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PRIMARY YOLK SAC TUMOUR OF LIVER WITH UNUSUAL CLINICAL PRESENTATION MIMICKING ACUTE APPENDICITIS

Abstract Primary hepatic yolk sac tumour (YST) is an extremely rare tumour of the liver. The exact etiology of primary hepatic YST is still unclear. This tumour is very aggressive with ability to spread into distant sites, where it can lead to the first clinical presentation. The authors present a case of a 20-year-old woman with fever and pain in the epigastrium, which later on moved to the right hypogastrium clinically resembling acute appendicitis. Ultrasound revealed tumorous mass in the liver and hypoechogenous tumorous mass in the area of right adnexes and terminal ileum. Tumorous mass in the liver was confirmed on the CT scan. Markedly raised levels of serum α-fetoprotein concentration were detected. Laparoscopic appendectomy was performed and there was bioptically verified a diagnosis of YST. Afterwards, patient underwent right hemihepatectomy, right hemicolectomy and right adnexectomy. There was found no evidence of the gonadal, mediastinal, retroperitoneal and central nervous system origin of the YST. Histological findings from the liver proved primary yolk sac tumour of the liver with the metastatic spread into the appendix, caecum and regional lymph nodes.

Complications of liver resection in geriatric patients

Introduction and aims. Liver resection is the treatment of choice for many primary and secondary liver diseases. Most studies in the elderly have reported resection of primary and secondary liver tumors, especially hepatocellular carcinoma and colorectal metastatic cancer. However, over the last two decades, hepatectomy has become safe and is now performed in the older population, implying a paradigm shift in the approach to these patients. MATERIAL AND METHODS We retrospectively evaluated the risk factors for postoperative complications in patients over 65 years of age in comparison with those under 65 years of age after liver resection (n = 360). The set comprised 127 patients older than 65 years (35%) and 233 patients younger than 65 years (65%). RESULTS In patients younger than 65 years, there was a significantly higher incidence of benign liver tumors (P = 0.0073); in those older than 65 years, there was a significantly higher incidence of metastasis of colorectal carcinoma to the liver (0.0058). In patients older than 65 years, there were significantly more postoperative cardiovascular complications (P = 0.0028). Applying multivariate analysis, we did not identify any independent risk factors for postoperative complications. The 12-month survival was not significantly different (younger versus older patients), and the 5-year survival was significantly worse in older patients (P = 0.0454). CONCLUSION In the case of liver resection, age should not be a contraindication. An individualized approach to the patient and multidisciplinary postoperative care are the important issues.INTRODUCTION AND AIMS Liver resection is the treatment of choice for many primary and secondary liver diseases. Most studies in the elderly have reported resection of primary and secondary liver tumors, especially hepatocellular carcinoma and colorectal meta-static cancer. However, over the last two decades, hepatectomy has become safe and is now performed in the older population, implying a paradigm shift in the approach to these patients. MATERIAL AND METHODS We retrospectively evaluated the risk factors for postoperative complications in patients over 65 years of age in comparison with those under 65 years of age after liver resection (n = 360). The set comprised 127 patients older than 65 years (35%) and 233 patients younger than 65 years (65%). RESULTS In patients younger than 65 years, there was a significantly higher incidence of benign liver tumors (P = 0.0073); in those older than 65 years, there was a significantly higher incidence of metastasis of colorectal carcinoma to the liver (0.0058). In patients older than 65 years, there were significantly more postoperative cardiovascular complications (P = 0.0028). Applying multivariate analysis, we did not identify any independent risk factors for postoperative complications. The 12-month survival was not significantly different (younger versus older patients), and the 5-year survival was significantly worse in older patients (P = 0.0454). CONCLUSION In the case of liver resection, age should not be a contraindication. An individualized approach to the patient and multidisciplinary postoperative care are the important issues.

