Research Spotlight

Posted November 15th 2017

Utilization of Indocyanine green to demonstrate lymphatic mapping in colon cancer.

Deborah S. Keller M.D.

Deborah S. Keller M.D.

Joshi, H. M., D. S. Keller and M. Chand (2017). “Utilization of indocyanine green to demonstrate lymphatic mapping in colon cancer.” J Surg Oncol: 2017 Oct [Epub ahead of print].

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The principles of oncologic resection for colon cancer are based on excising the primary tumor with its blood supply and associated lymph node basin. While resection of the tumor and its named vessel are relatively consistent, the extent of the mesenteric lymphadenectomy can be variable, which affects the quality of the specimen and nodal yield, and potentially the survival outcomes for the patient through under-staging. According to The Royal College of Pathologists and The College of American Pathologists, an adequate colonic oncological resection requires a minimum of 12 nodes to be removed but there is accumulating evidence this is still a substandard lymph node yield.[7] Proponents of complete mesocolic excision (CME) argue that performing more radical surgery with a larger mesenteric specimen results in a greater number of lymph nodes and potentially improved survival outcomes.[8] However, there is no current consensus for a CME approach, and there are concerns for increased morbidity after extended lymph node dissection.[9] In addition, while studies have shown value, the role of the sentinel lymph node biopsy is still undefined in colon cancer staging.[10]


Posted November 15th 2017

The American Society of Transplantation Consensus Conference on the Use of Hepatitis C Viremic Donors in Solid Organ Transplantation.

Göran Klintmalm M.D.

Göran Klintmalm M.D.

Levitsky, J., R. N. Formica, R. D. Bloom, M. Charlton, M. Curry, J. Friedewald, J. Friedman, D. Goldberg, S. Hall, M. Ison, T. Kaiser, D. Klassen, G. Klintmalm, J. Kobashigawa, A. Liapakis, K. O’Conner, P. Reese, D. Stewart, N. Terrault, N. Theodoropoulos, J. Trotter, E. Verna and M. Volk (2017). “The american society of transplantation consensus conference on the use of hepatitis c viremic donors in solid organ transplantation.” Am J Transplant 17(11): 2790-2802.

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The availability of direct-acting antiviral agents for the treatment of hepatitis C virus (HCV) infection has resulted in a profound shift in the approach to the management of this infection. These changes have affected the practice of solid organ transplantation by altering the framework by which patients with end-stage organ disease are managed and receive organ transplants. The high level of safety and efficacy of these medications in patients with chronic HCV infection provides the opportunity to explore their use in the setting of transplanting organs from HCV-viremic patients into non-HCV-viremic recipients. Because these organs are frequently discarded and typically come from younger donors, this approach has the potential to save lives on the solid organ transplant waitlist. Therefore, an urgent need exists for prospective research protocols that study the risk versus benefit of using organs for hepatitis C-infected donors. In response to this rapidly changing practice and the need for scientific study and consensus, the American Society of Transplantation convened a meeting of experts to review current data and develop the framework for the study of using HCV viremic organs in solid organ transplantation.


Posted November 15th 2017

Spectrum of orocutaneous disease associations: Genodermatoses and inflammatory conditions.

Alan M. Menter M.D.

Alan M. Menter M.D.

Wilder, E. G., J. Frieder, S. Sulhan, P. Michel, J. D. Cizenski, J. M. Wright and M. A. Menter (2017). “Spectrum of orocutaneous disease associations: Genodermatoses and inflammatory conditions.” J Am Acad Dermatol 77(5): 809-830.

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The oral cavity and cutaneous organ systems share a close embryologic origin. Therefore, there are numerous dermatologic conditions presenting with concomitant oral findings of which the dermatologist must be aware. The second article in this continuing medical education series reviews inflammatory orocutaneous conditions and a number of genodermatoses. It is essential for dermatologists to be familiar with oral cavity manifestations associated with dermatologic diseases for prompt diagnosis, management, and appropriate referral to stomatology and dentistry.


