Quantitative Measurement of Hepatic Fibrosis with Gadoxetic Acid-Enhanced Magnetic Resonance Imaging in Patients with Chronic Hepatitis B Infection: A Comparative Study on Aspartate Aminotransferase to Platelet Ratio Index and Fibrosis-4 Index

OBJECTIVE: To quantitatively measure hepatic fibrosis on gadoxetic acid-enhanced magnetic resonance (MR) in chronic hepatitis B (CHB) patients and identify the correlations with aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 index (FIB-4) values. MATERIALS AND METHODS: This study on gadoxetic acid-enhanced 3T MR imaging included 81 patients with CHB infection. To quantitatively measure hepatic fibrosis, MR images were analyzed with an aim to identify inhomogeneous signal intensities calculated from a coefficient of variation (CV) map in the liver parenchyma. We also carried out a comparative analysis between APRI and FIB-4 based on metaregression results. The diagnostic performance of the CV map was evaluated using a receiver-operating characteristic (ROC) curve. RESULTS: In the MR images, the mean CV values in control, groups I, II, and III based on APRI were 4.08 ± 0.92, 4.24 ± 0.80, 5.64 ± 1.11, and 5.73 ± 1.28, respectively (p < 0.001). In CHB patients grouped by FIB-4, the mean CV values of groups A, B, and C were 4.22 ± 0.95, 5.40 ± 1.19, and 5.71 ± 1.17, respectively (p < 0.001). The mean CV values correlated well with APRI (r = 0.392, p < 0.001) and FIB-4 (r = 0.294, p < 0.001). In significant fibrosis group, ROC curve analysis yielded an area under the curve of 0.875 using APRI and 0.831 using FIB-4 in HB, respectively. CONCLUSION: Gadoxetic acid-enhanced MR imaging for calculating a CV map showed moderate correlation with APRI and FIB-4 values and could be employed to quantitatively measure hepatic fibrosis in patients with CHB.

Combined Radiofrequency Ablation and Double Anti-Angiogenic Protein Therapy to Increase Coagulation Efficacy: An Experimental Study in a Murine Renal Carcinoma Model

OBJECTIVE: To evaluate whether suppression of tumor microvasculature by double anti-angiogenic protein (DAAP) treatment could increase the extent of radiofrequency ablation (RFA)-induced coagulation in a murine renal cell carcinoma model. MATERIALS AND METHODS: Renal cell carcinoma cell lines were implanted subcutaneously into 10 nude mice. Four mice received adenoviral DAAP treatment and 6 mice received sterile 0.9% saline solution as DAAP-untreated group. The effect of DAAP was evaluated according to the vascularity by contrast-enhanced ultrasound (CEUS) using microbubbles. Four DAAP-treated mice and 4 DAAP-untreated mice were then treated with RFA, resulting in 3 groups: no-therapy (n = 2), RFA only (n = 4), and RFA combined with DAAP treatment (n = 4). Immediately after RFA, the size of coagulation necrosis and mitochondrial enzyme activity were compared between the groups using analysis of variance (ANOVA) and post hoc test. RESULTS: The contrast enhancement ratio for tumor vascularization on CEUS was significantly lower in the DAAP treated group than in DAAP-untreated group (30.2 +/- 9.9% vs. 77.4 +/- 17.3%; p = 0.021). After RFA, the mean coagulation diameter was 0 mm for no-therapy group, 6.7 +/- 0.7 mm for the RFA only group and 8.5 +/- 0.4 mm for the RFA with DAAP group (ANOVA, p < 0.001). The area of viable mitochondria within the tumor was 27.9 +/- 3.9% in no-therapy group, 10.3 +/- 4.5% in the RFA only group, and 2.1 +/- 0.7% in the RFA with DAAP group (ANOVA, p < 0.001). CONCLUSION: Our results suggest the potential value of combining RFA with anti-angiogenic therapy.

Pulsed Dye Laser Fragmentation of Urinary Calculi : Clinical Experience / 대한비뇨기과학회지

The pulsed dye laser, emitting at wavelengths of 504nm. for 1 micro sec. at a frequency of 10 Hz. transmitted via a 200 micron in-diameter silicon-coated fiber, was send for fragmentation of urinary stones. The mechanism of stone fragmentation by laser is 'shock wave' formation by laser light ( photoacoustic effect). From Nov. 1988 to Apr. 1990, we performed 89 procedures in 86 patients for the removal of stones (80 procedures in 77 ureteral stones, 3 procedures in bladder stones and 6 procedures in urethral stones). Of the calculi 80 were fragmented to spontaneously passable or easily extractable fragments. There was no significant complications attributable to laser lithotripsy. And there was no significant differences in the fragmentation of stones according to the component. So, we think that laser lithotripsy is a safe and effective modality in management of the urinary stones including renal and upper ureter stones with some exceptions if deflecting ureterorenoscope is available.

Adult Wilms' Tumor with Erythrocytosis / 대한비뇨기과학회지

Adult Wilms' Tumor is rare. Furthermore, erythrocytosis caused by Wilms' tumor is extremely rare. There are many difficulties in the preoperative diagnosis of the adult Wilms' tumor, and more aggressive and multimodal therapy is recommended in comparison with that of child. We report a case of adult Wilms' tumor associated with erythrocytosis.

Bilateral Renal Angiomyolipomas with Tuberous Sclerosis / 대한비뇨기과학회지

Tuberous sclerosis is a complex neurocutaneous disease in which facial angiofibroma, mental retardation, seizures, renal tumor and phakoma of the retina are particularly frequent, in which renal tumors are usually angiomyolipomas and they are usually small, bilateral and not combined with symptom. We report a case of bilateral renal angiomyolipomas in association with facial angiofibroma, which resulted in spontaneous rupture and massive retroperitoneal hemorrhage.