A comparative study of portal vein embolization versus radiation lobectomy with Yttrium-90 micropheres in preparation for liver resection for initially unresectable hepatocellular carcinoma

BackgroundPortal vein embolization before liver resection is considered the therapy of choice for patients with inadequate future liver remnants. The concept of radioembolization with Yttrium-90 to achieve the same goal has limited data.MethodsWe retrospectively compared patients who underwent portal vein embolization and Yttrium-90 lobectomy before resection of hepatocellular carcinoma in patients with chronic liver disease.ResultsSeventy-three patients underwent portal vein embolization and 22 patients underwent Yttrium-90. Forty-seven percent of patients before portal vein embolization required additional procedures for tumor control, and 27% of patients after Yttrium-90 required additional procedure to mainly induce further hypertrophy. Both therapies achieved the goal of future liver remnants >40%, but the degree of hypertrophy was significantly higher in Yttrium-90 patients (63% for Yttrium-90, 36% for portal vein embolization, P < .01). Tumor response was significantly better with Yttrium-90, achieving complete response in 50% of patients. Resectability rate was higher after portal vein embolization (85% for portal vein embolization, 64% for Yttrium-90, P = .03). Tumor progression was the most common reason precluding surgery. Complete tumor control was the reason not to pursue surgery in 18% of patients after Yttrium-90.ConclusionBoth preoperative portal vein embolization and Yttrium-90, increases liver resectability rates by inducing hypertrophy of future liver remnants in patients with hepatocellular carcinoma and chronic liver disease. Yttrium-90 lobectomy achieved better tumor control and provided more time to assess therapy response, optimizing the indication for surgery.     

Relationship of exercise or pacing induced ST segment depression and myocardial lactate metabolism in patients with hypertrophic cardiomyopathy

To elucidate a mechanism and clinical implications of chest pain and ST segment depression during exercise in patients with hypertrophic cardiomyopathy (HCM), we investigated myocardial lactate metabolism during atrial pacing in 18 patients with HCM and 7 control subjects with normal coronary arteriograms. At an average peak pacing rate of 146 beats/min, 11 patients with HCM showed the lactate extraction ratio decreasing to less than 5%, and 6 of them produced lactate, suggesting the development of myocardial ischemia. These 11 patients with abnormal lactate metabolism demonstrated ST segment depression (82%) and chest pain (73%) during pacing and also presented abnormal results (55%) on an exercise stress test. These abnormal findings were not observed in the other 7 patients who had ratios of 5% or more at peak pacing. These observations suggest that ST segment depression and chest pain are manifestations of myocardial ischemia even in patients with HCM who have normal coronary arteriograms, and that patients with pacing induced abnormal lactate metabolism are at an increased risk of developing myocardial ischemia during exercise.     

Clinical studies on 6059-S for acute peritonitis. Clinical effect and tissue concentration (author's transl)

A new antibiotic drug of oxacephem, with marked resistance to beta-lactamase, 6059-S for parenteral use was tested in 10 patients with acute peritonitis. In 4 cases with appendicitis, 6059-S in a dose of 500 mg was given intramuscularly before operation. In 2 cases with perforate MECKEL'S diverticulitis and intestinal obstruction for right femoral hernia, 6059-S in a dose of 1 g was given by intravenous injection or intravenous drip infusion before or during operation. And in a case with peritonitis after gastrectomy for gastric cancer, 6059-S in a dose of 2 g was given by intravenous drip infusion. Tissue specimens of different sites or body fluids were taken during the operation and from the removed organs. The materials or purulent ascites were subsequently taken at intervals. Determination of 6059-S concentration was performed according to plate agar well bioassay method with Escherichia coli 7437 strain. The peak of 6059-S concentration in purulent ascites of patient with peritonitis for perforate MECKEL'S diverticulitis was 30.5 mcg/ml at 50 min. after 1 g intravenous administration. Concentration of 6059-S in drained pus was 8.38 mcg/ml soon after intravenous drip infusion (2 g, for 2 hrs.). In 10 patients with peritonitis, 6 patients were given 6059-S in a dose of 500 mg by intramuscular administration twice a day, and the serious 4 patients were given in a dose of 1 to 2 g by intravenous drip infusion 1 to 2 times a day. Clinical response was excellent in 6 cases, good in 3 cases, fair in 1 case and poor was none. Any clinical adverse effect was not recognized. On the 6059-S concentration in patients with peritonitis, the concentration in purulent ascites, drained pus and infected tissues were observed higher than the MIC of 6059-S against Escherichia coli and Klebsiella pneumoniae. Therefore 6059-S will be a very useful drug when used for chemotherapy of acute or subacute peritonitis.     

