Hepatic encephalopathy describes the array of neurological alterations that occur during acute liver failure or chronic liver injury. While key players in the pathogenesis of hepatic encephalopathy, such as increases in brain ammonia, alterations in neurosteroid levels, and neuroinflammation, have been identified, there is still a paucity in our knowledge of the precise pathogenic mechanism. This review gives a brief overview of our understanding of the pathogenesis of hepatic encephalopathy and then summarizes the significant recent advances made in clinical and basic research contributing to our understanding, diagnosis, and possible treatment of hepatic encephalopathy. A literature search using the PubMed database was conducted in May 2017 using "hepatic encephalopathy" as a keyword, and selected manuscripts were limited to those research articles published since May 2014. While the authors acknowledge that many significant advances have been made in the understanding of hepatic encephalopathy prior to May 2014, we have limited the scope of this review to the previous three years only.

Recent advances in hepatic encephalopathy.

The Abernethy malformation consists of a congenital extrahepatic portosystemic shunt and is believed to be extremely rare in humans. The potential implications of abnormal portovenous shunting and decreased hepatic portal flow are numerous and potentially serious. Although congenital extrahepatic portosystemic shunts are increasingly suspected and diagnosed in specialized centres, much of their clinical presentation and natural history is not fully understood. Symptoms of portosystemic shunt are mainly caused by increased levels of ammonia, which lead to signs of encephalopathy. Therapeutic options depend on the type of shunt and its clinical course, so the classification of the congenital portosystemic shunt is a key finding in these patients.

https://www.birpublications.org/doi/pdf/10.1259/bjrcr.20170054

Abernethy malformation: beware in cases of unexplained hepatic encephalopathy in adults-case report and review of the relevant literature.

Introduction The aim of this study was to compare epidemiological characteristics of breast cancer in young adolescent women (YAW) versus older women (OW). Methods This was a cross-sectional prospective observational study, conducted in Ward 3, Jinnah Postgraduate Medical Center, Karachi, Pakistan, from September 2021 to February 2022. A total of 120 female patients were recruited in this study from the Outpatient Department of Jinnah Postgraduate Medical Center, out of which 22 patients were below the age of 40 years and 98 were above 40 years. For breast cancer diagnosis, we used the triple assessment method involving clinical examination, radiology, and histopathology. Diagnosed patients were further evaluated for hormonal status and metastatic workup. Results were noted on a performa, and differences between both age groups were analyzed. Results Out of 120 patients, 22 were younger than 40 years and 98 were older than 40 years. YAW used to present late after the appearance of symptoms. Patients of both age groups mostly presented with breast lumps (68.18% in YAW and 81.6% in OW). YAW presented with larger sizes of lumps and with more nodal involvement as compared to OW. BI-RADS IV (Breast Imaging Reporting and Data System Category IV) was the most commonly observed (27.27% in YAW and 48.97% in OW) mammographic finding in both age groups. Invasive ductal carcinoma was the most common histological type in both age groups (72.73% in YAW and 76.53% in OW). The triple-negative disease was more commonly found in YAW than OW (40.91% in YAW vs 21.43% in OW). We found that usually YAW presented at advanced stages (stages III and IV, 54.55%) and higher grades (grade III, 63.63%). Conclusion Breast cancer in young patients is rare but more aggressive with higher grades, advanced stages, and poor prognostic features. Heredity is mainly the risk factor in young breast cancer patients. There should be proper screening programs for high-risk group for early diagnosis and prompt treatment. Other age-specific concerns such as psychological impact of disease should be addressed as well.

