Percutaneous treatment of hepatocellular carcinoma in patients with cirrhosis: A comparison of the safety of cryoablation and radiofrequency ablation

Purpose

To compare the safety of image-guided percutaneous cryoablation and radiofrequency ablation in the treatment of hepatocellular carcinoma in patients with cirrhosis.

Materials and methods

This retrospective HIPAA-compliant study received institutional review board approval. Forty-two adult patients with cirrhosis underwent image-guided percutaneous ablation of hepatocellular carcinoma from 2003 to 2011. Twenty-five patients underwent 33 cryoablation procedures to treat 39 tumors, and 22 underwent 30 radiofrequency ablation procedures to treat 39 tumors. Five patients underwent both cryoablation and radiofrequency ablation procedures. Complication rates and severity per procedure were compared between the ablation groups. Potential confounding patient, procedure, and tumor-related variables were also compared. Statistical analyses included Kruskal–Wallis, Wilcoxon rank sum, and Fisher's exact tests. Two-sided P-values <0.05 were considered significant.

Results

The overall complication rates, 13 (39.4%) of 33 cryoablation procedures versus eight (26.7%) of 30 radiofrequency ablation procedures and severe/fatal complication rates, two (6.1%) of 33 cryoablation procedures versus one (3.3%) of 30 radiofrequency ablation procedures, were not significantly different between the ablation groups (both P = 0.26). Severe complications included pneumothoraces requiring chest tube insertion during two cryoablation procedures. One death occurred within 90 days of a radiofrequency ablation procedure; all other complications were managed successfully.

Conclusion

No significant difference was seen in the overall safety of image-guided percutaneous cryoablation and radiofrequency ablation in the treatment of hepatocellular carcinoma in patients with cirrhosis.     

Effect of crush and axotomy of phrenic nerves on oxidative stress in diaphragm muscle of rats

Introduction: In this study we investigated the effect of crush and axotomy of phrenic nerves on oxidative stress and antioxidant enzyme activities in rat diaphragm muscle. Methods: The animals in the first group were not crushed or axotomized and served as controls. Phrenic nerves of the rats in the second and third groups were crushed or axotomized in the diaphragm muscle. Results: The malondialdehyde level increased in diaphragm muscles after both crush and axotomy. The antioxidant enzymes, such as superoxide dismutase, glutathione peroxidase, carbonic anhydrase, and catalase, decreased in diaphragm muscles after both crush and axotomy. Conclusions: Crushing or axotomizing the phrenic nerves may produce oxidative stress in the diaphragm muscle of the rat by increasing lipid peroxidation and decreasing antioxidant enzyme activities. Muscle Nerve, 2012     

Solitary littoral cell angioma of the spleen: computed tomography and magnetic resonance imaging features

Littoral cell angioma is a rare primary vascular neoplasm of the spleen composed of blood-filled vascular channels. Typically, littoral cell angioma presents with splenomegaly caused by multiple small hypoattenuating nodules that show delayed enhancement. We report an unusual case of littoral cell angioma of the spleen that presented as a large solitary mass.     

Multiple Atrophies Following Tooth Extraction

Following a molar tooth extraction, the patient developed a depression and atrophy of the right ear, the right half of the mentum, and the tongue. These atrophy deformities were successfully corrected with dermografts.     

Febrile neutropenia as the presenting sign of appendicitis in an adolescent with acute myelogenous leukemia

The diagnosis and management of a surgical abdomen in patients with acute leukemia is quite difficult because of the complications and treatment of disease itself. A 13-year-old boy with acute myelogenous leukemia developed 2 episodes of febrile neutropenia during induction therapy. The second one was treated with a 5-day course of parenteral antimicrobial therapy, but the patient then presented with right lower quadrant abdominal tenderness, guarding, and rebound tenderness. Abdominal ultrasonography and computed tomography revealed appendicitis. Conservative medical management was unsuccessful, and appendectomy was performed 5 days after appendicitis was diagnosed. The patient's clinical manifestations resolved 5 days later. The case illustrates that fever may be the first manifestation of appendicitis in a child with acute myelogenous leukaemia who is neutropenic. Surgery is acceptable as first-line treatment in such cases.     

