Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection

PURPOSE

To define indications for percutaneous ethanol injection (PEI) in patients with hepatocellular carcinoma (HCC) and cirrhosis.

MATERIALS AND METHODS

Survival rates were determined in 746 patients who had undergone PEI (567 men, 179 women; mean age, 64.3 years; mean follow-up, 36 months).

RESULTS

In patients with Child A (n = 293), B (n = 149), or C (n = 20) cirrhosis and single HCCs 5 cm or smaller, the 3-5 year survival rate was 47%-79%, 29%-63%, and 0%-12%, respectively. In patients with Child A cirrhosis, it was 36%-68% for multiple HCCs (n = 121), 30%-53% for single HCCs larger than 5 cm (n = 28), and 0%-16% for advanced HCC (n = 16). Treatment was associated with a 1.7% rate of severe complications and a 0.1% mortality rate.

CONCLUSION

PEI proved safe, effective, and repeatable and had a low cost. Survival after PEI was comparable to that after surgery, probably because of a balancing between greater radicality of surgery and absence of early mortality and liver damage of PEI.

[Cardiac lipoma of the septum with systemic and pulmonary emboli]

Cardiac lipoma is an uncommon tumor and is rarely a source of either lung or systemic emboli. A 46-year-old woman hospitalized because of left hemiplegia is presented. CT scan revealed a right temporo-parietal infarction. Chest x-ray showed a left lower lobe infiltrate. Pulmonary perfusion-ventilation scan indicated "high probability" of pulmonary embolism. Because brain and lung emboli are often associated, an echocardiogram was made and a 2 x 2 cm mass in the apical septum was found, confirmed by transesophageal echocardiogram. At operation a septal lipoma was resected. When pulmonary emboli occurs in association with systemic emboli, lipoma of the septum, although very rare, should be considered.

The effects of estrogen priming and puberty on the growth hormone response to standardized treadmill exercise and arginine-insulin in normal girls and boys

To determine the effects of puberty and estrogen priming on the GH response to standardized treadmill exercise and arginine-insulin in normal boys and girls, we performed tests in 84 normal children (41 girls and 43 boys) representing all stages of puberty. A subset of the prepubertal children received the tests twice, with or without the administration of ethinyl estradiol (40 micrograms/m2 daily) for 2 days before the tests. The peak GH response to the three tests increased significantly with pubertal stage (r = 0.57; P < 0.0001), but did not differ between boys and girls at the same stage. With advancing puberty, the percentage of normal children who failed to attain a GH level greater than 7 micrograms/L during any of the three tests declined from 61% at pubertal stage 1 to 44% at stage 2, 11% at stage 3, and 0% at stages 4 and 5. Administration of estrogen to the prepubertal subjects raised the normal range for the peak GH response to the three tests from 1.9-20.3 to 7.2-40.5 micrograms/L. We conclude that both puberty and estrogen administration significantly increase the peak GH response to exercise, arginine, or insulin in normal subjects. Moreover, the conventional criterion that the peak GH response to three stimulation tests should exceed 7 micrograms/L was applicable in our study only to subjects who had attained pubertal stage 4 or 5 or who had received estrogen administration.

The retinal targets of centrifugal neurons and the retinal neurons projecting to the accessory optic system

