Patterns in the prevalence of hepatitis C virus infection at the start of hemodialysis in Japan

Background Although hepatitis C virus (HCV) infection is a persistent public health concern in hemodialysis patients, there seem to have been only a few reports on the prevalence of HCV at the start of hemodialysis. In this study we investigated whether patients starting on hemodialysis therapy are positive for anti-HCV antibody or not. Methods The 400 patients who began regular hemodialysis between February 2003 and June 2007 were enrolled in this study. Clinical data such as age, anti-HCV antibody and primary cause of end-stage kidney disease (ESKD) were examined. As healthy controls we used 70,717 healthy blood donors in 2005 whose data were obtained from Tokyo Metropolitan Red Cross Blood Center. Anti-HCV antibody was used as an indicator of HCV infection. Since the prevalence of HCV infection is affected by age in Japan, we classified the patients by age group. Results The anti-HCV antibody prevalence rate among the patients who were new to hemodialysis was 7.3%, as opposed to 0.15% in the healthy volunteers. The prevalence of HCV in the 31–45-, 46–60-, and 61-year-old groups was significantly higher among the hemodialysis patients than among the healthy volunteers (P = 0.0209, <0.0001, and <0.0001, respectively). The prevalence rate of anti-HCV antibody was higher among men (10.0%) than among women (1.5%, P < 0.0001) in the hemodialysis patients. The anti-HCV-antibody-positive patients were significantly older than the anti-HCV-antibody-negative patients (66.4 ± 14.3 years versus 58.6±16.6 years; P = 0.0152). Diabetic nephropathy was a more frequent cause of ESKD among the anti-HCV-antibody-positive patients (30.4%) than among the anti-HCV-antibody-negative patients (19.9%, P = 0.0122). Among the anti-HCV-antibody-positive patients, 55.2% had received a blood transfusion. The rate was significantly higher than that among the anti-HCV-antibody-negative patients (19.4%, P < 0.0001). Conclusion The results showed a much higher rate of anti-HCV antibody positivity in patients new to hemodialysis than in healthy volunteers. Older age, blood transfusion, male gender, and diabetic nephropathy seemed to be risk factors for anti-HCV antibody positivity in Japan.     

Pulmonary torsion of the lingula following a segmentectomy of the left upper division

We report a case of pulmonary torsion of the lingula. Thoracoscopic segmentectomy of the left upper division was performed on a 67-year-old woman. The chest radiograph on the first postoperative day showed consolidation in the left apical area. By the second postoperative day, the consolidation had increased in size. Bronchoscopy and chest contrast-enhanced computed tomography (CT) were conducted, and she was diagnosed with torsion of the lingula. We performed an emergency operation and resected the affected lung because of a gangrenous lobe. Although pulmonary torsion is a rare complication following lung resection, thoracic surgeons should always consider the risk. To prevent pulmonary torsion, we should confirm the correct position of the remaining lobes, and fixation of the lobes should be performed if there is little or no parenchymal bridge between contiguous lobes. A high index of clinical suspicion is necessary for early diagnosis, and rethoracotomy should be performed without delay.     

Gender Difference as a Prognostic Factor in Patients Undergoing Resection of Non-Small Cell Lung Cancer

Purpose We studied the effects of gender difference on the incidence of lung cancer and its mortality rate, which is a subject of much discussion. Methods We examined gender difference in the clinical features of 491 men and 222 women who underwent resection of primary non-small cell lung cancer (NSCLC) between 1994 and 2004. Results The histological types of cancer were adenocarcinoma in 249 (51%) of the men and 182 (82%) of the women, and squamous cell carcinoma in 182 (37%) of the men and 27 (12%) of the women. The incidence of adenocarcinoma was significantly higher in the women. The proportion of stage IA disease was significantly higher in the women than in the men (45% vs 29%, respectively). The 5-year overall survival rates were 50% in the men and 63% in the women. In a multivariate analysis, gender difference was an independent prognostic factor; however, when death as a result of unrelated disease was excluded, there was no significant difference in prognosis. Conclusion Although the higher incidences of adenocarcinoma and stage IA cancer contributed to the good results of surgery in women, the low incidence of death attributed to diseases other than lung cancer was a major reason for their better prognosis.     

