Irinel Popescu

Pretreatment plasma HGF as potential biomarker for susceptibility to radiation-induced liver dysfunction after radiotherapy

Radiotherapy shows excellent local control in liver cancers but carries the risk of radiation-induced liver dysfunction and liver failure. We conducted a study of plasma hepatocyte growth factor (HGF) in a clinical trial of proton radiotherapy in patients with unresectable liver cancers (NCT00976898), and in an observational study for liver cancer patients undergoing surgical treatments. Liver dysfunction within 3 months after radiotherapy—a Childs−Turcotte−Pugh (CTP) score increase of 1 point or more—occurred in 9/34 (26%) of patients. Patients with no increase in CTP score had lower pretreatment plasma HGF level (pu2009=u20090.015). Both the increase in CTP score (pu2009=u20090.034) and the pretreatment plasma HGF (pu2009=u20090.017) were associated with OS. Plasma HGF was significantly associated with presence of cirrhosis (pu2009=u20090.0027) and with Model for End-stage Liver Disease (MELD) score (pu2009<u20090.0001), but not with OS in surgical liver cancer patients. Pretreatment plasma HGF is a candidate biomarker for patient selection for radiotherapy.

Intraoperative Ultrasound Guided Liver Resections: A Single Center Experience

Background: Liver resection (LR) is the standard treatment for most focal liver lesions. Intraoperative ultrasound (IOUS) improves their diagnosis and guides the liver resection. The present paper analyses our experience in IOUS guided LR, reviewing the indications, surgical techniques, and the short-term results. Material and Method: 198 LRs guided by IOUS in 186 patients operated in our center between January 2013 and December 2017 were included in a combined prospective and retrospective study. The median age of the patients was 60 years (mean 57, range 16-79), with a male/female ratio of 109/77, and adult/pediatric patient ratio of 185/1. Results: Malignant lesions were the main indication for IOUS guided LR (164 LRs; 82.8%); among these, colorectal liver metastases were the main indication (66 LRs; 33.3%), followed by hepatocellular carcinoma (44 cases, 22.2%). The mean number of tumors was 3 (range 1-16), and the median diameter of the largest tumor was 40 mm (mean 51; range 3-240). IOUS found new lesions in 22.3% of cases operated for liver metastases (46 LRs), and changed the surgical strategy in 41.9% of cases (83 LRs). Major resection rate was 18.2% (36 LRs); anatomical LRs were performed in 18 cases (9.1%). The median operative time was 330 minutes (mean 334; range 90-920). The median blood loss was 700 ml (mean 900; range 250-9500), with a transfusion rate of 54.8% (108 LRs). Overall and major complication rates were 46.5% (92 LRs) and 7.6% (15 LRs), respectively, while the mortality rate was 2% (4 pts). Conclusion: IOUS should be fully integrated in the modern liver surgery, providing improved diagnosis and optimal resection guidance, increasing resectability and surgical safety, with low perioperative morbidity and mortality.

Central pancreatectomy: an oncologically safe option to treat metastases of other neoplasms of the mid-portion of the pancreas?

Backgrounds/Aims Standard pancreatic resections are the current approach for patients with resectable, isolated pancreatic metastases of other neoplasms. However, the role of parenchyma-sparing pancreatectomies for such pathology is poorly investigated. The aim of the present study is to assess the oncological safety of central pancreatectomies for pancreatic metastases of other neoplasms. Methods A literature search was performed in order to identify patients with central pancreatectomies for pancreatic metastases of other neoplasms. The available data of the patients were extracted and analyzed. Results A total number of 16 patients were identified. Renal carcinoma was the primary origin for the largest number of these patients (11 patients - 69%). The mean overall survival time was 109 months, with 1-, 5- and 10-year survival rates of 100%, 84%, and 60%, respectively. Conclusions Although not often performed, a central pancreatectomy appears to be an oncologically safe surgical procedure in select patients with pancreatic metastases of other neoplasms of the pancreatic body and isthmus. However, no definitive conclusions should be drawn, based on the data provided in the present study, due to the limited number and heterogeneity of the patients.

Diagnostic and Therapeutic Challenges in Nonparasitic Liver Cysts

Nonparasitic hepatic cysts constitute a heterogeneous group of disorders. A proper diagnosis of hepatic cyst is necessary in order to adopt the best treatment. The term hepatic cyst usually refers to simple hepatic cysts. Nonparasitic hepatic cysts are also linked to genetic disorders such as polycystic liver disease (PLD) with/ without autosomal dominant polycystic kidney disease (ADPKD) or Caroli disease. Generally, patients with nonparasitic hepatic cysts less than 3 cm are asymptomat‐ ic. These cysts become symptomatic when are large, multiple, or complicated. Percutaneous abdominal ultrasound is the best imaging modality to diagnose hepatic cysts but must be completed by other imaging and serological tests. It is important to differentiate simple hepatic cyst from hydatid cyst, cystadenoma, and cystadenocarcinoma before proceeding with the treatment. Sometimes the diagnosis is very challenging. Asymptomatic single liver cysts need only surveil‐ lance, but symptomatic and complicated ones require therapeutic intervention. Percutaneous aspiration of the cyst under ultrasound guidance is a mini-invasive procedure generally associated with sclerotherapy. The highest success rates were reported for laparoscopic or open cyst fenestration. Liver transplantation is indicated for patients with severe PLD.

Effects Induced in Complex Biological Systems by High Density Green Photons

It is known that light interaction with matter may generate an optical force, which may produce modifications at the physical and chemical level. The basic technique of the field uses strongly focused laser beams that trap small objects and manipulate local structures. In our work we use irradiation of complex biological molecules with high density green photons, which may induce electric dipoles by polarization effects. The resulting dipolar interaction may lead to organized structures like molecular aggregates and microparticles. We present experimental evidence of such an optical manipulation on long alkanes chains and two specific enzymes. A preliminary physical model is suggested for acounting of these specific interaction forces.

LAPAROSCOPIC ASSISTED ILEOCECAL RESECTION FOR AN APPENDICEAL MUCOCELE WITH 5-YEAR POSTOPERATIVE FOLLOW-UP OF THE PATIENT

Case Report: One case of appendiceal mucocele (AM) with a large implantation base into the cecum was accurately preoperatively diagnosed by abdomino-pelvic ultrasonography, computed tomography, and colonoscopy. Laparoscopic approach of AM was anticipated for diagnosis confirmation and resection. Due to a large appendiceal base of AM and close proximity of the ileocecal valve to the edge of the mass, visualized by intraoperative ultrasound, the patient was submitted to ileocecal resection. A 6-cm minilaparotomy was used for extraction of the specimen and performance of an extracorporeal ileocolic hand sewn anastomosis. Malignancy was ruled out on frozen sections of the operative specimen. The postoperative patient’s evolution was simple, with rapid recovery and short hospitalization. After more than 5 years of follow-up patient remained asymptomatic and disease-free with no malignancy detected.