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Regression of recurrent granulosa cell tumor liver metastases following selective internal radiation therapy

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Hepatobiliary & Pancreatic diseases International 2023年第4期22卷 406-408页

作者： Omar A Mownah John d Leahy Jeffrey Summers Stephen M Gregory nigel d heaton Institute of Liver Studies King’s Healthcare PartnersKing’s College Hospital NHS Foundation TrustDenmark HillLondon SE59RSUK department of Oncology Maidstone and Tunbridge Wells NHS TrustMaidstone ME169QQUK

Granulosa cell tumor(GCT)is the most common sex cordstromal tumor,comprising 5%of all ovarian malignancies[1].The disease course is indolent,and the majority of cases present at stage 1.However,metastases may develop with potential sites being peritoneum,lung,brain,liver and bone[2].due to the rarity of the disease,published evidence for management of granulosa cell tumor liver metastases(GCTLM)is limited.Surgical resection is the optimal treatment in instances where there is a high chance of achieving complete resection[3].With regards to unresectable GCTLM there is a paucity of evidence to guide treatment strategy.

关键词： metastases liver lung

Pigmented well-differentiated hepatocellular neoplasm with β-catenin mutation

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Hepatobiliary & Pancreatic diseases International 2015年第6期14卷 660-664页

作者： Lara Neves Souza Rodrigo Bronze de Martino Richard Thompson Sandra Strautnieks nigel d heaton Alberto Quaglia Institute of Liver Studies King's College Hospital department of Gastroenterology Discipline of Liver and Gastrointestinal TransplantationHospital das ClínicasUniversity of S?o Paulo

ABSTRACT： According to the most recent WHO classification of hepatocellular adenomas, a small percentage of inflammatory hepatocellular adenomas presents with mutation in the β-catenin gene and are at higher risk of malignant transformation. It has been recognized that adenoma-like hepatocellular neoplasms with focal atypia, or in unusual clinical context present with similar cytogenetic and immunohistochemistry characteristics to well-differentiated hepatocellular carcino- mas.

关键词： hepatocellular adenoma hepatocellular carcinoma β-catenin glutamine synthetase diethylstilbestrol

Impact of comorbidity on waiting list and post-transplant outcomes in patients undergoing liver retransplantation

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World Journal of Hepatology 2017年第20期9卷 884-895页

作者： Mohammad A B Al-Freah Carl Moran Matthew R Foxton Kosh Agarwal Julia A Wendon nigel d heaton Michael A Heneghan Institute of Liver Studies King’s College HospitalLondon SE5 9RSUnited Kingdom

AIM To determine the impact of Charlson comorbidity index(CCI) on waiting list(WL) and post liver retransplantation(LRT) survival.METHOdS Comparative study of all adult patients assessed for primary liver transplant(PLT)(n = 1090) and patients assessed for LRT(n = 150), 2000-2007 at our centre. demographic, clinical and laboratory variables were recorded. RESULTS Median age for all patients was 53 years and 66% were men. Median model for end stage liver disease(MELd) score was 15. Median follow-up was 7- years. For retransplant patients, 84(56%) had ≥ 1 comorbidity. The most common comorbidity was renal impairment in 66(44.3%). WL mortality was higher in patients with ≥ 1 comorbidity(76% vs 53%, P = 0.044). CCI(OR = 2.688, 95%CI: 1.222-5.912, P = 0.014) was independently associated with WL mortality. Patients with MELd score ≥ 18 had inferior WL survival(LogRank 6.469, P = 0.011). On multivariate analysis,CCI(OR = 2.823, 95%CI: 1.563-5101, P = 0.001), MELd score ≥ 18(OR 2.506, 95%CI: 1.044-6.018, P = 0.04), and requirement for organ support prior to LRT(P d with reduced post-LRT survival. donor/graft parameters were not associated with survival(P = NS). Post-LRT mortality progressively increased according to the number of transplanted grafts(Log-Rank 18.455, P d 5-years were significantly inferior to those of PLT at 88% vs 73%, P d 69% vs 55%, P = 0.006, respectively. CONCLUSION Comorbidity increases WL and post-LRT mortality. Patients with MELd ≥ 18 have increased WL mortality. Patients with comorbidity or MELd ≥ 18 may benefit from earlier LRT. LRT for ≥ 3 grafts may not represent appropriate use of donated grafts.

