Elucidating therapeutic effects on patients with hepatocellular carcinoma and main portal vein thrombosis

BACKGROUND/AIMS

The survival duration for patients diagnosed with hepatocellular carcinoma (HCC) with main portal vein thrombosis (MPVT) was usually less than 3 months. The aim of this study is to elucidate whether treatment can prolong the survival for such patients.

METHODOLOGY

Retrospectively we analyzed the clinical features and outcomes of 63 patients with HCC and MPVT over a 7-year period. Three therapeutic modalities--transcatheter arterial chemotherapy (TAC) with or without radiotherapy (RT), and systemic chemotherapy--were applied.

RESULTS

The patients were divided into two groups: 34 (54%) patients were treated, while the remaining 29 (46%) were not. Multivariate analysis revealed that Child-Pugh class, Okuda stage for HCC and the presence of treatment were the principal factors to predict survival. The survival was significantly longer in treated patients than those untreated both in the Child-Pugh class A or B patients. Significantly longer survival is evident in patients treated by TAC combing RT compared to those underwent TAC alone, systemic chemotherapy or no treatment.

CONCLUSIONS

The survival of Child-Pugh class A or B patients can be extended by the use of an appropriate therapeutic modality. TAC combined with RT did the best benefit to prolong survival in such patients.

Splenic tumour: a clinicopathological study

Splenic tumours are occasionally found during routine physical check-ups or elective abdominal image studies. Histologically, most splenic tumours are of benign vascular origin. To avoid unnecessary surgery for asymptomatic patients with benign splenic tumours and clarify the clinicopathological features of spleen tumours, this study gathered 44 cases of primary or isolated metastatic spleen tumours confirmed by pathology from surgery specimens or biopsies. The differences in clinicopathological features and image presentations between benign and malignant spleen tumour were investigated. Thirty-two cases involved benign tumours while 12 cases were malignant. Among the benign tumours, vascular originating tumours were most common (with 14 cases of cavernous haemangiomas, 13 cases of lymphangioma, three cases of lymphangiohaemangioma and one case of Littoral cell angioma). Notably, one, case of inflammatory pseudotumour because of Schistosoma parasite infection was also noted. Among the malignant tumours, there were four cases of angiosarcomas with vascular endothelium origins, as well as lymphomas and six metastatic tumours. Image studies were non-specific. Image study alone is an inadequate basis for making differential diagnoses between benign and malignant tumours. Instead, pathological studies are required for a final diagnosis. Using previous studies and this investigation, fine needle aspiration biopsy of spleen tumours with the help of ultrasonic or computed tomography appears a safe and effective method for obtaining biopsy specimens. Splenectomy is recommended only for patients with malignancies or complications such as intractable abdominal pain, coagulopathy or tumour rupture with an unstable haemodynamic state.

Choline deficiency induces apoptosis in primary cultures of fetal neurons

Treatment of rats with choline during brain development results in long-lasting enhancement of spatial memory whereas choline deficiency has the opposite effect. Changes in rates of apoptosis may be responsible. We previously demonstrated that choline deficiency induced apoptosis in PC12 cells and suggested that interruption of cell cycling due to a decrease in membrane phosphatidylcholine concentration was the critical mechanism. We now examine whether choline deprivation induces apoptosis in nondividing primary neuronal cultures of fetal rat cortex and hippocampus. Choline deficiency induced widespread apoptosis in primary neuronal cells, indicating that cells do not have to be dividing to be sensitive to choline deficiency. When switched to a choline-deficient medium, both types of cells became depleted of choline, phosphocholine and phosphatidylcholine, and in primary neurons neurite outgrowth was dramatically attenuated. Primary cells could be rescued from apoptosis by treatment with phosphocholine or lysophosphatidylcholine. As described previously for PC12 cells, an increase in ceramide (Cer) was associated with choline deficiency-induced apoptosis in primary neurons. The primary neuronal culture appears to be an excellent model to explore the mechanism whereby maternal dietary choline intake modulates apoptosis in the fetal brain.

