Search

Background and aims. For the 8-week OPrD regimen, real world data are insufficient. This study aims to compare the efficacy of the two types of regimens (12-week versus 8-week) in a real world cohort of patients with genotype 1b. Material and methods. We analysed a multicentric retrospective cohort enrolling 1436 patients who started HCV therapy in 2018-2019. Liver fibrosis was staged in all subjects by Fibromax. Efficacy was assessed by the percentage of patients achieving SVR 12 weeks post-treatment (SVR12). Results. Out of the 1436 analysed patients, 112 received 8 weeks therapy and 1324 received 12 weeks. In this cohort the proportion of male patients was 25.2%, the median age 61 years, 28.2% were interferon pre-treated, and the rate of co-morbidities was 47%. 42% of the subjects had F2 fibrosis, 29% F1 fibrosis, 16% F3 and 12% F4. The SVR rate was comparable in both groups of patients (97% in those treated with OPrD 12 weeks vs 96.4% in those that received OPrD 8 weeks) (by intention-to-treat). In the 12 weeks arm, the drop-out rate was 0.8% and the rate of severe adverse events was 1%, while in the arm of 8 weeks therapy there were no severe adverse events reported and no drop-out (p = 0.25). The only predictive factor for non-response in both treatment arms was the male sex. Conclusions. OPrD 8 weeks proved to be highly efficient in our patients with a 96.4% SVR. No serious adverse events and no drop out were reported.

Pancreatic cancer remains one of the most aggressive neoplasms affecting people worldwide, with lower than one year rates of survival, especially if metastatic disease is encountered. In such cases palliative chemotherapy has been proposed, but the overall prognostic remains extremely poor. Meanwhile, in certain cases, spectacular response to chemotherapy has been observed, with significant reduction and even disappearance of the liver lesions. In this respect, attention was focused on establishing whether surgery might improve the outcomes in such cases. This is a literature review of the largest studies conducted on this issue.

Hematogenous path remains an important pathway of spread for ovarian cancer; the most commonly reported sites of involvement are represented by liver and lungs. The aim of this paper is to report a rare situation in which adrenal metastasis from ovarian carcinoma was encountered. Case report. The 55-year-old patient with previous history of surgically treated ovarian cancer was diagnosed at 18 months follow-up with an isolated lesion at the level of the right adrenal gland. After completing the biochemical analysis, in order to exclude an endocrine disorder, the final suspicion of diagnostic was of an adrenal metastasis and was submitted to adrenalectomy. The histopathological studies confirmed the presence of an adrenal metastasis of ovarian cancer. Conclusions. Although rare situations, adrenal metastases from ovarian cancer can be encountered and might be successfully treated by surgery with curative intent.

Inflammatory pseudotumors of the liver are rare entities, only few cases being reported so far, pathogenesis of these lesions being scarcely understood. However since now multiple mechanisms have been proposed in order to explain the development of these lesions, the knowledge of their pathogenesis being mandatory in order to further orientate the therapeutic strategy. The current paper is a literature review of the largest studies which aimed to discuss the etiopathogenesis of the inflammatory pseudotumors of the liver.

The aim of this study is to analyze the feasibility and safety of left upper abdominal resections as part of debulking surgery. Case series presentation. Between January 2015 and August 2019, 32 patients were submitted to left upper abdominal resections. Left upper abdominal resections were performed as part of primary cytoreduction in 22 cases, as part of secondary cytoreduction in eight cases, and respectively as part of tertiary cytoreduction in two cases. The complexity of the resection increased from primary to secondary and tertiary cytoreduction; in the meantime, the rates of postoperative complications also increased with the attempt of cytoreduction. Therefore the postoperative morbidity rate was of 27% at the time of primary cytoreduction, 37.5% at the time of secondary cytoreduction and 50% at the time of tertiary cytoreduction. However, association of left upper abdominal resections leaded to a complete resection rate of 77% at the time of primary cytoreduction, 62.5% at the time of secondary cytoreduction and 50% at the time of tertiary cytoreduction. Conclusions. Left upper abdominal resections might increase the rates of complete debulking in the setting of advanced stage or relapsed ovarian cancer. However the complexity of procedures and the risk of postoperative complications increase with the number of attempts of debulking.

