Long-Term Outcomes Comparing Surgery to Embolization-Ablation for Treatment of Solitary HCC <7 cm

Background

Resection has been the standard of care for patients with solitary hepatocellular carcinoma (HCC). Transarterial embolization and percutaneous ablation are alternative therapies often reserved for suboptimal surgical candidates. Here we compare long-term outcomes of patients with solitary HCC treated with resection versus combined embo-ablation.

Methods

We previously reported a retrospective comparison of resection and embo-ablation in 73 patients with solitary HCC <7 cm after a median follow-up of 23 months. This study represents long-term updated follow-up over a median of 134 months.

Results

There was no difference in survival among Okuda I patients who underwent resection versus embo-ablation (66 vs 58 months, p = .39). There was no difference between the groups in the rate of distant intrahepatic (p = .35) or metastatic progression (p = .48). Surgical patients experienced more complications (p = .004), longer hospitalizations (p < .001), and were more likely to require hospital readmission within 30 days of discharge (p = .03).

Conclusion

Over a median follow up of more than 10 years, we found no significant difference in overall survival of Okuda 1 patients with solitary HCC <7 cm who underwent surgical resection versus embo-ablation. Our data suggest that there may be a greater role for primary embo-ablation in the treatment of potentially resectable solitary HCC.     

Beiträge zur Pharmakodynamie der Gallensäuren Einfluß der Funktionsgruppen

Ohne ZusammenfassungMit 13 Textabbildungen.     

Introduction of an Acute Stroke Team: An effective approach to hasten assessment and management of stroke in the emergency department

Recombinant tissue plasminogen activator (rtPA) reduces the combined endpoint of death and disability if given within three hours of onset of ischaemic stroke. However few patients receive rtPA, with delays in in-hospital evaluation and treatment being key barriers to therapy. The Austin Hospital Acute Stroke Team (AST) was introduced with the aim of improving the speed of assessment and management of acute stroke patients presenting to the emergency department. We sought to assess the effect of the AST on number of eligible patients receiving rtPA and assessment times within our already active stroke service. Data were obtained prospectively for all AST calls during the period from 17 January 2005–31 December 2005. Information recorded included: demographics, time of call, clinical features, diagnosis and any treatment with rtPA. Information prospectively acquired from patients receiving stroke thrombolysis the previous year was also analysed. There were 663 stroke unit admissions and 224 AST calls during the study period. 53% of calls occurred within working hours and 68% had a final diagnosis of stroke. Twenty-seven patients received treatment with rtPA (12% of calls), whereas only ten patients received rtPA in 2004. The most common reason for not treating was mild or rapidly resolving deficit. Onset–needle time and door–needle times significantly improved following introduction of the AST. Thus, we conclude that the introduction of the AST emergency call system has increased the number of eligible patients receiving rtPA. Improved onset–needle and door–needle times are achievable by this team approach.     

A New Technique to Measure and Track Blood Resistivity in Intracardiac Impedance Volumetry

Objective. To propose and verify a technique by which blood resistivitycan be measured continuously and instantaneously with a conductance catheterused to measure ventricular volume by intracardiac impedance volumetry.Methods. Intracardiac impedance volumetry involves the measurement ofventricular blood volume using a multi-electrode conductance catheter.Ventricular volume measurement with the conductance catheter requires thevalue of blood resistivity. Previously, blood resistivity has beendetermined by drawing a sample of blood and measuring resistivity in aseparate measuring cell. A new technique is proposed that allows theresistivity of blood to be measured with the conductance catheter itself.Two adjacent electrodes of the catheter are chosen to establish a localizedelectric field. With a localized field, the resistance measured between theadjacent electrodes bears a constant ratio (resistivity ratio) to theresistivity of blood. Finite element cylindrical models with excitingelectrodes were created to determine the resistivity ratio. Bloodresistivity was determined by dividing the resistance found due to thelocalized electric field by the resistivity ratio. The proposed scheme wasverified in cylindrical physical models and in in vivo canine hearts.Results. Finite element simulations showed the resistivity ratio to be 1.30and 1.43 for two custom-made catheters (Ohmeda Inc. and Biosensors Inc.,respectively). The resistivity ratio remained constant as long as thecylindrical volume of blood around the adjacent electrodes had a radiuslarger than the electrode spacing. In addition, this ratio was found to be afunction of electrode width. The new technique allowed us to measure salineresistivity with an error, –0.99 ± 0.25% in a physicalmodel, and blood resistivity with an error, –0.625 ±2.75% in an in vivo canine model. Conclusion. The new in vivotechnique can be used to measure and track blood resistivity instantaneouslyand continuously without drawing blood samples.