Chylous ascites in acute pancreatitis during pregnancy: case report

Chylous ascites is a rare clinical manifestation characterized by ascitic chylomicrons resulting from mechanical obstruction of or leakage from the lymphatic channel. Chronic disorders, especially malignancies, account for most cases of chylous ascites. Acute chylous ascites is less common than the chronic form. We present a rare case of acute chylous ascites secondary to acute pancreatitis during the third trimester of pregnancy. This 24-year-old woman was referred to our emergency department because of severe epigastralgia for several days. Abdominal computed tomography revealed diffuse enlargement of the pancreas and peripancreatic exudation. Massive chylous ascites was found during emergent abdominal exploratory laparotomy. An emergent cesarean section was done because of fetal distress and there was no further accumulation of chyle. A pancreaticocutaneous fistula resulting from the cesarean section was treated successfully with a fistulectomy. In conclusion, chylous ascites is a rare complication of acute pancreatitis. Cesarean section may be helpful in terminating chylous accumulation in acute pancreatitis during the third trimester of pregnancy.

Inhibition of lipid peroxidation by Lactobacillus acidophilus and Bifidobacterium longum

The inhibition of lipid peroxidation by Lactobacillus acidophilus and Bifidobacterium longum was investigated using two lipid model systems. All eight strains, including six strains of L. acidophilus and two strains of B. longum, demonstrated an inhibitory effect on linoleic acid peroxidation. The inhibitory rates on linoleic acid peroxidation ranged from 33 to 46% when 1 mL of intracellular cell-free extract was tested. In the second model system, the cell membrane of osteoblast was used as the source for biological lipid. The results indicated that all strains were able to protect biological lipids from oxidation. The inhibition rates on cell membrane lipid peroxidation ranged from 22 to 37%. The effect of L. acidophilus and B. longum on inhibition of fluorescent tissue pigment accumulation was also obtained for osteoblastic cells. The inhibition rates on fluorescent tissue pigment accumulation ranged from 20 to 39%. The antioxidative effect of each milliliter of intracellular cell-free extract of L. acidophilus and B. longum was equivalent to 104-172 ppm of butylated hydroxytoluene (BHT). These results indicated that all strains demonstrated high antioxidative activity. The scavenging ability of lipid peroxidation products, tert-butyl hydroperoxide and malondialdehyde, was also evaluated. The results showed that L. acidophilus and B. longum were not able to scavenge the tert-butyl hydroperoxide. Nevertheless, malondialdehyde was scavenged well by these strains.

Reactive oxygen species and lipid peroxidation product-scavenging ability of yogurt organisms

The antioxidative activity of the intracellular extracts of yogurt organisms was investigated. All 11 strains tested, including five strains of Streptococcus thermophilus and six strains of Lactobacillus delbrueckii ssp. bulgaricus, demonstrated an antioxidative effect on the inhibition of linoleic acid peroxidation. The antioxidative effect of intracellular extracts of 10(8) cells of yogurt organisms was equivalent to 25 to 96 ppm butylated hydroxytoluene, which indicated that all strains demonstrated excellent antioxidative activity. The scavenging of reactive oxygen species, hydroxyl radical, and hydrogen peroxide was studied for intracellular extracts of yogurt organisms. All strains showed reactive oxygen species-scavenging ability. Lactobacillus delbrueckii ssp. bulgaricus Lb demonstrated the highest hydroxyl radical-scavenging ability at 234 microM. Streptococcus thermophilus MC and 821 and L. delbrueckii ssp. bulgaricus 448 and 449 scavenged the most hydrogen peroxide at approximately 50 microM. The scavenging ability of lipid peroxidation products, t-butylhydroperoxide and malondialdehyde, was also evaluated. Results showed that the extracts were not able to scavenge the t-butylhydroperoxide. Nevertheless, malondialdehyde was scavenged well by most strains.

