Massive ascites after living donor liver transplantation with a right lobe graft larger than 0.8% of the recipient’s body weight

Shirouzu Y, Ohya Y, Suda H, Asonuma K, Inomata Y. Massive ascites after living donor liver transplantation with a right lobe graft larger than 0.8% of the recipient’s body weight.
Clin Transplant 2010: 24: 520–527.
© 2009 John Wiley & Sons A/S. Abstract: Background: There are only limited data on post‐transplant ascites unrelated to small‐sized grafts in living donor liver transplantation (LDLT). Methods: The subjects were 59 adult patients who had received right lobe LDLT with a graft weight‐to‐recipient weight ratio (GRWR) > 0.8%. Patients were divided into either Group 1 (n = 14, massive ascites, defined as the production of ascitic fluid > 1000 mL/d that lasted longer than 14 d after LDLT) or Group 2 (n = 45, no development of massive ascites). Patients were followed for a median period of 3.0 yr (range, 0.5–7.5 yr). Results: Group 1 had both higher Model for End‐Stage Liver Disease score and Child‐Pugh score than Group 2. Portal venous flow volume just after reperfusion was significantly greater in Group 1 than Group 2 (307.8 ± 268.8 vs. 176.2 ± 75.0 mL/min/100 g graft weight, respectively; p < 0.05). Post‐transplant infectious complications including ascites infection developed more frequently within the first post‐transplant month in Group 1. Massive ascites was significantly associated with early graft loss (p < 0.05). Conclusion: Post‐transplant massive ascites associated with portal over‐perfusion into the graft liver can develop in patients with a GRWR over 0.8%. Recipients with post‐transplant massive ascites require careful management to prevent infection.     

Multicenter randomized comparison of LigaSure versus conventional surgery for gastrointestinal carcinoma

Purpose  

We conducted this randomized trial to compare the LigaSure Vessel Sealing System with conventional methods in gastrointestinal carcinoma surgery at five specialty cancer hospitals.     

Prognostic importance of neuroendocrine differentiation in Japanese breast cancer patients

Purpose

To evaluate the frequency and prognostic importance of neuroendocrine differentiation (NED) in Japanese breast cancer patients.

Methods

We used standard immunohistochemical techniques to examine 50 patients who underwent resection of breast cancer between 1988 and 1993 at the Department of Surgery II, Nagoya University Hospital, for NED, defined as positive reactivity for four markers: neuron-specific enolase (NSE), synaptophysin, CD57, and chromogranin A (CGA). Neuroendocrine differentiation was defined by the presence of at least one marker including CGA, CD57, and synaptophysin, or at least two markers when one was positive for NSE.

Results

Neuroendocrine differentiation was found in 13 (26%) of the 50 patients examined. There were no significant differences in the distribution of patients with positive or negative NED in terms of age, menopausal status, tumor size, lymph node metastasis, histological grade, ER, PgR, and HER2. We calculated the cumulative survival rates of patient groups according to NED status, and found no significant difference in overall or disease-free survival between patients with and those without NED.

Conclusion

Neuroendocrine differentiation was identified in a subset (26%) of Japanese breast cancer patients, but this appeared to have no relationship with established prognostic factors or patient outcome.     

New treatment method for developmental dysplasia of the hips after walking age: arthroscopic reduction with limboplasty based on the findings of preoperative imaging

Background  

What makes treatment choice for developmental dysplasia of the hips diagnosed after walking age difficult is the poor understanding of prereduction conditions that obstruct the reduction in spatial terms. To evaluate these problems, we employed subtraction three-dimensional imaging to search for the factors involved in intraarticular obstruction. On the basis of the findings of preoperative subtraction threedimensional imaging from computed tomography, we developed a new method, a minimum invasive arthroscopic reduction with limboplasty, for reduction of developmental dysplasia of the hips after walking age. The purposes of this report were to: (1) describe the technique of the arthroscopic procedure, and (2) evaluate our new method using radiographic parameters.     

Measurement of subclavicular pressure on the subclavian artery and brachial plexus in the costoclavicular space during provocative positioning for thoracic outlet syndrome

Background  

Thoracic outlet syndrome is thought to be caused by compression of the brachial plexus or subclavian artery in the interscalene, costoclavicular, or subcoracoid space. Some provocative tests are widely used for diagnosing thoracic outlet syndrome. However, whether provocative positions actually compress the neurovascular bundle in these spaces remains unclear. The purpose of this study was to investigate the possibility of neurovascular bundle compression in the costoclavicular space by measuring the pressure applied to the brachial plexus and subclavian artery in provocative positions.     