In birds, neurons of the isthmo-optic nucleus (ION), as well as "ectopic" neurons, send axons to the retina, where they synapse on cells in the inner nuclear layer (INL). Previous work has shown that centrifugal axons can be divided into two anatomically distinct types depending on their model of termination: either "convergent" or "divergent" (Ramon y Cajal, 1889; Maturana & Frenk, 1965). We show that cytochrome-oxidase histochemistry specifically labels "convergent" centrifugal axons and target neurons which appear to be amacrine cells, as well as three "types" of ganglion cells: two types found in the INL (displaced ganglion cells) and one in the ganglion cell layer. Labeled target amacrine cells have distinct darkly labeled "nests" of boutons enveloping the somas, are associated with labeled centrifugal fibers, and are confined to central retina. Lesions of the isthmo-optic tract abolish the cytochrome-oxidase labeling in the centrifugal axons and in the target amacrine cells but not in the ganglion cells. Cytochrome-oxidase-labeled ganglion cells in the INL are large; one type is oval and similar to the classical displaced ganglion cells of Dogiel, which have been reported to receive centrifugal input; the other type is rounder. Rhodamine beads injected into the accessory optic system results in retrograde label in both types of cells, showing that two distinct types of displaced ganglion cells project to the accessory optic system in chickens. The ganglion cells in the ganglion cell layer that label for cytochrome oxidase also project to the accessory optic system. These have proximal dendrites that ramify in the outer inner plexiform layer.(ABSTRACT TRUNCATED AT 250 WORDS)

Thyroid function and attention-deficit hyperactivity disorder

OBJECTIVE

To examine thyroid indices in a community referred sample of boys with attention-deficit hyperactivity disorder (ADHD) for evidence of generalized resistance to thyroid hormone (GRTH).

METHOD

TSH, T3, and T4 values were gathered prospectively in 53 physician, school, and/or parent referred ADHD subjects, and in 41 age and gender-matched normal controls.

RESULTS

None were in the range suggestive of global or pituitary thyroid hormone resistance.

CONCLUSIONS

GRTH is rare, and thyroid function should not be measured routinely in nonfamilial ADHD.

Endocrine profile of catch-up growth in the cynomolgus monkey

We studied catch-up growth following withdrawal of glucocorticoid administration in seven intact prepubertal cynomolgus monkeys. To reduce stress during blood sampling, a vascular access port was implanted subcutaneously in each animal for the duration of the study. After a baseline observation period of 50 weeks, the monkeys received injections of dexamethasone at a dose of 100 micrograms.kg-1.day-1 for 15 weeks. Growth velocity was monitored every 3 weeks by measuring lower leg length and body weight. Spontaneous serum growth hormone (GH) concentrations and GH levels after insulin and L-dopa stimulation, as well as serum insulin-like growth factor I (IGF-I) and plasma thyrotropin, triiodothyronine and thyroxine, were measured during the study. Differences between animals were analyzed by repeated measures analysis of variance and Student's paired t-test. Mean +/- SEM growth velocity (mm/3 weeks) decreased from 0.90 +/- 0.08 during the baseline period to 0.29 +/- 0.07 (p < 0.001) during the period of growth retardation, and increased to 1.23 +/- 0.2 (p < 0.001) during the period of catch-up growth. Spontaneous GH and peak GH levels following insulin did not show any significant variation during the study. Peak GH during the L-dopa test decreased from 15.4 +/- 3.2 micrograms/l during the baseline period to 6.2 +/- 2.4 micrograms/l during the period of growth retardation (p < 0.05), and increased to 23.0 +/- 5.9 micrograms/l during the period of catch-up growth (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Ring-valve abscess--a diagnostic challenge]

Infective endocarditis is a life-threatening disease which may be complicated by ring-valve abscess. Since this complication increases morbidity and mortality early diagnosis is important. Pericardial effusion complicating infective endocarditis is uncommon and should raise suspicion of the presence of an abscess. We describe 2 patients admitted for infective endocarditis and pericarditis. In both, ring-valve abscess was suspected on clinical grounds. At surgery there was pathological confirmation of the diagnosis. Both patients underwent successful aortic valve replacement with complete recovery. Controlled trials are providing increasing evidence for the superiority of transesophageal echocardiography in detecting valvular vegetations. Moreover, it is the most accurate means of detecting ring-valve abscess in cases of infective endocarditis. In view of these advantages, we propose the use of transesophageal echocardiography in every case of infective endocarditis.

