Hans Ackermann

Prospective Multicenter Study Evaluating Fecal Calprotectin in Adult Acute Bacterial Diarrhea

BACKGROUND Every year, about 2.2 million deaths occur worldwide due to diarrhea. Reliable diagnosis of patients with acute infectious diarrhea remains a formidable challenge to the clinicians. This is the first study reporting use of fecal calprotectin in diagnosing acute diarrhea. The aim was to compare the diagnostic accuracy of fecal calprotectin, fecal lactoferrin, and guaiac-based fecal occult blood test in a diverse group of consecutive patients with acute diarrhea in which routine bacterial stool cultures and cytotoxins for Clostridium difficile were performed. METHODS This was a prospective case-control multicenter study from January 2004 until October 2007 in 2383 consecutive patients with acute diarrhea. They provided stool samples for performing cultures. Patients with positive cultures and an equal number of matched controls with negative cultures underwent fecal occult blood test and calprotectin and lactoferrin assays. RESULTS Calprotectin, lactoferrin, and fecal occult blood tests demonstrated sensitivity and specificity of 83% and 87%, 78% and 54%, and 38% and 85%, respectively, for diagnosing acute bacterial diarrhea. CONCLUSIONS Calprotectin showed high correlation with bacteriologically positive infectious diarrhea compared with lactoferrin and fecal occult blood test. It may potentially revolutionize management algorithm for patients with acute diarrhea. As a screening test, calprotectin can generate results within hours to support presumptive diagnosis of infectious diarrhea, which can decide suitability of stool samples for culture.

Portal vein thrombosis and arterioportal shunts: Effects on tumor response after chemoembolization of hepatocellular carcinoma

AIM To evaluate the effect of portal vein thrombosis and arterioportal shunts on local tumor response in advanced cases of unresectable hepatocellular carcinoma treated by transarterial chemoembolization. METHODS A retrospective study included 39 patients (mean age: 66.4 years, range: 45-79 years, SD: 7) with unresectable hepatocellular carcinoma (HCC) who were treated with repetitive transarterial chemoembolization (TACE) in the period between March 2006 and October 2009. The effect of portal vein thrombosis (PVT) (in 19 out of 39 patients), the presence of arterioportal shunt (APS) (in 7 out of 39), the underlying liver pathology, Child-Pugh score, initial tumor volume, number of tumors and tumor margin definition on imaging were correlated with the local tumor response after TACE. The initial and end therapy local tumor responses were evaluated according to the response evaluation criteria in solid tumors (RECIST) and magnetic resonance imaging volumetric measurements. RESULTS The treatment protocols were well tolerated by all patients with no major complications. Local tumor response for all patients according to RECIST criteria were partial response in one patient (2.6%), stable disease in 34 patients (87.1%), and progressive disease in 4 patients (10.2%). The MR volumetric measurements showed that the PVT, APS, underlying liver pathology and tumor margin definition were statistically significant prognostic factors for the local tumor response (P = 0.018, P = 0.008, P = 0.034 and P = 0.001, respectively). The overall 6-, 12- and 18-mo survival rates from the initial TACE were 79.5%, 37.5% and 21%, respectively. CONCLUSION TACE may be exploited safely for palliative tumor control in patients with advanced unresectable HCC; however, tumor response is significantly affected by the presence or absence of PVT and APS.

Simplified technique for surgical ligation of the left atrial appendage in high-risk patients.

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Leiomyoma Volume Changes at Follow-up after Uterine Artery Embolization: Correlation with the Initial Leiomyoma Volume and Location

PURPOSE To study the changes in uterine leiomyoma volume after uterine artery embolization (UAE) and to correlate these changes with the initial tumor volume and location within the uterus. MATERIALS AND METHODS The study was performed retrospectively on 28 consecutive patients (age, 37-57 years; mean, 48 y +/- 4.81) with 84 uterine leiomyomas. UAE was performed between June 2006 and August 2007. All tumors in all patients were evaluated. Magnetic resonance imaging was performed before UAE and 3 months and 1 year after UAE. The volume and location of each tumor were evaluated in consensus by two radiologists. RESULTS The mean pre-UAE volume of the leiomyomas was 51.6 cm(3) (range, 0.72-371.1 cm(3); SD, 79.3). Seven tumors were submucous, 28 intramural, and 49 subserous. At 3-month follow-up, 83 tumors (98.8%) showed volume reduction (mean, 52.62% +/- 21.85%; range, 12.79%-96.67%) and one (1.2%) increased in volume. At 1-year follow-up, five tumors (6%) were undetectable, 72 (85.7%) showed a further volume reduction of 20.5% +/- 11.92% (range, 2.52%-58.72%) relative to the 3-month volume, and seven (8.3%) increased in volume. A statistically significant difference (P = .026 at 3 months and P = .0046 at 1 year) in percentage of volume change was observed based on tumor location; submucous tumors showed the greatest volume reduction and subserous tumors the least reduction. The initial tumor volume showed a weak negative correlation (Spearman correlation coefficients, -0.35 at 3 months and -0.36 at 1 year) with tumor volume change. CONCLUSIONS UAE results in leiomyoma volume reduction at 3-month and 1-year follow-up. The tumor location plays an important role in volume changes and the initial tumor volume plays a minor role. Further studies with larger numbers of submucous leiomyomas are needed.