Clinical outcomes of patients with a single hepatocellular carcinoma less than 5 cm treated with transarterial chemoembolization

BACKGROUND/AIMS@#Transarterial chemoembolization (TACE) is performed for single hepatocellular carcinoma (HCC) that are not eligible for surgery or ablation therapy. We investigated the clinical outcomes of patients with a single HCC ≤ 5 cm treated with TACE.@*METHODS@#This study analyzed 175 consecutive patients who underwent TACE as an initial treatment for single HCC ≤ 5 cm. Predictive factors for complete response (CR), recurrence after CR, and overall survival (OS) were evaluated.@*RESULTS@#Total 119 patients (68%) achieved CR after TACE. Tumor size 65 years and absence of liver cirrhosis were predictive factors for non-recurrence after CR (p < 0.05). The OS for all patients was 80.7 ± 5.6 months, and the 1-, 3-, and 5-year OS rates were 88.1%, 64.8%, and 49.9%, respectively. In multivariate analysis for OS, CR (hazard ratio [HR], 0.467; 95% confidence interval [CI], 0.292 to 0.747) and Child class A (HR, 0.390; 95% CI, 0.243 to 0.626) were significant factors. The OS for the CR and Child class A group were 92 and 93.6 months, respectively, and that of the non-CR and Child B, C group were 53.3 and 50.7 months, respectively (p < 0.001).@*CONCLUSIONS@#TACE can be a valid treatment in patients with a single HCC ≤ 5 cm not suitable for curative treatment, especially in patients with Child class A and CR after TACE.

A Case of Hepatocellular Carcinoma with Pulmonary Metastasis Who Showed Complete Response by Cytotoxic Chemotherapy after Sorafenib Failure

Hepatocellular carcinoma (HCC) is the 2nd most common cause of cancer related death in Korea and well-known malignancy with poor prognosis. Sorafenib is the first-line molecular targeted agent in patients with extra-hepatic spread of HCC. However, complete response is extremely rare in patients treated with sorafenib and the disease control rate is only 43%. We report a 53-year-old man with advanced HCC with pulmonary metastasis who showed complete response by cytotoxic chemotherapy with doxorubicin and cisplatin with relatively tolerable adverse effects after failure of treatment with sorafenib.

Cyanoacrylate injection versus band ligation for bleeding from cardiac varices along the lesser curvature of the stomach

BACKGROUND/AIMS: Practice guidelines recommend endoscopic band ligation (EBL) and endoscopic variceal obturation (EVO) for bleeding from esophageal varices and fundal varices, respectively. However, the optimal treatment for bleeding from cardiac varices along the lesser curvature of the stomach (GOV1) remains undefined. This retrospective study compared the efficacy between EBL and EVO for bleeding from GOV1. METHODS: Patients treated by EBL or EVO via cyanoacrylate injection for bleeding from GOV1 were enrolled. Patients diagnosed with hepatocellular carcinoma or treated with endoscopic injection sclerotherapy were excluded. RESULTS: The study included 91 patients treated for bleeding from GOV1. The mean age was 56.3±10.9 years (mean±SD), and 78 of them (85.7%) were men. Overall, 51 and 40 patients were treated with EBL and EVO, respectively. A trend for a higher hemostasis rate was noted in the EVO group (100%) than in the EBL group (82.6%, P=0.078). Varices rebled in 15 patients during follow-up. The rebleeding rate was significantly higher in the EBL group than in the EVO group (P=0.004). During follow-up, 13 patients died (11 in the EBL group and 2 in the EVO group); the survival rate was marginally significant between two groups (P=0.050). The rebleeding-free survival rate was significantly higher in the EVO group than in the EBL group (P=0.001). CONCLUSIONS: Compared to EBL, EVO offered significantly lower rebleeding rates, significantly higher rebleeding-free survival rates, and a trend for higher hemostasis and survival rates. EVO appears to be the better therapeutic option for bleeding from GOV1.

The Number of Endothelial Progenitor Cells is Decreased in Patients With Non-Dipper Hypertension

BACKGROUND AND OBJECTIVES: Circulating endothelial progenitor cells (EPCs) play a key role in the maintenance of endothelial homeostasis and promote vascular repair. A reduced number of EPCs and the functional activity have been associated with several cardiovascular risk factors. However, the relationship between the number of EPCs and circadian rhythm of the blood pressure (BP) remains unclear. The purpose of the present study was to evaluate the relationship between the circadian rhythm of the BP and EPCs in patients with essential hypertension. SUBJECTS AND METHODS: A total of 45 patients with essential hypertension who were newly identified by outpatient BP measurements, underwent 24-hour ambulatory BP monitoring. Among the 45 patients with essential hypertension, 20 were classified as dippers (12 men and 8 women; mean age 48+/-14 years) and 25 as non-dippers (14 men and 11 women; mean age 52+/-18 years). The EPC count was isolated from the peripheral bloodstream and quantified by flow cytometry. RESULTS: The baseline clinical characteristics were similar between the dipper and non-dipper hypertensive patients. The circulating EPCs were statistically reduced in the non-dipper patients as compared to the dippers (104+/-60 vs. 66+/-47 EPCs per 106 mononuclear cells, p=0.027). The circulating EPC level correlated positively with the circadian changes in the systolic and diastolic BP (r=0.435, p=0.003, and r=0.310, p=0.038, respectively). CONCLUSION: The present study demonstrated that the EPC count was reduced in the peripheral bloodstream in non-dipper hypertensive patients.

