Resit Demir

Management of the focal nodular hyperplasia of the liver: evaluation of the surgical treatment comparing with observation only

BACKGROUND Long-term results of both surgery and observation for patients with focal nodular hyperplasia (FNH) in a large single-center experience do not exist. Accordingly, the aim of this study was to compare long-term outcomes in patients with FNH who underwent either elective hepatectomy or observation alone. METHODS A retrospective single-institution analysis of 185 patients with FNH, treated from 1990 to 2009, was performed. RESULTS Seventy-eight patients underwent elective hepatectomy and 107 patients observation alone, with a median follow-up period of 113 months. There was no perioperative mortality. Postoperative complications were recorded in 12 patients, and 92% of patients reported symptomatic reductions. Among observation patients, 9 (13%) developed additional symptoms; tumor enlargement was seen in 3 patients (4%). CONCLUSIONS Elective liver resection for FNH is a safe procedure at high-volume centers. This single-center experience showed that 13% of observed patients had protracted symptoms. This justifies the therapeutic algorithm that elective surgery should be considered in symptomatic patients or in those with marked enlargement.

The Effect and Safety of the Treatment of Recurrent Hepatitis C Infection After Orthotopic Liver Transplantation With Pegylated Interferon α2b and Ribavirin

INTRODUCTION Recurrent hepatitis C infection in the posttransplant setting is a serious problem. The aim of this study was to evaluate the efficacy, safety, indications, optimal time of administration and adequate duration of antiviral therapy with pegylated interferon alpha 2 b (PEG-IFN) and ribavirin (RIB). PATIENTS AND METHODS Between 2003 and 2009, 16 patients received antiviral therapy (PEG-IFN: 0.8-1.6 μg/kg/wk, RIB 800-1200 mg/d) for at least 6 months. Patients with a biochemical without a virologicalresponse after 12 months of therapy received antiviral treatment for a further 6 months. Hepatitis C virus load was determined at 1, 3, 6, and 12 months after start of therapy. Liver biopsy was performed in all patients before the beginning and after the end of treatment. RESULTS The mean period of antiviral therapy was 14 months. The four patients who received the full-length treatment (12 months, 33%) showed sustained virological responses (SVR) and 8 showed virological and biochemical responses (VR, BR). Patients with SVR showed significant improvement in the grading and staging of HAI (histological activity index; P=.03). Nine patients had several side effects under antiviral treatment. Acute rejection episodes were not observed. CONCLUSION The antiviral treatment combination using PEG-IFN and RIB for recurrent hepatitis C is effective procedure. The SVR of 33% after 12 months of treatment with significant improvement in HAI grading and staging and stable HAI in all treated patients favor early initiation and 12-month administration of antiviral treatment. Furthermore, all patients with BR without VR, who underwent antiviral treatment for a further 6 months, achieved a VR. However, the optimal duration of treatment needs to be investigated in large prospective studies.

Definition of the “Drug-Angiogenic-Activity-Index” that Allows the Quantification of the Positive and Negative Angiogenic Active Drugs: A Study Based on the Chorioallantoic Membrane Model

Since the introduction of the angiogenic therapy by Folkman et al. in the 1970’ies many antiangiogenic drugs were identified. Only few of them are still now in clinical use. Also the Vascular Endothelial Growth Factor (VEGF), the cytokine with the highest angiogenic activity, has been identified. Its antagonist, Bevacizumab, is produced and admitted for the angiogenic therapy in first line for metastatic colorectal cancer. When we look at preclinical studies, they fail of in vivo models that define the “Drug-AngiogenicActivity-Index” of angiogenic or antiangiogenic drugs. This work proposes a possible standardized procedure to define the “Drug Angiogenic Activity Index” by counting the vascular intersections (VIS) on the Chorioallantoic Membrane after drug application. The equation was defined as follows: {ΔVIS[Drug]−ΔVIS[Control]} / Δ VIS[Control]. For VEGF a Drug-Angiogenic-Activity-Index of 0.92 was found and for Bevacizumab a −1. This means almost that double of the naturally angiogenic activity was achieved by VEGF on the Chorioallantoic membrane. A complete blocking of naturally angiogenic activity was observed after Bevacizumabs application. Establishing the “Drug-Angiogenic-Activity-Index” in the preclinical phase will give us an impact of effectivness for the new constructed antiangiogenic drugs like the impact of effectiveness in the cortisone family.

Antiviral re-treatment of IFN-ribavirin non-responders for recurrent post-transplantation hepatitis C.

Yedibela S, Demir R, Melling N, Aydin Ü, Schuppan D, Müller V, Hohenberger W, Schönleben F. Antiviral re‐treatment of IFN‐Ribavirin non‐responders for recurrent post‐transplantation hepatitis C.
Clin Transplant 2011: 25: 131–135.