Antioxidative ability of lactic acid bacteria

Nineteen strains of lactic acid bacteria were investigated for antioxidative activity. These includedLactobacillus acidophilus B, E, N1, 4356, LA-1, and Farr; Lactobacillus bulgaricus 12 278, 448, 449, Lb, 1006, and 11 842; Streptococcus thermophilus 821, MC, 573, 3641, and 19 987; and Bifidobacterium longum B6 and 15 708. Intracellular cell-free extract of all strains demonstrated antioxidative activity with inhibition rates of ascorbate autoxidation in the range of 7-12%. Antioxidative mechanisms including metal ion chelating ability, scavenge of reactive oxygen species, enzyme inhibition, and reducing activity of intracellular cell-free extract of lactic acid bacteria were studied. S. thermophilus 821 had the highest metal ion chelating ability for Fe(2+), and B. longum 15 708 showed the highest Cu(2+) chelating ability among the 19 strains tested. All strains demonstrated reactive oxygen species scavenging ability. L. acidophilus E showed the highest hydroxyl radical scavenging ability, and B. longum B6 had the best hydrogen peroxide scavenging ability. Reducing activity was also found in all strains. Most of the strains tested demonstrated excellent reducing activity. B. longum B6 showed the highest reducing activity among the 19 strains tested. In enzyme inhibition, superoxide dismutase activity was not found in these 19 strains, and the activity of superoxide dismutase was not induced when metal ion Mn(2+), Fe(2+), or Cu(2+)Zn(2+) was present.

High-performance liquid chromatographic method for determination of tramadol in human plasma

A modified high-performance chromatographic method using UV detection was developed for determination of tramadol concentration in human plasma. Plasma samples were extracted with ethyl acetate in a one-step liquid-liquid extraction (recovery 88.5+/-2.1%). Analysis of the extract was performed on a reversed-phase LiChrospher 60 RP-select B column with a particle size of 5 microm. The mobile phase consisted of 0.05 M KH2PO4 aqueous solution (pH 3.5) and acetonitrile in a ratio of 90:10 (v/v). Metoprolol was used as the internal standard and UV detection at 225 nm was employed. Accuracy of the assay in the concentration range examined was from 1.3 to 11.9% for the intra-day run and from 1.4 to 8.1% for the inter-day run. The precision of this method varied from 1.2 to 8.7%. The reproducibility of the method was determined to be from 0.8 to 7.2% over the six-day period. A limit of detection was 9 ng/ml at a signal-to-noise ratio of 3. This validated method was then applied to the determination of tramadol concentrations in healthy volunteers after oral administration of 100 mg of tramadol in capsules of Painlax and Tramal.

Choline deficiency-induced apoptosis in PC12 cells is associated with diminished membrane phosphatidylcholine and sphingomyelin, accumulation of ceramide and diacylglycerol, and activation of a caspase

It is not well appreciated that nutritional status can modulate apoptosis, a process that eliminates unwanted or damaged cells. Choline is an essential nutrient, and its absence induces apoptosis. When PC12 cells were cultivated in a choline-free medium, apoptosis was induced (27.4% of cells apoptotic at 72 h as compared to 4.4% in control medium). In choline-free medium at 72 h, there was a 49% decrease in phosphatidylcholine concentration (P<0.01) and a 34% decrease in sphingomyelin concentration (P<0.01); however, there was no change in phosphatidylethanolamine concentration. Before detecting increased apoptosis in choline-deficient cells, we measured a significant increase in ceramide (218% control) and diacyglycerol (155% control) concentrations. The addition of a cell-permeable ceramide to cells in control medium induced apoptosis; however, adding a cell-permeable diacyglycerol did not induce apoptosis. Caspase is a common mediator of apoptosis, and choline deficiency-induced apoptosis was prevented completely by replacing choline or adding a caspase inhibitor into the medium within 48 h of initial choline deprivation. In those cells rescued by replacing choline at 36 h, the concentrations of phosphatidylcholine, sphingomyelin, ceramide, and diacyglycerol returned to levels of control cells. In those cells rescued by adding a caspase inhibitor at 36 h, the concentrations of sphingomyelin and ceramide returned to control levels, but the concentrations of phosphatidylcholine and diacyglycerol did not return to normal. We propose that availability of dietary factors (choline in this model) can modulate apoptosis. Mechanisms that we identify using this model may help us to explain why dietary choline influences brain development.

Multiple lymphomatous polyposis of the gut: case report

Multiple lymphomatous polyposis (MLP) is an uncommon type of primary non-Hodgkin's gastrointestinal B-cell lymphoma characterized by the presence of multiple lymphomatous polyps along the gut. We present a patient with MLP in which the involvement was unusually widespread. The diagnosis was confirmed by the typical polyposis lesion, histology, phenotyping and clinical presentations. A 68-year-old man had a large mass at the ileocecal valve as well as multiple polyps along the whole digestive tract. At the time of diagnosis, lymphoma had involved bone marrow, peripheral blood, spleen, prostate and peripheral lymph nodes. The patient received 8 courses of chemotherapy with no remission. He died of pneumonia 11 months after diagnosis. Clinically, the diagnosis may be confused with epithelial polyps; and histologically, the diagnosis must be distinguished from benign lymphoid proliferations as well as other types of lymphoma. The prognosis for patients with MLP is relatively poor (the median survival is usually less than 3 years).