Described for the first time in 1982, intraductal papillary mucinous neoplasms have been widely studied so far. According to the site of origin and location, it seems that these tumors have a specific risk of malignisation and therefore their type of treatment as well as the moment in which it should be applied should be carefully tailored. In this respect, multiple therapeutic strategies have been proposed, ranging from follow up and limited excision to total pancreatectomy. The current paper is a literature review of the largest studies conducted on the theme of the therapeutic strategies in intraductal papillary mucinous neoplasms.

Indocyanine green guided surgery has gained significant popularity in the last decade in different areas including colorectal, gynecological or even hepatic surgery. Moreover, recently published papers came to demonstrate the utility of the method in pancreatic surgery, providing a better identification of pancreatic lesions and bringing significant information regarding the local anatomy. The current paper represents a literature review of the most relevant studies published so far on this issue.

Anatomical liver resection guided by segmental portal inflow compression proved to be an efficient tool in order to maximize the curative surgical treatment in hepatocellular carcinoma. In this respect, in the last decades, once the concept of indocyanine guided surgery gained more field, the method has been also implemented in hepatic surgery. Therefore it seems that intravenous injection followed by portal pedicle clamping and liver inspection in infrared light inspection might delimitate the segments of the liver and might successfully guide the gesture of anatomical liver resection. The current paper is a literature review of the studies which analyzed the efficacy and safety of indocyanine green guided liver surgery.

Introducere. În ultimii ani, s-au făcut progrese majore în ceea ce priveşte tratamentul şi prevenţia hepatitelor virale, însă această patologie reprezintă încă o problema majoră de sănătate şi socioeconomică. Elementul definitoriu pentru această boală este reprezentat de fibroza hepatică, componentă histologică dosebit de importantă datorită rolului sau în constituirea leziunilor hepatice de ciroză hepatică. Astfel, o etapă esenţială în depistarea şi monitorizarea hepatitei virale, o reprezintă detectarea şi măsurarea fibrozei hepatice. Astăzi dispunem de metode invazive de depistare a fibrozei hepatice, puncţia biopsie hepatică, precum şi de metode non-invazive, care la rândul lor se împart în metode serice şi metode imagistice (2). Scopul studiului. Scopul acestui studiu este de a determina dacă elastografia transcutană (FibroScan), metodă imagistică, non-invazivă de elecţie, este la fel de fiabilă în cazul hepatitei virale B, ca şi în cazul hepatitei virale C. Materiale şi metodă: Au fost luaţi în studiu un număr de 1127 pacienţi, având o afecţiune hepatică de etiologie VHB şi VHC. Aceşti pacienţi au fost examinaţi cu ajutorul FibroScan în perioada Iulie 2009 – Aprilie 2011. Rezultate: Din cei 1127 pacienţi investigaţi cu ajutorul FibroScan-ului, 40 dintre aceştia au efectuat şi Puncţie Biopsie Hepatică. Dintre aceştia, 82% au obţinut aceleasi stadii ale fibrozei hepatice la cele două investigaţii, iar 18% au obţinut grade de fibroză diferite la cele două teste. Comparativ, la pacienţii cu virus hepatitic C, am obţinut o concordanţă de 67,81% a celor două teste non-invazive, FibroScan şi FibroMax şi o concordanţă de 79,16% a FibroScan-ului comparativ cu Biopsia Hepatică. Pentru virusul B, concordanţa este chiar mai bună de 75% (FibroScan – FibroMax), respectiv 80% pentru FibroScan – PBH. Concluzii: FibroScan este una din metodele de evaluare non-invazivă a fibrozei hepatice cu acurateţe diagnostică asemănătoare FibroMax-ului şi apropiată de a Puncţiei Biopsie Hepatică.

