Case report: spinal cord compression due to metastatic hepatocellular carcinoma

Hepatocellular carcinoma is an uncommon cancer in the United States. Its initial presentation as spinal cord compression due to vertebral metastasis is rare. This article reports a case of radiculopathy and rapidly developing spinal cord compression because of bony metastasis from this form of liver cancer. This article also reviews pertinent literature and discusses the diagnostic modalities for early detection.

Hyperthyroxinemia and elevated lipids as paraneoplastic phenomena in hepatocellular carcinoma. A case report

In the United States and Western Europe, primary hepato-cellular carcinoma is an uncommon malignancy. Even though many well-defined associations have been reported, paraneoplastic manifestations are rare in North American patients. We describe an adolescent with complaints of weight loss, weakness, and a sensation of ¿fullness in the upper abdomen.¿ On initial laboratory workup a lactescent serum was found, with the following abnormalities; serum cholesterol level of 573 mg/dl (normal 120-260), triglycerides of 1,761 mg/dl (normal 10-190), and serum thyroxine level of 21 microgram/dl (normal 5.5-12.3). Serum albumin, calcium, and thyroid-stimulating hormone levels were also minimally elevated. Liver biopsy confirmed hepatocellular carcinoma. This is a rare hepatoma, which in our case manifested with multiple paraneoplastic phenomena, including hyperthyroxinemia, hypercholesterolemia, hypertriglyceridemia, and hyperalbuminemia. We review the pertinent literature.

Colonic tattooing with India ink: benefits, risks, and alternatives

OBJECTIVE

To provide comprehensive information on key issues concerning colonic tattooing with India ink in reported literature.

METHODS

A total of 735 citations on India ink alone were present in the English literature (1966-1995), including 16 on India ink and colonic tattooing. Nine major studies were identified and reviewed for 1) preparation before tattooing (type of ink used, sterilization process, colonic preparation, and antibiotic prophylaxis), 2) the tattooing process (technique and volume injected), 3) success in localization, and 4) complications.

RESULTS

A'total of 447 cases of colonic tattooing with India ink have been reported. Major indication was preoperative marking of tumor site. Various India ink preparations were used. Ink was unsterilized in 57% (255/447), autoclaved in 42% (187/447), and gas sterilized in 1% (5/447) of cases. Colonic preparation varied similarly. Prophylactic antibiotics were used in 1% (5/447) of cases. Dilution of India ink varied from undiluted to 1:100 (with 0.9% saline). The volume injected ranged from 0.1 to 2 ml per site injected, commonly with tangential needle insertion and delivery of ink into the submucosa in the majority of the cases. Intraoperative localization was easier with multiple tattoo injections. Five reports of complications have been made. In only one instance did overt clinical complications develop. Risk of a clinical complication with colonic tattooing with India ink is 0.22%.

CONCLUSION

Marked variability in technique, as well as potential for reporting bias, limit the quantitative conclusions. In general, colonic tattooing with India ink is a safe, accurate, and inexpensive method for preoperative marking and prospective study of colonic lesions.

Intestinal microbiome as a diagnostic marker of coronary artery disease: a systematic review and meta-analysis

BACKGROUND

The intestinal microbiome has been recently linked to several metabolic and chronic disorders, one of which is coronary artery disease (CAD). Our study aimed to analyze the intestinal microbiome of CAD patients and assess the eligibility of dysbiosis as a diagnostic marker of CAD.

METHODS

PubMed, Scopus, Embase, and Web of Science were searched using terms, such as 'CAD' and 'microbiome'. Only observational controlled studies were included. R version 4.2.2 was used for the analysis.

RESULTS

A significant association was found between the CAD group and increased Simpson and Shannon Indices compared with the control group (MD=0.04, 95% CI=0.03-0.05, and MD=0.11, 95% CI=0.01-0.22, respectively). Our analysis yielded a statistically significant association between the CAD group and increased Prevotella genus (MD=13.27, 95% CI=4.12-22.42, P-value=0.004), Catenibacterium genus (MD=0.09, 95% CI=0.09-0.10), Pseudomonas genus (MD=0.54, 95% CI=0.29-0.78, P-value), and Subdoligranulum (MD=-0.06, 95% CI=-0.06 to -0.06) compared with the control group. Another significant association was detected between the CAD group and decreased Bacteroides vulgatus and Bacteroides dorei (MD=-10.31, 95% CI=-14.78 to -5.84, P-value <0.00001).

CONCLUSION

Dysbiosis is an acceptable diagnostic marker of CAD. Decreased B. dorei and B. vulgatus among CAD patients suggests a protective role of these bacteria. Future clinical trials are necessary to investigate the potential benefit of supplementation of these bacteria in treating or preventing CAD.