Hepatocellular carcinoma: percutaneous radiofrequency ablation using expandable needle electrodes and the double-insertion technique

The authors present a case of percutaneous radiofrequency ablation for the treatment of a confirmed hepatocellular carcinoma using expandable needle electrodes and the double-insertion technique. The patient underwent radiofrequency ablation for a 5.0-cm-in-diameter hepatocellular carcinoma in liver segment VIII. One radiofrequency ablation session using the double-insertion technique was performed, resulting in the complete necrosis of the tumor. A collection of pleural effusion as a complication of radiofrequency ablation was revealed by a computed tomography scanning which was performed after the radiofrequency ablation session. However, no other serious complication was encountered. No local recurrences have been observed after a 10-month follow-up period. The present case suggests the therapeutic efficacy of radiofrequency ablation using expandable needle electrodes and the double-insertion technique.     

Effects of maintenance treatment after high-dose intravenous gamma-globulin for idiopathic thrombocytopenic purpura]

High-dose intravenous immunoglobulin (IVIG) for idiopathic thrombocytopenic purpura (ITP) produces a dramatic and substantial increase in platelet count, but the increased count tends to return rapidly to its pretreatment level. We studied the effects of immunosuppressive treatment aimed at the maintenance of platelet counts following the IVIG administration in ITP. Thirty-five patients with ITP were treated with IVIG, and then thirty-two of them with an immunosuppressant (azathioprine) and a glucocorticoid (prednisolone). After IVIG, the platelet count increased significantly. With immunosuppressive therapy after IVIG, most patients had a tendency to maintain the counts. In particular, this maintaining effect was remarkable in those patients who had been responsive to the standard prednisolone therapy while non-responders to the prior prednisolone failed to maintain the counts. When prednisolone was given after IVIG, the effect of maintaining platelet counts was dose-dependent. The treatment with azathioprine and prednisolone after IVIG appears to be effective in maintenance of platelet counts.     

Relationship between platelet volume and anti-platelet autoantibodies in idiopathic thrombocytopenic purpura

We used flow cytometry to explore the relationship between platelet volume and anti-platelet autoantibodies in 71 patients with idiopathic thrombocytopenic purpura (ITP). An increase in platelet volume was found more frequently in patients with a platelet count of less than 20,000/microliters. Platelet volume was larger in patients without anti-GPIIb/IIIa autoantibodies than in patients with these autoantibodies. Furthermore, the platelet count was significantly lower in patients without anti-GIIb/IIIa autoantibodies than in the patients with these autoantibodies. There was a positive correlation between a large platelet volume in patients with a platelet count of less than 30,000/microliters and high platelet-associated IgM levels. These results suggest that the platelet volume is related to the severity of thrombocytopenia in ITP.     

A study of the safety of rapid infusion of alendronate

To investigate the safety of rapid infusion of alendronate, we used alendronate therapy for 11 breast cancer patients with bone metastasis. Of the 11 patients, only 1 had hypercalcemia and the remaining 10 normocalcemia. Rapid infusion of alendronate consisted of an administration of alendronate 10 mg diluted in 100 ml saline in 30 minutes, and was repeated every two weeks. Each patient underwent 1 to 9 alendronate treatments. During alendronate therapy, only one patient complained of general fatigue, and the remaining 10 showed no alendronate-induced clinical symptoms. Rapid infusion of alendronate caused an increase in BUN level in two patients receiving intravenous hyperalimentation (IVH), a mild increase of GOT level in one, and a decrease of serum phosphorus level in two receiving IVH. However, no increase was found in serum creatinine and GOT levels. In addition, no patients showed alendronate-induced hypocalcemia. In conclusion, rapid infusion of alendronate brings about no major adverse effects, and makes it easier for many patients with bone metastasis to receive alendronate therapy on an outpatient basis.     

Clinical outcome of immediate breast reconstruction using a silicone gel-filled implant after nipple-preserving mastectomy

In order to evaluate the safety of silicone gel-filled implants for breast reconstruction in terms of cancer control, we reviewed 122 patients with postoperative stage I and II breast cancer who were treated by nipple-preserving mastectomy and immediate breast reconstruction using a silicone implant, and compared them with 92 controls treated by nipple-preserving mastectomy alone. Twelve complications requiring surgical management occurred in the 122 reconstructions (9.8%). Two implants were replaced, and 10 implants were removed. These 10 cases were excluded from survival analysis. The mean follow-up duration was 78 months in the 112 patients with breast reconstruction, and 55 months in the controls. There were no significant differences in the overall, disease-free, and locoregional disease-free survival rates between the two groups. In the reconstruction group, recurrence occurred in 14 patients. Five of them had locoregional recurrence alone, and are surviving free of disease following local resection. By the last follow-up, there was no incidence of secondary cancer at any site, including the contralateral breast cancer or connective tissue disease in the both group.     

Progressive dysphagia with peculiar laryngeal movement induced by tardive dystonia

Recently, patients receiving the long-term administration of typical antipsychotics have been recognized to be at risk of developing intractable tardive dystonia. A 44-year-old man was referred to our hospital because of progressive dysphagia for about 5 years. He had received several typical antipsychotic medications since at age of 24 years for the treatment of chronic schizophrenia. The patient had been suffering from an abnormal sensation in his throat and progressive dysphagia for five years, and nasal escape on deglutition for one year. A videotape recorder esophago pharyngography revealed that his larynx was positioned low, at the level of the 6th cervical vertebra, before swallowing, and was not elevated but rather descended to the level of the 7th vertebra upon swallowing. When the larynx was in this lower position, a small amount of swallowed material was transported to the esophagus. The remaining material in the pyriform sinus overflowed into the laryngeal cavity and lower airway after swallowing. However, the patient was able to eat with ease when he was with a girl friend, eating in a restaurant, and was hungry. The peculiar downward movement of the larynx was not observed during speech production, only during deglutition. Based on these findings, we suspected that his peculiar swallowing disorder might have been induced by tardive dystonia arising from the long-term administration of typical antipsychotics.     

Successful initial ablation therapy contributes to survival in patients with hepatocellular carcinoma

AIMTo evaluate the outcome predictors of percutaneous ablation therapy in patients with unresectable hepatocellular carcinoma(HCC),especially to identify whether the initial treatment response contributes to the survival of the patients.METHODSThe study cohort included 153 patients with single(102)and two or three(51)HCC nodules 5 cm or less in maximum diameter.As an initial treatment,110 patients received radiofrequency ablation and 43 patients received percutaneous ethanol injection.RESULTSThe Kaplan-Meier estimates of overall 3-and 5-year survival rates were 75% and 59%,respectively.The log-rank test revealed statistically significant differences in the overall survivals according to ChildPugh class(P = 0.0275),tumor size(P = 0.0130),serum albumin level(P = 0.0060),serum protein induced by vitamin K absence or antagonist Ⅱ level(P = 0.0486),and initial treatment response(P = 0.0130).The independent predictors of survival were serum albumin level(risk ratio,3.216;95% CI,1.407-7.353;P = 0.0056)and initial treatment response(risk ratio,2.474;95% CI,1.076-5.692;P = 0.0330)based on the Cox proportional hazards regression models.The patients had a serum albumin level 3.5 g/dL and the 3-and 5-year survival rates of 86% and 82%.CONCLUSIONIn HCC patients treated with percutaneous ablation therapy,serum albumin level and initial treatment response are the independent outcome predictors.