290 HEPATIC METASTASIS FROM COLORECTAL CANCER: AN ANALYSIS OF MORBIDITY AND MORTALITY OF METACHRONOUS AND SYNCHRONOUS TREATMENT Daniel R. Kozman, M.D., Michelle J. Thornton, M.D. F.R.A.C.S., David Z. Lubowski, M.D. F.R.A.C.S., David L. Morris, M.D. F.R.A.C.S., Denis W. King, M.D. F.R.A.C.S.*. St George Hopsital, Kogarah, Sydney, NSW, Australia and St George Hospital, Kogarah, Sydney, NSW, Australia. Purpose: Twenty five percent of patients presenting with colorectal ade- nocarcinoma have hepatic metastasis at their initial presentation. There is debate whether treating hepatic and primary disease synchronously in- creases peri operative morbidity and mortality. Methods: A retrospective review of 172 patients who underwent synchro- nous treatment of primary colorectal adenocarcinoma and hepatic disease at St George Hospital, Sydney was performed. Operative time, transfusion requirement, 30-day morbidity and mortality and length of hospital stay were reviewed. A medline search was then performed to obtain similar data for metachronous hepatic treatment alone. The data was then analysed and compared. Results: Median hospital stay was 15 days (3–57), compared with 10 –15 days. Thirty day over all mortality was 4.7% (7% for liver resection and 4.3% for Hepatic Artery Catheter (HAC)) compared with 4.7% for liver resection and 0.75% for HAC. Intra operative and 30 day morbidity was 26% compared with 23%. A median blood loss of 600ml (45– 8000) and a transfusion requirement of 0 units (0 –10) was recorded for the synchronous group. The median operative time was 235 minutes (95– 482). Conclusions: Synchronous treatment of hepatic metastasis and primary colorectal cancers does not increase patient peri-operative morbidity and mortality. Survival of those patients treated synchronously has been shown to be equivocal for those treated metachronously. 291 INTRAHEPATIC PORTAL HYPERTENSION SECONDARY TO METASTATIC CARCINOMA OF THE PROSTATE Tan Attila, M.D., Milton W. Datta, M.D., Gary Sudakoff, M.D., Majed Abu-Hajir, M.D., Benson T. Massey, M.D.*. Medical College of Wisconsin, Milwaukee, WI. Purpose: Diseases interfering with blood flow at any level within the portal venous system can cause portal hypertension (PH). While the liver is the most common site of metastatic disease, tumor metastasis is not a common cause of PH. We report a case of a pt with symptomatic PH due to diffuse metastatic prastate carcinoma (PC) infiltration of liver parenchyma that was not appreciated with imaging. As PC is the leading cause of cancer in American men and the second cause of cancer death in males, this potential disease manifestation is noteworthy. Methods: A 57 y/o male who presented with obstructive hydronephrosis, found to have elevated PSA. Prostate biopsy showed poorly differentiated adenocarcinoma. CT was negative for metastasis. Bone scan revealed diffuse areas of increased uptake. Pt treated with androgen blockade (leu- prolide, bicalutamide) and chemotherapy. Fourteen months after diagnosis, pt developed abdominal distention, lower extremity edema and jaundice. He denied any hepatotoxic drug or ETOH use. He was jaundiced, with hepatomegaly and no stigmata of chronic liver disease. Labs revealed bilirubin total/direct: 8.6/6.4 mg/dl, alk phos/GGT: 1353/1400U/L , AST/ ALT: 120/80U/L, alb: 2.4 g/dl, PT: 15.7s,PSA: 1676. Results: CT showed minimal ascites, numerous collaterals in the splenic hilum and mesentery, patent portal and hepatic veins, hepatomegaly. Be- cause of unclear etiology of PH, hepatic angiography and transvenous liver biopsy were done. This confirmed PH and demonstrated the patency of hepatic veins. Free hepatic vein/wedge/corrected sinusoidal pressures were 14/28/14mmHg. Biopsy showed no fibrosis, poorly differentiated prostatic carcinoma, characterized by groups of cells with uniform nuclei and prom- inent nucleoli. Immunohistochemistry was positive for PSA and negative for Chromogranin. Pt elected not to pursue further therapy. Conclusions: While metastatic PC to the liver is not an uncommon finding at autopsy, being the third most common site after bone and lung, it rarely results in a hepatic dysfunction. This is the first report of a case with an abrupt onset of PH secondary to hepatic replacement by metastatic PC which was confirmed by angiography and liver biopsy. This phenomenon should be considered in the differential diagnosis of hepatic dysfunction in patients with metastatic PC, particularly as standard imaging studies may be non-diagnostic. 