Introduction. Hepatitis C is a liver inflammation caused by hepatitis C virus. HCV is about 10 times as infectious as HIV. The acute infection rarely causes symptoms and can clear up spontaneously in the first six months in about 20% of those affected. In most cases, however, the infection becomes chronic (up to 80%)6. Chronic hepatitis C is a major cause of liver cirrhosis and hepatocellular carcinoma worldwide7. In the past decades, the standard treatment for hepatitis C viral infection was PEG-IFN and ribavirin (RBV). The future for the treatment of chronic hepatitis C infection is represented by DAAs and for Romania, the future is called Exviera+Viekirax. Objective of the study: The main purpose of the survaillance was to determine how these HCV chronic infection patients with F4 liver fibrosis tolerate the new DAAs treatment and how the liver fibrosis will decrease or increase. Matherial and methods: The study enrolled 33 patients from Internal Medicine Center, Fundeni Clinical Institute, during the time period 02.2016 – 08.2016. We evaluated the inflammatory syndrome, the cholestatic syndrome and the evolution of liver fibrosis. Results: We have noticed a significant decrease of inflammatory syndrome, the bilirubin level decreased also, but the stage of liver fibrosis remained the same, at the end of treatment with Eviera+Viekirax. Conclusions: We had a small experience so far, with Exviera+Viekirax regimen. The patients tolerated very well the therapy and the virological response was 100% for all subjects.

Introduction. In recent years there have been major advances in the treatment and prevention of viral hepatitis, but this pathology is still a major health and socio-economic problem. The defining element for this disease is the liver fibrosis, a histological component of particular importance due to its role in the formation of liver lesions of cirrhosis. Thus, an essential step in the management of chronic viral hepatitis is the detection and measurement of liver fibrosis. Today we have invasive methods for detecting liver fibrosis, the liver puncture biopsy, and non-invasive methods, which in turn are divided into serum methods and imaging methods (2). Purpose of the Study. The aim of this study is to determine if transcutaneous elastography (FibroScan) is equally reliable in case of viral hepatitis B, as with viral hepatitis C. Material and Method: The study comprises a total of 1,127 patients with liver disease of HBV and HCV aetiology. These patients were examined using FibroScan in the period July 2009 - April 2011. Results: Of the 1,177 patients investigated using FibroScan, 40 underwent liver biopsy as well. Of these, 82% have obtained same stages of liver fibrosis in these two investigations, and 18% achieved different stages of fibrosis in these two tests. For the patients with HCV infection, we obtained a 67.81% match of the two non-invasive tests, FibroScan and FibroMax, and a 79.16% match of FibroScan compared to the Liver Biopsy. For the B virus, the compliance is even better, of 75% (FibroScan - FibroMax), and 80% for FibroScan - LB. Conclusions: FibroScan is one of the non-invasive assessment methods of liver fibrosis with diagnose accuracy similar to FibroMax and close to Liver Biopsy.

Introducere. Hepatita C reprezintă o inflamaţie a ficatului, cauzată de virusul hepatitic C. Virusul C este de aproximativ 10 ori mai infecţios decât virusul HIV. Infecţia acută determina rar simptomatologie şi se poate vindeca spontan în primele 6 luni, la aproximativ 20% dintre pacienţii infectaţi. În cele mai multe cazuri, însă, infecţia devine cronică (până la 80% din cazuri) (6). Hepatita cronică VHC este o cauză majoră de ciroza hepatică şi hepatocarcinom, în întreaga lume (7). În ultimele decenii, tratamentul standard pentru infecţia cronică VHc a fost combinaţia PEG-IFN şi Ribavirina (RBV). Prezentul şi viitorul tratamentului pentru virusul C este reprezentat de noile generaţii de DAA, în general, Exviera+Viekirax pentru România, în special. Obiectivele studiului: Obiectivul principal al acestui studiu este de a determina cum tolerează pacienţii cu infecţie cronică VHC, cu fibroză hepatică F4, noul tratament cu DAA, precum şi care va fi evoluţia fibrozei hepatice. Material şi metodă: În acest studiu au fost înrolaţi 33 pacienţi, din Centrul de Medicină Internă, Institutul Clinic Fundeni, internaţi în perioada 02.2016 - 08.2016. Am evaluat sindromul inflamator, sindromul de colestaza şi evoluţia fibrozei hepatice la aceşti pacienţi. Rezultate: Am observant o reducere semnificativă a sindromului infamator, nivelul bilirubinei serice a înregistrat, de asemenea, o scădere, dar în ceea ce priveşte stadiul fibrozei hepatice, acesta a rămas acelaşi, la sfârşitul tratamentului antiviral cu DAA, Exviera+Viekirax. Concluzii: Este nevoie de mai multe date pentru a putea formula o concluzie solidă, în ceea ce priveşte rata SVR, efectele secundare, evoluţia fibrozei hepatice şi eventualele recăderi.