Clinical application of vestibular evoked myogenic potentials in healthy newborns

OBJECTIVE: Auditory and vestibular functions have critical importance in infancy because they may affect motor and mental development. We aimed to determine the normal values of the vestibular evoked myogenic potential (VEMP) parameters to provide a reference for further research regarding the early diagnosis of vestibular dysfunction in newborns. METHODS: Twenty-four term newborns (12 girls, 12 boys), with birth weights greater than 2500 g and Apgar scores higher than 7 at 1 min, were studied. Tympanometry, auditory-evoked brainstem responses, transient-evoked otoacoustic emissions, and VEMP recordings were assessed in all subjects during fourth week after birth. RESULTS: All newborns passed the audiologic evaluation, and biphasic waveforms of the VEMP were obtained in all 48 tested ears. Mean latencies of p13, n23, and p13-n23 intervals were 13.7+/-1.1, 20.5+/-1.6, and 7.1+/-2.1 ms, respectively. The mean amplitude value was 22.6+/-18.4 microV. There were no significant differences in latency values or amplitudes with regard to sex or side of ear tested in newborns. CONCLUSIONS: VEMP may easily be used for early evaluation of vestibular dysfunction in newborns. Because results may differ owing to test techniques and age, every laboratory should have its own normal values.     

Effect of cervical mucus aspiration before intrauterine insemination

Objective

To determine whether cervical mucus aspiration before intrauterine insemination (IUI) has any effect on clinical pregnancy rates.

Method

The outcomes of 186 IUI cycles in 95 consecutive patients in whom mucus was aspired prior to IUI were compared retrospectively with those of 1057 IUI cycles in 505 women.

Results

The pregnancy rate was 15.1% (28 pregnancies for 186 cycles) in the cervical mucus aspiration group and 9.9% (105 pregnancies for 1057 cycles) in the control group (P = 0.05). Mucus aspiration led to significantly increased pregnancy rates for women with unexplained infertility (24% in the aspiration group vs 9.5% in the control group; P = 0.04).

Conclusion

Cervical mucus aspiration before IUI might improve clinical pregnancy rates by yet-to-be-defined mechanisms.     

Pneumothorax in patients with coronavirus disease 2019 pneumonia with invasive mechanical ventilation

OBJECTIVESOur goal was to evaluate the prevalence of and risk factors for pneumothorax in patients with invasive mechanical ventilation in the intensive care unit (ICU) diagnosed with coronavirus disease 2019 pneumonia.Open in a separate windowMETHODSThe prevalence of pneumothorax was retrospectively reviewed in 107 patients diagnosed with coronavirus disease 2019 pneumonia and treated in an ICU in Turkey between 11 March 2020 and 30 April 2020.RESULTSThe patients were aged 19–92 years; 37 (34.6%) were women. Pneumothorax developed in 8 (7.5%) of the intubated patients. Four (50%) of the patients with pneumothorax and 68 (68.7%) of those without it died. In the univariable logistic regression analysis of the presence of comorbid diseases (P = 0.91), positive end-expiratory pressure (P = 0.18), compliance (P = 0.93), peak pressure (P = 0.41) and the Horowitz index (P = 0.13) did not show statistically significant effects in increasing the risk of pneumothorax.CONCLUSIONSThere was no significant increase or decrease in the risk of pneumothorax in patients treated with invasive mechanical ventilation after the diagnosis of coronavirus disease 2019-related pneumonia/acute respiratory distress syndrome. However, consideration of the risk of pneumothorax in these individuals may have the potential to improve the prognoses in such settings.     

Effects of Occupational Silica Exposure on OXIDATIVE Stress and Immune System Parameters in Ceramic Workers in TURKEY

ABSTRACT

Silica is the second most common element after oxygen, and therefore, exposures to crystalline silica dust occur in a large variety of occupations such as metal foundries, constructions, and ceramic, quarry, and pottery industries. Since crystalline silica exposure has been linked with silicosis, lung cancer, and other pulmonary diseases, adverse effect attributed to this element has be a cause for concern worldwide. Silica dust exposure in workers is still considered to be important health problem especially in developing countries. The aim of the study was to investigate the effects of occupational silica exposure on oxidative stress parameters including the activities of superoxide dismutase (SOD), catalase (CAT), glutathione reductase (GR), glutathione peroxidase (GPx), and levels of total glutathione (GSH) and thiobarbituric acid reactive substance (TBARS) as well as immune system parameters such as interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, and IL-10 and tumor necrosis factor (TNF)-α in Turkish ceramic workers. In this study, nearly 50% of Turkish ceramic workers were diagnosed with silicosis. Eighty-four percent of these silicotic workers were found to present with profusion category 1 silicosis, whereas controls (n = 81) all displayed normal chest radiographs. Data demonstrated a significant decrease in levels of GSH and activities of CAT, SOD, and GPx, but a significant increase in MDA levels and activity of GR in all workers. Further, workers possessed significantly higher levels of IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-10, and TNF-α. These observations suggest that ceramic workers may have impaired antioxidant/oxidant status and activated immune system indicative of inflammatory responses.