidence of infection elsewhere, is even less common. Herein, we report a case with primary TLA and review the literature.

Serum paraoxonase levels in gastric cancer

BACKGROUND/AIMS

Serum paraoxonase (PON) is a calcium-dependent esterase that is known to contribute to the antioxidant protection conferred by high-density lipoprotein (HDL) on low-density lipoprotein (LDL) oxidation. Serum PON activity was shown to be reduced in patients with diseases such as myocardial infarction, diabetes mellitus, etc in comparison to healthy subjects. However, the relation of serum PON levels to cancer is still not known. So, we intended to measure serum PON, HDL, LDL and very low-density lipoprotein (VLDL) levels and to investigate the relation of serum PON to plasma lipoproteins in the patients with gastric cancer.

METHODOLOGY

We measured serum PON, HDL, LDL and VLDL levels in 20 patients with gastric cancer and in 20 age-and gender-matched healthy controls. We investigated the relationship between PON and HDL, PON and LDL, and PON and VLDL.

RESULTS

Serum HDL levels were lower in the patients than in controls (33.10 +/- 7.75 mg/dL, and 47.30 +/- 6.65 mg/dL, respectively) (p<0.0001). Serum VLDL levels were lower in the patients than in controls (21.65 +/- 6.92 mg/dL, and 33.10 +/- 6.09 mg/dL, respectively) (p<0.0001). Serum LDL levels measured in the patients were not significantly different from those of the controls. Serum PON levels were lower in the patients than in controls (67.10 +/- 17.92 U/L, and 87.50 +/- 23.39 U/L, respectively) and there was a positive correlation between serum PON and HDL levels (r: 0.52, p<0.05).

CONCLUSIONS

We concluded that the patients with gastric cancer had low serum PON, HDL, and VLDL levels compared to healthy controls. The importance of PON as a predictive risk factor for cancer should be assessed in future studies.

Serum paraoxonase levels in pancreatic cancer

BACKGROUND/AIMS

Serum paraoxonase (PON) is a calcium-dependent esterase that is known to contribute to the antioxidant protection conferred by high-density lipoprotein (HDL) on low-density lipoprotein (LDL) oxidation. Serum PON activity was shown to be reduced in patients with diseases such as myocardial infarction, diabetes mellitus, etc in comparison to healthy subjects. However, the relation of serum PON levels to cancer is still not known. So, we intended to measure serum PON, HDL, LDL and very low-density lipoprotein (VLDL) levels and to investigate the relation of serum PON to plasma lipoproteins in the patients with pancreatic cancer.

METHODOLOGY

We measured serum PON, HDL, LDL, and VLDL levels in 20 patients with pancreatic cancer and in 20 age-and gender-matched healthy controls. We investigated the relationship between PON and HDL, PON and LDL, and PON and VLDL.

RESULTS

Serum HDL levels were lower in the patients than in controls (40.21 +/- 13.82 mg/dL, and 47.30 +/- 6.65 mg/dL, respectively) (p<0.05). Serum LDL and VLDL levels measured in the patient group were not significantly different from those of the control group. Serum PON levels were lower in the patients than in controls (61.57 +/- 22.44 U/L, and 87.50 +/- 23.39 U/L, respectively) (p<0.005). There was a positive correlation between serum PON and HDL levels (r: 0.69, p<0.05).

CONCLUSIONS

We concluded that the patients with pancreatic cancer had low PON and HDL levels compared to healthy controls. The importance of PON as a predictive risk factor for cancer should be assessed in future studies.

Addisonian crisis due to adrenal gland metastasis in Hodgkin's disease

Adrenal insufficiency or Addison's disease is a rare illness associated with multiple pathology. We describe the case of a 61-year-old male with Hodgkin's disease and metastases in both adrenal glands who was diagnosed with adrenal insufficiency as a result of an acute addisonian crisis.

Metastatic disease in the breast

Breast cancer is the commonest malignancy in women. However, metastatic involvement of the breast is relatively rare. Metastatic disease of the breast is therefore often an unexpected diagnosis in a female patient presenting with a breast mass. The commonest cause is spread from a contralateral breast carcinoma. Of solid tumors at other sites, the most common cancers to metastasize to the breast are, in declining order of frequency, malignant melanoma, lymphoma, lung cancer, ovarian carcinoma, soft tissue sarcoma, and gastrointestinal and genitourinary tumors. Besides these, metastases from osteosarcoma, thyroid neoplasms, and cervical, vaginal and endometrial carcinomas to the breast have been sporadically reported in the literature. A clinical presentation with pain, tenderness and discharge is distinctly unusual. A solitary lesion is the most common clinical presentation. Lesions that metastasize to the breast may produce changes that look similar to those of primary breast cancer on mammography, but they are more likely to be multiple, are frequently bilateral, and form a nidus of tumor cells that are usually round with fairly well-defined margins. Microcalcifications are not a distinguishing feature, and although their margins may be ill defined, spiculations are not commonly found. Diagnosis is generally achieved by means of fine-needle aspiration cytology or open biopsy of the breast masses. In recent reports, particular importance has been attached to the performance of fine-needle aspiration cytology diagnosis, to differentiate a metastasis from a second primary tumor, thus making it possible to avoid unnecessary mastectomy and ensure that appropriate chemotherapy and radiotherapy are implemented.

