Comparison of Surgical Outcomes for Hepatocellular Carcinoma in Patients With Hepatitis B Versus Hepatitis C: A Western Experience

Background: We reviewed our experience in patients with hepatocellular carcinoma (HCC) and chronic hepatitis to determine if differences exist in preoperative status and postoperative survival between those with hepatitis B virus (HBV) and hepatitis C virus (HCV) infections.Methods: We reviewed the records of 240 consecutive patients with HCC who underwent hepatic resection or liver transplantation at Mount Sinai Hospital between February 1990 and February 1998. Patients who tested negative for hepatitis B antigen and hepatitis C antibody (74 patients) as well as those who tested positive for both (2 patients) were excluded. Age as well as preoperative platelet count, prothrombin time (PT), albumin, and total bilirubin were measured in all patients. The presence of encephalopathy or ascites also was noted. Explanted livers and resection specimens were examined for size, number, and differentiation of tumors as well as the presence of vascular invasion and cirrhosis in the surrounding parenchyma.Results: One hundred twenty-one patients with HCC tested positive for HCV, and 43 tested positive for HBV. A significantly higher proportion of patients with HCV required transplant for the treatment of their HCC when compared to those with HBV. In the resection group, patients with HCV were significantly older that those with HBV. They also had significantly lower mean preoperative platelet counts and albumin levels and higher mean PT and total bilirubin levels. Resected patients with HCV had significantly less-differentiated tumors and a higher incidence of vascular invasion and cirrhosis when compared to those with HBV. There was no statistical difference in the multicentricity and size of tumors between the two groups. The 5-year disease-free survival was significantly higher for HBV patients treated with resection when compared to those with HCV (49% vs. 7%, P 5 .0480). Patients with HCC and HCV had significantly longer 5-year disease-free survival with transplant when compared to resection (48% vs. 7%, P 5 .0001).Transplanted patients with HBV and HCC had preoperative status, pathological findings, and survival similar to those of patients with HCV.Conclusions: Based on preoperative liver function and tumor location, a much higher proportion of HCC patients with HBV were candidates for resection. Significant differences in preoperative status, tumor characteristics and disease-free survival exist between HCC patients with chronic HBV and HCV infection who have not yet reached end-stage liver disease. Serious consideration should be given to transplanting resectable HCC with concomitant HCV, especially in cases with small tumors.Presented at the 52nd Annual Meeting of the Society of Surgical Oncology, Orlando, Florida, March 4–7, 1999.     

Effect of Scanning Strategy on Thermal Stresses and Strains during Electron Beam Melting of Inconel 625: Experiment and Simulation

This paper develops a hybrid experimental/simulation method for the first time to assess the thermal stresses generated during electron beam melting (EBM) at high temperatures. The bending and rupture of trusses supporting Inconel 625 alloy panels at ~1050 °C are experimentally measured for various scanning strategies. The generated thermal stresses and strains are thereafter simulated using the Finite-Element Method (FEM). It is shown that the thermal stresses on the trusses may reach the material UTS without causing failure. Failure is only reached after the part experiences a certain magnitude of plastic strain (~0.33 ± 0.01 here). As the most influential factor, the plastic strain increases with the scanning length. In addition, it is shown that continuous scanning is necessary since the interrupted chessboard strategy induces cracking at the overlapping regions. Therefore, the associated thermal deformation is to be minimized using a proper layer rotation according to the part length. Although this is similar to the literature reported for selective laser melting (SLM), the effect of scanning pattern is found to differ, as no significant difference in thermal stresses/strains is observed between bidirectional and unidirectional patterns from EBM.     

Assessment of heavy metal content in refined and unrefined salts obtained from Urmia,Iran

A heavy metal is any relatively dense metal that may be potentially toxic in a variety of foods. Heavy metals pollute and contaminate foods. These metals are usually toxic to human body. Heavy metals are the most important toxic metals which may cause health risks following the consumption of contaminated foods. The edible salt (NaCl) is a substance that has been used as a food additive since ancient times. Twenty samples of refined and unrefined edible salts produced in Iran were analyzed using flame atomic absorption spectrometry (FAAS) method for the presence of toxic heavy metals. The precision of the analysis was assured through the repeated analysis of the samples. The mean (±standard deviation) concentrations of toxic metals in dried samples of rock salt were as follows: Ni (1.870?±?0.850), Cd (0.328?±?0.143), Mn (0.184?±?0.230) and Co (3.124?±?0.880) mg/kg and in dry weights of samples obtained from Urmia market: Ni (1.982?±?0.021), Cd (2.461?±?0.036), Mn (0.192?±?0.028) and Co (8.450?±?0.025) mg/kg. There was a significant difference between the toxic metal concentrations and their guideline values. Therefore, it was important to assess the public health risks posed by the presence of toxic contaminants.     

Pattern and amount of change after orthodontic correction of upper front teeth 7 years postretention

Objective:To investigate the amount and pattern of changes of maxillary front teeth 7 years postretention, which previously were retained with a bonded retainer.Materials and Methods:The study group consisted of 27 patients. Study models before treatment (T1), at debonding (T2), 1 year after removal of the upper bonded retainer (T3), and 7 years postretention (T4) were present. The irregularity index (sum of contact point displacements) and the rotations of front teeth toward the raphe line were calculated.Results:The irregularity index of the maxillary front teeth changes very little or not at all during the first year postretention. Further change long term resulted in an irregularity index of mean 2.0 (range 0.0–5.8). The contact relationship between the laterals and centrals seems to be the most critical. Forty rotated teeth in 21 patients were corrected more than 20°. Mean relapse during the first year postretention was 6.7° (range 0.0°–14.7°). Mean changes during 7 years was 8.2° (range 0.0°–19.3°).Conclusions:Relapse of upper front teeth retained with a bonded retainer is minor in both the short and long term. If permanent retention is required after 3 years of retention, it is enough to retain the incisors.     

