Atypical Hepatocellular Carcinoma Mimicking Abscess on Multiphasic CT Images and Comparison between Imaging Finding and Gross Specimen

Although multiphasic CT is an efficient technique for determination of hepatocellular carcinoma (HCC), occasionally, diagnosis of HCC using multiphasic CT can be difficult. Herein we present a case of HCC that was indicative of a typical abscess on CT imaging and compared the image findings with the gross specimen. The patient's body temperature and laboratory results indicated that inflammation were in the normal range. This case emphasizes that not only imaging findings but also clinical presentation should be considered to achieve a correct diagnosis in clinical practice.

The Impact of Concomitant Splenectomy on the Portal Pressure in Patients with Liver Cirrhosis

PURPOSE: Concomitant splenectomy in cirrhotic patients is known to ameliorate the tendency to bleed and it decreases the portal venous pressure (PVP). However, the direct measurement of the change in the PVP after concomitant splenectomy has not yet been reported. We tried to measure the change of the PVP before and after splenectomy. METHODS: From March 2000 to May 2006, 18 patients underwent anatomical liver resection with concomitant splenectomy. All the patients had liver cirrhosis, thrombocytopenia and/or esophageal varix. Through the 5 French feeding tube, which was inserted into the right gastroepiploic vein after laparotomy, we directly measured the PVP before and after splenectomy, and also under portal triad clamping (PTC). RESULTS: After splenectomy, the PVP decreased significantly from 261.11+/-45.87 mmH2O to 221.11+/-38.48 mmH2O (p<0.05). Under PTC, the PVP decreased significantly from 605.00+/-116.48 mmH2O to 513.89+/-70.56 mmH2O (p<0.05). CONCLUSION: Concomitant splenectomy in patients with liver cirrhosis resulted in a significant reduction of the PVP.

Direct and Indirect Effects of Androgens on Survival of Hematopoietic Progenitor Cells In Vitro

Androgens remain a common treatment for certain type of anemia, based upon its myelostimulating effects; however, it has not been established whether androgens affect apoptosis of hematopoietic progenitor cells (HPCs). We investigated the effects of the androgens, such as testosterone, 5beta-dihydrotestosterone (5-DHT), and oxymetholone, on apoptosis of normal hematopoietic progenitor cells in vitro. Androgens did not rescue normal bone marrow (BM) CD34+ cells and colony-forming cells (CFCs), other than mature erythroid CFCs, from apoptosis induced by serum- and growth factor deprivation. Oxymetholone did not affect growth factor-mediated survival of normal CD34+ cells or its inhibition by interferon-gamma (IFN-gamma). In a standard methylcellulose clonogenic assay, low concentrations of oxymetholone and 5-DHT stimulated the clonal growth of colony-forming unit (CFU)-erythroid, but did not affect growth of CFU-granulocyte/macrophage or burst-forming unit-erythroid. Oxymetholone and 5-DHT stimulated the production of stem cell factor in normal bone marrow stromal cells (BMSCs) via transcriptional regulation. In agreement with this, oxymetholone-treated BMSCs better supported the survival of HPCs. These data indicate that survival-enhancing or growth-stimulatory effects of androgens on hematopoietic progenitor cells are minimal and mostly restricted to mature erythroid progenitors, and its myelostimulating effects could be attributed, at least in part, to the stimulation of production of hematopoietic growth factors in BMSCs.

Frequency of Concomitant Cardiac Disease and Postoperative Cardiac Events in the Patients Underwent Elective Arterial Surgery: with Reference to Ischemic Heart Disease (IHD)

PURPOSE: Cardiac disease has been known as the most common cause of early and late postoperative mortality following elective arterial surgery. We attempted to investigate the prevalence of concomitant cardiac disease and predictor of postoperative cardiac events in the patients undergoing elective arterial surgery. METHOD: We retrospectively reviewed 300 patients who underwent elective arterial operations at the Department of Surgery, Kyungpook National University Hospital. For preoperative cardiac screening, history taking and physical examination were done with ECG and CK-MB enzyme (OPUS CK-MB, Behring Diagnostic) measurement. Transthoracic echocardiography (145), myocardial perfusion scanning (81, adenosine Tc-99m MIBI or thallium-201 SPECT), and coronary angiography (5) were performed in selective basis. IHD was defined by perfusion defect on myocardial scan and clinical criteria consisting of chest pain, ECG abnormality and serum CK-MB>5%. Possible risk factors including age(> or= 70 years), previous cardiac symptom, aortic clamping, abnormal cardiac function tests, and comorbidities were analyzed to determine the predictor of cardiac events after arterial surgery. RESULT: IHD was associated with in 20.2% of the patients with chronic arterial occlusive disease and 12.8% of patients with abdominal aortic aneurysm. IHD were more commonly associated with diabetes (30.3% vs 15.8%, p=0.014) and hypertension (28.2% vs 11.8%, p=0.0003). After 340 arterial operations for 300 patients, 11 (3.7%) cardiac events (1 congestive heart failure, 10 myocardial infarction or anginal attack and 1 cardiac deaths) were followed. By univariate statistical analysis, postoperative cardiac events occurred more frequently in the patients with prior history of cardiac symptom (9.5% vs 2.7%, p=0.052) and higher CK-MB titer (11.8% vs 3.0%, p=0.038). CONCLUSION: In determining the indications for more detailed preoperative cardiac evaluation, presence of diabetes or hypertension should be considered. To reduce the risk of postoperative cardiac events after elective arterial surgery, more intensive cardiac monitoring is required for the patients with previous cardiac symptoms and/or elevated serum CK-MB.