Recurrence-free survival after radiofrequency ablation of hepatocellular carcinoma. A registry report of the impact of risk factors on outcome

BACKGROUND: Despite the high complete necrosis rate of radiofrequency ablation (RFA), tumor recurrence, either local tumor recurrence or new tumor formation, remains a significant problem. Purpose of this study is to evaluate the pattern and risk factors for intrahepatic recurrence after percutaneous RFA for hepatocellular carcinoma (HCC). METHODS: We studied 40 patients with 48 HCCs (< or = 3.5 cm) who were treated with percutaneous RFA. The mean follow-up period was 24.1 +/- 15.7 months. We evaluated the cumulative disease-free survival of overall intrahepatic recurrence, local tumor progression (LTP) and intrahepatic distant recurrence (IDR). Thirty host, tumoral and therapeutic risk factors were reviewed for significant tie-in correlation with recurrence: age; gender; whether RFA was the initial treatment for HCC or not; severity of liver disease; cause of liver cirrhosis; contact of tumor to major hepatic vessels and liver capsule; degree of approximation of tumor to the liver hilum; ablation time; degree of benign pre-ablational enhancement; sufficient safety margin; tumor multinodularity; tumor histological differentiation; tumor segmental location; maximum tumor diameter; degree of tumor pre-ablational enhancement at arterial phase CT, MRI or CT-angiography; and laboratory markers pre- and post-ablation (AFP, PIVKA II, TP, AST, ALT, ALP and TB). RESULTS: The incidence of overall recurrence, LTP and IDR was 65, 23 and 52.5%, respectively. The cumulative disease-free survival rates were 54.6, 74.8 and 78.3% at 1 year, 27.3, 71.9 and 46.3% at 2 years and 20, 71.9 and 29.4 at 3 years, respectively. Univariate and multivariate analysis showed that the significant risk factors for LTP were: tumor size > or = 2.3 cm, insufficient safety margin, multinodular tumor, tumors located at segments 8 and 5, and patient's age > 65 years (P < 0.05). No significant risk factor relationship for IDR could be detected. CONCLUSION: Our results would have clinical implications for advance warning and appropriate management of patients scheduled for RFA. Patients at risk of LTP should be closely monitored in the first year. Furthermore, regular long-term surveillance is essential for early detection and eradication of IDR.     

Selection bias: neighbourhood controls and controls selected from those presenting to a Health Unit in a case control study of efficacy of BCG revaccination

Background  

In most case control studies the hardest decision is the choice of the control group, as in the ideal control group the proportion exposed is the same as in the population that produced the cases.     

Laparoscopic hysterectomy in a case of male pseudohermaphroditism with persistent Mullerian duct derivatives

We describe laparoscopic diagnosis and treatment for a case of dysgenetic male pseudohermaphroditism with persistent Mullerian ducts. The patient, a 32 year old man, with a history of surgery for hypospadias and cryptorchidism during childhood, was referred because of anejaculation. He was of short stature, with male external genitalia composed of a small penis and hypoplastic testis (1 ml right, 6 ml left side). Plasma follicle stimulating hormone (FSH) was high (17 mUI/ml), testosterone low (1.9 ng/ml), and his karyotype was 46,XY. Pelvic ultrasound, nuclear magnetic resonance (NMR) and genitography disclosed a uterine-like structure with cavity communicating with the urethra. Laparoscopy and urethrocystoscopy confirmed the presence of a 4 cm uterus, which was removed endoscopically at the same time. A biopsy of the left gonad was also performed. The uterus contained endometrial tissue and was fibrotic. Histology of the left gonad showed spermatocytic arrest. We diagnosed dysgenetic male pseudohermaphroditism. Laparoscopy, in our opinion, is an optimal tool to diagnose and treat abnormal sexual conditions.      

Detection of ventricular thrombosis in acute myocardial infarction: Value of indium-111 platelet scintigraphy in relation to two-dimensional echocardiography and clinical course

In order to detect left ventricular (LV) thrombosis, ¹¹¹In-platelet scintigraphy and two-dimensional echocardiography were performed in 40 patients 15 days±6 days after acute myocardial infarction. A dual isotope subtraction method, using ¹¹¹In-platelet scintigraphy and ^99mTc-blood pool scintigraphy, was used to assess LV platelet deposition expressed as LV counts per pixed. Seven patients (group A) had a positive ¹¹¹In-platelet scintigram and 33 patients (group B) had a negative ¹¹¹In-platelet scintigram (LV counts per pixel: 0.56±0.23 and 0.28±0.19, respectively, P<0.05). Three group A patients but no group B patients had a positive echocardiogram. Arterial embolism was noted in four patients, of whom two showed both positive echocardiogram and platelet scintigram. LV counts per pixel were 0.57±0.13 and 0.31±0.21, respectively (P<0.02) in patients with and without arterial embolism. Thus, both ¹¹¹In-platelet scintigraphy and two-dimensional echocardiography can detect LV thrombosis. ¹¹¹In-platelet scintigraphy may help to define patients at risk for embolization and may be used in conjunction with echocardiography to study the effect of antithrombotic therapy.     

Diagnostic interplay of proton magnetic resonance spectroscopy and diffusion weighted images with apparent diffusion coefficient values in suspicious breast lesions

Aim of the work

To study the diagnostic performance of combined single voxel 1H-MRS and DW-MRI with ADC values as a non-contrast diagnostic tool, compared to the DCE-MRI, in suspicious breast lesions.