Concomitant ablation of atrial fibrillation in rheumatic mitral valve surgery

Objective

Efficacy of atrial fibrillation ablation in rheumatic mitral valve disease has been regarded inferior to that in nonrheumatic diseases. This study aimed to evaluate net clinical benefits by the addition of concomitant atrial fibrillation ablation in rheumatic mitral valve surgery.

Patient preference and willingness to pay for transient elastography versus liver biopsy: A perspective from British Columbia

BACKGROUND:

The cost of liver biopsy (LB) is publicly funded in British Columbia, while the cost of transient elastography (FibroScan [FS], Echosens, France) is not. Consequently, there is regional variation regarding FS access and monitoring of liver disease progression.

OBJECTIVE:

To evaluate patient preference for FS versus LB and to assess the willingness to self-pay for FS.

METHODS:

Questionnaires were distributed in clinic and via mail to LB-experienced and LB-naive patients who underwent FS at Vancouver General Hospital, Vancouver, British Columbia.

RESULTS:

The overall response rate was 76%. Of the 422 respondents, 205 were LB-experienced. The mean age was 53.5 years, 50.2% were male, 54.7% were Caucasian, 38.2% had hepatitis C and 26.3% had an annual household income >$75,000. Overall, 95.4% of patients preferred FS to LB. FS was associated with greater comfort than LB, with the majority reporting no discomfort during FS (84.1% versus 7.8% for LB), no discomfort after (96.2% versus 14.6% LB) and no feelings of anxiety after FS explanation (78.2% versus 12.7% LB). FS was also associated with greater speed, with the majority reporting short test duration (97.2% versus 48.3% LB) and short wait for the test result (95.5% versus 30.2% LB). Most (75.3%) respondents were willing to self-pay for FS, with 26.3% willing to pay $25 to $49. Patients with unknown liver disease preferred LB (OR [FS preference] 0.20 [95% CI 0.07 to 0.53]).

CONCLUSIONS:

FS was the preferred method of assessing liver fibrosis among patients, with the majority willing to self-pay. To ensure consistency in access, provincial funding for FS is needed. However, LB remains the procedure of choice for individuals with an unknown diagnosis.     

Sonographic appearance of Krukenberg tumor from gastric carcinoma

Sonographic findings in 16 cases of Krukenberg tumor from gastric carcinoma were analyzed. The patients' ages ranged from 25 to 52 years (mean 42 years). The tumor involved both ovaries in 14 patients with asymmetrical masses in 9 of 14 cases. Ascites was noted in 15 cases. Echogenicity of the tumor varied from solid to predominantly cystic: solid in 8, mixed in 6, and predominantly cystic in 2 cases. Solid masses tended to be smaller than mixed or cystic masses. The primary gastric carcinoma had been diagnosed before emergence of the tumors in only 7 cases. The findings suggest that in relatively young patients with ovarian mass, particularly bilateral tumors, careful evaluation for gastrointestinal tract involvement should be done.     

Evolution of portal vein tumor thromboses in patients with hepatocellular carcinoma: CT findings and transition of serum tumor markers

We investigated the patterns of evolution of portal vein tumor thromboses (PVTTs) and the changes in serum tumor marker levels in untreated hepatocellular carcinomas. The mean time required for the subsegmental or lower-order branch PVTTs and the segmental PVTTs to reach the large portal vein was 120 and 101 days, respectively. The mean values of the serum alpha-fetoprotein levels markedly increased after the appearance of PVTTs from 1858.7 ng/ml to 6795.2 ng/ml.