Thorotrast-Induced Multiple Primary Malignant Tumors of the Liver--Cholangiocarcinoma and Malignant Hemangioendothelioma

A case of multiple primary malignant tumors of the liver (cholangiocarci-nomaand malignant hemangioendothelioma) that developed 40 yearsafter Thorotrast administration is described, with radiologicaland autoradiographic findings. The estimated organ dose to theliver was approximately 580 rads.     

Epidemiology of Dural Arteriovenous Fistula in Japan: Analysis of Japanese Registry of Neuroendovascular Therapy (JR-NET2)

We developed the Japanese Registry of Neuroendovascular Therapy 2 (JR-NET2) database and used the information for a retrospective, nation-wide multicenter, observational study to clarify the clinical characteristics, current status of procedures, and outcome of patients treated by neuroendovascular therapy in Japan. In this report, we analyzed the clinical characteristics of dural arteriovenous fistulas (dAVFs) in the JR-NET2 database. All patients with dAVFs treated with endovascular therapy in 150 Japanese hospitals were included. Patient characteristics, clinical presentations, and imaging characteristics were analyzed. A total of 1,075 patients with dAVFs underwent 1,520 endovascular procedures. Of 1,075 patients, 45% were men and 55% were women. The mean age was 65 ± 13 years. The most frequent location of dAVFs was the cavernous sinus (43.6%), followed by the transverse-sigmoid sinus (TSS) (33.4%). Twelve percent of the patients had intracranial hemorrhage, 9% had venous infarction, and 3% had convulsion. The statistically significant independent risk factors of intracranial hemorrhage were TSS, superior sagittal sinus (SSS), tentorium, anterior cranial fossa, cranio-cervical junction, cortical venous reflux (CVR), and varix. Risk factors of venous infarction were age older than 60 years, male sex, TSS, SSS, and CVR. Risk factors of convulsion were male sex, SSS, and CVR. This is the largest nationwide report, to date, of the clinical characteristics of dAVFs treated by neuroendovascular therapy. CVR was a major risk factor of aggressive symptoms.     

Loss of heterozygosity on chromosome 16 in hepatocellular carcinoma

In order to understand the molecular genetics of human hepatocellular carcinoma (HCC) a common chromosomal abnormality in HCC was examined using restriction fragment length polymorphism (RFLP) analysis. Sixty-eight HCC specimens were examined for loss of heterozygosity at 11 different chromosomal arms including 1p, 5p, 11p, 11q, 13q, 14q, 15q, 16p, 16q, 18q, and 19q. Losses were not detected on chromosome 1, 5, 14, 15 or 19, and the frequencies of losses were low (11-19%) for chromosomes 11, 13 and 18. In contrast, loss of heterozygosity was frequently observed for three different loci on chromosome 16, the HBA locus at 16p13.3 (22%), the MT2 locus at 16q21-22.1 (15%) and the HP locus at 16q22.1-22.2 (39%). There was no remarkable difference in the frequencies of loss of heterozygosity at these loci among HBV related HCC, HCV related HCC and neither virus (NBNC) related HCC. Thus, the results indicate that at least three different genetic abnormalities in chromosome 16 are commonly observed in various HCC, and that this chromosome may have some important role(s) in recessive genetic changes which generate this tumour.     

Decreased variation of electrocardiographic R–R interval in patients with liver cirrhosis

Electrocardiographic R–R interval variations were assessed to determine the functional integrity of the cardiac vagal nervous system in 20 normal controls and 71 cirrhotic patients. The ratio of the coefficient of variation to standard prediction value was used as an index. The cirrhotic patients showed significant reductions in the ratio of the coefficient compared with controls (0.71 ± 0.27 vs 0.91 ± 0.14; P < 0.01). There was a significant relationship between decreased R–R interval variation and the liver function tests. The ratio of the coefficient increased with improvement in encephalopathy, and decreased with the development of encephalopathy. These results show that there is dysfunction of the cardiac vagal nervous system in patients with liver cirrhosis, and that this abnormality is partially reversible and might be related to liver dysfunction.