关键词： Hepatic Organ Outcome diabetes Renal

The variation of dOM during long distance water transport by the China South to North Water diversion Scheme and impact on drinking water treatment

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Frontiers of Environmental Science & Engineering 2024年第5期18卷 85-100页

作者： Hankun Yang Yujuan Li Hongyu Liu nigel J.d.Graham Xue Wu Jiawei Hou Mengjie Liu Wenyu Wang Wenzheng Yu State Key Laboratory of Environmental Aquatic Chemistry Key Laboratory of Drinking Water Science and TechnologyResearch Center for Eco-Environmental SciencesChinese Academy of SciencesBeijing100085China School of Environment and Municipal Engineering Qingdao Technological UniversityQingdao266033China Colleges of Forestry Northeast Forestry UniversityHarbin150006China department of Civil and Environmental Engineering Imperial College LondonSouth Kensington CampusLondonSW7 2AZUK School of Chemistry and Chemical Engineering Beijing Institute of TechnologyBeijing100081China State Key Laboratory of Separation Membrane Processes School of Environment Science and EngineeringTiangong UniversityTianjin300387China

In this study,samples were taken from three locations,upstream to downstream,along the central route project of the China South to North Water diversion(SNWd)scheme in summer and winter.These were used to reveal the variations of dissolved organic matter(dOM)during the water transfer process,and the effects of these variations on drinking water treatment and disinfection by-products formation potential(dBPs-FP).The results showed that polysaccharides accumulate in summer and reduce in winter with flow distance,which has an important effect on the overall properties of dOM,as well as on the performance of coagulation,ultrafiltration,and the formation of dBPs.Humic substances,and their hydrophilic content,also increased in summer and decreased in winter with flow distance.In contrast,the concentration of small organic substances(MW⩽1000 da)increased in both summer and winter with flow distance,which affected both nanofiltration(NF)membrane fouling and dBPs-FP.The results provide a useful case study of spatial and temporal changes in raw water dOM during long distance water transfer and their impact on the treatment and quality of drinking water from the SNWd.

关键词： Long-distance water transfer The China South to North Water diversion Scheme Coagulation Membrane filtration disinfection by-products

Late recurrence after surgery for cholangiocarcinoma:implications for follow-up?

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Hepatobiliary & Pancreatic diseases International 2008年第5期7卷 544-546页

作者： Harun Thomas nigel david heaton Institute of Liver Studies Kings College Hospital Denmark HillLondonSE5 9RSUK

BACKGROUNd:Biliary tract cancer is uncommon,but has a high rate of early recurrence and a poor prognosis. There is only limited information on patients surviving more than 5 years after resection. METHOdS:We report a patient who developed recurrence 8 years after resection of cholangiocarcinoma.descriptions of late recurrence after excision of cholangiocarcinoma are reviewed. RESULTS:Few long-term survivors with biliary tract cancer have been reported.The survivors tend to have well differentiated or papillary tumors.The present case had no recurrence for 8 years despite poor prognostic factors including poor differentiation,invasion through the muscle wall and perineural invasion.It has been suggested that tumor cells left after the first operation grow and present as late recurrence.There is a need to differentiate a new primary and field change from recurrence of the previous tumor. CONCLUSIONS:Long-term follow-up after resection of cholangiocarcinoma is needed because late recurrence after 5 years occurs.The mortality rate between 5 and 10 years after resection of cholangiocarcinoma ranges from 6%to 43%in different series.Early detection of local recurrence may give an opportunity for further surgical resection.

关键词： cholangiocarcinoma late recurrence long-term survivors

Cancer of the uncinate process of the pancreas:surgical anatomy and clinicopathological features

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Hepatobiliary & Pancreatic diseases International 2009年第6期8卷 569-574页

作者： Adrian W. O'Sullivan nigel heaton Mohamed Rela Institute of Liver Studies King's College Hospital National Health Service(NHS) Foundation Trust

BACKGROUNd:The clinicopathological features of uncinate process pancreatic cancer(UPPC) are poorly described.Furthermore the anatomy of the uncinate process and its division during surgery are central to pancreaticoduodenectomy for UPPC.We set out to describe the embryology and anatomy of the uncinate process and the clinicopathological features of UPPC.dATA SOURCES:All published case series of UPPC were reviewed and included in this review.RESULTS:The true incidence of UPPC is difficult to quantify,with the reported incidence ranging from 2.5% to 10.7% of pancreatic cancer.There are 5 published series of UPPC including 117 patients,72 males and 45 females,aged from 45-53 years to 61-84 years.The median survival was 5 or 5.5 months in 3 of the series,12.1 months in another based only on potentially resectable lesions and 17 months in another based only on resected cases.CONCLUSIONS:The number of reported series of UPPC is limited,with vague symptoms as the predominant presenting features of the disease.The prognosis is poor with synchronous venous resection demonstrating a survival advantage.