Posted November 15th 2017

The Role of C4d Deposition in the Diagnosis of Antibody-Mediated Rejection after Lung Transplantation.

Patrick R. Aguilar M.D.

Patrick R. Aguilar M.D.

Aguilar, P. R., D. Carpenter, J. Ritter, R. D. Yusen, C. A. Witt, D. E. Byers, T. Mohanakumar, D. Kreisel, E. P. Trulock and R. R. Hachem (2017). “The role of c4d deposition in the diagnosis of antibody-mediated rejection after lung transplantation.” Am J Transplant: 2017 Oct [Epub ahead of print].

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Antibody-mediated rejection (AMR) is an increasingly recognized form of lung rejection. C4d deposition has been an inconsistent finding in previous reports and its role in the diagnosis has been controversial. We conducted a retrospective single-center study to characterize cases of C4d-negative probable AMR and to compare these to cases of definite (C4d-positive) AMR. We identified 73 cases of AMR: 28 (38%) were C4d-positive and 45 (62%) were C4d-negative. The two groups had a similar clinical presentation, and although more patients in the C4d-positive group had neutrophilic capillaritis (54% vs. 29%, p = 0.035), there was no significant difference in the presence of other histologic findings. In spite of aggressive antibody-depleting therapy, 19 of 73 (26%) patients in the overall cohort died within 30 days, but there was no significant difference in freedom from chronic lung allograft dysfunction (CLAD) or survival between the two groups. We conclude that AMR may cause allograft failure, but the diagnosis requires a multidisciplinary approach and a high index of suspicion. C4d deposition does not appear to be a necessary criterion for the diagnosis, and although some cases may initially respond to therapy, there is a high incidence of CLAD and poor survival after AMR.


Posted November 15th 2017

Beta-blockers in hospitalised patients with cirrhosis and ascites: mortality and factors determining discontinuation and reinitiation.

Jacqueline O'Leary M.D.

Jacqueline O’Leary M.D.

Bhutta, A. Q., G. Garcia-Tsao, K. R. Reddy, P. Tandon, F. Wong, J. G. O’Leary, C. Acharya, D. Banerjee, J. G. Abraldes, T. M. Jones, J. Shaw, Y. Deng, M. Ciarleglio and J. S. Bajaj (2017). “Beta-blockers in hospitalised patients with cirrhosis and ascites: Mortality and factors determining discontinuation and reinitiation.” Aliment Pharmacol Ther: 2017 Oct [Epub ahead of print].

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BACKGROUND: It has been suggested that beta-blockers may increase mortality in patients with cirrhosis and refractory ascites but the effect of beta-blockers discontinuation or reinitiation has not been examined. AIMS: To compare, in hospitalised patients with cirrhosis and ascites, the effect of BB on survival and to examine the effect/predictors of beta-blockers discontinuation and reinitiation. METHODS: Sub-analysis of NACSELD (North American consortium for the study of end-stage liver disease, database containing prospective data on hospitalised patients with cirrhosis) data from 7 centres enrolling >100 patients with ascites. Data on BB discontinuation and reinitiation were collected by chart review. RESULTS: Seven hundred and sixteen patients, 307 (43%) on beta-blockers at admission and 366 (51%) with refractory ascites, were followed to death or hospital discharge. Beta-blocker use was associated with a lower white blood cell count at admission. Beta-blocker use in hospitalised patients with ascites was not associated with a higher mortality, even in those with refractory ascites. No significant changes in mean arterial pressure (MAP) were observed between groups. Discontinuation of beta-blockers (49%) was driven by low MAP, infection and acute kidney injury at time of discontinuation but was not associated with a higher mortality. Beta-blocker reinitiation occurred in 40% prior to discharge and was mainly driven by an increase in MAP. CONCLUSIONS: Beta-blocker use is safe in patients with cirrhosis and ascites (including those with refractory ascites) provided beta-blockers are discontinued in the presence of a low MAP and reinitiated once MAP reincreases. A potentially beneficial anti-inflammatory effect of beta-blockers is suggested.