The use of neoadjuvant lobar radioembolization prior to major hepatic resection for malignancy results in a low rate of post hepatectomy liver failure

BackgroundNeoadjuvant yttrium-90 transarterial radioembolization (TARE) is increasingly being used as a strategy to facilitate resection of otherwise unresectable tumors due to its ability to generate both tumor response and remnant liver hypertrophy. Perioperative outcomes after the use of neoadjuvant lobar TARE remain underinvestigated.MethodsA single center retrospective review of patients who underwent lobar TARE prior to major hepatectomy for primary or metastatic liver cancer between 2007 and 2018 was conducted. Baseline demographics, radioembolization parameters, pre- and post-radioembolization volumetrics, intra-operative surgical data, adverse events, and post-operative outcomes were analyzed.ResultsTwenty-six patients underwent major hepatectomy after neoadjuvant lobar TARE. The mean age was 58.3 years (17–88 years). 62% of patients (n=16) had primary liver malignancies while the remainder had metastatic disease. Liver resection included right hepatectomy or trisegmentectomy, left or extended left hepatectomy, and sectorectomy/segmentectomy in 77% (n=20), 8% (n=2), and 15% (n=4) of patients, respectively. The mean length of stay was 8.3 days (range, 3–33 days) and there were no grade IV morbidities or 90-day mortalities. The incidence of post hepatectomy liver failure (PHLF) was 3.8% (n=1). The median time to progression after resection was 4.5 months (range, 3.3–10 months). Twenty-three percent (n=6) of patients had no recurrence. The median survival was 28.9 months (range, 16.9–46.8 months) from major hepatectomy and 37.6 months (range, 25.2–53.1 months) from TARE.ConclusionsMajor hepatectomy after neoadjuvant lobar radioembolization is safe with a low incidence of PHLF.     

Localized Kaposi''s sarcoma in a patient with pemphigus vulgaris

We report the case of a patient with a 13-year history of pemphigus vulgaris (PV) treated with immunosuppressive agents, prednisone and mycophenolate mofetil who had developed lesions of Kaposi's sarcoma (KS) on a sole plaque of PV that had been previously treated with intralesional injections of steroids. The lesions were surgically removed and polymerase chain reaction (PCR) demonstrated human herpesvirus-8 (HHV-8) DNA. There were neither recurrences nor later dissemination of KS following gradual decrease of the immunosuppressive therapy. We suggest that the treatment with intralesional steroids may have influenced the local reactivation of a latent infection of the virus, determining the appearance of this localized KS.     

Thrombotic occlusion of the common carotid artery (CCA) in acute ischemic stroke treated with intravenous tissue plasminogen activator (TPA)

Although common carotid artery (CCA) occlusions are rare, acute clinical presentations vary from mild to devastating strokes primarily due to tandem occlusions in the intracranial arteries. Three patients with acute CCA occlusions were treated with systemic tissue plasminogen activator (TPA). Blood pressures were kept at the upper limits allowed with TPA therapy with fluid balance and the 'head-down' position. Recanalization occurred in intracranial vessels only. Marked early neurological improvement occurred in two of three patients. CCA occlusions should not be considered contra-indication to systemic thrombolysis.     

Comparison of 180° and 360° acquisition for myocardial perfusion SPECT with compensation for attenuation, detector response, and scatter: Monte Carlo and mathematical observer results

