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Introduction: Bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor has demonstrated a significant benefit on overall survival (OS) and progression free survival (PFS) in patients with metastatic colorectal carcinoma. Many adverse effects of Bevacizumab are well-known. We report here the first case of diaphragmatic perforation after Bevacizumab treatment., Patients and Methods: A case of Bevacizumab induced diaphragmatic perforation was reported and a search of PubMed and Cochrane databases was performed in order to review relevant literature on the adverse effects of Bevacizumab., Discussion: Serious late surgical complications may occur even if the delay between surgery and Bevacizumab treatment is respected. These complications may be life threatening for patients, and demonstrate the importance of careful monitoring after postoperative administration of Bevacizumab., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Cancer arising in abdominal wall endometriosis is a rare event, hindering diagnosis and making management uncertain. A cesarean section scar is generally at the origin of the disease. We report the case of a 45-year-old woman, with a past medical history of cesarean deliveries, complaining of a repeat abdominal wall endometriosis which transformed into a clear-cell carcinoma. Outcome was rapidly fatal. Compared with endometriosis-associated ovarian carcinoma, the prognosis of this abdominal scar complication is poor. In the literature, survival rate reaches only 57% after a short follow-up of 20 months. Clear-cell carcinoma is the most common histological subtype, followed by endometrioid carcinoma. Radical surgery is the main treatment. Good technique and proper care during cesarean section may help in preventing this endometriosis complication.

Radiation-induced bile duct strictures are rare since bile ducts are considered to be resistant in radiation injury. We report a case of bile duct stenosis where evidence is presented that bile duct stricture was the result of radiation injury and which illustrates the major contribution of magnetic res-onance cholangiography in biliary tract disease evaluation.

The acute-phase protein (APP) response is regulated by cytokines such as interleukin-6 (IL-6), interleukin-1 (IL-1) and tumor necrosis factor (TNF), but may also be influenced by malnutrition. The aims of this study were as follows: 1) to determine in rats the effect of a protein-deficient diet on IL-6 mRNA expression in intestine, liver and peripheral blood mononuclear cells (PBMC), and on alpha-1 acid glycoprotein (AGP) and alpha-2 macroglobulin (A2M) serum levels and hepatic mRNA expression; 2) to compare, in protein-deficient rats, the IL-6 and APP responses after a turpentine (TO)- or a lipopolysaccharide (LPS)-induced inflammation; and 3) to determine the effect of a protein malnutrition on IL-6 mRNA expression in rat PBMC treated ex vivo with LPS. Interleukin-6 mRNA was present in intestine and PBMC but not in the liver of malnourished rats, and was absent in any tissue or cells of controls. A2M was present in the serum from malnourished rats but not after refeeding. AGP mRNA expression was not influenced by protein malnutrition. In malnourished rats, IL-6 serum level peaked later than in controls after TO and LPS treatment. In malnourished TO-treated rats, A2M mRNA increased earlier than in controls and remained detectable later than in controls. AGP mRNA expression after TO was not influenced by protein malnutrition. In PBMC of malnourished rats, LPS-induced IL-6 mRNA expression occurred earlier and lasted longer than in controls. Our results indicate that protein malnutrition by itself induces IL-6 and A2M expression, and that it modulates the APP response to inflammation.

Biliary complications are a continuing source of morbidity and mortality following orthotopic liver transplantation. The results of 100 whole-liver allografts performed in 92 adult patients were reviewed to determine whether cold ischemia time and preservation injury influenced both the incidence and type of biliary complications. Mean cold ischemia time was 10.2 +/- 0.5 h (range 3.6-19). Eighteen patients (19.6%) developed 25 biliary complications: there were eight anastomotic leaks, eight anastomotic strictures, six non-anastomotic strictures, two cystic duct mucoceles, and one biliary fistula following T-tube removal. Despite the high rate of reoperative surgery (68%), no death was attributable to biliary complications. Neither cold ischemia time nor early graft function influenced the rate of biliary complications or strictures of either type. Furthermore, an analysis of different factors revealed no predisposing effect of the pre-operative status of the recipient, type of biliary reconstruction, blood requirement, vascular complications, rejection or cytomegalovirus infection on the incidence of biliary complications or strictures. Only chronic rejection could be singled out as a risk factor for non-anastomotic strictures (p = 0.05). These results suggest that prolonged cold ischemia time does not seem to affect the rate or type of biliary complications following orthotopic liver transplantation. In view of these data, there is no clear reason to reconsider prolonged cold ischemia up to 15 h in University of Wisconsin solution, as it has transformed liver transplantation from an emergency operation to a semi-elective procedure and allows longer back-table preparation for graft reduction of splitting.