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BackgroundFibrolamellar carcinoma is a rare and poorly understood malignancy that affects the young in the absence of underlying liver disease. Despite reported small review series, the literature lacks large retrospective studies that may help in understanding this disease.MethodsMedical record review was undertaken for all patients histopathologically diagnosed with fibrolamellar carcinoma, seen at Memorial Sloan-Kettering Cancer Center, the University of California San Francisco, and Johns Hopkins Hospital from 1986 to 2011. Demographic, clinical, pathologic, and treatment data were recorded. Overall survival was estimated by using Kaplan-Meier methods. The impact of different clinicopathologic variables on survival was assessed with Cox regression models.ResultsNinety-five patients were identified. Median age was 22 years, 86% were Caucasian, and 50% presented with stage IV disease. There were more females than males (58% vs. 42%). Seventy-seven percent of the patients underwent surgical resection and/or liver transplantation; of these 31.5% received perioperative therapy. Patients with unresectable disease, including 8 patients treated in clinical trials, were treated with chemotherapy, occasionally given with interferon or biologic agents. Ten patients received sorafenib, and 7 received best supportive care. Median survival was 6.7 years. Factors significantly associated with poor survival were female sex, advanced stage, lymph node metastases, macrovascular invasion, and unresectable disease.ConclusionsThe clinicopathologic characteristics and survival outcomes from this dataset are consistent with those reported in the literature. Surgical resection and disease extent were confirmed as important predictors of survival. The possibility of a negative association between female sex and prognosis could represent a clue as to future therapeutic strategies.

Drainage after laparoscopic cholecystectomy (LC) for acute calculous cholecystitis (ACC) is used without evidence of its efficacy. The present pilot study was designed to address this issue. After laparoscopic gallbladder removal, 15 patients were randomized to have a drain positioned in the subhepatic space (group A) and 15 patients to have a sham drain (group B). The primary outcome measure was the presence of subhepatic fluid collection at abdominal ultrasonography, performed 24 h after surgery. Secondary outcome measures included postoperative abdominal and shoulder tip pain, use of analgesics, and morbidity. Abdominal ultrasonography did not show any subhepatic fluid collection in eight patients (53.3 %) in group A and in five patients (33.3 %) in group B ( P = 0.462). If present, median (range) subhepatic collection was 50 mL (20-100 mL) in group A and 80 mL (30-120 mL) in group B ( P = 0.573). No significant differences in the severity of abdominal and shoulder pain and use of parenteral ketorolac were found in either group. Two biliary leaks and one subhepatic fluid collection occurred postoperatively. The present study was unable to prove that the drain was useful in LC for ACC, performed in a selected group of patients. [ABSTRACT FROM AUTHOR]

Objective: To assess the role of polyclonal antibodies to basic fibroblast growth factor (bFGF) in inhibiting myointimal hyperplasia after insertion of polytetrafluoroethylene (PTFE) grafts in rats. Design: Experimental study. Setting: University laboratory, Italy. Animals: 24 inbred Lewis rats. Interventions: A segment of PTFE 1 cm long was interposed in the abdominal aorta. The animals were randomised in two groups, n = 12 in each. The first were given polyclonal antibodies to bFGF at the time of operation, and for the first two postoperative days; and the second were given non-specific IgG at the same time periods. Main Outcome and Measures: Two animals died during the immediate postoperative period of anaesthetic complications. 12 animals (6 in each group) were killed 7 days postoperatively (24 hours after injection of 5-bromo-deoxyuridine BrdU) to assess smooth muscle cell proliferation. The remaining 10 animals (5 in each group) were killed after 1 month to assess the degree of anastomotic myointimal hyperplasia. Results: Antibodies to bFGF resulted in less smooth muscle cell proliferation at the anastomoses as well as anastomotic myointimal hyperplasia. Smooth muscle cell proliferation was reduced to about half in animals treated with anti-bFGF antibodies. Neointimal thickness was reduced in treated animals. Conclusions: We conclude that after PTFE arterial grafting there is increased production of bFGF at the anastomotic regions that leads to smooth muscle cell proliferation and formation of myointimal hyperplasia. Agents that reduce the production of bFGF may also reduce the development of myointimal hyperplasia after PTFE arterial grafting. [ABSTRACT FROM AUTHOR]