Phase II study of preoperative systemic treatment with the combination of docetaxel and trastuzumab in patients with locally advanced HER-2-overexpressing breast cancer

We conducted a phase II study using docetaxel and trastuzumab as preoperative systemic treatment for locally advanced HER-2-overexpressing breast cancer (stage IIIB or IIIC) to evaluate the efficacy and safety, and to perform a subset analysis based on tumor biomarkers. Patients received 4 mg/kg trastuzumab on day 1, followed by weekly treatments of 2 mg/kg, in addition to 75 mg/m² docetaxel every 3 weeks for 4 cycles before surgery. The primary end point was clinical response rate measured by MRI or CT. Twenty-five patients were enrolled. The median age was 54 years and median tumor size was 63 mm. The overall clinical response rate was 68% [95% CI: 47–85%] and the pCR rate was 22% [95% CI: 8–44%]. The clinical response and the pCR rates of patients with ER- and PgR- tumors were 79% and 31%, respectively, while they were 55% and 10%, respectively, in the patients with ER+ and/or PgR+ tumors (p = 0.34, p = 0.34, respectively). Cardiac toxicity was well tolerated; there was no evidence of clinical cardiac events in any patient. The combination of docetaxel and trastuzumab produced highly favorable clinical and pathological responses for locally advanced HER-2-overexpressing breast cancer. Subgroup analysis suggests that ER/PgR negative tumors might be associated with pathological response in locally advanced breast cancer.     

Administration of interferon for two or more years decreases early stage hepatocellular carcinoma recurrence rate after radical ablation: A retrospective study of hepatitis C virus‐related liver cancer

Background: Since hepatocellular carcinoma often recurs after surgical resection or radiofrequency ablation, we analyzed a retrospective large cohort of patients with small hepatocellular carcinoma caused by hepatitis C virus (HCV). Methods: Among 379 patients with HCV RNA‐positive small hepatocellular carcinoma (multiple up to three nodules, 3 cm or less each), 77 received interferon‐alpha injection and 302 received no anti‐viral therapy. Results: Four patients (5.2%) attained sustained virological response (SVR). Cumulative recurrence rates in the treated and untreated groups were 41.1% and 57.5% at the end of the third year, and 63.0% and 74.5% at the fifth year, respectively (P = 0.013). Fifth year‐recurrence rates in treated group were 25.0% in SVR, 85.7% in biochemical response, 71.1% in no response, and 46.7% in patients with continuous administration. When four patients with SVR were excluded, recurrence rates in short‐term interferon therapy (<2 years) and long‐term therapy (≥2 years) were 46.2% and 39.3% at the third year, and 66.2% and 57.4% at the fifth year, respectively (P = 0.012). Multivariate analysis showed that long‐term interferon therapy significantly decreased recurrence rate (hazard ratio for interferon <2 years 0.80, interferon ≥2 years 0.60, P = 0.044), after adjustment with background covariates including indocyanine green retention rate (P = 0.018), alpha‐fetoprotein (P = 0.051), and tumor treatment (P = 0.066). Conclusion: A long‐term administration of low‐dose interferon significantly decreased recurrence of hepatocellular carcinoma after surgical resection or radiofrequency ablation.     

Insulin resistance raises the risk for recurrence of stage I hepatocellular carcinoma after curative radiofrequency ablation in hepatitis C virus‐positive patients: A prospective,case series study

Aim: Several studies have reported that insulin resistance raises the risk of primary hepatocellular carcinoma (HCC). We conducted a prospective, case series study to test the impact of insulin resistance on the recurrence after curative radiofrequency ablation (RFA) of stage I HCC in HCV‐positive patients. Methods: From January 2006 to December 2007, 226 consecutive patients underwent treatment for primary HCC at our institutions, including 37 stage I cases. Among them, 33 were HCV‐positive, and three, six and 24 received curative surgery, transarterial chemoembolization or RFA, respectively. In the 24 patients treated with RFA, recurrence‐free survival was analyzed using the Kaplan–Meier method. The factors contributing to recurrence of HCC were subjected to univariate and multivariate analyses using the Cox proportional hazards model. Insulin resistance was estimated by the Homeostatic Model Assessment of Insulin Resistance (HOMA‐IR). Results: Kaplan–Meier analysis showed that the recurrence‐free survival was lower in patients with higher HOMA‐IR (>2.3, P = 0.0252) or with lower serum albumin level (<3.3 g/dL, P = 0.0004). In the univariate analysis, HOMA‐IR (P = 0.0420) and albumin (P = 0.0036) were significantly associated with recurrence of HCC. Multivariate analysis revealed albumin (odds ratio = 0.01, 95% confidence interval = 0.0002–0.015, P = 0.0001) and HOMA‐IR (odds ratio = 3.85, 95% confidence interval = 1.57–14.2, P = 0.0015) to be independent predictors for recurrence of HCC. Conclusion: Serum albumin level and HOMA‐IR were independent risk factors for recurrence of stage I HCC after curative RFA in HCV‐positive patients. Patients with these factors require closer surveillance.