Predictors of repeat transarterial chemoembolization in the treatment of hepatocellular carcinoma

ObjectivesRepeat transarterial chemoembolization (TACE) is a common intervention performed for hepatocellular carcinoma (HCC). The aim of this study was to identify predictors of the need for repeat TACE.MethodsBetween 2008 and 2012, data on patient and tumour variables were collected for 262 patients treated with a first TACE procedure for HCC. The decision to perform repeat TACE procedures was made at the completion of the first TACE or after follow-up imaging demonstrated the subtotal treatment of HCC tumours.ResultsRepeat TACE was performed in 67 of 262 (25.6%) patients. Necrosis of HCC, measured after the first TACE, was lower in patients who subsequently received repeat TACE (P = 0.042). On multivariable analysis, total tumour diameter of >5 cm [odds ratio (OR) 2.76, 95% confidence interval (CI) 1.45–5.25; P = 0.002] and increasing age (OR 1.04/year, 95% CI 1.00–1.07; P = 0.030) were predictive of the need for repeat TACE. Measures of liver function and TACE approach (selective versus non-selective) were not predictive of repeat TACE. Median survival did not differ significantly between patients who did (median survival: 21.1 months) and did not (median survival: 26.1 months) receive a repeat TACE procedure (P = 0.574).ConclusionsThe requirement for repeat TACE is associated with older age, increased HCC tumour burden and subtotal TACE-induced HCC necrosis. Importantly, repeat TACE was not associated with reduced survival.     

Sphenoid wing meningiomas: peritumoral brain edema as a prognostic factor in surgical outcome

Neurosurgical Review - Sphenoidal meningiomas constitute 18% of intracranial masses, and still present a difficult surgical challenge. PTBE has been associated with several complications and future...     

Diaphragme sous-aortique par muscularisation de grande valve mitrale : à propos de deux cas

Subaortic stenosis was considered for a long time as a congenital anomaly, but it is considered now as an acquired form of obstacle to the left ventricle ejection. It constitutes 8 to 20% of the causes of obstacle left ventricle. Ventricular septal defect and aortic coarctation are the most frequent anomalies associated with the subaortic stenosis. The anomalies of mitral valve and especially muscularization of the anterior mitral valve leaflet remain very rare and underestimated. The diagnosis is made by the echocardiography and must be systematically looked for because its misunderstanding in preoperative can be at the origin of recurrences. We report in this work two cases of muscularization of the anterior mitral valve leaflet associated to subaortic stenosis. Through these cases and through a review of the literature, we are going to put the point on this rare anomaly.     

Superficial temporal artery as an external landmark for deeper-lying brain structures

Additional localizing superficial landmarks for intracranial structures can be of use to the neurosurgeon. This study was performed to evaluate the usefulness of the superficial temporal artery (STA) as an external landmark for deeper brain structures. Thirteen adult cadavers (26 sides) underwent latex injection of their STA bilaterally. Dissections were next carried out to identify this vessel. Once the STA and its frontal and parietal branches were skeletonized, craniectomies were performed and the underlying dura mater excised. Measurements were made between the frontal and parietal branches of the STA and deeper brain structures. The STA was found to branch on average 3 cm superior to the tragus. The bifurcation of the STA was found to commonly bifurcate at the level of the floor of the middle cranial fossa or superior temporal gyrus. The Sylvian fissure was found at a mean of 2 cm superior to the STA bifurcation. The angle between the frontal branch of the STA and the zygomatic arch had a mean of 37 degrees. The angle between the frontal and parietal branches of the STA had a mean of 87 degrees. At the level of the glabella, the frontal branch of the STA was on average 3 cm posterior to the frontal pole. The temporal tip was located a mean of 3.2 cm anterior to the frontal branch of the STA. The plane of the foramen of Monro was found to lie at a mean distance of 2.3 cm posterior to the frontal branch of the STA. The parietal branch of the STA was noted to travel more or less parallel with the central sulcus in all specimens and to travel an average of 2 cm posterior to this sulcus. At the level of the lateral attachment of the tentorium cerebelli, the parietal branch of the STA was found to travel a mean of 4.8 cm anterior to the entrance of the vein of Labbé into the transverse sinus. The parietal branch of the STA was also found to travel a mean of 4.2 cm anterior to the angular gyrus and 3.9 cm anterior to the supramarginal gyrus. Palpation or Doppler identification of the STA and its branches with subsequent mapping on the lateral cranium may prove useful as an additional superficial landmark for the neurosurgeon.     

Evaluation of three test procedures for identification of Staphylococcus aureus from clinical sources.

A total of 520 clinical and environmental isolates of the family Micrococcaceae that fermented glucose anaerobically were tested for their ability to produce coagulase, thermostable nuclease, and deoxyribonuclease. Of these, 450 isolates coagulated rabbit plasma, produced thermostable nuclease, and were identified as Staphylococcus aureus, 447 of which produced a 3+ to 4+ clot. The remaining three isolates produced a 2+ clot, deoxyribonuclease, and thermostable nuclease. It was found that three of the S. aureus isolates failed to produce deoxyribonuclease. A total of 70 isolates which did not coagulate rabbit plasma and which were thermostable nuclease negative were identified as S. epidermidis. Three of them produced deoxyribonuclease. It is suggested that the thermostable nuclease test be performed on all isolates producing a 2+ (or 1+) clot in the coagulase test before identifying them as S. aureus.     

Spinal injuries in contact sports

Contact and collision sports such as American football expose the athlete to a wide array of potential injuries. Knee injuries garner much of the attention, but spinal injuries are potentially catastrophic and all levels of medical coverage of football must be knowledgeable and prepared to attend to an athlete with a neck injury. Of the other possible spinal conditions, some resolve on their own, others might require conservative therapy, and still others might require surgical intervention. The spectrum of potential injury is wide, yet the medical team must practice and prepare to treat the possible catastrophic neck injury.     

Combination of conventional multiplex PCR and quantitative real-time PCR detects large rearrangements in the dystrophin gene in 59% of Syrian DMD/BMD patients

ObjectivesAdaptation of a low-cost protocol to diagnose large rearrangements of the dystrophin gene in DMD/BMD Syrian patients and to establish the distribution of these mutations in the 2 hotspots.Design and methodsgDNA from 51 unrelated Syrian DMD/BMD male patients was isolated and analyzed by multiplex PCR of 25 hotspot exons in order to detect deletions. Patients who did not show any deletions were further analyzed by quantitative real-time PCR and the ΔΔCt method in order to detect duplications in exons 4, 17, 47 and 52.ResultsWe found a deletion in 25 (49%) out of 51 patients studied. Quantitative real-time PCR revealed a duplication in 5 (9.8%) out of 51 patients. Combination of traditional multiplex PCR of hotspot exons with real-time PCR quantification of only exons 4, 17, 47 and 52 positively diagnosed 59% of Syrian DMD/BMD patients.ConclusionOur method may be useful as a cost-effective first-line test for the diagnosis of DMD/BMD patients before using exhaustive and expensive methods.     

Simple changes save lives: a multi-centre clinical audit of the management of trauma patients on arrival at the emergency room in the Gaza Strip,occupied Palestinian territory

Background

The WHO trauma checklist reduces morbidity and mortality. This study evaluates adherence of three hospitals in Gaza to the basic WHO checklist standards in order to promote set standards of care.