Fetal middle cerebral artery Doppler waveforms in twin-twin transfusion syndrome

The aim of this study was to compare the fetal middle cerebral artery (MCA) Doppler waveforms in growth-retarded twin fetuses with (n = 11) and without (n = 24) twin-twin transfusion syndrome (TTTS). Umbilical artery (UA) and fetal MCA Doppler velocity waveforms were recorded on admission. The mean values of the UA pulsatility index (PI) of smaller twin fetuses with and without TTTS were significantly higher than those of normal singleton pregnancies. The mean values of the MCA PI of smaller twin fetuses in the TTTS group (+0.7 +/- 1 SD) were significantly higher than those of normal singleton pregnancies on admission, and these levels did not markedly change following amniocentesis. On the other hand, the values of the MCA of the growth-retarded fetuses without TTTS (-0.9 +/- 1 SD) were significantly lower than those of normal singleton pregnancies. Our findings suggest that measurement of fetal MCA PI is a useful method to assess growth-retarded fetuses in monochorionic twin pregnancies. Copyright Copyright 1999 S. Karger AG, Basel     

Nonpenetrating traumatic injury of the thoracic aorta and left subclavian artery; report of a case

Nonpenetrating traumatic injury of the thoracic aorta and/or its major branch is usually fatal and the treatment of this condition carries extremely high risk because of associated visceral organ injuries. Accurate diagnosis have been difficult. However, recently developed multi-slice helical computed tomography (CT) is highly sensitive in early detection of precise location of injury and associating injuries of other organs. Here we report our case with combined thoracic aortic and left subclavian artery injuries, diagnosed by 3-dimensional (3-D) CT and treated successfully.     

The clinical strategy for the Barrett's esophagus

The treatment of Barrett's esophagus is controversial. Current treatments include endoscopic therapy, surgical procedures, gastric acid-suppressive therapy with proton pump inhibitors (PPIs), and cancer chemoprevention such as nonsteroidal anti-inflammatory drugs. Endoscopic therapy combined with gastric acid suppressive therapy can result in squamous reepithelialization of the Barrett's mucosa. Antireflux surgery and PPIs therapy are potential options for the treatment of gastroesophageal reflux symptoms in patients with Barrett's esophagus. But there are no prospective studies that support any alternative approach to treatment. Although chemoprevention therapy may reduce cancer risk in Barrett's esophagus, no randomized controlled trials that prove its efficacy have been reported.     

Recurrent intractable seizures in children with cortical dysplasia adjacent to dysembryoplastic neuroepithelial tumor

The purpose of this study was to identify the pathologic features that predict postoperative outcome in children with cortical dysplasia adjacent to dysembryoplastic neuroepithelial tumors. We reviewed the records of children with dysembryoplastic neuroepithelial tumor who underwent epilepsy surgery and who had at least 1 year of surgical follow-up. We divided the dysembryoplastic neuroepithelial tumors into three pathology classes (simple, complex, and nonspecific), categorized adjunctive cortical dysplasia into four types, and compared histopathology with seizure outcomes. We identified 26 children with dysembryoplastic neuroepithelial tumors. Dysembryoplastic neuroepithelial tumors were complex in 19 patients (73%), simple in 6 (23%), and nonspecific in 1 (4%). Cortical dysplasia was adjacent to dysembryoplastic neuroepithelial tumors in 18 patients. Six patients had type IA cortical dysplasia, 5 had type IB, 3 had type IIA, and 1 had type IIB. The 3 remaining patients had repeated surgeries; of these, 2 patients had cortical dysplasias of type IA/IB and 1 was type IIA/IIB. Eight (39%) of 18 patients with dysembryoplastic neuroepithelial tumors and cortical dysplasia required further surgery for recurrent intractable seizures (P < .05), whereas none of 8 patients without cortical dysplasia required additional surgery. Of 13 patients with type I cortical dysplasia, only 4 had a poor seizure outcome, whereas all 5 patients with type II had a poor seizure outcome postoperatively (P < .05). Children with dysembryoplastic neuroepithelial tumor and cortical dysplasia often had recurrent intractable seizures postoperatively and required further epilepsy surgery. Cortical dysplasia adjacent to dysembryoplastic neuroepithelial tumor can play a role in the epileptogenicity of dysembryoplastic neuroepithelial tumor. Complete resection of a dysembryoplastic neuroepithelial tumor and its adjacent cortical dysplasia should be considered.     

Endocutter no-knife and extraparenchymal control of the main hepatic veins for major hepatectomy

BACKGROUND/AIMS: Extraparenchymal control of the main hepatic veins (ECHV) and use of vascular staplers are now considered as effective methods to prevent intraoperative hemorrhage and duration of hepatic transection. The aim of the present preliminary study was to investigate whether extraparenchymal control of the hepatic veins combined with inflow occlusion and a new articulating linear stapler without a knife (Endocutter no-knife) were effective for major hepatectomy. METHODOLOGY: Twenty patients with hepatic malignant disease underwent major hepatectomies in which 4 or more Couinaud's segments were removed. Extraparenchymal control of the hepatic veins and Endocutter no-knife were used in 7 (Recent group) of the 20 patients after June 2003. Hemihepatic devascularization before hepatic transection, and intermittent hepatic inflow occlusion were also performed in these 7 patients. In the other 13 (Previous group) patients before June 2003, major hepatectomy was performed under only intermittent hepatic inflow occlusion. Intraoperative blood loss volume, transfusion of packed red blood cells, and duration of hepatic transection were compared between the Recent group and Previous group. RESULTS: Estimated blood loss and number of intraoperative blood transfusion were significantly smaller in the Recent group than in the Previous group. Duration of hepatic transection was also significantly shorter in the Recent group than in the Previous group. CONCLUSIONS: The present preliminary study showed that extraparenchymal control of the hepatic veins and Endocutter no-knife are useful for major hepatectomy.     

Changes in the characteristics and survival rate of hepatocellular carcinoma from 1976 to 2000: analysis of 1365 patients in a single institution in Japan

BACKGROUND: The authors analyzed changes in the characteristics and survival rate of patients with hepatocellular carcinoma (HCC) in the past 25 years. METHODS: Trends in clinical characteristics and survival rate of patients with HCC were evaluated retrospectively based on data from 1365 patients who were diagnosed, treated, and followed between 1976 and 2000. RESULTS: Between 1976-1995, the number of patients with smaller tumors, a less advanced tumor stage, and with a lower Child-Pugh class increased markedly. No differences were observed in the distributions of these three factors between the periods 1991-1995 and 1996-2000. The year of HCC diagnosis, tumor size, tumor stage, Child-Pugh class, and the kind of initial treatment received correlated significantly with patient survival rates by multivariate analysis. The year of HCC diagnosis was found to contribute independently to the improvement in patient survival rates. Using the Kaplan-Meier comparison, the time periods during which the highest patient survival rates occurred were found to be 1991-1995/1996-2000, 1986-1990, and 1976-1985, in that order. The authors did not observe a difference with regard to survival rates between patients in the 1991-1995 and 1996-2000 groups. CONCLUSIONS: The characteristics of patients with HCC changed dramatically from 1976 to 1995 (but not in the past 10 years) toward the earlier detection of HCC. This contributed to the improvement noted in patient survival rates during this period. The year of HCC diagnosis was found to be an independent factor for the improved survival rates by multivariate analysis. This indicated that the progress of treatment and care for patients with HCC contributed to the annual improvement in patient survival rates.