Resectability of bilobar liver tumours after simultaneous portal and hepatic vein embolization versus portal vein embolization alone: meta-analysis

BACKGROUND

Many patients with bi-lobar liver tumours are not eligible for liver resection due to an insufficient future liver remnant (FLR). To reduce the risk of posthepatectomy liver failure and the primary cause of death, regenerative procedures intent to increase the FLR before surgery. The aim of this systematic review is to provide an overview of the available literature and outcomes on the effectiveness of simultaneous portal and hepatic vein embolization (PVE/HVE) versus portal vein embolization (PVE) alone.

METHODS

A systematic literature search was conducted in PubMed, Web of Science, and Embase up to September 2022. The primary outcome was resectability and the secondary outcome was the FLR volume increase.

RESULTS

Eight studies comparing PVE/HVE with PVE and six retrospective PVE/HVE case series were included. Pooled resectability within the comparative studies was 75 per cent in the PVE group (n = 252) versus 87 per cent in the PVE/HVE group (n = 166, OR 1.92 (95% c.i., 1.13-3.25)) favouring PVE/HVE (P = 0.015). After PVE, FLR hypertrophy between 12 per cent and 48 per cent (after a median of 21-30 days) was observed, whereas growth between 36 per cent and 67 per cent was reported after PVE/HVE (after a median of 17-31 days). In the comparative studies, 90-day primary cause of death was similar between groups (2.5 per cent after PVE versus 2.2 per cent after PVE/HVE), but a higher 90-day primary cause of death was reported in single-arm PVE/HVE cohort studies (6.9 per cent, 12 of 175 patients).

CONCLUSION

Based on moderate/weak evidence, PVE/HVE seems to increase resectability of bi-lobar liver tumours with a comparable safety profile. Additionally, PVE/HVE resulted in faster and more pronounced hypertrophy compared with PVE alone.

Carpal tunnel syndrome: usefulness of sonography

The aim of this study was to evaluate sonographic signs described for carpal tunnel syndrome (CTS). Sixty-four wrists from 40 patients with CTS confirmed by electromyography, and 42 wrists from 24 healthy individuals, were examined using sonography. Cross-sectional area, flattening ratio in proximal, middle and distal segments of the carpal median nerve and bowing of the flexor retinaculum were measured. The accuracies of the sonographic diagnostic criteria for CTS were assessed using receiver-operating-characteristic (ROC) analytical techniques. A significant swelling of the median nerve was observed at the proximal (p < 0.001), middle (p < 0.0001) and distal (p< 0.0001) segments and a significant bowing of the flexor retinaculum in CTS patients with respect to healthy subjects. No significant differences were found in the mean value of flattening ratio between the groups. The sensitivity, specificity, positive predictive value, and the negative predictive value were 73.4, 57.1, 72.3 and 58.5%, respectively, in the proximal and middle segments; 75, 57.1, 72.7 and 60% in the distal segment for areas greater than 11 mm2: and 81.3, 64.3, 77.6 and 69.2% for the bowing of the flexor retinaculum greater than 2.5 mm. All sonographic criteria were found in 34 CTS patients (53.1%) and none in 3 patients. Sonography may be useful in the diagnosis of CTS. The most reliable sign was increased bowing of the flexor retinaculum and cross-sectional area of median nerve with specificity close to 60%.

Correlation of central venous pressure with Doppler waveform of the common femoral veins

The objects of this prospective study were to determine the nature of the flow in the right femoral vein and to correlate the flow velocity with the venous pressure measured in the right atrium. We performed 236 pulsed Doppler ultrasonographic examinations in 1 year on patients with a venous catheter with the distal tip in the right atrium. In the Doppler wave readouts we analyzed wave frequency, velocity components, and relationships among them and the existence of pulsatile flow. These parameters were then compared to the right atrium pressure. We investigated the correlation between the atrium pressure and the flow velocity obtained from the Doppler waveforms of the common femoral veins, obtaining a significant correlation (P<0.0001) with the following: the atrium systolic wave a, the atrium diastolic wave v, the pulsatility ratio (PR = Vmin/Vmax) and the pulsatility index (PI = [Vmax - Vmin] /Vavg). The receiver operating characteristic showed that the pulsed Doppler ultrasonography is not a sensitive technique in diagnosis high atrium pressures. In addition, both cardiac and respiratory phasicity of the venous wave was observed. A significant inverse relation was found between the pulsatile flow and high atrium pressure. Nonetheless, the low sensitivity of this technique does not allow the use of pulsatile Doppler ultrasonography in the common femoral vein for diagnosing increases of the atrium pressure.

[Evaluation of mutations that confer resistance to nucleoside analogs and protease inhibitors in HIV-1-infected patients. Study Group on Resistance to Antiretroviral Agents]

Genotypes that confer drug resistance to reverse transcriptase inhibitors and protease inhibitors were evaluated in HIV-1 proviral DNA obtained from peripheral blood mononuclear cell samples. Fifty-three HIV-1-infected patients were studied, 19 of whom had not received antiretroviral treatment. In the other 34 patients, 9 had been treated with combinations of two reverse transcriptase inhibitors (AZT, ddI, d4T, 3TC) and 25 had been treated with triple antiretroviral therapy including a protease inhibitor (nelfinavir, indinavir, saquinavir, ritonavir). To determine the presence of mutations involved in the development of resistance to reverse transcriptase inhibitors a hybridization Microtiter assay was carried out. Mutations were detected in treated patients as well as in those without previous antiretroviral treatment, with the most frequent mutations being those that confer resistance to AZT, followed by those that develop cross-resistance to ddI/ddC and 3TC, which are the most commonly used drugs to date. No mutations were detected to any nucleoside analog in only 13 cases. To analyze the presence of mutations in the protease gene a dot-blot hybridization was carried out which included the mutations in codons 36, 82 and 90. Mutation 82 was detected in one case. Therefore, with the aim of determining the pattern of genotypic mutations in patients infected with HIV-1 and in order to make the best therapeutic choice, it would be recommended to consider carrying out genotypic resistance assays in clinical practice.