/pdf/epidemiology-of-carcinoma-breast-in-young-adolescence-women-2ndk6wa8.pdf

Epidemiology of Carcinoma Breast in Young Adolescence Women

Dear Editor: We were very pleased to read the article about deformed wing virus infection in honeybees and the research about Nosema apis and Nosema ceranae tissue tropism in such a specialized journal as Veterinary Pathology. During the past years, many factors have reduced the number of honeybees worldwide, with great damage to biodiversity and to agrozootechnical economics. Honeybee pollination represents a key element in ecosystem function; it not only ensures the reproduction of wild plants and agricultural crops but also ensures genetic variability among species, thus defending global biodiversity. Moreover, the abundance and diversity of flora ensure food for human beings and feed for animals. Also, honeybee products are of great interest as a therapeutic tool, especially in fighting antimicrobial resistant infections. Although the concurrent action of different stressors (including bacteria, virus, parasites, pesticides) has been identified as the source of loss of honeybees, very little information is available about how these factors actually affect the health of honeybees. Honeybee pathology has been for many years a subject of great interest for researchers with different backgrounds, including biologists, agronomists, entomologists, and ecologists. However, this subject has elicited little interest among veterinarians and veterinary pathologists. Yet, who could better define the pathogenesis of viral, bacterial, parasitic, or fungal diseases than veterinary pathologists? Those of us who study honeybee pathology often find ourselves explaining why a veterinary pathologist should be the best researcher in this specific issue. We often answer by asking these simple rhetorical questions: “Aren’t honeybees animals?” “Don’t honeybees produce products that are consumed by people, and therefore mustn’t we, as veterinarians, be interested in honeybee health in order to guarantee animal food safety?” “Aren’t veterinarians the only people who study animal pathology thoroughly during their courses?” Moreover, identification of macroscopic and microscopic alterations, understanding of morphological changes that have occurred in tissues, and classification of lesions may be best performed by those who have studied these specific subjects and have deep knowledge and experience in disease processes, diagnostics, and research to better understand pathogenesis and association between pathogens and lesions. Increased interest of pathologists in this field could help unravel the mysteries around the huge colony losses by creating effective laboratory protocols, diagnostic tools, and therapeutics. Histopathology has already been suggested as an efficient tool to diagnose honeybee pathologies, and some research protocols are already available, but the road is still long. Very little is still known about basic phenomena such as what is the pathogenic mechanism behind the deformed wings caused by the deformed wing virus, how the honeybee immune system controls pathogens, and the reasons that colonies suddenly collapse. Unfortunately, until we understand the mechanisms and pathogenesis of these diseases, we will be unable to provide answers and solutions to beekeepers and to all of those who are interested in honeybee loss. Thus, this letter is an appeal to all veterinary pathologists, especially younger researchers, to broaden their knowledge and to engage in studying this new field that could generate new research opportunities, provide new discoveries, and open the world of veterinary pathology to new challenges. We strongly believe that today is the right time to start, as honeybees have never been in the public eye as nowadays, and funding by private and public institutions has never been so consistent. So why shouldn’t we put more energy in this field? Why shouldn’t veterinary pathologists be interested in honeybee pathology?

Why Shouldn't Veterinary Pathologists Be Interested in Honeybee Pathology?

Encephalopathy secondary to hyperammonemia due to Congenital Extra-hepatic Porto-systemic shunt (CEPS) in the absence of liver cirrhosis is an exceptionally unusual condition. We describe the case of a 54-year-old woman admitted to the Emergency Department complaining of recurrent episodes of confusion and worsening cognitive impairment. At admission, the patient displayed slowing cognitive-motor skills with marked static ataxia and impaired gait. Hyperammonemia was detected in the serum. An abdominal computed tomography (CT) excluded portal hypertension and liver cirrhosis, detecting a congenital extra-hepatic porto-systemic shunt which is a highly unusual vascular malformation. The patient was treated by interventional radiologists with a successful endovascular closure. We have performed a review of the last three decades of the literature, starting from the introduction of CT scanning in common clinical practice. Eighteen studies (case reports) described 29 patients with encephalopathy secondary to hyperammonemia due to CEPS in the absence of liver cirrhosis: They underwent treatment similar to our case report of CEPS. Encephalopathy secondary to hyperammonemia in the absence of hepatic dysfunction is an important diagnostic dilemma to many clinicians. An interventional radiologic approach is currently preferred.