Development of Solenoid RF Coil for Animal Imaging in 3T High Magnetic Field MRI

PURPOSE: The purpose of the present study was to develop and optimize solenoid coil for animal- model in 3 T MRI system and investigate and compare with the birdcage coil concerning the image quality with the various parameters such as SNR and Q-factor. MATERIALS AND METHODS: Solenoid coil for animal-model was made on the acryl structure (diameter 4 cm, length 10 cm) 3 times-winding cooper tape of width 2 cm , thickness 0.05 cm and length 10 cm with 2 cm interval between winded tapes. Capacitors from 2 pF to 100 pF were used, and the solenoid coil was designed for receiver only coil. RESULTS: SNR of the developed solenoid was 985 in CuSO4 0.7 g/L and 995 in rat experiment. Q-factor was 84-89 in unloaded condition and 203-206 in loaded condition. CONCLUSION: The resolution of the image obtained from solenoid was relatively higher than that of the conventional birdcage coil. In addition, the homogeneity of RF field by coil simulation was significantly excellent. The present study demonstrated that the solenoid coil could be useful to obtain small animal images with better contrast, resolution, visibility than images from birdcage.

Effects of Thoracic Spinal Exercise Program in VDT Workers: Pain Relief and Increased Flexibility / 대한산업의학회지

OBJECTIVES: The purpose of this study of the Thoracic Spinal Exercise Program was to evaluate its effects on VDT workers. These effects were found to include a decrease thoracic kyphosis, increase thoracic spine mobility and decrease in the VAS (visual analog scale). These measures provide a means of assessing the muscle endurance and muscle strength of the subjects. METHODS: This study was conducted during the period from July 1 to August 31, 2003, and involved 58 VDT workers belonging to a company located in Seoul who were working seated in front of a computer for most of the day. After applying the thoracic exercise program, we examined the changes in the of thoracic kyphosis angle, spinal length (C7-S3), TFED (thoracic flexibility in the extension direction), MEBH (maximal elevation with both hands in the overhead direction) and CE (chest expansion). RESULTS: Obtained f om this study are as follows. 1. A significant reduction in the VAS was observed in the exercise group (pre-exercise 5.90 +/- 0.88 points, post-exercise 4.23+/- 0.82 points), as compared with the control group (pre-exercise 6.00+/-0.90 points, post-exercise 5.93+/-0.81 points). 2. A significant reduction in thoracic kyphosis (pre-exercise 36.97+/-7.49, post-exercise 31.83 +/-5.90) and a significant increase in thoracic flexibility in the extension direction (pre-exercise 7 . 4 7+/-2.30, post-exercise 11.77+/-3.65) were observed in the exercise group. The thoracic kyphosis angle showed a significant reduction in the exercise group, as compared to the control group. The thoracic flexibility in the extension direction showed a significant increase in the exercise group, as compared to the control group. 3. There was a significant increase in the spinal length in the exercise group (pre-exercise 494 +/-27.66 mm, post-exercise 518.60+/-27.95 mm). CONCLUSIONS: The Thoracic Spinal Exercise Program results in an increase in thoracic spine mobility and a decrease in pain. In practical terms, the effects of the exercise program are good health and posture.

A Case of Dual-Chamber Pacing Treatment in a Patient with Hypertrophic Cardiomyopathy with Left Ventricular Outflow Tract Obstruction

The management of symptomatic patients with hypertrophic Cardiomyopathy has generally included the use of beta-blockers and calcium channel blockers. Surgical treatment has been attempted for operable patients who have become refractory to medical therapy. However, associated complications, high mortality rate, and high recurrence of symptoms have shifted the treatment focus toward alternative therapy modalities. Recently, a DDD type pacemaker has been introduced as an alternative treatment option. We report a case of a patient with hypertrophic cardiomyopathy treated with dual-chamber pacing.

A Study on the Injury Mechanism and Types of the Ocular Trauma

The study was the clinical analysis of 509 patients with pure ocular injuries who visited to Chonnam University Hospital Emergency center from July 1, 1996 to June 30, 1997 retrospectively. Clinical data survey including sex and age distribution, causes of trauma, injury site, ocular disease, and surgical intervention was done. Most of ocular injury patients were male. 3rd and 4th decade who were socially active were nearly 50%. Direct and indirect injury from foreign body was the most common cause of ocular injuries followed by fist blow, traffic accident, falling down, and sport injury. Cornea was the most common ocular injury site (209 patients, 41.1%). The incidence of the traumatic ocular disease showed corneal erosion (117 patients, 22.9%) and then eyeball perforation, traumatic hyphema etc. by frequency of order. Eyeball perforation was the most common ocular injury which needed a emergency surgical intervention. As a results, emergency physicians have to pay attention to the cornea in case of any type of ocular injuries and eyeball perforation which caused by direct and indirect injury from foreign body.