The development of a relevant and comprehensive research agenda to improve Hispanic health

The development of an appropriate research agenda for Hispanics requires progress in three areas: (a) developing an appropriate research infrastructure, (b) increasing the availability of appropriate research instrumentation, and (c) identifying and assigning priority areas. In addition, a Latino health research agenda must identify mechanisms for increasing the number of trained Hispanic researchers and the number of Latino professional staff members at the Department of Health and Human Services. It is recommended that an Office of Hispanic Health be established within the Office of Minority Health at the Department to oversee the implementation of the recommendations made as part of the Surgeon General's National Hispanic Health Initiative.

[The frontal bonding of a microprosthesis with respect to arch physiognomy]

A series of 4124 patients who presented at the Gnathoprosthetic Clinic of Iasi with dental coronary lesions were investigated. The dental lesions situated at the level of frontal arches, the possibilities of aggregating the microprostheses at this level and the clinical-technical procedure of realizing them were studied. By the joint efforts of the entire dental team, artificial substitutes completing the lack of dental substance were obtained and the physiognomic function, cosmetic harmony and facial esthetics were fully restored.

Inference of pair bonds from capture data based on low variation of the sex ratio among catches

Paired individuals of monogamous animal species often stay in close contact when moving in their home range and can be caught together if sampling is done by a method that does not disrupt their spatial association (e.g., capture of birds by mist nets). We propose a statistical procedure that uses the counts by sex of specimens in a number of samples to detect the presence of pairs and to roughly estimate the proportion of paired individuals in the population. This method appears to be efficient enough to be used with data sets of small to moderate size (10-40 samples of 2-10 specimens each). The use of the method is exemplified by an analysis of capture data from two European populations of bearded tit (Panurus biarmicus): a large set of 536 net samples (1,111 specimens) from Le Sambuc in Camargue, France, and a much smaller one of 46 samples (367 specimens) from Malcontenta, near Venice, Italy. A separate analysis of premolt juveniles in Malcontenta (15 samples, 53 individuals) detects a significant proportion of pairs among them. This finding confirms quantitatively the anecdotal observation of precocious pair formation in the bearded tit.

[The prosthetic saddle in physiognomic reconstruction of the dental-alveolar arches]

The investigation of 2087 patients with partially extended, subtotal and total edentations who presented to the Clinic of Dental Gnathoprosthetics of Iaşi made possible the assessment of the role and importance of prosthetic saddle in the physiognomic restoration in such patients. By applying the modern clinical and technical methods of designing and making the gnathoprosthetic apparatus, the physiognomy of dento-alveolar arches according to actual exigencies and observing the dento-facial harmony can be achieved.

[Physiognomic reconstruction of the dental arches in emergency treatment]

The gnathoprosthetic treatment in emergency is now a compulsory step in solving the esthetic problems raised by the affections of stomatognathic system (coronary lesions, edentation) localised in visible areas of dental arches. Nowadays, the state of stress induced by these affections can be relieved by an immediate and highly physiognomic treatment, a method at hand being the Scutan mask. Excellent technic results can be obtained by using conformators obtained by thermoplasticizing and vacuumating, in current use in our clinic.

Predictors of condom accessibility among Hispanics in San Francisco

Ready access to condoms can be an important means of slowing the spread of sexually transmitted diseases and human immunodeficiency virus. We identified the factors associated with keeping or carrying condoms in a random-digit dialing survey of 522 Hispanic adults aged 18 to 65 years in San Francisco. Overall, more Hispanic men reported having condoms than Hispanic women (55.2% vs 23.8%). Hispanic men also reported much higher levels of risky sexual behavior than Hispanic women. Condom promotion efforts with Hispanics will require different approaches for each gender.