Efficacy of anatomic resection vs nonanatomic resection for small nodular hepatocellular carcinoma based on gross classification

Background/Purpose  It has been reported that anatomic resection may be preferable to nonanatomic resection for small hepatocellular carcinomas (HCCs), by reducing socalled “micrometastases” (portal venous tumor extension and intrahepatic metastases). Nonanatomic resection or ablation has also been used as therapy for small HCCs. We studied the effectiveness of anatomic resection for small nodular HCCs, especially from the viewpoints of tumor size and gross classification. Methods  A retrospective cohort study was performed in 116 consecutive patients who underwent curative hepatic resection for HCCs 3 cm or smaller and with three or fewer nodules. The outcome of anatomic resection (including segmentectomy, sectoriectomy, and hemihepatectomy) was compared to that of nonanatomic partial hepatectomy. Results  The group that underwent anatomic resection (n = 52) had relatively better overall survival and significantly better recurrence-free survival than those with nonanatomic resection (n = 64). On Cox multivariate analysis, however, liver function was more closely associated with survival. The effect of anatomic resection was more prominent in the subgroup with the nonboundary type nodules (single nodular type with extranodular growth, confluent multinodular type, and invasive type) than in the subgroup with the boundary type (vaguely nodular and single nodular type). Micrometastases in the nonboundary type were found further from the main tumor (9.5 ± 6.2 mm) than those in the boundary type (within 3.1 +-1.4 mm). Conclusions  In patients with HCC nodules equal to or less than 3 cm and with the nonboundary type, anatomic resection should be employed to the extent that liver function allows, because this procedure would be more favorable than nonanatomic resection in eradicating micrometastases that have extended away from the tumor’s margin.     

Real-Time Intraoperative Assessment of Residual Liver Functional Reserve Using Pulse Dye Densitometry

BACKGROUND: For a safe major hepatectomy, preoperative methods that can reliably estimate postoperative liver function are necessary. The aim of this study was to assess the utility of ICG-R15 measured by pulse dye densitometry to predict residual liver function prior to hepatectomy. PATIENTS AND METHOD: In 29 patients who underwent various types of hepatectomies, indocyanine green (ICG)-R15 was measured by pulse dye densitometry at the time of opening the abdomen (laparotomy phase), clamping the Glisson's pedicles to cutting (clamping phase), and closing abdomen after hepatectomy (resection phase). The relationships among these measurements and postoperative liver function were examined. RESULTS: The mean ICG-R15 was 12.3 +/- 6.0% preoperatively (+/-SD), 9.3 +/- 7.0% at laparotomy, 18.8 +/- 11.6% at clamping, and 20.1 +/- 10.9% at resection. The preoperative and laparotomy and the clamping and resection ICG-R15 values correlated significantly. Eleven (38%) patients developed postoperative hyperbilirubinemia [total bilirubin (T-Bil) >3.0 mg/dl]. The postoperative peak T-Bil correlated significantly with clamping ICG-R15 (r = 0.637, p = 0.0002), but not with preoperative ICG-R15 (r = 0.283, p = 0.137), total clamp time (r = 0.005, p = 0.975), and blood loss (r = 0.097, p = 0.615). Multivariate analysis identified ICG-R15 measured at clamping as the only determinant of postoperative peak T-Bil (r = 0.612). ICG-R15 measured at clamping correlated with the postoperative hospital stay (p = 0.046). CONCLUSIONS: ICG-R15 can be measured in real time during surgery by pulse dye densitometry. ICG-R15 measured by this technique before hepatectomy provides a direct and reliable measure of postoperative residual liver function, thus helping in surgical decision making regarding the extent of hepatectomy.     

Examination of percutaneous application in a 26-week carcinogenicity test in CB6F1-TG rasH2 mice

We examined the possibility of expanding applications of rasH2 mice, which are genetically manipulated mice for short-term carcinogenicity tests, to percutaneous application. A 26-week short-term carcinogenicity study was performed on a total of 300 mice including 75 male and female rasH2 mice each, and 75 male and female non-Tg mice each from the same litter as the rasH2 mice divided into untreated group, an ethanol group, a white Vaseline group, an acetone group, and a phorbol 12-myristate 13-acetate (TPA) group. Only shaving of dorsal skin was performed on the untreated mice. As a positive control, TPA was administered percutaneously at a dose of 2.5 microg/kg and 3 times/week for 26 weeks based on the protocol for Tg.AC mice in the ILSI/HESI international validation study. In the ethanol, white Vaseline, and acetone groups, no tumorous changes were observed on the skin at the administration site. In the TPA group, nodular changes at the administration site were observed from seven weeks after the start of administration in rasH2 mice, and the incidence in males and females was 50.0% (7/14) and 53.3% (8/15), respectively. In a pathological examination, nodules in 21.4% (3/14) of males and 46.7% (7/15) of females were diagnosed as skin papilloma or keratoacanthoma, and the rest as squamous cell hyperplasia. In the non-Tg mice, no nodules or tumorigenic changes were observed at the administration site. These findings show that percutaneous application in rasH2 mice is possible in 26-week carcinogenicity tests.