Image guided percutaneous gastrostomy catheter placement: How we do it safely and efficiently

Gastrostomy tube is an effective and safe long-term feeding access that is welltolerated by patients.The typical placement routes include surgical,endoscopic and interventional radiologic placement.In particular,percutaneous interventional radiologic gastrostomy(PIRG)has increasingly become the preferred method of choice in many practices.Although many PIRG techniques have been developed since the 1980s,there is still a paucity of evidence supporting the choice of a most-optimal PIRG technique.Hence,there is a large variation in institutional approach to PIRG.We are a large,quaternary academic institution with an extensive experience in PIRG.Therefore,we aim to present the“push”PIRG technique utilized in our institution,to review the current literature,to discuss the optimal choice of PIRG technique and to generate further interests in comparison studies.     

Multifocal hepatocellular carcinoma and precancerous lesions in a patient with autoimmune hepatitis-related cirrhosis

A 44-year-old woman with a 29-year history of autoimmune hepatitis (AIH) received a living donor liver transplant for multifocal hepatocellular carcinoma (HCC) and cirrhosis in 2007. Her initial laboratory workup at our institution in 1996 revealed a positive antismooth muscle antibody with a titer of 1:640. Serum electrophoresis showed a monoclonal gamma globulin spike with elevated IgG, IgA, and IgM. The patient was negative for hepatitis B and hepatitis C (HCV) by serology and serum polymerase chain reaction. She was treated with corticosteroids and azathioprine, but her disease progressed. In 1997, a liver needle biopsy revealed cirrhosis and a focus of small cell change. In 2004, a 2-cm exophytic mass was detected on magnetic resonance imaging. Follow-up imaging in 2005 and 2006 showed growth of the exophytic mass and development of new tumors. The exophytic mass was treated with ethanol ablation and she received a transplant. Examination of the explant revealed multiple high-grade dysplastic nodules and four moderately differentiated HCCs, one of which is arising in a high-grade dysplastic nodule. We believe this to be the first case in the English literature documenting the presence of preneoplastic lesions in an HCV-negative patient with AIH who developed HCC.     

Phacoemulsification and goniosynechialysis for the management of refractory acute angle closure

Purpose. To evaluate the effectiveness of phacoemulsification with goniosynechialysis in the management of refractory acute angle closure (AAC). Methods. In this prospective, noncomparative interventional case series, patients with AAC who were unresponsive to medical and laser therapy were included. Success was defined as complete if intraocular pressure (IOP) had a drop of at least 30% and was between 6 and 21 mmHg without medication, and qualified if IOP was within that range with medication. Results. A total of 24 patients with a mean age of 56 years (range 39-77) were treated. Mean follow-up time was 15.7±4.2 months (range 6-24). Mean preoperative and last visit IOPs were 34.27±7.23 mmHg and 17.5±3.21 mmHg, respectively (p<0.001). Mean number of glaucoma medication dropped from 3.67±0.48 to 0.63±1.05 (p<0.001). There was a positive correlation between the attack-surgery interval and last visit IOP (p<0.001, r=0.697). There was a negative correlation between the preoperative anterior chamber depth and last visit IOP drop (p=0.03, r=-0.56). Also, a positive correlation was found between the preoperative IOP and last visit IOP drop (p<0.001, r=0.896). At final visit, complete and qualified success was achieved in 17/24 (71%) and 5/24 (21%) cases, respectively. The most common intraoperative and postoperative complications were hyphema and anterior chamber fibrinous reaction, respectively. Conclusions. Phacoemulsification with goniosynechialysis seems to be a safe and effective method for the management of patients with refractory AAC. This procedure can be considered for these patients before proceeding with filtering surgery.     

Spectrum separation resolves partial-volume effect of MRSI as demonstrated on brain tumor scans

Magnetic resonance spectroscopic imaging (MRSI) is currently used clinically in conjunction with anatomical MRI to assess the presence and extent of brain tumors and to evaluate treatment response. Unfortunately, the clinical utility of MRSI is limited by significant variability of in vivo spectra. Spectral profiles show increased variability because of partial coverage of large voxel volumes, infiltration of normal brain tissue by tumors, innate tumor heterogeneity, and measurement noise. We address these problems directly by quantifying the abundance (i.e. volume fraction) within a voxel for each tissue type instead of the conventional estimation of metabolite concentrations from spectral resonance peaks. This 'spectrum separation' method uses the non-negative matrix factorization algorithm, which simultaneously decomposes the observed spectra of multiple voxels into abundance distributions and constituent spectra. The accuracy of the estimated abundances is validated on phantom data. The presented results on 20 clinical cases of brain tumor show reduced cross-subject variability. This is reflected in improved discrimination between high-grade and low-grade gliomas, which demonstrates the physiological relevance of the extracted spectra. These results show that the proposed spectral analysis method can improve the effectiveness of MRSI as a diagnostic tool.     

Saffron as a promising therapy for diabetes and Alzheimer's disease: mechanistic insights

The prevalence of both Alzheimer's disease (AD) and diabetes mellitus is increasing with the societies' aging and has become an essential social concern worldwide. Accumulation of amyloid plaques and neurofibrillary tangles (NFTs) of tau proteins in the brain are hallmarks of AD. Diabetes is an underlying risk factor for AD. Insulin resistance has been proposed to be involved in amyloid-beta (Aβ) aggregation in the brain. It seems that diabetic conditions can result in AD pathology by setting off a cascade of processes, including inflammation, mitochondrial dysfunction, and ROS and advanced glycation end products (AGEs) synthesis. Due to the several side effects of chemical drugs and their high cost, using herbal medicine has recently attracted attention for the treatment of diabetes and AD. Saffron and its active ingredients have been used for its anti-inflammatory, anti-oxidant, anti-diabetic, and anti-AD properties. Therefore, in the present review paper, we take account of the clinical, in vivo and in vitro evidence regarding the anti-diabetic and anti-AD effects of saffron and discuss the preventive or postponing properties of saffron or its components on AD development via its anti-diabetic effects.