Percutaneous ethanol injection in the treatment of hepatocellular carcinoma in cirrhosis. A study on 207 patients

In 207 cirrhotic patient carriers of hepatocellular carcinoma (HCC), percutaneous ethanol injection (PEI) was administered with ultrasound guidance. The patients were classified as Child's Class A, 136; B, 54; and C, 17. Their mean age was 63.5 years, and the male-female ratio was 3.5:1. There was a single HCC less than 5 cm in diameter in 162 patients; 45 had more than one HCC. The follow-up ranged from 5 to 71 months (mean, 25 months). No noteworthy complications occurred during or after 2485 treatments. The 1-year, 2-year, and 3-year survival percentages (by the Kaplan-Meier method) for the patients with one HCC were 90%, 80%, and 63%, respectively. The corresponding percentages by Child's class were 97%, 92%, and 76% for Class A; 88%, 68%, and 42% for B; and 40%, 0%, and 0% for C. The 1-year, 2-year and 3-year survival rates for patients with more than one HCC were 90%, 67%, and 31% respectively. These results were similar to those found by others and showed that PEI was a safe, reproducible, easy-to-do, and low-cost therapeutic technique. In terms of survival, these PEI results were better than the published results of no treatment and equivalent to those of surgery. In uncontrolled series, bias can play an important role. Therefore, additional trials would be useful.

Percutaneous ethanol injection in the treatment of hepatocellular carcinoma in cirrhosis. A study on 207 patients

In 207 cirrhotic patient carriers of hepatocellular carcinoma (HCC), percutaneous ethanol injection (PEI) was administered with ultrasound guidance. The patients were classified as Child's Class A, 136; B, 54; and C, 17. Their mean age was 63.5 years, and the male-female ratio was 3.5:1. There was a single HCC less than 5 cm in diameter in 162 patients; 45 had more than one HCC. The follow-up ranged from 5 to 71 months (mean, 25 months). No noteworthy complications occurred during or after 2485 treatments. The 1-year, 2-year, and 3-year survival percentages (by the Kaplan-Meier method) for the patients with one HCC were 90%, 80%, and 63%, respectively. The corresponding percentages by Child's class were 97%, 92%, and 76% for Class A; 88%, 68%, and 42% for B; and 40%, 0%, and 0% for C. The 1-year, 2-year and 3-year survival rates for patients with more than one HCC were 90%, 67%, and 31% respectively. These results were similar to those found by others and showed that PEI was a safe, reproducible, easy-to-do, and low-cost therapeutic technique. In terms of survival, these PEI results were better than the published results of no treatment and equivalent to those of surgery. In uncontrolled series, bias can play an important role. Therefore, additional trials would be useful.

Percutaneous ethanol injection in the treatment of hepatocellular carcinoma in cirrhosis. A study on 207 patients

In 207 cirrhotic patient carriers of hepatocellular carcinoma (HCC), percutaneous ethanol injection (PEI) was administered with ultrasound guidance. The patients were classified as Child's Class A, 136; B, 54; and C, 17. Their mean age was 63.5 years, and the male-female ratio was 3.5:1. There was a single HCC less than 5 cm in diameter in 162 patients; 45 had more than one HCC. The follow-up ranged from 5 to 71 months (mean, 25 months). No noteworthy complications occurred during or after 2485 treatments. The 1-year, 2-year, and 3-year survival percentages (by the Kaplan-Meier method) for the patients with one HCC were 90%, 80%, and 63%, respectively. The corresponding percentages by Child's class were 97%, 92%, and 76% for Class A; 88%, 68%, and 42% for B; and 40%, 0%, and 0% for C. The 1-year, 2-year and 3-year survival rates for patients with more than one HCC were 90%, 67%, and 31% respectively. These results were similar to those found by others and showed that PEI was a safe, reproducible, easy-to-do, and low-cost therapeutic technique. In terms of survival, these PEI results were better than the published results of no treatment and equivalent to those of surgery. In uncontrolled series, bias can play an important role. Therefore, additional trials would be useful.