Clinical evaluation of ciprofloxacin on biliary tract infection following oral administration

A newly synthesized antibiotic of quinoline carboxylic acid group, ciprofloxacin (BAY o 9867, CPFX) for oral administration, has a broad spectrum and high antibacterial activity against various bacterial species including aerobic and anaerobic bacteria such as P. aeruginosa and B. fragilis. The CPFX was administered orally in a dose of 200 mg 3 times daily for 5 to 8 days (6.3 +/- 1.0 days) to 12 patients with biliary tract infection consisting of 2 males and 10 females. Two of them were outpatients and 10 were hospitalized. Ages ranged from 27 to 72 years (mean 51.8 +/- 14.8 years), weights from 48.5 to 73.5 kg (mean 60.5 +/- 7.7 kg). All cases were complicated with cholecystolithiasis, with 4 acute and 8 subacute cases. Organisms isolated before the initiation of the CPFX treatment included 3 strains of E. coli from ERCP bile of 3 cases. Infected bacteria were eradicated in 3 cases but results were unknown in the other 9 cases. Clinical responses were excellent in 2 cases, good in 8 cases, fair in 1 case and poor in 1 case. No adverse effect was recognized. Therefore, CPFX appears to be a very useful drug when used for chemotherapy of biliary tract infectious diseases.     

Cefoperazone concentration in infected tissues and clinical effect for patients with peritonitis (author's transl)

A new antibiotic drug of cephalosporin, with marked resistance to beta-lactamase, cefoperazone (CPZ) for parenteral use was used in 6 patients with acute peritonitis and perforated appendicitis. CPZ in a dose of 1 g was given intravenously during the operation. Tissue specimens of different sites were taken from removed organs. The materials of purulent ascites and appendix were subsequently taken at intervals. Determination of CPZ concentration was performed according to paper disk bioassay with Micrococcus luteus ATCC 9341 strain. CPZ concentration in purulent ascites increased quickly after injection, and reached high level peak at 30 minutes to 1 hour, then they were very slowly declined. CPZ concentration in the infected appendix, was directly proportional to the degree of pathological changes of inflammation. CPZ concentration in serious gangrenous appendix reached to 50.3 mcg/g at 20 minutes after intravenous injection, and increased to 54.3 mcg/g at 30 minutes, 60.3 mcg/g at 38 minutes, respectively. On the CPZ concentration in patients with appendicitis, the concentration in purulent ascites and appendix were observed higher than the MIC of CPZ for Escherichia coli and Klebsiella pneumoniae bacilli. CPZ therefore will be a very useful drug when used for chemotherapy of acute peritonitis.     

Clinical studies on 6059-S for biliary tract diseases. Clinical effect and tissue concentration (author's transl)

A new antibiotic drug of oxacephem, with marked resistance to beta-lactamase, 6059-S for parenteral use was used in 12 patients with acute cholecystitis and cholangitis. 6059-S was given by intramuscular, intravenous or drip intravenous administration at a daily dose of 500 mg to 2 g. Clinical response was excellent in 1 case, good in 10 cases, fair in 1 case and poor in none. Any clinical adverse effect was not recognized. 6059-S is a dose of 500 mg was given by intramuscular administration before the operation to 9 patients. Tissue specimens of different sites were taken from removed organs. The materials of A-bile and B-bile were subsequently taken at intervals. 6059-S concentrations in the A-bile increased after injection and reached to peak from 2 hours to 2.5 hours, then declined very slowly. 6059-S concentration in the B-bile reached to high level of the concentration comparative quickly after intramuscular administration, and it was thought to be excreted through the wall of the gallbladder. 6059-S concentration in the gallbladder wall was directly proportional to the degree of pathological changes of inflammation. On the 6059-S concentration in patients with acute cholecystitis and cholangitis, the concentration in A-bile, B-bile and gallbladder wall were observed higher than the MIC of 6059-S for Escherichia coli and Klebsiella pneumoniae. Therefore 6059-S will be a very useful drug when used for chemotherapy of the infectious diseases of the biliary tract.