Ian Cadden

Investigating paediatric airways by non-bronchoscopic lavage: Normal cellular data

Background Bronchoscopic bronchoalveolar lavage in children to investigate bronchia disorders such as asthtna has both ethical and procedural difficulties.

Primary biliary cirrhosis is associated with oxidative stress and endothelial dysfunction but not increased cardiovascular risk

Aim:  Primary biliary cirrhosis (PBC) is a chronic cholestatic disease which is associated with hypercholesterolaemia. Further, cholestatic diseases are associated with deficiencies of anti‐oxidant vitamins. Despite these associations PBC is not associated with an increase in cardiovascular mortality. The aim of this study is to assess if primary biliary cirrhosis is associated with oxidative stress, endothelial dysfunction and alteration of vascular compliance which is a surrogate marker for cardiovascular risk.

Cyclooxygenase‐2 expression correlates with phaeochromocytoma malignancy: evidence for a Bcl‐2‐dependent mechanism

Aims:  Phaeochromocytomas are rare but potentially life‐threatening neuroendocrine tumours of the adrenal medulla or sympathetic nervous system ganglia. There are no histological features which reliably differentiate benign from malignant phaeochromocytomas. The aim of the study was to evaluate cyclooxygenase (COX)‐2 and Bcl‐2 as tissue‐based biomarkers of phaeochromocytoma prognosis.

An evaluation of cyclooxygenase-2 as a prognostic biomarker in mid-gut carcinoid tumours

Background/Aims: Mid-gut carcinoids (MGC) are the most common of the gastrointestinal carcinoid tumours. There is a lack of reliable prognostic indicators for MGC. Cox-2 and Bcl-2 were evaluated as prognostic biomarkers in a cohort of well-characterised non-appendiceal MGC. Methods: Tissue from the primary MGC tumours of 37 patients was subjected to immunohistochemical detection of Cox-2 and Bcl-2. In 9 cases, tissue from secondary lesions was also examined. The study assessed whether tumour-associated Cox-2 and Bcl-2 expression were related to patient survival. Results: Cox-2 expression was demonstrated in 30/36 primary tumours. When all tumours were analysed, Cox regression analysis indicated a trend towards worsening survival with increasing Cox-2 histoscore (intensity × proportion; hazard ratio 1.53, 95% CI 0.93, 2.52; p = 0.09). Analysis of Cox-2-positive tumours revealed a highly significant association between increasing histoscore and decreased survival (hazard ratio 3.03, 95% CI 1.33, 6.91; p = 0.008). Tumour-associated Bcl-2 expression had no effect on patient survival (hazard ratio 1.12, 95% CI 0.42, 2.99; p = 0.82). There was no significant association between Cox-2 and Bcl-2 expression (χ2 p = 0.16), or Cox-2 histoscore and Bcl-2 expression (MWU p = 0.59). Analysis of the Cox-2 histoscores of primary tumours and their corresponding secondary lesions revealed a statistically significant trend towards increasing histoscore in the latter (Wilcoxon p = 0.04). Conclusions: This study has provided evidence that Cox-2 expression in primary MGC may be associated with a more negative prognostic outlook.

PMO-160 Liver transplantation for chronic hepatitis C in Northern Ireland

Introduction Chronic hepatitis C (CHC) is a leading cause of chronic liver disease in the UK. Orthotopic liver transplantation (OLT) is commonly used for end stage cirrhosis or hepatocellular cancer secondary to CHC. Unfortunately recurrence of CHC in the graft of transplant recipients is almost universal, often leading to accelerated liver damage. Our aim was to assess the outcome of patients attending a Regional Liver Unit in Northern Ireland who underwent OLT for liver disease due to CHC. Methods A retrospective study was carried out of patients from Northern Ireland who had OLT between 1998 and 2010 for CHC associated chronic liver disease. Cases were identified by review of the regional OLT database and cross-referenced with the centre where OLT was carried out (KCH, London). Results Sixteen patients (11 male) underwent 20 OLTs for CHC between April 1998 and December 2010 (<10% of all OLTs). Mean age was 54 years. 13 patients had single OLT and 3 required multiple transplants. The HCV genotypes were 1 (7), 3 (5) and 2 (4). Prior to OLT, 10 patients received antiviral therapy—all failed (five non-responders, two relapsed following treatment and three failed to tolerate treatment). Data were only available on 19 OLT episodes. Immunosuppressant maintenance therapy was as follows: tacrolimus (9), tacrolimus + mycophenolate (4), cyclosporine (1) and mycophenolate + prednisolone (1). Short-term complications included acute cellular rejection in 5 (26.3%) requiring pulsed methylprednisolone (4) or IL2 blockade (1). Two patients developed renal failure requiring short-term dialysis post transplantation. Long-term complications included biliary anastomotic stricture in 6 (31%) patients and vascular complications in 3 (2 hepatic artery thrombus, 1 hepatic vein stenting). One patient acquired hepatitis B from the transplanted liver. Reasons for re-transplantation were hepatic artery thrombosis (2), recurrent cirrhosis with portal hypertension (1) and primary non-function of the graft (1). Seven (35%) transplants had cirrhosis confirmed on biopsy (5) or clinically (ascites (1) or oesophageal varices (1)) at a mean time of 25.6 months post transplant (range 12–48 months). Five-year mortality in the cohort was 25%. Conclusion Hepatitis C accounted for <10% of OLT episodes in Northern Ireland during the study period. This demand may increase in the future as the chronic complications of previously undiagnosed hepatitis C are seen. One third of this small cohort developed cirrhosis within a few years of OLT. Competing interests None declared.