The effect of growth hormone on 24-h urinary creatinine levels in burned patients

Catabolism is increased in burned patients. Creatinine excreted in urine is accepted as an indicator of catabolism of muscle mass. Growth hormone (GH) is one of the most potent anabolic agents. We investigated the effect of GH on 24-h urinary creatinine levels as an indicator of catabolism of muscle mass in burned patients. In 20 patients with severe burns, 24-h urinary creatinine levels were investigated for 3 days following hospitalisation. Then the patients were divided into two groups of 10. In the study group, following investigation of 24-h urinary creatinine levels for 3 days, GH 0.1 mg/kg was injected subcutaneously three times in a week. Following the last dose of GH, 24-h urinary creatinine levels were investigated for 3 days again. In the control group, an equal volume of isotonic saline solution was injected at the same times instead of GH, and 24-h urinary creatinine levels were investigated for 3 days again. Mean burn size and age were not significantly different between the groups. 24-h urinary creatinine level obtained in the early period was 48.5+/-16.6 mg/day in the study group and 49.9+/-11.3 mg/day in the control group. There was no statistical difference between these two values (p>0.5). 24-h average urinary creatinine level obtained in the late period was 36.6+/-16.4 mg/day in the study group and 50.6+/-9.9 mg/day in the control group, and the difference was statistically significant (p<0.05). In the comparison of early and late 24-h urinary creatinine levels in the study group, there was a statistically significant difference between these two values (p<0.05). In the control group, there was no difference between early and late 24-h urinary creatinine levels (p>0.5). We concluded that GH is effective in decreasing urinary creatinine excretion. This decrease in urinary creatinine excretion may be associated with diminished muscle catabolism.

Effect of nitric oxide synthase inhibitor on experimentally induced burn wounds

BACKGROUND

Nitric oxide (NO) may have an important role in the healing of burn wounds. This study investigated the effect of NO on experimentally induced burn wounds by preventing NO synthesis.

METHODS

A total of 40 mice weighing 25 to 30 g were used in this study. The shaved skin on the back of the mice was immersed in 100 degrees C water for 10 seconds to achieve a partial-thickness scald burn. The mice were divided into two groups of 20. In group I (control group), 17.5 mg/kg of serum physiologic (placebo) was injected intraperitoneally two times a day for 15 days. In group II (study group), 17.5 mg/kg of aminoguanidine (NO synthase inhibitor) was injected intraperitoneally two times a day for 15 days. On day 15 of the burn, the animals were killed and the burn areas were investigated histologically. Histologic changes such as epithelial proliferation, abscess, collagen, and granulation tissue were evaluated.

RESULTS

Epithelial proliferation, formation of collagen, and granulation tissue with rich capillaries observed in the control group were statically significantly higher than those observed in the study group (z = -2.022, p < 0.05; z = -2.02, p < 0.05; and z = -2.022, p < 0.05; respectively).

CONCLUSION

We concluded that healing of the burn wound is delayed by preventing NO synthesis.

Surgical treatment of hydatid disease of the liver: review of 304 cases

HYPOTHESIS

To review the results of different modalities of treatment of hydatid disease of the liver.

DESIGN

Retrospective study of 304 patients.

SETTING

A university hospital in Turkey.

PATIENTS

Three hundred four patients with hepatic hydatid disease who underwent operation between 1981 and 1996.

MAIN OUTCOME MEASURES

Mortality and morbidity.

RESULTS

Two hundred thirty-eight patients had a cyst on the right lobe, 41 patients had a cyst on the left lobe, and 25 patients had a cyst on both lobes. Forty-five patients had multiple hepatic cysts and 18 patients had coexisting cysts in other intra-abdominal organs. Surgical procedures were tube drainage, capitonnage, omentoplasty, cystectomy, segmentectomy, and cystoenterostomy. Of the patients with tube drainage, 36 developed an infection of the remaining cavity, 10 developed long-lasting biliary fistula, 8 developed cholangitis, and 6 developed septicemia. Four patients died of unreleated complications. Of the patients with capitonnage, 7 developed cholangitis and 3 developed an infection of the remaining cavity. Of the patients with omentoplasty, 1 developed an infection of the remaining cavity and 1 developed cholangitis. One patient who underwent segmentectomy developed pulmonary complications. Of the patients with cystoenterostomy, 1 developed cholangitis, 1 developed septicemia, and 1 developed pulmonary complications.