[The use of intra-arterial lipiodol in assessing hepatocarcinomas treated by percutaneous alcoholization. The initial experience]

Eight patients with inoperable hepatocellular carcinoma were treated by means of percutaneous alcoholization of the malignancy (11 nodular lesions less than 5 cm O). Upon treatment completion they were all given intraarterial injection of lipiodol, which was followed, a week later, by a CT scan. At angiography, during the parenchymal phase, 7 of 11 nodules appeared as avascular areas, whereas in the remaining 4 cases an intense parenchymal effect was seen within the previously treated areas. Lipiodol CT scans revealed intense uptake of oily material in the 4 hypervascular lesions as well as in 1 of those with avascular appearance. In 4 lesions, pathology of bioptic specimens obtained from the areas with contrast pooling was consistent with the persistence of viable neoplastic tissue. In these patients alcoholization had therefore to be continued. Lipiodol accumulation within previously treated nodules has proved to be related to the presence of residual neoplasm. Moreover, in 2 cases, focal retention of lipiodol was very helpful for biopsy under CT guidance. According to our experience, we believe lipiodol administration followed by CT to be very useful in evaluating and staging HCCs. We nevertheless believe that the procedure should be performed only after alcoholization has been completed: this would inform us of treatment effectiveness and subsequently enable us to decide whether treatment can be discontinued.

Growth hormone (GH) responses to the hexapeptide GH-releasing peptide and GH-releasing hormone (GHRH) in the cynomolgus macaque: evidence for non-GHRH-mediated responses

GH-releasing peptide (GHRP; His-D-Trp-Ala-Trp-D-Phe-Lys-NH2), a hexapeptide derived from enkephalin, has been shown to have GH-releasing activity in man and several animal species. To characterize the GHRP dose-response curve and compare it with that of GH-releasing hormone [GHRH-(1-44)NH2], six unanesthetized young adult cynomolgus macaques were tested with a range of iv doses of GHRP or GHRH in random order. Animals were fitted with vests and tethers. Blood samples were obtained before and at 15-min intervals after the administration of drugs. Doses ranged from 0.03-3 mg/kg for GHRP and from 1-30 micrograms/kg for GHRH. The dose-response curves for the two peptides were not parallel. GHRP had lower potency, but evoked a much higher peak GH response than GHRH (greater than 55 vs. 12 micrograms/L). Because one of the proposed mechanisms of action of GHRP is the inhibition of somatostatin (SS), we tested the effects of propranolol, which inhibits SS, on the GH responses to GHRH and GHRP. Propranolol was given at a dose of 14 micrograms/kg, iv, 10 min before the injection of saline, GHRH (10 micrograms/kg), or GHRP (1 mg/kg). GH responses to propranolol alone did not differ from those to placebo (peak, 6 +/- 2 vs. 8 +/- 2 micrograms/L). However, propranolol pretreatment doubled the GH responses to both GHRH and GHRP compared with those to GHRH or GHRP alone 28 +/- 5 micrograms/L vs. 14 +/- 5 (P less than 0.05) and 54 +/- 2 vs. 25 +/- 6 micrograms/L (P less than 0.001), respectively]. These results show that GHRP causes a potent dose-dependent release of GH in this primate species. Since GHRP can produce a greater maximal GH response than GHRH, mechanisms other than release of endogenous GHRH must be involved.

Preoperative and postoperative evaluations by means of three-dimensional computed tomography in cases of Chiari osteotomy

Three-dimensional computed tomography was employed to investigate the changes of pelvic and hip morphology in nine adult cases of congenital hip dysplasia. Six cases were treated with Chiari pelvic osteotomy and were reexamined postoperatively using the same technique. This new method clearly showed a number of important anatomic features that were not easy to detect with conventional roentgenography. Information provided by three-dimensional computed tomography imaging is useful in selecting the appropriate type of surgical treatment and in evaluating the results of Chiari pelvic osteotomy.

[Physiognomic reconstruction of the frontal arch with a microprosthesis]

The connective restoration of dental arches still raises physignomic problems. The less visible in the context of individual's facial architecture the more esthetic the prosthetic artifice is. Based on the statistic data of the Iaşi Clinic of Dental Prosthetics the results of the gnathoprosthetic treatment performed in the years 1987 and 1988 in 1,751 patients were evaluated. The efficiency was estimated by the quantitative relation between the various types of prostheses used in restoring the integrity of frontal arch.