Lege Artis Medicinae

[Treatment of hepatocellular carcinoma by liver transplantation: results in Hungary]

GÖRÖG Dénes, VÉGSŐ Gyula, DOROS Attila, GERLEI Zsuzsa, FEHÉRVÁRI Imre, NEMES Balázs, KÓBORI László

APRIL 20, 2012

Lege Artis Medicinae - 2012;22(04)

[INTRODUCTION - Hepatocellular carcinoma is an internationally accepted indication for liver transplantation in selected cases. The aim of this study was to present treatment results of patients diagnosed with hepatocellular carcinoma and put on the waiting list between 1995 and 2010. PATIENTS AND METHODS - Sixty patients were put on the waiting list, 23 of who died or became unfit for operation while waiting for transplantation. Liver transplantation was performed in 37 patients. Pathological examination revealed no tumour in 3 of the explanted livers, whereas incidentalomas were detected in 4 livers that were explanted because of cirrhosis. Thus, in total 38 patients were examined. RESULTS - Four patients died within 3 months of surgery because of arterial circulatory problems or graft dysfunction and 14 patients died thereafter, including seven whose tumour recurred. There was no recurrence of tumours in the early state among the 25 patients meeting the Milan criteria, and the overall 1-, 3-, and 5-year survival rates with an average follow-up period of 39 months were similar to those after transplantation because of viral cirrhosis: 72%, 72% and 67% vs. 78%, 71% and 67%, respectively. Survival rates after tumours beyond the Milan criteria were significantly lower (69%, 38%, 23%). CONCLUSION - Early-state (T1,T2) hepatocellular carcinoma that has developed following cirrhosis and is unsuitable for resection can be efficiently treated with liver transplantation, but our results do not support the use of transplantation for the treatment of tumours that do not fit the Milan criteria.]

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[OBJECTIVES - In November 2010, wescreened patients admitted to the MilitaryHospital, 1st Department of Internal Medi-cine for meticillin-resistant Staphylococcusaureusand Gram-negative, extended spec-trum beta-lactamase producing bacteria.We detected the prevalence of colonisationor infection by these strains during hospitalstay. METHODS - We compiled a datasheet toregister patient data and results. Swabsfrom one of the anterior nares, the throatand the rectal area were taken at admissionand discharge after informed consent of thepatients. Microbiological samples wereprocessed by current microbiology guide-lines. RESULTS - During the one-month studyperiod, 134 adult patients were admitted,105 of who consented to the examination.At admission, six patients (5.7%) carriedmeticillin-resistant Staphylococcus aureusand five patients (4.76%) carried extendedspectrum β-lactamase producing Esche-richia coli. In one patient (0.95%) nosoco-mial extended spectrum β-lactamase pro-ducing Enterobacter cloacaewas identifiedin the rectal sample. In two patients (1.9%),rectal colonisation by Streptococcus pyogeneswas detected. CONCLUSIONS - Screening patients formeticillin-resistant Staphylococcus aureusin our department is important because ofthe high rate of patients returning to thehaematologic department, and consideringthat 4.5% of patients admitted to ourDepartment were transported to surgicaldepartments in 2010. It is particularlyimportant to determine the sampling location. The prevalence of rectal colonisatonby extended spectrum β-lactamase produc-ing bacteria was in accordance with international data. We didn’t detect infectionprovoked by the examined bacteria duringthe study period.]

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