CONCLUSION

For management of hydatid disease of the liver, capitonnage, omentoplasty, cyst excision, segmentectomy, or cystoenterostomy are all superior to tube drainage.

Tc-99m tetrofosmin in breast carcinoma and axillary lymph node metastases: a comparative study with Tc-99m MIBI

The potential of Tc-99m tetrofosmin for the imaging of breast carcinoma and axillary lymph node metastases was investigated and compared with that of Tc-99m MIBI. Thirty female patients with palpable breast masses underwent Tc-99m MIBI scintigraphy; 17 of those underwent Tc-99m tetrofosmin scintigraphy. The axillary and breast regions were evaluated in all patients. All patients underwent biopsy within 2 weeks of the study. Twenty patients were found to have a primary malignancy of the breast, whereas 10 had benign disease. The patients with breast carcinoma had surgery. Twelve patients had axillary lymph node metastases. Tc-99m MIBI breast imaging showed abnormal uptake in 18 of 20 malignancies and in 8 of 12 axillary lymph node metastases. Tc-99m tetrofosmin breast imaging showed abnormal uptake in 13 of 14 malignancies and in 6 of 10 axillary lymph node metastases. Sensitivity, specificity, and accuracy values obtained with Tc-99m MIBI and Tc-99m tetrofosmin scintigraphy for breast carcinoma were 90%, 90%, 90%, and 93%, 100%, 94%, respectively. The values obtained with Tc-99m MIBI and Tc-99m tetrofosmin scintigraphy for axillary lymph node metastases were 66%, 100%, 86%, and 60%, 100%, 76%, respectively. The authors conclude that both of these techniques are effective in the differentiation of malignant breast masses from benign ones and in detecting axillary lymph node metastases. However, Tc-99m tetrofosmin is superior to Tc-99m MIBI in detecting breast carcinoma.

Fine needle aspiration biopsy in hepatic Echinococcus multilocularis

OBJECTIVE

To determine the fine needle aspiration biopsy (FNAB) findings in hepatic Echinococcus multilocularis.

STUDY DESIGN

FNAB and tru-cut liver needle biopsy were applied in 14 hepatic E multilocularis cases. Cytologic smears were stained with May-Grünwald-Giemsa and periodic acid-Schiff (PAS) stain. Tissue sections were stained with hematoxylin-eosin (HE) and PAS stain.

RESULTS

In tissue sections, homogeneous, thin, cystic structures of various dimensions strongly stained with PAS. Mucoid material was stained with PAS in the cystic structures. Wide, coagulative necrosis was observed in all cases. In some cases there were foreign body-type giant cells at the periphery of the lesion. In all the cytologic smears there were an intense necrotic ground, PAS-positive hyaline cuticular structures and mucoid globules; in some cases there were foreign body-type giant cells.

CONCLUSION

The above cytologic characteristics are basic diagnostic criteria for FNAB of E multilocularis.

Bacterial translocation in experimental intestinal obstruction

In this study, bacterial translocation to the mesenteric lymph nodes (MLN), liver and spleen and the histopathological changes in the intestine MLN, liver and spleen were investigated in Wistar Albino rats with intestinal obstruction. The subjects were divided into three main groups: the control group, simple obstruction group and loop obstruction group. Each group was further subdivided into two sub-groups: those who underwent repeat laparotomy at 12 h or at 24 h. No bacterial translocation was observed in the control group. The incidences of bacterial translocation to the MLN, livers and spleens of the rats with loop obstruction who underwent repeat laparotomy at 24 h were the highest. According to the cultured bacteria growth results, Escherichia coli was most abundant (48%). Most histopathological changes were observed in the MLN, livers, spleens and intestines of the rats with loop obstruction who underwent second laparotomy at 24 h.

Tumor-induced ileo-ileal invagination in adults

We report two cases of ileo-ileal intussusception due to a lymphoma in a 25-year-old and a leiomyoma in a 35-year-old woman. Both were diagnosed by laparotomy. Intussusception is a rare condition in adults and is usually difficult to diagnose. In contrast to childhood, idiopathic intussusception is quite rare in adults. The etiology is usually an intestinal tumor. In adults treatment is always surgical.