Non-cirrhotic Extra-Hepatic Porto-Systemic Shunt Causing Adult-Onset Encephalopathy Treated with Endovascular Closure.

Transhepatic embolization of a congenital intrahepatic portosystemic shunt for the treatment of hepatic encephalopathy in a noncirrhotic patient using Amplatzer vascular plug device.

The purpose of this study was to characterize presenting imaging findings in women younger than 40 diagnosed with invasive breast cancer in the context of pathology and clinical course. Retrospective chart and imaging reviews were performed in patients under 40 diagnosed with breast cancer between July 1, 2004, and December 31, 2013. Patient demographic, imaging, pathology, and clinical data were collected. Overall and recurrence-free survival were estimated using the Kaplan-Meier method. Univariate Cox proportional hazards models were performed to identify factors associated with recurrence-free survival. Our study cohort consisted of 110 patients with invasive mammary carcinoma. One hundred one (91.8%) presented with a palpable mass. The mean size of all lesions on imaging was 3.5 cm ± 2.9 cm. Malignant calcifications were present in 54 (49.1%) cases. Imaging demonstrated multifocal or multicentric disease in 45 (40.9%) cases. Seventy four (67.3%) cancers were high grade. Luminal genomic subtypes were the most common (n = 61, 55.5%). At presentation, 4 (3.6%) patients had bilateral malignancy and 8 (7.3%) patients had distant metastatic disease. Ninety seven (88.2%) underwent neoadjuvant chemotherapy and 67 (60.9%) underwent radiation therapy. Seventy five (68.2%) of the patients underwent mastectomy. The restricted mean time to recurrence was 9.01 years (standard error 3.162 months). ER positivity was associated with compromised recurrence-free survival. The overall survival rate was 0.962 at 10 years. Young patients diagnosed with breast cancer typically present with advanced breast imaging findings and undergo aggressive treatment. Recurrence often occurs >5 years from diagnosis, and ER positive subtypes are at increased risk for recurrence.

Breast cancer in young women: Imaging and clinical course

Prostatic Artery Embolization for the Treatment of Benign Prostatic Hyperplasia in the Setting of Bladder Calculi.

Comparison of Postprostatic Artery Embolization Cone-Beam CT and Estimated Radiopaque Particle Distribution on Follow-up Imaging: A Case Report.

Background: Prostatic artery embolization (PAE) has emerged as a treatment option in the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Management guidelines addressing PAE remain mixed with recommendations for more long-term trials comparing the procedure to standard therapies.
Materials and Methods: This review presents PAE indications and technical considerations. To evaluate recent updates to the PAE evidence base, a limited literature search of the last 2 years was conducted. Three recent randomized controlled trials (RCTs), comparing PAE to either transurethral resection of the prostate (TURP) or sham procedure, were identified and analyzed.
Results: PAE and TURP performed similarly in significant reductions in international prostate symptoms score (IPSS) and Quality of life (QoL) scoring at 3 and 12 months. The majority of improvement after PAE occurred within a few months, with potentially greater effect in patients with larger prostates and severe symptoms. TURP was generally superior in functional outcomes such as peak urinary flow (Qmax), prostate volume (PV) reduction and post void residual (PVR), although TURP patients underperformed in Qmax improvement in one trial. PAE was superior to sham procedure in all relevant outcomes at 6 months. Overall, complication rates were lower with PAE than with TURP.
Conclusions: PAE and TURP produced similar significant improvements in LUTS. Functional improvements favored TURP while complication rates favored PAE. Clinical improvement after PAE significantly surpassed initial placebo effects of sham procedure. Further comparative studies with longer term follow-up are still needed.

/pdf/update-on-prostatic-artery-embolization-3t0qcolq97.pdf

Update on Prostatic Artery Embolization

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