BACKGROUND: The optimal projection data acquisition strategy for myocardial perfusion (MP) single photon emission computed tomography (SPECT) remains controversial. METHODS: We compared MP SPECT using 180 degrees and 360 degrees projection data obtained with the same acquisition time, reconstructed either with filtered back projection (FBP) or the iterative ordered-subsets expectation maximization (OS-EM) algorithm with various combinations of attenuation, detector response, and scatter compensation using mathematical observers and a myocardial defect detection task. We used Monte Carlo-simulated projection data from a population of 3-dimensional nurbs-based cardiac-torso (NCAT) phantoms with ranges of variability in patient anatomy, organ uptake, defect location, defect size, and noise level based on clinical data. Projection data from 180 degrees and 360 degrees acquisitions were generated by assuming the same acquisition time. After iterative or FBP reconstruction, standard postprocessing methods were applied. For each acquisition and reconstruction method, we optimized the number of iterations and cut-off frequency of the Butterworth filter using the Channelized Hotelling Observer methodology. The optimum set of parameters was that which gave the maximum area under the curve. RESULTS: For both acquisition protocols, OS-EM with compensations provided better performance than FBP or OS-EM without compensation. For FBP, the optimized 180 degrees acquisition provided a statistically significant increase in AUC as compared with optimized 360 degrees acquisition. For OS-EM, the AUCs for 180 degrees were slightly larger than for 360 degrees acquisitions when comparing images reconstructed with the same compensations. However, the differences were smaller and not statistically significant. CONCLUSION: With optimized reconstruction and filtering parameters, 180 degrees acquisition provided a statistically significant improvement over 360 degrees acquisition for FBP reconstruction. However, for OS-EM the differences were small and not statistically significant.     

Experimentelle Untersuchungen über die Ultraschallwirkung auf das Jensen-Sarkom der Ratte

Ohne ZusammenfassungMit 24 Textabbildungen.Vorgetragen: 1. I. Hausser, Ultraschall-Arbeitstagung Erlangen, 3. 5. 49; s. Kongreßbericht. 2. W. Doerr, ebendort; infolge Erkrankung vertreten durch I. Hausser. 3. R. Frey, Deutscher Chirurgenkongreß in Frankfurt, 9. 6. 49.     

Ein streng dominant erbliches Kinnmuskelzittern

Zusammenfassung An einem genealogisch zusammenhängenden Menschenmaterial von über 100 Personen wurde bis jetzt an 55 ein streng dominant erbliches, von Geburt an bestehendes Kinnmuskelzittern nachgewiesen.Bei vielen Trägern dieses Merkmals ist dieses mit gewissen bahnenden Tätigkeiten verknüpft, denen ein gemeinsamer spezifischer Gemütszustand (Achtsamkeit) innezuwohnen scheint, zu dessen Darstellung das Phänomen unter Umständen dienen könnte.Verf. sieht in dieser Verknüpfung eine Verwandtschaft des Phänomens mit den Affektäußerungen und mimischen Ausdrucksbewegungen des Menschen.Nach einem am 28. III. 1930 in der Wiener Gesellschaft der Ärzte gehaltenen Vortrage, wobei sieben Träger des Phänomens (Nr. 26, 28, 31, 34, 47, 50 und 52 des Stammbaums) vorgeführt wurden.Das Geburtsjahr wurde darum überall mitangeführt, weil es eine Hypothese, die sog. H. Swobodasche Siebenjahrlehre gibt, die den Einfluß eines Zeitfaktors in Form einer meist siebenjährigen Periodizität auf das erbliche Geschehen behauptet. Wie man sieht, könnte mau bei weniger ausführlichem Studium durch einige Beispiele (3, 11, 40!) versucht sein, auch aus dem vorliegenden Stammbaum ein solches Gesetz zu konstruieren. Genauerer Hinblick gibt aber schlagende Gegenbeispiele. Denn wie will H. Swoboda das unmittelbare Alternieren von Merkmalträgern und Merkmalfreien mit seiner Theorie in Einklang bringen? Z. B. Franz Sch. (4) ist tatsächlich 21, also dreimal sieben Jahre nach seiner Mutter Barbara (2) geboren. Der Einfluß dieses Siebenjahres muß nun aber schon im nächsten Jahr nach Swoboda erloschen sein, da ja der 1847 geborene Josef das KMZ. nicht bekam. Dann müßte aber das nächste Siebenjahr (1853) einen viel breiteren Einflußbereich (volle 5 Jahre) gehabt haben, da ihm sowohl Johanna (1850) wie Anton (1855) ihr KMZ. verdanken sollten. Das nächste Siebenjahr aber blieb überhaupt wirkungslos, denn Josefa (1860) ist frei von KMZ. Nun, was für das eine Siebenjahr recht ist, muß für das andere billig sein. Dies nur ein Beispiel für viele, das genugsam zeigt, wie trügerisch solches Spiel mit Zahlen ist. Und es ist immerhin bedenklich, wenn eine Lehre, die sich bis zu eugenetisehen Ratschlägen an hereditär belastete Eltern versteigt (!), an einem Erbmerkmal von so ungeheurer Durchschlagskraft, wie es das hier besprochene ist, ihre Gültigkeit nicht zeigen kann.     

