Alpna R. Limaye

Hepatocellular carcinoma: current trends in worldwide epidemiology, risk factors, diagnosis, and therapeutics

Hepatocellular carcinoma (HCC) is a common malignancy in developing countries and its incidence is on the rise in the developing world. The epidemiology of this cancer is unique since its risk factors, including hepatitis C and B, have been clearly established. The current trends in the shifting incidence of HCC in different regions of the world can be explained partly by the changing prevalence of hepatitis. Early detection offers the only hope for curative treatment for patients with HCC, hence effective screening strategies for high-risk patients is of utmost importance. Liver transplantation and surgical resection remains the cornerstone of curative treatment. But major advances in locoregional therapies and molecular-targeted therapies for the treatment of advanced HCC have occurred recently. In this review, current trends in the worldwide epidemiology, surveillance, diagnosis, standard treatments, and the emerging therapies for HCC are discussed.

Neutrophil–lymphocyte ratio predicts overall and recurrence‐free survival after liver transplantation for hepatocellular carcinoma

The goal of this study is to evaluate whether an elevated neutrophil–lymphocyte ratio (NLR) at the time of diagnosis predicts survival of patients with hepatocellular carcinoma (HCC) after liver transplantation (LT). We hypothesize that the NLR is predictive of overall survival (OS) and recurrence‐free survival (RFS) in patients with HCC who undergo LT.

Bouveret's Syndrome: Case Report and Review of the Literature

Bouverets syndrome is defined as gastric outlet obstruction caused by duodenal impaction of a large gallstone which passes into the duodenal bulb through a cholecystogastric or cholecystoduodenal fistula. Initial attempts at endoscopic retrieval with or without mechanical or extracorporeal lithotripsy should be performed as first-line treatment, though success rates with endoscopic treatment are variable. We describe a case of Bouverets Syndrome in an elderly patient that was successfully treated with endoscopic extraction combined with mechanical lithotripsy, and review the literature on this uncommon condition.

The anti-viral effect of sorafenib in hepatitis C-related hepatocellular carcinoma.

Sorafenib is currently the only approved systemic therapy shown to have efficacy in the treatment of advanced hepatocellular carcinoma (HCC). Recent studies suggest that hepatitis C (HCV)‐related HCC patients derive more clinical benefit from sorafenib than other subgroups, but the mechanism for this effect is unknown. In vitro data suggest that sorafenib may exert anti‐viral properties, and thus our aim in this study was to evaluate potential anti‐viral activity of sorafenib in patients with HCV‐related HCC.

Disseminated gonococcal infection in women

A high index of suspicion is critical in the prevention of serious complications of gonorrheal infection. This article reviews published information regarding the pathophysiology, epidemiology, clinical characteristics, diagnosis, and treatment of gonorrhea. MEDLINE was used to search the literature for articles and studies that have a bearing on these issues. Keywords used were disseminated gonococcal infection; septic arthritis; gonorrhea and pregnancy; and gonorrhea and pathophysiology. We conclude that disseminated gonococcal infection (DGI) should be in the differential diagnosis of any sexually active patient who presents with arthritis, dermatitis, and/or tenosynovitis. Although the incidence of DGI has declined in recent years, it still is the most common cause of newly diagnosed arthritis requiring hospitalization. Careful culturing of every site that could be infected is imperative to aid in diagnosis and treatment. Prompt therapy with appropriate antibiotics such as ceftriaxone will prevent the more serious complications of DGI.

Management of recurrent hepatitis C infection after liver transplantation.

Recurrence of hepatitis C virus remains a near-universal phenomenon after liver transplantation (LT) and is responsible for the high morbidity and low survival seen in these patients. The severity of recurrent disease varies depending on multiple factors, only some of which are modifiable. Antiviral therapy is associated with improved outcomes, but viral clearance is only attainable in a small percentage of this patient population. This patient population is in need of new therapeutic options, and it remains to be seen whether direct-acting antiviral agents will be the answer to this ongoing therapeutic question.

Liver Biopsy After Liver Transplantation

Histological evaluation of liver allograft biopsies is an integral part of the management of liver transplant patients. From the time of donor hepatectomy onward, the allograft is sus‐ ceptible to multiple insults, including warm and cold ischemia, complications related to sur‐ gical anastomoses, acute cellular rejection, and recurrence of underlying liver disease. It is often quite challenging to distinguish these various entities by their clinical presentation alone. In these situations, evaluation of a liver biopsy is frequently necessary to confirm the diagnosis, to stage recurrent fibrosis, or to monitor response to treatment.