Small hepatocellular carcinoma with intravascular tumor growth into the right atrium

A 66-year-old man with ascites and marked edema in the lower extremities was suspected of having secondary Budd-Chiari syndrome due to primary liver cancer, based on imaging diagnosis, i.e., ultrasonography, computed tomography, and inferior venacavogram. At autopsy, an encapsulated small liver cancer was found to have extended into the inferior vena cava and right atrium. There have been few reports of small hepatocellular carcinoma with intravascular tumor growth into the right atrium.     

Subcostal transabdominal incision with midline extension for tumors of the kidney, adrenal gland or retroperitoneal cavity.

Subcostal transabdominal incision with midline extension is excellent for removal of large renal or adrenal tumors, or bilateral or retroperitoneal tumors. This incision is simple and gives a wide surgical field without involving the pleural cavity. No troublesome complications resulting from this approach have occurred.     

Supplemental Oxygen During Endoscopic Variceal Ligation: Effects on Arterial Oxygenation and Cardiac Arrhythmia

Objectives: Endoscopic variceal ligalion may affect cardiopulmonary function. The aim of this study was to determine the effect of either nasal oxygen (2 L/min) or no oxygen on arterial oxygenation and cardiac arrhythmia during variceai ligation.
Methods: A prospective, endoscopy team-blinded, randomized, cross-over study (first session vs second session) was conducted in 30 cirrhotic patients undergoing variceal ligation. Oxygen saturation (SaO₂) and cardiac arrhythmia were assessed by a pulse oximeter. In this study, 15 patients received supplemental oxygen in the first sessions, and 15 received oxygen in the second sessions.
Results: Oxygen desaturation (nadir SaO₂ < 90%) occurred in 23% of patients breathing room air but was prevented hy oxygen ( p < 0.01), and the nadir SaO₂ was significantly lower in patients breathing room air than in those receiving oxygen (93.2 ± 0.7% vs 98.3 ± 0.3%, p < 0.01). During the procedure, premature ventricular contraction was more frequently observed in patients breathing room air than in those receiving oxygen (14.0 ± 3.2/h vs 5.4 ± 1.5/r, p < 0.05).
Conclusions: These data suggest that oxygen desaturation and cardiac arrhythmia are common in patients undergoing variceal ligation and that low flow nasal oxygen can alleviate these events. Supplemental oxygen is therefore advisable to avoid potential serious cardiopulmonary accidents in patients undergoing variceal ligalion.     

Seminal vesicle cyst associated with ipsilateral renal agenesis

A case of seminal vesicle cyst associated with ipsilateral renal agenesis was experienced recently in our clinic. A 23-year-old male presented with a complaint of right hemiscrotal pain. Right kidney was not visualized by excretory urography. Cystoscopic examination revealed the absence of the right half of trigone and the right posterolateral wall bulging into the bladder, suggestive of an extrinsic mass displacing the bladder wall. Ultrasonography and computerized tomographic scan showed a large cystic mass in the right side of the retrovesical region. Exploratory operation disclosed that the cystic mass was part of the dilated seminal vesicle. Seminal vesiculectomy was done. Many cases of seminal vesicle cyst are associated with a simple or complex malformation of ipsilateral upper urinary tract (renal agenesis, dysplasia, hypoplasia and ectopic ureter). We speculate that most of the benign seminal vesicle cysts are formed as a congenital anomaly due to defective mesonephric duct development which causes concomitant malformations in the upper urinary tract.     

Hypochromism of poly(N-vinylcarbazole) in solution

Absorption spectra were measured for poly(N-vinylcarbazole) (PNVC), fractionated by means of the gel-permeation chromatographic technique. The intensities of the UV absorption bands of the carbazolyl group diminished with increasing molecular weight of the polymer from 1200 to ca. 10⁴, and were constant when the molecular weight was higher than 10⁴. The diminution of the absorption intensities was regarded as a hypochromism, and the hypochromism was discussed with respect to the local structure of PNVC in solution.     

Higher elimination rate of hepatitis C virus among women

SUMMARY. The mortality rate from liver disease in H town of the Fukuoka prefecture in Japan is significantly higher in men than in women. To clarify the gender-related difference, we evaluated subjects with hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in the S area of this town. A total of 824 adults participated in this study, 332 men and 492 women. The incidence of positivity for hepatitis B surface antigen (HBsAg) in serum did not differ significantly between the subjects in the S area (1.9%) and Japanese blood donors (1.5%); however, the incidence of positivity for serum antibody to hepatitis C virus (HCVAb) in the subjects (31.8%) greatly exceeded that in Japanese blood donors (1.3%). The rate of positivity for HCVAb did not differ significantly between men (28.3%) and women (34.1%), but the proportion of serum HCV RNA-positive to HCVAb-positive subjects was significantly higher in men (78.2% in men vs 67.3% in women). The incidence of elevated serum alanine aminotransferase (ALT) in subjects positive for serum HCV RNA was also significantly higher in men (77.0% in men vs 55.8% in women). These results suggest that a more frequent elimination of HCV from serum in women may explain the observed lower mortality from liver disease.