Das Wachstum Nach Konstanten Proportionen

Ohne ZusammenfassungAntrittsvorlesung.     

FEASIBILITY OF CONDUCTING CARDIOVASCULAR OUTCOME RESEARCH IN AUSTRALIAN GENERAL PRACTICE: RESULTS FROM THE ANBP2 PILOT STUDY

1. The present study aimed to determine the feasibility of conducting a 5 year cardiovascular outcome trial of the treatment of 6000 elderly hypertensive patients in Australian general practices. 2. General practitioners (GPs) were invited to participate by mail and personal follow-up. Patient records were reviewed to identify subjects for a blood pressure (BP) screening programme. Blood pressure was measured on three occasions and eligible subjects were included if the average BP was 160 mmHg systolic or 90 mmHg diastolic if systolic BP was 140 mmHg. 3. Seven hundred and forty-one GPs were approached and 89 were enrolled in the study (12% of mail invites and 75% of those receiving a personal contact). In 16 practices where screening was completed, 82 000 records were reviewed to identify 4% patients eligible for screening. Twenty-two per cent of eligible subjects attended screening. Of 1938 subjects screened, 180 (9%) had BP 5=160/90 mmHg. Forty-seven percent of subjects (n = 916) were receiving antihypertensive therapy and 184 (20%) were withdrawn from therapy. One hundred and sixteen (63%) of these subjects had BP return to study entry levels within 6 weeks. Fifty-seven newly diagnosed and 81 previously treated subjects were randomized (7% of the screened population). 4. Based on the high participation rate of GPs, the response rate of patients to attend a BP screening programme and the 7% randomization to screening ratio for entry into the study, the ANBP2 pilot study has demonstrated that it is feasible to recruit subjects from Australian general practices to a cardiovascular outcome trial.     

Affinity labeling of mu opioid receptors by sulfhydryl alkylating derivatives of morphine and morphinone.

After reduction of a disulfide bond at or near the mu opioid binding site in rat brain membranes, incubating membranes with 14 beta-bromoacetamido derivatives of either morphine, dihydromorphine, morphinone, or dihydromorphinone resulted in the irreversible inhibition of mu opioid binding to rat brain membranes. Without the addition of the disulfide bond-reducing reagent dithiothreitol, these affinity ligands bound reversibly to opioid binding sites. Binding to either delta or kappa opioid binding sites was not altered by alkylation of the membranes with the affinity ligands. The percentage of irreversible inhibition of mu opioid binding was dependent on the time and temperature of the incubation of membranes with the affinity ligands and on the concentrations of dithiothreitol and the affinity ligands. Incubating membranes with morphine afforded almost complete protection from alkylation of the mu opioid binding site. Naloxone and the l-isomer levorphanol also protected the site from alkylation, whereas the d-isomer dextrorphan and the kappa-selective opioid U50,488H did not protect the site. The mu-selective peptide [D-Ala2, (Me)Phe4,Gly(ol)5]enkephalin was the peptide that afforded the greatest protection. These studies have shown that, after the reduction of a disulfide bond at or near the mu opioid binding site, this sulfhydryl group can be specifically alkylated, resulting in the affinity labeling of the mu opioid binding site.