EASL-EORTC clinical practice guidelines : management of hepatocellular carcinoma

The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

Since the publication of the American Association for the Study of Liver Diseases (AASLD) practice guidelines on the management of hepatocellular carcinoma (HCC) in 2005, new information has emerged that requires that the guidelines be updated. The full version of the new guidelines is available on the AASLD Web site at http://www.aasld.org/practiceguidelines/ Documents/Bookmarked%20Practice%20Guidelines/ HCCUpdate2010.pdf. Here, we briefly describe only new or changed recommendations.

/pdf/aasld-practice-guideline-management-of-hepatocellular-51bocalv0r.pdf

AASLD PRACTICE GUIDELINE Management of Hepatocellular Carcinoma: An Update

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.20933

Management of hepatocellular carcinoma.

Clinical Management of Hepatocellular Carcinoma. Conclusions of the Barcelona-2000 EASL Conference

Background Chronic intestinal pseudo-obstruction (CIPO) and enteric dysmotility (ED) are small intestinal motility disorders defined by radiological and manometric criteria. In the absence of consensus guidelines, we surveyed opinions on the diagnosis and management of CIPO and ED among experts from different countries. Methods A survey questionnaire was circulated electronically to members of the European society for Clinical Nutrition and Metabolism, European Society of Neurogastroenterology and Motility, and United European Gastroenterology. Only responses from participants completing all required components were included. Key results Of 154 participants, 93% agreed that CIPO and ED should be classified separately. Overall, 73% reported an increasing incidence of CIPO and ED, with hypermobile Ehlers-Danlos Syndrome the group with the largest increase in referrals (37%), particularly in the UK (P 50% cases) and full thickness biopsies were reported to seldom influence medical treatment, nutritional management, and prognosis. Respondents reported that very few treatments are useful for most patients, with bacterial overgrowth treatment, prucalopride, and psychological therapies felt to be the most useful. While only 23% of clinicians felt that parenteral nutrition (PN) improves gastrointestinal symptoms in >50% of cases, 68% reported PN dependency at 5 years in the majority of cases. Conclusions and inferences These data highlight the difficulties with diagnosing and managing CIPO and ED and underscore the urgent need for international, multidisciplinary, clinical practice guidelines.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/nmo.13937

An international survey on clinicians' perspectives on the diagnosis and management of chronic intestinal pseudo-obstruction and enteric dysmotility.

Eleven cases of parotid tumors in children under 16 years of age are considered. The series accounts for 1.6% of 657 cases of parotid tumor of all ages observed during the period 1930-1975 and consists of 6 mixed tumors, 2 mucoepidermoid tumors, 2 angiomas, and 1 benign lymphoepithelial lesion. All the patients underwent surgical treatment, 6 radical and 5 limited. The results of treatment point out that mixed tumors require radical parotidectomy. The attitude towards pediatric parotid tumors is dicussed.

Parotid Gland Tumors in Infants and Children

AIMS & BACKGROUND It is not known whether the presence of micrometastases in the regional lymph nodes has an impact on the oncologic outcome of patients undergoing a curative (R0) gastrectomy for cancer. The aim of the study was to assess the effects of the presence of micrometastases on survival. METHODS We reviewed 29 patients operated on for curative (R0) gastrectomy, with a final diagnosis of pN0, 16 or more lymph nodes in the specimen, and a follow-up of at least 4 years. The original hemotoxylin and eosin slides were reviewed, and a new section was cut from the lymph nodes and immunostained with a pool of antibodies against different types of cytokeratins. Micrometastases were detected in 5 patients (27.5% of the series) and 11 lymph nodes (1.51% of all removed lymph nodes). RESULTS Mortality due to cancer progression occurred in 3 patients from the pN0 group (14.2%) and 1 patient from the pN1 group (12.5%). CONCLUSIONS There was no suggestion from the data that the presence of micrometastases carries an ominous prognosis in terms of survival.

Prognostic effects of lymph node micrometastases in patients undergoing curative gastrectomy for cancer.

We evaluated the follow-up of 105 patients who received surgical treatment at our Institute for early gastric cancer (EGC). Median follow-up was 71 months. Operative mortality was 5.7% and the 5-year survival rate was 82.8%, approximately that of an age- and sex- matched Italian population. Overall mortality was assessed with regard to mortality from gastric cancer or other causes. Ten second primary malignancies were identified, and the standardized mortality ratio (1.12; 90% confidence interval [CI] 0.77‐1.64) and standardized morbidity ratio (1.50; 90% CI 0.89‐2.50) were determined using data from the Tumor Registry of Lombardy. To our knowledge, this is the biggest Western series to measure the risk EGC patients face of developing a second primary tumor. In conclusion, oncologists who follow-up patients surgically treated for EGC, a disease that is much less frequent in Western countries than in Eastern ones, should be aware of the possible occurrence of extragastric primary tumors so that they may plan the appropriate diagnostic investigation when necessary.

https://link.springer.com/content/pdf/10.1007%2Fs101200050024.pdf

Federico Bozzetti

Papers

An international survey on clinicians' perspectives on the diagnosis and management of chronic intestinal pseudo-obstruction and enteric dysmotility.

Parotid Gland Tumors in Infants and Children

Prognostic effects of lymph node micrometastases in patients undergoing curative gastrectomy for cancer.

Risk of second malignancies after surgical treatment for early gastric cancer.

Tailoring the nutritional regimen in the elderly cancer patient