Ureteral Stenosis of Transplanted Kidney

Abstract Introduction: Ureteral stenosis is one of the most commonly reported urological complications after kidney transplantation. Material and methods: This is a retrospective analysis of the risk factors for ureteral stenosis (type of donor, age of donor, presence of interior polar arteria, unilateral dual transplantation, diabetes mellitus of the recipient and the donor, BK positivity, child recipient, cold ischaemia time, and delayed graft function), as well as the causes and types of treating ureteral stenoses. Results: In the group of 278 patients, the occurrence was 7.2 %. The medial of occurrence of ureteral stenoses was 24.6 months. The independent risk factor for ureteral stenosis in our group was the age of the donor ≥ 70 years [HR 6.5833; 95 % CI 2.2448-19,3070 (P = 0.0006)], BK positivity [HR 13.6667; 95 % CI 6.9127-27.0196 (P<0.0001)], cold ischaemia time > 1080 min [HR 4.0368; 95 % CI 1.7250-9,4465 (P = 0.0013)], and diabetes mellitus in the donor’s history [HR 16.2667; 95 % CI 7.8629-33.6525 (P <0.0001)]. The most frequent type of treating the ureteral stenosis in our group was retroureteroneocystostomy. After surgical treatment, we recorded no recurrence of stenosis. Conclusion: In our analysis, the confirmed independent risk factor was diabetes mellitus of the donor. However, further monitoring and analyses of large groups of patients are necessary. Surgical treatment of ureteral stenosis is safe. However, the most important momentum in surgical treatment of ureteral stenosis still remains the surgeon´s experience in the given type of treatment.

Correlation between CMV Infection and NODAT

Purpose: New-onset diabetes mellitus after transplantation (NODAT) is a well-known complication of transplantation. Materials and methods: Retrospectively, we detected CMV replication (PCR) in every month after transplantation of kidney in the first 12 months after transplantation in patients in a homogenous group from the aspect of immunosuppresion. Results: In the group of 167 patients (control group: n = 103, NODAT group: n = 64), the average value of CMV viremia was without any significant difference between the NODAT group and the control group (P = 0.9285). In the 10th month after kidney transplantation, we recorded significantly higher CMV viremia in the NODAT group (p < 0.0001), however, in the multi variant analysis, that difference was not confirmed. Thus, in our group, CMV is of no relevance with the development of NODAT in the monitored period. The survival of patients and graft was 12 months after kidney transplantation without any statistically significant difference between the monitored groups (P = 0.6113 - survival of the patient; P = 0.5381 – survival of the graft). Conclusion: Our analysis shows that in regular monitoring of CMV viremia and applying chemoprophylaxison the risk recipeints, CMV is not the risk factor for NODAT.

Effect of Smoking on Development of New Onset Diabetes Mellitus after Transplantation (NODAT) of Kidney

Abstract Purpose: Cigarette smoking has adverse effects on kidney transplant recipients, causing cardiovascular disease, kidney function impairment, and cancer. New onset diabetes mellitus after transplantation (NODAT) represents serious complication of transplantation of solid organs. Methods: In the group of 252 patients after kidney transplantation, we identified smokers and current non-smokers (the patient who has not been smoking or who is ex smoker) for the period of minimum 24 months. In the monitored period of 12 months after transplantation, we detected presence of NODAT in both groups. The group contained only those patients who did not have diabetes mellitus (of type 1 and 2) at the time of kidney transplantation. Results: The group of smokers was composed of 88 patients (34.9 %) and non-smokers 164 patients (65.1 %). The average age of smokers was 52 years ± 12.4, and of current non-smokers it was 44.8 years ± 12.8 (P < 0.0001). The smokers had significantly lower body mass index (BMI) at the time of kidney transplantation (P = 0.0059) and also 12 months after transplantation (P = 0.0069), lower weight gain 12 months after transplantation (P = 0.0220) and larger waist circumference 12 months after transplantation (P < 0.0001). Conclusion: In our group, smoking had no effect on development of NODAT, the smokers had lower values of BMI and waist circumference, however, the guideline development group feels that, as for the general population, success of smoking cessation can be enhanced by offering structured smoking cessation programs.