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Volume 70 - 2007 - Fasc.1 - Original articles

Fine needle trucut biopsy in focal liver lesions : a reliable and safe method in identifying the malignant nature of liver lesions

Background and study aims : The correct management of a focal liver lesion, suspected of being malignant, requires tissue for histopathological examination. To this purpose an ultrasonically guided fine needle trucut biopsy technique (FNTCB) can be used, to allow obtaining large tissue samples. The aim of the study is to see that FNTCB is a reliable method in identifying the malignant or benign character of a focal liver lesion. Patients and methods : We retrospectively compared the results of 231 FNTCB of focal liver lesions with the final diagnosis. Results : In 191 lesions a final diagnosis was obtained (164 were malignant, 27 were benign). In our series FNTCB has a sensitivity of 86.6% (142/164), a specificity of 100% (27/27) and an overall accuracy of 88.5% (169/191) in identifying malignancy. There was a correct identification in 79.4% (27/34) of primary liver tumours and 88.5% (115/130) of liver metastases. In 52% (60/115) of liver metastases the primary site was accurately suggested by the pathologist. Correct characterization of benign liver lesions was obtained in 63% (17/27) of the cases. The insufficient sample rate was 3.1% (6/191). In one patient with thrombocytopenia an intraabdominal haemorrhage occurred Conclusions : FNTCB is a reliable and safe method in identify- ing the malignant nature of liver lesions. Due to the large tissue sample, insufficient sample rate is low and an accurate histological identification of benign lesions, primary liver malignancies and metastases can be made. In case of metastases it is often possible to determine the site of the primary tumour. (Acta gastroenterol. belg., 2007, 70, 1-5).


The outcome after Transjugular Intrahepatic Portosystemic Shunt (TIPS) for hepatic hydrothorax is closely related to liver dysfunction : a long-term study in 28 patients

Objectives : Hepatic hydrothorax is a rare but challenging com- plication of cirrhosis. The Transjugular Intrahepatic Porto- systemic Shunt (TIPS) appears as one of the most successful approach of therapy. Methods : To assess long-term efficacy and safety, we reviewed 28 patients (Child B/C : 43/57%) who underwent TIPS placement for refractory hepatic hydrothorax in our institution between 1992 and 2001. Results : The 30-days mortality was 14%, reaching 25% at 90 days. The one-year survival without liver transplantation was 41.2%. Reduction in the volume of pleural effusion and improve- ment in clinical symptoms was observed in 68% while a complete radiological and echographic disappearance of hydrothorax was documented in 57%. Statistical analysis showed that poor liver function was predictive of mortality and non-response. Of the different liver function parameters and in this small series, the Child-Pugh score was more discriminating than the recently described Mayo risk score. Conclusion : This study shows that TIPS is effective in the treat- ment of hepatic hydrothorax for selected patients. Poor liver func- tion is a strong predictive of bad outcome. (Acta gastroenterol. belg., 2007, 70, 6-10).


Treatment of small bowel subocclusive Crohn's disease with infliximab : an open pilot study

Stricturing subocclusive small bowel Crohn's disease (CD) is often an indication for surgery. We embarked on an open label pilot study to assess the safety and efficacy of infliximab in patients with stricturing subocclusive CD. Patients and methods : A cohort of patients with a documented and symptomatic small bowel stricture caused by CD was studied. Patients had to be refractory to corticosteroids and/or immuno- suppressives, and not in need for immediate surgery. The patients were treated by a single infusion of infliximab 5 mg/kg and fol- lowed up at w1, w2, w4 and w8. Results : After the 6th patients, the study was prematurely dis- continued because the predefined safety thresholds of more than 2 surgeries within the first 5 patients was reached. Only two patients completed the 8 weeks study, with a positive response to infliximab and improvement of inflammation confirmed by the CRP and CT scan. Two patients had to be operated early and the last two patients first did well but worsened after one month and were operated 35 and 42 days after infliximab, respectively. No surgical complications occurred in the 4 operated patients. In conclusion, a subset of patients with subocclusive small bowel stricturing CD may benefit from infliximab. (Acta gastroenterol. belg., 2007, 70, 15-19).


Lamivudine monotherapy and lamivudine plus interferon alpha combination therapy in HBeAg negative chronic hepatitis B not responding to previous inter- feron alpha monotherapy

Background and study aims : To investigate the efficacy of the combined therapy of lamivudine (LAM) plus alpha interferon (IFN) and LAM monotherapy in HBeAg negative chronic hepati- tis B (CHB) patients who were unresponsive to previous IFN monotherapy, and the incidence of YMDD mutations. Patients-Methods: Forty-five HBeAg negative patients were enrolled in this study. 24 of these were treated with LAM (100 mg/day, PO. for 24 months) alone (group 1) and 21 with com- bined therapy (IFN-alpha-2b, 10 MU, tiw, SC, for 6 months plus LAM 100 mg/day, PO. for 24 months) (group 2). Normal alanine aminotransferase values and negativity of HBV DNA (molecular hybridization; Digene, USA) were accepted as treatment response. YMDD variants were analyzed at the end of treatment or when clinical breakthrough was observed (Inno-Lipa Innogenetic kit, Belgium). Results : End of follow-up response rate was 29.2%, by ITT in group 1, 19% in group 2 (p > 0.05). Histological activity index was statistically decreased by LAM monotherapy as compared to com- bination therapy. YMDD mutation rates were 59% in group 1, 62.5% in group 2 (p > 0.05). Conclusions : Additional IFN-alpha therapy to LAM in HBeAg negative CHB not responding to previous IFN-alpha monotherapy does not increase the response rate compared to LAM mono- therapy and does not also decrease the incidence of YMDD muta- tions. (Acta gastroenterol. belg., 2007, 70, 20-24).