Interventional Radiological Treatment of Hepatocellular Carcinoma: An Update

Hepatocellular carcinoma is the commonest primary liver tumor and its incidence is on an increase.Transplantation and surgical resection are the gold standard curative treatment options but less than 20%patients are surgical candidates because of advanced liver disease and/or co-morbidities.Various interventional radiological procedures have been developed and intensively investigated for treatment of inoperable HCC.This review summarizes the various interventional radiological treatments in HCC including patient selection, procedural considerations and response evaluation. Transarterial chemoembolization, radioembolization and radiofrequency ablation are mainly discussed.     

Mid‐face toddler excoriation syndrome (MiTES): a new paediatric diagnosis

Chronic ulcerating lesions on the face are rarely seen in toddlers. Blistering disease, vasculitis, infections and self‐mutilation due to neurometabolic disease can usually be excluded on clinical and histological grounds. In the absence of identifiable disease, such lesions are sometimes attributed to child abuse or fabricated illness. We describe three toddlers with chronic mid‐face erosions, two from India and one from the UK. One had moderate developmental delay and one had had seizures. The lesions appeared to be self‐inflicted, no underlying disease was identified and there was no suspicion of child abuse. Recognition of the same disease pattern in different continents implies a distinct pathological entity. The pattern closely resembles that seen in some patients with mutations in the pain‐insensitivity genes PRDM12 and SCN11A. We suggest the term ‘mid‐face toddler excoriation syndrome’ (MiTES) to acknowledge the existence of this condition, encourage further reports and help clarify the pathogenesis.     

Preclosure Pressure Gradients Predict Patent Ductus Arteriosus Patients at Risk for Later Left Pulmonary Artery Stenosis

The objective of this study was to evaluate the incidence of pre-existing catheterization left pulmonary artery (LPA) gradients and correlation of these gradients with later LPA stenosis after successful patent ductus arteriosus (PDA) occlusion. We performed a single-center review of 130 patients with PDA closure from October 1993 to February 2005. We analyzed the pre-PDA closure LPA pressure gradients at catheterization to determine if these were predictive of late LPA stenosis. On follow-up, a V _max >2 m/s by echocardiogram (transthoracic echocardiography; TTE) was considered indicative of possible LPA stenosis. Left lung perfusion of <35% was considered diagnostic of significant LPA stenosis. Post PDA closure, possible LPA stenosis by TTE was seen in 8 of 128 patients (6.25%). Seven of these eight had precatheter LPA gradients >7 mm Hg. Five of these had perfusion scans, three of the five had significant LPA stenosis, and two underwent LPA angioplasty. Patients with LPA catheter gradients >7 mm Hg were more likely to have possible LPA stenosis by TTE, significant LPA stenosis by lung scan, and intervention with LPA angioplasty. In conclusion, a preclosure main pulmonary artery-to-LPA pressure gradient >7 mm Hg was found in all patients who developed significant LPA stenosis on follow-up after transcatheter PDA closure. It appears likely that these patients have LPA abnormality rather than stenosis caused by the PDA occlusion device. Patients with preclosure LPA gradients >7 mm Hg should undergo follow-up evaluations for detection of significant stenosis and may require treatment if an important flow abnormality is documented.     

Ramipril-Like Activity of <Emphasis Type="Italic">Spondias Mombin</Emphasis> Linn Against No-Flow Ischemia and Isoproterenol-Induced Cardiotoxicity in Rat Heart

The cardioprotective property of Spondias mombin (SM) was investigated and compared with that of the ACE inhibitor, ramipril. Alterations to markers of myocardial injury and indices of antioxidant capacity by isoproterenol (ISP) intoxication were significantly corrected in groups treated with SM. The inflammatory index was increased by 24% in ISP-intoxicated group compared with control (P < 0.001) but reduced in the groups administered ISP and treated with 100 or 250 mg/kg SM by 17% (P < 0.001) and 11% (P < 0.05) respectively. Serum lactate dehydrogenase activity and cholesterol level which were significantly increased in ISP-intoxicated group compared with control were reduced in groups administered ISP and treated with SM. Serum phosphate levels in groups administered ISP and treated with SM were significantly lower than values obtained for the ISP-intoxicated group (P < 0.001). Tissue catalase and superoxide dismutase activities as well as glutathione level were significantly increased in groups administered ISP and treated with SM compared to ISP-intoxicated group while MDA and nitrite levels were decreased. Disruption in the structure of cardiac myofibrils by ISP intoxication was reduced by treatment with SM. Comparable results were obtained for ramipril. These results are indicative of the potent cardioprotective property of SM.     

Origin of left main and right coronary arteries from right aortic sinus of Valsalva

Coronary anomalies may be a part of complex congenital malformations of the heart or be an isolated defect. Anomalous coronary arteries are associated with a higher incidence of congenital heart diseases, but do not appear to be associated with an increased risk for development of coronary atherosclerosis. Coronary anomalies are recognized readily on angiography. Unexpected findings during invasive procedures would suggest a possibly existing coronary anomaly, especially when main branches cannot be opacified by selective contrast medium injection. This case report illustrates the clinical and angiographic findings of a patient undergoing coronary angiography for evaluation of ischemic heart disease with an unexpected presence of anomalous origin of the left coronary artery from the right aortic sinus.     

The developmental stages of the middle phalanx of the third finger (MP3): a sole indicator in assessing the skeletal maturity?

Assessment of skeletal maturity is an integral part of interceptive diagnosis and treatment planning. The present day methods of skeletal maturity assessment like the hand-wrist radiographs or cervical vertebrae radiographs are expensive, require elaborate equipment and accounts for high radiation exposure, especially for growing children. The present study was thus undertaken to provide a simple and practical method of skeletal maturity assessment using the developmental stages of the middle phalanx of the third finger (MP3) as seen on an IOPA film taken using a standard dental x-ray machine. The results of the study showed that this simple method was highly reliable and could be used as an alternative method to assess the skeletal maturity of growing children.