Role of radiofrequency ablation in the treatment of colorectal liver metastases

Surgical resection is the standard of care for colorectal metastases isolated to the liver. However, only 10-25% are eligible for resection because of extent and location of the disease in the liver or concurrent medical conditions. Severe series have shown that radiofrequency ablation [RFA] can result in tumor eradication in properly selected candidates. The purpose of this study was to determine the efficacy of RFA for treatment of such lesions. Thirty patients with documented colorectal liver metastases who met the following criteria were considered for RFA: metastases confined to the liver; judged irresectable due to technical considerations or co-morbidity, number of metastatic deposits no greater than 5; and size less than 10 cm. Median follow-up was 26 [range 9-63] months. Overall 1-and 2-year survival rates were 76 and 61% respectively. Median survival was 32 months. Disease-free survival at 1 year was 35% at 2 years 7%. Six patients developed recurrence at the site of RFA; given that the total number of RFA-treated lesions was 69 the local recurrence rate was 9%. RFA can achieve effective local treatment for patients with colorectal liver metastases who were considered unsuitable for surgical treatment

Resistance index [R.I] as a predicitive in the treatment of erectile dysfunction [E.D]

The aim of this work is to utilize the Pharmaco-Penile Duplex Ultrasonography [P.P.D.U] as a treatment-directed instead of an etiology-directed approach in cases of Erectile Dysfunction [E.D]. The intended treatment is Intra-Corporeal Injection [I.C.I] therapy using PEi; and the approach aims at 1- nullifying the most feared complication of prolonged erection; and 2- assessing the predictive value of the Resistance Index'[R.I] regarding an adequate erectile response with subsequent dose escalation. 68 cases of [E.D], all have started with a low dose [4mg of PEi] during the [P.P.D.U] and two parameters were traced in all cases 1- the patient's self report of erectile response. And 2- Resistance Index [R.I]: a] 8cases[41.8 percent] have achieved an adequate erectile response with this low dose [responders], all have adhered to self-injection therapy and within 4-7 months of follow-up, 75 percent of them experienced recovery of spontaneous erection. b] 40 cases [58.8 percent] failed to achieve an adequate erectile response with the low dose [non-responders], all have adhered to self-injection with dose escalation; 91.6 percent of the cases with R.I > 0.8 [during the initial P.P.D.U test] have achieved an adequate erectile response with dose escalation, while only 12.5 percent of the cases with R.I<0.8 have achieved an adequate erectile response with dose escalation [the maximum dose per injection did not exceed 20mg]. No cases of prolonged erection have been reported. The treatment-directed approach helps to: 4 Obviate the risk of prolonged erection. 4 Greatly simplify and nullify the limitation of operator dependency of the [P.P.D.U test] because; It doesn't require the measurement of pre- and post-injection diameters of the small cavernously arteries with its inherent inaccuracy. It relies on the measurement of [R.I], therefore; variations and/or possible errors in measurement of [P.S.V] and [E.D.V] are filtered out in the ratio R.I-P.S.V - E.D.V / P.S.V. R.I > 0.8 strongly predicts an adequate erectile response with subsequent dose escalation

Ureteral meatotomy by endoscopic knife electrode in the management of large stones impacted in the intramural ureter

Transurethral meatotomy with knife electrode or Collings ' knife was done in 18 patients who either had a stone impacted in the intramural ureter and not suitable for ureteroscopic manipulations due to its large size [13] or when the dormia basket became impacted during attempts to extract the stone [5]. The stone was recurrent following open surgery in 10 of the 18 patients. This method resulted in successful endoscopic removal of the stones in all patients. Vesicoureteric reflux was detected in 10 patients at 1 month and in only 3 patients at 3 months. Follow up of these patients revealed no symptomatic upper tract infection or renal damage caused by this reflux. It was concluded that endoscopic ureteral meatotomy is recommended for the removal of impacted intramural ureteric stones not suitable for ureteroscopic manipulations or stones impacted in the dormia basket at the ureteric orifice, especially in recurrent cases

Fas antigen in serum and liver tissue of patients with chronic hepatitis C

Fas [APO-1/CD95], a member of the tumor necrosis factor receptor Family, can mediate apoptosis when engaged by its ligand or by anti-Fas antibody. Fas is upregulated on the surface of hepatocytes in patients with a variety of liver pathologies, including hepatitis, alcoholic cirrhosis, and acute liver failure. Moreover, expression of Fas ligand is substantially upregulated, in areas of lymphocytic infiltration, in liver diseases, suggesting Fas/FasL interactions may mediate liver damage in humans. The purpose of this study was to evaluate the relationship of serum soluble Fas [sFas] levels and hepatic Fas antigen expression with the degree of hepatic inflammatory activity in patients with chronic hepatitis C infection. The effect of concomitant schistosomiasis, as an endemic liver disease in Egypt, on serum and liver Fas expression was also studied. Serum sFas levels were measured by enzyme-linked immunosorbant assay in 69 chronic hepatitis C patients; 16 of them were under 18 years and compared with those in normal volunteers, and patients with chronic HBV infection. The results of serum tests were compared with ALT levels. HCV-RNA titer, histological inflammatory activity, and Fas expression in liver biopsies. The effect of combined HCV infection and schistosomal infestation on serum sFas and tissue Fas expression was also studied. Serum sFas and tissue Fas expression were then evaluated with each components of histological inflammatory activity scoring system [modified Knodell's HAI]. Serum sFas levels in chronic hepatitis C patients were significantly higher than those in normal volunteers [p<0.001]. They showed no difference from those in patients with chronic HBV infection [p>0.05]. Hepatic schistosomiasis didn't affect serum sFas levels or tissue expression of Fas antigen in chronic hepatitis C patients. Histologically, serum sFas levels showed strong correlation with tissue Fas expression [p<0.001] and with the degree of hepatic inflammatory activity [p<0.01]. Likewise, tissue Fas expression correlated with the degree of histological inflammatory activity [p<0.05]. Moreover, positive correlation was found between serum sFas and tissue Fas expression and the degree of interface hepatitis [piecemeal necrosis] in chronic hepatitis C patients with mild [p<0.01] and moderate and severe activity [p<0.05]. However, no correlation was observed between serum sFas and serum ALT levels. Also, no correlation was observed between HCV-RNA titer and sFas levels or tissue Fas expression. Our findings suggest that serum sFas levels may reflect the expression of Fas antigen on hepatocytes and the severity of liver inflammation in chronic hepatitis C and may be used as a serological indicator of histological inflammatory activity. They also support the concept that immune-mediated apoptosis may play a crucial role in the pathogenesis of chronic hepatitis C. Hepatic schistosomiasis seems to have no impact on serum sFas levels or hepatic tissue Fas expression