Contrast‐Enhanced Ultrasound Guidance for Interventional Procedures

Since its introduction, contrast‐enhanced ultrasound (CEUS) has gained an important role in the diagnosis and management of abdominal and pelvic diseases. Contrast‐enhanced ultrasound can improve lesion detection rates as well as success rates of interventional procedures when compared to conventional ultrasound alone. Additionally, CEUS enables the interventionalist to assess the dynamic enhancement of different tissues and lesions, without the adverse effects of contrast‐enhanced computed tomography, such as exposure to ionizing radiation and nephrotoxicity from iodinated contrast material. This review article describes the various applications and advantages of the use of CEUS to enhance performance of ultrasound‐guided interventions in the abdomen and pelvis.     

Recurrent pancreatic carcinoma and cholangiocarcinoma: <Superscript>18</Superscript>F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT)

Although the current literature is limited, available data suggest that ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) imaging improves the evaluation of patients with recurrent pancreatic carcinoma and cholangiocarcinoma. There is evidence that PET/CT is particularly useful in the setting of elevated tumor markers and negative or equivocal CT findings. This article reviews the nature of these carcinomas in the post-therapy setting and describes the strengths and limitations of PET/CT when used for monitoring recurrence.     

Comparison of Standardized Uptake Values in Normal Structures Between PET/CT and PET/MRI in an Oncology Patient Population

Purpose

The purpose of this study was to compare and correlate standardized uptake values (SUV) derived from magnetic resonance attenuation correction (MRAC) with those derived from computed tomography attenuation correction (CTAC) in an oncology patient population.

Procedures

The HIPAA-compliant study was approved by the Internal Review Board and all subjects gave written informed consent prior to inclusion in the study. Forty patients (mean age 61?±?15.1; 20 male) referred for clinically indicated 2-deoxy-2-[¹⁸F]fluoro-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) scans also underwent a PET/magnetic resonance imaging (MRI) examination. MRAC was performed using an automatic three-segment model. Regions of interest were drawn over eight normal structures in order to obtain SUVmax and SUVmean values. Spearman rank correlation coefficients (r) were calculated and two-tailed paired t tests were performed to compare the SUVmax and SUVmean values obtained from CTAC with those from MRAC.

Results

The mean time after FDG injection was 66?±?7 min for PET/CT and 117?±?15 min for PET/MRI examination. MRAC SUV values were significantly lower than the CTAC SUV values in mediastinal blood pool (p?<?0.001 for both SUVmax and SUVmean) and liver (p?=?0.01 for SUVmean). The MRAC SUV values were significantly higher in bone marrow (p?<?0.001 for both SUVmax and SUVmean), psoas major muscle (p?<?0.001 for SUVmax), and left ventricular myocardium (p?<?0.001 for SUVmax and p?=?0.01 for SUVmean). For the other normal structures, no significant difference was observed. When comparing SUV values generated from CTAC versus MRAC, high correlations between CTAC and MRAC were observed in myocardium (r?=?0.96/0.97 for SUVmax/mean), liver (r?=?0.68 for SUVmax), bone marrow (r?=?0.80/0.83 for SUVmax/mean), lung tissue (r?=?0.70 for SUVmax), and mediastinal blood pool (r?=?0.0.68/.069 for SUVmax/mean). Moderate correlations were found in lung tissue (r?=?0.67 for SUV mean), liver (r?=?0.66 for SUVmean), fat (r?=?0.48/0.53 for SUVmax/mean), psoas major muscle (r?=?0.54/0.58 for SUVmax/mean), and iliacus muscle (r?=?0.41 for SUVmax). Low correlation was found in iliacus muscle (r?=?0.32 for SUVmean).

Conclusions

Using the automatic three-segment model, our study showed high correlation for measurement of SUV values obtained from MRAC compared to those from CTAC, as the reference standard. Differences observed between MRAC and CTAC derived SUV values may be attributed to the time-delay between the PET/CT and PET/MRI scans or biologic clearance of radiotracer. Further studies are required to assess SUV measurements when performing different MR attenuation correction techniques.     

Aortenklappenstenose: von der Valvuloplastie zum perkutanen Klappenersatz

Calcified aortic stenosis is the predominant valve disease. Patients affected are most commonly elderly people, who often show associated comorbidities like reduced left ventricular function, impaired renal function, and pulmonary hypertension. The risk of open-heart surgery is elevated. Balloon aortic valvuloplasty enables a reduction of symptoms, an increase in physical performance, and, therefore, an improved quality of life. However, a reduction in mortality cannot be reached with this method. New techniques and improved equipment induced a "revival" of balloon aortic valvuloplasty, which has been introduced almost 20 years ago. In addition, brachytherapy after balloon valvuloplasty has recently been investigated and represents an interesting approach to reduce early restenosis. The technical improvement of balloon valvuloplasty is the percutaneous heart valve, which is under present clinical investigation. The antegrade/transseptal and retrograde approaches are used, as is the transapical access to the left ventricle. Even if long-term results are not yet available and the procedures still require technical improvement, especially minimization of catheter size, percutaneous valve replacement is a new chapter in the treatment of the calcified aortic stenosis.