BACKGROUNDHepatic neoplasms can be the primary indication for hepatic transplantation. The tumors can also be incidentally identified in explanted livers. We explored the clinicopathologic features of hepatic neoplasms identified in explanted livers.MATERIALS AND METHODSAll explanted livers resected between 2001 and 2006 were evaluated for the presence of neoplasms and their clinicopathologic features were examined.RESULTSIn 98 liver transplants, 15 neoplasms (15.3%) were identified. Patient ages ranged from 5 to 63 years (median, 56 years). The primary etiology of hepatic disease was hepatitis C virus in 12 cases, hepatitis B virus in 1 case, cryptogenic cirrhosis in 1 case and congenital hepatic fibrosis in 1 case. Serum alpha-fetoprotein was significantly elevated (>400 U/L) in only 2 cases. CA19-9 was not elevated in any of the cases. The tumors included hepatocellular carcinoma (HCC) in 13 cases, 1 case of cholangiocarcinoma and 1 case of combined HCC and hepatoblastoma. The tumors ranged in size from 0.5 to 5 cm (median 1.4 cm) and were multifocal in 5 of the cases (33%). Tissue alpha-fetoprotein expression was only seen in the cases associated with elevated serum levels.CONCLUSIONIn our institution hepatic neoplasms are seen in more than 15% of explanted livers. They can be incidentally identified, are frequently not associated with elevated serum levels of alpha-fetoprotein and CA19-9, are commonly multifocal but small, and are associated with good prognosis. Elevated serum alpha-fetoprotein, albeit specific, is not a very sensitive marker in the detection of hepatic neoplasms.

No abstract

BACKGROUNDHepatic neoplasms can be the primary indication for hepatic transplantation. The tumors can also be incidentally identified in explanted livers. We explored the clinicopathologic features of hepatic neoplasms identified in explanted livers.MATERIALS AND METHODSAll explanted livers resected between 2001 and 2006 were evaluated for the presence of neoplasms and their clinicopathologic features were examined.RESULTSIn 98 liver transplants, 15 neoplasms (15.3%) were identified. Patient ages ranged from 5 to 63 years (median, 56 years). The primary etiology of hepatic disease was hepatitis C virus in 12 cases, hepatitis B virus in 1 case, cryptogenic cirrhosis in 1 case and congenital hepatic fibrosis in 1 case. Serum alpha-fetoprotein was significantly elevated (>400 U/L) in only 2 cases. CA19-9 was not elevated in any of the cases. The tumors included hepatocellular carcinoma (HCC) in 13 cases, 1 case of cholangiocarcinoma and 1 case of combined HCC and hepatoblastoma. The tumors ranged in size from 0.5 to 5 cm (median 1.4 cm) and were multifocal in 5 of the cases (33%). Tissue alpha-fetoprotein expression was only seen in the cases associated with elevated serum levels.CONCLUSIONIn our institution hepatic neoplasms are seen in more than 15% of explanted livers. They can be incidentally identified, are frequently not associated with elevated serum levels of alpha-fetoprotein and CA19-9, are commonly multifocal but small, and are associated with good prognosis. Elevated serum alpha-fetoprotein, albeit specific, is not a very sensitive marker in the detection of hepatic neoplasms.

Background and Aims Chronic kidney disease (CKD) is a leading public health problem in Morocco, its consequences and costs have implications for public health policy. The present study aimed to estimate the social cost of CKD before the start of renal replacement therapy in a Moroccan region. Method A cross-sectional cost of illness study, using bottom-up approach was performed at the department of nephrology in university hospital of Fez during 2020, among stages 3 to 5 CKD patients, followed up for at least one-year. The analyzed costs include the following annual expenditures: hospitalizations, outpatient visits, day care hospital, drugs, laboratory tests, imaging, and medical specialized acts. Non-medical costs such as transportation and indirect costs like loss of productivity were also assessed. Determinants of CKD cost were identified by univariate analysis using t test, ANOVA or non-parametric tests, p < 0.05 is the level of statistical significance. Results Eighty-eight patients were included (63.6% women, mean age: 61.8±14.0 years), 76.1% were on CKD stage 4 or 5. The estimated annual social cost of CKD was 2231,12 US$ (95% CI, 1676,09-2793,93 US$). The direct cost accounted for 99,5% (direct medical cost: 91,2%, direct non-medical cost: 8,3%), and the indirect cost accounted for 0,5 % of the social cost. Hospitalizations, diagnosis and treatments represented the main expenses of the direct medical cost (32,2%, 29,7%, 32,2% respectively). The social cost components were not significantly different between CKD stages. Conclusion The cost of CKD in its early stages still lower than the cost of renal replacement therapy, which brings the light on the necessity of secondary prevention of CKD to postpone or prevent the progression toward ESRD.

The use of data in medical research that was originally collected for different purposes, known as secondary data, is an effective way to conduct reliable and cost-effective studies so as to progress knowledge in medicine. A number of serious practical, ethical and legal issues and concerns about this process exist, however. Ensuring a high level of data quality is imperative to produce reliable results, and researchers may face accessibility problems. Projects designed to alleviate these issues are underway, however, lowering the cost and increasing the access to secondary data even further. Although secondary data is de-identified to protect the confidentiality, ethical problems of individual rights versus the benefit of society persist, leading some to call for a new ‘macroethics’ surrounding data use. Legislation to this end has been introduced in many countries, but issues relating to the exemptions it offers and its interpretability remain. To ensure that the use of secondary data in medical research can continue to accelerate the pace of development in medicine, a global effort involving technological and ethical standardization needs to be developed.