Management of lactose maldigestion by consuming milk containing lactobacilli

The influence of nonfermented milk containing L. acidophilus or L. bulgaricus on lactose utilization by lactose maldigesters was investigated. Nonfermented milks containing L. acidophilus or L. bulgaricus at 10(8) and 10(9) CFU/ml were prepared using 2% low-fat milk. Lactose maldigestion was monitored by measuring breath hydrogen at hourly intervals for 8 hr following consumption of 400 ml of each diet. Nonfermented milk containing L. acidophilus B at 10(8) CFU/ml were not effective in reducing breath hydrogen and symptoms. Nonfermented milk containing L. acidophilus B at 10(9) CFU/ml only slightly decreased breath hydrogen production; however, the symptoms were significantly improved. Nonfermented milks containing L. bulgaricus 449 at 10(8) and 10(9) CFU/ml were effective in reducing breath hydrogen and symptoms. The results for bulgaricus milk were all significant. In this study, L. acidophilus B and L. bulgaricus 449 were chosen because of their similar beta-galactosidase activity and bile sensitivity. L. acidophilus and L. bulgaricus are both thermophilic lactobacilli and an active transport (permease) system is found in both species for lactose transport. The major factor affecting in vivo lactose digestion in this study appears to be the bacterial cell wall/membrane structures. That the cell wall/membrane structures of L. acidophilus are different from those of L. bulgaricus can be indirectly proven by the results of sonication time for maximum beta-galactosidase activity measurement. The results of this study indicate that L. bulgaricus is usually a better choice than L. acidophilus for manufacturing nonfermented milks for lactose maldigesters.

Restoring the apoptosis suppression response to IL-5 confers on erythroleukemic cells a phenotype of IL-5-dependent growth

We have established a human IL-5 (hIL-5) dependent cell line, JYTF-1, derived from TF-1 parental human erythroleukemic cells by long-term cultivation in the presence of hIL-5. The ED50 values of hIL-5 for both TF-1 and JYTF-1 cell lines remained similar. However, when cells were grown in an optimal concentration of IL-5, some TF-1 cells but not JYTF-1 cells died via apoptosis. Although the rates of DNA synthesis were similar for TF-1 and JYTF-1 cells grown in IL-5, [3-H]thymidine releasing of pulse-labeled DNA analysis indicated that the viable TF-1 cells in IL-5 were more apoptosis-prone than were JYTF-1 cells. Therefore, in the JYTF-1 variant, the ability to suppress apoptosis has apparently been restored. The following findings suggest that overexpression of the hIL-5 receptor alpha-chain may be responsible for restoring the apoptosis suppression ability of IL-5: 1) the growth of JYTF-1 cells remained cytokine-dependent; 2) the proliferation of JYTF-1 cells in IL-5 was not mediated by autocrine secretion; 3) JYTF-1 and TF-1 cells responded similarly to other cytokines such as human erythropoietin; 4) Northern blot analysis revealed that JYTF-1 cells expressed approximately eightfold more IL-5 receptor alpha-chain mRNA than did TF-1. To our knowledge, JYTF-1 represents the first example in which coupling of mitogenesis stimulation and apoptosis suppression from otherwise uncoupled parental cells confers a phenotype of IL-5-dependent growth.

Restoring the apoptosis suppression response to IL-5 confers on erythroleukemic cells a phenotype of IL-5-dependent growth

