K.F. Lee

Meta‐analysis: the efficacy of anti‐viral therapy in prevention of recurrence after curative treatment of chronic hepatitis B‐related hepatocellular carcinoma

Aliment Pharmacol Ther 2011; 33: 1104–1112

Promoter methylation of the Wnt/β‐catenin signaling antagonist Dkk‐3 is associated with poor survival in gastric cancer

Abnormal activation of the Wnt/β‐catenin signaling pathway is common and critical in the pathogenesis of digestive cancers. In this study, the authors investigated the promoter methylation of the dickkopf homolog 3 gene Dkk‐3 in these cancers and its prognostic significance in gastric cancer.

Biliary cystadenoma and other complicated cystic lesions of the liver: diagnostic and therapeutic challenges.

Biliary cystadenomas are complicated cystic lesions of the liver. They are rare and pose considerable diagnostic and therapeutic challenges. We present our experience managing these lesions by performing a retrospective review of all patients with a preoperative diagnosis of or histologically proven biliary cystadenoma who underwent surgery between January 1995 and January 2005 at our institution. Altogether, 20 patients (16 women, 4 men) with a mean age of 58 years underwent a total of 22 operations. The diagnosis of biliary cystadenoma was based on exclusion of other pathologic entities and the presence of radiologic characteristics of biliary cystadenoma. Abdominal ultrasonography (US), computed tomography, or both were performed in all patients. US-guided fine-needle aspiration cytology was performed in seven patients and all of them were negative for malignancy. A preoperative diagnosis of biliary cystadenoma was made in 16 patients based on clinical and radiologic features and was correct in 6 of them. Diagnosis of biliary cystadenoma was not suspected in four patients. The overall diagnostic accuracy was 30%. Enucleation was the most common surgical procedure and was performed in 10 patients. The mean follow-up period was 5.5 ± 2.8 years. No recurrence was detected in patients with confirmed biliary cystadenoma after adequate excision. The findings of this study highlight the difficulty with preoperative diagnosis of biliary cystadenoma, which has seldom been discussed in the literature. Preoperative differentiation by means of radiologic imaging is inaccurate (30%). Any therapy short of complete excision leads to local recurrence and risk of malignant transformation. Complete excision of any suspicious lesion remains the best method of diagnosis and treatment.

The analgesic efficacy of continuous wound instillation with ropivacaine after open hepatic surgery.

The analgesic efficacy of continuous local anaesthetic wound instillation after open hepatic surgery was evaluated. Forty‐eight patients scheduled for elective liver surgery were assigned to receive either ropivacaine 0.25% or saline infusion at 4 ml.h−1 for 68 h via two multi‐orifice indwelling catheters placed within the musculo‐fascial layer before skin closure; plasma ropivacaine concentrations were measured during the infusion. Supplemental analgesia was provided by intravenous patient‐controlled analgesia morphine. Patients in the ropivacaine group had decreased mean (SD) total morphine consumption (58 (30) mg vs 86 (44) mg, p = 0.01) and less pain at rest as well as after spirometry at 4, 12, 24, 48 and 72 h postoperatively (p < 0.01). Forced vital capacity was reduced postoperatively in both groups, but the reduction was greater in the saline group at 12 and 24 h (p = 0.03). The mean plasma concentration of ropivacaine increased to 2.05 (0.78) μg.ml−1 at the point when the infusion was terminated.

Antiviral therapy improves post‐hepatectomy survival in patients with hepatitis B virus‐related hepatocellular carcinoma: a prospective‐retrospective study

The effect of antiviral therapy on the post‐hepatectomy long‐term survival in patients with hepatitis B virus (HBV)‐related hepatocellular carcinoma (HCC) remains uncertain.

Randomized clinical trial of open hepatectomy with or without intermittent Pringle manoeuvre

The intermittent Pringle manoeuvre (IPM) is commonly applied during liver resection. Few randomized trials have addressed its effectiveness in reducing blood loss and the results have been conflicting. The present study investigated the hypothesis that IPM could reduce blood loss during liver resection by 50 per cent.

Routine early laparoscopic cholecystectomy for acute cholecystitis after conclusion of a randomized controlled trial

The aim of this retrospective review was to assess the clinical outcomes of laparoscopic cholecystectomy for acute cholecystitis since the conclusion of a randomized controlled trial in 1997.

Techniques for liver resection: A review

Improvement in surgical outcomes of liver resection has been achieved in the past decade. Among other factors, a gradual change of technology platforms and refinement of surgical techniques have played significant roles. In this review, the various surgical approaches, operative techniques, operative instruments, and adjunctive measures as applied in liver resection are described, along with discussion of the pros and cons of each of these attributes. A brief description of laparoscopic liver resection is also included to address this important and emerging area in liver surgery.

Ruptured gastroduodenal artery pseudoaneurysm as the initial presentation of chronic pancreatitis

Gastroduodenal artery pseudoaneurysm is a rare but life threatening complication of pancreatitis. Diagnosis and management of it remain challenging. Surgical treatment was associated with a high mortality. Percutaneous transarterial embolization of bleeding artery has recently been advocated as a definitive therapy and can be attempted as the initial measure to control bleeding. We herein report a case of chronic pancreatitis presented with ruptured pseudoaneurysm of gastroduodenal artery which was successfully controlled with transarterial embolisation.

Surrogate target cells expressing surface anti-idiotype antibody for the clinical evaluation of an internalizing CD22-specific antibody

SM03, a chimeric antibody that targets the B-cell restricted antigen CD22, is currently being clinically evaluated for the treatment of lymphomas and other autoimmune diseases in China. SM03 binding to surface CD22 leads to rapid internalization, making the development of an appropriate cell-based bioassay for monitoring changes in SM03 bioactivities during production, purification, storage, and clinical trials difficult. We report herein the development of an anti-idiotype antibody against SM03. Apart from its being used as a surrogate antigen for monitoring SM03 binding affinities, the anti-idiotype antibody was engineered to express as fusion proteins on cell surfaces in a non-internalizing manner, and the engineered cells were used as novel “surrogate target cells” for SM03. SM03-induced complement-mediated cytotoxicity (CMC) against these “surrogate target cells” proved to be an effective bioassay for monitoring changes in Fc functions, including those resulting from minor structural modifications borne within the Fc-appended carbohydrates. The approach can be generally applied for antibodies that target rapidly internalizing or non-surface bound antigens. The combined use of the anti-idiotype antibody and the surrogate target cells could help evaluate clinical parameters associated with safety and efficacies, and possibly the mechanisms of action of SM03.