292 PNEUMOCYSTIS CARINII PNEUMONIA COMPLICATING CORTICOSTEROID THERAPY IN ACUTE SEVERE ALCOHOLIC HEPATITIS Manjushree Gautam, M.D., Sushil Rattan, M.D., Chala Ajit, M.D., Kenneth Rothstein, M.D.*. Mercy Catholic Medical Center, Philadelphia, PA and Albert Einstein Medical Center, Philadelphia, PA. Case Report: A 68-year old female with past medical history significant for hypertension and heavy alcohol abuse was admitted to hospital with right upper abdominal pain and jaundice. A diagnosis of acute alcoholic hepatitis was established and was started on corticosteroids (hepatitis discriminant factor of 78). She responded to corticosteroids, dietary sup- plementation and abstinence from alcohol and was discharged home. A month later she was re-hospitalized with upper abdominal pain, fever, cough and shortness of breath. She was found to be febrile, tachycardiac, tachypnea with a pulse oximetry of 93% on 2 liters oxygen. Her jaundice had worsened. Auscultation of lungs revealed fine diffuse rales. Differential diagnoses considered were hepatopulmonary syndrome, pneumonia and fluid overload. Chest x-ray showed patchy infiltrates. Patient was diagnosed with atypical pneumonia and was started on antibiotics. Corticosteroids were increased to accommodate for the change in the stress levels. The very next day, she developed profound respiratory distress and hepatic enceph- alopathy. She was promptly intubated and mechanically ventilated. Chest x-ray showed worsening of infiltrates. Echocardiogram revealed good left ventricular function. All laboratory investigations including Legionella antigen was negative. Emergent bronchoscopy was done and fluid was sent for all appropriate tests, which revealed Pneumocystis Carinii cysts and organisms. She was started on treatment for PCP. However, she developed multi-organ failure and expired. Her HIV test was negative. Discussion: Pneumocystis Carinii pneumonia (PCP), an opportunistic in- fection, has been very well described in HIV (human immunodeficiency virus) infected patients. Occasional case reports in non-HIV-infected pa- tients have also been described. To our knowledge, PCP in setting of alcoholic liver disease has not been described so far. Experimental studies indicate that corticosteroid administration causes a suppression of cyto- kines release leading to a reduction in recruitment of T lymphocytes. Additionally alcohol has been reported to decrease recruitment of CD4 and CD8 lymphocytes to lungs. These factors may lead to severe reduction in immunity and lead to opportunistic infections like PCP. Therefore, possi- bility of PCP should be considered in subjects who develop respiratory symptoms while on corticosteroid therapy for their alcoholic liver disease. 293 HEPATITIS C AND POST-TRAUMTIC STRESS DISORDER IN US VETERANS Muhamad Aly Rifai, M.D., James K. Moles, M.D.*, Brian J. Van der Linden, M.D. University of Virginia School of Medicine, Roanoke-Salem, VA; National Institute of Mental Health, Bethesda, MD and Veterans Affairs Medical Center, Salem, VA. Purpose: Post-traumatic stress disorder (PTSD); an anxiety disorder marked by an impairment in the immunological response, and Hepatitis C virus (HCV) infection are more prevalent in the US veteran population. To esatblish the interplay of these two chronic debilitating conditions we S99 AJG – September, Suppl., 2003 Abstracts