Biomedical subjects
Davor Hrabar
Publications and source records attributed to Davor Hrabar.
[Therapy with interferon alfa and ribavirin in patients with chronic hepatitis C and normal levels of alanine aminotransferase].
The aim of the study was to evaluate the efficacy of combination therapy with interferon-alpha (IFN-alpha) and ribavirin in patients with chronic hepatitis C and normal alanine aminotransferase (ALT) values. In this retrospective study, 12 HCV-RNA positive patients (7 males and 5 females, mean age 38.1 years), treated between 1998 and 2001, with normal or near normal ALT values on three consecutive occasions and histologically mild disease were identified. During the induction period of four weeks they received 56 MU IFN-alpha 2b and ribavirin 1000 mg daily. During the next 44 weeks they received 3 MU IFN-alpha 2b three times a week with ribavirin 1000 mg daily. Seven out of 12 (58%) patients were HCV-RNA negative at the end of the therapy (end-of-treatment-response) and 5 of 12 (42%) showed sustained virologic response at 6 months. No significant elevation of aminotransferase values was recorded during therapy. Patients with mild chronic hepatitis C and normal ALT levels respond well to combination therapy with interferon and ribavirin, similar to those with elevated ALT levels. As long as the natural history and long-term outcome of these patients are not completely known, this might be a beneficial treatment option.
[Therapy of malignant liver tumors].
The management of hepatic malignancy is one of the most controversial areas in medicine today. The most recent developments in technology, surgical methods, local treatment and neoadjuvant cancer therapy, have contributed significantly to improved results of treatment. A multidisciplinary approach including oncologists, hepatobiliary surgeons, radiotherapists, interventional radiologists and in few cases transplant surgeons, is important to advance the treatment outcomes. Although all the methods of treatment mentioned above add significantly to the prognosis of the disease, its early detection allows fotchoosing the optimal method and remains the key factor in the disease outcome. The aim of this paper is to review recent literature on the multimodal approaches to the treatment of the two most common primary carcinomas of the liver--hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCC), as well as metastasis to the liver predominantly derived from colorectal cancer.
Minimally invasive treatment of causes and complications of biliary pancreatitis.
We report a case of a 52-year-old man admitted to our hospital because of acute biliary pancreatitis caused by cholelithiasis. The patient also had choledocholithiasis complicated with pancreatic pseudocyst. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and a large number of common bile duct stones were extracted with Dormia basket upon papillotomy. Pancreatic pseudocyst as a major complication of acute pancreatitis was also managed endoscopically by transpapillary stenting. Laparoscopic cholecystectomy with choledochotomy and choledochoscopy was performed for the final removal of biliary stones. Postoperative subhepatic abscess was resolved by ultrasound-guided percutaneous drainage. In this case biliary pancreatitis with all its complications was treated through minimally invasive endoscopic, percutaneous and surgical procedures. Minimally invasive techniques are much better because they reduce surgical stress, caused by reduction of flow through the splanchnic, which can also be reinforced by general endotracheal anesthesia. In the case when relative hypoxia occurs and acute serous pancreatitis transfers to acute necrotic pancreatitis, minimally invasive technique is the first and the best choice for surgical procedure.