关键词： pancreatic neoplasms uncinate process anatomy embryology surgery

Liver resection for the treatment of a congenital intrahepatic portosystemic venous shunt

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Hepatobiliary & Pancreatic diseases International 2016年第3期15卷 329-333页

作者： michail papamichail amir ali alberto quaglia john karani nigel heaton department of Hepatobiliary Pancreatic Surgery First Affiliated Hospital:King's Healthcare PartnersKing's College Hos-pital FT NHS Trust Institute of Liver Studies Denmark HillLondon SE5 9RSUK

Intrahepatic portosystemic shtmts （IPSS） are rare congenital anomalies arising from disordered portal vein em- bryogenesis. It has been described in both children and adults and may be asymptomatic or be associated with a variety of neurophysiological and pulmonary complications. When rec- ognized, early intervention to occlude the shunt will reverse the associated complications. Literature review reports of surgical and radiological occlusion of the shunt, but due to its rarity, a standard therapeutic protocol has not been established. A case of a 38-year-old woman with abdominal pain and low grade encephalopathy, diagnosed with an IPSS and treated by right hepatectomy was reported.

关键词： intrahepatic portosystemic shunt liver resection

Cystic dystrophy in heterotopic pancreas:a rare indication for pancreaticoduodenectomy

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Hepatobiliary & Pancreatic diseases International 2009年第2期8卷 215-217页

作者： Harun Thomas Paul Marriott Bernard Portmann nigel heaton Mohamed Rela Institute of Liver Studies Kings College School of Medicine at Denmark Hill

BACKGROUNd:Cystic dystrophy in heterotopic pancreas (CdHP)is a rare benign condition characterized by the presence of cysts in the wall of the digestive tract associated with inflammation and fibrosis,intermingled with heterotopic pancreatic tissue.Treatment options for CdHP are poorly defined. METHOd:We report a case of CdHP,and review the literature focusing on the diagnosis and management. RESULTS:CdHP is mainly encountered in men in the fifth decade of life in association with chronic pancreatitis secondary to alcohol ingestion.Alcohol and mechanical obstruction of heterotopic pancreatic ducts have been implicated in its pathogenesis.Clinical presentation is varied and current imaging provides the diagnosis. Treatment options include somatostatin analogue injections, endoscopic cyst fenestration and surgical resection (pancreaticoduodenectomy or gastrointestinal bypass). CONCLUSION:CdHP is rare and presents a diagnostic and therapeutic challenge.The long term efficacy and indications for different treatment options need to be refined.

关键词： pancreas diseases duodenum cysts heterotopia

Clinical features and treatment of sump syndrome following hepaticojejunostomy

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Hepatobiliary & Pancreatic diseases International 2011年第3期10卷 261-264页

作者： Gabriele Marangoni Amir Ali Walid Faraj nigel heaton Mohamed Rela King's College London School of Medicine at King's College Hospital Institute of Liver StudiesDenmark Hill

BACKGROUNd:Cholangitis after Roux-en-Y hepaticojejunostomy is usually caused by anastomotic stricture.A small number of cases present without evidence of obstruction and are ascribed to reflux of gastro-intestinal content into the biliary tree above the anastomosis (sump syndrome).despite prophylactic rotating antibiotic therapy,the cholangitic episode may be severe and life-threatening.METHOdS:From 2001 to 2006,six patients who had undergone an end-to-side hepaticojejunostomy presented to our institution with recurrent episodes of biliary sepsis.Anastomotic stricture was excluded by liver MRI/MRCP and percutaneous transhepatic cholangiogram (PTC).Barium meal showed reflux of contrast into the biliary tree in all patients.Three patients had a short jejunal Roux limb (less than 50 cm) on pre-operative imaging.RESULTS:Five patients underwent surgery and two of them had two operations.One patient had a Tsuchida antireflux valve and subsequently underwent lengthening of the Roux loop.Three patients had lengthening of the Roux loop;one underwent re-do hepaticojejunostomy and one had concomitant revision of the hepaticojejunostomy and lengthening of the Roux loop.The latter underwent further lengthening of the Roux loop.Three patients are cholangitis-free 6,36 and 60 months after surgery;two still experience mild episodes of cholangitis.CONCLUSIONS:An adequate length of the Roux loop is important to prevent reflux.However,Roux loop lengthening to 70 cm or more does not always resolve the problem and cholangitis,although generally less frequent and severe,may recur despite appropriate reconstructive or antireflux surgery.In these cases,life-long rotating antibiotics is the only available measure.

关键词： biliary tract surgical procedures biliary tract disease septicemia