Predictors of microvascular invasion in patients with hepatocellular carcinoma who are candidates for orthotopic liver transplantation

Microvascular invasion affects survival after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). We sought to identify preoperative predictors of microvascular invasion in patients with HCC who were candidates for OLT. A cohort of 245 patients who underwent resection for HCC and fulfilled the criteria for OLT (i.e., single tumors ≤5 cm or no more than three tumors S3 cm) were identified from a multi-institutional database. Thirty-three percent of the patients had pathologic evidence of microvascular invasion. Thirty percent of patients with single tumors and 47% with multiple tumors had microvascular invasion (P = 0.04). Only 25% of patients with tumors smaller than ≤2 cm had microvascular invasion, compared to 31% and 50% with tumors greater than 2 to 4 cm or larger than 4 cm, respectively (P = 0.01). Tumor grade was highly correlated with microvascular invasion: 12% of patients with well-differentiated tumors had microvascular invasion, compared to 29% and 50% with moderately or poorly differentiated tumors, respectively (P < 0.001). The independent predictors of microvascular invasion were tumor size greater than 4 cm (odds ratio [OR], 3.0, 95% confidence interval [CI], 1.2 to 7.1), and high tumor grade (OR, 6.3; 95% CI, 2.0 to 19.9). Tumor size and grade are strong predictors of microvascular invasion. A tumor biopsy with pathologic grading at the time of pretransplantation ablative therapy could improve selection of patients with HCC for OLT. Presented at the Forty-Second Annual Meeting of The Society for Surgery of the Alimentary Tract, Atlanta, Georgia, May 20–23, 2001. Supported by a T-32 Surgical Oncology Training Grant from the National Institutes of Health (N.F.E).     

Endoscopic transaxillary subpectoral augmentation mammaplasty: a safe and predictable procedure.

During the last decades breast augmentation has gained worldwide acceptance. In addition to the inframammary and periareolar approach for augmentation mammaplasty, the transaxillary route provides an elegant means of retaining the integrity of the breast mound by avoiding visible scars. Due to concerns as to the safety of this technique we analysed 47 patients who underwent endoscopy-assisted transaxillary submuscular augmentation mammaplasty in our department from 1999 to 2004. The inclusion criteria were aesthetic breast augmentation due to breast hypoplasia. Patients with a history of breast cancer, other malignancies, or previously performed mastectomy were excluded. Procedures for tuberous breast deformity as well as concomitantly performed mastopexy were also excluded. No complications were observed impairing final outcome or requiring early operative intervention, such as infection or haematoma. This technique is suitable for patients who prefer a hidden incision at a distant site, and provides predictability of aesthetic outcome and is safe.     

Psychosis, psychopathy, and homicide: a preliminary neuropsychological inquiry.

OBJECTIVE: This study attempted to statistically distinguish subgroups of murderers with mental disorders from among 26 hospitalized men (mean age=34 years) who were committed to a maximum security forensic hospital. METHOD: Measures consisted of objective ratings of psychosis and psychopathy and neuropsychological tests of intelligence, memory and attention, executive functions, and academic abilities. RESULTS: Cluster analysis produced two distinct subgroups: one defined by high incidence of psychosis and low level of psychopathy and one by low incidence of psychosis and high level of psychopathy, each corresponding to distinct neuropsychological differences in intellectual abilities, learning disabilities, and social intelligence. CONCLUSIONS: In light of this relatively small, highly select group, these novel findings must be viewed as preliminary. Studies of larger cohorts are needed before definitive conclusions can be drawn as to the reliability of these two distinct symptom clusters, each independently validated by neuropsychological measures of intelligence, sociality, and academic abilities.     

Association between quantitative EEG and neurocognition in methamphetamine-dependent volunteers.

OBJECTIVE: Exposure to methamphetamine is associated with long-lasting reductions in markers for dopaminergic neurons in preclinical models and in humans. These changes may be associated with alterations in brain electrical activity and in cognition. METHODS: The sample included 9 methamphetamine-dependent subjects and 10 non-drug-using volunteers. Methamphetamine-dependent subjects were hospitalized for 4 days to document abstinence; non-drug-using volunteers were studied as outpatients. EEGs were recorded in the eyes-closed resting state, and absolute EEG power in each frequency band (0.5-4 Hz, 4-8 Hz, 8-12 Hz, and 12-20 Hz) was measured using a fast Fourier transform. EEG power was log-transformed prior to analysis. Cognition was measured using computerized reaction time tasks. RESULTS: Within the methamphetamine-dependent group only, increased theta quantitative EEG (QEEG) power correlated significantly with reaction time on tasks that were more difficult or that were degraded by fatigue. Increased theta QEEG power also correlated with reduced accuracy on a working memory task. CONCLUSIONS: Increased QEEG power in the theta band is associated with worse performance on reaction time tasks in the methamphetamine-dependent sample but not in the non-drug-using volunteers. SIGNIFICANCE: Methamphetamine dependence is associated with pathological alterations in brain electrical activity and in cognitive performance. QEEG appears to provide a sensitive measure of methamphetamine-associated alterations in brain function.     

Necrotizing sialometaplasia associated with bulimia: case report and literature review.

Necrotizing sialometaplasia (NSM) is a self-limiting disorder affecting mainly the minor salivary glands. The significance of NSM resides in its clinical and histopathological resemblance to carcinoma. Few cases of NSM associated with eating disorders have been reported to date. We present here the clinical features and histomorphology of an additional case of bulimia-associated NSM closely mimicking an invasive carcinoma. A high index of suspicion and good communication between clinician and pathologist are essential in recognizing this entity and preventing unnecessary surgical therapy.     

Infective endocarditis after transcatheter closure of a patent foramen ovale.

Infection of devices for percutaneous transcatheter closure of atrial septal defects are exceedingly rare. Two cases of device-associated endocarditis have been reported, which were both operated on. We describe the successful treatment with antibiotics of a device-associated endocarditis.