We have established a human IL-5 (hIL-5) dependent cell line, JYTF-1, derived from TF-1 parental human erythroleukemic cells by long-term cultivation in the presence of hIL-5. The ED50 values of hIL-5 for both TF-1 and JYTF-1 cell lines remained similar. However, when cells were grown in an optimal concentration of IL-5, some TF-1 cells but not JYTF-1 cells died via apoptosis. Although the rates of DNA synthesis were similar for TF-1 and JYTF-1 cells grown in IL-5, [3-H]thymidine releasing of pulse-labeled DNA analysis indicated that the viable TF-1 cells in IL-5 were more apoptosis-prone than were JYTF-1 cells. Therefore, in the JYTF-1 variant, the ability to suppress apoptosis has apparently been restored. The following findings suggest that overexpression of the hIL-5 receptor alpha-chain may be responsible for restoring the apoptosis suppression ability of IL-5: 1) the growth of JYTF-1 cells remained cytokine-dependent; 2) the proliferation of JYTF-1 cells in IL-5 was not mediated by autocrine secretion; 3) JYTF-1 and TF-1 cells responded similarly to other cytokines such as human erythropoietin; 4) Northern blot analysis revealed that JYTF-1 cells expressed approximately eightfold more IL-5 receptor alpha-chain mRNA than did TF-1. To our knowledge, JYTF-1 represents the first example in which coupling of mitogenesis stimulation and apoptosis suppression from otherwise uncoupled parental cells confers a phenotype of IL-5-dependent growth.

[Biliary ascariasis]

From January 1982 to September 1987, ten diagnosed cases of biliary ascariasis were collected among 8,160 cases who were admitted for biliary tract diseases in our hospital. It represented an incidence of 0.12% in our hospital. In our series, the patients' ages ranged from 33 to 68 years old, with a female predominances. The clinical impression on admission were those of biliary tract stone, infection or pancreatitis. Signs and symptoms of biliary ascariasis were abdominal pain, fever, jaundice, vomiting of round worms and distended gallbladder. Laboratory findings disclosed leukocytosis, mildly elevated alkaline phosphatase, transaminase and bilirubin. There was a relatively high incidence of positive bile culture for bacteria. The reliable diagnostic tools for biliary ascariasis were abdominal real-time ultrasonography and endoscopic retrograde cholangiopancreatography (ERCP). They yielded a diagnostic rate of 40% and 87.5% respectively in our series. The principles of management of biliary ascariasis were conservative treatments including intravenous fluids, nasogastric decompression, antibiotics and antihelmintic agents. Other treatments that were also tried included endoscopic removal of round worms through a T-tube, or nasobiliary drainage. Surgery was considered when there were signs of complications, such as uncontrolled sepsis or suppurative cholangitis. The prognosis of biliary ascariasis was good if patients were diagnosed and treated properly. Regular follow-up with antihelmintic agents is also recommended to avoid reinfection.

Double primary tumors of the liver

A rare case of double primary tumors of the liver is reported. A 69-year-old male presented with fever and right upper quadrant pain. On admission blood culture grew Salmonella group B. Laboratory data showed leucocytosis, mild elevation of aspartate aminotransferase, alanine aminotransferase and sugar, positive-HBsAg, and normal range CEA and AFP. Abdominal sonography disclosed a well demarcated solid mass and another cystic lesion with a ragged wall in the left lobe of liver. Abdominal CT revealed a mixed density solid mass in the medial segment, and laterally located cystic mass with internal septa. A preoperative diagnosis of double tumors of the left lobe of the liver was made and the patient underwent a left hepatic lobectomy. Hepatocellular carcinoma and cystadenocarcinoma were diagnosed by histopathological examination. The patient has been well without tumor recurrence after one and a half year's follow-up.

Somatosensory evoked potentials and number connection test in the detection of subclinical hepatic encephalopathy

To compare the diagnostic ability of somatosensory evoked potentials and the number connection test in the detection of subclinical hepatic encephalopathy, 44 decompensated cirrhotic patients with no overt encephalopathy were admitted to the study and followed up for 6 months. Twenty-two patients developed overt encephalopathy during follow-up, and were retrospectively considered as patients with subclinical encephalopathy at entry. Of the 15 patients with abnormal somatosensory evoked potentials, 14 (93%) experienced at least one episode of hepatic encephalopathy in the following 6 months, while 16 (70%) of the 23 patients with abnormal number connection test did so. The data suggested that somatosensory evoked potential measurement was less sensitive, but more specific than number connection test in the detection of subclinical encephalopathy, although the differences were not statistically significant. Besides, the number connection test is much simpler, convenient and cheap, and it specificity could be improved if the learning effect and age, education and visual factors were carefully considered. We therefore recommend using the number connection test routinely in patients with decompensated liver diseases for the detection of subclinical hepatic encephalopathy, and reserving somatosensory evoked potential measurement as a complementary examination, when appropriate, or for assessment of overt hepatic encephalopathy.