Cysts of the tunica albuginea: sonographic appearance

OBJECTIVE

Testicular cysts of the tunica albuginea are an uncommon phenomenon, important because of their possible confusion with testicular tumors. Accurate diagnosis may avoid aggressive and irreversible treatment such as testicular ablation. The purpose of this study is to report our experience in such diagnosis through sonographic detection of albuginea cysts.

CONCLUSION

Sonography is the technique of choice in the diagnosis of any testicular tumor formation, allowing the differentiation of cysts from neoplasia and avoiding unnecessary intervention in patients with cysts of the tunica albuginea.

Association between HIV and other DNA viruses in vitro

To investigate the association of human immunodeficiency virus (HIV) with various DNA viruses, including hepatitis B virus (HBV), cytomegalovirus (CMV) and Epstein-Barr virus, (EBV), simultaneous detection of HIV p24 antigen, HBV surface antigen and DNA, CMV-DNA and EBV-DNA expression was performed in phytohemagglutinin-stimulated peripheral blood mononuclear (PBMC) culture supernatants obtained from 54 individuals at risk for HIV infection. HIV expression in PBMC culture supernatants never occurred alone; expression of other viruses was always detected in the 24 samples expressing HIV antigen in vitro. Furthermore, in 16 patients expression of other viruses was detected without HIV expression, and in 14 patients none of the tested viruses were detected. These results indicate a strong association between the presence of HIV antibody and expression of DNA viruses in vitro (p = 0.0001). The coexpression of these viruses could be related to the evolution of HIV infection and AIDS.

[Production of hepatitis B virus from peripheral blood lymphocytes stimulated with phytohemagglutinin]

BACKGROUND

It was studied the production of HBV from lymphocytes from peripheral blood induced with a mitogen agent as phytohemagglutinin (PHA), in patients infected by HIV.

METHODS

The methodology developed included the culture of peripheral blood mononuclear cells and its induction to proliferate with PHA, in order to study the viral activity in the supernatants of the cultures by detection of HIV-Ag (ELISA), HBsAg (ELISA) and DNA-HBV (Dot-blot).

RESULTS

Production of HBV in 23 out of the 42 patients included in this study, corresponding to 21 anti-HIV positive and 2 anti-HIV negative.

CONCLUSIONS

Induction to proliferate lymphocytes with a mitogen agent as PHA may represent an alternative way of culture to study interactions between HIV and HBV.

[Hybridization using a digoxigenin-labeled probe for the detection of hepatitis delta virus]

BACKGROUND

The presence of hepatitis delta virus was investigated in liver biopsies by in situ cyto-hybridization with a probe labelled with digoxigenin.

METHODS

The techniques developed included extraction of plasmid DNA by lysis by alkali, electroelution, electrophoresis in agarose gel and digoxigenin labelling, and the application in liver tissue.

RESULTS

Viral RNA was detected in 6 of the 10 patients, and the reactivity was exclusively restricted to the nucleolus of the hepatocytes.

CONCLUSION

This method reveals as a sensitive and quick diagnostic procedure, which allows to study the intensity of the infection as well as the serological state of the patient.

Evidence of an in vitro association between human immunodeficiency virus antigen P24 and Epstein-Barr virus DNA

To investigate the association between human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV), simultaneous determinations of HIV antigen (HIV Ag) p24 and EBV DNA were performed in lymphocyte culture supernatants from 63 individuals at risk of HIV infection. In vitro data, together with HIV immune status results, were subjected to a statistical analysis. HIV infection was identified in 49 patients (78%); of these, in vitro EBV DNA was found in 44 individuals (90%), while in only 3 of the 14 non-infected ones (21%). Statistical analysis demonstrated a close relationship between evidence of HIV infection and in vitro detection of EBV DNA (87.3% concordant with 95% confidence interval: 76.5%-94.5%). Furthermore, a strong dependence was revealed between the presence of EBV DNA and HIV Ag in culture (p less than 0.00001). These results indicate the existence of in vitro viral interactions, with likely in vivo implications in the pathogenesis and evolution of HIV infection.

[Presence of HBsAg in lymphocyte cultured from patients infected with human immunodeficiency virus (HIV)]

The behavior of the hepatitis B virus was investigated in mononuclear cell cultures in nine patients infected by the human immunodeficiency virus. Although only one of them was a carrier of HBsAg and four had anti-HBs in their sera, HBsAg was detected in the supernatant of the cultures from all patients. These results suggest that mononuclear cells might act as a reservoir for hepatitis B virus, and that the concomitant infection by this virus and human immunodeficiency virus may alter the natural evolution of any of both conditions.

[Detection of human immunodeficiency virus in seronegative adults]

The diagnosis of human immunodeficiency virus infection is sometimes difficult or nonspecific, both in early and late stages, as the patients may be seronegative at the time of testing. Although serologic testing usually suffices to identify infected individuals and to follow up the course of the infection, in some cases direct detection of the virus is required. The culture of the mononuclear cells of the patient permits, after stimulation with mitogens and interleukin-2, the expression of viral antigens even in asymptomatic patients with latent or apparently nonproductive infection. In this way we have recovered the virus in four patients without serological evidence of infection. The possibility that human immunodeficiency virus infection can be undetectable with the usual diagnostic techniques, at least in a small proportion of patients, supports the need to use other methods such as direct viral culture to permit the identification of a greater number of infected individuals and the adoption of the appropriate prophylactic or therapeutic measures.